Citation Nr: 25005222 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 14-43 430 DATE: April 17, 2025 ORDER Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is denied. FINDING OF FACT The evidence of record weighs persuasively against finding that the Veteran's service-connected disabilities result in the need for regular aid and attendance. CONCLUSION OF LAW The criteria for entitlement to SMC aid and attendance have not been met. 38 U.S.C. §§ 1114(l), 5107(b); 38 C.F.R. §§ 3.102, 3.350(b), 3.352, 3.400. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active-duty service from October 1965 to February 1970. This matter comes before the Board of Veterans' Appeals (Board) from a September 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that a hearing was held in December 2015 before the undersigned Veterans Law Judge. A transcript of that hearing is of record. The Board last remanded the Veteran's claim in May 2024 to acquire outstanding private treatment records, as well as addendum medical examinations and opinions. Upon review of the record, as addressed at greater length below, the Board finds that its remand directives were substantially complied with. See Stegall v. West, 11 Vet. App. 268 (1998) 1. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance The Veteran contends that he is entitled to SMC aid and attendance. SMC under 38 U.S.C. § 1114(l) and 38 C.F.R. § 3.350(b) is payable as the result of service-connected disability if a 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 (or concentric contraction of the field of vision beyond 5 degrees in both eyes); is permanently bedridden; or is so helpless as to be in need of regular aid and attendance. As an initial matter, the Veteran is service-connected for PTSD, coronary artery disease, and hearing loss. Need for aid and attendance means being so helpless as to require the regular aid and attendance of another person. 38 C.F.R. § 3.350(b)(3). The following will be accorded consideration in determining the need for regular aid and attendance: inability of claimant to dress or undress himself, or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of claimant to feed himself through loss of coordination of upper extremities or through extreme 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 claimant from hazards or dangers incident to his or her daily environment. 38 C.F.R. § 3.352. It is not required that all of the disabling conditions enumerated in this paragraph be found to exist before a favorable rating may be made. Turco v. Brown, 9 Vet. App. 222, 224 (1996). The particular personal functions that the Veteran is unable to perform should be considered in connection with his or her 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. A Veteran will be found to be bedridden if the condition actually requires that he remain in bed, but not if he voluntarily stays in bed or if a physician merely recommends bed rest. Determinations that the Veteran is so helpless, as to be in need of regular aid and attendance will not be based solely upon an opinion that the claimant's condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance from others. 38 C.F.R. § 3.352. Initially, the Board notes that upon remand the Veteran was requested by the RO to complete a VA Form 21-4142 in order to acquire private treatment records. Subsequently, the RO notified the Veteran that the request was rejected due to an incorrect address. See August 2024 Correspondence. As the Veteran did not provide a response after having been notified as to the aforesaid, the Board finds that VA's duty to assist was met. See Wood v. Derwinski, 1 Vet. App. 190 (1991) (VA's duty to assist is not a one-way street). As to the Veteran's claim, he was afforded an October 2024 VA examination assessing the need for regular aid and attendance. Although the VA examiner noted that the Veteran needs mild-moderate assistance with dressing and undressing, bathing, grooming, keeping self ordinarily clean and presentable, requires medication management, cannot manage his own financial affairs, and suffers limitation of motion, said restrictions/limitations were identified as being attributable to his non-service-connected cerebrovascular accident with altered gait and dysphagia, and vertigo conditions. As to the Veteran's service-connected PTSD disability, the VA examiner noted that the disability less likely than not impacts his ability to engage in most routine daily activities. To point, the VA examiner noted that the Veteran reported a high degree of self-dependence, and that he is currently able to dress and undress himself without assistance, is able to keep himself clean and presentable without assistance, and where his current memory deficiencies are not attributable to his PSTD. Lastly, the VA examiner noted that the Veteran is not permanently bedridden as due to his PSTD, as he is able to independently get around, to include having attended the examination by himself, as well as being able to shop for groceries on his own without assistance. Id. As to the Veteran's service-connected cardiovascular disease, his VA treatment records reveal appropriate medical therapy without any symptoms of obstructive CAD. See April 2, 2024, VA treatment record; see also July 31, 2023, VA treatment record ("He had a TTE with our last visit which was normal, did not demonstrate any structural heart disease which would contribute to hypotension or falls."). The evidence does not demonstrate that the Veteran's noncompensable hearing loss in any way affects his ability to attend to his activities of daily living. The Board acknowledges that the Veteran may require some assistance occasionally due to service-connected disability, particularly his PSTD. However, as previously noted, the most persuasive evidence of record, namely the October 2024 VA examiner's medical opinions, ultimately do not indicate he is so helpless, as a result of his PTSD, that would require the regular aid and attendance of another person. Rather, it was determined that his non-service-connected cerebrovascular accident with altered gait and dysphagia, and vertigo conditions are the more likely cause. See October 2024 VA medical opinion. The Board finds the October 2024 VA examiner's opinion(s) to be most probative on the issue, as the findings are based upon a thorough review of the Veteran's medical history, an in-person medical examination, as well as the Veteran's own lay statements, of which revealed that the Veteran maintains a level self-dependence in relation to his service-connected disabilities that weighs persuasively against the claim. In sum, the Board ultimately finds that the Veteran was not so helpless as to need regular aid and attendance due to service-connected disability, and therefore entitlement to SMC aid and attendance must be denied. See 38 C.F.R. § 3.350(b)(3). As the evidence persuasively weighs against the claim, the benefit of the doubt rule is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.R. Fey, 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.