Case A25082796

KELLI A. KORDICH · 2025 · Case ID: A25082796

GRANTED

Summary

The veteran, who served from August 1974 to July 1975, appeals the denial of Special Monthly Compensation (SMC) based on the need for regular aid and attendance. The Board previously denied this claim in August 2024, but the decision was vacated and remanded by the Court of Appeals for Veterans Claims following a Joint Motion for Partial Remand. The parties agreed the Board erred in limiting the evidentiary record. The veteran's primary service-connected disabilities are schizophrenia with PTSD, rated at 100 percent, and erectile dysfunction. The Board reviewed evidence including VA psychiatric examinations from December 2017 and March 2018, a VA aid and attendance examination from March 2018, VA treatment records from June 2019 and October 2022, a VA caregiver program assessment from November 2022, and testimony from the veteran's wife at a March 2024 hearing. The veteran's wife provided detailed accounts of the assistance required for the veteran's daily living, medication management, home safety, and personal care due to his schizophrenia, PTSD, and associated medications causing dizziness and imbalance. The Board found that while some needs were related to non-service-connected conditions like diabetes, the service-connected schizophrenia and PTSD were major contributing factors to the need for regular aid and attendance. The Board concluded the evidence was in relative equipoise and resolved doubt in the veteran's favor, granting SMC for aid and attendance.

Rationale

Evidence indicates need for regular aid and attendance due to service-connected schizophrenia with PTSD and medications.; Veteran requires assistance with bathing, dressing, cooking, medication management, and activities of daily living.; Veteran needs protection and supervision 24/7 to remain safe.; Evidence is in relative equipoise; doubt resolved in veteran's favor.

Special Benefit

SMC - AID & ATTENDANCE

Docket No.

190719-388912

Full Decision Text

Citation Nr: A25082796
Decision Date: 09/26/25 Archive Date: 09/26/25

DOCKET NO. 190719-388912
DATE: September 26, 2025

ORDER

Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance is granted.

FINDING OF FACT

Resolving reasonable doubt in his favor, the Veteran requires regular aid and attendance of another person due to his service-connected disabilities.

CONCLUSION OF LAW

The criteria for special monthly compensation based on the need for regular aid and attendance have been met. 38 U.S.C. §§ 1114(l), 5107; 38 C.F.R. §§ 3.102, 3.350, 3.351, 3.352, 4.3.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from August 1974 to July 1975.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2019 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In the July 2019 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. The Veteran appeared for a hearing before a Veterans Law Judge on March 5, 2024. A transcript of the hearing is of record. Therefore, the Board may only consider the evidence of record through the July 11, 2019, notification of the July 2019 rating decision in this case, and any evidence submitted at the hearing and within 90 days of the hearing. The Board will not consider evidence added to the record in between the date of the July 2019 rating decision notification and the date of the hearing or added to the record more than 90 days after the date of the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

In an August 2024 Board decision, the Board denied the issue of entitlement to SMC based on aid and attendance. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In April 2025, the parties agreed to a Joint Motion for Partial Remand (JMPR). The JMPR formally requested that the Court vacate the Board's August 2024 denial and remand the matter to the Board for corrective measures. In April 2025, the Court granted the JMPR.

The case is now again before the Board for further appellate action.

Entitlement to SMC based on the need for regular aid and attendance is granted.

The Veteran contends that he is entitled to SMC based on the need for regular aid and attendance.

In August 2024, the Board denied entitlement to SMC based on aid and attendance. After the Veteran appealed the decision to the Court, an April 2025 JMPR vacated the August 2024 Board decision and remanded the matter for further development and adjudication.

The parties to the JMPR agreed that the Board erred when it conflated the limitations on the evidentiary record with the period on appeal. 38 C.F.R. § 20.303 defines the evidentiary record before the Board, and it does not impose a requirement that evidence submitted during an open evidence window must relate to the disability picture at or before the date of the rating decision. The JMPR noted that under 38 U.S.C. § 7113(b), the Board's decision must be based on all evidence of record at the time of the agency of original jurisdiction decision on appeal and evidence submitted by the Veteran or his representative at the hearing, or within 90 days thereafter.

The parties noted that the Board erred when it determined that evidence and testimony from the Veteran's March 2024 Board hearing and
record with the period on appeal. 38 C.F.R. § 20.303 defines the evidentiary record before the Board, and it does not impose a requirement that evidence submitted during an open evidence window must relate to the disability picture at or before the date of the rating decision. The JMPR noted that under 38 U.S.C. § 7113(b), the Board's decision must be based on all evidence of record at the time of the agency of original jurisdiction decision on appeal and evidence submitted by the Veteran or his representative at the hearing, or within 90 days thereafter.

The parties noted that the Board erred when it determined that evidence and testimony from the Veteran's March 2024 Board hearing and submitted within 90 days of that hearing was not relevant because it did not pertain to the period on appeal, which the Board found ended in July 2019, at the issuance of the July 2019 rating decision. The JMPR notes that the Veteran's wife testified at the March 2024 Board hearing that in 2021 she installed locks on all of the doors to prevent the Veteran from leaving the bedroom at night or from leaving the house unsupervised. Thus, the JMPR directed the Board to readjudicate the appeal consistent with the foregoing.

The Veteran contends he is entitled to SMC due to needing regular assistance from his significant other. He asserts he should be granted SMC from July 1993. See March 2024 Board Hearing Transcript.

The Veteran is service connected for schizophrenia with PTSD rated at 100 percent from July 30, 1993, and erectile dysfunction rated as noncompensable from January 4, 2022.

SMC at the aid and attendance rate is available when a veteran, as the result of service-connected disability, has experienced the anatomical loss or loss of use of both feet, or of one hand and one foot; is blind in both eyes, with visual acuity of 5/200 or less; is permanently bedridden; or is 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).

The criteria for determining that a veteran is so helpless as to be in need of regular aid and attendance include: (1) inability to dress or undress or to keep 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 assistance; (3) inability to feed oneself through loss of coordination of upper extremities or through extreme weakness; (4) inability to attend to the wants of nature; or (5) incapacity, either physical or mental, that requires care or assistance on a regular basis to protect from hazards or dangers incident to their daily environment. 38 C.F.R. § 3.352(a). It is not required however that all of the disabling conditions enumerated be present before a favorable rating may be made. The particular personal functions which the claimant is unable to perform should be considered in connection with his or her condition as a whole, and the need for aid and attendance must be regular, not that there be a constant need. 38 C.F.R. § 3.352(a).

An individual who is bedridden as the result of service-connected disability shall also be considered to require regular aid and attendance. "Bedridden" constitutes a condition that through its essential character actually requires that an individual remain in bed. The fact that a claimant has voluntarily taken to bed or that a physician has prescribed bedrest for a lesser or greater portion of the day to promote convalescence or cure will not suffice. Id.

In February 2018, the Veteran submitted a copy of a VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, completed by his VA psychiatrist in December 2017. The psychiatrist reported the Veteran's diagnosis was schizophrenia, paranoid type, and indicated the disability that restricted the listed activities and functions was that the Veteran heard voices. The psychiatrist reported that the Veteran was not confined to bed. He was able to feed himself. The psychiatrist reported that the Veteran's wife said she prepared food for him but did not answer whether the Veteran was able to prepare his own meals. As to whether the Veteran needed assistance with bathing and tending to other hygiene needs, the psychiatrist stated that she could not assess this. He was not legally blind, and he did not require nursing home care. He required medication management, and the psychiatrist explained that the Veteran was started on a medication and had not been on medication for over a year. The psychiatrist advised that the Veteran had the ability to manage his own
the listed activities and functions was that the Veteran heard voices. The psychiatrist reported that the Veteran was not confined to bed. He was able to feed himself. The psychiatrist reported that the Veteran's wife said she prepared food for him but did not answer whether the Veteran was able to prepare his own meals. As to whether the Veteran needed assistance with bathing and tending to other hygiene needs, the psychiatrist stated that she could not assess this. He was not legally blind, and he did not require nursing home care. He required medication management, and the psychiatrist explained that the Veteran was started on a medication and had not been on medication for over a year. The psychiatrist advised that the Veteran had the ability to manage his own financial affairs and further explained that per the Veteran's wife, she was the one managing his financial affairs. In addition, the psychiatrist explained that, per his wife, the Veteran was "doing nothing."

In March 2018, the Veteran underwent a VA aid and attendance examination. The examiner reported that the Veteran was not permanently bedridden or currently hospitalized. He was able to travel beyond his domicile, and he travelled to the exam by car with his wife driving. His typical day was described as waking up in the morning and having breakfast made by his wife. The Veteran watched television or read a newspaper. He would sometimes get jittery and walked around a lot, pacing like his "mind can't get settled." His wife gave him medication as the day progressed. He only left his home for necessary appointments. He would get paranoid in grocery stores, and he also needed mobile carts to get around as he would fall easily, and his wife could not pick him up. He could assist his wife with setting the table, but his wife prepared the meals. He napped occasionally during the day because he only slept about 4 hours per night. He could empty the trash but did not clean the house or do any other chores. His wife drove most of the time. As to whether the Veteran used an orthopedic or prosthetic appliance, the examiner reported that the Veteran used a cane because he was unable to climb stairs due to arthritis of the knees and neuropathy of the feet due to diabetes.

The Veteran could not walk without the assistance of another person, and he required the use of one cane for ambulation. He left his home for medical care only. His functional impairments were permanent. His best corrected vision was not 5/200 or worse in both eyes. He had limited range of motion of the cervical spine and the thoracolumbar spine. As to the ability of the Veteran to protect himself from daily hazards/dangers, the examiner reported he experienced intermittent dizziness, severe short term memory loss, and nearly constant imbalance that affected his ability to ambulate. The examiner reported that he had fallen down the stairs due to dizziness, which may be due to his psychiatric medications as well as diabetes and diabetic peripheral neuropathy. His legs were also painful due to constant cramping. Self-care skills that the Veteran was unable to perform included self-feeding, dressing, and undressing, bathing, grooming, and toileting. He had mild to moderate impairment of the ability to self-feed and attend to toileting needs and marked difficulty in the ability to dress and undress, self-bathe, and self-groom due to the bilateral upper extremities. As to his mental competency, he knew the amount of his benefit payment and the amount of his monthly bills, but he was unable to prudently handle payments, handle money or pay bills, and he was not capable of managing his financial affairs.

The examiner opined that it is at least as likely as not that the Veteran requires the assistance of another person in protecting himself from the ordinary hazards of his daily environment on a consistent basis due to his schizophrenia with PTSD. As rationale, the examiner stated that, according to the Veteran's medical records, the Veteran was unable to discern between reality and at times suffered from hallucinations and delusions. The examiner stated that his wife assisted the Veteran with virtually all activities of daily living.

A June 2019 VA treatment record reports that the Veteran was hearing voices every 3 days and that he had experienced hallucinations about a year earlier. The Veteran reported sleeping only two hours a night and indicated he did not have very much energy.

An October 2022 VA treatment record includes an addendum written by a VA psychiatrist. The psychiatrist indicated in the addendum that the Veteran would benefit from having his wife as a caregiver. The psychiatrist reported that the Veteran needs assistance with bathing, dressing, cooking, medications, and activities of daily living. The psychiatrist reported that the Veteran cannot go out alone by himself and needs his wife to go to all medical appointments.

assisted the Veteran with virtually all activities of daily living.

A November 2022 VA Program of Comprehensive Assistance for Family Caregivers home assessment reported that the Veteran needs protection and supervision "24/7" to remain safe. The assessment concluded that the Veteran would not be able to sustain himself in the community without his caregiver's protection and supervision.

In November 2022, the Veteran's application for VA's Program of Comprehensive Assistance for Family Caregivers was approved. The program approval letter indicates the approval was based on the determination that the Veteran is in need of personal care services for a minimum of six continuous months based on a need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury.

During the March 2024 Board hearing, the Veteran's wife testified as to the assistance she provided the Veteran. The Veteran's wife testified that she had helped him manage his medication since 2013 and that she started storing his medication in a lockbox five or six years ago because of an incident when the Veteran took his medication twice after forgetting he had already taken his medication. The Veteran's wife also testified that she placed locks on kitchen cabinets to prevent the Veteran from using or mixing cleaning chemicals, locked up the sharp kitchen knives, and locked the refrigerator to prevent the Veteran from eating inedible or spoiled food. She indicated that the Veteran's psychiatrist had prescribed medication that made him hungry all the time. However, she also stated that he had periods of depression where he would not eat unless encouraged to do so. The Veteran's wife described an incident in which the Veteran left the house and became lost until a police officer brought him home. To keep the Veteran from leaving the house, in 2021 she installed locks on all the doors that lead outside. She also stated that she bathes the Veteran because his medication for his schizophrenia makes him dizzy and "loopy."

The Veteran does not contend, and the evidence does not show that the Veteran had anatomical loss or loss of use of both of his feet or of one hand and one foot. The Veteran is not blind in both eyes, and the evidence does not show that the Veteran was permanently bedridden. The question for the Board is whether the Veteran's service-connected disabilities were so significant to render the Veteran to be in need of regular aid and attendance.

With regard to the issue of SMC based on the need for regular aid and attendance, the Board finds no reason to question the probative value of the statements from the Veteran's wife and other evidence of record relevant to the issue. Although the evidence suggests that the Veteran was in need of regular aid and attendance in part due to nonservice-connected disabilities, including diabetic peripheral neuropathy, it also indicates that the Veteran's service-connected disabilities were a major cause of that need for regular aid and attendance. Based on the record, the Board concludes that the evidence is at least in relative equipoise as to whether the Veteran's service-connected disabilities cause him to be so helpless as to be in need of personal assistance from others. Due to the Veteran's service-connected schizophrenia with PTSD and the medications required to treat the disorder, the Veteran needs constant protection and supervision to remain safe. Resolving any remaining doubt in the Veteran's favor, entitlement to SMC based on the need for regular aid and attendance of another person under 38 U.S.C. § 1114(l) and 38 C.F.R. § 3.352 is warranted and the claim is granted.

KELLI A. KORDICH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T. Moore, Associate 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.

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