Citation Nr: 1321012 Decision Date: 06/28/13 Archive Date: 07/05/13 DOCKET NO. 98-06 592A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to a disability rating greater than 70 percent for service-connected depressive disorder associated with left pelvic fracture with shortening of the left leg and degenerative arthritis (psychiatric disability). 2. Entitlement to special monthly compensation (SMC) pursuant to 38 U.S.C.A. § 1114(s). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Jarrette A. Marley, Associate Counsel INTRODUCTION The Veteran served on active duty from April 1983 to October 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2005 rating decision by the Huntington, West Virginia Department of Veterans Affairs (VA) Regional Office (RO) that increased the disability rating for the Veteran's psychiatric disability 50 percent, effective May 31, 2005. In April 2007, the RO increased the rating to 70 percent, also effective May 31, 2005. The Veteran's claims file is now in the jurisdiction of the St. Petersburg, Florida RO. In a September 2008 decision, the Board denied the Veteran's claim for a rating in excess of 70 percent for psychiatric disability. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In September 2009, the Court vacated the September 2008 Board decision, and remanded the matter for readjudication consistent with the instructions outlined in a Joint Motion for Remand to the Board (Joint Motion) by the parties. In May 2011 and October 2012, the Board remanded the matter for additional development. The Veteran has a combined 100 percent schedular evaluation effective October 30, 1996. In Rice v. Shinseki, 22 Vet. App. 447 (2009), however, the Court held that a request for a total disability rating based on individual unemployability due to service-connected disabilities (TDIU), whether expressly raised by a Veteran or reasonably raised by the record, is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability or disabilities, either as part of the initial adjudication of a claim or, if a disability upon which entitlement to TDIU is based has already been found to be service connected, as part of a claim for increased compensation. Id. at 453-54. The Court further explained that "[w]hen entitlement to TDIU is raised during the adjudicatory process of the underlying disability or during the administrative appeal of the initial rating assigned for that disability, it is part of the claim for benefits for the underlying disability." Id. at 454. Thus, in adjudicating the Veteran's claim for a higher rating for her service-connected psychiatric disability the Board must consider whether a higher rating is warranted based on a TDIU due to a single disability, here psychiatric disability. Further, VA has a "well-established" duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); see also Bradley v. Peake, 22 Vet. App. 280 (2008). Under this duty to maximize benefits, SMC are to be accorded when a veteran becomes eligible without need for a separate claim. See Bradley, 22 Vet. App. 280, 294 (2008). Thus, the Board has included the issue of entitlement to SMC as part of the appeal, as reflected on the title page. FINDINGS OF FACT 1. The evidence shows that since May 31, 2005, the Veteran's psychiatric disability alone has rendered her unable to secure or follow a substantially gainful occupation. 2. Separate from her psychiatric disability, the Veteran has additional service-connected disabilities independently ratable at 60 percent or more disabling. CONCLUSIONS OF LAW 1. Resolving all reasonable doubt in the Veteran's favor, throughout the appeal period, the criteria for a 100 percent disability rating for depressive disorder have been met. 38 U.S.C.A. §§ 1154(a), 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 4.7, 4.16, 4.126, 4.130, Diagnostic Code 9434 (2012). 2. The criteria for special monthly compensation at the housebound rate, effective May 31, 2005, have been met. 38 U.S.C.A. §§ 1114(s), 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.350 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In this decision, the Board grants a 100 percent disability rating for the Veteran's service-connected depressive disorder, and grants entitlement to special monthly compensation pursuant to 38 U.S.C.A. § 1114(s). As such, no discussion of VA's duty to notify or assist is necessary. Increased Rating for Depressive Disorder Initially, the Board notes that it has reviewed all of the evidence in the Veteran's claims and in Virtual VA (i.e., VA's electronic data storage system), with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (VA must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims. The Veteran must not assume that the Board overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the veteran). Disability ratings are based upon VA's Schedule for Rating Disabilities as set forth in 38 C.F.R. Part 4. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity in civil occupations. 38 U.S.C.A. § 1155. The disability must be viewed in relation to its history. 38 C.F.R. § 4.1. A higher evaluation shall be assigned where the disability picture more nearly approximates the criteria for the next higher evaluation. 38 C.F.R. § 4.7. Where, as here, entitlement to compensation has already been established and increase in disability rating is at issue, present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Thus, although the Board has thoroughly reviewed all evidence of record, the more critical evidence consists of the evidence generated during the appeal period. Further, the Board must evaluate the medical evidence of record since the filing of the claim for increased rating and consider the appropriateness of a "staged rating" (i.e., assignment of different ratings for distinct periods of time, based on the facts). See Hart v. Mansfield, 21 Vet. App. 505 (2007); see also Fenderson v. West, 12 Vet. App. 119 (1999). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (a veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, 492 F.3d at 1376-77. The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the Federal Circuit, citing its decision in Madden, recognized that the Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C.A. § 7104(a) (West 2002). Moreover, the Court has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility consistency with other evidence submitted on behalf of the veteran, and the veteran's demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995); aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996). In evaluating a service-connected disability, if it is not possible to separate the effects of a service-connected condition from that of a nonservice-connected condition, then 38 C.F.R. § 3.102 requires that reasonable doubt be resolved in the veteran's favor; that is, any such ambiguity as to the origin of such signs and symptoms shall be attributed to the service-connected disability. Mittleider v. West, 11 Vet. App. 181, 182 (1998). Thus, if any symptoms cannot be distinguished as between service-connected and nonservice-connected symptomatology, the Board will consider both as service service-connected disability. Id. The Veteran's depressive disorder is currently rated pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9434. According to 38 C.F.R. § 4.126(a), a mental disorder shall be evaluated "based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of examination." The regulations establish a general rating formula for mental disorders. 38 C.F.R. § 4.130. Ratings are assigned according to the manifestation of particular symptoms. However, the use of the term "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). When determining the appropriate disability evaluation to assign, however, the Board's "primary consideration" is the Veteran's symptoms. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). The Veteran's depressive disorder is rated under 38 C.F.R. § 4.130, Diagnostic Code 9434. Under that Code, pursuant to the general rating formula, a 70 percent rating is warranted if evidence shows occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and an inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted if evidence shows total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Id. In rating the severity of the Veteran's psychiatric disability under the criteria listed above, psychiatric health care providers have their own system for rating psychiatric disability. This is the Global Assessment of Functioning (GAF) rating schedule, which is a scale reflecting the psychological, social, and occupational functioning on a hypothetical continuum of mental-health illness. See Diagnostic and Statistical Manual for Mental Disorders, 4th ed., American Psychiatric Association (DSM-IV); Richard v. Brown, 9 Vet. App. 266, 267 (1996) (citing DSM-IV). The GAF scale score assigned does not determine the disability rating VA assigns, but it is one of the medical findings employed in that determination. The medical evidence shows that GAF scores have been assigned during the pendency of this claim. An examiner's classification of the level of psychiatric impairment, by words or by a score, is to be considered but is not determinative of the percentage rating to be assigned. VAOPGCPREC 10-95. A GAF score, however, is highly probative as it relates directly to the veteran's level of impairment of social and industrial adaptability, as contemplated by the rating criteria for mental disorders. See Richard v. Brown, 9 Vet. App. 266, 267 (1996). The following applies to the GAF scores relevant to this case. A GAF score from 41 to 50 is defined as serious symptoms or any serious impairment in social, occupational, or school functioning. A GAF score from 51 to 60 represents moderate symptoms, or moderate difficulty in social or occupational functioning. As noted above in the Introduction, the Veteran's depressive disorder is presently rated 70 percent disabling throughout the appeal period. The Veteran asserts that her depressive disorder is more severely disabling than currently reflected by the 70 percent disability rating. On June 2005 VA examination, the examiner described the Veteran as being rather loquacious, providing over-elaborate responses to many of the questions. She reported living with her 22-year-old daughter and her four-year-old granddaughter, with whom she apparently had a fairly good relationship. She reported having a very low energy level during the day. She no longer engaged in many activities and finding it difficult to go shopping or do cooking. She indicated she had no meaningful social support. She further related she has poor concentration and has a tendency to misplace things. She also stated she has poor self-esteem, cries all the time, and has suicidal ideation. On mental status examination, the Veteran was pleasant and cooperative during the examination, displaying good personal hygiene. She was alert and oriented times four. Her affect was labile, often becoming very tearful, and her mood was dysphoric. Thought content and processes were within normal limits. There was no evidence of delusions or hallucinations. No inappropriate behavior was noted. There was no gross memory loss or impairment, although she displayed some difficulty recalling important historical events. Her speech was somewhat circumstantial but coherent, and of normal rate and volume. The diagnosis was major depressive disorder, recurrent, moderate to severe. A GAF score of 51 was assigned. The examiner opined that due to the chronicity of the Veteran's depressive symptomatology, her comorbid personality disorder, and limited response to treatment, the Veteran's prognosis is very guarded. Pensacola VA treatment records from May 2005 to October 2006 show intermittent treatment for depression. The Veteran revealed good hygiene, depression, and her thought processes, speech, and memory were noted to be within normal limits. She also reported detachment/estrangement from others, as well as anger, irritability, poor concentration, and an exaggerated startle response (i.e., jumping to loud sounds or people coming up unexpectedly). GAF scores assigned during this period ranged from 49 to 55. In her October 2006 Substantive Appeal, the Veteran reported significant isolation for the past six years. She also stated she has difficulty expressing herself. While she has enjoyment interacting with her family and cooking for them, such instances are rare. A November 2006 Pensacola VA treatment record noted the Veteran's complaint that doing anything is a major effort. She reported that it was a major ordeal to make it through Thanksgiving with her family. A GAF score of 49 was assigned. On January 2007 VA examination (by the same VA examiner as June 2005), noted the Veteran's report that she was basically homebound because of her depression and anxiety. She indicated she was concerned about her cognitive functioning. She stated she was sleeping poorly and has a low energy level, spending a great deal of time in bed. She indicated that she did not want to be around people like she used to. She further related she has constant suicide ideation with two previous overdose attempts. She reported she does not do the things she loves, to include cooking, and that she has no friends. On mental status examination, the Veteran had good personal hygiene. She was pleasant and cooperative during the examination, and was much more focused and coherent than she was during the previous examination. Her mood was dysphoric, and her affect was labile. She fluctuated between being very tearful and having a flat affect. There was no evidence of delusions. There were apparent hallucinations as she reported seeing black spots in her peripheral vision that she believes are bugs and seeing a flash of white light in front of her. She admitted to chronic suicidal ideation. She was alert and oriented times four. There was no evidence of gross memory impairment or loss, although she often lost her train of thought. Her speech was far more linear and coherent than on June 2005 VA examination. Her speech was of normal rate and volume. The diagnoses included major depressive disorder, recurrent, severe, with likely psychotic symptoms, chronic without inter-episode recover; PTSD; and borderline personality traits. A GAF score of 49 was assigned. The examiner noted that the Veteran describes symptoms of depression that fall into the severe range and occur on a daily basis. Moreover, she has been unemployed for years due to her depression. On this basis, the examiner believed the Veteran's depression would make it difficult to function in an employment setting. As the Veteran has always worked in a mental health capacity since service, the examiner did not believe it would be wise for the veteran to function in that capacity now. In April 2008 correspondence, the Veteran reported that she attempted suicide six months earlier by overdosing on prescription medication but became very ill. In a separate April 2008 statement, she reported she did not look forward to anything, and had no joy in anything. She further stated she was always crying, spending some nights in her bathtub with a razor blade. She reported she has no friends, and that her daughter cuts her hair (because she is unable to leave her home). She also stated she has difficulty sleeping. She further indicated she was irritable with noise. The Board notes that the Veteran repeated herself several times in the letter. In a May 2008 letter from W.T., the appellant's daughter, it was reported that the Veteran cries all the time and refuses to go anywhere. In addition, she does not like to talk to people. She spends her time watching television or sleeping in the same pajamas for days at a time. In a January 2011 letter from W.T., the appellant's daughter stated the Veteran stays in bed most of the time and cries every day. She is very irritable when there is a lot of noise. W.T. also related it is hard to communicate with the appellant because she is very forgetful. It was also reported that the appellant was afraid of dealing with people. In a January 2011 letter from A.H., a former Service Officer at the local Vet Center, it was noted that the Veteran has significant difficulty communicating, and has had at least three suicide attempts. Moreover, the Veteran is extremely isolated. She also becomes paralyzed when a deadline is set. In an April 2011 letter from K.S., the appellant's sister, it was reported that she lived with the appellant for a short period of time and that the appellant was constantly crying during this period of time, rarely showered, and was extremely difficult to get along with. It was further noted that the appellant isolates herself, and has obsessive rules in her apartment. Pensacola VA treatment records from January 2007 to June 2011 show treatment for the Veteran's depression. The Veteran's hygiene was found to be good throughout this period. GAF scores assigned ranged from 45 to 52. On June 2011 VA examination, the Veteran reported she has been very stressed lately. She stated that she stays home and watches television. She indicated her energy was not good and she had poor focus. She related she does not have any friends. Her daughter is the only person she talks to as she lives with the appellant with her two children. On mental status examination, the Veteran was neatly dressed and groomed, and arrived early for the appointment. Her thought process/communication was mildly circumstantial but the Veteran was able to re-direct her thoughts. She denied delusions or hallucinations with the exception of seeing a bright white light when she feels ashamed of herself. She reported she has some passive suicidal ideation, but no recent intent or plan. She further reported she sometimes goes days without grooming. She was oriented to person, place, time and situation. There was no noted memory loss or impairment. There was also no reported obsessive or ritualistic behavior that interferes with routine activities. The Veteran's speech was of regular rate, rhythm, and volume, albeit somewhat over-elaborative. She had a depressed mood with a tearful, mood congruent affect. There was no impairment of impulse control. The diagnoses were major depressive disorder, recurrent, moderate to severe, and posttraumatic stress disorder by history. A GAF score of 45 to 50 was assigned. It was opined that from the perspective of the Veteran's documented and subjectively reported symptoms of major depressive disorder exclusively, she does not currently appear to be unemployable. Pensacola VA treatment records from June 2011 to March 2013 show the Veteran was assigned GAF scores ranging from 45 to 50, with a score of 58 in February 2013. In a March 2013 VA opinion, it was opined that after a review of all the Veteran's claims file, it is less likely as not the Veteran's service-connected major depressive disorder alone makes her unable to secure or follow a substantially gainful occupation. Although the Veteran does have apparent significant mental health problems that would limit her ability to work in a public or high stress setting, her depression alone would not prevent her from working. Her borderline personality disorder contributes greatly to her difficulty in dealing with others and managing stress and her emotions, and results in a significant portion of her problems. She is also diagnosed with PTSD which results in some of her impairments. After a review of the evidence, the Board finds that the preponderance of the evidence shows that the Veteran's psychiatric disability does not warrant a schedular evaluation in excess of 70 percent under the general schedule for rating mental disorders set forth in 38 C.F.R. § 4.130. See Vazquez-Claudio v. Shinseki. Although the Veteran's psychiatric disability is productive of suicidal ideation the disorder is not productive of total occupational and social impairment due to gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior or that she is a persistent danger of hurting self or others. In addition, although she is essentially housebound, she is able to perform many activities of daily living and is not disoriented to time or place and does not have memory loss for names of close relatives, own occupation, or own name. The Board also notes that the Veteran was found to have good personal hygiene on VA examination reports and in VA treatment records notwithstanding lay statements submitted on her behalf by her daughter and her sister have indicated that she goes days without any grooming, which the Veteran herself reported on June 2011 VA examination, and her daughter cuts her hair because she does not leave her home. That, however, does not end the Board's inquiry. The Veteran's psychiatric disability, which is rated as 70 percent disabling, satisifies the schedular TDIU criteria set forth in 38 C.F.R. § 4.16(a). As noted above, in Rice the Court held that a TDIU is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability or disabilities, either as part of the initial adjudication of a claim or, if a disability upon which entitlement to TDIU is based has already been found to be service connected, as part of a claim for increased compensation. Id. at 453-54. The Court further explained that "[w]hen entitlement to TDIU is raised during the adjudicatory process of the underlying disability or during the administrative appeal of the initial rating assigned for that disability, it is part of the claim for benefits for the underlying disability." Id. at 454. As such, the Board must determine if a 100 percent rating for psychiatric disability is warranted based on the Veteran's entitlement to a TDIU based solely on that condition. In this case, the Board finds significant that on January 2007 VA examination, by the same examiner that conducted the June 2005 VA examination, it was found that the Veteran's depression symptoms were severe and that her depression would make it difficult to function in an employment setting. The Board also finds significant that the examiner considered the Veteran's employment history in formulating this opinion, specifically, that she had worked in a mental health capacity (i.e., as a child protective investigator). Moreover, throughout the appeal period, the Veteran has consistently reported she was essentially housebound due to her depression, that she had a very low energy level and motivation, and that she had significant suicidal ideation that has resulted in at least three suicide attempts. In addition, she has been consistently noted to be socially isolated, having no friends, and being afraid to be around other people. In light of the foregoing, and resolving all reasonable doubt in the Veteran's favor, the Board finds that a 100 percent rating for psychiatric disability is warranted because she is unable to secure and follow a substantially gainful occupation due solely to her depressive disorder. As such, a TDIU is warranted due to the Veteran's psychiatric disability alone. SMC The Board reiterates that VA has a "well-established" duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993). This duty to maximize benefits requires VA to assess all of a claimant's disabilities to determine whether any combination of disabilities establishes entitlement to special monthly compensation (SMC) under 38 U.S.C.A. § 1114. See Bradley v. Peake, 22 Vet. App. 280, 294 (2008) (finding that SMC "benefits are to be accorded when a veteran becomes eligible without need for a separate claim" and remanding, pursuant to VA's duty to maximize benefits, for VA to determine whether the Veteran's posttraumatic stress disorder, rated 70 percent disabling, would entitle him to TDIU and, therefore, to SMC). Indeed, as noted in Bradley, VA must consider a TDIU claim despite the existence of a schedular total rating and award SMC under 38 U.S.C.A. § 1114(s) if VA finds the separate disability supports a TDIU rating independent of the other 100 percent disability rating. See Bradley, 22 Vet. App. 280, 294 (2008); see also DVA Sum. Op. Gen. Counsel Prec., 75 Fed. Reg. 11229-04 (March 10, 2010) (withdrawing VAOPGCPREC 6-99, 64 Fed. Reg. 52375 (1999) (the logic of Bradley suggests that if a Veteran has a schedular total rating for a particular service-connected disability and subsequently claims TDIU for a separate disability, VA must consider the TDIU claim despite the existence of the schedular total rating and award SMC under section 1114(s) if VA finds the separate disability(ies) support a TDIU rating independent of the other 100 percent disability rating). Special monthly compensation is payable where the Veteran has a single service-connected disability rated as 100 percent and (1) has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. This requirement is met when the Veteran is substantially confined as a direct result of service-connected disabilities to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime. 38 U.S.C.A. § 1114(s); 38 C.F.R. § 3.350(i). Subsection 1114(s) requires that a disabled Veteran whose disability level is determined by the ratings schedule must have at least one disability that is rated at 100 percent in order to qualify for the special monthly compensation provided by that statute. Under the law, subsection 1114(s) benefits are not available to a Veteran whose 100 percent disability rating is based on multiple disabilities, none of which is rated at 100 percent disabling. The Court has held that although a TDIU may satisfy the "rated as total" element of section 1114(s), a TDIU based on multiple underlying disabilities cannot satisfy the section 1114(s) requirement of "a service-connected disability" because that requirement must be met by a single disability. The Court declared, however, if a Veteran were awarded a TDIU based on multiple underlying disabilities and then later receives a schedular disability rating for a single, separate disability that would, by itself, create the basis for an award of a TDIU, that the order of the awards was not relevant to the inquiry as to whether any of the disabilities alone would render the Veteran unemployable and thus entitled to a TDIU rating based on that condition alone. Buie v. Shinseki, 24 Vet. App. 242, 250 (2010). In this case, the Board notes that the Veteran has been rated a combined 100 percent disabled due to her service-connected disabilities effective since October 30, 1996. As this decision granted a 100 percent disability rating for the Veteran's service-connected depressive disorder (based on a TDIU due solely to that condition), and thus has a single service-connected disability rated as total, and has an additional service-connected disabilities that are independently rated at 60 percent. As such, the criteria for SMC at the housebound rate under 38 U.S.C.A. § 1114(s) were met as of May 31, 2005. Therefore it follows that in light of the Court's decisions in Bradley and in Buie, entitlement to SMC at the housebound rate under 38 U.S.C.A. § 1114(s) is granted, effective May 31, 2005. ORDER Subject to the laws and regulations governing payment of monetary benefits, effective May 31, 2005, a 100 percent disability rating for depressive disorder is granted. Subject to the law and regulations governing payment of monetary benefits, effective May 31, 2005, entitlement to special monthly compensation at the housebound rate under 38 U.S.C.A. § 1114(s) is granted. ____________________________________________ STEVEN D. REISS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs