Citation Nr: 25004804 Decision Date: 04/09/25 Archive Date: 04/09/25 DOCKET NO. 11-30 029 DATE: April 9, 2025 ORDER Entitlement to service connection for cardiovascular accident (CVA) and residuals is granted. Entitlement to special monthly compensation (SMC) at the housebound rate under 38 U.S.C. § 1114(s) is granted. FINDINGS OF FACT 1. The issue of entitlement to service connection for CVA was raised by the record. 2. The Veteran's CVA was causally related to his service-connected diabetes mellitus, type 2 (diabetes) and hypertension. 3. Resolving all doubt in the Appellant's favor, the Veteran was housebound due to residuals of his CVA. CONCLUSIONS OF LAW 1. The criteria for service connection for CVA have been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for SMC pursuant to 38 U.S.C. § 1114(s) have been met. 38 U.S.C. §§ 1114(s), 5107, 5110; 38 C.F.R. §§ 3.102, 3.350(i). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1967 to April 1987. These matters come before the Board of Veterans' Appeals (Board) on appeal from a March 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2023, the Veteran died. In July 2023, his surviving spouse was granted substitution as the Appellant in this matter. In August 2015, October 2019, January 2023, and October 2024, the Board remanded the issue of entitlement to SMC at the housebound rate. 1. Entitlement to service connection for CVA secondary to service-connected disability. In its August 2015 decision, the Board found that, by virtue of the combined 100 percent rating in effect, SMC was raised by the record. The Board remanded the matter so the RO could consider if TDIU could be based on one disability and, if so, to adjudicate entitlement to SMC at the housebound rate. Although the decision indicated the RO should consider SMC under 38 U.S.C. § 1114(s) based on TDIU for one disability and additional disabilities adding up to 50 percent or greater, compensation based on being housebound is also applicable under the statute. The Board finds that in the context of adjudicating the claim for SMC, the issue of entitlement to service connection for CVA and its residuals was raised by the record and falls within the scope of entitlement to SMC at the housebound rate. Therefore, service connection will also be adjudicated. During the appeal, additional development occurred, and although the Veteran died prior to having an examination, an opinion was obtained in June 2024. The physician stated that the Veteran would be homebound due to CVA attributed as secondary to chronic hypertension and diabetes, which were significant risk factors for development of a CVA (stroke). He included a link to literature that supported the opinion. The Board Remand had noted that the Veteran had required a skilled nursing home placement since July 2, 2019, following a stroke, as well as the level of care the Veteran needed at the facility, but stated that it was unclear if this was required due to service-connected disability. The physician's response was that the Veteran required skilled nursing to get in and out of bed, particularly since he required a motorized wheelchair. See June 2024 C&P Exam. The RO sought an addendum opinion because the Veteran's stroke was not service-connected and, in the July 2024 response, the physician stated that there was no evidence that the service-connected disabilities caused a housebound situation directly, as the stroke, which was secondary to his diabetes and hypertension, was the cause of the housebound status. See August 2024 C&P Exam. As shown, the VA physician provided a favorable opinion regarding the Veteran's stroke as being secondary to service-connected disabilities. While neither the Veteran nor the Appellant explicitly raised this claim, it was clearly raised by the record and is shown to be inextricably intertwined with the claim for entitlement to SMC at the housebound rate. The August 2024 supplemental statement of the case also acknowledged the nexus between the Veteran's CVA and his service-connected disabilities. In DeLisio, the U.S. Court of Appeals for Veterans Claims held that where a claim for service connection for peripheral neuropathy remained open when medical evidence indicated that the Veteran's peripheral neuropathy was caused by diabetes and VA found diabetes related to service, the claim reasonably encompassed a claim for service connection for diabetes. See DeLisio v. Shinseki, 25 Vet. App. 45, 54 (2011). Here, the Board finds that the circumstances of this case fall within the overall intent of DeLisio in how to construe the scope of a claim. In this regard, it is appropriate for the Board, in light of DeLisio, to recognize that the SMC issue reasonably included the secondary service connection claim for the Veteran's CVA and its residuals, since it was a necessary link between SMC and the Veteran's service-connected disabilities. Thus, to reach the claim of entitlement to service connection for CVA, the Veteran was not required to file a separate claim for service connection. It is VA's general practice to identify and adjudicate issues and claims that are logically related. See Bailey v. Wilkie, 33 Vet. App. 188, 201 (2021). The Board also finds it is analogous to and not unlike maximizing benefits by contemplating secondary service connection for disabilities prior to determining if extraschedular consideration is considered. See Morgan v. Wilkie, 31 Vet. App. 162, 164 (2018). With respect to the secondary theory of entitlement, service connection may be granted for a disability which is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either caused or aggravated by a service-connected disease or injury. Allen v. Brown, 7 Vet. App. 439, 448-49 (1995). Here, service connection was in effect for the primary disabilities of diabetes and hypertension. There is also evidence that the Veteran had a CVA in August 2016 with residuals. Further, the Board finds the VA physician's opinion is probative and provides a nexus between the Veteran's CVA and his service-connected disabilities. Hence, secondary service connection for the CVA and its residuals is established. 2. Entitlement to SMC pursuant to 38 U.S.C. § 1114(s). SMC is available when, as the result of service-connected disability, a veteran suffers additional hardships above and beyond those contemplated by VA's schedule for rating disabilities. Breniser v. Shinseki, 25 Vet. App. 64, 68 (2011) (citing 38 U.S.C. § 1114(k)-(s)). SMC is payable under 38 U.S.C. § 1114(s) where a veteran has a single service-connected disability rated as 100 percent and (1) has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. 38 C.F.R. § 3.350(i). The requirement of "permanently housebound" will be considered to have been met when the veteran is substantially confined to his or her house (ward or clinical areas, if institutionalized) or immediate premises due to a service-connected disability or disabilities which it is reasonably certain will remain throughout his or her lifetime. Id. In the present case, the Veteran's CVA and residuals are shown to render the Veteran "permanently housebound" within the meaning of the regulation. As noted, he had a stroke in August 2016. Records in June, July, and September 2019 show that he was accepted into long-term care, had weakness in all four extremities, and that his prior CVA justified using a wheelchair. See November 2019 CAPRI records. A November 2021 admission evaluation indicates the Veteran's CVA caused chronic right-sided and generalized weakness and that he was wheelchair bound. An assessment also shows he was bed and wheelchair bound prior to admission. The June 2024 opinion and July 2021 addendum also show that the Veteran was homebound due to his CVA. Since the opinion and other evidence of record show the Veteran was housebound due to his now service-connected CVA and its residuals, entitlement to SMC under 38 U.S.C. § 1114(s) is granted. M. M. Celli Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bredehorst, D. 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.