Citation Nr: 22046052 Decision Date: 08/15/22 Archive Date: 08/15/22 DOCKET NO. 10-05 786 DATE: August 15, 2022 ORDER Entitlement to an initial rating of 40 percent, but no higher, for neurogenic bladder, prior to October 10, 2018, is granted. Entitlement to an initial rating in excess of 40 percent for neurogenic bladder, from October 10, 2018, is denied. Entitlement to a separate rating of 40 percent for left lower extremity (LLE) radiculopathy, sciatic nerve, prior to October 10, 2018, is granted. Entitlement to a separate rating of 30 percent for LLE radiculopathy, femoral nerve, is granted. Entitlement to an effective date of October 1, 2007, but no earlier, for the grant of entitlement to a total disability rating based on individual unemployability (TDIU) is granted. Entitlement to an effective date of October 1, 2007, but no earlier, for basic eligibility to Dependents' Educational Assistance (DEA) is granted. Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance (A&A) is granted. FINDINGS OF FACT 1. For the entire period prior to October 10, 2018, the Veteran's neurogenic bladder required the wearing of absorbent materials which must be changed 2 to 4 times per day. 2. For the entire period on appeal, the Veteran does not require changing of absorbent materials more than 4 times per day. 3. For the entire period on appeal, the Veteran's LLE radiculopathy for both the sciatic and femoral nerves has been manifested by severe symptoms. 4. From October 1, 2007, it is reasonably ascertainable that the Veteran was unable to obtain or maintain substantially gainful employment due to his service-connected disabilities. 5. Basic eligibility to DEA benefits is based on the date entitlement to TDIU is granted and entitlement to TDIU is now effective from October 1, 2007. 6. For the entire period since October 1, 2007, the Veteran needed the regular A&A of another person because of his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for an initial rating of 40 percent, but no higher, for neurogenic bladder, prior to October 10, 2018, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.115a, 4.115b, Diagnostic Code 7542. 2. The criteria for an initial rating in excess of 40 percent for neurogenic bladder, from October 10, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.115a, 4.115b, Diagnostic Code 7542. 3. The criteria for a separate rating of 40 percent for LLE radiculopathy, sciatic nerve, prior to October 10, 2018, have been met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.27, 4.124a, Diagnostic Code 8520. 4. The criteria for a separate rating of 30 percent for LLE radiculopathy, femoral nerve, have been met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.27, 4.124a, Diagnostic Code 8526. 5. The criteria for an effective date of October 1, 2007, but no earlier, for the grant of entitlement to TDIU have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400, 4.16. 6. The criteria for an effective date of October 1, 2007, but no earlier, for basic eligibility to DEA have been met. 38 U.S.C. §§ 3501, 5110, 5113; 38 C.F.R. §§ 3.400, 3.807, 21.3020, 21.3021. 7. The criteria for SMC based on the need for regular A&A have been met. 38 U.S.C. § 5110; 38 C.F.R. § § 3.350, 3.351. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1982 to June 1988. As an initial matter, the issue of an increased rating for the Veteran's back condition will be adjudicated in a separate Board of Veterans' Appeals (Board) decision under the Appeals Modernization Act (AMA). See May 2021 VA Form 10182. The Veteran filed a claim for TDIU received March 4, 2008 due to his back and radiculopathy pain. See March 2008 Veteran statement. This was also taken as an increased rating claim for the Veteran's back condition. In a September 2008 rating decision, the Agency of Original Jurisdiction (AOJ) denied an increased rating for the Veteran's back condition and denied entitlement to TDIU. The Board notes the Veterans back and left sciatica radiculopathy were originally combined as a single disability. The Veteran then appealed the September 2008 rating decision. See May 2009 notice of disagreement (NOD). The Veteran filed a claim for service connection for a bladder condition received February 12, 2010. A September 2011 rating decision increased the Veteran's back condition rating to 20 percent effective February 1, 2011. A July 2012 rating decision denied service connection for a bladder condition. A July 2012 Board decision remanded the back increased rating and TDIU claims to schedule a Board hearing. A December 2012 Board decision remanded the issues again for a new examination and to obtain SSA records. The Veteran appealed the July 2012 rating decision regarding service connection for a bladder condition in July 2013 correspondence. An April 2015 rating decision separated the Veteran's LLE radiculopathy rating at a 10 percent rating effective January 29, 2011. The Veteran appealed both the effective date and evaluation of the radiculopathy award in the April 2015 rating decision. See August 2015 NOD. A June 2016 rating decision granted service connection for a neurogenic bladder at 20 percent disabling effective September 4, 2009. The Veteran appealed both the effective date and evaluation of the necrogenic bladder rating in the June 2016 rating decision. See June 2017 NOD. A December 2017 Board decision remanded the issues regarding an increased rating for the Veteran's back condition and TDIU for a new examination and TDIU opinion. A January 2019 rating decision increased the Veteran's back rating to 40 percent, increased the Veteran's radiculopathy sciatic nerve to 40 percent effective October 10, 2018, granted service connection and a separate 10 percent rating for left lower extremity radiculopathy at a 10 percent rating effective October 10, 2018, and granted entitlement to TDIU and DEA effective October 10, 2018. A May 2019 Board decision denied a higher back rating, granted a higher staged radiculopathy rating, granted an earlier effective service connection date for the Veteran's bladder condition, and remanded the issues regarding a higher rating for a neurogenic bladder for a new examination and TDIU prior to October 10, 2018 for extraschedular considerations. In June 2019, the Court of Appeals for Veterans Claims (Court) dismissed the appeal to the Court and noted the May 2019 Board decision properly assumed jurisdiction of all the issues. The Veteran submitted an NOD in October 2019 regarding the effective date for TDIU and DEA, and the radiculopathy femoral nerve rating and effective date in the January 2019 rating decision. A January 2020 rating decision granted a 40 percent rating for neurogenic bladder effective October 10, 2018. A March 2020 Court Joint Motion for Partial Remand (JMPR) remanded the issues of a higher back rating prior to October 10, 2018, a higher radiculopathy rating prior to October 10, 2018, and an effective date earlier than August 13, 2009 for service connection for neurogenic bladder in the May 2019 Board decision. An April 2020 Board decision denied an increased rating for the Veteran's neurogenic bladder and an earlier effective date for TDIU. A January 2021 Board decision granted an earlier effective date for service connection for neurogenic bladder effective September 20, 2017, denied a higher than 20 percent rating prior to October 10, 2018 for radiculopathy, and remanded the issue of a higher rating for a back condition prior to October 10, 2018. A January 2021 Court JMR remanded the April 2020 Board decision denying a higher rating for the Veteran's neurogenic bladder and an earlier TDIU effective date due to failure to respond to a Privacy Act request. A June 2021 Board decision remanded the issues of a higher rating for neurogenic bladder and TDIU prior to October 10, 2018 in order to address an extension request. An August 2021 Court JMPR vacated the January 2021 Board decision to the extent it denied a rating in excess of 20 percent prior to October 10, 2018 for LLE radiculopathy. A November 2021 Board decision remanded the issues regarding neurogenic bladder, radiculopathy, and TDIU in order to obtain medical treatment records. The Board finds there has been substantial compliance with its past remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board notes that the Veteran is a doctor. The Board further finds the Veteran's statements are competent and credible as to the symptoms and severity of his service connected conditions. As noted above, the effective date for service connection for the Veteran's bladder condition was previously on appeal. However, the January 2021 Board decision granted an earlier effective date of September 20, 2007, and the Veteran did not appeal this decision further as noted in the August 2021 Court JMPR. Therefore, the earlier effective date claim regarding the Veteran's bladder condition is no longer on appeal. Regarding radiculopathy, neurological complications as radiculopathy, which are associated with the Veteran's back condition, are to be addressed separately for the entire period on appeal with respects to an increased rating claim for the back. The Veteran's increased rating claim for his back condition remains on appeal and dates back to his claim received March 4, 2008. Additionally, as noted above, both radiculopathy ratings were appealed. The Board will consider both radiculopathy ratings for the entire period on appeal back to March 4, 2008. However, the issue of a higher than 60 percent rating from October 10, 2018 under Diagnostic Code 8520 was adjudicated by the May 2019 Board decision and not appealed to the Court. See March 2020 Court JMPR. Therefore, the Board will not address that issue in this decision. Increased Rating When a Veteran seeks an increased evaluation, it will generally be presumed that the maximum benefit allowed by law and regulation is sought, and it follows that such a claim remains in controversy where less than the maximum benefit available is awarded. See AB v. Brown, 6 Vet. App. 35, 38 (1993). Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Where the question to consider is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a "staged" rating are required. See Fenderson v. West, 12 Vet. App. 199, 125-26 (1999). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," whether it is an initial rating case or not. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Importantly, the evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. However, when it is not possible to separate the effects of the service-connected disability from a nonservice-connected condition, such signs and symptoms must be attributed to the service-connected disability. Mittleider v. West, 11 Vet. App. 181, 182 (1998); 38 C.F.R. § 3.102. 1. Bladder The Veteran's bladder condition is rated under Diagnostic Code 7542, which rates neurogenic bladder under voiding dysfunction or urinary tract infection. Voiding dysfunction is rated based on urine leakage, frequency, or obstructed voiding. For urinary leakage, a 20 percent rating contemplates leakage requiring the wearing of absorbent materials, which must be changed less than two times per day. When there is leakage requiring the wearing of absorbent materials, which must be changed two to four times per day, a 40 percent disability rating is warranted. When these factors require the use of an appliance or the wearing of absorbent materials which must be changed more than four times per day, a 60 percent evaluation is warranted. 38 C.F.R. § 4.115a. The Board notes that the Veteran does not have kidney disease and urinary tract infection allows for only a 30 percent rating. As such, it is most advantageous to rate the Veteran under voiding dysfunction. September 2007 treatment records noted the Veteran is unable to work due to urinary pain. July 2008 treatment records noted urinary frequency and urgency. The Veteran noted in September 2009 correspondence that he developed neurogenic bladder due to his back condition. January 2013 treatment records noted urinary obstruction. The May 2015 examination report noted the Veteran's neurogenic bladder is manifested by voiding dysfunction, but the Veteran does not wear absorbent materials despite occasional urinary leakage, daytime voiding interval between 2 and 3 hours, and nighttime awakening to void 3 to 4 times. The July 2019 examination report noted voiding every 45 minutes, that the Veteran wakes up 6 times a night to void, that if his back flares up, he has more frequent urination both during the day and night, and use of absorbent materials with 2 to 4 changes per day. The Veteran's spouse, a vascular surgeon, noted the Veteran has had significant urinary symptoms since 2007 with episodes of nocturia at least 5 times a night. See April 2021 spousal statement. The Veteran's April 2021 statement noted that since 2007, he was voiding every 1 to 2 hours, had frequent nocturia 5 to 6 times per night, and that he started taking medication for his condition. Based on the evidence presented above, the Board finds that the Veteran's voiding dysfunction manifests during the appeal period as the wearing of absorbent materials which must be changed 2 to 4 times per day. The Veteran has to urinate frequently throughout the day, must be near a restroom at all times, changes absorbent material at least 2 times a day, and has had similar urinary frequency throughout the period on appeal. Therefore, a 40 percent rating is warranted for the entire period on appeal. However, the Veteran's disability picture is not more closely approximated by the next higher ratings because neither the Veteran nor the evidence of record reflects that he has to change absorbent materials more than four times a day or that he uses an appliance. The Veteran's arguments and statements focus on the urinary frequency and voiding, but evidence generally does not note or focus on the use of absorbent materials. Therefore, a higher rating is not warranted at any point during the period on appeal. 2. Radiculopathy Under Diagnostic Code 8520, mild incomplete paralysis warrants a 10 percent disability rating, moderate incomplete paralysis warrants a 20 percent disability rating, moderately severe incomplete paralysis warrants a 40 percent disability rating, and severe incomplete paralysis with marked muscular atrophy warrants a 60 percent disability rating. An 80 percent disability rating is warranted for complete paralysis, where the foot dangles and drops, there is no active movement possible of the muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. Under Diagnostic Code 8526, mild incomplete paralysis warrants a 10 percent disability rating, moderate incomplete paralysis warrants a 20 percent disability rating, and severe incomplete paralysis warrants a 30 percent disability rating. A 40 percent disability rating is warranted for complete paralysis of quadriceps extensor muscles. Descriptive words such as "slight," "moderate" and "severe" as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence for "equitable and just decisions." 38 C.F.R. § 4.6. The term "incomplete paralysis" indicates a degree of lost or impaired function that is substantially less than that which is described in the criteria for an evaluation for complete paralysis of this nerve, whether the less than total paralysis is due to the varied level of the nerve lesion or to partial nerve regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. March 2008 correspondence noted left lumbar radiculopathy and burning pain radiating down the Veteran's left leg, and that the pain was so severe he was unable to complete surgical procedures. March 2008 treatment records noted constant pain. The January 2015 examination report regarding the back noted mild radicular symptoms. The October 2018 examination report regarding the back noted severe pain and persistent radiculopathy and muscle atrophy at the calf muscle. Based on the evidence, the Board finds that the Veteran is entitled to a rating of 40 percent throughout the period on appeal for his LLE radiculopathy sciatic nerve symptoms and 30 percent throughout the period on appeal for his LLE radiculopathy femoral nerve symptoms. The Veteran suffers from severe symptoms that greatly impact his functional limitations with physical activities. Throughout the period on appeal, the Veteran has consistently sought medical intervention for his radicular symptoms, to include visits to the emergency room. The Board also notes medical evidence does not generally distinguish between the Veteran's sciatic and femoral nerve symptoms. As such, the Board affords the Veteran the benefit of the doubt and finds that he has severe symptoms in both nerves. Additionally, the Veteran has been originally rated to have radiculopathy with his back condition together. Therefore, he has had radiculopathy since his original back claim in March 2008. Evidence notes radicular symptoms throughout the entire period dating back to the original claim date. As such, the Veteran is entitled to radiculopathy ratings for both his sciatic and femoral nerves for the entire period on appeal dating back to the original March 2008 claim. A higher rating would require there to be severe incomplete paralysis with marked muscular atrophy or complete paralysis. However, the Veteran has not been found to have either condition regarding the sciatic nerve prior to October 10, 2018 or complete paralysis regarding the femoral nerve. As such, higher ratings are not warranted. EED TDIU Total disability will be considered to exist where there is present any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that the Veteran meets the schedular requirements. Specifically, if there is only one such disability, this disability shall be ratable at 60 percent or more; if there are two or more disabilities, there shall be at least one disability that is ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). For the stated purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable; and (2) disabilities resulting from common etiology or a single accident. 38 C.F.R. § 4.16(a). "Substantially gainful employment" is that employment "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the Veteran resides." Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). "Marginal employment shall not be considered substantially gainful employment." 38 C.F.R. § 4.16(a). In determining whether unemployability exists, consideration may be given to the Veteran's level of education, special training, and previous work experience, but not to his age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. With respect to an earlier effective date, TDIU is a form of increased rating claim, and, therefore, the effective date rules for increased compensation claims apply. See Norris v. West, 12 Vet. App. 413, 420 (1999); Hurd v. West, 13 Vet. App. 449 (2000). As a claim for TDIU is a claim for an increased rating, the Board will generally review evidence from that date and during the one year "look back period" preceding the submission of the claim. See 38 U.S.C. § 5110(b); 38 C.F.R. § 3.400(o)(2). Pursuant to this decision, the Veteran has a combined rating of at least 70 percent for the entire period on appeal and his service connected conditions all relate to the Veteran's back condition. The Veteran filed his claim for TDIU received March 4, 2008. The Veteran is a doctor and was a general and thoracic surgeon. See March 2008 correspondence. The Veteran noted that his pains would hinder his ability to complete procedures. Id. The Veteran noted an inability to lift heavy objects, stand for prolonged periods of time, and inability to lean forward. Id. September 2007 correspondence noted the Veteran will close his medical practice on October 31, 2007. The May 2008 VA Form 21-8940 noted the Veteran stopped working full time March 2, 2007 and stopped working all together September 26, 2007. The January 2010 SSA decision, referencing the Veteran's back condition, found the Veteran disabled since September 26, 2007. Dr. D.S.'s correspondence dated October 1, 2017, and received November 27, 2007, noted the Veteran's back condition is severe and that he will need to discontinue his practice due to his disability. The Veteran also noted he is unable to drive more than 30 minutes. See October 2009 testimony. The June 2011 opinion noted the Veteran's service connected conditions would limit his ability to perform standing activities. The January 2015 examination report regarding the back noted the Veteran is unable to work. Medical evidence received May 12, 2021 noted issues with standing, sitting, and walking. A rehabilitation counselor provided an assessment in November 2020 noting the Veteran warrants TDIU from at least September 2007 to present. The responsibility for making the ultimate TDIU determination is placed on the adjudicator and not a medical examiner. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). A medical examiner's role is limited to describing the effects of disability upon the person's ordinary activity. See Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). The Veteran is competent to testify as to facts he personally observed or described; this includes recalling what he personally felt, saw, smelled, heard, or tasted. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). It is clear that the Veteran stopped working September 26, 2007. Therefore, the Veteran has been unemployed for the entire period on appeal. The Veteran is highly educated as a surgeon. However, evidence clearly indicates that the Veteran was not able to practice medicine or complete surgical procedures because of the pain associated with his back and radiculopathies. The Veteran is unable to stand, sit, walk, or drive for long periods. Practicing medical doctors need to be on their feet and walk from patient to patient. However, the Veteran's functional limitations would prevent satisfactory performance and examination of his patients. Furthermore, because the Veteran is unable to sit for long periods, he would not be able to adequately work a desk or administrative job doing medical review. Furthermore, the Veteran's constant need to use the restroom due to his bladder condition would impact his performance. Furthermore, especially during flare-ups, the Veteran would have to lie down due to his back condition. This would not be suitable for the Veteran to complete any kind of administrative work. As such, the Board finds the Veteran credible as to his functional limitations attributable to his service-connected conditions in combination. Therefore, the Veteran is entitled to TDIU from at least March 4, 2008. However, during the one year look back period, there is only a single piece of relevant evidence that pertains to TDIU and the severity of the Veteran's condition. Dr. D.S.'s correspondence dated October 1, 2007 was received November 27, 2007. This letter noted the Veteran must close his practice due to his back condition. Therefore, based on the evidence during the one year look back period, it is reasonably ascertainable that the Veteran was unable to work from October 1, 2007. The Board notes that prior to March 4, 2008, being the date of claim, the Veteran is only service connected for a back condition at a 10 percent rating and his bladder condition at a 40 percent rating. Therefore, the Veteran does not meet the schedular criteria for TDIU prior to March 4, 2008. Where these percentage requirements are not met, entitlement to benefits on an extraschedular (ES) basis may be considered when the veteran is unable to secure and follow a substantially gainful occupation due to service-connected disabilities, and consideration is given to the veteran's background including his or her employment and educational history. 38 C.F.R. § 4.16(b). The Board does not have the authority to assign an ES total disability rating for compensation purposes based on individual unemployability in the first instance. Wages v. McDonald, 27 Vet. App. 233, 235-39 (2015). Entitlement to ES TDIU was initially denied in a July 2019 decision by the Compensation Service Director. Competent medical evidence notes the Veteran was unable to work prior to March 4, 2008 based on his back condition and his bladder condition also impacts his work performance. As such, the Veteran is entitled to an effective date of October 1, 2007, but no earlier, for entitlement to TDIU. The Board understands the Veteran seeks TDIU from the date he stopped working on September 26, 2007. However, the effective date here is either the date of claim, being March 4, 2008, or based on evidence received during the one year look back period. Here, the evidence during the one year look back period only afford an effective date as early as October 1, 2007. EED DEA DEA benefits are payable to the child, spouse, or surviving spouse of a veteran if the following conditions are met: (1) the veteran was discharged from service under conditions other than dishonorable, or died in service; and (2) the veteran has a permanent total service-connected disability; or (3) a permanent total service-connected disability was in existence at the date of the Veteran's death; or (4) the Veteran died as a result of a service-connected disability. 38 U.S.C. § 3510 ; 38 C.F.R. § 3.807(a). P&T means permanent and total "disability," permanently and totally "disabled," or permanent and total "rating," when any of these terms are used in reference to a veteran with a service-connected disability rating determined by VA to be total for the purposes of VA disability compensation where the impairment is reasonably certain to continue throughout the life of the disabled veteran. 38 C.F.R. § 21.3021(p). The term "effective date of the P&T rating" means the date from which VA considers that the veteran's P&T disability commenced for purposes of VA benefits, as determined by the initial rating decision. 38 C.F.R. § 21.3021(q), (r). The AOJ initially determined in a January 2019 rating decision that basic eligibility for DEA benefits was established effective from October 10, 2018, the date of the original grant of entitlement to TDIU, as the Veteran has a total service-connected disability that is permanent in nature. Given the grant of an earlier effective date for entitlement to TDIU pursuant to this decision, the Board finds that entitlement to DEA benefits for that same period from October 1, 2007 is warranted. Prior to October 1, 2007, the Veteran is not awarded TDIU and does not have a total service-connected disability. Therefore, October 1, 2007, is the earliest date for which such entitlement is warranted. Accordingly, entitlement to an effective date of October 1, 2007, but no earlier, for DEA benefits is granted. A&A Entitlement to A&A has been raised by the Veteran due to his service connected disabilities. See November 2020 correspondence. SMC based on the need for A&A is warranted where a Veteran's service-connected disabilities render him "so helpless as to be in need of regular aid and attendance." 38 C.F.R. § 3.352(a). Basic criteria for A&A include the inability to dress or undress oneself, or to keep oneself ordinarily clean and presentable. The need for A&A may include incapacity, physical or mental, which requires care or assistance on a regular basis to protect the Veteran from hazards or dangers incident to their daily environment. The regulation states that the Veteran needs only regular care, not constant or daily A&A. Id. Here, the Board finds that the Veteran met the criteria for SMC for A&A of another. The Veteran is service connected for a back condition and LLE radiculopathy that renders him unable to do various day to day tasks and the Veteran is granted TDIU since October 1, 2007. In July 2020 correspondence, it is noted that the Veteran has pronounced IVDS treated with bed rest, that he needs help with most activities of daily living, and he frequently requires rest in a reclined position. In November 2020 correspondence, it is noted the Veteran required A&A from September 26, 2007 and that the Veteran is unable to perform household chores, has needed a shower chair and help of grabbing bars to use the bathroom since 2007, and his family must help with preparing his own meals. The evidence noted throughout this decision clearly notes severe symptoms that greatly limits the Veteran's physical ability to complete even simple tasks. Importantly, the Veteran's condition requires him to have to lie down for prolonged periods. Therefore, it is reasonable to suggest that the Veteran needs the help of others just to complete daily living tasks granted he must lay down and not participate in any physical activity that requires walking or prolonged sitting and standing. Given the above evidence, the Board finds that entitlement to SMC by reason of the need for regular A&A from another person is warranted. The evidence of record demonstrates that the Veteran needs assistance with activities of daily living including housework, bathroom/bathing, and meal preparation due to his service-connected disabilities. Thus, he met the prerequisite for A&A from another. See Turco v. Brown, 9 Vet. App. 222 (1996). As noted from above, it is not required that all the disabling factors be found to exist before a favorable determination is made for regular need for A&A of another person. 38 C.F.R. § 3.352(a). The personal functions that the Veteran was unable to perform should be considered in connection with his condition as a whole. Id. It is only necessary that the evidence establish that the Veteran is so helpless as to need regular A&A, not that there is a constant need. Id. In sum, the evidence of record supports the Veteran's statements that his service-connected disabilities rendered him unable to perform daily activities of living without the assistance of another. Accordingly, resolving all doubt in his favor, the criteria for SMC based on the need for A&A have been met for the entire period on appeal, and the claim is granted. See 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 9, 55-57 (1990). DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Zheng, 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.