Citation Nr: 18150306 Decision Date: 11/15/18 Archive Date: 11/14/18 DOCKET NO. 16-36 861 DATE: November 15, 2018 ORDER An effective date earlier than November 7, 2016 for the assignment of a 70 percent disability rating for service-connected bilateral hearing loss is denied. A rating of 100 percent for ischemic heart disease is granted. A total disability rating based on individual unemployability (TDIU) prior to November 7, 2016 is denied. Special monthly compensation (SMC) at the housebound rate since February 1, 2017 is granted. REMANDED Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to a TDIU, to include consideration of SMC at the housebound rate from November 7, 2016 to January 31, 2017, is remanded. FINDINGS OF FACT 1. In a February 2016 letter, the Veteran’s representative reported the Veteran’s request for a VA examination for his bilateral hearing loss; this letter did not meet the standards of a complete claim or intent to file a claim and is considered a request for an application form for benefits of a higher disability rating for service-connected bilateral hearing loss. 2. On November 7, 2016, the Veteran filed a complete claim for a higher disability rating for service-connected bilateral hearing loss by submission of a VA Form 21-526b. 3. In a December 2016 VA rating decision, the issue of entitlement to a rating in excess of 20 percent for bilateral hearing loss was granted and a 70 percent disability rating was assigned effective for the entire appeal period from November 7, 2016. 4. Within one year prior to the date of claim on November 7, 2016, the Veteran’s bilateral hearing loss was not manifested by worsened hearing acuity in either ear to warrant a rating in excess of a 70 percent disability rating. 5. For the entire rating period since February 1, 2017, the Veteran’s service-connected ischemic heart disease has been manifested by a workload of 3 METs or less resulting in dyspnea and fatigue. 6. On August 8, 2013, VA initiated the claim for entitlement to a TDIU. 7. For the rating period prior to November 7, 2016, the Veteran’s combined schedular disability rating meets the minimum percentage requirements in 38 C.F.R. § 4.16(a) for consideration of a TDIU on a schedular basis, and the Veteran’s service-connected disabilities did not render him unable to secure or follow substantially gainful employment. 8. For the rating period since February 1, 2017, the Veteran’s combined schedular rating is 100 percent disabling, his service-connected ischemic heart disease has been rated at 100 percent disabling, and another service-connected disability (bilateral hearing loss) has been rated at 70 percent disabling. CONCLUSIONS OF LAW 1. The criteria for entitlement to an effective date earlier than November 7, 2016 for the assignment of a 70 percent disability rating for service-connected bilateral hearing loss have not been met. 38 U.S.C. §§ 5110, 7105 (2012); 38 C.F.R. §§ 3.1(p), 3.155, 3.160, 3.400(o)(2), 20.204, 20.302, 20.1103 (2018); 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100 (2018). 2. With resolution of reasonable doubt in the Veteran’s favor, the criteria for entitlement to a rating of 100 percent for ischemic heart disease have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.104, Diagnostic Code 7005 (2018). 3. The criteria for entitlement to a TDIU prior to November 7, 2016 have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.340, 3.341(a), 4.16, 4.25 (2018). 4. The criteria for entitlement to SMC at the housebound rate since February 1, 2017 have been met. 38 U.S.C. § 1114(s) (2012); 38 C.F.R. §§ 3.350(i), 4.25 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from April 1969 to October 1970 and August 1973 to June 1979. He earned the Combat Action Ribbon. With regard to the issues of an earlier effective date for the assignment of a 70 percent disability rating for service-connected bilateral hearing loss and a TDIU prior to November 7, 2016, the Veteran’s representative noted VA’s procedural due process protections in written briefs submitted with notices of disagreement in December 2014 and September 2017. The Board finds these notations were generic with no specific assertion as to any failure or deficiency in this case. Neither the Veteran nor his attorney has raised any other issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Given the decision below for entitlement to a rating in excess of 60 percent for ischemic heart disease, a detailed explanation of how VA complied with its duties to notify and assist is unnecessary. 1. Entitlement to an effective date earlier than November 7, 2016 for the assignment of a 70 percent disability rating for service-connected bilateral hearing loss At the outset, the Board notes that the Veteran filed a timely notice of disagreement with the December 2016 VA rating decision that established the effective date for the assignment of a 70 percent disability rating for service-connected bilateral hearing loss, and he perfected this appeal. Thus, the Board has proper jurisdiction over this claim on appeal for an earlier effective date. See Rudd v. Nicholson, 20 Vet. App. 296, 299 (2006) (there is no such thing as a freestanding claim for an earlier effective date). Generally, the effective date of an award “shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor.” 38 U.S.C. § 5110(a). However, in a claim for increased compensation, the effective date may date back as much as one year before the date of the application for increase if it is factually “ascertainable that an increase in disability had occurred” within that one year. 38 U.S.C. § 5110(b)(3); 38 C.F.R. § 3.400(o)(2); see Gaston v. Shinseki, 605 F.3d 979, 983 (Fed. Cir. 2010) (the statute and its implementing regulation require “that an increase in a veteran’s service-connected disability must have occurred during the one year prior to the date of the Veteran’s claim in order to receive the benefit of an earlier effective date”). Effective on and after March 24, 2015, VA updated the regulations concerning the filing of claims. See 79 Fed. Reg. 57,660 (Sept. 25, 2014) (codified in 38 C.F.R. Parts 3, 19, and 20 (2018)). In part, VA replaced the informal/formal claims process with a standardized and more formal process. See 79 Fed. Reg. at 57,663-64; see also 38 C.F.R. § 3.155. As a result of the rulemaking, a complete claim on an application form prescribed by the Secretary is required for all types of claims. 38 C.F.R. §§ 3.1(p), 3.155(d), 3.160. When a claimant or his/her representative submits a communication indicating desire to file a claim for benefits, but the communication does not meet the standards of a complete claim for benefits, the communication will be considered a request for an application form for benefits. 38 C.F.R. § 3.350(a); 38 C.F.R. § 3.155(a). When such a communication is received, VA shall notify the claimant and his/her representative of the information needed to complete the application form or form prescribed by the Secretary. 38 C.F.R. § 3.155(a). The updated regulations also allow a claimant or his/her representative to submit an intent to file a claim, and VA may recognize the receipt date of the intent to file a claim as the date of a compete claim so long as VA receives the complete application form prescribed by the Secretary within one year. See 38 C.F.R. § 3.155(b). There are three ways in which an intent to file a claim can be submitted: (i) saved electronic application, (ii) written intent, signed and dated on the intent to file a claim form prescribed by the Secretary, and (iii) oral intent communicated to designated VA personnel, recorded in writing, and documented in the claimant’s records. Id. By way of procedural history, the Board notes that service connection for bilateral hearing loss was granted in an August 1986 VA rating decision and a 10 percent disability rating was assigned effective for the entire appeal period from May 1, 1986. 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100. Pursuant to a February 2003 claim for a higher rating, the 10 percent disability rating was continued in an April 2003 VA rating decision. Id. Pursuant to a December 2008 claim for a higher rating, the 10 percent disability rating was continued in a February 2009 VA rating decision. Id. The Veteran was notified of these actions and of his appellate rights, but did not file a timely Notice of Disagreement or submit new and material evidence within a year thereafter; therefore, the August 1986, April 2003, and February 2009 VA rating decisions are final. See 38 U.S.C. § 7105(b), (d); 38 C.F.R. § 20.302. Pursuant to an October 2011 claim for a higher rating, a 20 percent disability rating effective for the entire appeal period from October 27, 2011 was in an August 2012 VA rating decision. 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100. The Veteran submitted a timely notice of disagreement in September 2012, a Statement of the Case was issued in June 2014; however, the Veteran withdrew this appeal in written correspondence dated in June 2014 and July 2014. As a result, the August 2012 VA rating decision is final. See 38 C.F.R. § 20.204. In a February 2016 letter, the Veteran’s representative reported the Veteran’s request for a VA examination because his bilateral hearing loss has gotten worse. In a May 2016 notice letter, VA informed the Veteran and his representative that if he would like to file a claim for an increase in evaluation for bilateral hearing loss, completion of the enclosed VA Form 21-526EZ (Application for Disability Compensation and Related Compensation Benefits) was required under the new VA regulations. On November 7, 2016, VA received the Veteran’s completed VA Form 21-526b (Veteran’s Supplemental Claim for Compensation) for an increased evaluation for service-connected bilateral hearing loss. In the December 2016 VA rating decision on appeal, the issue of entitlement to a rating in excess of 20 percent for bilateral hearing loss was granted and a 70 percent disability rating was assigned effective for the entire appeal period from November 7, 2016. 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100. In this case, the Board finds that the February 2016 letter from the Veteran’s representative did not meet the standards of a complete claim as it was not provided on an application form prescribed by the Secretary. See 38 C.F.R. §§ 3.1(p), 3.155(d), 3.160. The February 2016 letter also did not meet the standards of an intent to file a claim as it was not submitted in a saved electronic application, on the prescribed intent to file a claim form, or orally directed to a VA employee and recorded in writing. See 38 C.F.R. § 3.155(b). On the other hand, the Board finds that the February 2016 letter is considered a request for an application form for benefits of a higher disability rating for service-connected bilateral hearing loss. In fact, VA accepted the February 2016 letter as such and sent the Veteran and his representative the May 2016 notice requesting the completion of a complete claim on the specified VA Form, which was obtained and associated with the record on November 7, 2016. As a result, the Board finds that the date of claim for an increased rating for service-connected bilateral hearing loss was received on November 7, 2016. Having determined that November 7, 2016 is the date of receipt of the increased rating claim for bilateral hearing loss for purposes of assigning an effective date for the award of a 70 percent disability rating, the Board has reviewed the evidence of record to determine whether an ascertainable increase in the severity of his bilateral hearing loss occurred during the preceding year. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). Review of the evidentiary record during the period from November 7, 2015 to November 6, 2016 includes VA treatment records dated from May 2015 to November 2017 which document sensorineural hearing loss among the Veteran’s list of active problems but silent for any increased symptoms of or audiological testing for bilateral hearing loss. While the Veteran reported worsening of his bilateral hearing loss in the February 2016 letter, the assignment of a disability rating for hearing impairment is derived by a mechanical application of the Rating Schedule to the numeric designations based on the audiology examination results. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). In this case, the Veteran is not competent to measure his level of hearing loss and apply it to the rating schedule, as the record does not show he has the expertise or training to conduct audiological testing to measure the degree of his hearing loss. Moreover, the Board notes that the Veteran’s last prior VA audiological examination was in April 2012 and his most recent VA audiological examination was on November 30, 2016, which are both outside the period from November 7, 2015 to November 6, 2016. After a review of the medical and lay discussed above, the Board finds that the Veteran’s service-connected bilateral hearing loss was not manifested by worsened hearing acuity in either ear at any time from November 7, 2015 to November 6, 2016. As a result, a rating in excess of 70 percent for service-connected bilateral hearing loss is not warranted at any time during the one-year period prior to November 7, 2016. 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100. For these reasons, an effective date earlier than November 7, 2016 for the assignment of a 70 percent disability rating for service-connected bilateral hearing loss is denied. 2. Entitlement to a rating in excess of 60 percent for ischemic heart disease Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the veteran’s favor. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, such as for the service-connected ischemic heart disease in this case, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. 38 C.F.R. § 4.2; Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In an August 2013 VA rating decision, service connection for ischemic heart disease was granted because the disability was presumed have been caused by service because it manifested to a compensable degree following separation from service. The Veteran was assigned a 60 percent disability rating effective for the entire rating period from September 21, 2012. See 38 C.F.R. § 4.104, Diagnostic Code 7005. In January 2017, VA initiated a routine examination of the Veteran’s service-connected ischemic heart disease. On February 1, 2017, the Veteran underwent a VA DBQ examination for heart conditions. The Board considers whether a rating in excess of 60 percent for ischemic heart disease is warranted at any time since February 1, 2017. Diagnostic Code 7005 provides that for arteriosclerotic heart disease (coronary artery disease), the next-higher rating of 100 percent, the maximum available, is warranted for chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; LVEF of less than 30 percent. See 38 C.F.R. § 4.104. At the February 2017 VA DBQ examination, interview-based METs test results revealed dyspnea and fatigue at 1-3 METs, a level found to be consistent with activities such as eating, dressing, taking a shower, or slow walking (2 mph) for 1-2 blocks. The VA examiner concluded that the limitation in METs level is due to multiple medical conditions including the heart condition(s); and it is not possible to accurately estimate the percent of METs limitation attributable to each medical condition. Specifically, it was explained that the Veteran “has severe [chronic obstructive pulmonary disease (COPD)] requiring oxygen [and] [t]here has never been a method for differentiating the METs in COPD with that in [d]iastolic function (low METs with normal left ventricular ejection fraction (LVEF)).” The Board notes that the Veteran is not currently service connected for COPD. When it is not possible to separate the effects of the service-connected disability from a nonservice-connected condition, such signs and symptoms must be attributed to the service-connected disability. 38 C.F.R. § 3.102; Mittleider v. West, 11 Vet. App. 181, 182 (1998) (per curiam). Moreover, the VA examiner did not indicate that using the Veteran’s LVEF, measured at 60 percent, would provide a more accurate picture of the Veteran’s service-connected heart disability. After review of the pertinent evidence of record discussed above, the Board finds the most probative evidence of record shows the Veteran’s service-connected ischemic heart disease has been manifested by a workload of 3 METs or less resulting in dyspnea and fatigue for the entire rating period since February 1, 2017. As such, a rating of 100 percent since February 1, 2017 is warranted. 3. Entitlement to a TDIU prior to November 7, 2016, to include consideration of SMC at the housebound rate since February 1, 2017 All veterans who are shown to be unable to secure and follow a substantially gainful occupation by reason of service-connected disability shall be rated totally disabled. For VA purposes, total disability exists when there is any present impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. §§ 3.340, 4.16. A total disability rating for compensation may be assigned, where the schedular rating is less than total, when a veteran is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16. Entitlement to a total rating must be based solely on the impact of service-connected disabilities on the ability to keep and maintain substantially gainful employment. See 38 C.F.R. §§ 3.340, 3.341, 4.16. The central inquiry is “whether the veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). For VA purposes, the term “unemployability” is synonymous with inability to secure and follow a substantially gainful occupation. VAOPGPREC 75-91, 57 Fed. Reg. 2317 (Jan. 21, 1992). A. Prior to November 7, 2016 On August 8, 2013, VA initiated the claim for entitlement to a TDIU. Prior to November 7, 2016, the Veteran was service-connected for ischemic heart disease at 60 percent disabling, PTSD at 50 percent disabling, bilateral hearing loss at 20 percent disabling, tinnitus at 10 percent disabling, and residuals of inguinal hernia at 0 percent disabling. The combined disability evaluation is 90 percent for rating period from August 8, 2013 to November 6, 2016. See 38 C.F.R. § 4.25. As a result, the Board considers whether there is evidence to warrant assignment of a TDIU rating on a schedular basis, pursuant to 38 C.F.R. § 4.16(a), from August 8, 2013 to November 6, 2016. Prior to the appeal period, records from the Social Security Administration (SSA) were obtained and associated with the record in February 2013. The Veteran filed a claim for social security and supplemental security income disability benefits, asserting that he was unable to work because of COPD, hearing, heart attack, and rheumatoid arthritis, but the claim was denied in an October 2005 letter. Additionally, the Veteran underwent VA DBQ examinations for hearing loss in April 2012 and for hernias, ischemic heart disease, and mental disorders in July 2013. At the April 2012 VA DBQ audiological examination, the VA examiner noted the Veteran’s bilateral hearing loss impacts ordinary conditions of daily life, including ability to work, and explained the Veteran has difficulty understanding speech in adverse listening conditions and on the phone. In July 2013, the Veteran underwent VA DBQ examinations for hernias and ischemic heart disease. Following the clinical evaluations, the examiner noted the Veteran’s hernia does not impact his ability to work, but ischemic heart disease does impact his ability to work but explained “the Veteran’s exercise tolerance is very limited due to shortness of breath that seems more due to his pulmonary problems than cardiac.” In July 2013, the Veteran also underwent a VA DBQ examination for mental disorders. He reported completing the 11th grade of education and mostly worked in factories after his period of active service. Following the clinical evaluation, the examiner noted symptoms included difficulty in establishing and maintaining effective work relationships, and concluded the Veteran’s level of occupational and social impairment was best characterized by occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks although generally functioning satisfactorily with normal routine behavior, self-care, and conversation. Review of VA treatment records during the appeal period prior to November 7, 2016 documents the Veteran’s occupational status as disabled/retired and does not indicate any degree to which the Veteran’s service-connected disabilities impact his ability to secure or follow substantially gainful employment. On November 4, 2016, the Veteran underwent a VA DBQ examination for PTSD. The Veteran reported he dropped out of high school due to frustration of repeating classes, worked part-time on a dairy farm, then entered active service and re-enlisted because he could not find steady work. After separation from active service in 1979, he worked in factories doing assembly work and learned things on the job. In 2003 or 2005 he had a heart attack and thought it became too physically demanding to work so he did a few odd jobs such as mowing lawns. Following the clinical evaluation, the examiner noted symptoms included difficulty in adapting to stressful circumstances, including work or a work-like setting, and concluded the Veteran’s level of occupational and social impairment was the same as characterized in the July 2013 VA DBQ examination report mental disorders. On November 21, 2016, the Veteran submitted a completed VA Form 21-8940 (Application for Increased Compensation Based on Unemployability). He reported that his nonservice-connected lung disorder and service-connected depression and heart disabilities prevent him from securing or following any substantially gainful occupation. He documented working as a spot welder from 1989 to 2000 for 40 hours per week, in 2000 for 30 to 40 hours per week for a second employer, and in 2000 for 40 hours per week for a third employer. His reported disabilities affected his full-time employment in 2005, he last worked full-time in 2003, and his highest earned income in one year was $16,840 in 2000. He did not leave his last employment because of a disability and did not try to obtain employment since he became too disabled to work. The Veteran further reported his highest level of education is three years of high school and did not receive any other education or training since he became too disabled to work. In an August 2018 written brief, the Veteran’s representative reported the Veteran cannot work, in part, due to his mental health symptoms. It was further noted that the Veteran last worked full time in 2003 and since then has not been able to adapt to a stressful environment, to include a work-like setting. After a full review of the record, the Board finds that the evidence is against the claim for a TDIU on a schedular basis prior to November 7, 2016. As discussed above, the pertinent evidence of record does not demonstrate that the Veteran’s service-connected disabilities, alone, are of sufficient severity to render him unable to secure or follow substantially gainful employment at any time during this appeal period. The Board acknowledges the Veteran’s reported symptomatology of the service-connected disabilities, as well as the VA examiners’ notations that his service-connected disabilities (particularly bilateral hearing loss and PTSD) impact his ability to work. The Veteran informed the November 2016 VA DBQ examiner for PTSD that work became too physically demanding after his heart attack in 2003 or 2005. Moreover, the evidence of record demonstrates the Veteran has not engaged in full-time employment since approximately 2003 or 2005, and his highest level of education is 3 years of high school. Nevertheless, the service-connected disabilities, alone, are not of sufficient severity to suggest he is unable to obtain or retain substantially gainful employment during the appeal period prior to November 7, 2016. In fact, on the November 2016 VA Form 21-8940, the Veteran attributed, in part, his nonservice-connected respiratory disorder to preventing him from securing or following any substantially gainful occupation and marked that he did not leave his last employment because of a disability. Following clinical evaluation, a July 2013 VA examiner explained the Veteran’s shortness of breath seems more due to his pulmonary problems than cardiac. Moreover, with his educational background and work experience, the Veteran could obtain or retain substantially gainful employment, for example, as a factory worker or a similar job. The reported impact and symptomatology of his service-connected disabilities, particularly bilateral hearing loss, PTSD, and ischemic heart disease, are already contemplated in the currently assigned disability ratings. These difficulties alone do not establish that he is unable to obtain or maintain employment, but rather show that he would have some level of impairment while working. B. Since February 1, 2017 In light of the decision above, since February 1, 2017, the Veteran has been service-connected for ischemic heart disease at 100 percent disabling. He has also been service-connected for bilateral hearing loss at 70 percent disabling, PTSD at 50 percent disabling, tinnitus at 10 percent disabling, and residuals of inguinal hernia at 0 percent disabling. The combined disability evaluation is 100 percent for rating period since February 1, 2017. See 38 C.F.R. § 4.25. As a result, the Board considers whether there is evidence to warrant assignment of SMC at any time since February 1, 2017. SMC is payable at the housebound rate where the Veteran has a single service-connected disorder rated as totally disabling and one or more distinct service-connected disabilities, which are independently ratable at 60 percent or more and involve different anatomical segments or bodily systems. 38 U.S.C. § 1114(s)(1); 38 C.F.R. § 3.350(i). Generally, subsection 1114(s) benefits are not available to a veteran whose total disability rating is based on multiple disabilities, none of which is rated as 100 percent disabling. That said, TDIU may satisfy the total rating element under section 1114(s), but only when that award is predicated on a single disability, rather than on multiple service-connected disorders. See Bradley v. Peake, 22 Vet. App. 280, 293 (2008) (noting the circumstances under which a disorder, while rated less than 100 percent disabling, satisfies the requirement of “service-connected disability rated as total” for section 1114(s) purposes). The Board finds that for the rating period since February 1, 2017, the Veteran’s combined schedular rating is 100 percent disabling, his service-connected ischemic heart disease has been rated at 100 percent disabling, and another service-connected disability (bilateral hearing loss) has been rated at 70 percent disabling. As a result, SMC at the housebound rate is warranted since February 1, 2017. See 38 U.S.C. § 1114(s)(1); 38 C.F.R. § 3.350(i). REASONS FOR REMAND 1. Entitlement to a rating in excess of 50 percent for PTSD In October 2016, VA initiated a routine examination of the Veteran’s service-connected PTSD. On November 4, 2016, the Veteran underwent a VA DBQ examination for PTSD. Since then, in a written brief submitted with the September 2017 VA Form 21-0958 (Notice of Disagreement), the Veteran’s representative requested an additional examination to adequately evaluate the Veteran’s symptoms of depression affecting his ability to function appropriately and additional symptoms of PTSD. Review of VA treatment records document findings of anxiousness in April 2017 and complaint of anxiety in October 2017. Most recently, in an August 2018 written brief, the Veteran’s representative further noted the Veteran’s complaint of having no energy, not being able to summon the energy to do the activities he used to enjoy, and multiple other symptoms not previously considered. In light of such evidence, additional development is needed to properly adjudicate the appeal. See 38 U.S.C. § 5103A(a) (2012); 38 C.F.R. § 3.159 (2018); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 2. Entitlement to a TDIU, to include consideration of SMC at the housebound rate from November 7, 2016 to January 31, 2017 From November 7, 2016 to January 31, 2017, the Veteran was service-connected for bilateral hearing loss at 70 percent disabling, ischemic heart disease at 60 percent disabling, PTSD at 50 percent disabling, tinnitus at 10 percent disabling, and residuals of inguinal hernia at 0 percent disabling. The combined disability evaluation was 100 percent for rating period from November 7, 2016 to January 31, 2017. See 38 C.F.R. § 4.25. As a result, the Board considers whether there is evidence to warrant assignment of SMC at any time from November 7, 2016 to January 31, 2017. While the Board remands the issue of entitlement to a rating in excess of 50 percent for PTSD for additional evidentiary development, as discussed above, that decision may impact the claim for entitlement to a TDIU, to include consideration of SMC at the housebound rate from November 7, 2016 to January 31, 2017. As such, these issues are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following actions: 1. Schedule the Veteran for an examination with an appropriate clinician to determine the current severity of his PTSD. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner must provide all findings, along with a complete rationale for any opinions provided. 2. Then, review the examination report and any medical opinions to ensure that the requested information was provided. If any report or opinion is deficient in any manner, the AOJ must implement corrective procedures. 3. Then, readjudicate the claims. If any decision is adverse to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then, return the case to the Board. REBECCA N. POULSON Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Carter, Counsel