## Facts

- A Korean War veteran had a 100% service-connected disability rating for paranoid schizophrenia (effective since 1982).
- He also had non-service-connected conditions, including spinal disease and hypertension.
- In 2000, he sought special monthly compensation (SMC) based on (1) need for regular aid and attendance and (2) housebound status under 38 U.S.C. § 1114.
- A treating physician and a VA examiner stated he was unable to care for himself due to combined physical and mental disabilities, but neither opinion separated limitations caused by service-connected schizophrenia from those caused by non-service-connected conditions.
- VA denied SMC; the Board of Veterans’ Appeals affirmed, finding the service-connected disability did not, by itself, require aid and attendance or render him housebound.
- In denying housebound SMC, the Board relied heavily on the fact that he could leave home to attend a VA examination.

## Issues

1. Whether “substantially confined” under 38 U.S.C. § 1114(s) requires an inability to leave the home, and whether leaving home for medical purposes can, by itself, defeat housebound status.
2. Whether the Board adequately addressed whether the veteran’s service-connected disability rendered him in need of regular aid and attendance under 38 U.S.C. § 1114(l).
3. Whether the Board provided an adequate statement of reasons or bases for discounting favorable medical evidence and for failing to address whether additional development was needed to distinguish service-connected from non-service-connected impairment.

## Decision

- The court vacated the Board’s decision and remanded.
- “Substantially confined” does not require literal confinement to the home; medically necessary trips outside the home do not automatically preclude housebound SMC.
- The Board erred by treating attendance at a VA examination as dispositive evidence that the veteran was not housebound.
- The Board’s reasons or bases were inadequate regarding the medical evidence suggesting the veteran could not care for himself and regarding whether further clarification or examination was required.

## Legal Principles

- For SMC housebound benefits under 38 U.S.C. § 1114(s), “substantially confined” is a practical limitation standard; a veteran need not be unable to leave home.
- Leaving the home for medical purposes cannot, by itself, serve as the basis to find a veteran not substantially confined.
- When evidence indicates inability to perform activities of daily living but does not separate service-connected from non-service-connected causes, the Board must explain the weight assigned to favorable evidence and consider whether the duty to assist requires clarification or further examination.
- The Board must provide a reviewable statement of reasons or bases under 38 U.S.C. § 7104(d)(1), including articulating the governing standard it applies.

## Conclusion

The court set aside the denial of SMC because the Board applied an overly restrictive view of “substantially confined” and failed to adequately explain its treatment of medical evidence and the need for development on aid-and-attendance; the matter was remanded for readjudication under the correct legal standards.


Howell v. Nicholson, 19 Vet. App. 535 (2006)