Citation Nr: 22044167 Decision Date: 08/03/22 Archive Date: 08/03/22 DOCKET NO. 15-10 960 DATE: August 3, 2022 REMANDED Entitlement to special monthly compensation (SMC) due to the need for aid and attendance and/or due to being housebound is remanded. REASONS FOR REMAND The Veteran had active duty service from October 1996 to February 1997 and from June 1999 to September 2000. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) in December 2013. The Veteran testified before the undersigned Veterans Law Judge (VLJ) during a Board hearing in February 2018. A copy of the hearing transcript has been reviewed and associated with the claims file. This matter was previously before the Board in October 2018, at which time it was remanded for further development. The Board denied entitlement to SMC in a June 2020 decision. The Veteran appealed the June 2020 decision to the United States Court of Appeals for Veterans Claims (Court). In March 2021, the Court granted a Joint Motion for Remand (JMR) submitted by the parties, vacating the Board's denial of SMC and remanding the issue to the Board. The Board denied entitlement to SMC again in a July 2021 decision, which the Veteran also appealed to the Court. In April 2022, the Court granted a JMR submitted by the parties, vacating the July 2021 decision and remanding the issue to the Board. Entitlement to special monthly compensation (SMC) due to the need for aid and attendance and/or due to being housebound is remanded. When VA undertakes the effort to provide an examination, the examination must be adequate. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Inadequate medical examinations include those that provide unsupported conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Barr, 21 Vet. App. at 311. It is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes probative value to a medical opinion. Nieves-Rodriguez, 22 Vet. App. at 304. VA must consider all lay and medical evidence of record. 38 U.S.C. §§ 1154(a), 5107; 38 C.F.R. § 3.303. The Veteran underwent a VA examination in relation to his SMC claim in October 2019. The examiner stated that the Veteran drove himself to the examination and that he brought his wife along "for company" but would have been able to come to the examination appointment unattended. The examiner also indicated that the Veteran reported being able to mow his lawn on a riding mower. The examiner opined that the Veteran is capable of performing all self-care functions but also stated that he has several codependent behaviors with his wife, as she manages his medication and brings him food to prevent him from having to walk. The Veteran reported requiring assistance from his wife due to memory problems, but the examiner stated that he does not have a diagnosed cognitive disorder. The examiner also stated that the Veteran reported having a grab bar in the bathroom to help him stand from the toilet. She stated that his service-connected disabilities do not interfere with his ability to self-care. In correspondence received in January 2020, the Veteran challenged the adequacy of the October 2019 examination. First, he stated that his wife drove him to the examination and that he would be unable to attend the examination alone. The Veteran also stated that his wife mows the yard. He also expressed disagreement with the examiner stating that he does not have any memory loss problems. He further stated that he does not have a grab bar in the bathroom, and that his wife has to assist him in getting on and off the toilet, showering, and getting dressed. The Veteran's wife submitted a statement in May 2021, in which she indicated that she has to manage the Veteran's medications, keep him clean and remind him to perform activities such as brushing his teeth, help him get out of bed, and prepare his meals. The Board finds that the October 2019 VA SMC examination is inadequate for the purpose of adjudicating this matter because it is not factually accurate. See Nieves-Rodriguez, 22 Vet. App. at 304. The examiner indicated that the Veteran drove himself to the examination and would be able to get to the examination unattended, is able to mow his lawn, and has a grab bar in the bathroom. The Veteran's and his wife's statements indicate that these findings are inaccurate. The Board has no basis for rejecting the Veteran's or his wife's statements and therefore accepts their statements as factually accurate. Further, the examiner stated that the Veteran reported memory problems but had no diagnosed cognitive disorder; however, an April 2009 VA psychiatric examination lists difficulty with concentration and short-term memory as symptoms related to his service-connected mental disorder. Therefore, his memory loss issues should be considered within the context of his service-connected depression. Accordingly, due to the apparent factual inaccuracies of the October 2019 examination, the Board finds that a new VA examination is warranted. The matter is REMANDED for the following actions: 1. Obtain and associate with the claims file the Veteran's updated VA treatment records, from April 2020 to the present. 2. After completing #1, schedule the Veteran for a VA examination with an appropriate specialist to assess his need for aid and attendance. The entire claims file, including a copy of this remand, must be made available for review by the examiner, and such review should be noted in the examination report. The examiner is asked to provide an evaluation of the effect of the Veteran's service-connected disabilities (depression, migraine headaches, subacute bursitis of the left shoulder, right ankle lateral ligamentous sprain, left and right knee patellofemoral pain disorder with synovitis, onychomycosis and tinea pedis of the bilateral feet, tinea cruris of the groin, chronic cervical spine strain with degenerative changes, chronic left ankle sprain, gastroesophageal reflux disease with hiatal hernia, and facial herpes) on his capability for self-care in his home. The examiner's assessment must include, but is not limited to, evaluations of such conditions as inability of the Veteran to dress 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; inability of the Veteran to feed himself through loss of coordination of the upper extremities or 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 the hazards or dangers inherent in his daily environment. The examiner should opine as to whether the Veteran is so helpless due to his service-connected disabilities as to be in need of regular aid and attendance. The examiner must provide a comprehensive rationale for each proffered opinion and should discuss all relevant medical and lay evidence, to include statements from the Veteran and his wife. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion. If any opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner does not have the knowledge or training. As appropriate, the AOJ should conduct additional development or supplement the record. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Pratt, Austin M. 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.