Citation Nr: A22025568 Decision Date: 12/16/22 Archive Date: 12/15/22 DOCKET NO. 220518-244180 DATE: December 16, 2022 REMANDED Entitlement to benefits under the Program of Comprehensive Assistance for Family Caregivers (PCAFC) is remanded. REASONS FOR REMAND The Veteran had active service from June 1968 to June 1970. M.A.T., the Veteran's spouse, is the individual who submitted the underlying joint application with the Veteran and is interested in serving as Primary Family Caregiver. 38 U.S.C. § 1720G(a)(12); 38 C.F.R. § 71.25. In the May 2022 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Entitlement to benefits under the PCAFC is remanded. PCAFC is a VA program that provides certain benefits to eligible veterans who have incurred or aggravated serious injuries during military service, and to their caregivers. 38 C.F.R. § 71.10(a). In the March 2021 decision on appeal, the Veteran was found to be ineligible for the PCAFC because he had not been in need of personal care services for a minimum of six continuous months based on an inability to be able to perform an activity of daily living and not needing supervision, protection, or instruction. Eligibility under the PCFAC program requires a finding that an eligible Veteran is in need of personal care services for a minimum of six continuous months from an eligible caregiver because of: An inability to perform an activity of daily living, a need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury, or a need for regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired. 38 U.S.C. § 1720G(a)(2); 38 C.F.R. § 71.20(a); see Veterans Warriors, Inc. vs. McDonough, 29 F.4th 1320 (Fed. Cir. 2022). "In need of personal care services" means that the eligible Veteran requires in-person personal care services from another person, and without such personal care services, alternative in-person caregiving arrangements (including respite care or assistance of an alternative caregiver) would be required to support the eligible Veteran's safety. 38 C.F.R. § 71.15. "An inability to perform an activity of daily living" means the individual requires personal care services each time he or she completes one or more of the following: (1) Dressing or undressing oneself; (2) Bathing; (3) Grooming oneself in order to keep oneself clean and presentable; (4) Adjusting any special prosthetic or orthopedic appliance, that by reason of the particular disability, cannot be done without assistance (this does not include the adjustment of appliances that nondisabled persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); (5) Toileting or attending to toileting; (6) Feeding oneself due to loss of coordination of upper extremities, extreme weakness, inability to swallow, or the need for a non-oral means of nutrition; or (7) Mobility (walking, going up stairs, transferring from bed to chair, etc.). Id. An "eligible veteran" is a member of the Armed forces undergoing a medical discharge, or an individual who had a serious injury incurred or aggravated in the line of duty during active service. See 38 C.F.R. § 71.20(a). "Serious injury" means any service-connected disability that is rated 70 percent or more by VA, or is combined with any other service-connected disability or disabilities, and a combined rating of 70 percent or more is assigned by VA. 38 C.F.R. § 71.15. Individuals who wish to be considered for designation by VA as a Primary or Secondary Family Caregiver must submit a joint application with the Veteran, and evaluations and caregiver training must take place within 90 days of the application unless VA issues an extension based on VA's inability to complete the assessments and training. 38 C.F.R. § 71.25(a)(2)(ii). Before VA approves an applicant to serve as a Primary or Secondary Family Caregiver, the applicant must be initially assessed by VA as being able to complete caregiver education and training. 38 U.S.C. § 71.25(c). Furthermore, there must be an initial home-care assessment which requires VA to visit the eligible veteran's home to assess his well-being and the well-being of the caregiver, and the caregiver's competence to provide personal care services at the eligible veteran's home. 38 U.S.C. § 71.25(e). Service connection is currently in effect for posttraumatic stress disorder, rated 70 percent. A total disability rating based on individual unemployability is also in effect. At a November 2020 assessment it was noted that the Veteran assisted with washing dishes and doing some errands. The Veteran also would heat food in the toaster oven, but the caregiver noted that he would forget what he was doing, and she had to pay attention. The caregiver also stated that the Veteran got easily distracted by things in his environment and would forget things like what he went to a store for. The Veteran agreed that he got distracted and wished to isolate and be away from others. He used a walker and was limited to walking 100 feet at a time. The caregiver made sure that the Veteran took his medications, and she assisted him with peri care, including washing and applying cream. Sometimes the Veteran needed assistance with this in the middle of the night. The caretaker said that there were times when the Veteran did not appear to understand that he had missed cleaning himself. She also noted that the Veteran needed structure and to get out of the house because otherwise he would isolate himself. The examiner noted that the Veteran had some independence with regard to going out of the home and seeing his friends. It was also noted that the Veteran required assistance on a daily basis with bathing. The Veteran underwent another assessment in November 2020. The caregiver reported that she stayed nearby while the Veteran performed grooming, such as brushing his teeth and cleaning his upper body, to make sure that the water got turned to the right temperature and turned off. The Veteran received footcare and otherwise seemed to be independent with bathing with use of a walk-in shower, bench, and grabrail. The caregiver advised the Veteran regarding proper clothing for the season, and it appears that the Veteran independently dressed himself. As noted at the prior assessment, the Veteran required the assistance of his spouse with maintaining peri cleanliness, and he has a gastrointestinal condition that caused him to have diarrhea multiple times a day. The Veteran wore prescribed wrist wraps/gloves, and there is no indication from the record that he cannot independently take them on and off. Regarding mobility, the Veteran used a cane and walker. The Veteran said he was independent with stairs and took them one stair at a time. The caregiver said that she went ahead of him and supervised. The Veteran said that he "could not pick up objects from the floor" and that the caregiver assisted with that. The evidence shows that the Veteran needs assistance each time with toileting. Therefore, the record reflects that the Veteran has an inability to perform at least one of the enumerated activities of daily living. See 38 C.F.R. § 71.15. The record also shows that this has been continuous for at least six months. The Board therefore finds that the Veteran is not independent in activities of daily living. The record does not currently reflect that the caregiver has undergone caregiver training, as is required. See 38 C.F.R. § 71.25. It has been greater than 90 days since the Veteran and his spouse completed the PCAFC application in October 2020. The Board finds that the caregiver training was not completed in 90 days, as required under 38 C.F.R. § 71.25, by no fault of the caregiver due to the lack of further development of the claim after November 2020. Consequently, the Board is extending the 90-day period until the development ordered below can be completed. See 38 C.F.R. § 71.25(a)(2)(ii). Therefore, the claim must be remanded before it can be decided on the merits. The matters are REMANDED for the following action: 1. Arrange for the caregiver, M.A.T., to complete caregiver training and demonstrate the ability to carry out the specific personal care services, core competencies, and any additional care requirements. 2. Undertake any other development related to the Veteran and caregiver that has not already been completed. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Scott Shoreman, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.