BVA9501487 DOCKET NO. 92-04 314 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to service connection for coronary artery disease and hypertension secondary to service connected disability. 2. Entitlement to special monthly compensation by reason of being in need of regular aid and attendance or at the housebound rate. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD T. Hal Smith, Counsel INTRODUCTION The veteran served on active duty from December 1943 to August 1945. This appeal arises from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. The case was remanded by the Board of Veterans' Appeals (Board) in February 1994. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the RO erred when it denied him entitlement to special monthly compensation at either the aid and attendance or housebound rates. He asserts that his service- connected shrapnel wounds to the left thigh have caused the heart problem which has rendered him wheelchair bound. 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 secondary service connection for coronary artery disease and hypertension and is against the veteran's claim for special monthly compensation based on the need for regular aid and attendance or at the housebound rate. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's claim has been developed. 2. Service connection is in effect for residuals of a penetrating shell fragment wound of the left thigh, Muscle Group XIII, rated as 30 percent disabling; and for residuals of a penetrating shell fragment wound of the left thigh, Muscle Group XIV, rated as 30 percent disabling. A combined disability rating of 50 percent is in effect. 3. Coronary artery disease and hypertension, first shown many years after service separation, are not causally related to service-connected residuals of shell fragment wounds to the left thigh. 4. The veteran's service-connected disabilities do not render him unable to care for most of his daily needs without the regular aid and attendance of another person, or render him unable to protect himself from the hazards and dangers incident to his daily environment. 5. The veteran is not permanently housebound by reason of service-connected residuals of shell fragment wounds to the left thigh. CONCLUSIONS OF LAW 1. Coronary artery disease and hypertension are not proximately due to or the result of service-connected residuals of shell fragment wounds to the left thigh. 38 C.F.R. § 3.310(a) (1993). 2. The criteria for an award of special monthly compensation based on the need for regular aid and attendance of another person are not met. 38 U.S.C.A. § 1114(1) (West 1991); 38 C.F.R. §§ 3.351(c) (3), 3.352(a) (1993). 3. The criteria for additional special monthly compensation at the housebound rate are not met. 38 U.S.C.A. §§ 1114(s), 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board acknowledges that the veteran's claim is well-grounded, triggering the duty to assist. Consistent with the duty to assist, the Board, in its February 1994 remand, instructed that the issue of entitlement to service connection for cardiovascular disease as secondary to service-connected residuals of shell fragment wounds to the left thigh be decided by the RO because this issue was inextricably intertwined with his claim for special monthly compensation. This development was accomplished, and an examination was conducted. On review of the current record, it is the Board's conclusion that all the relevant facts have been properly developed and that no further assistance to the veteran is required to comply with the statutory duty to assist. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 19.9 (1993). Service Connection The evidence available for review includes service medical records and post service medical documents. The VA records include recently conducted examination reports from March 1994. The service records show that the veteran received a penetrating wound to the left thigh in April 1945. This injury resulted in laceration of the femoral artery requiring ligation. A single elevated blood pressure was reported on hospitalization in 1945. No abnormality of the heart was shown during service or on VA examination in 1946. Service connection was established soon after service, and 30 percent ratings for shell fragment wound residuals to the left thigh have been in effect since rating determination in 1947. Post service medical records essentially are from recent years (1990-1994). A hospital report from August-October 1990 shows a history of multiple strokes since 1965. The veteran's medical history also included coronary artery disease and hypertension. The report notes that in April 1990 the veteran had a parietal occipital lacunar infarction and a left-sided infarction in May 1990. It was also noted that the veteran had non-Hodgkin's lymphoma after splenectomy. Subsequently dated outpatient treatment records show that the veteran was in a wheelchair for mobility. A September 1991 examination conducted for purposes of determining housebound status or the need for regular aid and attendance, shows that the veteran needed assistance for most daily activities. For example, while he was able to feed himself, he was unable to dress or bathe himself. He needed assistance with his catheter for bladder function and was unable to get out of doors without assistance. This need for assistance was noted to be due to the residuals of cerebral vascular accidents, parkinsonism and a splenectomy for non-Hodgkin's lymphoma. He also had a history of falls due to leg weakness which was related to the diagnoses of cerebral vascular accidents and Parkinson's Disease. Upon VA cardiovascular examination in March 1994, the veteran gave a history of stable angina, Parkinson's disease, spleen cancer and several strokes. He reported that the left leg was cold, and that he experienced occasional pain up and down that extremity. He had difficulty walking and had used a walker for the last three years. At this examination, he was in a wheelchair. He experienced occasional chest pain when walking. The examiner noted that the veteran was able to rise out of his wheelchair without assistance and stand on his own, but he did need help for stability to walk. His gait was described as slow and shuffling. Left leg sensation was grossly warm and intact. There were a few scattered spider varicosities about the ankles. There was no atrophy of musculature in the left thigh. There was no notable tendon damage or damage to the bone, joints or nerves. The veteran exhibited decreased strength of the lower extremities with impaired mobility. There was no sign of significant venous or arterial disease. The heart beat of seventy two per minute was described as normal. The examiner's medical opinion was that there was "absolutely no chance that the subject's shrapnel injury to the left thigh caused any cardiovascular abnormality to the heart or brain." On VA medical examination in March 1994, the diagnoses included status multiple strokes with residual left extremity weakness and spasticity; and atherosclerotic vascular insufficiency of the lower extremities. The evidence related above does not demonstrate that the veteran's post service coronary artery disease to include hypertension is the result of his left thigh disorder. While we have noted the veteran's contention that they are related, he is not considered competent on questions of medical causation. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). A recent examination to determine a possible relationship, resulted in an opinion that any cardiovascular disorder was not related to the service-connected shell fragment wound injuries. From the evidence noted above, we are unable to conclude that any cardiovascular disorder was caused by or related to his inservice shell fragment wounds. Competent evidence does not support the veteran's claim. Special Monthly Compensation In considering whether the veteran is entitled to special monthly compensation, these benefits are governed by VA statute and regulations. The statutory provision, 38 U.S.C.A. § 1114(1) (West 1991), provides, in pertinent part, that if a veteran as the result of service-connected disability is in need of regular aid and attendance of another person, then additional monetary benefits are payable. The pertinent criteria for determining that a veteran needs regular aid and attendance are contained in 38 C.F.R. § 3.351(c)(3) (1993). § 3.351(c)(3) provides for the benefit when the veteran establishes a factual need for aid and attendance under the criteria set forth in 38 C.F.R. § 3.352(a) (1993). The basic criteria include the inability to do the following because of service-connected disability: dress and undress, maintain ordinary cleanliness, feed oneself or attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance to protect the veteran from hazards and dangers incident to his daily environment. In this case, it is clear that the veteran is in need of continuous aid and attendance of another person for most daily activities. However, as indicated by the medical evidence summarized above, this need is precipitated by his nonservice- connected disabilities including non-Hodgkin's lymphoma, cerebral vascular accidents and parkinsonism. Therefore, we must conclude that the criteria for special monthly compensation by reason of being in need of regular aid and attendance due to service- connected disability have not been met. 38 U.S.C.A. § 1114(1) (West 1991); 38 C.F.R. §§ 3.351(c)(3), 3.352(a) (1993). As for special monthly compensation at the housebound rate, the condition precedent to such an award is a single service- connected disability rated as totally disabling. 38 U.S.C.A. § 1114(s) (West 1991). As neither of the veteran's service-connected disabilities (residuals of shell fragment wounds to the left thigh, Muscle Groups XIII and XIV), are totally disabling, the threshold criteria for housebound status have not been satisfied. ORDER Service connection for coronary artery disease and hypertension secondary to service connected disability is denied. Special monthly compensation based on the need for regular aid and attendance or at the housebound rate is denied. NANCY I. PHILLIPS 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.