Citation Nr: A25035473 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 220111-506999 DATE: April 17, 2025 REMANDED Entitlement to eligibility for benefits under the Program of Comprehensive Assistance for Family Caregivers (PCAFC). REASONS FOR REMAND The Veteran served on active duty from May 2005 to June 2020. He has been 100 percent disabled plus in receipt of special monthly compensation (SMC) pursuant to 38 U.S.C. § 1114(k) since June 30, 2020. He and the Caregiver-Applicant (spouse) filed an application for PCAFC benefits in March 2021. In July 2021, the agency of original jurisdiction (AOJ) denied the claim. In January 2022, the Veteran appealed to the Board via a VA Form 10182 and elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal. 38?C.F.R. § 20.301. However, because the Board is remanding the claim, any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103 (c)(2)(ii). Turning to the evidence, a July 2021 PCAFC Centralized Eligibility and Appeals Team (CEAT) review note reports that the Veteran was not in need of personal care services for a minimum of 6 continuous months based on a determination that he did not require hands-on assistance each time he completed at least one ADL or assistance on a "daily or continuous basis" for supervision, protection, or instruction.? However, the Board finds that the July 2021 PCAFC CEAT review is legally inadequate to support the decision made. As a general matter, a determination by VA about the "furnishing of assistance or support" under the Caregiver Support Program shall be considered a medical decision, which is not within the Board's jurisdictional authority to review. See 38 U.S.C. § 1720G; Beaudette v. McDonough, 93 F.4th 1361 (Fed. Cir. 2024). These issues turn on the medical judgment of VHA and the CEAT in determining whether a veteran met the medical eligibility criteria under PCAFC. The CEAT is responsible for making the initial medical decision regarding eligibility for PCAFC benefits. See 85 Fed. Reg. 46226, 46230 (July 31, 2020). However, decisions as to eligibility under PCAFC are subject to Board review. See Beaudette v. McDonough, 93 F.4th 1361 (Fed. Cir. 2024). The Board has the authority to determine the types of Caregiver Program eligibility decisions that fall within its jurisdiction. Id. Decisions not related to the "furnishing of assistance and support" are within the Board's jurisdiction. Id. To this end, the Board finds that it is within its jurisdictional authority to review the adequacy of all medical opinions related to the CEAT's decision regarding the "furnishing of assistance and support." See Owens v. Brown, 7 Vet. App. 429, 433 (1995); Wilson v. Derwinski, 2 Vet. App. 614 (1992). This includes the CEAT's medical opinion upon which the instant eligibility decision was based. A VA opinion is adequate if it "sufficiently inform[s] the Board of the medical expert's judgment on a medical question and the essential rationale for that opinion." The VA opinion need not discuss each piece of favorable evidence in the record. Likewise, a VA opinion is not nonprobative simply because it does not "explicitly lay out the examiner's journey from the facts to a conclusion." Rather, the VA medical report "must be read as a whole" to determine the examiner's rationale. See Monzingo v. Shinseki, 26 Vet. App. 97, 105-06 (2012). A non-exhaustive list of factors that, depending on the case, may be relevant considerations in determining the adequacy and probative value of a medical opinion include: (1) whether there was personal examination of the patient; (2) the expert's knowledge and skill in analyzing the data; (3) whether the opinion contains clear conclusions with supporting data and a reasoned medical explanation connecting the two; (4) whether the opinion is clear and susceptible of only one meaning; (5) the expert's familiarity with pertinent medical history; (6) whether there is any inconsistency in the expert's statements; (7) whether the expert has provided a thorough and detailed opinion about an area within his or her expertise; (8) whether the expert has provided factually accurate, fully articulated, and sound reasoning for his or her conclusion; (9) whether the expert relied on sufficient facts or data; (10) whether the opinion is the product of reliable principles and methods; (11) whether the opinion is the result of principles and methods reliably applied to facts; and (12) whether medical text evidence that a medical opinion relies on contains qualifying or contradictory aspects where the text is entered into the record, at least in part. See McCray v. Wilkie, 31 Vet. App. 243, 257 (2019). An unexplained conclusory opinion is entitled to no weight in a service-connection context. Horn v. Shinseki, 25 Vet. App. 231, 240 (2012). In short, 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 a 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's July 2021 review does not meet these requirements as it is conclusory and unexplained. The decision found that the Veteran did not require personal care services for a minimum of 6 continuous months based on an inability to perform an ADL and/or a need for supervision, protection, or instruction. The CEAT determined that level of personal care needs did not meet eligibility requirements as he did not require hands-on assistance each time he completed at least one ADL and did not have a daily need for supervision, protection, instruction without citing to any evidence specific to the Veteran. Accordingly, a remand is required for a new medical opinion that adequately addresses the criteria for eligibility for PCAFC benefits as set forth in 38 C.F.R. § 1720G (a)(2)(C). Additionally, the July 2021 CEAT determination was based on an incorrect interpretation of a "need for supervision, protection, or instruction" as defined under 38 C.F.R. § 71.15. The Board notes that the Federal Circuit has since invalidated 38 C.F.R. § 71.15 to the extent that the definition for a need for supervision, protection, or instruction included a single frequency requirement ("on a daily basis") and a personal safety requirement that were inconsistent with 38 U.S.C. § 1720G(a)(2)(C)(ii)-(iii). See Veteran Warriors, Inc. v. Sec'y of Veterans Affairs, 29 F.4th 1320, 1342-43 (Fed. Cir. 2022). As such, the Board remands the claim for a pre-decisional error based on the precedential rule announced in Veteran Warriors. VAOGCPREC 7-03 (rules announced in judicial decisions apply retroactively to all cases still open on review when the new rule is announced); see also Brewer v. West, 11 Vet. App. 228, 234 (1998). Upon remand, the Veteran's eligibility should be evaluated under the correct statutory criteria for "need for supervision, protection, or instruction." 38 U.S.C. § 1720G(a)(2)(C). The matter is REMANDED for the following actions: 1. Obtain a current 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: i. Dressing or undressing oneself; ii. Bathing; iii. Grooming oneself in order to keep oneself clean and presentable; iv. 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.); v. Toileting or attending to toileting; vi. 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 vii. 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. 2. Issue a notice of the decision on the issue of entitlement to eligibility for PCAFC benefits as described in 38 U.S.C. § 5104. The notice shall include but is not limited to, a summary of the evidence; a summary of the applicable laws and regulations; identification of findings favorable to the claimant; and identification of the elements not satisfied but necessary for establishing eligibility for PCAFC benefits under 38 C.F.R. § 71.15-71.25. Notice must be ? sent to the Veteran, his representative, and the Caregiver-Applicant. L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Oettle, Teresa I. 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.