Laska v. McDonough addressed whether VA unlawfully imposed an additional regulatory requirement for entitlement to Special Monthly Compensation under 38 U.S.C. § 1114(t), the statutory provision governing aid-and-attendance benefits for veterans with qualifying traumatic brain injury (TBI) residuals.

The veteran suffered severe service-connected TBI residuals following combat injuries in Vietnam, including cognitive dysfunction, balance problems, memory impairment, disorientation, and dependence on his spouse for medication management, safety supervision, and daily activities. VA had already awarded SMC(l) for regular aid and attendance and SMC(s) for housebound status.

The dispute centered on VA’s implementing regulation, 38 C.F.R. § 3.352(b)(2), which required veterans seeking SMC(t) to demonstrate the need for a “higher level of care” equivalent to the demanding standard contained in SMC(r)(2). The Board denied SMC(t) because it concluded the veteran required regular aid and attendance but not licensed professional-level care or supervision.

The Court rejected VA’s interpretation. Applying traditional statutory interpretation principles, the Court held that the plain language of § 1114(t) clearly requires only:

1. the need for regular aid and attendance due to TBI residuals,
2. ineligibility for SMC(r)(2),
3. and the need for institutional care absent such aid and attendance.

The Court emphasized that Congress deliberately used the phrase “regular aid and attendance” in § 1114(t), while separately using the more demanding “higher level of care” language only in § 1114(r)(2). The Court explained that VA improperly attempted to graft the subsection (r)(2) standard into subsection (t), contrary to the statutory text and structure.

The Court also examined the legislative history underlying § 1114(t). Congress specifically intended subsection (t) to recognize the unique cognitive and psychological impairments caused by TBI, including the need for supervision, cueing, safety monitoring, and assistance often provided by family members rather than licensed medical personnel.

In addition, the Court found reasons-and-bases error because the Board failed to adequately explain why it assigned greater probative value to a nurse practitioner’s opinion over a neurology specialist’s findings that the veteran was totally dependent on his spouse.

The Court ultimately invalidated 38 C.F.R. § 3.352(b)(2), set aside the Board decision, and remanded the matter for readjudication under the proper statutory standard.

38 U.S.C. § 1114(t) requires only the need for regular aid and attendance due to service-connected TBI residuals and does not require the “higher level of care” standard contained in 38 U.S.C. § 1114(r)(2). A VA regulation imposing that additional requirement is invalid.

VA cannot impose regulatory requirements that exceed or conflict with the plain language of the governing SMC statute.

Laska is one of the most important modern SMC(t) decisions because it invalidated a longstanding VA regulation that improperly restricted entitlement to higher-level TBI aid-and-attendance compensation. The decision substantially expands access to SMC(t) for severely impaired TBI veterans who require regular supervision and assistance but not licensed professional care.

VA often:
• improperly requires professional-level or licensed medical care for SMC(t),
• conflates SMC(t) with SMC(r)(2),
• misinterprets statutory language through restrictive regulations,
• or inadequately explains how conflicting medical opinions were weighed.

A veteran with severe TBI requires constant supervision from a spouse for medication management, safety monitoring, transportation, and daily functioning. VA denies SMC(t) because the spouse is not a licensed medical professional. Laska directly rejects that requirement.

Laska is especially useful when:

• litigating SMC(t) claims,
• challenging restrictive regulatory interpretations,
• arguing statutory text controls over conflicting VA regulations,
• or establishing that non-medical supervision and assistance may satisfy SMC(t).

The case is particularly powerful in TBI-related aid-and-attendance claims involving family caregiver support.

38 U.S.C. §§ 1114(l), 1114(r)(2), 1114(t), 7104(d)(1), 7261(a)(3), 38 C.F.R. §§ 3.350(j), 3.352(b)(2), Russello v. United States, Loper Bright Enterprises v. Raimondo, Carr v. McDonough