Citation Nr: 18142647 Decision Date: 10/16/18 Archive Date: 10/16/18 DOCKET NO. 16-11 233A DATE: October 16, 2018 ORDER For the entire period under review, entitlement to a 50-percent rating, and no higher, for migraine including migraine variants associated with traumatic brain injury (including lightheadedness) is granted, subject to controlling regulations applicable to the payment of monetary benefits. For the entire period under review, entitlement to a 40-percent rating, and no higher, for traumatic brain injury (including lightheadedness) is granted, subject to controlling regulations applicable to the payment of monetary benefits. REMANDED Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. Entitlement to special monthly compensation (SMC) is remanded. FINDINGS OF FACT 1. Throughout the entire period under review, the Veteran’s service-connected headaches have involved very frequent, completely prostrating, prolonged attacks that produce severe economic inadaptability. 2. Throughout the entire period under review, the Veteran’s traumatic brain injury residuals other than headaches and tinnitus have not been manifested by a level of severity higher than “2” for any facet due to cognitive impairment, emotional/behavioral impairment, or physical impairment, to include subjective symptoms. CONCLUSIONS OF LAW 1. The criteria for a 50-percent rating, and no higher, for migraine including migraine variants associated with traumatic brain injury (including lightheadedness) have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.159, 4.124(a), Diagnostic Code 8100. 2. The criteria for a rating of 40-percent rating, and no higher, for traumatic brain injury (including lightheadedness) have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.159, 4.124(a), Diagnostic Code 8045. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 2006 to July 2007. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision. Increased Rating Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Separate, “staged” evaluations may be assigned for separate periods of time based on the facts found. See Hart v. Mansfield, 21 Vet. App. 505 (2007). Under the anti-pyramiding provision of 38 C.F.R. § 4.14, the evaluation of the same disability or manifestation under various diagnoses is to be avoided. When there is an approximate balance of evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Entitlement to a rating in excess of 30 percent for migraine including migraine variants associated with traumatic brain injury (TBI), including lightheadedness. A rating decision of May 2013 granted service connection for migraine including migraine variants associated with traumatic brain injury (including lightheadedness). A 30-percent rating was assigned with an effective date of June 22, 2011. The Veteran appealed as to the assigned rating. See NOD of May 2014; VA Form 9 of March 2016. Under 38 C.F.R. § 4.124(a), DC 8100, migraine headaches with very frequent, completely prostrating, prolonged attacks productive of severe economic inadaptability warrant a 50-percent evaluation. Migraine headache disorders with characteristic prostrating attacks occurring on an average of once a month over the last several months warrant a 30-percent evaluation. A 10-percent evaluation requires characteristic prostrating attacks averaging one in two months over the last several months. A noncompensable evaluation is assigned for migraine headaches with less frequent attacks. The rating criteria do not define "prostrating.” Two dictionary definitions of prostration are "complete physical or mental exhaustion" (Merriam Webster’s Collegiate Dictionary, 11th Ed. 2007) and "extreme exhaustion or powerlessness" (Dorland’s Illustrated Medical Dictionary, 32nd Ed. 2012). In March 2011, the Veteran reported headaches characterized by throbbing pain, nausea, and emesis. See VA treatment record of March 2011. The Veteran underwent a VA examination for headaches in May 2013. She was found to have characteristic prostrating attacks of migraine headache pain more frequently than once a month and very frequent prostrating and prolonged attacks of migraine headache pain. In April 2014, the Veteran reported that her migraines require her to lay down in a dark, quiet room, with associated symptoms of light and noise sensitivity, nausea, and vomiting. See April 2014 VA treatment record. The Veteran’s mother states that she cares for the Veteran’s children and drives her places when her “medical condition” prevents her from doing so. The Veteran’s husband states that his wife’s “medical condition” prevents sexual relations. See lay statements of May 2014. The Veteran has identified her migraines as interfering with care for her children and preventing sex with her husband. See Veteran’s statement of May 2014. The January 2016 VA examination report for headaches noted the Veteran’s report of having migraine headaches three to four times per week. According to the Veteran, the migraine episodes are characterized by not being able to do anything and needing to lie down with the lights and the television off. There is also nausea and occasional dizziness. The migraines usually last for 24 hours but, approximately four times per year, they last for three days. The Veteran loses approximately eight days of work per month as a self-employed hair stylist as a result. Despite this report of symptoms, the examiner found the Veteran to have characteristic prostrating attacks of migraine pain once every month and not to have very prostrating and prolonged attacks of migraines productive of severe economic inadaptability. The July 2016 VA examiner found that the Veteran experienced headache pain and associated nausea and sensitivity to light. No finding was made as to the duration of the Veteran’s headaches. It was merely noted that the Veteran’s report as to duration was “vague” and “inconsistent with examination in Jan.” The Veteran was found not to have characteristic prostrating attacks of migraine headache pain. In the examiner’s opinion, the Veteran does not meet the diagnostic criteria for migraine headaches as defined by the International Headache Society in 2013 and as evidenced by: (1) headache descriptions inconsistent with the claimed diagnosis; (2) inadequate response to highly effective/ diagnostic migraine medications; and (3) absence of MRI changes expected on patients with chronic migraines. The examiner stated, “The effect of veteran's current environmental situation and of her more recent mental health issues cannot be completely rule[d] out, as the current etiology of her reported symptoms.” For the award of a higher, 50-percent rating, the evidence must be at least in equipoise as to whether the Veteran experiences migraine headaches with very frequent, completely prostrating, prolonged attacks productive of severe economic inadaptability. The May 2013 VA examiner found the Veteran to have characteristic prostrating attacks of migraine headache pain more frequently than once a month and very frequent prostrating and prolonged attacks of migraine headache pain. That finding is consistent with the Veteran’s competent and credible reporting of her symptoms, as reflected in the VA treatment records and VA examination reports. Accordingly, the Board finds that the criteria of a 50-percent rating have been met for the entire period under review. Certain findings of the VA examination reports of January 2016 and July 2016 tend to weigh against the claim. Deficiencies in the analysis, however, lead the Board to assign less weight to those reports than to the May 2013 examination report. See Stefl v. Nicholson, 21 Vet App. 120, 124 (2007). The May 2013 VA examiner reviewed the VA claims file in conjunction with the examination. The January and July 2016 examiners, in contrast, specifically indicated that the VA claims file had not been reviewed. The VA claims file includes the Veteran’s lay statements and supporting lay statements of her family. Furthermore, the January 2016 examiner’s finding that the Veteran does not experience very prostrating and prolonged attacks of migraines productive of severe economic inadaptability does not address the notation in the report itself that, four times per week, the Veteran must lie down and not do anything due to a migraine. In addition, in the July 2016 report, the etiology of the Veteran’s headaches was explained only by broad reference to the Veteran’s “current environmental situation” and her “more recent mental health issues.” The examiner did not explain whether his new diagnosis represented a correction of the record diagnosis of migraine headaches. Moreover, without explanation, the examiner found the Veteran’s description of the duration of her headaches to be at the same time “vague” and in contradiction to an earlier report. A response that was specific enough to be deemed contradictory of an earlier response should have noted verbatim and so analyzed and not dismissed merely as vague, especially where there is ample evidence of very frequent, prolonged, prostrating attacks of migraine pain. The grant of a 50-percent evaluation for migraine headaches represents the maximum schedular rating under Diagnostic Code 8100. The Board has considered whether there is any other schedular basis for granting a higher rating, but has found none. Entitlement to a rating in excess of 10 percent for traumatic brain injury (TBI) (including lightheadedness). A rating decision of May 2013 granted service connection for traumatic brain injury (including lightheadedness). The in-service injury was caused by a medical chest that fell and hit the Veteran’s head and shoulder. A 10-percent rating and an effective date of June 22, 2011 were assigned. The Veteran appealed as to the assigned rating. See NOD of May 2014; VA Form 9 of March 2016. The May 2013 rating decision also granted service connection for tinnitus and migraine headache disabilities associated with the TBI. The Veteran appealed as to the 30-percent rating assigned for migraines. The issue of entitlement to a higher rating for migraine headaches including migraine variants has been addressed as a separate issue in the above section of this order. There was no appeal as to the tinnitus rating. The Veteran’s traumatic brain injury is rated under 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8045, which provides for the evaluation of three main areas of dysfunction that may result from traumatic brain injury and have profound effects on functioning. These areas are cognitive, emotional/behavioral, and physical. Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal-setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem-solving, judgment, decision-making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Cognitive impairment is to be evaluated under the table, Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified (“Table”). 38 C.F.R. § 4.124a, DC 8045. Emotional/behavioral dysfunction must be evaluated under § 4.130 (schedule of ratings for mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, emotional/behavioral symptoms are evaluated under the criteria in the Table. Physical (including neurological) dysfunction will be evaluated under an appropriate diagnostic code for that disability. Each condition is to be evaluated separately, as long as the same signs and symptoms are not used to support more than one evaluation. The evaluations for each separately rated condition will be combined under 38 C.F.R. § 4.25. Subjective symptoms may be the only residual of a traumatic brain injury or may be associated with cognitive impairment or other areas of dysfunction. Subjective symptoms that are residuals of a traumatic brain injury, whether or not they are part of cognitive impairment, are to be evaluated under the subjective symptoms facet in the Table. Any residual with a distinct diagnosis that may be evaluated under another diagnostic code must be separately evaluated, even if that diagnosis is based on subjective symptoms, rather than under the Table. The Table contains ten important facets of a traumatic brain injury related to cognitive impairment and subjective symptoms. It provides the criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level (the highest level of impairment) which is labeled "total." Not every facet has every level of severity. A 100-percent evaluation must be assigned if "total" is the level of evaluation for one or more facets. If no facet is evaluated as "total," the overall percentage evaluation is assigned based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, a 70 percent evaluation should be assigned if 3 is the highest level of evaluation for any facet. The manifestations of conditions evaluated pursuant to the Table may overlap with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, more than one evaluation should not be assigned based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, a single evaluation is to be assigned under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. If, however, the manifestations are clearly separable, a separate evaluation should be assigned for each condition. Symptoms listed as examples at certain evaluation levels in the Table are only examples and are not symptoms that must be present in order to assign a particular evaluation. 38 C.F.R. § 4.124a, DC 8045. The terms "mild," "moderate," and "severe" traumatic brain injury, which may appear in medical records, refer to a classification of traumatic brain injury made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under Diagnostic Code 8045. 38 C.F.R. § 4.124a, DC 8045, Note (4). The Board will analyze whether the Veteran is entitled to a rating higher than 10 percent for her TBI disability. The Veteran’s distinctly diagnosed conditions of tinnitus and migraine headaches with lightheadedness have been separately rated. See rating decision of May 2013. This analytic approach is required by DC 8045 and the anti-pyramiding provision 38 C.F.R. § 4.14. Entitlement to a rating in excess of 10 percent would require that a "2" or a “3” be assigned as the highest level of any one facet, or that a total evaluation be assigned for one or more facets. As explained below, the highest level of severity for any facet during the period under review is "2.". Facet 1: Memory, Attention, Concentration, Executive Functions “0” corresponds to: No complaints of impairment of memory, attention, concentration, or executive functions. “1” corresponds to: A complaint of mild loss of memory (such as having difficulty following a conversation, recalling recent conversations, remembering names of new acquaintances, or finding words, or often misplacing items), attention, concentration, or executive functions, but without objective evidence on testing. “2” corresponds to: Objective evidence on testing of mild impairment of memory, attention, concentration, or executive functions resulting in mild functional impairment. “3” corresponds to: Objective evidence on testing of moderate impairment of memory, attention, concentration, or executive functions resulting in moderate functional impairment. “Total” corresponds to: Objective evidence on testing of severe impairment of memory, attention, concentration, or executive functions resulting in severe functional impairment. The May 2013, January 2016, and July 2016 VA examinations made findings of no complaint of impairment of memory, attention, concentration, or executive functions. In fact, however, the Veteran has complained of a memory problem, as noted by the July 2016 examiner in the medical history section of the report. In numerous VA treatment records, the Veteran reports experiencing frequent memory loss, inability to concentrate, and loss of attention span. For example, she has complained of forgetting hairdressing steps in her work as a hairdresser and forgetting her destination when driving. See statement of May 2014. Memory impairment has been diagnosed based on testing. In September 2014, immediate memory was “borderline (mild impairment).” See September 2014 VA treatment record. In May 2015, the Veteran had difficulty recalling three-sentence-length material through seven-sentence-length material for retention with the auditory rehabilitation for memory, language, and comprehension probes. She failed a concentration component of the testing (“70% accuracy with a 5.04 reaction time”). See VA treatment record of May 2015. In addition, a VA examination report of July 2016 noted mild memory problems. Because testing shows objective evidence of impairment of memory, attention, concentration or executive functions, a “2” is assigned for this facet. Facet 2: Judgment “0” corresponds to: Normal. 1” corresponds to: Mildly impaired judgment. For complex or unfamiliar decisions, the person is occasionally unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision. “2” corresponds to: Moderately impaired judgment. For complex or unfamiliar decisions, the person is usually unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision, although has little difficulty with simple decisions. “3” corresponds to: Moderately severely impaired judgment. For even routine and familiar decisions, the person is occasionally unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision. “Total” corresponds to: Severely impaired judgment. For even routine and familiar decisions, the person is usually unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision. For example, the person is unable to determine appropriate clothing for current weather conditions or judge when to avoid dangerous situations or activities. The May 2013, January 2016, and July 2016 VA examination reports indicate that the Veteran’s judgment was normal. A “0” is assigned for this facet. Facet 3: Social Interaction “0” corresponds to: Social interaction is routinely appropriate. “1” corresponds to: Social interaction is occasionally inappropriate. “2” corresponds to: Social interaction is frequently inappropriate. “3” corresponds to: Social interaction is inappropriate most or all of the time. The May 2013, January 2016, and July 2016 VA examination reports indicate that the Veteran’s social interaction is routinely appropriate. The Veteran states that her TBI affects her “social interaction” in that she is unable to leave her residence, to maintain gainful employment, or to participate in recreational activities. See May 2014 statement. The TDIU issue will be remanded, as explained below. Otherwise, the Veteran’s statement does not address the appropriateness of her social interaction as contemplated by the facet. Because the Veteran’s social interaction is routinely appropriate, a “0” is assigned for this facet. Facet 4: Orientation “0” corresponds to: Always oriented to person, time, place, and situation. “1” corresponds to: Occasionally disoriented to one of the four aspects (person, time, place, situation) of orientation. “2” corresponds to: Occasionally disoriented to two of the four aspects of orientation or often disoriented to one aspect of orientation. “3” corresponds to: Often disoriented to two or more of the four aspects of orientation. “Total” corresponds to: Consistently disoriented to two or more of the four aspects of orientation. The May 2013, January 2016, and July 2016 VA examination reports found that the Veteran is always oriented to person, time, place, and situation. A “0” is assigned for this facet. Facet 5: Motor Activity (with Intact Motor and Sensory System) “0” corresponds to: Motor activity normal. “1” corresponds to: Motor activity normal most of the time, but mildly slowed at times due to apraxia (inability to perform previously learned motor activities, despite normal motor function). “2” corresponds to: Motor activity mildly decreased or with moderate slowing due to apraxia. “3” corresponds to: Motor activity moderately decreased due to apraxia. “Total” corresponds to: Motor activity severely decreased due to apraxia. The May 2013, January 2016, and July 2016 VA examination reports indicate that the Veteran’s motor activity is normal. A “0” is assigned for this facet. Facet 6: Visual Space Orientation “0” corresponds to: Normal. “1” corresponds to: Mildly impaired. Occasionally gets lost in unfamiliar surroundings, has difficulty reading maps or following directions. Is able to use assistive devices such as global positioning system (GPS). “2” corresponds to: Moderately impaired. Usually gets lost in unfamiliar surroundings, has difficulty reading maps, following directions, and judging distance. Has difficulty using assistive devices such as GPS. “3” corresponds to: Moderately severely impaired. Gets lost even in familiar surroundings, unable to use assistive devices such as GPS. “Total” corresponds to: Severely impaired. May be unable to touch or name own body parts when asked by the examiner, identify the relative position in space of two different objects, or find the way from one room to another in a familiar environment. The May 2013, January 2016, and July 2016 VA examination reports indicate that the Veteran’s visual spatial orientation is normal. A “0” is assigned for this facet. Facet 7: Subjective Symptoms “0” corresponds to: Subjective symptoms that do not interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples are: mild or occasional headaches, mild anxiety. “1” corresponds to: Three or more subjective symptoms that mildly interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples of findings that might be seen at this level of impairment are: intermittent dizziness, daily mild to moderate headaches, tinnitus, frequent insomnia, hypersensitivity to sound, hypersensitivity to light. “2” corresponds to: Three or more subjective symptoms that moderately interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples of findings that might be seen at this level of impairment are: marked fatigability, blurred or double vision, headaches requiring rest periods during most days. A May 2013 VA examination for ear conditions determined that her lightheadedness is directly related to the in-service TBI and that the symptom is mild and not incapacitating. For the May 2013 and January 2016 VA examination reports relating to TBI, the Veteran reported the subjective symptoms headaches three to four times a week, with photophobia, emesis, and dizziness. The July 2016 VA examination report found there to be no subjective symptoms. Based on the Veteran’s report of three mild subjective symptoms, a ‘1” is assigned for this facet. The Veteran’s headaches are addressed in a separate rating discussion below. Facet 8: Neurobehavioral Effects “0” corresponds to: One or more neurobehavioral effects that do not interfere with workplace interaction or social interaction. Examples of neurobehavioral effects are: irritability, impulsivity, unpredictability, lack of motivation, verbal aggression, physical aggression, belligerence, apathy, lack of empathy, moodiness, lack of cooperation, inflexibility, and impaired awareness of disability. Any of these effects may range from slight to severe, although verbal and physical aggression are likely to have a more serious impact on workplace interaction and social interaction than some of the other effects. “1” corresponds to: One or more neurobehavioral effects that occasionally interfere with workplace interaction, social interaction, or both but do not preclude them. “2” corresponds to: One or more neurobehavioral effects that frequently interfere with workplace interaction, social interaction, or both but do not preclude them. “3” corresponds to: One or more neurobehavioral effects that interfere with or preclude workplace interaction, social interaction, or both on most days or that occasionally require supervision for safety of self or others. The Veteran has been diagnosed with unspecified neurocognitive disorder and unspecified depressive disorder. See July 2016 VA examination report for mental disorders. The May 2013, January 2016, and July 2016 VA examination reports found that no neurobehavioral effects are associated with the Veteran’s TBI. Because the lowest rating under this facet requires at least one neurobehavioral effect, there is no level of impairment for this facet. Facet 9: Communication “0” corresponds to: Able to communicate by spoken and written language (expressive communication), and to comprehend spoken and written language. “1” corresponds to: Comprehension or expression, or both, of either spoken language or written language is only occasionally impaired. Can communicate complex ideas. “2” corresponds to: Inability to communicate either by spoken language, written language, or both, more than occasionally but less than half of the time, or to comprehend spoken language, written language, or both, more than occasionally but less than half of the time. Can generally communicate complex ideas. “3” corresponds to: Inability to communicate either by spoken language, written language, or both, at least half of the time but not all of the time, or to comprehend spoken language, written language, or both, at least half of the time but not all of the time. May rely on gestures or other alternative modes of communication. Able to communicate basic needs. “Total” corresponds to: Complete inability to communicate either by spoken language, written language, or both, or to comprehend spoken language, written language, or both. Unable to communicate basic needs. The May 2013, January 2016, and July 2016 VA examination reports found the Veteran to be able to communicate by, and to comprehend, spoken and written language. A “0” is assigned for this facet. Facet 10: Consciousness “Total” means a persistently altered state of consciousness, such as vegetative state, minimally responsive state, coma. The May 2013, January 2016, and July 2016 VA examination reports found consciousness to be normal. Therefore, there is no level of impairment for this facet. Conclusion The Board finds the Veteran to have the following levels of severity for her facets of cognitive impairment and other residuals of TBI not otherwise classified: memory, attention, concentration, concentration, executive functions (2); judgment (0); social interaction (0); orientation (0); motor activity (0); visual spatial orientation (0); subjective symptoms (1); and communication (0). Accordingly, the overall percentage evaluation for cognitive impairment and other residuals not otherwise classified is 40 percent, because “2” is the highest level of any rated facet, and only one disability evaluation is assigned for all the applicable facets. 38 C.F.R. § 4.124a, DC 8045. The Veteran has already been awarded separate ratings for her TBI-associated tinnitus and headaches. She also has an eye disorder and a psychiatric disability that are unrelated to her TBI. See May 2013 VA examination report for eye conditions; July 2016 VA examination report for TBI. The Board determines that the preponderance of the evidence is against finding entitlement to an initial disability rating in excess of 40 percent for service-connected TBI residuals under the rating criteria. The VA examinations conducted in May 2013, January 2016, and July 2016, as well as the VA treatment records (dating from May 2013 to December 2017), do not reveal symptomatology associated with any facet that could be rated at a level higher than “2.” The Veteran, as a layperson, is competent to report her observable symptoms. See Layno v. Brown, 6 Vet. App. 465 (1994). The lay testimony has been considered with the probative clinical evidence in evaluating the severity of the pertinent disability symptoms. The Board has considered whether staged ratings are appropriate for the Veteran's service-connected TBI. Because the symptomatology has been stable throughout the period under review, assigning staged ratings is not warranted. REASONS FOR REMAND Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU). Entitlement to a TDIU is not a freestanding claim, but rather part of a claim for an increased rating when reasonably raised by the record. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). In a filing of May 2014, the Veteran stated that she cannot maintain gainful employment as a result of her TBI. The issue of entitlement to a TDIU has been raised by the record and should be developed and adjudicated by the agency of original jurisdiction (AOJ). Entitlement to special monthly compensation. In rating residuals of traumatic brain injury, VA must consider the need for special monthly compensation for such problems as the loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc. 38 C.F.R. § 4.124a, DC 8045. Special monthly compensation may be granted, among other reasons, on the basis that a veteran needs regular aid and attendance to perform the personal functions of daily living; has a single service-connected disability rated as 100-percent disabling and other service-connected disability(ies) that involve a different bodily system than a 100-percent disability and are rated at a combined disability rating of 60 percent or higher; or has a single service-connected disability rated as 100 percent disabling and is permanently housebound because of a service-connected disability or disabilities. 38 U.S.C. §1114(d); 38 C.F.R. § 3.350(i), 3.352(a). The issue of entitlement to SMC will be remanded as being inextricably intertwined with the remanded TDIU claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Undertake any warranted development with respect to the TDIU claim on appeal. (Continued on the next page)   2. Undertake any warranted development with respect to the SMC claim on appeal. 3. After any needed development has been completed, readjudicate the issues on appeal. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and her representative a supplemental statement of the case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Steven D. Najarian, Associate Counsel