Case A26040385

Summary

The veteran, who served from April 1982 to March 1991, appeals the denial of Special Monthly Compensation (SMC) for aid and attendance and the grant of SMC for housebound status. The veteran has service-connected disabilities including persistent depressive disorder, obstructive sleep apnea, lumbar spine disability, radiculopathy, and foot conditions. The Board denied SMC for aid and attendance, finding that the veteran's service-connected disabilities did not render him so helpless as to require regular aid and attendance. While acknowledging the veteran's TBI diagnosis and cognitive impairments, the Board noted he lived independently, managed his finances with some assistance, and performed most activities of daily living. The Board found the evidence weighed against the need for regular aid and attendance. However, the Board granted SMC at the housebound rate, finding that the veteran's persistent depressive disorder alone rendered him unable to secure substantially gainful employment, and he had additional service-connected disabilities independently ratable at 60 percent or more. The Board noted the veteran's TDIU award based on persistent depressive disorder and other disabilities, satisfying the criteria for housebound SMC.

Rationale

Veteran's service-connected disabilities did not render him helpless; Veteran able to complete activities of daily living independently; Evidence weighs against need for regular aid and attendance

Full Decision Text

Citation Nr: A26040385
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 251212-614504
DATE: April 29, 2026

ORDER

Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance of another person is denied.

Entitlement to SMC at the housebound rate is granted subject to the laws and regulations governing the payment of monetary benefits.

FINDINGS OF FACT

1. The Veteran's service-connected disabilities do not render him so helpless as to require the regular aid and attendance of another person to perform personal care functions of everyday living or to protect him from the hazards and dangers incident to his daily environment.

2. Resolving all reasonable doubt in the Veteran's favor, it is factually ascertainable that his service-connected persistent depressive disorder alone rendered him unable to secure or follow a substantially gainful occupation, and he had additional service-connected disabilities, separate from the basis for the award of a total disability rating based on individual unemployability (TDIU), ratable at 60 percent or more throughout the relevant period.

CONCLUSIONS OF LAW

1. The criteria for SMC based on the need for regular aid and attendance of another person have not been met.  38 U.S.C. §§ 1114(l), 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.350, 3.352, 4.3.

2. The criteria for a SMC at the housebound rate have been met.  38 U.S.C. §§ 1114(s), 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.350, 3.352, 4.3.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1982 to March 1991.

These matters are before the Board of Veterans' Appeals (Board) on appeal from a December 2025 rating decision adjudicated under the Appeals Modernization Act (AMA) by a Department of Veterans Affairs (VA) Regional Office (RO).  

Within the framework of the AMA, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) and elected Direct Review by a Veterans Law Judge in December 2025.  The Board notes that under the direct review option, no additional evidence received after the appealed rating decision is to be considered; rather, review is limited to the evidence on record at the time of that decision.  38 C.F.R. §§ 19.2(d), 20.301.

In his December 2025 VA Form 10182, the Veteran indicated that he also wanted to appeal the disability rating assigned for his service-connected persistent depressive disorder and listed the "date of decision" as December 12, 2025.  However, the increased rating claim was not adjudicated in the December 2025 rating decision.  In this regard, the Board acknowledges that a September 2025 rating decision continued the 70 percent evaluation assigned for the Veteran's service-connected persistent depressive disorder; however, prior to the submission of the December 2025 VA Form 10182, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR) in September 2025 and that review option was still pending at the time the Veteran submitted his December 2025 VA Form 10182.  

Although multiple administrative reviews can be filed as to one Agency of Original Jurisdiction (AOJ) decision within one year of notice of that decision, concurrent election of review options is prohibited.  See 38 U.S.C. § 5104C(a) (permitting a claimant to pursue review options in succession with respect to a specific claim or issue, but prohibiting concurrent election of multiple review options); see also 38 C.F.R. § 3.2500(c)(1) (a claimant may file a supplemental claim, request higher-level review, or appeal to the Board); 84 Fed. Reg. 138, 142-43, 145 (Jan. 18, 2019) (stating that a claimant may request "one of the three review options" under 38 C.F.R. § 3.2500); Terry v. McDonough, 37 Vet. App. 1 (2023) (holding that section 5104C(a) provides more than one administrative review request may be filed within one year of notice of a decision so long as these administrative reviews do not run concurrently).

Here, the submission of the December 2025 VA Form 101
) (a claimant may file a supplemental claim, request higher-level review, or appeal to the Board); 84 Fed. Reg. 138, 142-43, 145 (Jan. 18, 2019) (stating that a claimant may request "one of the three review options" under 38 C.F.R. § 3.2500); Terry v. McDonough, 37 Vet. App. 1 (2023) (holding that section 5104C(a) provides more than one administrative review request may be filed within one year of notice of a decision so long as these administrative reviews do not run concurrently).

Here, the submission of the December 2025 VA Form 10182 did not include any indication that the Veteran wished to withdraw his September 2025 request for higher level review.  Thus, because the September 2025 higher-level review request was still pending and had not been withdrawn when the Veteran submitted his December 2025 VA Form 10182, the latter submission was an impermissible concurrent election as to his claim for entitlement to an increased rating for his service-connected persistent depressive disorder.  However, the December 2025 VA Form 10182 was a valid and timely appeal of the denial of entitlement to SMC, which was adjudicated in a December 2025 rating decision.  As such, the only issues currently before the Board are entitlement to SMC based on the need for regular aid and attendance of another person and at the housebound rate. 

Lastly, the Board acknowledges that the Veteran had the right to select a different Board review option by submitting a new VA Form 10182 within one year from the date the AOJ mailed the decision on appeal, or within 60 days of the date the Board received his VA Form 10182.  See 38 C.F.R. § 20.202(c)(2); see also Williams v. McDonough, 37 Vet. App. 305 (2024) (mandating the Board wait over a year to process direct docket cases unless waiver is submitted).  However, in his December 2025 VA Form 10182, the Veteran waived his right to select a different Board review option.  Accordingly, the Board will proceed with adjudicating the appeal.

1. Entitlement to SMC based on the need for regular aid and attendance of another person is denied.

As an initial matter, the Veteran filed a formal claim for entitlement to a SMC and indicated that he needed the regular aid and attendance of another person due to his service-connected disabilities in December 2018.  See December 2018 VA Form 21-526b, Veteran Supplemental Claim.  At that time, the Veteran had a pending claim for entitlement to an increased rating for his service-connected persistent depressive disorder, which had been continuously pursued.  Thus, the Board finds that the issue of entitlement to SMC was raised by the record and is part and parcel to his increased rating claims, which were filed on July 24, 2018.  See Rice v. Shinseki, 22 Vet. App. 447 (2009); Harper v. Wilkie, 30 Vet. App. 356 (2018); see also July 2018 VA Form 21-0966 Intent to File; July 2018 VA Form 21-526EZ, Fully Developed Claim (Compensation).  

SMC at the aid and attendance rate is payable when a 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.  See 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b).

The following will be accorded consideration in determining the need for regular aid and attendance: inability of the veteran 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 (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of veteran to feed himself through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the veteran from hazards or dangers incident to his daily environment.

It is not required that all the disabling conditions enumerated in 38 C.F.R. § 3.352(a) be found to exist before a favorable rating may be made.  The particular personal functions which the veteran is
 by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of veteran to feed himself through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the veteran from hazards or dangers incident to his daily environment.

It is not required that all the disabling conditions enumerated in 38 C.F.R. § 3.352(a) be found to exist before a favorable rating may be made.  The particular personal functions which the veteran is unable to perform should be considered in connection with his condition as a whole.  It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there is a constant need.  38 C.F.R. § 3.352(a); see also Turco v. Brown, 9 Vet. App. 222, 224 (1996) (noting that at least one factor listed in § 3.352(a) must be present for a grant of special monthly pension based on need for aid and attendance).

For the purposes of 38 C.F.R. § 3.352(a), "bedridden" will be a proper basis for the determination of whether a veteran needs the regular aid and attendance of another person.  "Bedridden" will be that condition which, through its essential character, requires that the Veteran remain in bed.  The fact that the Veteran has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice.  38 C.F.R. § 3.352(a).

Here, the Veteran has been awarded service connection for the following disabilities: persistent depressive disorder; obstructive sleep apnea (OSA); chronic lumbar strain with mild degenerative joint disease and degenerative disc disease of the lower lumbar spine (lumbar spine disability); right lower extremity radiculopathy, left lower extremity radiculopathy; painful bilateral feet scars; right fifth toe post-operative status with varus rotation of the fifth pharynx and hammertoes of the right second, third, fourth, and fifth toes and arthritis of the interphalangeal joint (right foot disability); left third toe post-operative status with hammertoes of the left second, third, fourth, and fifth toes and arthritis of the interphalangeal joint (left foot disability); right foot second toe scars; and left foot second and third toe scars.  See, e.g., December 2025 Rating Decision - Codesheet.  

Turning to the evidence of record, the Veteran reported that the combined effects of his service-connected acquired psychiatric disorder, lumbar spine disability, and foot disabilities prevented him from securing or following any substantially gainful occupation in October 2017.  In this regard, he stated that he last worked fulltime and became too disabled to work in 2016 and reported that his lumbar spine disability prevented him from standing for extended periods, lifting things, and bending.  He also indicated that his acquired psychiatric disorder impacted his ability to work and hold down a job.  With respect to past employment, the Veteran reported that he worked as a spray painter from April 1992 to January 1993, as a taxi driver from January 1993 to June 1995, and as a monitor from April 2015 to June 2016.  See November 2017 VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability.

In June 2018, the Veteran was admitted to a hospital for injuries sustained from falling out of a taxi and hitting his head after he "passed out" from alcohol intoxication.  He was subsequently diagnosed with acute alcohol intoxication and a large left subdural hematoma, a traumatic brain injury (TBI).  The Veteran spent approximately 26 days in the hospital before he was discharged to a health and rehabilitation nursing home for physical, occupational and speech therapy.  See July 2018 Medical Treatment Record - Non-Government Facility; August 2018 CAPRI.  He returned to his private residence in October 2018.  See October 2018 CAPRI.  The Board notes that the Veteran has not been awarded service connection for his diagnosed TBI; however, to the extent that the symptoms of the Veteran's service-connected persistent depressive disorder and his diagnosed TBI cannot be distinguished, the Board will consider them for the purpose of establishing entitlement to SMC.  See, e.g., September 2025 Rating Decision - Narrative.

In a June 2018 statement, the
 in the hospital before he was discharged to a health and rehabilitation nursing home for physical, occupational and speech therapy.  See July 2018 Medical Treatment Record - Non-Government Facility; August 2018 CAPRI.  He returned to his private residence in October 2018.  See October 2018 CAPRI.  The Board notes that the Veteran has not been awarded service connection for his diagnosed TBI; however, to the extent that the symptoms of the Veteran's service-connected persistent depressive disorder and his diagnosed TBI cannot be distinguished, the Board will consider them for the purpose of establishing entitlement to SMC.  See, e.g., September 2025 Rating Decision - Narrative.

In a June 2018 statement, the Veteran reported that he was experiencing memory loss, cognitive issues, and mobility issues.  See July 2018 VA Form 21-4138 Statement in Support of Claim.

A September 2018 mental health medication management note shows that the Veteran had a poor memory and that he was having difficulty concentrating and remembering things.  The examiner also noted defects in safety, problem solving, judgement, attention, impulsivity, and medication management.  However, she also stated that the Veteran was able to complete activities of daily living independently and to ambulate without using a cane or walker, despite chronic dizzy spells.  The examiner also noted the Veteran's sister's reports that she did not feel the Veteran could manage his own activities of daily living.  Specifically, she stated that she managed his medical appointments and bills and provided his transportation and indicated that she had called a corporate guardian to become his health care Power of Attorney.  See January 2019 CAPRI.

During a September 2018 speech pathology evaluation and management consultation, the Veteran reported that he was returning to live independently at his home the following week and indicated that he did not have any concerns related thereto.  However, the examiner noted that he spoke to the Veteran's in-patient speech language pathologist and sister in connection with the consultation.  In this regard, the pathologist expressed concern for the Veteran to return home alone and indicated that she was recommending that he be placed in an environment with constant supervision like a group home.  Similarly, the Veteran's sister stated that she was very concerned about the Veteran's plan to return home because of his significant memory deficits and questioned his safety and ability to take care of himself on his own.  Following the consultation, the examiner stated that the Veteran had good speech intelligibility, moderate deficits in receptive and expressive language, and likely moderate cognitive deficits, and recommended that he be placed in an environment with constant supervision.  See January 2019 CAPRI.

An October 2018 VA examination for back conditions indicates that the Veteran's service-connected lumbar spine disability would prevent him from doing heavy or medium duty work, climbing ladders, walking more than one block, and from standing for prolonged periods.  However, the examiner found that his lumbar spine disability would not prevent him from employment in a sedentary position and did not indicate that it would interfere with his activities of daily living.  See December 2018 C&P examination.

The Veteran also underwent a VA examination for mental disorders in October 2018.  The examiner found that the Veteran's persistent depressive disorder and TBI were manifested by occupational and social impairment due to mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress, or by symptoms controlled by medication.  She further stated that it was not possible to differentiate the symptoms or degree of social and occupational impairment attributable to his TBI and persistent depressive disorder.  

During the examination, the Veteran reported that he was able to shower and dress independently and stated that he was "some type of alcoholic" and involved in a relationship with a woman who physically abused him.  He indicated that he was working with a speech therapist and stated that he was still being watched by staff at the center where he lived as the determination for his initial blackout, which resulted in a TBI, was still undetermined.  In addition, the Veteran's sister stated that he used his disability income on others and hung out with "the wrong kind of people" because he wanted to feel needed.  On examination, the examiner found that the Veteran was oriented to person, place, and time and appeared casually groomed with adequate personal appearance and self-care skills.  His attention and concentration were fair throughout the examination, though his memory appeared to be poor related to recall of his June injury.  In addition, the examiner found that the Veteran was not competent to manage his own affairs and explained that his recent TBI with cognitive issues would make managing finances difficult.  See December 2018 C&P examination.  

In addition, during an October 2018 VA examination for TBI residuals, the examiner stated that the Veteran made a good recovery from his TBI and indicated that
the wrong kind of people" because he wanted to feel needed.  On examination, the examiner found that the Veteran was oriented to person, place, and time and appeared casually groomed with adequate personal appearance and self-care skills.  His attention and concentration were fair throughout the examination, though his memory appeared to be poor related to recall of his June injury.  In addition, the examiner found that the Veteran was not competent to manage his own affairs and explained that his recent TBI with cognitive issues would make managing finances difficult.  See December 2018 C&P examination.  

In addition, during an October 2018 VA examination for TBI residuals, the examiner stated that the Veteran made a good recovery from his TBI and indicated that he was living alone, performed activities of daily living independently, and drove himself to the appointment.  However, the examiner also noted that the Veteran ambulated with a cane.  See December 2018 C&P examination.

An October 2018 private long term care outcome record shows that the Veteran had returned home to live in his apartment without supervision and that he preferred to be as independent as possible.  The private provider further noted that the Veteran was independent with his finances, though he had a history of giving others money without receiving repayment and that he had been given permission to return to making his own financial and medical decisions in August 2018, after such was temporarily taken away following his June 2018 TBI.  He was also noted to be independent with using his home and physically very capable of meeting most of his personal care needs, caring for his apartment, and taking his medications as prescribed.  

At that time, the Veteran declined any need of help with grocery shopping and other household tasks, and the physician found that the Veteran would be successful with independent living as he was able to take medications as ordered, had not had any falls or injuries, and kept himself and his apartment clean and safe.  However, the private provider did note that the Veteran had been experiencing unsteadiness and dizziness related to lack of coordination and indicated that he could be safer with help when mopping, sweeping, and vacuuming.  See December 2018 Medical Treatment Record - Non-Government Facility.

In support of his claim, the Veteran submitted an examination for housebound status or permanent need for regular aid and attendance from Dr. Bhatia dated in December 2018.  Dr. Bhatia stated that the Veteran ambulated with an unsteady gait and found that his mild dermatitis, lumbar spine disability, and left knee disability restricted his activities and functions.  However, he also stated that the Veteran's bowel and bladder control were intact and found that he was able to feed himself, prepare his own meals, and bathe and tend to his other hygiene needs.  He also acknowledged that the Veteran had dizziness, poor balance, and mild memory loss but emphasized that he did not use aids for locomotion and continued to drive his own car and to do his own grocery shopping.  In addition, although Dr. Bhatia noted that a home care nurse went to the Veteran's home weekly to set up his medications, he also indicated that he was not confined to bed, did not require nursing home care, and continued to balance his bank account and to pay his own bills.  See January 2019 VA Form 21-2680 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance.

In a January 2019 letter, the Veteran stated that the December 2018 VA examination for mental disorders underreported that true severity of his service-connected persistent depressive disorder.  He further argued that the level of social and occupational impairment noted by the examiner was inaccurate because it failed to consider the Veteran's reports of suicidal ideation.  See January 2019 Third Party Correspondence.

During a January 2019 psychology consultation, the Veteran acknowledged trouble remembering conversations, misplacing and forgetting important items, and forgetting medication doses.  He also reported that he managed his own finances and appointments independently with occasional mistakes related to date and time, cooked for himself, cleaned his own house, and drove without incident though he occasionally missed his exits.  He also indicated that his daily and weekly activities included watching television, napping, and spending time with his girlfriend but endorsed feelings of boredom, anger, and frustration regarding his poor memory.  

In addition, during an interview with the Veteran's sister conducted in connection with the consultation, she reported that the Veteran experienced an abrupt cognitive decline and substantial personality changes following his head injury, and the examiner noted that the Veteran appeared disheveled and wore a snowsuit throughout the consultation.  Following the consultation, the examiner diagnosed major neurocognitive disorder, alcohol abuse/dependence, depression, and dysthymic disorder.  In this regard, she stated that test findings suggested that the Veteran was able to maintain structured daily routines but would benefit
 exits.  He also indicated that his daily and weekly activities included watching television, napping, and spending time with his girlfriend but endorsed feelings of boredom, anger, and frustration regarding his poor memory.  

In addition, during an interview with the Veteran's sister conducted in connection with the consultation, she reported that the Veteran experienced an abrupt cognitive decline and substantial personality changes following his head injury, and the examiner noted that the Veteran appeared disheveled and wore a snowsuit throughout the consultation.  Following the consultation, the examiner diagnosed major neurocognitive disorder, alcohol abuse/dependence, depression, and dysthymic disorder.  In this regard, she stated that test findings suggested that the Veteran was able to maintain structured daily routines but would benefit from assistance in managing complex instrumental activities of daily living.  She further stated that the Veteran exhibited disinhibition and poor judgment and noted that he made threatening statements in a public waiting room.  In this regard, she recommended activation of the Veteran's Power of Attorney for health care and a driving safety evaluation in light of his deficits in memory and executive function.  She also stated that the Veteran would benefit from increased structure and support at home.  See March 2019 CAPRI.

In an April 2019 affidavit, the Veteran reported that his service-connected lumbar spine and foot disabilities were manifested by severe pain, prevented him from climbing stairs and ladders, and impaired his ability to walk.  See May 2019 Hearing Related.

VA treatment records dated in May 2019 show that the Veteran lived alone, did his own cooking and cleaning, managed his own finances, and took his own medication daily, though a home health aide did come to his home once every other week to organize his medications.  The examiners further noted that the Veteran had memory impairments and some impairments of activities of daily living though he had been able to continue independently.  However, they also recognized that the Veteran's son had been activated as his power of attorney for healthcare decisions and that his son and sister helped with finances.  See May 2019 CAPRI.  However, in June 2019, the Veteran reported that he no longer needed home health aides to assist with medication management and indicated that his girlfriend and son were assisting with setting up his medications.  See July 2019 CAPRI. 

A May 2019 VA addendum medical opinion regarding the current severity of the Veteran's service-connected lumbar spine disability indicates that the Veteran had difficulty moving and sitting and was reportedly not able to bend or twist at all during flare-ups.  See March 2019 C&P examination; September 2019 Medical Opinion. 

VA treatment records dated in October 2019 and January 2020 show that the Veteran continued to live and function independently despite memory impairment and some impairments of activities of daily living.  See August 2020 CAPRI.

In a March 2020 affidavit, the Veteran reported that he felt more homicidal than suicidal due to his depression and indicated that he could not really be around people.  He further explained that his service-connected lumbar spine disability, radiculopathy, and bilateral foot disability symptoms prevented him from walking long distances, holding or carrying things for long periods, lifting heavy objects, and bending over to pick objects up off the floor.  He also indicated that his back went out on him and prevented him from standing approximately once per month and noted that there had been times when he had to be taken to the hospital by ambulance during episodes of severe back pain.  However, he also indicated that he went grocery shopping once per week, though he parked close to the building and used motorized carts to shop to avoid falling, and noted that he was able to bathe and dress himself despite barely being able to bend over to reach his feet and having to be cautious to avoid falling.  See March 2020 Correspondence.

A March 2020 initial evaluation/plan of care indicates that the Veteran's lumbar spine disability resulted in impairments with posture, gait, and lifting mechanics and caused deficits that limited his ability to perform tasks involving traversing stairs, bed mobility, bending, emptying the dishwasher, making his bed, carrying, vacuuming, sweeping, driving, lifting from the floor, lifting overhead, performing overhead tasks, jogging, exercising, golfing, pulling, pushing, squatting, walking, standing for more than 30 minutes, and sleeping for more than six hours.  See August 2020 VA Form 21-2680 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance.  However, the private provider did not indicate that the Veteran's lumbar spine disability prevented him from performing the above tasks.  

A September 2020 mental health outpatient medication management note shows that the Veteran had a major neurocognitive disorder, lived alone, and left his stove on multiple times when he left his residence.
, making his bed, carrying, vacuuming, sweeping, driving, lifting from the floor, lifting overhead, performing overhead tasks, jogging, exercising, golfing, pulling, pushing, squatting, walking, standing for more than 30 minutes, and sleeping for more than six hours.  See August 2020 VA Form 21-2680 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance.  However, the private provider did not indicate that the Veteran's lumbar spine disability prevented him from performing the above tasks.  

A September 2020 mental health outpatient medication management note shows that the Veteran had a major neurocognitive disorder, lived alone, and left his stove on multiple times when he left his residence.  He also reported a history of falls and indicated that he continued to drive his car.  After performing an examination, the examiner expressed concerns related to the Veteran's memory and safety and noted that he had not been able to contact the Veteran's son.  In this regard, the examiner indicated that he contacted Adult Protective Services (APS) because the Veteran may need guardianship, protective placement, or a court appointed guardian.  The following month, the Veteran's son noted that the Veteran's house was usually clean and well stocked with food but expressed support of increased assistance or possibly a nursing home placement for the Veteran.  In this regard, the examiner noted that APS was involved in the Veteran's case and continued to express his opinion that the Veteran may need a protective placement or a court appointed guardian.  However, he also noted that the Veteran was not interested and that no changes were made at that time.  Similar findings were recorded in November 2020, January 2021, and May 2021.  See August 2021 CAPRI.

The Veteran next underwent a VA examination for mental disorders in October 2020.  The examiner diagnosed persistent depressive disorder and a TBI and found that they were manifested by occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or by symptoms controlled by medication.  In this regard, the examiner indicated that it was not possible to differentiate the symptoms or level of social and occupational impairment attributable to the Veteran's TBI from those associated with his service-connected persistent depressive disorder.

During the examination, the Veteran reported that he lived independently in an apartment and indicated that he had been able to maintain his housing on his own.  He further stated that he cleaned independently, ate regular meals, and was financially "okay" but acknowledged concerns related to memory and forgetting about leaving food on the stove.  In addition, the examiner found that the Veteran was casually-groomed with adequate personal appearance and self-care skills.  His attention and concentration were fair with poor memory related to events related to his June 2018 TBI.  The examiner also stated that the Veteran appeared somewhat unstable in his gait and ambulated with a cane but found that he denied suicidal ideation and any thoughts of hurting others.  Following the examination, the examiner found that the Veteran was competent to manage his financial affairs.  See October 2020 C&P examination.

The Veteran also underwent a VA examination for back conditions in October 2020.  The examiner found that the Veteran's service-connected lumbar spine disability prevented him from lifting, pulling, pushing, or carrying items that weighed more than five pounds and from performing maneuvers that required bending or twisting at the waist.  See October 2020 C&P examination.

The Veteran underwent VA examinations for lumbar spine conditions, foot conditions, and scars/disfigurement in March 2021.  The examiners found that the Veteran's service-connected lumbar spine and foot disabilities affected his ability to walk for extended periods, sit, stand, and bend at the waist to pick up items from ground level, but indicated that his service-connected scars did not result in functional impairment.  See August 2021 C&P examination.

In addition, following a March 2021 VA examination for sleep apnea, the examiner found that the Veteran's insomnia and sleep apnea could cause difficulty when attempting to focus on work related tasks especially tasks that required mental focus and concentration.  See August 2021 C&P examination.

The Veteran also underwent a VA examination for mental disorders in July 2021.  The examiner diagnosed persistent depressive disorder manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood but indicated that she did not find any evidence of a diagnosed TBI in the records reviewed.  The examiner found that the Veteran's persistent depressive disorder was manifested, in pertinent part, by impairment of short and long term memory, for example, retention of only highly learned material, while forgetting to complete tasks, inability to establish and maintain effective relationships, and intermittent inability to perform activities of daily living
 tasks especially tasks that required mental focus and concentration.  See August 2021 C&P examination.

The Veteran also underwent a VA examination for mental disorders in July 2021.  The examiner diagnosed persistent depressive disorder manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood but indicated that she did not find any evidence of a diagnosed TBI in the records reviewed.  The examiner found that the Veteran's persistent depressive disorder was manifested, in pertinent part, by impairment of short and long term memory, for example, retention of only highly learned material, while forgetting to complete tasks, inability to establish and maintain effective relationships, and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene.  Following the examination, the examiner found that the Veteran was capable of managing his own financial affairs.  See July 2021 C&P examination.

VA obtained an addendum medical opinion in July 2021.  At that time, the examiner acknowledged that the Veteran had been diagnosed with a TBI and found that his persistent depressive disorder symptoms and TBI symptoms were comorbid and could not be differentiated.  The examiner also acknowledged that the Veteran's memory was impaired but found that he was competent to care for himself.  In this regard, she emphasized that the Veteran was living alone and managing his own funds.  See July 2021 C&P examination.

Following an August 2021 VA examination for traumatic brain injuries, the examiner found that the Veteran's TBI residuals, to include his limitations in comprehension and behavioral irregularities, would make it very difficult for him to find or keep any employment.  See September 2021 C&P examination.

The Veteran underwent a VA aid and attendance or housebound examination in December 2021.  During the examination, the Veteran reported that he lived in an apartment and drove locally to purchase groceries and other necessities.  He also indicated that he watched television most of the day and ate meals that he prepared on his own.  The examiner found that the Veteran was not restricted to his home or its immediate vicinity or hospitalized and did not require an attendant in reporting to the examination.  In addition, the Veteran indicated that he handled money and paid bills for himself and denied any complaints of dizziness, loss of memory, poor balance, and the examiner noted that he was adequately groomed and able to perform all self-care skills.  The examiner also indicated that the Veteran was able to bend, dress, and walk without assistance.  See January 2022 CAPRI.

The Veteran next underwent a VA examination for mental disorders in January 2022.  The examiner found that the Veteran's persistent depressive disorder and TBI were manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood.  In this regard, the examiner found that it was not possible to differentiate the symptoms and level of functional impairment attributable to the Veteran's persistent depressive disorder from those associated with his TBI without speculation.  The Veteran reported that he had a home health aide who regularly managed his medication and described an occasion when he forgot to turn off his stove while he was boiling water and left it on overnight. However, he explained that his nurse taught him techniques to help him recall turning off the stove and noted that he kept a very clean apartment.  He also reported that he had been considering bombing a courthouse commission for 32 years due to past issues related to child support and visitation, though he also acknowledged that he did not have any access to explosives.

The examiner noted the following symptoms: impairment of short and long term memory, for example, retention of only highly learned material, while forgetting to complete tasks; difficulty in understanding complex commands; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work like setting; inability to establish and maintain effective relationships; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene.  The examiner further stated that the Veteran presented with a flight of ideas, provided tangential responses, and frequently needed to be redirected to the initial question.  He also demonstrated poor insight and judgment and was found to be a poor historian.

Following the examination, the examiner reported that he contacted the physician helpline for assistance and indicated that the individual he spoke to requested an email detailing the Veteran's comments related to homicidal ideation and indicated that he was going to seek consultation regarding the need to report to authorities.  In this regard, the examiner noted that the Veteran reported that he had been experiencing homicidal ideation for approximately 32 years but emphasized that there had been no mention of homicidal ideation in his previous VA examination reports and that his children were in their 40s and 50s.  He further noted the Veteran's reports that he would blow up
 to the initial question.  He also demonstrated poor insight and judgment and was found to be a poor historian.

Following the examination, the examiner reported that he contacted the physician helpline for assistance and indicated that the individual he spoke to requested an email detailing the Veteran's comments related to homicidal ideation and indicated that he was going to seek consultation regarding the need to report to authorities.  In this regard, the examiner noted that the Veteran reported that he had been experiencing homicidal ideation for approximately 32 years but emphasized that there had been no mention of homicidal ideation in his previous VA examination reports and that his children were in their 40s and 50s.  He further noted the Veteran's reports that he would blow up the courthouse but emphasized that he did not have the knowledge or means to access explosives.  The examiner also noted that the Veteran reported beliefs that the state of Wisconsin and the Navy were conspiring against him to limit his involvement with his children.  See January 2022 C&P examination.  

A January 2024 social work outpatient evaluation and management note shows that APS contacted VA to state that they were seeking guardianship on behalf of the Veteran.  However, VA treatment records dated from April 2023 to August 2025 show that the Veteran continued to live independently and to manage his apartment and perform activities of daily living without assistance, though he was noted to be receiving help with medication management.  See March 2024 CAPRI; July 2024 CAPRI; September 2025 CAPRI.

The Veteran also underwent a VA examination for mental disorders in November 2024.  The examiner found that the Veteran's diagnosed persistent depressive disorder and TBI were manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood and found that it was not possible to distinguish the symptoms and level of functional impairment associated with his persistent depressive disorder from those associated with his TBI.  During the examination, the Veteran reported that he lived alone but noted that he was sending money to a 31 year old woman every month because she promised that she would "give him sex" one day.  He further explained that he had not met the woman but spoke to her on an app.  The Veteran's symptoms included difficulty in understanding complex commands, impaired judgment, impaired abstract thinking, and difficulty in establishing and maintaining effective work and social relationships.  The examiner also indicated that the Veteran's abstract thought, judgment, memory, and concentration were compromised, but found that he was capable of managing his own financial affairs.  See November 2024 CAPRI.

During a January 2025 visit from a home healthcare nurse, the Veteran waived a knife around and reported that he used it on himself to excise dry skin while she was attempting to prepare his medications.  She further explained that he continued to handle and brandish the knife after she asked him to put it away and indicated that he refused to show her any of the spots where he reportedly used it on himself.  See July 2025 VAMC Other Outpatient/Reports.  The following month, the Veteran was seen for confusion and home safety issues with self-care.  In this regard, the examiner indicated that the Veteran was visited by home healthcare nurses several times per week but noted that the providers had to come in pairs due to concerning behaviors, to include brandishing a knife.  The examiner also noted that the Veteran reported that he was chatting with Ukrainian women online, though he denied sending them money.  He also indicated that he almost caused a fire at home in the preceding week because he forgot about brats he was boiling.  However, he also stated that he wanted to remain independent until death.  See July 2025 VAMC Other Output/Reports.  

The Veteran next underwent a VA aid and attendance or housebound examination in November 2025.  The examiner noted that the Veteran had been diagnosed with sleep apnea, a lumbar spine disability, a right shoulder disability, and chronic obstructive pulmonary disease (COPD), but indicated that none of his diagnoses were considered permanent and totally disabling.  In this regard, the examiner noted that a nurse came to his apartment once per month to up his medications for 30 days and checks his vital signs but indicated that he did not require assistance with bathing/showering, eating or self-feeding, dressing, ambulating within his home, tending to hygiene needs, transferring in or out of a bed or chair, toileting, or with additional activities.  The examiner further noted that the Veteran took a medical transportation van to his medical appointments, though he drove to the examination and was able to drive to the grocery store as needed.  She also found that the Veteran had the mental capacity to manage his benefit payments or to direct someone to do so.  See November 2025 C&P
  In this regard, the examiner noted that a nurse came to his apartment once per month to up his medications for 30 days and checks his vital signs but indicated that he did not require assistance with bathing/showering, eating or self-feeding, dressing, ambulating within his home, tending to hygiene needs, transferring in or out of a bed or chair, toileting, or with additional activities.  The examiner further noted that the Veteran took a medical transportation van to his medical appointments, though he drove to the examination and was able to drive to the grocery store as needed.  She also found that the Veteran had the mental capacity to manage his benefit payments or to direct someone to do so.  See November 2025 C&P examination.

In a November 2025 letter, Dr. Schleevogt stated that the Veteran had long demonstrated an inability to adequately manage his VA financial benefits to the detriment of his own wellbeing.  In support of his opinion, Dr. Schleevogt explained that the Veteran had a documented history of being financially exploited by women whom he had never met, to include sending them all of his monthly VA benefits, which had left him in situations where he was unable to pay utility bills and other necessities.  See November 2025 Care Expense Statement.

Lastly, VA obtained an aid and attendance or housebound examination in December 2025.  The examiner indicated that she reviewed the evidence of record but did not perform an in-person examination. The examiner noted that the Veteran had been diagnosed with dementia and required medication management but indicated that no diagnoses were considered permanent or totally disabling.  In this regard, the examiner noted that a nurse came to his apartment once per month to up his medications and to check his vital signs but indicated that he did not require assistance with bathing/showering, eating or self-feeding, dressing, ambulating within his home, tending to his hygiene needs, transferring in or out of a bed or chair, toileting, or with additional activities.  She also indicated that the Veteran was able to perform self-care, travel beyond the premises of his home, to include driving himself to the grocery store, and to manage his own disability payments or to direct someone else to do so.  See December 2025 C&P examination.

Following a review of the evidence of record, the Board finds that the evidence demonstrates that the Veteran does not require the regular aid and attendance of another person as a result of his service-connected disabilities.  

In this regard, the Board acknowledges that the Veteran spent approximately 26 days in the hospital following his June 2018 TBI and subsequently resided at a health and rehabilitation nursing home for physical, occupational and speech therapy until he returned to his private residence in October 2018.  However, the Board emphasizes that the Veteran has not been awarded service connection for his diagnosed TBI, and the evidence of record, to include the September 2018 mental health medication management note, shows that the Veteran was able to complete activities of daily living independently while he was receiving in-patient treatment, despite reports from his sister and son that he was not able to do so.  Thus, the Board finds that the evidence of record does not reflect that the Veteran's service-connected disabilities, to include persistent depressive disorder, rendered him unable to protect himself from the daily hazards of living during the above period.  

The Board further notes that the Veteran's son has been his Power of Attorney for medical decisions since 2019 and that he has intermittently been found to have difficulty performing some activities of daily living and to be incapable of managing his own finances.  In addition, the Board acknowledges that the medical evidence of record includes multiple treatment records recommending that the Veteran be kept under constant supervision, appointed a guardian, or otherwise receive assistance with completing activities of daily living.  In addition, APS has been contacted on the Veteran's behalf and is involved in his case.  However, the Board emphasizes that the Veteran has also consistently been found to be capable of performing activities of daily living independently, with some assistance from home healthcare nurses who assist with preparing his medications, and that, with the exception of the time he spent in the hospital and at the rehabilitation facility, he has lived alone in an apartment without the regular aid and assistance of any other persons throughout the relevant period.  

In this regard, the Board acknowledges that the Veteran receives home healthcare services to assist with medication management.  However, with the exception of the February 2025 medical record, the evidence shows that the Veteran was visited by home healthcare aides and/or nurses, at most, once per week throughout the relevant period and that their services were limited to assisting with medication management and taking the Veteran's vital signs.  As such, the Board finds that the evidence of record weighs against finding that the Veteran was mentally incapacitated, unable to attend to his own wants of nature, and/or unable to dress or und
 hospital and at the rehabilitation facility, he has lived alone in an apartment without the regular aid and assistance of any other persons throughout the relevant period.  

In this regard, the Board acknowledges that the Veteran receives home healthcare services to assist with medication management.  However, with the exception of the February 2025 medical record, the evidence shows that the Veteran was visited by home healthcare aides and/or nurses, at most, once per week throughout the relevant period and that their services were limited to assisting with medication management and taking the Veteran's vital signs.  As such, the Board finds that the evidence of record weighs against finding that the Veteran was mentally incapacitated, unable to attend to his own wants of nature, and/or unable to dress or undress himself/keep himself ordinarily clean and presentable at any time during the period on appeal.

Moreover, the evidence of record does not reflect that the Veteran's impairments render him unable to protect himself from the daily hazards of living.  To the contrary, the evidence shows that the Veteran continued to drive, perform his own grocery shopping, and to live independently in an apartment.

Based on the foregoing, the Board finds that the Veteran's service-connected disabilities have not rendered him so helpless as to need regular aid and attendance of another and the evidence does not show that the Veteran is bedridden.  Accordingly, as there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and entitlement to SMC based on the need for regular aid and attendance is denied.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (2021).

2. Entitlement to SMC at the housebound rate is granted subject to the laws and regulations governing the payment of monetary benefits.

If the Veteran does not qualify for increased benefits for aid and attendance, increased compensation benefits may still be payable if the Veteran is able to establish entitlement to SMC based on housebound status under 38 U.S.C. § 1114(s).  Specifically, SMC may be warranted 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.  38 U.S.C. § 1114(s); see Bradley v. Peake, 22 Vet. App. 280 (analyzing 38 U.S.C. § 1114(s)).

The law requires one single disability rated at 100 percent (including TDIU for a single disability) and an additional disability or disabilities at a 60 percent rating.  38 U.S.C. § 1114(s).  Several different disabilities, regardless of whether they are of the same bodily system or from the same accident, do not qualify as a single disability within the meaning of the law.  See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011) ("[A] total disability rating based on individual unemployability that is based on multiple underlying disabilities cannot satisfy the section 1114(s) requirement of 'a service-connected disability' because that requirement must be met by a single disability."); see also VA Gen. Coun. Prec. Op. 66-91 (Aug. 15, 1991) (holding that several separately ratable disabilities cannot be combined to achieve a single total (100 percent) rating in order to qualify for the special monthly compensation, even if based on a single disease entity or process).

In the present case, the Veteran has been awarded service connection for the following disabilities: persistent depressive disorder rated as 30 percent disabling from November 5, 2013 to June 1, 2018 and as 70 percent disabling thereafter; OSA rated as 50 percent disabling as of November 5, 2013; a lumbar spine disability rated as 20 percent disabling from September 17, 2013 to July 20, 2017 and as 40 percent disabling thereafter; right lower extremity radiculopathy rated as 20 percent disabling as of March 31, 2021; left lower extremity radiculopathy rated as 20 percent disabling as of March 31, 2021; painful bilateral feet scars rated as 20 percent disabling as of March 31, 2021; a right foot disability rated as 10 percent disabling as of February 19, 2008; a left foot disability rated as noncompensable from February 9 2008 to July 27, 2012 and as 10 percent disabling thereafter; right foot second toe scars rated as noncompensable as of March
 July 20, 2017 and as 40 percent disabling thereafter; right lower extremity radiculopathy rated as 20 percent disabling as of March 31, 2021; left lower extremity radiculopathy rated as 20 percent disabling as of March 31, 2021; painful bilateral feet scars rated as 20 percent disabling as of March 31, 2021; a right foot disability rated as 10 percent disabling as of February 19, 2008; a left foot disability rated as noncompensable from February 9 2008 to July 27, 2012 and as 10 percent disabling thereafter; right foot second toe scars rated as noncompensable as of March 31, 2021; and left foot second and third toes scars rated as noncompensable as of March 31, 2021.  

The Board further notes that the Veteran had a combined schedular disability rating of 80 percent from November 5, 2013 to June 1, 2018; of 90 percent from June 1, 2018 to March 31, 2021; and as 100 percent disabling thereafter.  In addition, the Veteran has been granted entitlement to a TDIU based on the combined effects of his service-connected disabilities effective July 20, 2017.  See December 2025 Rating Decision - Codesheet; see also January 2023 Rating Decision - Narrative.  As such, the issue of whether the Veteran is entitled to a TDIU based solely upon a single service-connected disability for the purpose of entitlement to SMC.

Following a review of the evidence of record, to include the evidence discussed in the section above, and after resolving reasonable doubt in the Veteran's favor, the Board concludes it is factually ascertainable that the Veteran's persistent depressive disorder, alone, precluded him from obtaining and maintaining substantially gainful employment throughout the period on appeal.  In this regard, the evidence shows that the symptoms and degree of functional impairment caused by the Veteran's persistent depressive disorder and TBI cannot be separated and that these disabilities alone prevented the Veteran from securing or following any substantially gainful employment throughout the relevant period.  The Board further notes that the Veteran has had additional service-connected disabilities independently ratable at 80 precent prior to March 31, 2021 and at 90 percent thereafter.   

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Based on the foregoing, the Board finds SMC at the housebound rate is warranted throughout the period on appeal as the Veteran had both a TDIU as the result of a single service-connected disability (persistent depressive disorder) and additional service-connected disabilities that are independently rated at 60 percent or more.  Thus, the Board finds that entitlement to SMC at the housebound rate pursuant to 38 U.S.C. § 1114(s) is warranted.  The claim is granted.

 

 

S. HENEKS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Justis, Counsel

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.