Citation Nr: 21031752 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 14-24 031 DATE: May 24, 2021 ORDER Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance of another person or housebound status is denied. FINDINGS OF FACT 1. The Veteran is service connected for the following disabilities: psychophysiological gastrointestinal reaction rated as 30 percent disabling and right hand degenerative arthritis rated as 10 percent disabling. 2. The Veteran's service-connected disabilities do not meet the schedular criteria for assignment of a TDIU, and the evidence of record does not reflect that the Veteran has been unable to engage in substantially gainful employment as a result of his service-connected disabilities. 3. The Veteran's service-connected disabilities do not render him so helpless as to require the regular aid and attendance of another person to perform personal care functions of everyday living or to protect him from the hazards and dangers incident to his daily environment. CONCLUSIONS OF LAW 1. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. 2. The criteria for SMC based on the need for regular aid and attendance have not been met. 38 U.S.C. §§ 1114; 38 C.F.R. §§ 3.350, 3.352. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1966 to April 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). By way of background, the Veteran's claim for entitlement to a TDIU was previously before the Board in April 2016, January 2017, October 2017, and September 2020, when it was remanded for additional development. 1. Entitlement to a TDIU is denied. At the outset, the Board notes that the Veteran filed his claim for entitlement to a TDIU in January 2011. To this end, the Veteran reported that his service-connected disabilities prevented him from obtaining and maintaining substantially gainful employment. See January 2011 VA Form 21-4138 Statement in Support of Claim. A total disability rating for compensation based on individual unemployability (TDIU) may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16(a). TDIU will be granted when the evidence shows that the veteran, due to service-connected disabilities, is precluded from obtaining or maintaining any gainful employment consistent with their education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. It is the established policy of the Department of Veterans Affairs that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Therefore, rating boards should submit to the Director, Compensation Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in paragraph (a) above. The Veteran has been service connected for the following disabilities: psychophysiological gastrointestinal reaction rated as 30 percent disabling as of April 30, 1968; and right hand degenerative arthritis rated as 10 percent disabling as of January 12, 2011. See September 2020 Rating Decision Codesheet. Thus, the Board notes that the Veteran's combined disability rating is 40 percent for the entire period on appeal, and therefore, he does not meet the schedular criteria for assignment of a TDIU. See 38 C.F.R. § 4.16(a). As the Veteran did not meet the schedular criteria, the Board remanded the appeal for referral to the Director of Compensation Service (Director) in January 2017 for consideration of assignment of an extraschedular TDIU under the provisions of 38 C.F.R. § 4.16(b). See January 2017 BVA Decision. In May 2017, the Director reviewed the record and opined that, because no service-connected disabilities were identified individually or collectively as the sole reason for the Veteran's unemployability, entitlement to an extraschedular TDIU was not warranted. See May 2017 Miscellaneous C&P Correspondence. The Board notes that the Director's opinion is not dispositive and is reviewable by the Board. See Ray v. Wilkie, 31 Vet. App. 58, 62 (2019); see also Wages v. McDonald, 27 Vet. App. 233 (2015) (explaining that the Director does not have nonreviewable discretion and the Board has the jurisdictional authority to review the Director's extraschedular decisions). The Board further notes that, at the time of the January 2017 Board decision and May 2017 determination from the Director, the Veteran had not been granted service connection for his right hand disability. Turning to the evidence of record, the Veteran submitted a letter from a private physician, Dr. Nanette A. Ortiz, dated in January 2011. In the letter, Dr. Ortiz noted that the Veteran had continuous gastrointestinal problems, to include daily episodes of diarrhea and abdominal cramping, which caused him to change his social and occupational lifestyles. Specifically, Dr. Ortiz stated that the Veteran needed an accessible bathroom facility and that he received special accomodation from his employer for such. Dr. Ortiz further noted that the Veteran presented with frustration and fatigue or low energy almost every day. With regard to the Veteran's right hand disability, Dr. Ortiz noted that the Veteran experienced right hand pain with some movements, morning stiffness, and intermittent painful range of motion. See February 2007 Third Party Correspondence. In February 2011, the Veteran reported that all service-connected disabilities of record prevented him from securing or following any substantially gainful employment. In this regard, the Veteran reported that he last worked as a supervisor for an air conditioning company from 2004 through January 2005 and indicated that he left the position because of his disability. He did not list any other employment during the last five years he worked. See February 2011 VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability. The Veteran underwent a VA examination for mental conditions in May 2011. During the examination, the Veteran reported that he had daily, episodic diarrhea as soon as he ate, abdominal cramping, anxiety and frequent awakenings. However, the examiner noted no problem with activities of daily living. Following the examination, the examiner found that the Veteran's mental disorder symptoms did not require continuous medication and that they were not severe enough to interfere with his occupational and social functioning. In this regard, the examiner noted that the Veteran still helped his neighbors with some electrical jobs and continued to help his wife with household chores. The examiner noted that the Veteran retired from his occupation as a refrigerator technician in 2007 based on eligibility by age or duration of work. However, the examiner acknowledged that the Veteran indicated that limitations attributable to his chronic diarrhea were very severe and determined that the Veteran's continuous need to use the bathroom may limit his ability to perform jobs, which occurred as soon as he ingested food. In this regard, the examiner noted that the Veteran's limitations were entirely physical, rather than mental, and reported that while anxiety or depression may aggravate the Veteran's physical symptoms, it did not cause any major mental impairment in his concentration, social interaction, or communication. The examiner further noted that the Veteran did not have any current psychiatric treatment, and that he had been stable, without any psychiatric hospitalizations. Thus, the examiner opined that a strenuous occupation or one that required excessive force or walking may not be appropriate for the Veteran, but found that a more sedentary type of employment may be more appropriate. The Veteran was afforded a VA examination for stomach, duodenum, and peritoneal adhesions in September 2011. During the examination, the Veteran endorsed repetitive episodes of watery diarrhea that lasted from three to five days, severe weight loss, and episodic stomach cramps. He also reported periods of incapacitation due to stomach or duodenal disease, which occurred two to three times per year and persisted for three days per episode. The examiner noted that the Veteran retired from his occupation as a refrigerator technician in 2008 based on eligibility by age or duration of work. After performing an examination, the examiner noted that the Veteran was not employed and found that the Veteran's disabilities severely affected his ability to do chores, shop, exercise, travel, feed himself, use the bathroom, and on his ability to participate in sports and other recreational activities. In addition, the examiner found that it mildly affected his ability to bathe, dress, and groom himself. The Veteran underwent a VA examination for hand and finger conditions in January 2012. During the examination, the Veteran endorsed frequent flareups of right hand pain, which occurred nearly every day and persisted for approximately three hours. Following the examination, the examiner noted that the Veteran's right hand disability impacted his ability to work. Specifically, the Veteran reported limitations in his job as a handyman such as difficulty using a drill. The Veteran also underwent a VA examination for hand and finger conditions in June 2016. During the examination, the Veteran reported that he was unable to carry weights in his hands during flare-ups. Following the examination, the examiner found that the Veteran's right hand disability rendered him unable to carry weights with his right hand. See December 2019 CAPRI. In a May 2017 advisory opinion, the Director found that the Veteran's service-connected psychophysiological gastrointestinal disorder did not prevent him from obtaining and maintaining gainful employment. In this regard, the Director noted that the Veteran was 30 percent service connected for psychophysiological gastrointestinal disorder, which caused frequent, daily episodes of diarrhea and cramping and that he stopped working as a supervisor in January 2005. To this end, while she acknowledged that the Veteran's service-connected disability imposed mild to severe restrictions on his daily life, it was not shown to preclude the Veteran from any activities. Moreover, the Director found that the Veteran had several non-service-connected diagnoses that had not been differentiated from his service-connected disorder. In this regard, she noted that the Veteran's past medical history included, but was not limited to, hypothyroidism, depression, hyperlipidemia, chronic renal failure syndrome, hypertension, fatty liver, bilateral hearing loss, irritable bowel syndrome, and osteoarthritis. Thus, the Director found that entitlement to an extraschedular TDIU was not warranted because no service connected disabilities were identified individually or collectively as the sole reason for the Veteran's unemployability. See May 2017 Miscellaneous C&P Correspondence. A December 2017 nutrition outpatient note shows that the Veteran was referred for an assessment by his primary care physician due to underweight status. The examiner noted that the Veteran had been diagnosed with hyperlipidemia, fatty liver, hypertension, and irritable bowel syndrome, and the Veteran denied gastrointestinal problems, barriers affecting food intake, and previous orientation on diet. He also described his appetite as good and stated that he was very active during the day. In June 2018, the Veteran reported that he continued to be active on daily living activities and indicated that he was working on home improvements. A June 2019 primary care outpatient note shows that the Veteran was able to bathe, dress, eat, shop, prepare food, travel, manage finances, take responsibility for his own medications, use the telephone and bathroom, and control urination and bowel movements without assistance. However, the examiner noted that the Veteran may use a support object, like a cane or walker, to move in and out of a bed or chair. In addition, the Veteran was found to require assistance maintaining an adequate diet and completing all home maintenance tasks. He also reported that he could not do laundry. See December 2019 CAPRI. In support of his claim, the Veteran submitted a vocational assessment from Frank Fazzolari, dated in January 2021. After reviewing the Veteran's claims file and selected records that described his medical history and limitations and after performing a telephonic vocational assessment with the Veteran, his wife, son, and a Spanish language interpreter, Fazzolari opined that it was at least as likely as not that the Veteran's service-connected psychophysiological gastrointestinal disorder and right hand disability, when evaluated individually, collectively, and independent of any other service or non-service-connected conditions, have precluded the Veteran from obtaining and maintaining substantially gainful employment in any occupation regardless of skill or exertion level, to include sedentary and unskilled work, since at least January 2011. Fazzolari noted that the Veteran graduated from high school and that he was the owner and operator of an air condition installation and maintenance company from 1974 until he sold the business in 2004. After selling his company, the Veteran reported that he worked fulltime as a supervisor at a commercial air conditioning installation company from 2004 until he resigned to work on his own in 2005. In both positions, the Veteran supervised groups of employees in the installation and maintenance of air conditioning units, but indicated that he was able to take unscheduled breaks and to rest his right hand in both positions. Since 2005, the Veteran indicated that he has continued to assist his neighbors as an electrical technician on an as needed basis but stated that he does not receive compensation for his work and requires help from his son and grandson to complete projects. In this capacity, he reported that he was able to choose projects, take breaks as needed for his service-connected disabilities, and did not have to meet deadlines or productivity quotas. In this regard, Fazzolari determined that the Veteran's irregular activity as an electrical technician from 2005 was inconsistent with substantially gainful employment and not indicative of an ability to obtain and maintain gainful employment. To this end, Fazzolari stated that, in his experience, all employers in the competitive labor market required that expectations be met by workers, regardless of the skill or exertional level of the position, and would not tolerate time off task for more than 10 percent of the workday. In this regard, Fazzolari stated that the Veteran's abdominal pain, cramps, and frequently unpredictable need to void would cause him to be distracted and away from work tasks for periods that exceed employers' tolerances of 10 percent of the workday, thus rendering him unable to sustain substantially gainful employment. In addition, Fazzolari found that impairments caused by the Veteran's right hand disability, to include limitations in handling and manipulating objects with his dominant hand due to chronic pain and weakness, chronic daytime fatigue due to compromised sleep (also caused by gastrointestinal symptoms), and inability to maintain concentration, focus, and pace as a result of distracting pain, physical limitations, and fatigue precluded the Veteran from obtaining and maintaining substantially gainful employment in any occupation regardless of skill or exertion level, to include sedentary and unskilled work, since at least January 2011 to the present. In this regard, Fazzolari found that the Veteran's education and work history would not provide the Veteran with a significant vocational advantage in the competitive workforce and that his service-connected disabilities and associated limitations in concentration "100 percent negat[ed]" any transferable skills he may have acquired. In addition, Fazzolari found that, regardless of his education and work history, the Veteran's inability to maintain even sedentary physical requirements, reduced pace, impaired concentration, productivity, and reliability would not be tolerated in even simple, unskilled occupations. See February 2021 Third Party Correspondence. After a thorough review of the evidence of record, the Board finds that the preponderance of the evidence shows that the functional limitations imposed by the Veteran's service-connected psychophysiological gastrointestinal disorder and right hand disability alone do not render him unable to perform the mental or physical tasks necessary to follow a substantially gainful occupation. In this regard, the Board recognizes that the Veteran's psychophysiological gastrointestinal disorder results in daily, episodic diarrhea, stomach cramps, and fatigue. See, e.g., December 2019 CAPRI. Nevertheless, the Board finds that the Veteran's service-connected psychophysiological gastrointestinal disorder does not impose restrictions, which when considered collectively and independently, preclude the Veteran from obtaining or maintaining employment. See May 2017 Miscellaneous C&P Correspondence. The Board further recognizes that the Veteran's service-connected right hand disability imposes limitations on his ability to hold objects, to include drills, and renders him unable to carry weights with his right hand. See December 2019 CAPRI. However, the Board finds that the Veteran's service-connected disabilities have not been shown to preclude substantial gainful employment that involves fewer physical demands. In this regard, while it is clear that the Veteran has some occupational and functional impairment as a result of his service-connected disabilities, the evidence does not support that the Veteran's service-connected disabilities alone preclude him from securing and maintaining substantially gainful employment. Here, the Board notes the evidence shows that the Veteran last worked fulltime as a supervisor for a commercial air conditioning installation company from 2004 to 2005, and pursuant to the January 2021 vocational assessment, the Veteran was the owner and operator of a company that installed and maintained air conditioning control units from 1974 to 2004. The vocational assessment also shows that the Veteran graduated from high school. See February 2021 Third Party Correspondence. The Board finds that the Veteran's experience as a supervisor and education level would help qualify him for a less physical job, even with his need for frequent bathroom breaks. In reaching this conclusion, the Board has considered the January 2021 vocational assessment from Fazzolari. In this regard, the Board recognizes that Fazzolari opined that the Veteran's service-connected disabilities individually, collectively, and independent of any other service or non-service-connected conditions, have precluded the Veteran from obtaining and maintaining substantially gainful employment in any occupation regardless of skill or exertion level, to include sedentary and unskilled work, since at least January 2011. Fazzolari reported that his opinion was based on a review of the evidence of record and a telephonic vocational assessment. However, although Fazzolari has a Master of Education in Rehabilitation Services and Counseling and a Bachelor's Degree in Rehabilitation Services, there is no indication that he, the Veteran, or the Veteran's family are competent to opine as to the etiology of the Veteran's symptoms. In this regard, the Board notes that Fazzolari found that the Veteran's service-connected disabilities resulted in fatigue, which in turn caused the Veteran's diminished concentration and memory impairment, without reference to corroborating objective evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376, 1377 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the Board notes that the Veteran has also been diagnosed with hypertension, impaired fasting glucose, hypothyroidism, dyslipidemia, stage three chronic kidney disease, gout, a cognitive disorder, left knee pain/degenerative joint disease, and weight loss. The Board further finds that it is not clear how Fazzolari determined that the Veteran's symptoms, particularly with regard to memory impairment, were attributable to the Veteran's psychophysiological gastrointestinal disorder and right hand disorder, rather than to one of his other non-service-connected disabilities, particularly in light of the May 2011 VA examiner's finding that the Veteran's psychophysiological gastrointestinal disorder did not cause any major mental impairment in his concentration, social interaction, or communication. See December 2019 CAPRI. To this end, the Board notes that Fazzolari reported that the Veteran had difficulty sustaining focus during the interview, occasionally veered off topic and required redirection and repetition of questions by Fazzolari and his Spanish language interpreter, but there is no indication that he reported hand pain or gastrointestinal symptoms at the time of the interview. See February 2021 Third Party Correspondence. As such, the Board affords the January 2021 vocational assessment reduced probative weight. In any event, the Board notes that the question of employability is ultimately a legal one. The Board finds that the Fazzolari opinion is outweighed by the more probative evidence of record, to include the May 2011 and June 2016 VA examination reports, VA treatment records dated in December 2017, June 2018, and June 2019, which found the Veteran to be functionally independent and without limitation. In this regard, while the Board acknowledges that the VA examiners have found that the Veteran's service-connected disabilities limit his ability to grip and hold objects with his right hand and necessitate access to a bathroom, none of the probative evidence reflects that he is completely prohibited from employment that allows for bathroom breaks and less physical employment not involving fine motor control. See December 2019 CAPRI. Although the Veteran's claim for entitlement to service connection for a right hand disability had not been granted when the case was referred for extraschedular consideration, the Board finds that the preponderance of the evidence weighs against a finding that the Veteran's claim meets the requirements for entitlement to a referral for consideration on an extraschedular basis. 38 C.F.R. § 4.16(a-b). Accordingly, the Board declines to refer the claim to the Director of VA Compensation Service for consideration of TDIU on an extraschedular basis. Thus, the Board finds that the preponderance of the evidence is against this claim, and it must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to SMC based on the need for regular aid and attendance of another person or housebound status is denied. As an initial matter, the Veteran seeks SMC based on the need for aid and attendance or housebound status. Specifically, in a February 2021 letter, the Veteran reported that he received assistance with the activities of daily living on a regular basis due to his service-connected disabilities. See February 2021 Third Party Correspondence. Accordingly, the Board finds that the issue of entitlement to SMC has been raised by the record. SMC at the aid and attendance rate is payable when a veteran, due to service-connected disability, has suffered the anatomical loss or loss of use of both feet or one hand and one foot, or is blind in both eyes, or is permanently bedridden or so helpless as to be in need of regular aid and attendance. See 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). The following will be accorded consideration in determining the need for regular aid and attendance: inability of the veteran to dress or undress himself, or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of veteran to feed himself through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the veteran from hazards or dangers incident to his daily environment. It is not required that all the disabling conditions enumerated in 38 C.F.R. § 3.352(a) be found to exist before a favorable rating may be made. The particular personal functions which the veteran is unable to perform should be considered in connection with his condition as a whole. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there is a constant need. 38 C.F.R. § 3.352(a); see also Turco v. Brown, 9 Vet. App. 222, 224 (1996) (noting that at least one factor listed in § 3.352(a) must be present for a grant of special monthly pension based on need for aid and attendance). For the purposes of 38 C.F.R. § 3.352(a), "bedridden" will be a proper basis for the determination of whether a veteran needs the regular aid and attendance of another person. "Bedridden" will be that condition which, through its essential character, requires that the Veteran remain in bed. The fact that the Veteran has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. 38 C.F.R. § 3.352(a). As stated above, the Veteran is currently service connected for the following disabilities: psychophysiological gastrointestinal reaction rated as 30 percent disabling as of April 30, 1968; and right hand degenerative arthritis rated as 10 percent disabling as of January 12, 2011. See September 2020 Rating Decision Codesheet. In this regard, the Veteran has been in receipt of a 40 percent rating throughout the period on appeal. Accordingly, the Board finds that the Veteran has been ineligible for SMC based on housebound status throughout the relevant period, and the current appeal concerns entitlement to SMC pursuant to 38 U.S.C. § 1114(l). Turning to the evidence of record, the Veteran underwent a VA examination for mental conditions in May 2011, during which the examiner found that the Veteran had no problem performing activities of daily living, some mild limitations with regard to daily functioning were noted. The Veteran was afforded a VA examination for stomach, duodenum, and peritoneal adhesions in September 2011. Following the examination, the examiner found that the Veteran's disabilities severely affected his ability to do chores, shop, exercise, travel, feed himself, use the bathroom, and to participate in sports and other recreational activities. In addition, the examiner found that the Veteran's disabilities mildly affected his ability to bathe, dress, and groom himself. In June 2018, the Veteran reported that he continued to be active on daily living activities and indicated that he was working on home improvements. A June 2019 primary care outpatient note shows that the Veteran was able to bathe, dress, eat, shop, prepare food, travel, manage finances, take responsibility for his own medications, use the telephone and bathroom, and control urination and bowel movements without assistance. However, the examiner noted that the Veteran may use a support object, like a cane or walker, to move in and out of a bed or chair. In addition, the Veteran was found to require assistance maintaining an adequate diet and completing all home maintenance tasks. He was also noted to be unable to do laundry. See December 2019 CAPRI. In support of his claim, the Veteran submitted a vocational assessment from Frank Fazzolari, dated in January 2021. After reviewing the evidence of record and performing a telephonic vocational assessment, Fazzolari found that the Veteran was limited in his ability to perform daily activities since at least January 2011. In this regard, Fazzolari noted that the Veteran did not drive long distances because he could not be too far away from a bathroom and because his right hand would start to hurt. He further noted that the Veteran reported that he could only drive with his nondominant left hand. In addition, Fazzolari noted that, although the Veteran was able to bathe and dress independently, he relied on his wife and daughter to complete household chores, to include housework, cooking and laundry. The Veteran further reported that he occasionally swept but indicated that he required 20 minutes of rest after 10 minutes of sweeping due to increased right hand pain and gastrointestinal symptoms. In addition, the Veteran reported that he rarely went shopping with his wife due to concerns pertaining to his unpredictable urge to void. However, he was noted to be able to prepare simple meals. See February 2021 Third Party Correspondence. Following a review of the evidence of record, the Board finds that the preponderance of the evidence demonstrates that the Veteran does not require the aid and attendance of another person as a result of his service-connected disabilities. In this regard, the Board finds that, although the medical evidence of record indicates that the Veteran may require a cane to get out of a bed or chair, his service-connected disabilities have not been shown to be medically associated with a physical need for adaptive equipment. Moreover, while the Board acknowledges that the Veteran relies on his wife and daughter to do housework, cooking and laundry, the record does not reflect that the Veteran is unable to dress himself, unable to tend to his personal hygiene, or unable to take his medications. As such, the Board finds that the evidence of record weighs against finding that the Veteran was mentally incapacitated, unable to attend to his own wants of nature, and/or unable to dress or undress himself/keep himself ordinarily clean and presentable. The Board notes that the September 2011 VA opinion found that the Veteran's disabilities severely affected his ability to do chores, shop, exercise, travel, feed himself, use the bathroom, and to participate in sports and other recreational activities. In addition, the examiner found that the Veteran's disabilities mildly affected his ability to bathe, dress, and groom himself. However, the Board notes that the opinion was based, at least in part, on impairment caused by the Veteran's non-service-connected disabilities, and in any event, is not indicative of impairment that would result in a regular inability to perform the activities of daily living. Moreover, the evidence of record does not reflect that the Veteran's impairments render him unable to protect himself from the daily hazards of living. To the contrary, the evidence shows that the Veteran continues to drive and to assist his neighbors with electrical work on an as needed basis. Thus, while the Veteran undoubtedly benefits from the assistance of his wife, the preponderance of the evidence weighs against a finding that the combined functional impairment from his service-connected disabilities have led to any of the functional impairments listed in 38 C.F.R. § 3.352(a) or any of comparable severity as to render the Veteran in need of regular aid and attendance of another person, and the evidence does not show that the Veteran is bedridden. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim of entitlement to SMC based on the need for aid and attendance is denied. See 38 U.S.C. § 5107. S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Justis, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.