Citation Nr: 21042625 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 17-04 179 DATE: July 13, 2021 REMANDED Entitlement to special monthly compensation (SMC) based upon the need for regular aid and attendance is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from January 1968 to November 1969, to include service in the Republic of Vietnam. His awards and decorations include the Purple Heart and Combat Action Ribbon. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2016 Decision Review Officer (DRO) decision issued by a Department of Veterans Affairs (VA) regional office. This matter was previously remanded by the Board in December 2018. Entitlement to SMC based upon the need for regular aid and attendance is remanded. The Board regrets the delay associated with this remand, particularly as this matter is the subject of a prior remand. However, based on a review of the evidence of record, the Board finds that another remand is necessary to allow the Agency of Original Jurisdiction (AOJ) to obtain an addendum opinion regarding the Veteran's claimed need for regular aid and attendance. In October 2019, the Veteran was afforded an examination regarding his claimed need for regular and attendance, in which the examiner opined that the Veteran's service-connected disabilities did not render him unable to adequately perform activities of daily living, thus requiring the regular aid and attendance of another person. In support of this opinion, the examiner noted that the Veteran was ambulatory and able to shave, bathe, prepare and cook meals, manage his own medications, and make sound judgment. See October 2019 VA Aid and Attendance Examination, received December 2019; October 2019 VA Medical Opinion Disability Benefits Questionnaire (DBQ), received December 2019. However, in November 2019, the Veteran underwent an examination regarding the severity of his service-connected posttraumatic stress disorder (PTSD). In this examination report, the examiner noted that the Veteran's PTSD manifests with impaired judgment and memory, as well as intermittent inability to perform activities of daily living. Though the examiner concluded that the Veteran was competent to manage his financial affairs, she also notes that, due to his PTSD, the Veteran was unable to remember or follow instructions and was unable to use judgment. See November 2019 VA Review PTSD DBQ, received December 2019; November 2019 VA Medical Opinion DBQ, received December 2019. As the October 2019 VA examiner was unable to consider the findings of the November 2019 VA examiner, and as the November 2019 examination's findings with respect to judgment and ability to perform activities of daily living conflict with the findings of the October 2019 examination report, the Board finds the October 2019 VA examination report to be inadequate with respect to such. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Therefore, a remand is necessary to afford the Veteran with an adequate Aid and Attendance examination. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Accordingly, the matter is REMANDED for the following action: 1. With the Veteran's assistance as appropriate, obtain and associate with the claims file any outstanding pertinent medical records, whether VA or private, including records relating to treatment at Palo Alto VA Medical Center (VAMC) from August 2019 to current, as well as records relating to treatment at Reno VAMC and Martinez VAMC from September 2019 to current. Pursuant to 38 C.F.R. § 3.159(e), any efforts to secure these records MUST be documented in the electronic claims file, and the Veteran MUST be informed if any of these records are unable to be secured. 2. After completing the development above, and any additional development warranted by the record, schedule the Veteran for a VA Aid and Attendance examination with an appropriate clinician to determine whether the Veteran requires regular aid and attendance of another person as a result of his service-connected disabilities. The entire claims file must be provided to, and reviewed by, the examiner, and any indicated tests, studies, or evaluations should be conducted. The examiner is asked to: (a.) Obtain the Veteran's detailed lay history, including the onset and progression of any impairment to performing activities of daily living. (b.) Opine as to whether it is at least as likely as not (i.e. a 50 percent or greater probability) that the Veteran's service-connected conditions result in disability (physical or mental) requiring the regular aid and attendance of another person to perform the daily activities of living, such as: dressing and undressing; keeping himself ordinarily clean and presentable; feeding; attending to the wants of nature; or protecting him from hazards or dangers incident to his daily environment. (c.) IN FORMULATING THE REQUESTED OPINION, THE EXAMINER IS INSTRUCTED TO CONSIDER AND SPECIFICALLY ADDRESS THE NOVEMBER 2019 EXAMINER'S FINDINGS THAT THE VETERAN'S SERVICE-CONNECTED PTSD MANIFESTS WITH IMPAIRED JUDGMENT AND MEMORY, AN INTERMITTENT INABILITY TO PERFORM ACTIVITIES OF DAILY LIVING, AND THAT THE VETERAN WAS UNABLE TO REMEMBER OR FOLLOW INSTRUCTIONS OR USE JUDGMENT. The term at least as likely as not does not mean within the realm of medical possibility. Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion. Any opinion expressed by the examiner should be accompanied by a complete rationale. If medical literature is relied upon in rendering a determination, the examiner should identify and specifically cite each reference material utilized. If the examiner is unable to offer an opinion without resort to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. The examiner is reminded that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions. The examiner is also reminded that consideration must be given to ALL of the Veteran's service-connected disabilities, symptoms of such disabilities, and effects of any treatments required for such disabilities. Further, the examiner should NOT consider the impact of any non-service-connected conditions have on the Veteran's ability to adequately perform the activities of daily living. 3. The AOJ must review the claims file and ensure that the foregoing development action has been completed in full. If any development action is incomplete, the appropriate corrective action must be implemented. If any report or opinion does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action. YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. T. Martin III, 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.