BVA9505047 DOCKET NO. 93-08 956 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Newark, New Jersey THE ISSUE Entitlement to special monthly pension on account of the need for regular aid and attendance or at the household rate. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD J. Johnston, Associate Counsel INTRODUCTION The veteran had active service from September 1974 to September 1975. This matter comes before the Board of Veterans' Appeals on appeal from an April 1992 rating decision of the Newark, New Jersey, Department of Veterans Affairs (VA) Regional Office (RO), which denied entitlement to the benefit sought on appeal. The veteran has been rated permanently and totally disabled and is receiving nonservice-connected disability pension. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the RO erred in denying him entitlement to special monthly pension on account of the need for regular aid and attendance. He contends that his totally disabling psychiatric disorder makes it necessary for him to receive assistance and supervision of all aspects of his daily life. He points out that he has been psychiatrically hospitalized on numerous occasions and that he is unable to drive a motor vehicle. The veteran's spouse indicates that although the veteran is not housebound it is necessary for her to remind the veteran when to eat, bathe, change clothes, and take his medication. DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), following review and consideration of all evidence and material of record in the veteran's claims folder, and for the following reasons and bases, it is the decision of the Board the preponderance of the evidence is against the veteran's claim for special monthly pension based on need for regular aid and attendance or by reason of being housebound. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appeal has been obtained. 2. The veteran is not blind, and is not a patient in a nursing home. 3. The veteran does not require regular assistance from others in performing the activities of daily living or to protect himself from hazards or dangers incident to his daily environment. 4. The veteran is not bedridden or confined to the premises of his house. 5. The veteran has a single disability, schizophrenia, paranoid type, rated as 100 percent disabling but he does not have any other independent disability or disabilities ratable at 60 percent or more, and the veteran has no other physical impairments. CONCLUSION OF LAW The veteran does not meet the criteria for entitlement to special monthly pension on account of the need for regular aid and attendance or at the housebound rate. 38 U.S.C.A. §§ 1155, 1502, 1521(d), 5107(a) (West 1991); 38 C.F.R. §§ 3.351, 3.352 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION This claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a) in that it is plausible. All of the facts have been properly developed and no further assistance is necessary to comply with the duty to assist required by law. Id. Where an otherwise eligible veteran is in need of regular aid and attendance, an additional rate of pension is payable. 38 U.S.C.A. § 1521(d). For pension purposes, the veteran shall be considered to be in need of regular aid and attendance: (1) If he 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 five degrees or less; (2) he is a patient in a nursing home because of mental or physical incapacity; or (3) he establishes a factual need for aid and attendance under the criteria set forth in 38 C.F.R. § 3.352(a). 38 U.S.C.A. § 1502(b); 38 C.F.R. § 3.351. In determining the need for regular aid and attendance, consideration will be given to the veteran's ability or inability to dress or undress, keep ordinarily clean and presentable, feed himself, and attend to the wants of nature. The physical or mental incapacity of the veteran, his ability to protect himself from hazards or dangers incident to the daily environment and the veteran's condition as a whole should be considered. The particular personal functions with which the veteran is unable to perform and the actual necessity of personal assistance from others will also be considered. 38 C.F.R. § 3.352(a). The monthly rate of pension otherwise payable to a veteran who is entitled to pension and who does not qualify for increased pension based upon the need of regular aid and attendance may be increased if, in addition to having a single permanent disability rated as 100 percent under regular schedular evaluation, the veteran: (1) Has additional disability or disabilities independently ratable at 60 percent or more, separate and distinct from the permanent disability rated as 100 percent disabling, and involving different anatomical segments or bodily systems; or (2) the veteran is substantially confined as a direct result of his disabilities to his dwelling and the immediate premises or, if institutionalized, to the ward or clinical area, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his lifetime. 38 U.S.C.A. § 1502; 38 C.F.R. § 3.351. The veteran is in receipt of a 100 percent nonservice-connected schedular evaluation for schizophrenia, paranoid type, competent. No other evaluation for physical disability or disease has been awarded and none is shown to be justified by the clinical evidence of record. All of the clinical evidence on file, including reports of private psychiatric hospitalization, medical records from the Georgia Department of Corrections, and VA examinations in January 1990 and July 1992, reveal that, other than the veteran's psychiatric disorder, he has no other disability by reason of disease or injury. The sole exception is that the veteran had borderline high diastolic blood pressure readings in 1980 and 1990. However, the clinical evidence does not show that this borderline high blood pressure in any way impaired the veteran's social and industrial ability to function and high blood pressure was not confirmed in the most recent VA examination conducted in July 1992. In all other respects, the veteran's physical condition is consistently shown to be normal. In December 1980, the veteran was first admitted for psychiatric treatment in a private hospital in Georgia where a diagnosis of acute schizophrenia, undifferentiated type, was made. He was admitted because he had become increasingly confused, psychotic, grandiose, and actively hallucinating at the time. The veteran was also apparently treated for his psychiatric disorder while incarcerated in a psychiatric ward of a correctional facility for attempted armed robbery in Georgia between 1980 and 1984. The record shows various subsequent admissions to private psychiatric hospitals and treatment including psychiatric admissions in 1986, 1987, 1991, and 1992. The medical evidence on file records that the veteran had a history of chronic drug and alcohol abuse but the most recent examinations show that this activity has not continued. In June 1990, the veteran was provided a VA psychiatric examination. He reported a history of restless sleep, poor appetite, violent temper, and occasional depression. He believed that people talked about him and he had occasional visual and auditory hallucinations. During the examination, the veteran was oriented but showed some memory lapses. Insight and judgment were marginal. His wife reportedly helped him manage his income. The examiner found that the veteran was competent for VA purposes. In July 1992, M. Kanther, M.D., wrote a letter that recounted the veteran's various psychiatric admissions and emergency outpatient treatment. He indicated that the veteran's symptoms varied from assaultive, suicidal behavior to at other times being oriented in all spheres, and that the symptoms associated with his chronic paranoid schizophrenia had involved auditory hallucinations, an angry mood, psychomotor agitation, and periods of confusion and disorientation. He indicated that the veteran's prognosis was poor. In July 1992, the veteran was provided with another VA psychiatric examination. The veteran said he was stable but not too good. His appearance was neat, clean and appropriate, and his manner during the interview was pleasant and cooperative. He was oriented in terms of time, place, and person. He reported occasionally hearing imaginary voices and occasionally seeing visions of his mother. Affect and emotional status were characterized by depression and feelings of being withdrawn. There was no recent suicidal ideation. The fund of information was somewhat deficient and his judgment appeared to be quite impaired. The diagnosis was schizophrenia, paranoid type, in partial remission and his prognosis was reported as fair. The VA examiner recommended continued outpatient treatment. The examiner also found that the veteran was competent for VA purposes. Again, no other physical abnormality was found to exist upon examination. A clear preponderance of the evidence of record does not support the veteran's claim for monthly pension on account of a need for regular aid and attendance and does not show that the veteran is housebound. The evidence does not show that the veteran is unable to dress himself, wash himself or feed himself or attend to the needs of nature. Although his spouse has indicated that she must remind the veteran of his responsibilities to take care of these things, the evidence demonstrates that he is clearly able to perform these functions on his own. The veteran does not have any physical limitation or restrictions of the upper or lower extremities, spine, trunk, or neck. He is not restricted to the home and does not require any aids for locomotion. Occasional borderline high diastolic blood pressure readings are not shown to interfere with the veteran's ability to care for himself. Although the veteran is shown to have psychiatric symptomatology which includes occasional auditory and visual hallucinations and other occasional inappropriate behavior, the veteran has consistently been found competent for VA purposes. No evidence has been submitted which demonstrates he is unable to cope with the hazards of his environment, or to take care of the activities of daily living including the needs of nature. He is not blind, is not a patient in a nursing home, and is not bedridden. The evidence does not establish that the veteran is so helpless as to need regular aid and attendance of another individual and he appears to be able to function well without such assistance as described by law and regulations pertaining to special monthly pension. 38 C.F.R. §§ 3.351, 3.352. The fact that the veteran's spouse provides assistance in the veteran's daily living does not itself establish that the assistance provided is necessitated by the veteran's psychiatric disability. The veteran is not confined to his dwelling or the immediate premises and he is not institutionalized. The evidence shows that the veteran is apparently able to leave his house at will. While the veteran has a single 100 percent schedular evaluation, an award of special monthly pension at the housebound rate would also include that he be confined as a direct result of his disability to his dwelling and the immediate premises or, if institutionalized, to the ward or clinical area, and that it is reasonably certain that such disability will result in confinement throughout his lifetime. The evidence does not support such a finding. 38 U.S.C.A. § 1502; 38 C.F.R. § 3.351. ORDER Entitlement to special monthly pension on account of the need for regular aid and attendance or at the housebound rate is denied. RENÉE M. PELLETIER 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.