Case A26040147

MELANIE J. MANN · 2026 · Case ID: A26040147

MIXED

Summary

The veteran, who served in the U.S. Army from September 1966 to September 1968, appeals decisions regarding effective dates for several granted claims and denials for others. The Board granted entitlement to an effective date of January 28, 2022, for service connection for a left leg amputation and associated scars, as well as for Special Monthly Compensation (SMC) based on anatomical loss of the left leg and for Dependents' Educational Assistance (DEA). The Board found the January 28, 2022, Intent to File date to be the proper effective date for these claims, as the veteran continuously pursued them. The Board denied entitlement to an earlier effective date for chronic headaches, hypertension, and type II diabetes, citing that effective dates cannot precede the initial claim filing or the effective date of relevant legislation like the PACT Act. The Board granted entitlement to SMC based on the need for regular aid and attendance, finding the veteran's service-connected left leg amputation, even with prosthesis, necessitated daily assistance with dressing and hygiene. For chronic headaches, the Board granted a 50 percent rating, finding the evidence, particularly from a favorable August 2023 VA examination, to be in equipoise regarding very frequent completely prostrating attacks, resolving doubt in the veteran's favor. The claim for a compensable rating for hypertension was denied, as the evidence did not meet the criteria for a higher rating, despite requiring medication. Service connection for an unspecified depressive disorder was granted, finding the veteran's symptoms began in service and continued, supported by service treatment records and lay testimony, resolving doubt in the veteran's favor.

Rationale

Continuous pursuit of claim from January 2022 Intent to File; Grant of service connection for left leg amputation and scars; Effective date of January 28, 2022, granted

Service Branch

ARMY

Special Benefit

SMC - AID & ATTENDANCE

Docket No.

260304-634758

Full Decision Text

Citation Nr: A26040147
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 260304-634758
DATE: April 29, 2026

ORDER

Entitlement to an effective date of January 28, 2022, for service connection for left leg amputation and associated scars is granted.

Entitlement to an effective date of January 28, 2022, but no earlier for special monthly compensation (SMC) based on anatomical loss of left leg is granted.

Entitlement to an effective date of January 28, 2022, but no earlier for the award of entitlement to Dependents' Educational Assistance (DEA) is granted.

Entitlement to an effective date prior to January 28, 2022, for service connection for chronic headaches is denied.

Entitlement to an effective date prior to August 10, 2022, for service connection for hypertension is denied.

Entitlement to an effective date prior to March 25, 2021, for the award of service connection for diabetes mellitus type II with chronic kidney disease stage 3 and erectile dysfunction (type II diabetes) is denied.

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

Entitlement to a 50 percent rating, but no higher, for chronic headaches is granted.

Entitlement to a compensable rating for hypertension is denied.

Entitlement to service connection for unspecified depressive disorder is granted.

FINDINGS OF FACT

1. The Veteran continuously pursued his claim for entitlement to service connection for a left leg amputation and associated scar, to include entitlement to SMC based on anatomical loss of use of the left leg from January 28, 2022.

2. As of January 28, 2022, the Veteran has permanent and total service-connected disability sufficient to support entitlement to DEA.

3. The Veteran filed his initial intent to file a claim for service connection for chronic headaches on January 28, 2022.

4. The Veteran filed a claim for service connection for hypertension in March 2023 asserting entitlement under the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act).

5. The Veteran filed an initial claim for entitlement to service connection for type II diabetes on March 25, 2021.

6. The Veteran's service connected disabilities caused him to require regular aid and attendance from another person to perform the personal functions required in everyday living.

7. Resolving the benefit of the doubt in the Veteran's favor, the Veteran's chronic headaches manifest with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.

8. The Veteran's hypertension did not present with diastolic pressure predominantly 100 or more, systolic pressure predominantly at 160 or more, or a history of diastolic pressure predominantly 100 or more who requires continuous medication for control.

9. Resolving the benefit of the doubt in favor of the Veteran, the Veteran's unspecified depressive disorder began in service and continued to the present.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an effective date of January 28, 2022, for service connection for left leg amputation have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.2500, 3.400.

2. The criteria for entitlement to an effective date of January 28, 2022, but no earlier for SMC based on anatomical loss of left leg have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.2500, 3.400.

3. The criteria for entitlement to an effective date of January 28, 2022, but no earlier for the award of entitlement to DEA have been met. 38 U.S.C. §§ 3501, 3510, 3512; 38 C.F.R. § 3.807.

4. The criteria for entitlement to an effective date prior to January 28, 2022, for service connection for chronic headaches have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.2500, 3.400.

5. The criteria for entitlement to an effective date prior to August 10, 2022, for service connection for hypertension have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.2500, 3.400.

6. The criteria for entitlement to an effective date prior to March 25, 2021, for the award of service connection for type II diabetes have not been met.
an effective date prior to January 28, 2022, for service connection for chronic headaches have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.2500, 3.400.

5. The criteria for entitlement to an effective date prior to August 10, 2022, for service connection for hypertension have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.2500, 3.400.

6. The criteria for entitlement to an effective date prior to March 25, 2021, for the award of service connection for type II diabetes have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.2500, 3.400.

7. The criteria for entitlement to SMC based on the need for regular aid and attendance have been met. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(a).

8. The criteria for entitlement to a 50 percent rating, but no higher, for chronic headaches have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8100.

9. The criteria for entitlement to a compensable rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.104, DC 7005.

10. The criteria for entitlement to service connection for unspecified depressive disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from September 1966 to September 1968.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued in March and July 2025 by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA).

By way of background, in November 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of rating decisions from November 2023, January 2024, July 2024, and August 2025. In March and July 2025, the Agency of Original Jurisdiction (AOJ) issued the rating decisions on appeal. The Veteran subsequently filed the March 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) and elected the direct docket.

Therefore, the Board may only consider the evidence of record at the time of the November 2023, January 2024, August 2024, and July 2025 AOJ decisions. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

Additionally, the Board notes that the Veteran separately claimed entitlement to service connection for macular degeneration as secondary to either hypertension or diabetes mellitus and SMC based on blindness in both eyes. However, the issues were not reasonably raised during the appeal period, nor were they adjudicated in the AOJ decisions on appeal.

Earlier Effective Dates

Generally, the effective date for the grant of service connection for a disease or injury is the day following separation from active duty or the date entitlement arose if a claim is received within one year after separation from service. Otherwise, the effective date is the date of receipt of claim, or date entitlement arose, whichever is later. The effective date of an award based on a claim reopened after final adjudication shall be fixed in accordance with the facts found but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110; 38 C.F.R. § 3.400.

Moreover, under the AMA, an effective date can be preserved if the claim is continuously pursued by filing an appropriate administrative review option to an AMA decision, generally within one year from when the decision was issued. 38 C.F
the date entitlement arose if a claim is received within one year after separation from service. Otherwise, the effective date is the date of receipt of claim, or date entitlement arose, whichever is later. The effective date of an award based on a claim reopened after final adjudication shall be fixed in accordance with the facts found but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110; 38 C.F.R. § 3.400.

Moreover, under the AMA, an effective date can be preserved if the claim is continuously pursued by filing an appropriate administrative review option to an AMA decision, generally within one year from when the decision was issued. 38 C.F.R. § 3.2500 (c). Under AMA, a veteran may continuously pursue a claim by timely filing a Supplemental Claim (VA Form 20-0995), a request for higher-level review (VA Form 20-0996), or an appeal to the Board (VA Form 10182) within one year from the date on which the AOJ issues a notice of a decision on a claim or issue. 38 C.F.R. § 3.2500(a), (c). If an AMA claim is continuously pursued, it will be considered filed as of the date of the first claim in the continuously pursued chain, not the date the most recent request for review was received. 38 C.F.R. § 3.2500(h).

As a general matter, if VA receives a complete claim application form within one year of receipt of an intent to file a claim, VA will consider the complete claim filed as of the date of the intent to file a claim was received. 38 C.F.R. § 3.155. However, the AMA regulation excluded supplemental claims from this intent-to-file framework. See preamble to 38 C.F.R. § 3.155.

Significantly, in November 2021, the United States Court of Appeals for the Federal Circuit invalidated the portion of 38 C.F.R. § 3.155 that excluded supplemental claims from the intent-to-file framework. Military-Veterans Advocacy v. McDonough, 7 F.4th 1110 (Fed. Cir. 2021) (holding that 38 C.F.R. § 3.155 excluding supplemental claims from the intent-to-file framework is invalid for contravening the unambiguous meaning of their governing statutory provisions).

Increased Ratings

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38?U.S.C. §?1155; 38?C.F.R. Part 4. Each disability must be viewed in relation to its history, and the limitation of activity imposed by the disabling condition should be emphasized. 38?C.F.R. §?4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38?C.F.R. §?4.2. All reasonable doubt will be resolved in the claimant's favor. 38?C.F.R. §?4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38?C.F.R. §?4.7.

Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id.

The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct
disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. See 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Therefore, where there is evidence showing that a disorder manifested or was incurred in service, and this disorder is not noted on the veteran's entrance examination report, this presumption of soundness operates to shield the veteran from any finding that the unnoted disease or injury preexisted service. See Gilbert v. Shinseki, 26 Vet. App. 48 (2012); Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991); 38 C.F.R. § 3.304 (b).

A Veteran's lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 C.F.R. §§ 3.159(a), 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Allergy symptoms, including runny nose, coughing, and an itchy throat are the type of symptoms or disability capable of observation by a lay person. See also Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that a layperson may comment on lay-observable symptoms). Thus, a layperson is competent to report on the onset and continuity of his current symptomatology. 38 C.F.R. § 3.159(a); Layno v. Brown, 6 Vet. App. 465, 470 (1994). "Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology." See Savage v. Gober, 10 Vet. App. 488, 496 (1997) (citing Wilson v. Derwinski, 2 Vet. App. 16, 19 (1991)).

The Board notes that a claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021). If "the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise) the claimant receives the benefit of the doubt." Id.

1. Entitlement to an effective date of January 28, 2022, for service connection for left leg amputation and associated scars.

2. Entitlement to an effective date of January 28, 2022, but no earlier for special monthly compensation (SMC) based on anatomical loss of left leg.

The Veteran contends that an earlier effective date is warranted for the award of service connection for a left leg amputation and associated scars as well as SMC based on the anatomical loss of use of the left leg.

On January 28, 2022, the Veteran filed VA form 21-0966, Intent to File a Claim. Within a year, in October 2022, the Veteran
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1. Entitlement to an effective date of January 28, 2022, for service connection for left leg amputation and associated scars.

2. Entitlement to an effective date of January 28, 2022, but no earlier for special monthly compensation (SMC) based on anatomical loss of left leg.

On January 28, 2022, the Veteran filed VA form 21-0966, Intent to File a Claim. Within a year, in October 2022, the Veteran filed VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, asserting entitlement to service connection for his left leg amputation.

In December 2022, the AOJ denied entitlement to service connection for his left leg amputation. Within a year, on August 10, 2023, the Veteran filed VA form 21-0966, Intent to File a Claim.

On February 13, 2024, the Veteran filed VA Form 20-0995, Decision Review Request: Supplemental Claim.

In March 2025, the AOJ granted entitlement to service connection for a left leg amputation, associated scars, and SMC based on loss of use of the Veteran's left leg, effective 2/13/2024.

Upon review, the Board finds that January 28, 2022, the date the Veteran filed the Intent to File, is the proper date of the Veteran's claim for entitlement to service connection for a left leg amputation, associated scars, and SMC based on loss of use of the left leg. Specifically, the Board notes that the Veteran continuously pursued the claim from the initial January 2022 Intent to File, and the Veteran did not file a claim for entitlement to service connection for a left leg amputation prior to this date.

Accordingly, the Board finds that entitlement to service connection for a left leg amputation, associated scars, and SMC based on loss of use of his left leg, is warranted from January 28, 2022, but no earlier. 38 U.S.C. § 5110; 38 C.F.R. § 3.400.

3. Entitlement to an effective date of January 28, 2022, but no earlier for the award of entitlement to DEA.

Chapter 35 benefits, Survivors' and DEA, is a program of education or special restorative training that may be authorized for an eligible person, such as a child or surviving spouse, if the applicable criteria are met. 38 U.S.C. §§ 3500, 3501; 38 C.F.R. §§ 3.807, 21.3020, 21.3021. Basic eligibility for certification of Survivors' and DEA benefits exists if the veteran: (1) was discharged from service under conditions other than dishonorable, or died in service; and (2) has a permanent total service-connected disability; or (3) a permanent total service connected disability was in existence at the date of the veteran's death; or (4) died as a result of a service-connected disability; or, (5) if a serviceperson is on active duty as a member of the Armed forces and is, and, for a period of more than 90 days, has been listed by the Secretary concerned as missing in action, captured in line of duty by a hostile force, or forcibly detained or interned in line of duty by a foreign government or power. Service-connected disability or death must have been the result of active military, naval, or air service on or after April 21, 1898.

The Veteran's combined rating is now 100 percent from January 28, 2022, which fulfills the requirement of permanent and total service-connected disability for eligibility to DEA. Prior to January 28, 2022, the Veteran did not meet any of the basic eligibility requirements for DEA under 38 U.S.C. Chapter 35. Accordingly, entitlement to an effective date of January 28, 2022, but no earlier, for the award of eligibility to DEA under 38 U.S.C. Chapter 35 is granted herein.

4. Entitlement to an effective date prior to January 28, 2022, for service connection for chronic headaches.

The Veteran contends that an effective date prior to January 28, 2022, is warranted for chronic headaches.

On January 28, 2022, the Veteran filed VA form 21-0966, Intent to File a Claim. Within a year, in June 2022, the Veteran filed VA
of the basic eligibility requirements for DEA under 38 U.S.C. Chapter 35. Accordingly, entitlement to an effective date of January 28, 2022, but no earlier, for the award of eligibility to DEA under 38 U.S.C. Chapter 35 is granted herein.

4. Entitlement to an effective date prior to January 28, 2022, for service connection for chronic headaches.

The Veteran contends that an effective date prior to January 28, 2022, is warranted for chronic headaches.

On January 28, 2022, the Veteran filed VA form 21-0966, Intent to File a Claim. Within a year, in June 2022, the Veteran filed VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, asserting entitlement to service connection for chronic headaches.

In December 2022 and March 2023, the AOJ deferred entitlement to service connection for headaches for additional development.

In March 2023, the AOJ denied entitlement to service connection for chronic headaches.

Within a year, in April 2023, the Veteran filed VA Form 20-0996, Decision Review Request: Higher-Level Review. In June 2023, the AOJ identified a duty to assist error in the adjudication of entitlement to service connection for chronic headaches.

In November 2023, the AOJ granted entitlement to service connection for chronic headaches effective January 28, 2022.

Upon review, the Board finds that an effective date prior to January 28, 2022, for entitlement to service connection for chronic headaches is not warranted. An effective date generally cannot be earlier than the date of an initial claim. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. As the effective date cannot be earlier than January 28, 2022, the date of the Veteran's initial filing, entitlement to an earlier effective date for the award of service connection for chronic headaches must be denied.

5. Entitlement to an effective date prior to August 10, 2022, for service connection for hypertension.

The Veteran contends that an effective date prior to August 10, 2022, is warranted for hypertension.

On March 15, 2023, the Veteran filed VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, asserting entitlement to service connection for hypertension.

In January 2024, the AOJ granted entitlement to service connection for hypertension pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act), and assigned a noncompensable rating effective August 10, 2022, the date the PACT Act went into effect. See 38 C.F.R. § 3.114 (noting that where service connection is granted pursuant to a liberalizing law such as the PACT Act, the earliest date service connection may be awarded is the effective date of said liberalizing law.)

Upon review, the Board finds that an effective date prior to August 10, 2022, for entitlement to service connection for hypertension is not warranted. Under the PACT Act, an effective date cannot be earlier than the date it went into effect. 38 C.F.R. § 3.114. As the effective date cannot be earlier than August 10, 2022, the date the PACT Act went into effect, entitlement to an earlier effective date for the award of service connection for hypertension must be denied.

6. Entitlement to an effective date prior to March 25, 2021, for the award of service connection for type II diabetes.

The Veteran contends that an effective date prior to March 25, 2021, is warranted for type II diabetes.

On March 25, 2021, the Veteran filed VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, asserting entitlement to service connection for type II diabetes.

In November 2021, the AOJ denied entitlement to service connection for type II diabetes. The Veteran timely appealed the decision, and in August 2022, the Board granted entitlement to service connection for type II diabetes. The AOJ implemented the Board decision in September 2022 and assigned an effective date of March 25, 2021, the date of the Veteran's initial claim.

Upon review, the Board finds that an effective date prior to March 25, 2021, for entitlement to service connection for type II diabetes is not warranted. An effective date generally cannot be earlier than the date of an initial claim. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. As the effective
entitlement to service connection for type II diabetes. The Veteran timely appealed the decision, and in August 2022, the Board granted entitlement to service connection for type II diabetes. The AOJ implemented the Board decision in September 2022 and assigned an effective date of March 25, 2021, the date of the Veteran's initial claim.

Upon review, the Board finds that an effective date prior to March 25, 2021, for entitlement to service connection for type II diabetes is not warranted. An effective date generally cannot be earlier than the date of an initial claim. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. As the effective date cannot be earlier than March 25, 2021, the date of the Veteran's initial filing, entitlement to an earlier effective date for the award of service connection for type II diabetes must be denied.

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

The Veteran contends that he requires regular aid and attendance due to his service-connected left leg amputation.

SMC(l) (aid and attendance) is payable when, as a result of a service-connected disability, the Veteran 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 is so helpless (due to physical or mental incapacity), that he requires the aid of another person to perform the personal functions required in everyday living. 38 U.S.C. § 1114 (l); 38 C.F.R. §§ 3.350 (b), 3.351(b), 3.352(a).

A Veteran will meet the criteria for payment at the aid and attendance rate if any of the following factors are met: (i) he has anatomical loss or loss of use of both feet, or one hand and one foot (38 U.S.C. § 1114 (l)); (ii) he 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 (38 C.F.R. § 3.351 (c)(1)); (iii) he is a patient in a nursing home because of mental or physical incapacity (38 C.F.R. § 3.351 (c)(2)); (iv) he is permanently bedridden or with such significant disabilities as to be in need of regular aid and attendance (38 C.F.R. §§ 3.350 (b), 3.352(a)); or (v) there is a factual need (38 C.F.R. § 3.351 (c)(3)).

The following factors are considered in determining the need for regular aid and attendance: inability of a claimant to dress or undress himself, or to keep himself 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 aid; inability of a claimant to feed himself through loss of coordination of upper extremities or through extreme weakness; 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 the claimant from hazards or dangers incident to his daily environment. 38 C.F.R. § 3.352 (a).

The above are only factors for consideration, and it is left to the Board to determine whether a veteran is factually in need of regular aid and attendance. The particular personal functions that a veteran is unable to perform are also considered in connection with their condition as a whole. It is only necessary that the evidence establish that a veteran is so helpless as to need regular aid and attendance, not that there be a constant need, however the need must be caused solely by service-connected disabilities. Further, there is no schedular threshold for the award of SMC(l) when granted on the basis of a need for regular aid and attendance.

The Veteran is currently in receipt of service connection for a left leg amputation, chronic headaches, type II diabetes, among other less severe disabilities.

A February 2019 VA examination documented that the Veteran required assistance in bathing and tending to hygiene due to his amputation.

The Veteran is currently in receipt of service connection for a left leg amputation, chronic headaches, type II diabetes, among other less severe disabilities.

A February 2019 VA examination documented that the Veteran required assistance in bathing and tending to hygiene due to his amputation.

In April 2019, the Veteran reported during a VA examination that following his left leg amputation, he has been unable to drive, do house work, yard work, cook, walk unassisted, care for his pets, or dress, and he is dependent on his wife and son for his care. The examiner opined that the Veteran requires regular aid and attendance due to non-service-connected eye disabilities as well as his service-connected left leg amputation. The examiner noted that the Veteran requires assistance "with all standing, limited walking, and sitting using his mechanize wheel chair and aluminum walker as he cannot due to his left leg [amputation] with poor balance and inability to stand well even with prosthesis."

Upon review, the Board finds that the Veteran's service-connected disabilities are so severe as to require regular aid and attendance of another person. 38 C.F.R. § 3.352 (a). Specifically, the record shows that the Veteran's service-connected left leg amputation was so severe, even with prosthesis, that the Veteran requires daily assistance with dressing and hygiene. See February and April 2019 VA examinations.

The Board acknowledges that the April 2019 VA examiner also considered non-service-connected eye disabilities in the VA medical opinion. However, the rationale supporting the opinion made clear that the Veteran's left leg amputation disability caused the Veteran's difficulties with dressing and bathing, even with prosthesis.

Consequently, the Board finds that SMC based on the need for regular aid and attendance is warranted due to his service-connected left leg amputation.

8. Entitlement to a 50 percent rating, but no higher, for chronic headaches.

The Veteran contends that a rating in excess of 30 percent is warranted for his chronic headaches.

The appeal period before the Board begins on January 28, 2022, the date service connection was awarded for chronic headaches.

The Veteran's chronic headache disability is currently rated under Diagnostic Code 8100. See 38 C.F.R. § 4.124a. Under Diagnostic Code 8100, a 30 percent rating is warranted with characteristic prostrating attacks occurring on average once a month over the last several months. A 50 percent rating is warranted with very frequent completely prostrating headaches and prolonged attacks productive of severe economic inadaptability. In Johnson v. Wilkie, 30 Vet. App. 245, 247 (2018), the Court held that the rating criteria under DC 8100 are successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating.

VA treatment records from October 2021 document that the Veteran experienced chronic daily headaches, with severe headaches once per month. The Veteran reported that when he has a severe headache, "he has to take a nap and will awake and the headache pain will be improved."

During the July 2022 VA examination, the Veteran reported sharp severe headache pain once per month with less severe headaches two to three times per week. He additionally noted that approximately once per month he needs bed rest for two to three hours. The examiner documented that the Veteran has characteristic prostrating attacks once per month, but that the Veteran does not experience completely prostrating or prolonged headache attacks.

In December 2022 VA treatment records, the Veteran reported continuing chronic daily headaches and noted that he had more severe headaches two to three times per week.

During the July 2023 VA examination, the Veteran reported worsening headache symptoms including "prostrating attacks with the throbbing pain where he will have to lie down and try to sleep" as well as constant less severe pain. The examiner documented that the Veteran has characteristic prostrating attacks once every other month, but that the Veteran does not experience completely prostrating or prolonged headache attacks.

An additional examination was performed in August 2023, where the Veteran reported chronic daily headaches and "[s]evere headaches twice a week that [are] debilitating" and prevent him from daily activities. The examiner noted that the Veteran's treatment records showed severe daily headaches beginning during service, and continuing to the present. The examiner documented that the Veteran has completely prostrating and prolonged attacks twice per week.

Upon review, and in resolving the benefit of the doubt in favor of the Veteran, the Board finds that a 50 percent rating, but no higher, is warranted. Specifically, during the August 2023 VA examination the examiner acknowledged the Veteran's treatment records and found the Veteran experienced completely prostrating and prolonged attacks twice per week. The Board finds the July 2023 and August 2023 VA examiners findings particularly probative because the examiners addressed the Veteran's treatment records documenting severe headache pain requiring bed rest. See October 2021 and December 2022 VA treatment records. Although the examiners arrived at different conclusions regarding severity, the favorable August 2023 VA examination report placed the evidence in at least relative equipoise as to whether the Veteran had very frequent completely prostrating headaches and prolonged attacks productive of severe economic inadaptability.

The Board acknowledges the July 2022 VA examination documenting less severe symptoms. However, the Board finds the examination inadequate, as the examiner did not address the Veteran's treatment records documenting constant daily headaches.

The Board has considered whether staged ratings under Fenderson, supra, are appropriate for the Veteran's service-connected disabilities on appeal; however, the Board finds that his symptomatology has been stable throughout the appeal period. Therefore, assigning staged ratings is not warranted. Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claim adjudicated herein. See Doucette, 28 Vet. App. at 369.

Accordingly, the Board resolves all doubt in favor of the Veteran and finds that the Veteran's chronic headache disability presents with very frequent completely prostrating headaches and prolonged attacks productive of severe economic inadaptability. Thus, entitlement to a rating of 50 percent, but no higher, for chronic headaches is warranted. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021).

9. Entitlement to a compensable rating for hypertension.

The Veteran contends that a compensable rating is warranted for hypertension.

The appeal period before the Board begins on August 10, 2022, the date service connection was awarded for hypertension.

The Veteran's hypertension is rated under Diagnostic Code 7101. Under DC 7101, a 10 percent rating applies where there is diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent rating applies where there is diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more. A 40 percent rating applies where there is diastolic pressure predominantly 120 or more. A 60 percent rating applies where there is diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104.

The Board finds that the Veteran's hypertension requires continuous medication, but the Veteran does not have diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or a history of diastolic pressure of predominantly 100 or more.

Private treatment records from May and June 2006 show at highest, diastolic pressure at 84, and systolic pressure at 120.

VA treatment records from May 2015 and November 2015 show at highest, diastolic pressure of 66 and systolic pressure at 133.

In April 2016, VA treatment records documented diastolic pressure at 76 and systolic pressure at 171.

VA treatment records from September 2018 through January 2019 show at highest, diastolic pressure at 95 and systolic pressure at 166.

VA treatment records from July 2019 to September 2022, show at highest, diastolic pressure at 85 and systolic pressure at 137.

During the November 2022 VA examination, the highest reading showed diastolic pressure at 80 and systolic pressure at 153. The examiner noted that there was no history of diastolic pressure predominantly over 100 and that the Veteran requires continuous medication.

During the December 2023 VA examination, the highest reading showed di
astolic pressure at 76 and systolic pressure at 171.

VA treatment records from September 2018 through January 2019 show at highest, diastolic pressure at 95 and systolic pressure at 166.

VA treatment records from July 2019 to September 2022, show at highest, diastolic pressure at 85 and systolic pressure at 137.

During the December 2023 VA examination, the highest reading showed diastolic pressure at 78 and systolic pressure at 130 . The examiner noted that there was no history of diastolic pressure predominantly over 100 and that the Veteran requires continuous medication.

Upon review, the Board finds that the evidence shows that throughout the period on appeal the Veteran's systolic pressure has predominantly been less than 160 and diastolic pressure has predominantly been less than 100. The Board acknowledges that in April 2016, the Veteran's systolic pressure measured 171. However, this is an isolated reading, and all other readings during, and prior to, the appeal period measured under 160. Therefore, entitlement to a compensable disability rating for the Veteran's service-connected hypertension is not warranted.

The Board has also considered whether staged ratings under Fenderson, supra, are appropriate for the Veteran's service-connected hypertension during the appeal period; however, the Board finds that his symptomatology has been stable throughout the appeal period. Therefore, assigning additional staged ratings for such disability is not warranted. Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the probative evidence is not in approximate balance and weighs against the Veteran's claim. Thus, the benefit of the doubt doctrine is not applicable in such regard, and his increased rating claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7.

The Board is grateful for the Veteran's honorable service, and this decision in no way is meant to detract from that service. However, given the record before it, an increased rating is not warranted at this time.

10. Entitlement to service connection for unspecified depressive disorder.

The Veteran contends that he has a currently diagnosed depressive disorder and that it was caused or aggravated by his service-connected disabilities, including his left leg amputation. Alternatively, the Veteran asserts that his depression began in service, and continued to the present. As the Board herein grants entitlement to service connection for an unspecified depressive disorder on a direct basis, it need not address the secondary theory.

As an initial matter, the Board notes that there is a question as to whether the Veteran's unspecified depressive disorder pre-existed his military service. The Veteran's May 1966 entrance examination showed he was psychologically normal, and no noted psychiatric disorders were noted. As no psychiatric disorders were noted at entrance to service, the presumption of soundness attaches. To rebut the presumption of soundness, there must be clear and unmistakable evidence that the Veteran's unspecified depressive disorder pre-existed his service. 38 C.F.R. § 3.304(b).

During the February 2024 VA examination, the examiner noted that treatment records from 2015 document "Veteran began to tell about his childhood and how he believes he is still impacted by events" including the divorce of his parents and emotional abuse from his stepmother. The examiner opined that the Veteran's unspecified depressive disorder is not related to service because he did not seek treatment for many years following service and because he experienced pre-service trauma.

Based on the above, the Board finds that there is not clear and unmistakable evidence that the Veteran's unspecified depressive disorder pre-existed service. Specifically, the Board notes that although the Veteran reported experiencing emotional abuse prior to service, there is no indication from the record that the Veteran was diagnosed with, a depressive disorder prior to service. Accordingly, it is presumed that the Veteran was in sound condition on entrance to service.

In July 2025, the AOJ favorably found that the Veteran has been diagnosed with unspecified depressive disorder. In support
mother. The examiner opined that the Veteran's unspecified depressive disorder is not related to service because he did not seek treatment for many years following service and because he experienced pre-service trauma.

In July 2025, the AOJ favorably found that the Veteran has been diagnosed with unspecified depressive disorder. In support of this finding, the Board notes that the March 2025 VA examination documents a diagnosis of unspecified depressive disorder.

Additionally, service treatment records from service treatment records from May 1967 and August 1968 document depression, loneliness, and nervous trouble.

Thus, the only remaining inquiry is whether the Veteran's current unspecified depressive disorder is related to his in-service depression.

VA treatment records from May 2006 document a history of depression and current medications for depression.

VA treatment records from November 2015 document that the Veteran has been experiencing "survivors guilt" and has been having increased psychiatric issues. At the time, he was prescribed Prozac and diazepam.

The Veteran sought treatment in December 2015 and described "spells of dark clouds that come over [him] . . . [e]ven back in the service." He reported that he has been taking medication for depression and anxiety since 1989, and described pre-service trauma. The examining physician noted that while in the "military [he] was dx with aggravated assault."

VA treatment records from April 2016 to March 2019 document continuing treatment for depression.

In February 2024, the Veteran reported that he has been experiencing depression "since serving at Camp Friendship, Karat, Thailand." He noted that "[a] few months after arriving in country [he] wasn't feeling like [himself]" and "was sad, pissed off, resentful and lonely." The Veteran additionally stated that during service he got into several fights, was charged with aggravated assault, and that "[f]rom that day forward, all [he] could think about was all the fights [he] had been in since [he] arrived in country and how lucky [he] was that [he] hadn't actually killed someone." Additionally, he reported that he sought treatment during service and was given medication. He noted that he "thought [his] depression and anxiety would go away when [he] got home" but "[i]t never went away." The Veteran reported that he was finally put on medication around 1990 and has "been on meds ever since."

The Veteran's wife submitted a statement in February 2024 that the Veteran changed after serving in Thailand and that "he started showing a lot of anger." She noted that she has observed the severity increase over the years and that when he sought treatment after trial and error, his medication began to help.

Upon review, and in resolving the benefit of the doubt in favor of the Veteran, the Board finds that the Veteran's current unspecified depressive disorder began in service and continued to the present. Specifically, the Board finds probative the Veteran's service treatment records, and VA treatment records documenting continuing symptoms and treatment following service. Further, the Veteran and his wife competently and credibly reported that his symptoms began during service, continued following service, and worsened in the years following service.

Based on the continuity of the Veteran's symptoms, the Board finds that the evidence is at least in equipoise that the Veteran's current unspecified depressive disorder began in service and has continued to the present. Lynch, 21 F.4th at 781.

Melanie J. Mann

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Webster, Rebecca

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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