Citation Nr: 24010604 Decision Date: 03/05/24 Archive Date: 03/05/24 DOCKET NO. 21-00 007 DATE: March 5, 2024 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) and alcohol-induced psychotic disorder is granted. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance of another is granted. FINDINGS OF FACT 1. Prior to his death, and after resolving reasonable doubt in the Appellant's favor, the Veteran had diagnoses of PTSD and an alcohol-induced psychotic disorder that were related to his military service. 2. Prior to his death, the Veteran's required the regular aid and attendance of another person due to his psychiatric symptoms. CONCLUSIONS OF LAW 1. The criteria for establishing service connection for PTSD and an alcohol-induced psychotic disorder have been met. 38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for entitlement to SMC based on the need for aid and attendance of another have been met. 38 U.S.C. §§ 1114; 38 C.F.R. §§ 3.102, 3.159, 3.350, 3.352. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1966 and January 1968, to include service in the Republic of Vietnam. The Veteran died during the pendency of his claim and his surviving spouse has been substituted as the Appellant for accrued benefits purposes. This matter comes before the Board of Veterans' Appeals (Board) from a January 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). While the decision on appeal contained additional service connection claims, the Appellant specifically limited her appeal to the two issues herein in her December 2020 VA Form 9 (Appeal to the Board of Veterans' Appeals). The Board also notes that, while the Appellant opted for a hearing before the Board in her December 2020 VA Form 9, the record indicates that she cancelled the hearing. See August 27, 2020 Third Party Correspondence. Thus, the request for a Board hearing is considered withdrawn. 38 C.F.R. § 20.704(e). 1. Service connection for PTSD is granted. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection for PTSD requires medical evidence diagnosing PTSD in accordance with §4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). One of the stressors asserted by the Veteran is that he witnessed the death of fellow soldiers in a mortar attack during Operation Prairie in the Republic of Vietnam. The Board finds no reason to doubt the Veteran's claimed stressor, as his military personnel records reflect both his participation in Operation Prairie, the deaths of multiple soldiers during this operation, and the Veteran's Military Operational Specialty (MOS) as a Mortar Man. There has been some dispute by the medical professionals, however, as to whether a diagnosis of PTSD is appropriate in this case, as a 2014 VA examiner diagnosed the Veteran with schizophrenia. The Board finds the evidence is in relative equipoise, however, as to whether the Veteran had PTSD as a result of the stressor noted above. In this regard, in a July 2021 opinion a private psychologist, Dr. J.M., after review of the record and interview of the Veteran's surviving spouse, diagnosed the Veteran with PTSD related to the above stressor, as well as a psychotic disorder as a result of alcohol abuse as secondary to his PTSD that was erroneously diagnosed by the VA examiner as schizophrenia. Dr. J.M. provided a persuasive explanation for why the diagnosis was appropriate and pointed out that the 2014 VA examiner, who indicated a diagnosis of PTSD was not warranted, based that opinion on the fact that the Veteran endorsed many, but not a sufficient number of, PTSD criteria. Dr. J.M., in contrast, addressed the remaining criteria for a PTSD diagnosis and provided sufficient rationale that they were met. The Board can find no reason to reduce the probative value of Dr. J.M.'s findings. Given the probative value of the private opinion, and while the record also reflects a negative opinion by a VA examiner in 2014 that the Veteran did not have PTSD related to service, the Board finds the evidence is at least evenly balanced or approximately so with regard to whether the Veteran had PTSD as a result of his claimed stressor. As such, after resolving all doubt in the Appellant's favor, service connection for PTSD is granted. 2. SMC based on the need for aid and attendance is granted. SMC based on aid and attendance is payable if, as the result of service-connected disability, the veteran has an anatomical loss or loss of use of both feet, or of one hand and one foot; has blindness in both eyes with visual acuity of 5/200 or less; is permanently bedridden; or is so helpless as to be in need of regular aid and attendance of another person. 38 U.S.C. §§ 1114 (l); 38 C.F.R. § 3.350. Aid and attendance means helplessness or being so nearly helpless as to require the regular aid and attendance of another person. See 38 C.F.R. § 3.350(b)(3). Determinations as to need for aid and attendance must be based on actual requirement of personal assistance from others. In making such determinations, consideration is given to such conditions as: inability to dress or undress himself or keep himself ordinarily clean and presentable, frequent need for adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid, inability to feed himself through loss of coordination of upper extremities or through 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 individual from hazards or dangers incident to his daily environment. 38 C.F.R. § 3.352; see also Turco v. Brown, 9 Vet. App. 222, 224 (1996) (holding that at least one factor listed in section 3.352(a) must be present for a grant of special monthly compensation based on need for aid and attendance). "Bedridden" will be a proper basis for the determination of being so helpless as to require regular aid and attendance of another and is defined as that condition which, through its essential character, actually requires that the claimant remain in bed. Id. It is not required that all of the disabling conditions enumerated 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 condition as a whole. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Id. Determinations that the veteran is so helpless, as to be in need of regular aid and attendance will not be based solely on an opinion that the claimant's condition is such that it would require him to be in bed. They must be based on the actual requirements of personal assistance from others. Id. In considering the evidence of record under the laws and regulations as set forth above, the Board finds that the Veteran is entitled to SMC based on the need for regular aid and attendance. The Veteran's claim was denied prior to his death based, in part, on a determination that nonservice-connected disabilities, such as PTSD and chronic obstructive pulmonary disease (COPD), contributed to his need for care or assistance on a regular basis to protect the individual from hazards or dangers incident to his daily environment. As noted above, however, the Veteran is now service connected for PTSD. The question now becomes whether the Veteran's PTSD alone, warranted SMC based on the need for aid and attendance of another. The Board notes that, while a VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, discusses only the Veteran exacerbating COPD, this was completed just prior to his death due to that disease. VA Forms 21-2680 completed prior to that, however, note the Veteran unable to manage his medication or financial affairs due to his acquired psychiatric disorder, and that he was unable to leave the home without supervision. During the aforementioned VA examination in 2014, the veteran's spouse described that the Veteran's psychiatric symptoms rendered him unable to care for himself. She reported having to monitor his bathing and use of household products given a history of pouring bleach on his body related to delusional beliefs. As relevant to the issue of SMC, the examiner noted symptoms of significantly impaired judgment and insight, persistent delusions or hallucinations, grossly inappropriate behavior, and an intermittent inability to perform activities of daily living. The Board also notes Veteran was found mentally incompetent for purposes of managing VA payments in a December 2014 rating decision, and the private psychologist who provided the above opinion regarding service connection for PTSD, Dr. J.M., also opined that the Veteran's mental health impairment required the need for the aid and attendance of another to protect the Veteran from being a danger to himself and others, to protect him from the dangers incident to daily life, and to make routine and familiar decisions due to severe impairment of judgement. Based on the foregoing, and resolving reasonable doubt in the Appellant's favor, the Board finds that the evidence establishes the Veteran was in factual need for aid and attendance due to his service-connected PTSD. The Veteran was not able to manage his medication or financial affairs, required assistance with his daily activities, and could not leave his home without supervision. Thus, entitlement to SMC based on the need for aid and attendance of another is granted. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Scarduzio, 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.