Case A26039791

Summary

The veteran, who served from November 1967 to June 1969, appeals the denial of Special Monthly Compensation (SMC) based on the housebound rate and the grant of SMC based on a need for regular aid and attendance. The veteran is service-connected for PTSD (50%), bilateral peripheral neuropathy of the lower extremities (40% each), and hypertension (non-compensable). He was awarded TDIU from May 18, 2020. The primary issue was entitlement to SMC aid and attendance. The veteran submitted a VA Form 21-2680 in April 2024, citing his service-connected PTSD and hypertension, along with other conditions, as reasons for needing aid and attendance. Recent assessments noted minimal supervision for dressing, supervision for bathing, and moderate independence with ADLs, but also indicated a need for assistance with driving, grab bars, and meals on wheels. The veteran also submitted affidavits from himself and a former caregiver, stating he required help with bathing, cooking, cleaning, standing, and transitioning, and could not drive. The Board found that giving the veteran the benefit of the doubt, the evidence supported a need for regular aid and attendance due to his service-connected disabilities. The Board granted entitlement to SMC based on a need for regular aid and attendance. However, the Board denied entitlement to SMC based on the housebound rate, as the veteran did not have a single 100% disabling condition, was not blind, and did not require nursing care, despite needing some assistance.

Rationale

Benefit of the doubt afforded to veteran; Veteran requires assistance with ADLs; Caregiver and veteran affidavits support need for aid

Full Decision Text

Citation Nr: A26039791
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 250924-587691
DATE: April 28, 2026

ORDER

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

Entitlement to SMC based on the housebound rate is denied.

FINDINGS OF FACT

1. Affording the Veteran the benefit of the doubt, the Veteran's service-connected disabilities cause him to require regular aid and attendance to keep him ordinarily clean and presentable, to attend to the wants of nature, and to protect him from the hazards or dangers incident to his daily environment.

2. The Veteran does not have a single service-connected disability rated at 100 percent, is not legally blind, and is not a patient in a nursing home.

CONCLUSIONS OF LAW

1. The criteria for entitlement to SMC based on a need for regular aid and attendance have been met.  38 U.S.C. §§ 1114, 5107; 38 C.F.R. §§ 3.102, 3.350, 3.352.

2. The criteria for entitlement to SMC based on the housebound rate have not been met.  38 U.S.C. §§ 1114, 5103, 5107; 38 C.F.R. §§ 3.102, 3.350(i), 3.352.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from November 1967 to June 1969.

In September 2025, the Board of Veterans' Appeals (Board) received a VA Form 10182, Decision Review Request: Board Appeal electing hearing docket to review an April 2025 rating decision issued by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

A Board hearing was scheduled for January 2026; however, in December 2025, the Veteran's attorney requested the hearing be canceled.  Therefore, the Board may only consider the evidence of record at the time of the April 2025 rating decision as well as any evidence submitted by the appellant or his representative within 90 days following receipt of the withdrawal.  38 C.F.R. § 20.302(b).

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.

The Board notes that it has thoroughly reviewed the evidence of record in conjunction with this case.  However, the Board has limited its discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record.  See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008).

1. Entitlement to SMC based on a need for regular aid and attendance

SMC at the aid and attendance rate is payable when the 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).

Determinations as to the need for regular aid and attendance are factual and must be based upon the actual requirements for personal assistance from others.  In making such determinations, consideration is given to such conditions as: the inability of the claimant to dress or undress himself or herself, or to keep himself or herself 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 assistance; the inability of the claimant to feed himself or herself through loss of coordination of upper extremities or through extreme weakness; the inability to attend to the wants of nature; or incapacity, either physical or mental, which requires care or assistance on a regular basis to protect a claimant from hazards or dangers incident to one's daily environment.  It is not required that all of the disabling conditions
 others.  In making such determinations, consideration is given to such conditions as: the inability of the claimant to dress or undress himself or herself, or to keep himself or herself 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 assistance; the inability of the claimant to feed himself or herself through loss of coordination of upper extremities or through extreme weakness; the inability to attend to the wants of nature; or incapacity, either physical or mental, which requires care or assistance on a regular basis to protect a claimant from hazards or dangers incident to one's daily environment.  It is not required that all of the disabling conditions enumerated be present before a favorable rating is made. 38 C.F.R. § 3.352(a).

The particular personal functions that the claimant is unable to perform should be considered in connection with his or her condition as a whole.  It is only necessary that the claimant be so helpless as to be in need of regular aid and attendance, not that there is a constant need.

"Bedridden" constitutes a condition which, 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 bed rest for a lesser or greater portion of the day will not suffice.  38 C.F.R. § 3.352(a).

In Turco v. Brown, 9 Vet. App. 222, 224 (1996), the U.S. Court of Appeals for Veterans Claims (Court) held that eligibility for special monthly compensation by reason of regular need for aid and attendance requires that at least one of the factors set forth in VA regulation is met.  In addition, determinations that the claimant is so helpless as to be in need of regular aid and attendance will not be based solely upon an opinion that the claimant's condition is such as would require him or her to be in bed.  They must be based on the actual requirement of personal assistance from others.  See Turco, 9 Vet. App. at 224.

The Veteran is service connected for post-traumatic stress disorder (PTSD) at 50 percent, left lower extremity (LLE) peripheral neuropathy at 40 percent, right lower extremity (RLE) peripheral neuropathy at 40 percent, and hypertension at noncompensable.  The Veteran had a combined 90 percent from February 15, 2012.  Further, the Veteran was awarded total disability based on individual unemployability (TDIU) from May 18, 2020.

In support of his claim for SMC aid and attendance, the Veteran filed a VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance in April 2024.  The Veteran stated he needed aid and attendance due to his hypertension, osteoarthritis, obstructive sleep apnea, PTSD, and degenerative disc disease of the back and neck.  The Board notes that out of the above listed disabilities, the Veteran is only service connected for his PTSD and hypertension.  

In February 2025, the Veteran was evaluated for home health care.  The Veteran's activities of daily living (ADL) category was rated low.  The Veteran needed minimal supervision or reminding for dressing, needed supervision only with bathing; however, he could eat without help, could move in bed without help, could transfer without help, walked with an assistive device, was independent in decision making, and his short-term memory was okay.  See February 2025 RMR HCBC Services note.

In March 2025, the Veteran was referred for an ADL/home safety assessment/fall risk.  The Veteran required assistance from friends with driving.  A shower chair was also ordered for the Veteran, and it was noted the Veteran would benefit from grab bars.  The Veteran ambulated with a walker and was found to have moderate independence with ADLs such as bathing, dressing, toileting, and grooming.  The Veteran was independent with feeding, and he was able to complete simple meal prep; however, he utilized meals on wheels.  See March 2025 Occupational Therapy Consult note.

In February 2026, the Veteran stated that he required help getting in and out of the shower and with his everyday needs.  The Veteran reported he had a caregiver with him about eight hours a day.  The caregiver cooked, cleaned, and helped him go to the bathroom.  The Veteran stated that he always had to use a cane or walker and he could not drive.  The Veteran stated that despite living on his own, he could not shop or clean his home.  See February 2026 VA Form 21-4138 Statement in Support of Claim
 Veteran was independent with feeding, and he was able to complete simple meal prep; however, he utilized meals on wheels.  See March 2025 Occupational Therapy Consult note.

In February 2026, the Veteran stated that he required help getting in and out of the shower and with his everyday needs.  The Veteran reported he had a caregiver with him about eight hours a day.  The caregiver cooked, cleaned, and helped him go to the bathroom.  The Veteran stated that he always had to use a cane or walker and he could not drive.  The Veteran stated that despite living on his own, he could not shop or clean his home.  See February 2026 VA Form 21-4138 Statement in Support of Claim.

Although it was originally signed in May 2020, the Veteran submitted an affidavit where he reported he was unable to walk, stand, or sit for long periods of time.  His bilateral lower extremity (BLE) neuropathy caused him to fall.  He had to use both a cane and walker and wore knee braces to ambulate.  See February 2026 Veteran's Affidavit.

Likewise, the Veteran re-submitted an "attendant affidavit" from his then caregiver that was signed in September 2015.  The caregiver reportedly helped the Veteran with his bathing, standing and sitting, transitioning, eating, walking, dressing, and medication management.  See February 2026 Care Expense Statement.

Giving the Veteran the benefit of the doubt with all things being equal, based on the foregoing the Board finds that the Veteran requires the regular aid and attendance of another person as a result of his service-connected disabilities.  In this regard, in reviewing the evidence in the light most favorable to the Veteran, the Veteran and his caregiver have both submitted affidavits, albeit not recently, which found the Veteran required help with bathing, cooking, cleaning, and he required assistance with activities of daily living, including basic task such as standing up from a chair and transitioning to ensure that he can reside safely in his own home.

Accordingly, the Board finds entitlement to SMC based on the need for regular aid and attendance of another person is warranted.

2. Entitlement to SMC based on the housebound rate

SMC is also payable at a specified rate if the Veteran, as the result of service-connected disability, has one service-connected disability rated as 100 percent disabling and a separate disability rated at 60 percent or higher or is permanently housebound.  Factual housebound, the second basis for this level of SMC, also requires a single disability rated totally (100 percent) disabling.  The Veteran will be found to be permanently housebound if, due to his or her service-connected disabilities he or she is confined to his or her home or the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that such confinement will continue throughout his or her lifetime. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i).

During the period on appeal, the Veteran did not have a single service-connected disability rating of 100 percent.  As noted above, the Veteran did require aid and attendance; however, he was able to feed himself, was not blind, traveled out of the house to show with assistance of a driver, and did not require nursing care.

Based on the probative evidence of record, the Board finds that the Veteran did not meet the criteria for entitlement SMC based on the housebound criteria. Accordingly, entitlement to SMC based on the housebound criteria is not warranted. 

 

DUSTIN L. WARE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Simons

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.