Citation Nr: A25005299 Decision Date: 01/22/25 Archive Date: 01/22/25 DOCKET NO. 230713-361687 DATE: January 22, 2025 ORDER Entitlement to special monthly compensation (SMC) based on aid and attendance/housebound status is denied. FINDINGS OF FACT 1. The Veteran has a PTSD rating of 100 percent as of September 27, 2021. 2. The Veteran is able to feed himself and shave. 3. The Veteran required a motorized scooter due to difficulty with ambulation secondary to his history of severe osteoarthritis at his bilateral knees, as well as his history of uncontrolled insulin dependent diabetes mellitus. 4. The Veteran was independent with activities of daily living when tested on bathing, dressing, toileting, transferring, continence, and feeding. 5. The Veteran's leisure activities were reported as "likes flea markets, out to dinner with wife, bike rallies, etc." 6. An April 2022 VA treatment record states that the Veteran "understands likely outcomes of behavior" and was "self-aware." CONCLUSION OF LAW The criteria for an award of SMC under subsection (l) based on aid and attendance/housebound status are not met. 38 U.S.C. §§ 1114(l), 5107; 38 C.F.R. §§ 3.102, 3.350(b). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Air Force from April 1974 until his honorable discharge in May 1980. In the July 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the July 2023 Regional Office decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the Regional Office decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Special Monthly Compensation A higher or additional rate of VA disability compensation above the 100 percent disability rate is referred to as "Special Monthly Compensation" or "SMC" for short. SMC is available when a veteran suffers hardships above and beyond those contemplated by the VA's schedule for rating disabilities as a result of a service-connected disability. See generally 38 U.S.C. § 1114 (k) through (s). That provision of law provides various rates of disability compensation, typically providing a certain dollar amount that correspond to the disability percentage assigned, and includes even higher rates for veterans with certain combinations of serious disabilities or for those whose service-related disabilities require a specified level of care. While most rates of compensation are predicated on the average reduction in earning capacity, special monthly compensation benefits are meant to provide additional compensation based on noneconomic factors such as personal inconvenience, social inadaptability, or the profound nature of the disability. SMC for "aid and attendance" is awarded "if the veteran, as the result of service-connected disability, ... with such significant disabilities as to be in need of regular aid and attendance" and the criteria for determining if aid and attendance is required can be found in 38 C.F.R. § 3.352(a). 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.350(b)(3). To be deemed so helpless as to be in need of regular aid and attendance, there must be at least one of the following: (1) an inability to dress or undress or to keep ordinarily clean and presentable independently; (2) frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without assistance; (3) an inability to feed independently through loss of coordination of upper extremities or through extreme weakness; (4) an inability to attend to the wants of nature; or (5) incapacity, either physical or mental, that requires care or assistance on a regular basis to protect from hazards or dangers incident in the daily environment. Being bedridden also is a proper basis for such a determination. The need does not have to be constant. 38 C.F.R. § 3.352(a). 1. Entitlement to special monthly compensation (SMC) based on aid and attendance/housebound status. On June 22, 2023, VA received the Veteran's claim for "SMC L BASED ON 2680 AND NEED FOR A&A." Currently, the Veteran has been awarded entitlement to service connection for posttraumatic stress disorder (PTSD) with major depressive disorder, tinnitus, and bilateral hearing loss. See Most Recent Codesheet. The Veteran has had a PTSD rating of 100 percent as of September 27, 2021. The Veteran submitted an examination for housebound status along with the claim form which was completed by the Veteran's primary care physician in the Daytona VA Clinic. The examiner noted that the Veteran was able to eat without assistance but not prepare meals. Aid was needed for bathing and other hygiene needs but the Veteran was able to shave without aid. The Veteran did not require nursing home care. The Veteran's wife manages the Veteran's medication and finances. The examiner stated, "Pt. can feed himself and shave..." The examiner noted that the Veteran's lower extremity limitations were due to neuropathy and stated, "Pt. can leave home as often as he likes, however only with his wife's assistance." VA treatment records report that the Veteran ambulates with the use of a cane or walker and that the gait problems were due to peripheral neuropathy. See June 2023 VA Treatment Record. Another record stated that the Veteran did not use an ambulatory assistive device and that gait and balance problems consisted of "balance deficit, dizziness/lightheaded, gait deficit, muscle weakness, unsteady." See June 2023 VA Treatment Record. Treatment records also reported that the Veteran required a motorized scooter due to "difficulty with ambulation secondary to his history of severe osteoarthritis at his bilateral knees, as well as his history of uncontrolled insulin dependent diabetes mellitus." See February 2022 VA Treatment Record. The question for the Board is whether the Veteran is in need or regular aid and attendance due to the service-connected disabilities. The Veteran is able to walk short distances with assistance, feed himself, and shave. The Veteran's difficulty with ambulation was noted to be due to neuropathy of the lower extremities. The Veteran has not been awarded service connection for diabetes or neuropathy. The Board finds that the Veteran does not have a service-connected disability that would make him unable to dress, undress, or keep ordinarily clean and presentable independently. A VA treatment record found that the Veteran was independent with activities of daily living when tested on bathing, dressing, toileting, transferring, continence, and feeding. See November 2022 VA Treatment Record. The service-connected disabilities do not require the use of a prosthetic or orthopedic appliance. The examiner found that the Veteran was able to feed himself, although not cook. Furthermore, the examiner did not report that the Veteran was unable to "attend to the wants of nature." The Veteran had a VA examination for PTSD in February 2022 where the examiner found that the Veteran's level of impairment was "total occupational and social impairment." The Veteran had "near-continuous depression affecting the ability to function independently, appropriately, and effectively; impairment of short- and long-term memory; impaired judgement; intermittent inability to perform activities of daily living, forgetting to complete tasks; forgetting directions;" among other symptoms. (Continued on the next page) ? The examination reported that the Veteran's "living situation" was in a "room/shed next to his daughter's house" and that his wife sleeps with him "but he is unable to withstand the noise and chaos in the house with his daughter and grandkids." Leisure activities were reported as "likes flea markets, out to dinner with wife, bike rallies, etc." An April 2022 VA treatment record states that the Veteran "understands likely outcomes of behavior" and was "self-aware." Although the Veteran's PTSD disability is severe, the Board finds that the Veteran is not entitled to SMC based on aid and attendance/housebound status. The Veteran's difficulty with ambulation is due to non-service-connected disabilities, specifically the severe osteoarthritis of the knees and uncontrolled diabetes as noted by the treating physician. The Board finds that the Veteran does not require care or assistance on a regular basis to protect from hazards or dangers incident in the daily environment because of the PTSD or any other service-connected disability. The Veteran was able to complete activities of daily living and the Veteran was "self-aware" and "understood the likely outcomes of behavior." The Veteran has a severe PTSD disability and has been compensated with a 100 percent disability rating. The evidence of record does not warrant SMC based on aid and attendance/housebound status. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. A. Johnston, 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.