Case A26039649

Summary

The veteran, who served from October 1962 to October 1969, appeals a January 2026 VA rating decision. The Board of Veterans' Appeals (Board) reviewed the evidence of record as of that date. The primary issue was entitlement to Special Monthly Compensation (SMC) based on a need for aid and attendance, pursuant to 38 U.S.C. § 1114(l). The Board considered the veteran's service-connected disabilities, including residuals of stroke, GERD, diabetes mellitus II, hypertension, kidney disease, ulcerative colitis, and Crohn's disease. The Board relied on a favorable April 2024 VA examination, which noted the veteran's inability to manage financial affairs and medication, and a May 2025 rating decision that confirmed the need for aid and attendance due to stroke residuals. The Board found that the veteran's service-connected stroke residuals rendered him helpless and in need of regular aid and attendance, meeting the criteria under 38 C.F.R. § 3.352(a). The Board granted entitlement to SMC based on aid and attendance, resolving all reasonable doubt in the veteran's favor.

Rationale

Service-connected stroke residuals render veteran unable to care for himself; Veteran requires regular aid and attendance for protection from daily hazards; Favorable findings from VA examinations and rating decisions relied upon

Full Decision Text

Citation Nr: A26039649
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 260323-640426
DATE: April 28, 2026

ORDER

Entitlement to special monthly compensation (SMC) based on aid and attendance pursuant to 38 U.S.C. § 1114(l) is granted.

FINDING OF FACT

Resolving all reasonable doubt in his favor, the Veteran's service-connected residuals of stroke disabilities rendered him unable to care for daily personal needs or to protect himself from the hazards and dangers incident to his daily environment without assistance of others.

CONCLUSION OF LAW

The criteria for entitlement to SMC for aid and attendance have been met. 38 U.S.C. §§ 1114(l), 5107; 38 C.F.R. §§ 3.104, 3.350(b), 3.352.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from October 1962 to October 1969. This matter is before the Board of Veterans' Appeals (Board) on appeal of a January 2026 Department of Veterans Affairs (VA) rating decision. The Veteran timely appealed this rating decision to the Board and requested the Board direct review lane option. Therefore, the Board's review is limited to evidence on record at the time of the January 9, 2026 rating decision.

On June 21, 2024, in Williams v. McDonough, the United States of Appeals for Veterans Claims (Court) held that, generally, the Board may not decide an appeal before the deadline for requesting an Appeals Modernization Act (AMA) docket switch has elapsed. 38 C.F.R. § 20.202(c)(2) allows claimants to switch AMA dockets by completing and submitting a new Notice of Disagreement (NOD) within one year from the date the Agency of Original Jurisdiction (AOJ) mails notice of the decision on appeal, or 60 days from when the Board receives the NOD, whichever is later; unless a claimant has already submitted evidence or testimony as described in 38 C.F.R. §§ 20.302 and 20.303. However, here, there is no prejudice to the Veteran as entitlement to SMC based on aid and attendance is being fully granted based on the evidence already associated with the record.

The appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2).

Entitlement to SMC based on aid and attendance pursuant to 38 U.S.C. § 1114(l) is granted.

SMC is available when, as the result of service-connected disability, a veteran suffers additional hardships above and beyond those contemplated by VA's schedule for rating disabilities. See 38 U.S.C. § 1114; 38 C.F.R. §§ 3.350, 3.352. The rates of SMC vary according to the nature of a veteran's service-connected disabilities and are awarded for various types of losses or levels of impairment, in addition to specific combinations of such impairments. The different types of SMC available are commonly referred to by their alphabetic designations, such as SMC(k), SMC(l), etc., which correspond to the paragraphs of 38 U.S.C. § 1114 that provide the statutory authority for SMC. These paragraphs are codified in VA regulations, predominantly at 38 C.F.R. § 3.350(a)-(i).

Entitlement to SMC based on a need for aid and attendance is established if the veteran, as a result of a service-connected disability, is unable to care for himself and to attend to his own personal care without the need for regular aid and attendance. 38 U.S.C. § 1114(l). "Need for aid and attendance" means helplessness or being so nearly helpless as to require the regular aid and attendance of another person. A claimant will be considered in need of regular aid and attendance if he or she (1) is blind or so nearly blind as to have corrected visual acuity of 5/200 or less in both eyes, or concentric contraction of the visual field to 5 degrees or less; (2) is a patient in a nursing home because of mental or physical incapacity; or (3) establishes a factual need for aid and attendance under the criteria set forth in 38 C.F.R. § 3.352(a). See 38 C.F.R. § 3.351(b), (c).

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
 need of regular aid and attendance if he or she (1) is blind or so nearly blind as to have corrected visual acuity of 5/200 or less in both eyes, or concentric contraction of the visual field to 5 degrees or less; (2) is a patient in a nursing home because of mental or physical incapacity; or (3) establishes a factual need for aid and attendance under the criteria set forth in 38 C.F.R. § 3.352(a). See 38 C.F.R. § 3.351(b), (c).

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) the inability of a 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 a 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 incapacity, physical or mental, which requires care or assistance on a regular basis to protect a veteran from the hazards or dangers incident to his daily environment.

The Veteran need not show all of the disabling conditions identified in 38 C.F.R. § 3.352(a) to establish entitlement to aid and attendance; the Court has held that it is logical to infer there is a threshold requirement that "at least one of the enumerated factors be present." Turco v. Brown, 9 Vet. App. 222, 224 (1996).

It is noted that, in order for the veteran to prevail in his claim, the evidence must show that it is a service-connected disability that has resulted in him being in need of regular aid and attendance or being housebound. See Prejean v. West, 13 Vet. App. 444, 447-48 (2000).

Where there is a question as to which of two ratings shall be assigned, the higher criteria will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. VA is responsible for determining whether the evidence persuasively favors one side or another. 38 C.F.R. § 4.3. When there is an approximate or nearly equal balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant and the claim will be granted on the merits. 38 U.S.C. § 5107(b). When the evidence persuasively favors against the claims of the Veteran, the benefit of the doubt doctrine is inapplicable and the claim will be denied on its merits. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021) (en banc).

The October 2024 rating decision found that an April 9, 2024 examination for housebound status or permanent need for regular aid and attendance noted service connected disabilities of cerebral infraction, gastroesophageal reflux disease (GERD), diabetes mellitus II, hypertension, kidney disease, ulcerative colitis, and crones disease. The AOJ found the examining provider noted that the Veteran was unable to identify numbers, unable to write checks to pay bills, failed short term memory, and did not remember what bills need to be paid or that have been paid.

The May 2025 rating decision found the Veteran required aid and attendance and that the April 9, 2024 examination for housebound status or permanent need for regular aid and attendance showed that he required assistance with medication management, transportation to medical appointments, and his financial affairs.

The Board is bound by these favorable findings. 38 C.F.R. § 3.104. The critical question remaining is whether the Veteran required aid and attendance due to his service-connected disability or disabilities. 

In the April 2024 examination for housebound status or permanent need for regular aid and attendance, which the AOJ relied on to form the favorable findings discussed above, the examining provider opined that the restrictions of the listed activities/functions were due to his stroke residual disabilities. 

Based on all the medical evidence of record, the Board finds that the Veteran is entitled to SMC aid and attendance, pursuant to 38 U.S.C. § 1114, subsection (l) and 38 C.F.R. § 3.350(b) based on his residual of stroke disabilities. The medical evidence establishes that the
.104. The critical question remaining is whether the Veteran required aid and attendance due to his service-connected disability or disabilities. 

In the April 2024 examination for housebound status or permanent need for regular aid and attendance, which the AOJ relied on to form the favorable findings discussed above, the examining provider opined that the restrictions of the listed activities/functions were due to his stroke residual disabilities. 

Based on all the medical evidence of record, the Board finds that the Veteran is entitled to SMC aid and attendance, pursuant to 38 U.S.C. § 1114, subsection (l) and 38 C.F.R. § 3.350(b) based on his residual of stroke disabilities. The medical evidence establishes that the Veteran met the criteria of requiring care or assistance on a regular basis for protection from the hazards or dangers incident to daily environment. 38 C.F.R. § 3.352(a). The Veteran's service-connected residual of stroke disabilities rendered him disabled to the extent that he required the regular aid and assistance of another person. Therefore, SMC based on the need for aid and attendance is warranted.  

 

 

S. CHARLES NEILL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Naumovich, Alexa

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.