Case A26038255

Summary

The Veteran, who served between March and June 1971, appeals the denial of special monthly compensation (SMC) based on the need for regular aid and attendance. The Veteran is service-connected for lower spine disability, peripheral neuropathy, and degenerative changes in the feet and ankles, and currently receives a 90% disability rating, including TDIU. The Veteran submitted multiple VA Forms 21-2680 detailing his need for assistance with ambulation, transferring, feeding, bathing, and medication management due to severe lower extremity weakness and chronic back pain. These reports noted his inability to sleep in a bed, reliance on a recliner, and need for help with daily living activities. A December 2023 VA report corroborated these findings, noting the Veteran's fall risk, difficulty with prolonged standing and cooking, and reliance on family and neighbors for assistance. VA treatment records also indicated a constant need for help with activities of daily living. The Board found the evidence supported the Veteran's claim for SMC-A&A, noting the need for regular aid and assistance in multiple areas. Applying the benefit of the doubt doctrine, the Board granted the claim for SMC based on the need for regular aid and attendance.

Rationale

Evidence supports need for aid and attendance in multiple ADLs; VA treatment records and reports corroborate need for assistance; Benefit of the doubt applied to grant claim

Full Decision Text

Citation Nr: A26038255
Decision Date: 04/23/26	Archive Date: 04/23/26

DOCKET NO. 250717-566781
DATE: April 23, 2026

ORDER

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

FINDING OF FACT

The evidence indicates that the Veteran needs regular aid and attendance of another person as the result of limitations caused by service-connected disability.  

CONCLUSION OF LAW

The criteria for an award of SMC based on the need for regular aid and attendance are met.  38?U.S.C. §?1114 (l); 38?C.F.R. § 3.350.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service between March and June 1971.          

This matter comes to the Board of Veterans' Appeals (Board) on appeal of an April 2025 rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO).  

In July 2025, the Veteran appealed the case to the Board by filing a VA Form 10182, notice of disagreement, against the decision.  He elected direct Board review.  See 38 C.F.R. § 20.301.  

SMC

The Veteran contends that he is entitled to SMC based on the need for regular aid and attendance due to service-connected disability. 

He is service connected for lower spine disability and for related peripheral neuropathy in each lower extremity, and for degenerative changes in the feet and ankles.  See 38 C.F.R. §§ 4.71a, 4.124a.  Since October 2015, he has been in receipt of a total disability rating based on individual unemployability (TDIU).  Since February 2023, the combined rating for service-connected disability has been 90 percent.  See 38 C.F.R. §§ 4.16, 4.25.  

	Law and regulations

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity.  Individual disabilities are assigned separate diagnostic codes (DCs).     38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Special monthly compensation is available when a veteran suffers additional hardships above and beyond those contemplated by VA's schedule for rating disabilities, as the result of service-connected disability.  38 U.S.C. § 1114;          38 C.F.R. §§ 3.350, 3.352.  The rate of SMC varies according to the nature of the service-connected disability.  Basic and higher levels of SMC are listed in the code under 38 U.S.C. § 1114.

Under 38?C.F.R. §?3.350(b), SMC based on the need for aid and attendance rate is addressed.  In relevant part, this SMC may be awarded where, as the result of service-connected disability, a claimant is so helpless as to need regular aid and attendance of another person.  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 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 is a constant need.  38?C.F.R. §?3.352(a). 

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant.  38 U.S.C. § 5107; 38 C.F.R. § 4.3.

	Evidence and
.352(a).  It is not required however that all 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 is a constant need.  38?C.F.R. §?3.352(a). 

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant.  38 U.S.C. § 5107; 38 C.F.R. § 4.3.

	Evidence and analysis

The evidence relevant to this matter consists of lay statements from the Veteran, private and VA treatment records, private reports dated in May 2022, March 2023, and June 2023, and a December 2023 VA report.  

The evidence tends to support the claim.  

The Veteran submitted three VA Forms 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, in May 2022, March 2023, and June 2023.    

The reports state that the Veteran needs the assistance of another person to ambulate while using a cane, crutches, and a wheelchair.  The reports note the Veteran's inability to sleep in a bed and that he generally slept in a recliner due to back pain, from which he needed assistance in transferring to the bathroom, shower, or kitchen.  The reports indicate an inability to feed himself and an inability to stand and prepare his own food, and that he needed the assistance of a friend to open medication bottles.  The reports also indicate the need for assistance while bathing and had intermittent incontinence and needed the use of diapers.  The reports find that the Veteran needed nursing home care and receives 2-3 visits per week and in addition relied on the regular assistance from his wife, daughter, and friends for his various needs.  And the June 2023 report indicated an even worsening situation, noting severe lower extremity weakness causing an inability to walk.  

The December 2023 VA report tends to favor the private reports, noting that the Veteran required the assistance of his daughter to attend and conduct the medical examination.  The examiner noted that the Veteran must use a cane or walker for assistance with ambulation due to fall risk, and had difficulty bending at the waist.  The examiner noted that his dinner is generally brought to him or prepared at his home by his neighbor or his daughter and that the Veteran spends a predominance of any given day at home in his living room chair.  The Veteran reported difficulty preparing a meal requiring stove, oven, or other involved cooking due to his difficulty with prolonged standing and walking as a result of his chronic back pain.  He also has difficulty showering due to his back pain and must use a shower stool for bathing process.  He also reports he cannot drive most days due to his back pain with bilateral lower extremity radiculopathy and bilateral foot arthritis.  The examiner noted risks involving standing, ambulating, and staying upright as the result of incoordination and deficits in balance, propulsion, and weight bearing caused by spinal disability and associated severe bilateral lower extremity radiculopathy.  

The VA treatment records also tend to favor the claim by repeatedly noting the Veteran's inability to ambulate for any considerable distance, and his constant need for assistance in completing ordinary activities of daily living around his home.  

In sum, the evidence indicates that, as the result of service-connected disability, the Veteran needs aid and assistance in dressing, maintaining hygiene, using the toilet and shower, preparing food, and operating in his home environment safely.  38?C.F.R. §?3.352(a).  

As such, the Board cannot find that the evidence demonstrates that SMC-A&A is unwarranted here.  This is an appropriate case in which to invoke VA's doctrine of reasonable doubt, grant the Veteran the benefit of the doubt, and grant the claim.  See 38 C.F.R. § 4.3.

 

 

G. A. WASIK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Christopher McEntee

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.