Case A26040506

Summary

The Veteran, who served from March 1966 to January 1969, including service in Vietnam, appeals the denial of additional special monthly compensation (SMC). The Veteran sought SMC at the (r) rate, asserting it was raised as part of a claim for an increased rating for PTSD with major depressive disorder. The Board reviewed the evidence, including a September 2025 rating decision and a June 2025 VA examination report. The VA examiner noted the Veteran's total social and occupational impairment due to PTSD, including memory loss, impaired judgment, neglect of hygiene, and intermittent inability to perform daily activities. The examiner also recorded the spouse's credible statements about the Veteran's hallucinations, delusions, and disorientation, and her role as primary caregiver assisting with bathing, toileting, and medication management. The Board found that the Veteran's PTSD alone warranted SMC at the (l) rate. Because the Veteran was already granted SMC(l) due to loss of use of both feet from Parkinson's disease, this established entitlement to SMC(o). The Board further found that the Veteran's need for regular aid and attendance from his spouse due to both the loss of use of his feet and his PTSD symptoms met the criteria for SMC(r)(2). Therefore, the Board granted entitlement to SMC at the (o) and (r)(2) rates, effective January 19, 2025.

Rationale

Veteran found to have suffered disability under conditions entitling to two awards of SMC(l); Resolving all reasonable doubt in Veteran's favor; SMC(o) granted effective January 19, 2025

Full Decision Text

Citation Nr: A26040506
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250928-583442
DATE: April 30, 2026

ORDER

Entitlement to special monthly compensation (SMC) at the (o) rate under 38 U.S.C. § 1114 is granted, effective January 19, 2025, subject to the laws and regulations governing the award of monetary benefits.

Entitlement to SMC at the (r)(2) rate under 38 U.S.C. § 1114 is granted, effective January 19, 2025, subject to the laws and regulations governing the award of monetary benefits.

FINDINGS OF FACT

1. Resolving all reasonable doubt in the Veteran's favor, the Veteran has suffered disability under conditions which would entitle him to two awards of SMC at the (l) rate without consideration of any condition twice.

2. The Veteran is entitled to an additional monthly allowance of SMC at the (r)(2) rate based on entitlement to the maximum rate under subsection (o) and the need for aid and attendance at and a higher level of care.

CONCLUSIONS OF LAW

1. The criteria for an award of SMC(o) based on the presence of two SMC(l) awards are met from January 19, 2025. 38 U.S.C. § 1114(o); 38 C.F.R. § 3.350.

2. The criteria for an award of SMC(r)(2) based on the award of SMC(o) and the need for a higher level of aid and attendance care are met from January 19, 2025. 38 U.S.C. § 1114(r)(2); 38 C.F.R. §§ 3.350, 3.352.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1966 to January 1969, to include service in Vietnam. For his meritorious service, the Veteran earned two Purple Hearts, the Vietnam Campaign Medal, and the Vietnam Service Medal, among other awards and decorations.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2025 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO).

In a September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. 

Therefore, the Board may only consider the evidence of record at the time of the September 2025 agency of original jurisdiction (AOJ) decision, as well as any evidence submitted by the appellant, who is proceeding pro se, with, or within 90 days from receipt of, the September 2025 VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the September 2025 decision on appeal and prior to the date the Board received the VA Form 10182 or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim(s), considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.902(c). See 38 U.S.C. § 7107(b)(1).

1. Entitlement to SMC at the (o) rate under 38 U.S.C. § 1114 is granted, effective January 19, 2025.

2. Entitlement to SMC at the (r)(2) rate under 38 U.S.C. § 1114 is granted, effective January 19, 2025.

The Veteran asserts that he is entitled to additional special monthly compensation (SMC) payment. See September 2025 VA Form 10182. Specifically, the Veteran contends that he is entitled to SMC at the (r) rate, or SMC(r), an issue that he asserts was raised part and parcel of a January 2025 claim for an increased rating for
).

1. Entitlement to SMC at the (o) rate under 38 U.S.C. § 1114 is granted, effective January 19, 2025.

2. Entitlement to SMC at the (r)(2) rate under 38 U.S.C. § 1114 is granted, effective January 19, 2025.

The Veteran asserts that he is entitled to additional special monthly compensation (SMC) payment. See September 2025 VA Form 10182. Specifically, the Veteran contends that he is entitled to SMC at the (r) rate, or SMC(r), an issue that he asserts was raised part and parcel of a January 2025 claim for an increased rating for service-connected posttraumatic stress disorder (PTSD) with major depressive disorder. See September 2025 VA Form 10182; October 2025 Statement in Support of Claim; see also January 2025 VA Form 21-526EZ.

The U.S. Court of Appeals for Veterans Claims has held that VA has a "well-established" duty to maximize a claimant's benefits. Buie v. Shinseki, 24 Vet. App. 242 (2010); Bradley v. Peake, 22 Vet. App. 280 (2008). This duty to maximize benefits requires VA to assess all of a claimant's disabilities to determine whether any combination of disabilities establishes entitlement to SMC under 38 U.S.C. § 1114. Bradley, 22 Vet. App. at 294. 

Veterans may have additional disabling conditions that warrant extra compensation beyond the compensation provided by 38 C.F.R. Part 4. The details of these SMC provisions are listed in 38 U.S.C. § 1114(k)-(t). Demonstrating eligibility for SMC requires a veteran to show specific disabling conditions.

In a June 2025 rating decision, the Veteran was granted SMC based on the need for aid and attendance, or SMC(l), due to the loss of use of both feet, effective January 19, 2025. See June 2025 Rating Decision. The Board notes that the Veteran is service-connected for Parkinson's disease with loss of use of both feet with balance impairment associated with bradykinesia, left lower extremity. The disorder is rated 100 percent disabling. See September 2025 Rating Decision - Codesheet.

Also in the June 2025 decision, the Veteran was awarded SMC at the (m) rate for additional single permanent disability or combination of permanent disabilities that are independently ratable at 50 percent or 100 percent disabling pursuant to 38 U.S.C. § 1114(p) and 38 C.F.R. § 3.350(f)(4). The agency of original jurisdiction (AOJ) explained that it based that decision on numerous service-connected disabilities, including the Parkinson's disease with loss of use of both feet and PTSD disabilities. The Board finds that entitlement to SMC(m) is warranted even without consideration of the service-connected Parkinson's disease with loss of use of both feet and PTSD disabilities. 

For the following reasons, the Board finds that an additional entitlement to SMC(l) based solely on PTSD is warranted such that SMC at the (o) rate as well as SMC at the (r)(2) rate, both under 38 U.S.C. § 1114, is warranted. 

SMC at the aid and attendance rate, or SMC(l), 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 need regular aid and attendance. See 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). In other words, as relevant to this appeal, SMC(l) is assigned when there is a factual need for regular aid and attendance due to a service-connected disability.

Pursuant to 38 C.F.R. § 3.350(b)(3) and (4), the criteria for determining that a veteran is so helpless as to need regular aid and attendance, including a determination that he is permanently bedridden, are contained in 38 C.F.R. § 3.352(a). That regulation provides that, in determining the need for regular aid and attendance, the following criteria will be considered: 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 to feed himself through the loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of
.350(b)(3) and (4), the criteria for determining that a veteran is so helpless as to need regular aid and attendance, including a determination that he is permanently bedridden, are contained in 38 C.F.R. § 3.352(a). That regulation provides that, in determining the need for regular aid and attendance, the following criteria will be considered: 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 to feed himself through the 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 him from hazards or dangers incident to his daily environment. 38 C.F.R. § 3.352(a).

"Bedridden" is defined as that condition which, through its essential character, requires that a claimant remain in bed, and is a proper basis for this determination. The fact that a claimant 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.

It is not required that all the above disabling conditions be found to exist before a favorable rating may be made. The particular personal functions that a 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 a veteran is so helpless as to need regular aid and attendance, not that there is a constant need.

Determinations that a veteran is so helpless as to need regular aid and attendance will not be based solely upon an opinion that his condition is such as would require him to be in bed. They must be based on the actual requirement of personal assistance from others. See 38 C.F.R. § 3.352(a).

Thus, the Board must determine whether the Veteran requires regular aid and attendance and if so, whether the reason for the need is a service-connected disability or disabilities. See 38 U.S.C. § 1114(l).

As discussed above, the initial SMC(l) award was based on the Veteran's loss of use of both feet due to Parkinson's disease. See June 2025 Rating Decision. 

Turning to the evidence, a June 2025 VA examiner indicated that the Veteran has total social and occupational impairment due to his service-connected mental health disorder. The examiner further found mild memory loss, impaired judgment, difficulty in understanding complex commands, neglect of personal appearance and hygiene, and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene, to be among the numerous symptoms stemming from the PTSD. See June 2025 VA Examination Report. 

The June 2025 VA examiner also recorded the credible statements of the Veteran's spouse regarding the Veteran's mental health history, to include that he has some hallucinations, delusions, and disorientation, and that she has been paying the bills and making a lot of decisions on behalf of the Veteran due to his cognitive and memory issues. See id. 

VA medical records reveal that the Veteran's spouse serves as his primary caregiver and aids the Veteran in many activities of daily living, including bathing, toileting, and medication management, among numerous others. See, e.g., August 2025 and September 2025 VA Medical Records. 

Based on the evidence and resolving all reasonable doubt in the Veteran's favor, the Board finds that SMC(l) based solely on the PTSD disability is warranted. 

SMC at the (o) rate is awarded if a veteran, as the result of service-connected disabilities, has suffered disability under conditions that would entitle him or her to two or more of the rates provided in one or more of subsections (l) through (n), no condition being considered twice in the determination. 38 U.S.C. § 1114(o); 38 C.F.R. § 3.350(e).

Thus, the Veteran has been found to have suffered disability under conditions which would entitle him to two awards of SMC at the (l) rate without consideration of any condition twice. Therefore, entitlement to SMC(o) from January 19, 2025, the date of the underlying claim, is warranted.

Further, with the above grant of SMC at the (o) rate, the Veteran meets the threshold requirement for SMC at the (r) rate. A veteran who meets the threshold requirement for SMC(r) may receive an additional allowance under 38 U.S.C. § 1114(r)(1) or (r)(2).

SMC(r)(1) (special aid and attendance) applies where a veteran is entitled to compensation authorized under SMC(o), at the
 conditions which would entitle him to two awards of SMC at the (l) rate without consideration of any condition twice. Therefore, entitlement to SMC(o) from January 19, 2025, the date of the underlying claim, is warranted.

Further, with the above grant of SMC at the (o) rate, the Veteran meets the threshold requirement for SMC at the (r) rate. A veteran who meets the threshold requirement for SMC(r) may receive an additional allowance under 38 U.S.C. § 1114(r)(1) or (r)(2).

SMC(r)(1) (special aid and attendance) applies where a veteran is entitled to compensation authorized under SMC(o), at the maximum rate authorized under SMC(p), or at the intermediate rate authorized under subsections (n) and (o) and at the rate authorized under subsection (k) and is in need of regular aid and attendance. 38 U.S.C. § 1114(r); 38 C.F.R. § 3.350(h).

SMC(r)(2) (higher special aid and attendance) applies when, as a result of a service-connected disability, a veteran otherwise entitled to SMC at the (l) rate needs in-home personal health-care services provided by a person who either (1) is licensed to provide such services; or (2) provides such services under the regular supervision of a licensed health-care professional.

Based on the evidence, the Board finds that entitlement to SMC(r)(2) is warranted, as the Veteran requires substantial care from his spouse due to his loss of use of both feet and PTSD symptoms. Additionally, it is reasonable to infer that the Veteran is dependent on his spouse for most activities of daily living, to include taking medication, driving, attending medical and other appointments, preparing meals, and managing finances, as a result of those severe deficiencies. Moreover, the record shows that the Veteran's spouse appears to attend most of the Veteran's medical appointments to provide clinicians with the Veteran's medical history and current symptoms and obtain the Veteran's treatment plans, in which she is actively involved in implementing. See, e.g., August 2025 and September 2025 VA Medical Records; August 2025 VA Form 21-2680.

Based on the foregoing and resolving all reasonable doubt in the Veteran's favor, entitlement to SMC(o) as well as SMC(r)(2) under 38 U.S.C. § 1114 is warranted, effective January 19, 2025, subject to the laws and regulations governing the award of monetary benefits. The appeal is therefore granted.

 

 

J. NICHOLS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C.Z. Noh

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.