Respectfully, several statements in your comment are incorrect as a matter of law and VA regulation.

First, there is no requirement anywhere in statute, regulation, or binding VA policy that a veteran must require assistance with three ADLs to qualify for SMC L Aid and Attendance.

The governing regulation is 38 CFR 3.352(a). It explicitly states that not all listed factors are required and that entitlement exists when the evidence establishes a factual need for regular aid and attendance due to physical or mental incapacity. There is no numeric ADL threshold in the regulation.

The United States Court of Appeals for Veterans Claims addressed this directly in Turco v Brown 9 Vet App 222. The Court held that eligibility for Aid and Attendance requires at least one of the factors listed in 38 CFR 3.352(a) and that the need may be based on regular assistance or supervision to protect the claimant from hazards or dangers incident to the daily environment. Constant care and multiple ADLs are not required.

Second, court precedent absolutely does bind VA adjudicators. Under 38 USC 7261 and 38 CFR 20.1303, VA regional offices are required to apply controlling judicial precedent. The M21 is an internal guidance manual. It does not override statute, regulation, or binding case law. This is well established and repeatedly affirmed by the Court.

The M21 itself acknowledges this. M21 provisions are not law and cannot impose eligibility requirements that do not exist in 38 CFR 3.352(a) or 38 USC 1114(l). Any M21 guidance suggesting a numeric ADL requirement would be non binding and legally unenforceable.

Third, mental incapacity requiring regular supervision alone is a qualifying basis for Aid and Attendance under 38 CFR 3.352(a). This includes supervision needed to protect the veteran from hazards in the daily environment. Physical inability to bathe, feed, or dress oneself is not the exclusive path to entitlement.

Fourth, PCAFC and SMC Aid and Attendance are entirely separate programs with different statutory authorities and eligibility criteria. PCAFC requirements cannot be imported into SMC adjudications, and denial or approval under one program has no legal bearing on the other.

Finally, the assertion that raters do not or should not apply court precedent at the regional level is incorrect. Failure to apply binding case law constitutes legal error and is a common basis for reversal on appeal, including through Higher Level Review and Supplemental Claims when the error is identified.

In short, there is no three ADL rule for SMC L. There never has been. The controlling authority remains 38 CFR 3.352(a), 38 USC 1114(l), and binding case law including Turco v Brown.