BVA9504657 DOCKET NO. 93-08 506 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Manila, Philippines THE ISSUE Entitlement to special monthly pension based on the need for regular aid and attendance or housebound status. WITNESSES AT HEARING ON APPEAL The appellant and her son ATTORNEY FOR THE BOARD Michael Martin, Counsel INTRODUCTION The veteran had active service from November 1945 to May 1965. He died in June 1986. The appellant is the veteran's surviving spouse. This matter came before the Board of Veterans' Appeals (Board) on appeal from a decision of May 1992 by the Department of Veterans Affairs (VA) Manila, Philippines, Regional Office (RO). CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that the RO made a mistake by denying her claim for pension benefits. She asserts that she has arthritis of the hands which prevent her from doing many things around the house such as cooking. She also states that she thinks that she may have low blood pressure which causes headaches and breathlessness. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the claim for a special monthly pension. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the appellant's appeal has been obtained. 2. The appellant's principal disability is a disorder of the hands and wrists. 3. The appellant is not 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; and is not a patient in a nursing home because of mental or physical incapacity. 4. The appellant is able to care for her daily personal needs without assistance from others and is able to protect herself from the hazards of daily living. 5. The appellant does not have one disability ratable as 100 percent disabling, and another separate disability ratable at 60 percent disabling. 6. The appellant is not substantially confined to her house or immediate premises as a result of physical or mental disability. CONCLUSION OF LAW The requirements for a special monthly pension based on the need for regular aid and attendance or housebound status are not met. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. §§ 3.351, 3.352 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board finds that the appellant's claim is "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, the claim is not inherently implausible. The Board is also satisfied that all relevant evidence has been properly developed. The appellant has been afforded a personal hearing and a VA disability evaluation examination. Her medical treatment records have been obtained. The Board does not know of any additional relevant evidence which is available. Therefore, all evidence necessary for an equitable disposition of the appellant's appeal has been obtained, and no further assistance to the appellant with the development of evidence is required. Increased pension is payable to a surviving spouse who has a need for regular aid and attendance, or who is housebound. See 38 C.F.R. § 3.351(a)(5) (1994). The need for regular aid and attendance means helplessness or being so helpless as to require the regular aid and attendance of another person. The claimant will be considered to be in need of regular aid and attendance if he or she (1) is blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less; or (2) is a patient in a nursing home because of mental or physical incapacity; or (3) establishes a factual need for aid and attendance under the criteria set forth in 38 C.F.R. § 3.352(a) (1994). The Board notes that it is undisputed that the appellant is not 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; and is not a patient in a nursing home because of mental or physical incapacity. After considering all of the evidence of record, the Board also finds that the appellant does not otherwise qualify for special monthly pension on the basis of having a need for regular aid and attendance or housebound status. The evidence which is of record shows that appellant's principal disability is a disorder affecting the wrists and hands. A VA orthopedic treatment record dated in November 1991 shows that the appellant was 59 years old and had de Quervain's disease of the right upper extremity. She was fitted with a thumb splint. A report of an aid and attendance/housebound examination of the appellant conducted by the VA in April 1992 shows that the appellant was born in April 1932. She came in with the driver only, and no other attendant. She reportedly had not been hospitalized for 10 years. She was not bedridden. Examination of her eyes revealed that her pupils reacted to light, and the lens were clear. Fungi was normal, and vision was 20/30 corrected to 20/20. No visual field defect was noted. She reported a history of having pain in the right wrist area for one year. She said that she took Motrin every four hours with only partial relief. Her height was 160 centimeters, and her weight was 68.5 kilograms. Her build and state of nutrition was described as being obese. Her gait was normal. She was described as being well-appearing. Pulse was 72 and blood pressure was 110/70. Examination of her right forearm revealed that there was severe loss of motion of the wrist and right thumb because of pain. There was tenderness, but no swelling and no atrophy. Examination of the left arm revealed that there was no loss of motion. She reportedly previously had been right handed, but had gradually learned to use the left hand. Although she reportedly needed some assistance in clothing and preparing food, she could do self-feeding, bathing, and attending to nature. Examination of the lower extremities revealed no loss of motion. The gait was normal. Examination of the spine, trunk, and neck, also revealed no loss of motion. It was noted that she had undergone a hysterectomy in 1974. She reportedly stayed home most of the time with a houseboy, but could travel out of the house a couple of times a week. She was able to go to church and to shop. She was able to ambulate without assistance and with no limitations. No mechanical aid was used. The examiner concluded that any restrictions were not permanent. The diagnosis was tenosynovitis-de Quervains, and hyperopia, compound astigmatism. During a hearing held in December 1992, the appellant testified that she had arthritis in her hands which required that she take medication for pain. She stated that she suffered from painful swelling in her arms, and that she sometimes had no sensation. She stated that she could still feed herself and go to the bathroom by herself, but that she needed an assistant because at times the pain from her arthritis prevented her from cooking for herself. She also stated that she was seldom able to go out of her house, and that when she went shopping she could not buy very many goods because she could not lift heavy items. She also stated that she thought that she had low blood pressure because the back of her head sometimes hurt and she had shortness of breath. The appellant's son testified that the appellant needed a companion because she could not do the work such as cooking, washing, and cleaning the house. A letter dated in December 1992 from Hipolita C. Gonzales, M.D., shows that he treated the appellant for rheumatoid arthritis. He said that he had been treating her since 1991, and that additional workup was recommended to facilitate recovery and proper management. In making a determination as to whether a claimant has a factual need of aid and attendance, 38 C.F.R. § 3.352(a) (1994) provides that consideration is to be given to such conditions as inability of the claimant to dress or undress herself or keep herself ordinarily clean and presentable; frequent need for adjustment of any special prosthetic device or orthopedic appliance which by reason of the particular disability cannot be done without aid; inability of the claimant to feed himself through extreme weakness; inability to attend the wants and needs of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from the hazards or dangers incident to his daily environment. Being bedridden will also be a proper basis for allowance of special monthly pension. Id. The aforementioned evidence does not establish that the appellant has a need for regular aid and attendance. The medical evidence demonstrates that she generally is in good health. There is no medical evidence supporting the appellant's contention that she has low blood pressure. The only disorder is the disease affecting the wrist and hands which has been diagnosed by the VA as being de Quervains disease and diagnosed by her own private physician as rheumatoid arthritis. The VA examination report shows that this primarily affects only the right hand and wrist. The Board notes that while having full use of only one hand may hinder the appellant in tasks such as getting dressed, her overall condition is not one of helplessness such as to require the aid and attendance of another person. There is no evidence that she is unable to keep herself ordinarily clean and presentable; that she has frequent need for adjustment of any special prosthetic device or orthopedic appliance which by reason of the particular disability cannot be done without aid; that she has inability of the claimant to feed himself through extreme weakness; inability to attend the wants and needs of nature; or that she suffers from incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from the hazards or dangers incident to his daily environment. Furthermore, the VA examination report and the appellant's own testimony also show that she is not bedridden. In summary, the evidence shows that the appellant's disabilities do not render her unable to care for her daily personal needs without assistance from others and do not render her unable to protect herself from the hazards of daily living. Therefore, she does not qualify for increased pension on the basis of having a regular need for aid and attendance. The Board notes that, under 38 C.F.R. § 3.351(d) (1994), claimants who do not qualify for increased pension based on the need for regular aid and attendance may be paid additional pension if the person has a single permanent disability rated as 100 percent disabling and (1) has additional disability or disabilities independently ratable at 60 percent or more, separate and distinct from the permanent disability rated as 100 percent and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of disability or disabilities. There is no evidence to indicate that the appellant has two separate disabilities which are severe enough to be rated as 100 and 60 percent disabling. The Board also notes that the appellant's own testimony demonstrates that she is not housebound as she is able to leave her home a couple of times a week. Thus, the evidence also shows that she is not substantially confined to her house or immediate premises as a result of physical or mental disability. For the foregoing reasons, the Board finds that, while the appellant has disabilities of sufficient severity to prevent her from working, the disorders do not fulfill the requirements for a special monthly pension based on a need for regular aid and attendance or housebound status. Accordingly, the appeal must be denied. ORDER Special monthly pension based on the need for regular aid and attendance or housebound status is denied. JACQUELINE E. MONROE Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.