Citation Nr: 22017574 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 18-36 418 DATE: March 25, 2022 ORDER Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is granted. FINDING OF FACT Resolving reasonable doubt in the Appellant's favor, prior to his death, the Veteran required aid and attendance of another person on a regular basis, and was unable to protect himself from hazards or dangers incident to his daily environment, due to his service-connected Parkinson's disease. CONCLUSION OF LAW The criteria for SMC based on the need for regular aid and attendance of another person have been met. 38 U.S.C. §§ 1114(l), 5107(b); 38 C.F.R. §§ 3.102, 3.350(b), 3.352(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from June 1966 to June 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran died during the pendency of this appeal in June 2019. The Veteran's surviving spouse has been deemed eligible for substitution and is the Appellant. The Board remanded the Veteran's claim in November 2019 to the agency of original jurisdiction (AOJ) for further development. The Board's remand directives have been substantially completed. See Stegall v. West, 11 Vet. App. 268 (1998). In November 2021, the Appellant testified at a hearing before the undersigned Veterans Law Judge (VLJ); a transcript is of record. Entitlement to SMC based on the need for aid and attendance For the reasons that follow, resolving all reasonable doubt in the Appellant's favor, the Board finds that entitlement to SMC based on the need for aid and attendance is warranted. SMC is payable if, as the result of service-connected disability, a veteran is permanently bedridden or with such significant disabilities as to be in need of regular aid and attendance. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). The following factors will be considered in determining whether a veteran is in need of regular aid and attendance of another person: inability of claimant to dress or undress himself (herself), or to keep himself (herself) 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 claimant to feed himself (herself) 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 claimant from hazards or dangers incident to his or her daily environment. 38 C.F.R. § 3.352(a). It is not required that all of the disabling conditions noted above be found to exist before a favorable rating may be made. Id. The particular personal functions which the veteran is unable to perform should be considered in connection with his or her condition as a whole. Id. 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. Id. The need for regular aid and attendance of another person must be based solely on impairment caused by service-connected disabilities. In this regard, prior to his death, the Veteran was service connected for posttraumatic stress disorder (PTSD), rated 70 percent disabling; Parkinson's disease, rated 30 percent disabling; diabetes, rated 20 percent disabling; tinnitus, rated 10 percent disabling; bilateral hearing loss, rated noncompensable; and left ear injury with scars, rated noncompensable. At the November 2021 Board hearing, the Appellant testified that, prior to his death, the Veteran was unable to sit down, dress, or use the bathroom by himself. He hallucinated, lost comprehension of time, and he was not able to take his daily medication without supervision, to include his daily insulin injections. The Appellant testified that the Veteran's neurologist attributed his mental health symptoms to his Parkinson's disease. The Board finds the Appellant's statement credible as they are consistent with the following evidence of record. A December 2017 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (VA Form 21-2680) shows that the Veteran required nursing home care due to his diagnosis of Dementia and Alzheimer's disease. The examining physician noted that the Veteran is unable to cook, bathe himself, or manage his own medication. It was noted that the Veteran is too shaky and unstable to feed, bathe or dress himself. It was also noted that the Veteran has severe balance difficulties, and he is at risk of falling without supervision. The August 2018 VA examination for the Veteran's PTSD noted that he had an impairment of short and long term memory, for example retention of only highly learned material, while forgetting to complete tasks, and he had obsessional rituals which interfere with routine activities. The November 2018 VA examination for the Veteran's Parkinson's disease noted that he has a moderate balance impairment, slowed motion, and mild loss of automatic movements and speech changes. Muscle rigidity and stiffness in lower extremities were noted bilaterally. Incontinence issues were also noted. In addition, mild mental manifestations due to Parkinson's disease, such as depression and cognitive impairment or Dementia, were noted. The January 2019 VA opinion noted that the Veteran needed assistance with activities of daily living due to his Dementia. The January 2019 psychiatric VA examination showed a diagnosis of major neurocognitive disorder with Lewy Body Dementia and behavioral disturbance. The examiner noted that the Veteran requires assistance with activities of daily living. The examiner opined that it is at least as likely as not that the Veteran's neurocognitive disorder with Lewy Body Dementia is the result of his Parkinson's disease. The May 2019 VA addendum opinion noted that the Veteran's Parkinson's disease affects his mobility, cognition, and fine motor skills. The May 2019 VA examinations for diabetes, tinnitus, and left ear injury with scars noted that these disabilities have no functional impact. However, it was noted that the Veteran has problems hearing conversations due to his Parkinson's disease and the resulting cognitive issues. The Veteran's death certificate is also of record, showing that the cause of his death was his Parkinson's disease. Based on the foregoing, resolving all reasonable doubt in favor of the Appellant, entitlement to SMC at the aid and attendance rate is warranted. See 38 U.S.C. § 1114(l). Review of the record reveals that, prior to his death, the Veteran required assistance in bathing and tending to other hygiene needs. He was too shaky and unstable to feed, bathe or dress himself. He required assistance with his medications, to include administration of his insulin injections. He had severe balance difficulties and he was at the risk of falling without supervision. He also had mental health manifestations due to his Parkinson's disease, to include hallucinations and memory loss, and he required care or assistance on a regular basis to protect him from hazards and dangers incident to his daily environment. Thus, the Board finds that the Veteran's service-connected disabilities rendered him so helpless as to require the regular aid and attendance of another person. Accordingly, the claim is granted. C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Kuzniar, 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.