St. Petersburg Regional Office Rating Decision: 05/22/15INTRODUCTION
The records reflect that you are a veteran of the Vietnam Era. You served in the Army from April 4, 1968 to March 30, 1970. The Board of Veterans Appeals made their decision on your appeal on May 14, 2015. We have implemented their decision based on the evidence listed below.
DECISION
1. Service connection for residuals of cerebral vascular accident ( claimed as stroke) to include bowel incontinence is granted with an evaluation of 100 percent effective March 10, 2012.
2. Service connection for loss of use of both legs is granted with an evaluation of 100 percent effective March 10, 2012.
3. Service connection for loss of use of the left upper extremity is granted with an evaluation of 70 percent effective March 10, 2012.
4. Service connection for urinary incontinence is granted with an evaluation of 60 percent effective March 10, 2012.
5. Entitlement to special monthly compensation based on the need for aid and attendance at a higher level is granted from March 10, 2012.
6. Entitlement to automobile or other conveyance and adaptive equipment is established.
7. Entitlement to specially adapted housing is established.
EVIDENCE
• Board of Veterans' Appeals (BVA) decision dated May 14, 2015, Docket No. 14-42 875, and all evidence considered therein
• VA Form 21-0820 Report of General Information, dated December 16, 2011
• VA Form 21-0820 Report of General Information, dated March 10, 2012
• VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, Dr. Stacy Pasquarella, dated April 5, 2013
• VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, Estela (last name illegl dated September 19, 2013
• VA examination results, Ft. Myers VA clinic, dated December 4, 2012
• Hospital records, Tampa General Hospital, dated November 2011 through February 2012
• VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, Dr. Mark Jawahir, dated February 18, 2012
• VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, Dr. W. Scott Burgin, dated February 16, 2012
REASONS FOR DECISION
1. Service connectio111 for residuals of cerebral vascular accident (claimed as stroke) to include bowel incontinence.
In their decision dated May 14, 2015, the Board of Veterans' Appeals (BVA) found that resolving all doubt in your favor, your stroke residuals are related to your service-connected spine and post-traumatic stress disorder (PTSD). As such, service connection for stroke residuals has been established as related to the service-connected disabilities of herniated nucleus pulposes/degenerative disc disease, lumbosacral spine and PTSD.
Hospital records from Tampa General Hospital show you suffered a cerebrovascular accident on November 6, 2011.
Medical evidence from Dr. Stacy Pasquarella, dated April 5, 2013, notes you have bowel incontinence as a result of your stroke.
Medical evidence from Estela (last name is illegible), ARNP, dated September 19, 2013, notes your use of absorbent materials and a catheter for treatment of incontinence.
An evaluation of 100 percent is assigned from March 10, 2012.
We have assigned a 100 percent evaluation for your residuals of cerebral vascular accident to include bowel incontinence based on:
• Complete loss of sphincter control
Additional symptoms include:
• Wearing of pad
This is the highest schcdular evaluation allowed under the law for impairment of sphincter control.
The effective date of grant is the date we received your claim for service-connection of a stroke, as you have continuously prosecuted your claim and it is held that your residuals existed at that time. When a claim of service connection is received more than one year after discharge from active duty, the effective date is the date VA received the claim.
This decision is made pursuant to BVA decision dated May 14, 2015. Please see that decision for more information as to the reasons and bases for this decision.
2. Service connection for loss of use of both legs.
In their decision dated May 14, 2015, the Board of Veterans' Appeals (BVA) found that your loss of use of both legs is service-connected. Paralysis of the right leg has been found to be due to service-connected lumbar spine disability, and loss of use of the left leg is a residual of your stroke. Therefore, service connection for loss of use of both legs has been established as related to the service-connected disabilities of residuals of cerebral vascular accident and lumbar spine disability.
The cited evidence shows that you are wheelchair bound and have bilateral foot drop with bilateral lower extremity weakness.
An evaluation of 100 percent is assigned from March I 0, 2012.
We have assigned a 100 percent evaluation for your loss of use of both legs based on:
• Loss of use of both feet
This is the highest schedular evaluation allowed under the law for loss of use of both feet.
The effective date of grant is the date service connection was established for stroke residuals, as your loss of use is considered in part a residual of your stroke and it is held that your impairments existed at that time.
3. Service connection for loss of use of the left upper extremity as secondary to the service connected disability of residuals of cerebral vasculatr accident.
In their decision dated May 14, 2015, the Board of Veterans' Appeals (BY A) found that service connection for stroke residuals is granted.
Medical evidence from Dr. Stacy Pasquarella, dated April 5, 2013, notes your left hand is your dominant hand. Your left hand, left wrist and left elbow are contracted.
Medical evidence from Estela (last name is illegible), ARNP, dated September 19, 2013, notes you have left hemi-plegia and your left fingers are contracted.
VA examination results from December 4, 2012, show you have atrophy of the left bicep as a result of your cerebrovascular accident. Left upper extremity muscle strength was 0/5.
Service connection for loss of use of the left upper extremity has been established as related to the service-connected disability of residuals of cerebral vascular accident.
An evaluation of 70 percent is assigned from March 10, 2012.
We have assigned a 70 percent evaluation for your loss of use of the left upper extremity based on:
• Loss of use of the major hand
A higher evaluation of 80 percent is not warranted for loss of use of one hand unless the evidence shows amputation of the arm above insertion of pronator teres.
Additionally, a higher evaluation of 100 percent is not warranted for loss of use of one hand unless the evidence shows amputation or loss of use of another extremity at any level.
The effective date of grant is the date service connection was established for stroke residuals, as your left upper extremity impairment is considered a residual of your stroke and it is held that your condition existed at that time.
4. Service connection for urinary incontinence as secondary to the service-connected disability of residuals of cerebral vascular accident.
In their decision dated May 14, 2015, the Board of Veterans' Appeals (BVA) found that service connection for stroke :residuals is granted.
Medical evidence from Dr. Stacy Pasquarella, dated April 5, 2013, notes you have bowel incontinence as a result of your stroke.
Medical evidence from Estela (last name is illegible), ARNP, dated September 19, 2013, notes your use of absorbent materials and a catheter for treatment of incontinence.
Service connection for urinary incontinence has been established as related to the serviceÂconnected disability of residuals of cerebral vascular accident.
An evaluation of 60 percent is assigned from March 10, 2012.
We have assigned a 60 percent evaluation for your neurogenic bladder based on:
• Requiring the use of an appliance
Additonal symptoms include:
• Daytime voiding interval between one and two hours.
This is the highest schedular evaluation allowed based on voiding dysfunction.
The effective date of grant is the date service connection was established for stroke residuals, as your urinary incontinence is considered a residual of your stroke and it is held that your condition existed at that time.
5. Entitlement to special monthly compensation based on the need for aid and attendance at a higher level
In their decision dated May 14, 2015, the Board of Veterans' Appeals (BVA) found you are entitled to special monthly compensation at the rate provided by 38 USC 1114(0) from March 10, 2012, on account of loss of use of both legs and loss of anal and bladder sphincter control, and the need for aid and attendance. You receive necessary and lift-sustaining daily health care with hands-on facilitation by your wife and grandson who perform under the direction, guidance, and supervision of a caregiver. You wife also consults with licensed health care providers on at least a monthly basis.
Therefore, special monthly compensation of account of the need for aid and attendance at a higher level under 38 USC l 14(r)(2) is granted.
The effective date of grant is March 10, 2012, the date service connection has been established for loss of use of both legs and loss of anal and bladder sphincter control, as these disabilities, along with your need for aid and attendance, support entitlement to the higher level of special monthly compensation.
This decision is made pursuant to BV A decision dated May 14, 2015. Please see that decision for more information as to the reasons and bases for this decision.
6. Entitlement to automobile or other conveyance and adaptive equipment or for adaptive equipment only.
A certificate of eligibility for financial assistance in the purchase of one automobile or other conveyance and of bas,ic entitlement to necessary adaptive equipment will be made when the veteran has loss or permanent loss of use of one or both feet which is the result of injury or disease incurred or aggravated during active military service.
Entitlement to automobile and adaptive equipment is established based on this level of impairment.
7. Entitlement to specially adapted housing.
A certificate of eligibility for assistance in acquiring specially adapted housing under 38 U.S.C. 2101(a) may be extended when the veteran is permanently disabled as the result of the loss, or loss of use, of both lower extremities, such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair.
ANCILLARY DECISIONS
Entitled to Specially Adapted Housing
Not Entitled to Special Home Adaptation
Entitled to Automobile and Adaptive Equipment
Basic Eligibility under 38 USC Ch 35 from 11/18/1999
