Citation Nr: A25035496 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 240731-469126 DATE: April 17, 2025 ORDER Entitlement to special monthly compensation (SMC), based on the need for aid and attendance due to a service-connected disability is granted. INTRODUCTION The Veteran served on active duty in the U.S. Army from November 1992 to February 1993. In May 2024, the Regional Office (RO) issued a rating decision which addressed the above-noted issue. Thereafter, in July 2024, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), wherein she sought to appeal the claim in the Appeals Modernization Act (AMA) System. She selected the Direct Review option; therefore, the Board may only consider the evidence of record at the time the RO issued the May 2024 rating decision. 38 C.F.R. § 20.301. FINDING OF FACT The evidence shows the Veteran's service-connected paranoid schizophrenia has resulted in impairments that have necessitated the regular aid and attendance of another person to protect the Veteran from the hazards or dangers incident to her daily environment. CONCLUSION OF LAW The criteria for special monthly compensation based on the need for regular aid and attendance of another person have been met. 38 U.S.C. §§ 1114 (l), 5107; 38 C.F.R. §§ 3.102, 3.350(b), 3.352(a). REASONS AND BASES FOR FINDING AND CONCLUSION Duties to Notify and Assist As explained below, the Board has determined the evidence currently of record is sufficient to substantiate the Veteran's claim for entitlement to SMC based upon the need for aid and attendance. Therefore, no further development is required under 38 U.S.C. §§ 5103, 5103A or 38 C.F.R. § 3.159. Legal Criteria Special monthly compensation is payable under 38 U.S.C. § 1114 (l) if, as the result of service-connected disability, the Veteran is permanently bedridden or is so helpless as to be in need of regular aid and attendance of another person. 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.350 (b). 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). As it pertains to the present case, criteria for establishing such need include whether the Veteran is permanently bedridden or is so helpless as to be in need of regular aid and attendance as determined under criteria enumerated under 38 C.F.R. § 3.352 (a). Under 38 C.F.R. § 3.352 (a), the following factors will be accorded consideration in determining whether the Veteran is in need of regular aid and attendance of another person: (1) inability of the Veteran to dress or undress herself, or to keep herself 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 herself 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 her 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 particular personal functions which the Veteran is unable to perform should be considered in connection with 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 is a constant need for aid and attendance. 38 C.F.R. § 3.352 (a); see Turco v. Brown, 9 Vet. App. 222, 224 (1996) (holding that at least one factor listed in § 3.352(a) must be present to grant special monthly compensation based on the need for aid and attendance). Further, pursuant to 38 C.F.R. § 3.351(c)(2), a veteran will be considered in need of regular aid and attendance if he or she is a patient in a nursing home because of mental or physical incapacity. Burden of Proof Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Factual Background and Analysis The Board observes the Veteran submitted an intent to file a claim in July 2023, followed by a claim for entitlement to special monthly compensation, based on the need for aid and attendance in January 2024. A review of the Veteran's record indicates she provided several examinations assessing her need for aid and attendance in January, February, March, and July 2024. At the time of the examinations the clinicians chronicled the Veteran's medical history, and noted the Veteran required assistance with bathing/showering, dressing, meal preparation, medication management, and finances, due at least in part to her paranoid schizophrenia. The record also shows the Veteran has experienced significant symptomatology as a result of her service-connected psychiatric disorder, which includes gross impairment of thought processes, persistent delusions and hallucinations, grossly inappropriate behavior, a persistent danger of hurting others or herself, periods of inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation of time and place, and persistent paranoia. Further, the record indicates the Veteran lives in an assisted living facility, which provides not only assistance with her daily living needs, but also specialized care for her mental and cognitive impairments. (Continued on the next page) ? In sum, the evidence indicates the Veteran currently resides in an assisted living facility (i.e. nursing home), in large part, to protect her from the hazards caused by her service-connected paranoid schizophrenia, to include assistance with disorganized thoughts, impulsivity, impaired judgment, and reality focusing. As noted in 38 C.F.R. § 3.352, it is not required that a veteran be found unable to perform all activities of daily living to warrant entitlement to aid and attendance benefits. Rather, it is only necessary that the evidence establish the veteran is so helpless as to need regular aid and attendance. Based on the foregoing, the Board finds the Veteran's psychiatric disorder is sufficiently disabling to warrant entitlement to aid and attendance benefits in accordance with 38 C.F.R. § 3.350 (b)(3). T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Fraser, Gordon 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.