Citation Nr: 18159907 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 12-03 439 DATE: December 20, 2018 ORDER Entitlement to a rating in excess of 20 percent for prostate cancer from July 1, 2010, to April 21, 2016, is denied. Entitlement to an increased rating for erectile dysfunction, evaluated as zero percent from October 27, 2009, and 20 percent from August 7, 2017, is denied. Entitlement to a total rating based on individual unemployability due to service connected disabilities (TDIU) from July 1, 2010, to April 20, 2016, is granted. REMANDED The appeal for entitlement to a rating in excess of 40 percent for lumbar muscular strain with intervertebral disc syndrome and bilateral lower extremity radiculopathy is remanded. The appeal for entitlement to special monthly compensation (SMC) at the housebound rate for the period from July 1, 2010, to April 20, 2016, is remanded. FINDINGS OF FACT 1. For the period between July 1, 2010, to April 20, 2016, the Veteran used absorbent materials on an occasional basis; he had a daytime voiding interval of two and three hours and he awoke to void twice a night; there was no obstructed voiding or renal dysfunction. 2. For the period from October 27, 2009, to August 6, 2017, the Veteran had loss of erectile power without evidence of penile deformity; penile deformity in the form of atrophy of the penile gland was noted on a VA examination conducted on August 7, 2017. 3. During the period from July 1, 2010, to April 20, 2016, the Veteran’s lumbar muscular strain with intervertebral disc syndrome was evaluated as 40 percent disabling; his combined evaluations were 80 percent from July 1, 2010, and 90 percent from August 16, 2010, through April 20, 2016. 4. The Veteran’s service connected disabilities combined to render him unable to obtain or maintain gainful employment from July 1, 2010, to April 20, 2016. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for the residuals of prostate cancer from July 1, 2010, to April 20, 2016, have not been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.7, 4.10, 4.21, 4.115a, 4.115b, Code 7528 (2017). 2. The criteria for an increased rating for erectile dysfunction, evaluated as zero percent from October 27, 2009, and 20 percent from August 7, 2017, have not been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.7, 4.10, 4.20, 4.21, 4.31, 4.115b, Code 7522 (2017). 3. The criteria for a total rating based on individual unemployability due to service connected disabilities from July 1, 2010, to April 20, 2016, have been met. 38 C.F.R. §§ 3.341, 4.16, 4.19 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In January 2017, the Veteran appeared at a hearing before the undersigned Veterans Law Judge. A transcript is in the record. The issues on appeal were previously before the Board in December 2015 when they were remanded for further development. The remand directed that VA treatment records were to be obtained. Furthermore, VA was to provide the Veteran with an opportunity to submit any additional private treatment records. Attempts were to be made to obtain release forms for any private treatment sources that were identified, including Pioneer Valley Hospital. The Veteran also was to be scheduled for a VA examination. The record shows that updated VA treatment records were obtained and associated with the claims file. A November 2016 letter to the Veteran requested that he identify and/or submit any additional evidence in support of his claims. He was provided with release forms to enable VA to obtain any private records. The Veteran did not reply. Although this letter did not specifically mention records from Pioneer Valley Hospital, an April 2018 letter to the Veteran did request records from Pioneer Valley Hospital, but there was no reply. The requested examinations have been completed. The Board concludes that the development requested by the December 2015 remand has been completed, and the Board may proceed with consideration of the Veteran’s claims. The Veteran’s claims for service connection for peripheral neuropathy for the upper and lower extremities were the subject of a second Board remand in August 2017. As it does not appear that the requested development has been completed in that the requested examinations have not been scheduled, these appeals will be the subject of a future separate decision after the development has been completed. Increased Rating The Veteran asserts that the evaluations assigned for his service connected prostate cancer for the period from July 1, 2010, to April 20, 2016, was insufficient to reflect the impairment that resulted from this disability. He notes that he experiences urine leakage and other problems as a residual of the surgery for his prostate cancer. Similarly, the Veteran believes that his erectile dysfunction merits a compensable rating. The evaluation of service-connected disabilities is based on the average impairment of earning capacity they produce, as determined by considering current symptomatology in the light of appropriate rating criteria. 38 U.S.C. § 1155. Consideration is given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they are raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In addition, the entire history of the veteran's disability is also considered. Consideration must be given to the ability of the veteran to function under the ordinary conditions of daily life. 38 C.F.R. § 4.10. If there is a question as to which of two evaluations should apply, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). The Board, however, will consider whether a staged rating is appropriate for the period on appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). Prostate Cancer Entitlement to service connection for prostate cancer was granted in a July 2009 rating decision. A 100 percent rating was assigned from December 8, 2008. The evaluation was decreased to 20 percent in an April 2010 rating decision, effective July 1, 2010. The propriety of this reduction was affirmed by the Board in a December 2015 decision. During this appeal, a May 2018 rating decision increased the evaluation for prostate cancer to 100 percent, effective from April 21, 2016. The 100 percent rating is considered a complete grant of the benefits sought on appeal for this issue; however, entitlement to a rating in excess of 20 percent for the period from July 1, 2010, to April 20, 2016, remains before the Board. The Veteran’s prostate cancer is evaluated under the rating criteria for malignant neoplasms of the genitourinary system. A 100 percent evaluation is assigned for a malignant neoplasm. 38 C.F.R. § 4.115b, Code 7528. However, the note to this rating code adds that following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100 percent shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 C.F.R. § 3.105(e) (2017). If there has been no local reoccurrence of metastasis, the disability is to be rated on residuals such as voiding dysfunction or renal dysfunction, whichever is predominant. The record shows that the April 2010 reduction that became effective July 1, 2010, was carried out in accordance with the note to 38 C.F.R. § 4.115b, Code 7528. The 100 percent rating that was assigned effective April 21, 2016, is unfortunately based on a reoccurrence of the malignancy. The 20 percent rating for the interim period was based on the rating criteria for a voiding dysfunction. Under 38 C.F.R. § 4.115a, a voiding dysfunction can be rated according to urine leakage, frequency, or obstructed voiding. For urine leakage, a 20 percent rating for a voiding dysfunction is warranted if it requires the wearing of absorbent materials which must be changed less than two times per day. A 40 percent rating is warranted for requiring the wearing of absorbent materials which must be changed two to four times per day. A 60 percent rating is warranted for requiring the use of an appliance, or wearing of absorbent materials which must be changed more than four times per day. Urinary frequency has ratings ranging from 10 to 40 percent. A 10 percent rating contemplates daytime voiding intervals between two and three hours; or awakening to void two times per night. A 20 percent rating contemplates daytime voiding intervals between one and two hours; or awakening to void three to four times per night. A 40 percent rating contemplates daytime voiding intervals of less than one hour; or awakening to void five or more times per night. Obstructed voiding has ratings ranging from noncompensable to 30 percent. A noncompensable rating contemplates obstructive symptomatology with or without stricture disease requiring dilatation one to two times per year. A 10 percent rating contemplates marked obstructive symptomatology, such as hesitancy, slow or weak stream, decreased force of stream, with any one or combination of the following: (1) post void residuals greater than 150 cc.; (2) uroflowmetry; markedly diminished peak flow rate, less than 10 cc/sec; (3) recurrent urinary tract infections secondary to obstruction; (4) stricture disease requiring periodic dilatation every two to three months. Finally, a 30 percent rating contemplates urinary retention requiring intermittent or continuous catheterization. 38 C.F.R. § 4.115a. In summary, to receive a rating in excess of 20 percent during the period at issue, the evidence must show either the return of the Veteran’s malignancy, in which case a 100 percent rating is appropriate, or that he meets the criteria for a rating of 30 percent or higher under any of the three categories of voiding dysfunction. 38 C.F.R. § 4.115a, 4.115b, Code 7528. The evidence includes the report on an April 2011 VA general medical examination. The Veteran had a history of prostate cancer that was diagnosed in 2008. He underwent a radical retropubic prostatectomy in August 2008, but did not receive brachytherapy, radiation, or chemotherapy. This examiner states that the Veteran did not have urinary frequency, dysuria, hesitancy, weak or intermittent stream, straining, or hematuria. He did have nocturia, with waking up twice a night to urinate and some dribbling; however, his urinary leakage/incontinence had gone away, and he did not need to wear absorbent material. The examiner specifically notes that the Veteran does not have a history of renal dysfunction, and that he is not on dialysis. The diagnosis was prostate cancer status post radical retropubic prostatectomy with no evidence of active cancer at that time. He added that the bladder dysfunction and incontinence had resolved. The Veteran underwent a VA examination of his prostate cancer in September 2011. The history of the 2008 diagnosis of prostate cancer and subsequent surgery was noted. His most recent PSA testing had been conducted in December 2010, when the level was undetectable. There were no changes in the Veteran’s symptoms since the April 2011 examination, and no other evidence of active prostate cancer. The examiner stated that the cancer was in remission. The Veteran was noted to have a voiding dysfunction. There was urine leakage that did not require the wearing of absorbent material or the use of an appliance. He did have increased urinary frequency, with a daytime voiding interval between two and three hours, and awakening to void twice a night. There was no obstructive voiding, and no urinary tract or kidney infections. There were no other residual conditions or complications due to prostate cancer or the treatment for prostate cancer. VA treatment records from June 2013 recount the Veteran’s 2008 radical prostatectomy. His PSA continued to be low; however, an October 2014 VA treatment record noted increasing PSA. VA treatment records dated April 21, 2016, show that the Veteran was seen for his annual visit for low back pain and metastatic prostate cancer. At the January 2017 hearing, the Veteran testified that although he had urine leakage with coughing, he only occasionally required the use of absorbent materials. Based on the above findings, entitlement to a rating higher than 20 percent for the Veteran’s prostate cancer for the period from July 1, 2010, to April 20, 2016, is not warranted. The earliest evidence of record to show the return of active prostate cancer is the VA treatment record dated April 21, 2016. At this juncture, the Board notes that the VA treatment records refer to private treatment for prostate cancer. Although it is possible that these records might show the return of active prostate cancer prior to April 21, 2016, the Veteran did not respond to requests to either provide the records or provide permission for VA to obtain these records. The earliest evidence in the record to show that active cancer had returned is the April 21, 2016, VA treatment note. Therefore, a 100 percent rating prior to April 21, 2016, is not warranted. The evidence for the period between July 1, 2010, and April 20, 2016, also fails to support a rating higher than 20 percent. Both VA examinations state that the Veteran did not wear absorbent materials, so a rating higher than 20 percent based on the criteria for urine leakage is not supported. Similarly, the Veteran did not have daytime voiding intervals of less than one hour, and he did not awake to void five or more times per night, so a higher rating based on urinary frequency is precluded. The Veteran did not have obstructed voiding. He also did not have kidney dysfunction, so consideration of a rating based on renal dysfunction is not possible. The evidence supports no more than a 20 percent rating based on either the criteria for urine leakage or urinary frequency during this period. Erectile Dysfunction Entitlement to service connection for penile deformity with loss of left testicle associated with prostate cancer with impotence was granted in the July 2009 rating decision. A 20 percent rating was assigned, effective from December 8, 2008. The April 2010 rating decision decreased this evaluation to zero percent, effective from October 7, 2009. The propriety of this reduction was affirmed by the Board in a December 2015 decision. The diagnosis of the Veteran’s disability was changed to erectile dysfunction associated with prostate cancer by the May 2018 rating decision. The evaluation was increased to 20 percent by this decision, effective from August 7, 2017. As the Veteran has not expressed satisfaction with this increase, the evaluation of the Veteran’s erectile dysfunction for the entire period from October 7, 2009, to the present is for consideration. AB v. Brown, 6 Vet. App. 35, 38 (1993). The Veteran has also been in receipt of special monthly compensation for loss of use of a creative organ from December 8, 2008. The rating code does not include a separate listing for erectile dysfunction. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. The Veteran’s disability was initially evaluated by analogy to the rating criteria for atrophy of a testis. 38 C.F.R. § 4.115b, Code 5253 (2017). Because, however, the rating criteria for deformity of the penis with loss of erectile power is potentially more advantageous to the Veteran, his disability is now evaluated under these criteria. They hold that a 20 percent rating is to be assigned for deformity of the penis with loss of erectile power. 38 C.F.R. § 4.115b, Code 5252. These criteria do not provide for a rating of less than 20 percent; however, in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. The Veteran was afforded an October 2009 VA examination of his prostate cancer and impotency. His impotency began after his radical prostatectomy in September 2008. He was unable to achieve and maintain erections. The Veteran did not have any other conditions that affected his sexual functioning, and he had not been given any treatment for this condition. On examination, the Veteran had a normal penis and normal testicles. At the April 2011 VA general medical examination, the Veteran was reportedly unable to have erections, and was not able to have penetration or ejaculation. He had not tried any medications for his erectile dysfunction. The Veteran was noted to have previously been given a diagnosis of penile deformity, which had apparently been based on atrophy of the penile gland secondary to his cancer and surgery. The Veteran also had a history of a left orchiectomy in 2000, but this was prior to the prostate cancer. His erectile dysfunction began after the prostatectomy, and he had been able to achieve erections with penetration and ejaculation prior to that surgery. On physical examination, the examiner stated that the right testicle and penis were normal, and the examiner said that he did not see any evidence of a penile deformity. The September 2011 VA examiner stated that the Veteran had erectile dysfunction, and that it was attributable to prostate cancer with prostatectomy. The Veteran was not able to have an erection, penetration or ejaculation with or without medication. There were no other pertinent physical findings, complications, conditions, signs, or symptoms. The June 2013 VA treatment records show that the Veteran had ceased to have erections after his 2008 surgery, and he had been unresponsive to injections and suction devices. The report of the physical examination did not mention an examination of the genitalia. The assessment was impotence since prostatectomy. The Veteran underwent another VA examination of his erectile dysfunction on August 7, 2017. The examiner found that the Veteran had erectile dysfunction due to his prostatectomy, although it was felt that other conditions contributed to it as well. Medication had been tried, but he remained unable to achieve an erection. On physical examination, the penis was described as abnormal. There was a penis deformity, which was atrophy of the corpora cavernosa and corpus spongiosum with glans located at mons. The examiner opined the Veteran’s service-connected disability resulted in both penile deformity and erectile dysfunction. The Board finds that entitlement to a compensable rating for the Veteran’s erectile dysfunction for the period from October 27, 2009, to August 6, 2017, is not warranted. The Veteran’s disability was evaluated by analogy to that of a penis deformity, with loss of erectile power. The rating criteria indicate that there must be both an actual penile deformity and loss of erectile dysfunction to receive the 20 percent rating; however, the October 2009 examiner, the April 2011 examiner, and the September 2011 examiner all failed to identify a deformity of the penis. The April 2011 examiner even noted the history of the previous diagnosis of a deformity based on atrophy of the penile gland, but did not find such a deformity on his examination. As the criteria for a 20 percent rating were not met during this period, the zero percent rating was appropriate. 38 C.F.R. §§ 4.31, 4.115b, Code 5252. In reaching this decision, the Board reminds the Veteran that although the zero percent rating was appropriate, he did not go uncompensated for his condition. In fact, he was in receipt of SMC for loss of use of a creative organ due to his impotency from December 8, 2008, which covers the entire period on appeal. Similarly, the Board must find that entitlement to a rating in excess of 20 percent for the period beginning August 7, 2017 is not warranted. The examination conducted on that date once again found that the Veteran had a penile deformity due to atrophy of the penile gland. This is the basis for the current 20 percent rating; however, the 20 percent rating is the highest that is available under the appropriate rating criteria. Therefore, no further discussion is required. See 38 C.F.R. § 4.115b, Code 7522; Johnston v. Brown, 10 Vet. App. 80, 85 (1995). The Board has considered an evaluation under a different rating code, but there are no codes more appropriate. The Board observes that in addition to this 20 percent rating, the Veteran continues to be in receipt of SMC for his loss of use of his creative organ. TDIU from July 1, 2010, to April 20, 2016 The Veteran contends that his service-connected disabilities combined to render him unemployable. By regulation, TDIU may be assigned where the schedular rating is less than total. 38 C.F.R. § 4.16(a). Because the Veteran was evaluated as 100 percent disabled until June 30, 2010, and because a 100 percent evaluation was assigned during consideration of this appeal effective from April 21, 2016, the Board will consider whether TDIU is appropriate for the interim period from July 1, 2010, to April 20, 2016. TDIU may be assigned, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. Marginal employment shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). The record shows that the Veteran is service connected for a post-operative herniated disc pulposus at L4-L5 with chronic lumbar muscular strain and intervertebral disc syndrome and that this disability has been evaluated as 40 percent disabling from October 1, 1991. He is also service connected for many other disabilities, including the residuals of prostate cancer status post prostatectomy; major depression and dementia; bladder dysfunction; degenerative joint disease of the cervical spine; type II diabetes mellitus; erectile dysfunction; chronic tendonitis with synovitis of the right acromioclavicular joint; tendonitis of the left shoulder; bilateral tinnitus; superficial varicosities of the lower extremities; diverticulitis; hemorrhoids; a post-operative umbilical hernia; the loss of a left testicle; tinea cruris; and bilateral hearing loss. The Veteran had a combined rating of 80 percent from July 1, 2010, and a combined rating of 90 percent from August 16, 2010. Clearly, he met the schedular criteria for the period in question. The remaining question concerns whether the Veteran was unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. See 38 C.F.R. § 4.16(a). The fact that a veteran is unemployed or has difficulty finding employment does not warrant assignment of a TDIU alone as a high rating itself establishes that his disability makes it difficult for him to obtain and maintain employment. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Rather, the evidence must show that he is incapable "of performing the physical and mental acts required" to be employed. See Van Hoose, 4 Vet. App. at 363. Thus, the central question is "whether the [V]eteran's service connected disabilities alone are of sufficient severity to produce unemployability," and not whether the Veteran could find employment. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to a veteran's education, training, and special work experience, but not to his age or to impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Van Hoose v. Brown, 4 Vet. App. 361, 363. A September 2010 VA psychiatric examination indicates that the Veteran held several jobs after retiring from active duty. He had worked as a dental technician for two months but neck pain caused him to quit. Afterwards, he had worked in maintenance, but quit because he hurt his back. He had worked as a truck driver for six years, but decided not to pursue further employment due to back pain and his age. His unemployment was not due to the effects primarily of a mental condition; however, the examiner’s remarks after the examination noted the Veteran was unable to establish and maintain effective work/school and social relationships. His psychiatric impairment caused occasional decrease in work efficiency and an intermittent inability to perform his occupational tasks although he was generally able to function satisfactorily. The report of a September 2010 VA examination of the back states that the effects of that condition on the Veteran’s usual occupation was not applicable as he was retired. Neck pain and stiffness, however, impaired his ability to drive, and thoracic and lumbar pain impaired his ability to perform chores that involved the spine. The examiner who conducted the April 2011 general examination opined that the Veteran’s service connected disabilities did not render him unable to secure and maintain substantially gainful employment. The Veteran had voluntarily retired from the work force. The examiner believed he would have a difficult time working a physically demanding job with his current shoulder and back impairment, but he could work a sedentary job in an office setting that did not require repetitive lifting or prolonged periods of standing or walking. The Veteran was afforded an additional VA psychiatric examination in April 2011. He had not worked since 2004/2005 when he was driving trucks. Pain in his back had been a huge problem because he could not sit still and focus on his work. The examiner concluded that the Veteran’s primary issues were with his chronic lower back pain, which was said to cause him frequent falls. He was not able to get comfortable either by sitting, standing, moving, or bending. There was also occupational impairment due to his depression and dementia. The September 2011 VA prostate examination said that condition did not currently impact the Veteran’s ability to work. No explanation was provided. A November 2014 VA examination of the back states that the Veteran’s thoracolumbar spine condition did not impact his ability to work. Again, no explanation was provided. At the January 2017 hearing, the Veteran testified that he was unable to work anymore. He said that he was unable to stand up to do his dishes for more than 10 minutes at a time. Based on the above, the Board finds that the Veteran’s service connected disabilities combined to make him unemployable for the entire period at issue. The April 2011 VA general examiner noted the Veteran would have a difficult time doing physical work due to his shoulder and back disabilities but suggested he could do sedentary work. The April 2011 VA psychiatric examiner, however, notes that the Veteran’s pain prevents him from sitting still and concentrating on work, and the Veteran was not able to get comfortable either by sitting, standing, moving, or bending. Finally, the September 2010 VA examiner opined that the Veteran was unable to establish and maintain effective work/school and social relationships. Given that one examiner found that the Veteran was unable to do physical labor due to his back and shoulder pain but could do sedentary labor, another examiner found that the Veteran’s chronic pain syndrome prevents him from sitting still and concentrating, impairing sedentary employment, and a third examiner found the Veteran was unable to establish or maintain work relationships, it appears to the Board that the Veteran is unable to perform any of the occupations for which he might his work experience and education might qualify him. Thus, his service connected disabilities combined to render him unable to obtain or maintain gainful employment from July 1, 2010 to April 20, 2016, and he is entitled to TDIU for this period. REASONS FOR REMAND Entitlement to an increased rating for lumbar muscular strain with intervertebral disc syndrome and bilateral lower extremity radiculopathy At the January 2017 hearing, the Veteran testified that he receives ongoing treatment for his back disability from Dr. Stein, who is a private physician. There are no records from Dr. Stein in the claims file, and no request to obtain these particular records or any other private records regarding the back disability has been made since the January 2017 testimony. As VA has a duty to assist the Veteran in obtain all potentially relevant records, an attempt must be made to obtain these. Furthermore, the most recent VA examination of the Veteran’s back was conducted in November 2014, and is now over four years old. This examination does not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016). It does not contain passive range of motion measurements. The Veteran should be scheduled for a new VA examination in order to obtain a current and complete assessment of this disability. Entitlement to SMC from July 1, 2010, to April 20, 2016 The record shows that the Veteran was in receipt of SMC under 38 U.S.C. § 1114(s) (2012) and 38 C.F.R. § 3.350(i) (2017) due to having a single disability evaluated as 100 percent disabling with other disabilities independently ratable as 60 percent or more from December 8, 2008, to July 1, 2010. When the evaluation for the Veteran’s prostate cancer was reduced from 100 percent, entitlement to SMC also ended. In a December 2015 decision, the Board determined that the discontinuation of SMC for housebound benefits was proper. After the evaluation for the Veteran’s prostate cancer was increased to 100 percent on April 21, 2016, he once again became eligible for SMC on that same date, as he continued to have other service connected disabilities that were independently ratable at 60 percent or more. The Veteran contends that he met the criteria for SMC between July 1, 2010, to April 20, 2016. SMC is payable at the housebound rate where a veteran has a single service-connected disability 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.A. § 1114(s)(1); 38 C.F.R. § 3.350(i). Currently, the Veteran does not have a single service connected disability that was rated as 100 percent disabling during the period from July 1, 2010, to April 20, 2016. The rating criteria, however, for the Veteran’s lumbar muscular strain with intervertebral disc syndrome provide for a potential 100 percent rating. See 38 C.F.R. § 4.71a, Codes 5242, 5243. Because the claim for an increased rating for the back must be remanded for the reasons outlined above, the Board must also remand the claim for SMC. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). The matter is REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for the records of the treatment of his back disability by Dr. Stein. If this release form is returned by the Veteran, make two requests for the authorized records from Dr. Stein unless it is clear after the first request that a second request would be futile. The Veteran should also be notified that in the alternative, he may obtain and submit these records to the VA himself. 2. All VA treatment records dating from March 29, 2018 that pertain to the treatment of the Veteran’s back disability should be obtained and associated with the claims file. 3. After any records are received due to the above requests and associated with the claims file, schedule the Veteran for an examination of the current severity of his lumbar muscle strain and intervertebral disc syndrome. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The frequency and duration of incapacitating episodes (acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician) should be obtained. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the lumbar spine disability alone and discuss the effect of the Veteran’s lumbar spine disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues of entitlement to an increased rating for lumbar muscular strain with intervertebral disc syndrome and SMC. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his 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. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. L. Prichard, Counsel