Citation Nr: 22017783 Decision Date: 03/26/22 Archive Date: 03/26/22 DOCKET NO. 18-11 031A DATE: March 26, 2022 REMANDED Entitlement to special durable medical equipment, a stair lift, including under the Home Improvement and Structural Alterations program, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1963 to February 1985. The appellant is the Veteran's spouse, who is his fiduciary, and has filed this appeal on behalf of the Veteran. This matter is before the Board of Veterans' Appeals (Board) on appeal from a September 2017 decision of a Department of Veterans Affairs (VA) Health Administration (VHA). In a March 2018 VA Form 9, Appeal to Board of Veterans' Appeals, the appellant requested to appear at a hearing before the Board. In October 2021, the appellant withdrew the hearing request. Entitlement to durable medical equipment, a stair lift, is remanded. The Veteran seeks a stair lift and/or stair glide to have access to the second level of his home to have time alone due to his service-connected posttraumatic stress disorder (PTSD) symptoms. In a January 2018 statement, the Veteran's representative did not dispute the finding that the Home Improvements and Structural Alterations (HISA) grant could not be used for the stair lift modification. However, the representative noted that the VA Medical Center (VAMC) has other authorities through which it can furnish a veteran with a stair glide through Prosthetic and Sensory Aids Service, if deemed medically necessary. The representative asserted that medical documentation from the Veteran's civilian provider indicates multiple health care conditions that demonstrate medical need for the prescribed stair lift and/or stair glide. The representative also noted that no feasibility or property suitability determination had been made by VA. Pursuant to 38 U.S.C. § 1717, as part of medical services furnished to a veteran under 38 U.S.C. § 1710(a), VA may furnish a veteran such home health services as necessary or appropriate for the effective and economical treatment of the veteran. 38 U.S.C. § 1717(a). The Veteran is service-connected for PTSD, rated as 100 percent disabling; hypertension, rated as 10 percent disabling; a meniscectomy of the right knee, rated as noncompensable; diabetes mellitus, rated as noncompensable; and chronic headaches, rated as noncompensable. He has a total disability rating of 100 percent and is entitled to special monthly compensation under 38 U.S.C. § 1114(l) based on the need of regular aid and attendance. The Veteran's requested stair glide is subject to regulations pertaining to the provision of prosthetic and rehabilitative items and services under 38 C.F.R. §§ 17.3200-17.3230. A Veteran is eligible to receive items and services described in § 17.3230 if they are enrolled in the VA healthcare system under 38 C.F.R. § 17.36 and are otherwise receiving care or services under Chapter 17, and a VA provider or eligible entity prescribes the item or service for the veteran. VA will provide eligible veterans with items and services (including adaptive household items and home medical equipment, among others) if VA determines that such item is needed under § 17.38(b), serves as a direct and active component of the veteran's medical treatment and rehabilitation, and does not solely support the comfort or convenience of the veteran. 38 C.F.R. § 17.3230. VHA Handbook 1173.08, subpart 4 (Issuing Medical Equipment for Home Use), subsection c (Stair Glides), specifies that certain action "must be taken whenever a request for a stair glide is received." This includes "[a] home visit by an evaluation team consisting of the Prosthetic Representative and/or a Physical Medicine and Rehabilitation Service therapist to determine that alternative facilities or rooms suitable for the prescribed activity are not available on the accessible level of the home." July 2017 VA Medical Center (VAMC) records indicate that the Veteran's wife stated that he had PTSD and needed to get away from everyone. His wife was not able to get up the stairs, so she stayed in the downstairs bedroom. The Veteran indicated that he needed to be able to get to his own room on the second level so he could be by himself due to his PTSD symptoms. A March 2018 Statement of the Case reflects that the claim was denied because prosthetics special purpose funding can only be used to provide a stair lift when it is necessary to allow a beneficiary to access essential lavatory and/or living facilities if those facilities are on different levels of the home. VHA records indicate that "Per a phone conversation with [the Veteran], it was determined that there was an accessible bedroom, bathroom, living area, and kitchen on the primary accessible level of the home." The VHA Handbook 1173.08 provides that stair glides may be furnished as part of medical and/or prosthetic services to eligible veterans provided that they are medically necessary for the veteran's care and treatment. In many cases the need is apparent, e.g., access to dialysis equipment located in the basement of the home. In other cases, the need is not as clear, e.g., prescribed rehabilitative exercise equipment located on another level, leather crafts or some other vocational pursuit prescribed for rehabilitation, etc. The Handbook states that following a request for a stair glide, a home visit by an evaluation team consisting of the Prosthetic Representative and/or a Physical Medicine and Rehabilitation Service therapist, or engineering personnel or other appropriately trained individual must be taken to determine that alternative facilities or rooms suitable for the prescribed activity are not available on the accessible level of the home. A June 2021 letter from a private provider reflects that the Veteran had multiple conditions limiting his physical activities around the house. There is no indication that a medical determination was made as to whether access to the second floor was medically necessary to the Veteran's care and treatment due to the Veteran's service-connected PTSD and a home visit was not conducted. The Statement of the Case only addressed whether there was an accessible bedroom, bathroom, living area, and kitchen on the primary accessible level of the home, but did not address the Veteran's assertion that time alone on a separate floor was medically necessary due to his PTSD symptoms. On remand, a supplemental opinion concerning medical necessity, and if necessary, an in-home evaluation, must be provided. The Board also notes that in a January 2018 statement, the appellant stated that the Veteran's VA physicians have indicated in his record that it would be medically feasible for the Veteran to reside in the home after adaptions have been made. In the January 2018 statement, the appellant referred to attached evidence from the Veteran's private provider which does not appear to be in the claims file. The June 2021 letter from a private provider referenced above is in the claims file. However, as the letter is dated after the January 2018 statement, it appears that records from a private provider may be missing from the claims file. The Veteran's VA treatment records are also not in the file. On remand, an attempt should be made to obtain the records referenced by the appellant in the January 2018 statement and the Veteran's VA treatment records. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from 2017 to the Present. 2. Obtain the evidence from the Veteran's private provider referenced in the appellant's January 2018 letter and add it to the claims file. If necessary, ask the Veteran to complete a VA Form 21-4142 for the record. Make two requests for the authorized records unless it is clear after the first request that a second request would be futile. 3. Obtain a medical opinion clarifying whether it is medically necessary for the Veteran's treatment and care for the Veteran to be able to access the second floor of his home to spend time alone due to his service-connected PTSD and knee disability. A rationale for any opinion/conclusion stated must be included. (Continued on the next page) 4. Thereafter, if and only if the Veteran's access to the second floor is found to be medically necessary for his treatment and care, provide a home visit by an evaluation team consisting of the Prosthetic Representative and/or a Physical Medicine and Rehabilitation Service (PM&RS) therapist, or engineering personnel or other appropriately-trained individual to determine that alternative facilities or rooms suitable for the medically necessary activity are not available on the accessible level of the home. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Marenna, 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.