Citation Nr: 0005436 Decision Date: 02/29/00 Archive Date: 03/07/00 DOCKET NO. 98-04 039 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUES 1. Entitlement to an increased rating for duodenal ulcer, currently evaluated as 20 percent disabling. 2. Entitlement to special monthly pension based on the need for regular aid and attendance or on housebound status. REPRESENTATION Appellant represented by: Disabled American Veterans INTRODUCTION The veteran served on active duty from February 1952 to February 1954. This case first came before the Board of Veterans' Appeals (Board) from a rating decision rendered in November 1996 by the New Orleans, Louisiana, Regional Office (RO) of the Department of Veterans Affairs (VA). In October 1998, the Board, inter alia, remanded the issues identified on the first page of this decision. Following accomplishment of the requested development by the RO, these issues have been returned to the Board for further appellate review. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's claims has been developed. 2. A duodenal ulcer is manifested primarily by complaints of occasional discomfort, and by the use of medication; it is productive of no more than moderate impairment. 3. The veteran is not, as a result of his various disabilities, so helpless or blind as to require regular aid and attendance, nor is he shown to be either institutionalized or confined to the immediate premises of his home as a result of those disabilities so as to be deemed housebound. CONCLUSIONS OF LAW 1. The criteria for an increased rating for duodenal ulcer are not met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, § 4.114, Diagnostic Code 7305 (1999). 2. The criteria for the assignment of special monthly pension based on the need for regular aid and attendance, or as a result of housebound status, are not met. 38 U.S.C.A. §§ 1502, 1521 (West 1991); 38 C.F.R. §§ 3.351, 3.352 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, the Board finds that the veteran's claims are "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991); that is, he has presented claims that are plausible. (See Proscelle v. Derwinski, 2 Vet. App. 629 (1992), with regard to the application of the well-grounded standard for claims for increased compensation.) He has not alleged the existence of any records of probative value that may be obtained, and which are not already associated with his claims folder. The Board accordingly finds that the duty to assist him, as mandated by 38 U.S.C.A. § 5107(a) (West 1991), has been satisfied. I. An Increased Rating for Duodenal Ulcer The veteran contends, essentially, that his service-connected duodenal ulcer is more severe than currently evaluated, and that an increased rating is warranted. After a review of the record, however, the Board finds that his contentions are not supported by the evidence, and that his claim fails. Service connection for duodenal ulcer was granted in April 1954 by a VA rating board located in Shreveport, Louisiana, following review of evidence that included the veteran's service medical records and the report of a VA examination. A 20 percent rating, effective March 16, 1954, has remained in effect (other than for periods during which the veteran could not be located) since that time. The severity of a service-connected disability, such as the veteran's duodenal ulcer, is ascertained by application of rating criteria set forth in VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4. Under the criteria pertinent to duodenal ulcer (Diagnostic Code 7305), the 20 percent rating currently in effect contemplates moderate impairment, exemplified by recurring episodes of severe symptoms two or three times a year and which average 10 days in duration, or by continuous moderate manifestations. A rating greater than the 20 percent rating now in effect is appropriate for a duodenal ulcer that is productive of moderately severe impairment, as would be exemplified by symptoms that are productive of less than severe impairment, but which result in impairment of health manifested by anemia and weight loss, or by recurrent incapacitating episodes averaging 10 days or more in duration and occurring four or more times a year. The criteria for an increased rating are not satisfied. Although the veteran has alleged that his duodenal ulcer significantly interferes with his daily life, the report of the most recent clinical examination, which was conducted by VA in March 1999, shows that he merely indicated that his stomach "still bothers him on and off, and he continues to take his maintenance medications." There was no hematemesis or dark stools, and the examination report specifically notes that anemia was not found. In addition, the medical evidence does not demonstrate that his duodenal ulcer results in weight loss; while the report of the March 1999 VA examination shows that his present weight was 198.9 pounds, apparently down from a "[m]aximum weight [of] 219 [pounds]," the Board notes that the report of a previous VA examination, conducted in December 1996, indicates that his weight at that time was only 187 pounds. Likewise, the report of a July 1996 VA examination indicates that his weight as of that date was only 180 pounds. The Board must also note that the veteran's allegations of significant physical impairment are not supported by clinical findings to that effect. To the contrary, the recent medical record does not show that he has been accorded recurrent treatment for gastrointestinal problems, and the Board cannot conclude, based on his contentions alone, that his duodenal ulcer is manifested by recurrent incapacitating episodes averaging 10 days or more in duration and occurring four or more times a year. In brief, the evidence does not demonstrate that the veteran's service-connected duodenal ulcer is productive of more than moderate impairment, as defined by the diagnostic criteria. The Board must therefore conclude that the preponderance of the evidence is against the veteran's claim for an increased rating for this disorder. His claim, accordingly, fails. II. Special Monthly Pension Benefits The veteran also contends, essentially, that he should be assigned special monthly pension on the basis that he requires regular aid and attendance, or, in the alternative, that he is housebound. However, after a review of the evidence, the Board finds that his contentions are not supported by the record, and that assignment of special monthly pension based on the need for aid and attendance, or as a result of housebound status, is not appropriate. Under regulations set forth at 38 U.S.C.A. §§ 1502 and 1521 (West 1991), and at 38 C.F.R. §§ 3.351 and 3.352 (1999), special monthly pension may be granted when a claimant is permanently and totally disabled as a result of nonservice- connected disability and is in need of regular aid and attendance, wherein regular assistance is required as a result of being blind, or being so nearly blind as to have corrected bilateral visual acuity no greater than 5/200, or concentric contraction of the visual field to 5 degrees or less; as a result of being a patient in a nursing home because or mental of physical incapacity; or is unable to clean or dress oneself. See 38 C.F.R. § 3.351(c) (1999); see also 38 C.F.R. § 3.352(a) (1999). In circumstances in which these criteria are not satisfied, special monthly pension may be granted as a result of being housebound, wherein there is essentially confinement to the dwelling and the immediate premises, or to an institution's ward and clinical areas, and it is reasonably certain that such confinement is permanent. In addition, housebound status may be established if a veteran has a single permanent disability rated as 100 percent disabling under VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4 (1999), and has an additional disability or disabilities rated as at least 60 percent disabling, and such disability or disabilities are separate and distinct from the disability rated as 100 percent disabling, and which involve anatomical segments or bodily systems that are different from the disability rated at 100 percent. See 38 C.F.R. § 3.351(d) (1999). As to the veteran's need for regular aid and attendance, the clinical record does not demonstrate that he has vision that is so compromised as to satisfy the criteria cited above. The report of the most recent medical examination of the veteran, conducted in March 1999, does not indicate that his corrected vision is impaired; to the contrary, it shows that his vision was correctable to 20/20, bilaterally. The evidence does not show that the veteran has any impairment of his vision as to render him blind, or so nearly blind as that term is construed in the applicable regulations. Likewise, the record does not show that the veteran currently resides in a nursing home. The report of the March 1999 VA examination specifically indicates that "[h]e states that he walks around the house and in his apartment." No evidence dated subsequent to March 1999 shows that he is now a nursing home resident. With regard to the veteran's ability to care for himself, the Board notes that the March 1999 VA examination report in particular indicates that he was alert, oriented, and ambulatory. The report also includes comments by the examining physician that the veteran "does not meet the criteria of being eligible for an aide in attendance. He still does self-care." Based on these findings, the Board must conclude that the evidence does not demonstrate that the veteran, at this time, requires regular aid and attendance. Having so determined, it is now incumbent upon the Board to ascertain whether special monthly pension may be assigned on the basis that he is housebound. Again, the Board must conclude that such benefits cannot be granted. As discussed above, special monthly pension based on housebound status is appropriate when the veteran has a single permanent disability deemed 100 percent disabling by the RO. The most recent rating decision wherein the RO set forth the ratings assigned for the veteran's disabilities, which was that promulgated in November 1996, shows that this criterion is not satisfied. To the contrary, this rating decision shows that none of his disabilities was deemed to be more than 30 percent disabling. Special monthly pension based on housebound status may also be granted when the veteran is institutionalized, or when there is essential confinement to the dwelling and the immediate premises. In the case herein, it must be reiterated that the evidentiary record does not show that the veteran is institutionalized; rather, as discussed above, he has reported that he is not a nursing home resident. Moreover, the evidence does not demonstrate that he is confined to his dwelling and its immediate premises. It must be emphasized, in that regard, that the findings presented on the March 1999 examination report clearly show that he was ambulatory, albeit with a limp. The report also shows that he indicated to the examiner that he drove his car, although not for long distances. This evidence demonstrates that, while his mobility may to some extent be limited, he in no manner can be described as so disabled as to be confined to his dwelling and its immediate premises. In view of the above, the Board must conclude that the preponderance of the evidence is against the veteran's claim for special monthly pension based on the need for regular aid and attendance, or on housebound status. That claim, therefore, fails. 38 U.S.C.A. §§ 1502, 1521 (West 1991); 38 C.F.R. §§ 3.351, 3.352 (1999). ORDER An increased rating for duodenal ulcer is denied. Special monthly pension based on the need for regular aid and attendance or on housebound status is denied. M. S. SIEGEL Acting Member, Board of Veterans' Appeals