OTHERS

Summary

The veteran, who served from June 2002 to December 2002 and June 2004 to May 2005, appeals a May 2025 rating decision concerning special monthly compensation (SMC). The veteran sought higher-level aid and attendance under 38 U.S.C. § 1114(r)(2), but the Board found he did not meet the threshold requirements for that benefit, as his service-connected disabilities did not qualify him for SMC under the specified subsections (o), (n), (k), or (r). The veteran has a 100% rating for an acquired psychiatric disorder, including PTSD, bipolar II disorder, and panic disorder with agoraphobia, and other physical disabilities rated over 60%. He also has a TDIU rating. Evidence submitted included statements from the veteran detailing his severe anxiety, panic attacks, memory issues, and need for assistance with daily living, supported by private medical opinions from a nurse practitioner and another examiner, as well as statements from a friend and a cleaning professional. These documents highlighted his need for help with bathing, dressing, eating, medication management, and his inability to leave home without assistance due to his conditions. The Board acknowledged the veteran's significant need for aid and attendance but found he did not meet the specific statutory criteria for the higher-level benefit. However, the Board found the veteran is entitled to SMC at the housebound rate under 38 U.S.C. § 1114(s). This was based on his total rating for psychiatric conditions, additional physical disabilities rated over 60%, and the Board's finding that his service-connected disabilities permanently housebound him due to severe agoraphobia, panic attacks, and limited mobility. Therefore, the claim for housebound benefits was granted.

Rationale

Veteran has total rating for psychiatric disorder; Veteran has additional service-connected disabilities rated at 60% or more; Evidence establishes Veteran is permanently housebound due to psychiatric symptoms and limited mobility

Full Decision Text

Citation Nr: A26039448
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 251116-608119
DATE: April 28, 2026

ORDER

Entitlement to additional compensation under 38 U.S.C. § 1114(s) is granted.

FINDING OF FACT

The Veteran is service-connected for an acquired psychiatric disorder, rated as total, and has additional service-connected disabilities independently ratable at 60 percent or more, and, by reason of his service-connected disabilities, he is permanently housebound.

CONCLUSION OF LAW

The criteria for entitlement to special monthly compensation at the housebound rate under 38 U.S.C. § 1114(s) have been met. 38 U.S.C. §§ 1114(s), 5107; 38 C.F.R. §§ 3.102, 3.350.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 2002 to December 2002, and from June 2004 to May 2005.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In the November 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the May 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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. 

Higher-Level Aid and Attendance under 38 U.S.C. § 1114(r)(2)

Certain Veterans are entitled to special monthly compensation (SMC), an ancillary benefit paid in addition to a schedular rating. SMC is an additional level of compensation above the basic levels of compensation for various types of losses or levels of impairment, solely due to service-connected disabilities. For example, additional compensation may be awarded for Veterans with amputation(s), blindness, or those in need of aid and attendance. The varied types of SMC are enumerated in 38 U.S.C. § 1114 and 38 C.F.R. § 3.350.  

Here, the Veteran is in receipt of SMC for aid and attendance under 38 U.S.C. § 1114(l) and seeks the higher-level of aid and attendance authorized by 38 U.S.C. § 1114(r)(2). 

A veteran is entitled to the higher-level aid and attendance allowance authorized by 38 U.S.C. § 1114(r)(2) and 38 C.F.R. § 3.350(h)(3) if the veteran needs a higher level of care than is required to establish entitlement to the regular aid and attendance allowance, and in the absence of the provision of such higher level of care the veteran would require hospitalization, nursing home care, or other residential institutional care. However, as a threshold matter, to qualify for compensation under § 1114(r)(2), a Veteran must be entitled to special monthly compensation under § 1114(o), § 1114(n) and (k), or § 1114(r). 

Compensation under § 1114(o) is warranted if the 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 subsections (l) through (n) of this section, 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 20/200 visual acuity or less, or if the veteran has suffered service-connected total 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
 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 subsections (l) through (n) of this section, 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 20/200 visual acuity or less, or if the veteran has suffered service-connected total 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 the anatomical loss of both arms with factors that prevent the use of prosthetic appliances. 

Compensation under § 1114(l) is warranted if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of both feet, or of one hand and one foot, or is blind in both eyes, with 5/200 visual acuity or less, or is permanently bedridden or with such significant disabilities as to be in need of regular aid and attendance.

Compensation under § 1114(m) is warranted if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of both hands, or of both legs with factors preventing natural knee action with prostheses in place, or of one arm and one leg with factors preventing natural elbow and knee action with prostheses in place, or has suffered blindness in both eyes having only light perception, or has suffered blindness in both eyes, rendering such veteran so significantly disabled as to be in need of regular aid and attendance. 

Compensation under § 1114(n) is warranted if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of both arms with factors preventing natural elbow action with prostheses in place, has suffered the anatomical loss of both legs with factors that prevent the use of prosthetic appliances, or has suffered the anatomical loss of one arm and one leg with factors that prevent the use of prosthetic appliances, or has suffered the anatomical loss of both eyes, or has suffered blindness without light perception in both eyes. 

Compensation under § 1114(k) is warranted if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of one or more creative organs, or one foot, or one hand, or both buttocks, or blindness of one eye, having only light perception, has suffered complete organic aphonia with constant inability to communicate by speech, or deafness of both ears, having absence of air and bone conduction. 

Compensation under § 1114(r) is warranted if any veteran, otherwise entitled to compensation authorized under subsection (o) of this section, at the maximum rate authorized under subsection (p) of this section, or at the intermediate rate authorized between the rates authorized under subsections (n) and (o) of this section and at the rate authorized under subsection (k) of this section, is in need of regular aid and attendance. 

Compensation under § 1114(p) is warranted in the event the veteran's service-connected disabilities exceed the requirements for any of the rates prescribed in this section, the Secretary may allow the next higher rate or an intermediate rate. 

The need for a higher level of care shall be considered to be need for personal health-care services provided on a daily basis in the veteran's home by a person who is licensed to provide such services or who provides such services under the regular supervision of a licensed health-care professional. Personal health-care services include (but are not limited to) such services as physical therapy, administration of injections, placement of indwelling catheters, and the changing of sterile dressings, or like functions which require professional health-care training or the regular supervision of a trained health-care professional to perform. A licensed health-care professional includes (but is not limited to) a doctor of medicine or osteopathy, a registered nurse, a licensed practical nurse, or a physical therapist licensed to practice by a State or political subdivision thereof. 38 C.F.R. § 3.352(b)(3). 

After review of the evidence, the Board finds that additional compensation under 38 U.S.C. § 1114(r)(2) is not warranted, but the Veteran is entitled to SMC at the housebound rate under 38 U.S.C. § 1114(s).  

At the outset, the Board notes that the Veteran is service connected for an acquired psychiatric disorder including post-traumatic stress disorder (PTSD), bipolar II disorder, and
 health-care professional includes (but is not limited to) a doctor of medicine or osteopathy, a registered nurse, a licensed practical nurse, or a physical therapist licensed to practice by a State or political subdivision thereof. 38 C.F.R. § 3.352(b)(3). 

After review of the evidence, the Board finds that additional compensation under 38 U.S.C. § 1114(r)(2) is not warranted, but the Veteran is entitled to SMC at the housebound rate under 38 U.S.C. § 1114(s).  

At the outset, the Board notes that the Veteran is service connected for an acquired psychiatric disorder including post-traumatic stress disorder (PTSD), bipolar II disorder, and panic disorder with agoraphobia, rated at 100 percent. The Veteran is service connected for various physical disabilities which, together, are ratable at above 60 percent. Additionally, he is in receipt of a total disability rating for individual unemployability. 

In a December 2024 rating decision, the RO granted SMC for aid and attendance, effective January 31, 2022, under 38 U.S.C. § 1114(l). In a December 2024 Rating Calculator worksheet, the RO noted that the Veteran received compensation under 38 U.S.C. § 1114(l) and 38 C.F.R. § 3.350(b) on account of being so helpless as to be in need of regular aid and attendance while not hospitalized at U.S. government expense from January 31, 2022. Such a finding is referred to as factual aid and attendance. The RO also noted that the Veteran received SMC under 38 U.S.C. § 1114(k) and 38 C.F.R. § 3.350(a) on account of loss of use of a creative organ from January 31, 2022. 

The Veteran sought additional compensation under 38 U.S.C. § 1114(r)(2) through filing a March 2025 VA Form 21-0995, Supplemental Claim Application. Concurrently, the Veteran submitted a statement detailing the severity of his service-connected disabilities and his need for aid and attendance. He stated that he often woke extremely anxious and overwhelmed prompting reliving traumatic events from combat. The Veteran stated that his nurse had to help him from bed and into the bathroom in order to relieve himself and to shower. However, even the physical sensation of water falling upon him was overwhelming, causing him to require further assistance from his caretaker. Further, the Veteran stated that he was unable to cook for himself due to his inability to focus, his panic attacks, and his forgetfulness. In the past, he had nearly started a fire while using the stove. Given this, he hired an individual to prepare and deliver meals. Additionally, the Veteran struggled to clean his home, interact with others, and manage his medications. Lastly, the Veteran noted that his constant fear, pain, and anxiety, including his debilitating panic attacks, render him unable to leave his home without help. 

The Veteran submitted January 2025 and February 2025 examinations for housebound status or permanent need for regular aid and attendance from two separate private examiners detailing the severity of his service-connected disabilities and his need for aid and attendance. The January 2025 examination was provided by a licensed nurse practitioner who had cared for the Veteran for three years. She noted that the Veteran suffered from debilitating symptoms related to his PTSD, including frequent and intense episodes of anxiety and panic. Such episodes rendered him unable to concentrate or focus, thereby limiting his ability to maintain his personal safety and well-being. She stated he was unable to cook or use appliances and required assistance to remember to take his medications correctly. Due to his chronic pain, the Veteran was required to cancel physical therapy appointments as he could not leave the house. Lastly, she stated that the Veteran needed assistance with activities of daily living, such as eating, dressing, and bathing. 

In the February 2025 statement, the examiner summarized the evidence, including the basis on which the RO granted SMC in the December 2024 rating decision, and all the statements reviewed above. After consultation with the Veteran, the examiner opined that the Veteran required substantial assistance in all aspects of daily living, including personal hygiene, bathing, dressing, toileting, eating, and transferring. The examiner noted the Veteran only left his house twice a month for medical appointments and then only with the assistance of others. Without aid and assistance, the examiner concluded, the Veteran would require placement in a long-term care facility. The examiner's summary of the evidence, namely the Veteran's need for assistance with activities of daily living, is consistent with the evidence summarized by the Board herein. 

The Veteran also submitted a December 2024 statement from his friend detailing his observations of the Veteran's service-connected disabilities.
 decision, and all the statements reviewed above. After consultation with the Veteran, the examiner opined that the Veteran required substantial assistance in all aspects of daily living, including personal hygiene, bathing, dressing, toileting, eating, and transferring. The examiner noted the Veteran only left his house twice a month for medical appointments and then only with the assistance of others. Without aid and assistance, the examiner concluded, the Veteran would require placement in a long-term care facility. The examiner's summary of the evidence, namely the Veteran's need for assistance with activities of daily living, is consistent with the evidence summarized by the Board herein. 

The Veteran also submitted a December 2024 statement from his friend detailing his observations of the Veteran's service-connected disabilities. The friend stated that he had assisted the Veteran with various activities of daily living, including grooming, dressing, and preparing meals. On multiple occasions, the friend assisted the Veteran after falls due to his balance and anxiety issues. Additionally, the friend had driven the Veteran to many medical appointments as the Veteran's anxiety made it challenging for him to leave the house. 

Lastly, the Veteran submitted a March 2025 statement from a cleaning professional who had provided cleaning services to the Veteran for three years. She stated that she had observed the Veteran deteriorate physically and mentally during this time. In particular, she noted that the Veteran's mobility was significantly limited and his memory had worsened, leaving him disoriented. She also noted her observation of the Veteran's complete dependence on his nurse and caregivers for assistance with activities of daily living. 

In the May 2025 rating decision on appeal, the RO continued the rate of SMC. In denying increased compensation, the RO summarized the regulations. And after reviewing these requirements, the RO found that the record did not indicate that the Veteran had been evaluated by a physician or contract physician with the VA, nor did it suggest the need for a person who is licensed to provide such services themselves or under the regular supervision of a licensed health-care professional. 

The Veteran sought higher-level review of this adverse decision through filing a June 2025 VA Form 20-0996, Request for Higher Level Review. In a September 2025 rating decision, the RO identified a duty to assist error and developed the record further, including a request for additional records from the VA medical center and for an examination. 

In a September 2025 VA Aid and Attendance or Housebound Examination, the examiner described the limitations experienced by the Veterans and his need for aid and attendance. The examiner noted the Veteran's need for assistance with bathing, dressing, ambulating within his home, tending to hygiene needs, transferring in or out of his bed and/or chair, medication management, and meal preparation. While the examiner summarized the Veteran's physical mobility limitations, the examiner did not detail the significant limitations posed by the Veteran's psychological disability.  

In an October 2025 rating decision, the RO continued the Veteran's rate of SMC without further comment.  The Veteran then initiated the present appeal through filing a November 2025 VA Form 10182. 

As noted above, as a threshold matter, to qualify for compensation under § 1114(r)(2), a Veteran must be entitled to SMC under § 1114(o), § 1114(n) and (k), or § 1114(r). Here, the Veteran has been awarded SMC under §§ 1114(k) and (l). He is not entitled to compensation under § 1114(o), because he has not suffered the anatomical loss or loss of use of extremities or experienced blindness as stated in § 1114(m) and (n).  Additionally, he is not entitled to compensation under § 1114(r), because he is not entitled to compensation authorized under subsection (o), at the maximum rate authorized under subsection (p), or at the intermediate rate authorized between the rates authorized under subsections (n) and (o) and at the rate authorized under subsection (k). The Board acknowledges that the evidence shows that the Veteran requires significant aid and attendance; however, the Veteran does not meet the threshold requirement for aid and attendance under § 1114(r) or (r)(2).  

Notwithstanding, the Board finds that the Veteran is entitled to benefits under 38 U.S.C. § 1114(s) as he is housebound. Section 1114(s) states that, if the veteran has a service-connected disability rated as total, and (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, or, (2) by reason of such veteran's service-connected disability or disabilities, is permanently housebound, then the monthly compensation shall be $2,993. For the purpose of this subsection, the requirement of "permanently housebound" will be considered to have been met when the veteran is substantially confined to such veteran
4(r) or (r)(2).  

Notwithstanding, the Board finds that the Veteran is entitled to benefits under 38 U.S.C. § 1114(s) as he is housebound. Section 1114(s) states that, if the veteran has a service-connected disability rated as total, and (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, or, (2) by reason of such veteran's service-connected disability or disabilities, is permanently housebound, then the monthly compensation shall be $2,993. For the purpose of this subsection, the requirement of "permanently housebound" will be considered to have been met when the veteran is substantially confined to such veteran's house (ward or clinical areas, if institutionalized) or immediate premises due to a service-connected disability or disabilities which it is reasonably certain will remain throughout such veteran's lifetime.

Here, the Veteran's acquired psychiatric disorder is rated as total and he has additional service-connected disabilities independently ratable at 60 percent or more. Additionally, the Board finds that the evidence establishes that the Veteran is permanently housebound as a result of his service-connected disabilities. In so finding, the Board relies on the ample evidence that the Veteran is unable to leave his home without the assistance of caretakers due to his psychiatric symptoms including severe agoraphobia, panic attacks, and flashbacks to combat trauma, as well as his significantly limited mobility. 

Therefore, entitlement to additional compensation under 38 U.S.C. § 1114(s) is warranted, and the claim is granted. 

 

Leetra J. Harris

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J.S.L.

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.