HYPERTENSION

Summary

The Veteran served from April 1954 to April 1955. The Veteran appeals the denial of service connection for hypertension and the grant of a total disability rating for mental health disability, as well as entitlement to Special Monthly Compensation (SMC) at the housebound rate and SMC-O for aid and attendance. The Board found that the Veteran's hypertension manifested decades after service and was not related to service or Toxic Exposure Risk Activities (TERA), citing negative nexus opinions from VA examiners in June 2024 and April 2025. These opinions were found to be persuasive and adequately reasoned, outweighing earlier inadequate opinions. The Board denied service connection for hypertension, finding the evidence persuasively weighed against the claim and thus the benefit of the doubt doctrine was inapplicable. Regarding the mental health disability, the Board found that the Veteran's recent treatment records, showing gross impairment of thought processes, inability to perform daily living activities, and significant memory loss, supported a total disability rating. The Board granted a 100% rating for the mental health disability from January 17, 2012. The Board also granted SMC at the housebound rate from January 17, 2012, to October 8, 2021, and SMC-O for aid and attendance from October 8, 2021, based on the combined severity of the mental health disability and bronchial asthma, and the need for higher aid and attendance.

Rationale

Negative nexus opinions from June 2024 and April 2025 VA examiners; Hypertension attributed to non-service related factors (diet, genetics, lifestyle); No evidence of service connection or aggravation by service-connected conditions

Full Decision Text

Citation Nr: 25011472
Decision Date: 09/09/25	Archive Date: 09/09/25

DOCKET NO. 15-09 028A
DATE: September 9, 2025

ORDER

Service connection for hypertension, claimed as heart problem, is denied.

A total disability rating for mental health disability is granted. 

Entitlement to a special monthly compensation (SMC) at the housebound rate from January 17, 2012 to October 8, 2021, is granted.

Entitlement to a SMC-O for aid and attendance from October 8, 2021, is granted.

FINDINGS OF FACT

1. The Veteran's hypertension first manifested many decades following his separation from his service; and was not caused or aggravated by his service, to include his Toxic Exposure Risk Activities (TERA). 

2. From January 17, 2012, the Veteran's mental health disability was manifested by total occupational and social impairment.

3.  From October 8, 2021, the Veteran's total disability ratings of bronchial asthma and mental health disability required a higher level of aid and attendance than his bronchial asthma alone. 

CONCLUSIONS OF LAW

1. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310.

2.  The criteria for a 100 percent rating for mental health disability have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9435.

3. From January 17, 2012 to October 8, 2021, the statutory criteria for SMC at the housebound rate have been met. 38 U.S.C. § 1114 (s).

4. From October 8, 2021, the criteria for SMC-O based on aid and attendance have been met. 38 U.S.C. § 1114 (o).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1954 to April 1955. 

The matter comes to the Board of Veterans' Appeals (Board) on appeal from a February 2015 Statement of the Case (SOC) issued by a Department of Veterans Affairs (VA) Regional Office (RO).  

The matter was previously before the Board in March 2023 and September 2024. The September 2024 Board Remand required the Agency of Original Jurisdiction (AOJ) to make attempts to expand the medical evidence of record and acquire adequate medical opinions regarding the claims of service connection for a mental health disability and hypertension.  

The Board finds that the AOJ substantially complied with the Remand directives and the post-Remand record shows that the AOJ sent the Veteran an October 2024 Subsequent Development Letter requesting his treatment records from 1999 to 2009. The AOJ also acquired medical opinions in March and April 2025 which provided evidence adequate to adjudicate this matter. 38 U.S.C. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303 (2007); D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict compliance with the terms of a remand request, is required). 

This appeal is advanced on the docket on account of the Veteran's advanced age. 38 U.S.C. § 7107(a)(2). 38 C.F.R. § 20.900(c).

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service.  38?U.S.C. §?1110; 38?C.F.R. §?3.303.  

Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury.  38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.310.  Secondary service connection is provided for a disability that is caused or aggravated by a service-connected disease or disability.  38 C.F.R. § § 3.310 (a), (b).

Hypertension

The Veteran generally contends that this hypertension is due to his service. See April 2013 Notice of Disagreement.

The Veteran
.C. §?1110; 38?C.F.R. §?3.303.  

Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury.  38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.310.  Secondary service connection is provided for a disability that is caused or aggravated by a service-connected disease or disability.  38 C.F.R. § § 3.310 (a), (b).

Hypertension

The Veteran generally contends that this hypertension is due to his service. See April 2013 Notice of Disagreement.

The Veteran's enlistment examination reports normal results. His service treatment record reports no treatment for or diagnosis of hypertension. 

The Veteran has a current diagnosis of hypertension. See April 2025 VA Examination. 

An April 2023 VA examiner provided a negative nexus opinion which attributed the Veteran's hypertension to fat deposits caused by hypercholesterolemia. The examiner also opined that the Veteran's hypertension had followed a natural progression and was not aggravated by his service-connected disabilities. The examiner failed to include an adequate rationale. For this reason, the opinion is inadequate for adjudication. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The examiner also provided a May 2023 addendum which is also inadequate for adjudication as the examiner cited the lack of service treatment records related to hypertension and merely repeated his findings in April 2023 opinion without providing an adequate rationale. 

A June 2024 VA examiner provided a negative nexus opinion stating that the Veteran was diagnosed with essential hypertension, which affects up to 45 percent of the adult population. The examiner cited medical literature which stated that essential hypertension was likely due to salt intake and a genetic sensitivity to salt.  The examiner also provided an opinion regarding secondary service connection stating that the Veteran's hypertension is a separate entity entirely from his service-connected bronchial asthma, bilateral hearing loss, and tinnitus. The examiner reported that a thorough review of medical literature failed to demonstrate a causal relationship between the Veteran's hypertension and his service-connected disabilities. The examiner also opined that the Veteran's service-connected bronchial asthma, bilateral hearing loss, and tinnitus did not aggravate the Veteran's hypertension beyond its natural progression. The examiner opined that the course of the Veteran's hypertension has been consistent with the natural history of hypertension. This opinion reflects full consideration of all the pertinent medical evidence of record and includes an adequate rationale for the opinion rendered with supporting data.  See Nieves-Rodriguez v. Peake, 22?Vet. App.?295 (2008). The Board assigns this opinion substantial probative weight.

An April 2025 VA examiner provided a negative nexus opinion regarding the Veteran's TERA. The examiner noted the medical evidence of record reports that the Veteran had no herbicide agent exposure, no radiation exposure, no mustard gas exposure, and no Camp Lejeune water contamination exposure. The Veteran's May 2024 TERA Memo reports that he had a minimal probability of exposure to asbestos during his service. The examiner opined that primary hypertension doesn't have a single, clear cause, but usually, many factors come together to cause it. The examiner noted that primary factors included unhealthy eating patterns (including a diet high in sodium), lack of physical activity, and high alcohol use. The examiner noted the causes of secondary hypertension include: certain medications, including immunosuppressants, NSAIDs and oral contraceptives, kidney disease, obstructive sleep apnea, primary aldosteronism (Conn's syndrome), and recreational drug use. The examiner concluded that the Veteran's minimal probability of asbestos exposure during his brief period of service did not cause or aggravate the Veteran's hypertension. This opinion reflects full consideration of all the pertinent medical evidence of record and includes an adequate rationale for the opinion rendered with supporting data.  See Nieves-Rodriguez v. Peake, 22?Vet. App.?295 (2008). The Board assigns this opinion substantial probative weight. 

The above examinations have adequately addressed direct service connection, secondary service connection to include aggravation, and whether the Veteran's hypertension was due to his TERA. The medical opinion evidence does not support a finding that the Veteran's hypertension was due to his service. 

The Board recognizes the Veteran's general contention that the claimed hypertension resulted from his military service, but the record does not show that the Veteran has or has had, specialized education, training, or experience that would qualify him to offer an opinion on nexus elements, which requires clinical expertise on the nature and etiology of hypertension. See Woehlaert v. Nicholson, 21?Vet. App.?456 (2007
8). The Board assigns this opinion substantial probative weight. 

The above examinations have adequately addressed direct service connection, secondary service connection to include aggravation, and whether the Veteran's hypertension was due to his TERA. The medical opinion evidence does not support a finding that the Veteran's hypertension was due to his service. 

The Board recognizes the Veteran's general contention that the claimed hypertension resulted from his military service, but the record does not show that the Veteran has or has had, specialized education, training, or experience that would qualify him to offer an opinion on nexus elements, which requires clinical expertise on the nature and etiology of hypertension. See Woehlaert v. Nicholson, 21?Vet. App.?456 (2007).  Therefore, the Board assigns minimal probative weight to the Veteran's general contentions and statements regarding whether the claimed disability resulted from his service.   As discussed above, the June 2024 and April 2025 opinions are from examiners with the necessary training and medical knowledge to competently speak to the nexus issue at hand and therefore is significantly probative.  

For the above reasons, the Board finds that the evidence is neither evenly balanced nor approximately so regarding entitlement to a service connection for hypertension. Rather, the evidence persuasively weighs against the Veteran. Thus, the benefit of the doubt doctrine, see 38?U.S.C. §?5107(b), cannot be applied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side, or another is the benefit of the doubt doctrine not for application). As the evidence is persuasively against the claim, it must be denied.   

?

Increased Rating 

VA's percentage ratings are based on the average impairment of earning capacity as a result of service-connected disability.  38 U.S.C. § 1155; 38C.F.R. § 4.1.  If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned.  38C.F.R. § 4.7.  All reasonable doubt will be resolved in favor of the claimant.  38C.F.R. § 4.3.

This decision will focus on the evidence pertinent to the rating criteria and disability severity during the relevant period on appeal, but the Board has considered the entire record to have a full picture of the disability.  See 38C.F.R. §§ 4.1, 4.2, 4.41; Gonzales v. West, 218 F. 3d 1378 (Fed. Cir. 2000).

Mental health disability

Legal Criteria

Under the General Formula for Mental Disorders (General Formula), the Board

must conduct a holistic analysis that considers all associated symptoms,

regardless of whether they are listed as criteria. Bankhead v. Shulkin , 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130 (2018). The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must

determine whether the associated symptoms, both listed and unlisted, caused the

level of impairment required for a higher disability rating. Vazquez Claudio v.

Shinseki, 713 F.3d 112, 114 118 (Fed. Cir. 2013).

Under the General Formula, a 10 percent rating is warranted for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.

A 30 percent rating is warranted when there is  occupational and social impairment with occasional decrease in work efficiency  and intermittent periods of inability to perform occupational tasks (although  generally functioning satisfactorily, with routine behavior, self-care, and   conversation normal), due to such symptoms as: depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; and mild memory loss (such as forgetting names, directions, recent events). 

A 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity, due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. 

A 70 percent rating
 such symptoms as: depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; and mild memory loss (such as forgetting names, directions, recent events). 

A 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity, due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. 

A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or work-like setting); and inability to establish and maintain effective relationships.

A 100 percent rating is warranted when there is total occupational and social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closest relatives, own occupation, or own name.

?

Factual Background

In an August 2012 lay statement the Veteran's spouse of 54 years reported that "right from the beginning of our relationship I knew that something was bothering him, for he was moody and prone to outbursts."  She noted that the Veteran never wanted to leave home and that he had trouble getting along with co-workers. She reported that the Veteran had sleep disruptions and once told her he planned to commit suicide. 

An August 2012 VA examiner diagnosed the Veteran with social anxiety disorder and a personality disorder. The examiner reported that the Veteran's symptoms included anxiety, panic attacks that occur weekly or less often, and mild memory loss. The examiner noted that the Veteran had relationships with his family and with a limited number of friends.  The examiner opined that the Veteran exhibits obsessive compulsive personality traits as a way to cope with and bring order to his own stress.

A February 6, 2013 private examiner noted that the Veteran's symptoms included panic attacks twice a week, that the Veteran only sleeps 4 hours per night, is irritable with angry outburst, has difficulty concentrating, and exhibits hypervigilance. 

The Board notes that there is a significant gap in treatment records related to the Veteran's mental health disability. While the medical evidence of record is chronologically complete, it appears that the Veteran was not actively treated for his mental health disability for many years. The Veteran's mental status is generally noted during routine medical encounters. However, the medical evidence of record lacks probative mental health treatment records from 2014 to 2024. 

An October 1, 2024 nursing note reports that the Veteran was taking his normal medications while simultaneously taking refills sent to him. The caregiver explained to the Veteran that the bottles in the box are medications that he is already on. The caregiver explained to the Veteran that the boxes are just refills for his regular daily meds. When questioned why he was taking both his regular dose and a dose from his refill bottle, he said, "well they sent them to me, so I thought I was supposed to take them." The caregiver noted this has been explained to the Veteran multiple times in the past that when he receives the refills, he needs to just put them on the shelf.  See April 2025 VA Treatment Record.

A March 13, 2025 nursing note reports the Veteran's caregiver opened the Veteran's prescribed medication and showed Veteran that all meds were still in there. He responded, "I thought I took those already." The caregiver noted that Id. "evidently, he is doing this most days but thinks he has taken them."  Id.

A March 27, 2025 nursing outpatient note reports the Veteran rode his scooter to the "Pizza Place" on Saturday and asked them to contact EMS as he needed to go to the emergency department. The Veteran stated he "gets turned around" sometimes but was alert and oriented during his treatment on that day.  The clinician noted that the Veteran's son contacted VA requesting more in home care for the Veteran. The Veteran was recently hospitalized due to
 the Veteran's caregiver opened the Veteran's prescribed medication and showed Veteran that all meds were still in there. He responded, "I thought I took those already." The caregiver noted that Id. "evidently, he is doing this most days but thinks he has taken them."  Id.

A March 27, 2025 nursing outpatient note reports the Veteran rode his scooter to the "Pizza Place" on Saturday and asked them to contact EMS as he needed to go to the emergency department. The Veteran stated he "gets turned around" sometimes but was alert and oriented during his treatment on that day.  The clinician noted that the Veteran's son contacted VA requesting more in home care for the Veteran. The Veteran was recently hospitalized due to reportedly failing to take several days' worth of medications and not eating or drinking.  Id.

Analysis

VA attempted to schedule the Veteran for examinations to evaluate his mental health disability in May 2023, May 2024, December 2024, May 2025, and July 2025. The Veteran either canceled or failed to report for his examinations.  As such, the claim could be denied due to the Veteran's failure to report to his scheduled examination without showing good cause. 38 C.F.R. § 3.655.

However, the Veteran's recent VA treatment records show that the Veteran's gross impairment of thought processes, inability to perform activities of daily living and significant memory loss support a finding that the Veteran's mental health disability symptoms are more approximate to a total disability rating. As noted above, the Veteran has had periods where he has failed to eat, drink, or take his prescribed medications. These deficits are most consistent with a 100 percent rating and, for these reasons, his appeal is granted. 

Special Monthly Compensation

SMC is authorized in particular circumstances in addition to compensation for service-connected disabilities. 38 U.S.C. § 1114; 38 C.F.R. §§ 3.350, 3.352. SMC is authorized by subsections (k) through (s), with the rate amounts increasing the later in the alphabet the letter appears (except for the "s" rate). SMC at the "k" and "r" rates are paid in addition to any other SMC rates, with certain monetary limits.

SMC at the "l" rate is payable when a veteran, due to service-connected disability, has suffered the anatomical loss or loss of use of both feet or 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), 3.352.

The Board notes that, in addition to regular levels of compensation for aid and attendance as authorized by 38 U.S.C. § 1114 (l), 38 U.S.C. § 1114 (r) provides for a higher level of benefit (called "special aid and attendance") in certain circumstances. A veteran receiving the maximum rate under 38 U.S.C. § 1114 (o), who is in need of regular aid and attendance or a higher level of care, is entitled to an additional allowance during periods that the veteran is not hospitalized at United States government expense. 38 U.S.C. § 1114 (r)(1)-(2). A still higher-level aid and attendance allowance is authorized by 38 U.S.C. § 1114 (r)(2), and is payable in lieu of the regular aid and attendance allowance authorized by 38 U.S.C. § 1114 (r)(1).

SMC at 38 U.S.C. § 1114 (o) level is warranted if a veteran, as the result of service-connected disability, has suffered disability under conditions which would entitle such veteran to two or more of the rates provided in one or more of § 1114(l) through § 1114(n), no condition being considered twice in the determination, or if the veteran has suffered bilateral deafness (and the hearing impairment in either one or both ears is service connected) rated at 60 percent or more disabling and the veteran has also suffered service-connected total blindness with 5/200 visual acuity or less, or if the veteran has suffered service-connected deafness in one ear or bilateral deafness (and the hearing impairment in either one or both ears is service connected) rated at 40 percent or more disabling and the veteran has also suffered service-connected blindness having only light perception or less, or if the veteran has suffered anatomical loss of both arms so near the shoulder as to prevent the use of prosthetic appliances. 38 U.S.C. § 1114 (o).

Determinations for entitlement under § 1114(o) must be
 the hearing impairment in either one or both ears is service connected) rated at 60 percent or more disabling and the veteran has also suffered service-connected total blindness with 5/200 visual acuity or less, or if the veteran has suffered service-connected deafness in one ear or bilateral deafness (and the hearing impairment in either one or both ears is service connected) rated at 40 percent or more disabling and the veteran has also suffered service-connected blindness having only light perception or less, or if the veteran has suffered anatomical loss of both arms so near the shoulder as to prevent the use of prosthetic appliances. 38 U.S.C. § 1114 (o).

Determinations for entitlement under § 1114(o) must be based upon separate and distinct disabilities. That requires, for example, that where a veteran has suffered the loss or loss of use of two extremities is being considered for the maximum rate on account of helplessness requiring aid and attendance, the latter must be based on need resulting from pathology other than that of the extremities. 38 C.F.R. § 3.350 (e).

Next, 38 U.S.C. § 1114 (p) provides for "intermediate" SMC rates between the different subsections, with the maximum SMC not exceeding that prescribed at the 38 U.S.C. § 1114 (o) rate. 38 U.S.C. § 1114 (p); 38 C.F.R. § 3.350 (f).

A veteran receiving the maximum rate under 38 U.S.C. § 1114 (o) or (p) who is in need of regular aid and attendance or a higher level of care is entitled to an additional allowance during periods that the veteran is not hospitalized at the United States government's expense. Determination of this need is subject to the criteria of 38 C.F.R. § 3.352.

The regular or higher-level aid and attendance allowance is payable whether or not the need for regular aid and attendance or a higher level of care was a partial basis for entitlement to the maximum rate under 38 U.S.C. § 1114 (o) or (p), or was based on an independent factual determination. 38 C.F.R. § 3.350 (h)(1).

The following will be afforded consideration in determining the need for regular aid and attendance: inability of a claimant to dress or undress oneself, or to keep oneself 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 a claimant to feed oneself through loss of coordination of the 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 a claimant from the hazards or dangers incident to the veteran's daily environment. 38 C.F.R. § 3.352 (a).

It is not required that all of the disabling conditions enumerated in provisions 38 C.F.R. § 3.352 (a) be found in order to establish eligibility for aid and attendance, but that such eligibility requires at least one of the enumerated factors present. Turco v. Brown, 9 Vet. App. 222 (1996). The particular function that a veteran is unable to perform should be considered in connection with the veteran's condition as a whole. Also, it is only necessary that the evidence establish that a veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Id; 38 C.F.R. § 3.352.

The Veteran currently meets the statutory requirements for SMC at the housebound rate from January 17, 2012. In this decision, the Board has granted a total disability rating for the Veteran's mental health disability from January 17, 2012, which satisfies the requirement for a single disability rated total. Bradley v. Peake, 22 Vet. App. 280 (2008). Further, the Veteran has additional service-connected disabilities which combined are rated at least 60 percent (i.e. bronchial asthma with a 100 percent rating from January 17, 2019, bilateral hearing loss with a 10 percent rating from January 17, 2012, a 20 percent rating from April 13, 2021 to August 8, 2022, and a for percent rating from August 8, 2022, tinnitus with a 10 percent rating from January 17, 2012). As such, he is entitled to SMC at the
 the requirement for a single disability rated total. Bradley v. Peake, 22 Vet. App. 280 (2008). Further, the Veteran has additional service-connected disabilities which combined are rated at least 60 percent (i.e. bronchial asthma with a 100 percent rating from January 17, 2019, bilateral hearing loss with a 10 percent rating from January 17, 2012, a 20 percent rating from April 13, 2021 to August 8, 2022, and a for percent rating from August 8, 2022, tinnitus with a 10 percent rating from January 17, 2012). As such, he is entitled to SMC at the housebound rate from January 17, 2012 to October 8, 2021. 

From October 8, 2012, the Veteran was granted SMC L-1 for aid and attendance for his totally disabling bronchial asthma. The Veteran now has been granted a total disability for both bronchial asthma and his mental health disability. Both disabilities meet the requirements for SMC-L based on the Veteran's need for higher aid and attendance. The medical evidence of record supports a finding that the Veteran's mental health disability symptomology requires a higher level of aid and attendance than his bronchial asthma alone. The Veteran's limited ability to care for himself on a daily basis warrants the higher benefit of SMC-O. The Veteran is granted SMC-O from October 8, 2021.  

 

JIMMY L. BARDIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Danilowicz, B.

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.