Citation Nr: A25009167 Decision Date: 01/31/25 Archive Date: 01/31/25 DOCKET NO. 220331-384694 DATE: January 31, 2025 REMANDED Eligibility for benefits under the Department of Veterans Affairs (VA) Program of Comprehensive Assistance for Family Caregivers (PCAFC) is remanded. REASONS FOR REMAND The?Veteran?served on active duty in the United States Air Force from September 1967 to September 1971. The case is on appeal from a March 2021 decision of the?Veterans?Health Administration (VHA), which is the agency of original jurisdiction (AOJ). In the March 2022 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date of the Board hearing, or (2) more than 90 days following the date of the Board hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Eligibility for benefits under VA's PCAFC. The Veteran in this case has a combined service-connected disability rating of 100 percent since April 2014. He and his spouse applied for Caregiver Program benefits in January 2021. This appeal is remanded because the medical decision upon which the decision was based is legally inadequate to support the decision made. The March 2021 Centralized Eligibility and Appeals Team (CEAT) determination that the Veteran is not in need of personal care services is conclusory and unexplained. A medical opinion will be considered probative if it includes clear conclusions and supporting data with a reasoned analysis connecting the data and conclusions. A medical opinion that is factually accurate, fully articulated, and based on sound reasoning carries significant weight. See Nieves-Rodriguez v. Peake, 22?Vet. App.?295, 304 (2008). Here, the CEAT provided no reasoning, rationale, or justification for this decision. It did not cite to any medical findings or records underpinning the decision. Simply put, the Board has no way to know how or why, to include on what medical basis, the CEAT reached this decision. This is significant because the functional assessment concluded that the Veteran was in need of some assistance with at least one activity of daily living. Further, the functional assessment notes that the Veteran needs help with medication management. As such, remand is warranted for a more detailed and thoroughly explained medical opinion. The matters are REMANDED for the following action: Obtain a medical opinion from the CEAT as to whether the Veteran: (a.) Requires personal care services each time he completes one or more of the following: 1. Dressing or undressing oneself; 2. Bathing; 3. Grooming oneself in order to keep oneself clean and presentable; 4. Adjusting any special prosthetic or orthopedic appliance, that by reason of the particular disability, cannot be done without assistance (this does not include the adjustment of appliances that nondisabled persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); 5. Toileting or attending to toileting; 6. Feeding oneself due to loss of coordination of upper extremities, extreme weakness, inability to swallow, or the need for a non-oral means of nutrition; or 7. Mobility (walking, going up stairs, transferring from bed to chair, etc.) (b.) Has a need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury; or (c.) Has a need for regular or extensive instruction or supervision without which the ability of the Veteran to function in daily life would be seriously impaired. In answering all questions, the medical facts and reasons underpinning every conclusion must be articulated. That is, the CEAT must (1) identify what facts and information, whether found in the record or outside the record, support the conclusion, and (2)?explain how that evidence justifies each conclusion. Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Uller, 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.