Citation Nr: A25099720 Decision Date: 11/17/25 Archive Date: 11/17/25 DOCKET NO. 241212-497857 DATE: November 17, 2025 ORDER Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance is denied. FINDING OF FACT The evidence does not demonstrate that the Veteran requires the regular aid and attendance of another person to perform the routine activities of daily living. CONCLUSION OF LAW The criteria for entitlement to SMC based on the need for regular aid and attendance have not been met. 38 U.S.C. §§ 1114, 5107; 38 C.F.R. §§ 3.102, 3.350, 3.352. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from July 1990 to July 2010. The rating decision on appeal was issued in November 2024 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the December 2024 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 November 2024 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ 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. On his December 2024 VA Form 10182, the Veteran attempted to appeal an October 2018 rating decision denying entitlement to a total disability rating based on individual unemployability (TDIU). As this decision is outside of the one-year appeal period, the Board does not have jurisdiction to review it on appeal. Moreover, the Veteran is in receipt of a 100 percent disability rating, which generally renders the issue of entitlement to a TDIU moot. Entitlement to SMC based on the need for regular aid and attendance The Veteran generally seeks entitlement to SMC based on the need for regular aid and attendance. The Board notes that the Veteran has not put forth any specific contentions as to why he believes he is entitled to this benefit. SMC at the aid and attendance rate is warranted if the Veteran, as the result of service-connected disability, has the anatomical loss or loss of use of both feet, or of one hand and one foot, or is blind in both eyes, or is permanently bedridden or so helpless as to be in need of regular aid and attendance. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). Here, there is no evidence or allegation that the Veteran has the anatomical loss or loss of use of both feet, or of one hand and one foot, or is blind in both eyes; thus, the Board need only consider whether the Veteran's service-connected disabilities cause him to be permanently bedridden or so helpless as to be in need of regular aid and attendance. In making such a determination, consideration is given to: (1) inability of the Veteran to dress or undress himself, or to keep himself ordinarily clean and presentable; (2) frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without such aid; (3) inability of the Veteran to feed himself because of the loss of coordination of upper extremities or because of extreme weakness; (4) inability to attend to the wants of nature; or (5) physical or mental incapacity which requires care or assistance on a regular basis to protect the Veteran from the hazards or dangers incident to his daily environment. 38 C.F.R. § 3.352(a). It is not required that all of the disabling conditions enumerated in 38 C.F.R. § 3.352(a) be found to exist before a favorable rating may be made. The Veteran is currently service-connected for posttraumatic stress disorder (PTSD) with alcohol use (70 percent); gastroesophageal reflux disease (GERD) (60 percent); congestive heart failure with secondary dilated cardiomyopathy (60 percent); obstructive sleep apnea (50 percent); hypertension (40 percent); right knee degenerative arthritis (10 percent); left knee degenerative arthritis (10 percent); pseudofolliculitis barbae (10 percent); tinnitus (10 percent); umbilical hernia repair with residual scar (noncompensable); erectile dysfunction (noncompensable); status post adenocarcinoma of sigmoid colon (noncompensable); and dry eye syndrome with vitreous floater and pinguecula (noncompensable). The Veteran's combined disability rating is 100 percent from March 8, 2019. In October 2024, the Veteran submitted VA Form 21-2680 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, which was completed by Dr. K.T., the Veteran's VA primary care physician, in September 2024. The Veteran's diagnoses are cerebrovascular accident (stroke), lumbago, and congestive heart failure. The disabilities that are considered permanent and totally disabling are severe back pain and chronic heart failure. The doctor indicated that the disability that restricts the following activities and functions is "severe back pain." This disability results in the Veteran being confined to bed for 22 hours per 24 hour period; he requires assistance with bathing/showering, dressing, ambulating within the home or living area, tending to hygiene needs, transferring in and out of bed/chair, toileting, and medication management. The Veteran is not legally blind; he does not require nursing home care; and he is able to manage his own financial affairs. The doctor also noted weakness in the bilateral upper and lower extremities. The Veteran leaves his home twice weekly for medical appointments. He does not require an aid (i.e., cane, braces, crutches) or the assistance of another person for locomotion. Review of the Veteran's voluminous VA treatment records during the relevant period show that the Veteran regularly drives to and attends his VA medical appointments on his own. He lives in a home with a roommate. He has consistently reported to this treating clinicians that he is independent with activities of daily living and instrumental activities of daily living and does not report any functional deficits. He does not require the use of durable medical equipment for ambulation and he manages his own medications and meals. During periods of hospitalization for stroke and heart failure, the Veteran was emphatic in his ability to care for himself at home, and he was observed being able to feed, toilet, and bathe himself. See, e.g., December 10, 2021 occupational therapy consult; December 7, 2022 nurse case manager inpatient assessment; April 20, 2023 social work admission evaluation note; September 6, 2023 nursing inpatient note; May 6, 2024 social work admission evaluation note; May 13, 2024 case manager note. At a June 2024 heart conditions examination, the Veteran was noted to have symptoms of breathlessness and fatigue with activities resulting in greater than 3 to 5 METs, such as light yard work, mowing lawn, or brisk walking. At a June 2024 VA central nervous system examination, the Veteran was found to have a normal gait and normal muscle strength in his upper and lower extremities with no evidence of weakness. At an August 2024 VA PTSD examination, the Veteran reported that he enjoys attending live music events, spending time with friends and his daughter, and attending similar social events. After careful consideration of the medical and lay evidence of record, the Board finds that entitlement to SMC based on the need for regular aid and attendance is not warranted. While the Board acknowledges that the evidence shows that the Veteran has significant health challenges, he is not shown to meet the criteria for aid and attendance as outlined in 38 C.F.R. § 3.352(a). In this regard, there is no evidence to establish that the Veteran is so physically or mentally incapacitated that he requires regular assistance carrying out activities of daily living, such as bathing, dressing, preparing meals and feeding himself, or managing medications, due solely to service-connected disabilities. Rather, the medical and lay evidence of record persuasively shows that the Veteran is both physically and mentally capable of performing routine activities of daily living, such as self-care, household chores, attending his medical appointments, and maintaining his medications and finances, without the assistance of another person. In making this finding, the Board has considered the October 2024 VA Form 21-2680 of record, which contains information that the Veteran is unable to feed himself, bathe himself, ambulate, or manage his own medications. It also states that the Veteran spends 22 hours out of a 24 hour period in bed. However, these findings are directly refuted by the Veteran's contemporaneous medical records in which his treating clinicians have routinely observed him to be independent and self-sufficient with his own care, mobility, and functioning. The Veteran's own reports to his clinicians, which are recorded in the medical notes, support that he is able to carry out activities of daily living independently and that enjoys hobbies outside of his home. Even if the Board were to accept Dr. K.T.'s findings as to the Veteran's level of functioning, the doctor indicated on the VA Form 21-2680 that these deficits are caused solely by his nonservice-connected back pain. Moreover, the doctor's finding that the Veteran's chronic heart failure is permanent and totally disabling is not supported by the evidence of record. While the Veteran's heart condition is noted to cause breathlessness and fatigue with light chores and brisk walking, the Veteran has routinely denied requiring any assistance with his activities of daily living. For these reasons, the Board does not find this examination report to be probative evidence as to the issue of whether the Veteran requires the regular aid and attendance of another person to perform the routine activities of daily living due to service-connected disabilities. Although the Veteran's multiple service-connected disabilities undoubtedly interfere with several aspects of daily living, he is compensated for this impairment with a combined 100 percent disability rating. Where, as in this case, there is no competent evidence that service-connected disabilities are of such a level of severity or impairment as to render the Veteran permanently bedridden or require the regular aid and attendance of another person to perform the routine activities of daily living, there can be no entitlement to SMC paid at the aid and attendance rate. As a final matter, the Board notes that in a January 2025 informal hearing presentation, the Veteran's representative argued that the Veteran should be service-connected for his cerebrovascular accident and that this disability contributes to his need for the regular aid and attendance of another person. VA does not accept informal claims for service connection; if the Veteran wishes to pursue a service connection claim for this disability, he needs to file a formal claim on the proper form. As the Veteran is not currently service-connected for cerebrovascular accident, any functional deficits associated with this disability have not been considered by the Board in its decision herein. (Continued on next page) In light of the above, the Board concludes that the most persuasive evidence of record weighs against the Veteran's claim. In this regard, the competent and probative evidence does not demonstrate that the Veteran requires the regular aid and attendance of another person to perform the routine activities of daily living. As the evidence persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply. Accordingly, the appeal for entitlement to SMC based on the need for regular aid and attendance is denied. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776, 780-81 (Fed. Cir. 2021). J. NICHOLS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Melissa Barbee 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.