Citation Nr: 20081069 Decision Date: 12/28/20 Archive Date: 12/28/20 DOCKET NO. 07-30 051 DATE: December 28, 2020 ORDER For the appellate period prior to November 1, 2016, entitlement to an initial disability rating of 20 percent, but no higher, for left lower extremity radiculopathy with diabetic peripheral neuropathy of the sciatic and posterior tibial nerves (hereinafter “left lower extremity radiculopathy”) is granted. Between November 1, 2016 and February 7, 2018, entitlement to a disability rating in excess of 20 percent for left lower extremity radiculopathy is denied. Beginning February 8, 2018, entitlement to a disability rating of 40 percent, but no higher, for left lower extremity radiculopathy is granted. Beginning June 1, 2013, entitlement to a total disability rating based upon individual unemployability (TDIU) based solely upon the Veteran’s service-connected ischemic heart disease (IHD), is granted. Beginning March 26, 2015, entitlement to SMC at the housebound rate is granted. FINDINGS OF FACT 1. For the appellate periods prior to November 1, 2016 and between November 1, 2016 and February 7, 2018, the Veteran’s left lower extremity radiculopathy was no more than moderate in nature. 2. Beginning February 8, 2018, the Veteran’s left lower extremity radiculopathy was no more than moderately severe in nature. 3. Beginning June 1, 2013, the evidence is in equipoise as to whether the Veteran has been rendered unable to maintain gainful employment due solely to his service-connected IHD. 4. Beginning March 26, 2015, the Veteran has a service-connected disability rated as total (IHD), and his other service-connected disabilities are rated as at least 60 percent disabling. CONCLUSIONS OF LAW 1. For the appellate period prior to November 1, 2016, the criteria for an initial rating of 20 percent, but no higher, for left lower extremity radiculopathy are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code (DC) 8520. 2. Between November 1, 2016 and February 7, 2018, the criteria for a disability rating in excess of 20 percent for left lower extremity radiculopathy are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.124a, DC 8520. 3. Beginning February 8, 2018, the criteria for a disability rating of 40 percent, but no higher, for left lower extremity radiculopathy are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.124a, DC 8520. 4. Beginning June 1, 2013, the criteria for a TDIU based solely upon the Veteran’s service-connected IHD are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 3.400, 4.16. 5. Beginning March 26, 2015, the criteria for SMC at the housebound rate are met. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, served on active duty from February 1968 to January 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The issue of entitlement to SMC at the housebound rate, as well as the issue of entitlement to a TDIU for the purpose of establishing entitlement to SMC, have been raised by the record and added to the instant appeal. Akles v. Derwinski, 1 Vet. App. 118 (1991). The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Procedural History As detailed below, this case has a complex procedural history. In a March 2014 rating decision, in pertinent part, the RO granted entitlement to service connection for left lower extremity radiculopathy, assigning an initial disability rating of 10 percent, effective March 3, 2006. In April 2014, the Veteran filed a Notice of Disagreement (NOD) as to the March 2014 rating decision, a Statement of the Case (SOC) was issued in December 2014, and the Veteran filed a VA Form 9 in January 2015. In a November 2014 rating decision, in pertinent part, the RO granted entitlement to a TDIU based on all of the Veteran’s service-connected disabilities, effective June 1, 2013. In March 2015, the Veteran filed a Supplemental Claim for service connection for diabetes mellitus and for peripheral neuropathy of the lower extremities. In a May 2015 rating decision, the RO denied entitlement to service connection for diabetes mellitus and for peripheral neuropathy of the left lower extremity. In June 2015, the RO issued a Supplemental Statement of the Case (SSOC) which, in pertinent part, continued the denial of entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy. In July 2015, the Veteran filed a NOD as to the May 2015 rating decision and the RO issued an SOC continuing the denials of service connection for diabetes mellitus and peripheral neuropathy of the left lower extremity. The Veteran filed a VA Form 9 in August 2015. In a June 2016 decision, in pertinent part, the Board denied entitlement to service connection for diabetes mellitus and remanded the issues of service connection for peripheral neuropathy of the bilateral lower extremities and entitlement to an increased rating for left lower extremity radiculopathy. In a May 2017 Memorandum Decision, in pertinent part, the United States Court of Appeals for Veterans Claims (Court) reversed the Board’s finding that the Veteran did not have diabetes mellitus and remanded the matter to determine whether the Veteran’s diabetes mellitus was related to service. In an October 2017 rating decision, the RO assigned a disability rating of 20 percent for left lower extremity radiculopathy, effective November 1, 2016. In April 2018, the RO issued an SSOC which, in pertinent part, continued the denials of service connection for peripheral neuropathy of the bilateral lower extremities and entitlement to an initial disability rating in excess of 10 percent for left lower extremity radiculopathy prior to November 1, 2016 and in excess of 20 percent thereafter. In a July 2018 decision, in pertinent part, the Board remanded the issues of entitlement to service connection for peripheral neuropathy of the bilateral lower extremities and entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy prior to November 1, 2016 and in excess of 20 percent thereafter. In June 2020, the RO issued a SSOC which continued the denials of service connection for peripheral neuropathy of the bilateral lower extremities and entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy prior to November 1, 2016 and in excess of 20 percent thereafter. In a September 2020 decision, the Board granted entitlement to service connection for peripheral neuropathy of the bilateral lower extremities and remanded the issue of entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy prior to November 1, 2016 and in excess of 20 percent thereafter. In remanding the matter, the Board found that, prior to adjudicating entitlement to an increased rating for left lower extremity radiculopathy, it was necessary for the RO to assign in the first instance the appropriate ratings for the Veteran’s service-connected bilateral lower extremity peripheral neuropathy, as the assignment of an initial rating for left lower extremity peripheral neuropathy would likely affect adjudication of the Veteran’s increased rating claim for left lower extremity radiculopathy. In a September 2020 rating decision, the RO effectuated the Board’s grant of service connection for peripheral neuropathy of the bilateral lower extremities and made the following pertinent determinations: (1) service connection for left lower extremity diabetic peripheral neuropathy of the femoral nerve was granted with an evaluation of 20 percent, effective March 26, 2015; and (2) service connection for left lower extremity radiculopathy with diabetic peripheral neuropathy of the sciatic and posterior tibial nerves was granted with an evaluation of 10 percent, effective March 26, 2015, and an evaluation of 20 percent was assigned from November 1, 2016. In September 2020, the RO issued a SSOC which continued the denial of entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy with diabetic peripheral neuropathy of the sciatic and posterior tibial nerves prior to November 1, 2016 and in excess of 20 percent thereafter. The matter has now returned to the Board for further appellate consideration. The Board emphasizes that the only increased rating claim before it is that involving the Veteran’s service-connected left lower extremity radiculopathy, which, per the September 2020 rating decision, is now rated along with the Veteran’s diabetic peripheral neuropathy of the left sciatic and posterior tibial nerves, so as not to violate the rule against pyramiding. 38 C.F.R. § 4.14. While the issue of an increased rating for radiculopathy and peripheral neuropathy of the left lower extremity affecting the sciatic and posterior tibial nerves remains on appeal before the Board, because the Veteran has not challenged the initial rating assigned for peripheral neuropathy of the left lower extremity affecting the femoral nerve, and because that rating was specifically awarded for peripheral neuropathy of the left lower extremity (as opposed to radiculopathy), that issue will not be addressed. 1. Entitlement to an initial disability rating in excess of 10 percent for left lower extremity radiculopathy prior to November 1, 2016, and in excess of 20 percent thereafter Disability evaluations are determined by comparing a veteran’s present symptoms with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the veteran. 38 C.F.R. § 4.3. The veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Staged ratings are appropriate for any initial rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). Where a veteran is diagnosed with multiple disabilities of the same body part or system, and it is unclear from the record which symptoms are attributable to each distinct disability, the Board is precluded from differentiating between the symptomatology and the disabilities. See Mittleider v. West, 11 Vet. App. 181, 182 (1998) (per curiam). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. at 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Where a veteran is diagnosed with multiple disabilities of the same body part or system, and it is unclear from the record which symptoms are attributable to each distinct disability, the Board is precluded from differentiating between the symptomatology and the disabilities. See Mittleider, 11 Vet. App. at 182. DC 8520 provides ratings for incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a. Disability ratings of 10, 20, and 40 percent are warranted, respectively, for mild, moderate, and moderately severe incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124, DC 8520. A disability rating of 60 percent is warranted for severe incomplete paralysis with marked muscle atrophy. An 80 percent rating is warranted with complete paralysis of the sciatic nerve. Id. DC 8525 provides ratings for incomplete paralysis of the posterior tibial nerve. Disability ratings of 10, 10, and 20 percent are warranted, respectively, for mild, moderate, and severe incomplete paralysis of the posterior tibial nerve. 38 C.F.R. § 4.124a, DC 8525. A 30 percent rating is warranted for complete paralysis of the posterior tibial nerve. Id. Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as “mild,” “moderate,” “moderately severe,” and “severe.” Sellers v. Wilkie, 30 Vet. App. 157 (2018) (“DC 8520 does not define ‘mild,’ ‘moderate,’ ‘moderately severe,’ or ‘severe,’ or generally associate those terms with specific symptoms”). It should also be noted that use of terminology such as “mild” and “moderate” by VA examiners or other physicians, although an element of evidence to be considered by the Board, is not dispositive of an issue. Rather than applying a mechanical formula, the Board must instead evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. In this matter, the Veteran is currently in receipt of an initial rating of 10 percent for left lower extremity radiculopathy for the appellate period prior to November 1, 2016, and a 20 percent rating thereafter. As an aside, the Board notes that, per the September 2020 rating decision codesheet, the left lower extremity radiculopathy was rated under DC 8520 from March 3, 2006 to March 26, 2015, and it was rated under DC 8525 from March 26, 2015 onward. The Veteran asserts that higher ratings are warranted. Upon thorough review of the evidence, both lay and medical, the Board makes the following findings: (1) the manifestations of the Veteran’s left lower extremity radiculopathy more nearly approximate the criteria for an initial rating of 20 percent prior to February 8, 2018 under DC 8520; and (2) beginning February 8, 2018, the manifestations of the Veteran’s left lower extremity radiculopathy more nearly approximate the criteria for a 40 percent rating under DC 8520. First, for the appellate period prior to November 1, 2016, and between November 1, 2016 and February 7, 2018, the manifestations of the Veteran’s left lower extremity radiculopathy more nearly approximate the criteria for an initial rating of 20 percent under DC 8520 for radiculopathy that is moderate in nature. Notably, during the September 2006 VA back examination, the Veteran endorsed numbness, paresthesias, leg or foot weakness, and unsteadiness, and the VA examiner noted decreased pinprick sensation in the left lateral thigh, lateral calf, medial ankle, and foot, as well as hypoactive knee jerk reflexes in the left lower extremity. Additionally, during the July 2014 VA back examination, the VA examiner indicated the Veteran had muscle strength rated as 4 out of 5 in left hip flexion and knee extension, hypoactive reflexes in the left knee and ankle, and decreased sensation in the left lower leg, ankle, foot, and toes. The July 2014 VA examiner also determined that the Veteran had left lower extremity radiculopathy symptoms of moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness, and characterized the overall severity of the Veteran’s left lower extremity radiculopathy as moderate. Furthermore, the November 2016 VA examiner noted absent reflexes in the left knee and ankle, decreased sensation in the left thigh, knee, foot, and toes, and indicated that the severity of the Veteran’s left lower extremity radiculopathy was moderate, with symptoms of mild constant pain, mild paresthesias and/or dysesthesias, and moderate numbness. For these reasons, the Board finds that the Veteran’s radicular symptoms in his left lower extremity were moderate in nature for the appellate period prior to November 1, 2016, and between November 1, 2016 and February 7, 2018. However, the evidence does not meet or more nearly approximate a finding of neurological impairment to a moderately severe degree prior to February 8, 2018, so as to warrant a higher rating of 40 percent. In this regard, the Board observes that the Veteran’s left lower extremity radiculopathy symptoms were mostly sensory in nature, such as numbness, paresthesias, and decreased sensation, and the findings of absent and/or hypoactive reflexes and slightly diminished strength are encompassed in the 20 percent rating under DC 8520 for radiculopathy that is moderate in nature. Second, beginning February 8, 2018, the manifestations of the Veteran’s left lower extremity radiculopathy more nearly approximate the criteria for a 40 percent rating under DC 8520 for radiculopathy that is moderately severe in nature. In a private treatment record dated February 8, 2018, the Veteran endorsed a progression of his neuropathic symptoms, reporting he was experiencing more numbness and tingling in his feet, unsteadiness when he ambulates, and numbness in his knees, and the provider, a neurologist, noted decreased sensation to pain, vibration, and temperature that was more prominent in the left lower extremity, and indicated she was unable to elicit reflexes at the Achilles tendon. In a May 2018 private treatment record, the same provider wrote that the Veteran’s neuropathy symptoms “seem to be worsening.” Additionally, the February 2019 VA examiner (who completed both the back and peripheral nerves conditions examinations) indicated that the Veteran had left lower extremity radiculopathy and/or peripheral neuropathy symptoms of severe constant pain, severe intermittent pain, severe paresthesias and/or dysesthesias, and severe numbness. The February 2019 VA examiner also noted that the Veteran had decreased sensation on examination and that reflexes in his left ankle were absent. For these reasons, the Board finds that the Veteran’s left lower extremity radiculopathy symptoms and impairment more nearly approximate the criteria for a 40 percent rating under DC 8520 beginning February 8, 2018. However, the evidence does not meet or more nearly approximate a finding of neurological impairment to a severe degree. DC 8520 provides that a 60 percent rating is warranted for severe incomplete paralysis of the sciatic nerve “with marked muscular atrophy.” Here, there is no evidence of muscular atrophy of the left lower extremity on examination. See August 2018 VA diabetic sensory-motor peripheral neuropathy examination report; February 2019 VA back and peripheral nerves conditions examination reports. Therefore, a higher rating of 60 percent is not warranted. The Board acknowledges that there is an overlapping of symptoms of the Veteran’s left lower extremity radiculopathy and peripheral neuropathy. In a June 2019 VA medical opinion, the VA examiner explained, “Symptoms from nerve root compression (rad[i]culopathy) and symptoms from nerve damage (neuropathy), are often similar and one cannot be distingu[i]shed from the other.” As mentioned, where a veteran is diagnosed with multiple disabilities of the same body part or system, and it is unclear from the record which symptoms are attributable to each distinct disability, the Board is precluded from differentiating between the symptomatology and the disabilities. See Mittleider, 11 Vet. App. at 182. Moreover, per the September 2020 rating decision, the Veteran’s left lower extremity radiculopathy is rated along with his diabetic peripheral neuropathy of the left sciatic and posterior tibial nerves. Lastly, the Board notes that a separate rating under DC 8525 is not available as the posterior tibial nerve is also part of the sciatic nerve branch, and to provide a separate rating under DC 8525 would constitute pyramiding. 38 C.F.R. § 4.14. Accordingly, with resolution of all reasonable doubt in the Veteran’s favor, the Board awards an initial rating of 20 percent for left lower extremity radiculopathy for the appellate period prior to February 8, 2018, and a 40 percent rating thereafter. 2. Entitlement to a TDIU based solely on the service-connected IHD The Board observes that the Veteran is already in receipt of a TDIU based on all of his service-connected disabilities, effective June 1, 2013. However, VA’s duty to maximize benefits requires VA to assess all of a claimant’s disabilities to determine whether any combination of disabilities establishes entitlement to SMC under 38 U.S.C. § 1114, even when the Veteran is already in receipt of a TDIU based on multiple service-connected disabilities. See Bradley v. Peake, 22 Vet. App. 280, 294 (2008) (finding that SMC “benefits are to be accorded when a Veteran becomes eligible without need for a separate claim”). 38 U.S.C. § 1114(s) provides for additional compensation if the Veteran is in receipt of a 100 percent rating and has additional service-connected disability or disabilities independently ratable at 60 percent or more; or, is permanently housebound due to service-connected disabilities. A TDIU rating can satisfy the need for a rating of 100 percent if it can be sustained by a single disability. Buie, 24 Vet. App. at 250-51 (2011). Controlling laws provide that a TDIU may be assigned when a Veteran has one service-connected disability rated at 60 percent or more, or two or more service-connected disabilities where at least one disability is rated at 40 percent or more and the combined rating is at least 70 percent. 38 C.F.R. § 4.16(a). The record must also show that the service-connected disabilities alone result in such impairment of mind or body that the average person would be precluded from securing or maintaining a substantially gainful occupation. Id. See 38 U.S.C. § 1155. Effective August 31, 2010, the Veteran is in receipt of a 60 percent rating for IHD. Therefore, the Veteran met the schedular requirement for a TDIU, based solely on his IHD, as of August 31, 2010. The remaining question is whether his IHD, alone, precludes the Veteran from securing and following a substantially gainful occupation. For the reasons expressed below, and for the purpose of establishing entitlement to SMC at the housebound rate, the Board finds that the evidence is at least in equipoise as to whether the Veteran was unable to maintain substantially gainful occupation due solely to his IHD. Specifically, considering the Veteran’s occupational and educational background, which suggests that his inability to work was impacted, at least in part, by his service-connected IHD, the Board finds that the Veteran would not have been able to maintain any type of employment that was relevant to his educational background and work experience. In this regard, the Board notes that in Ray v. Wilkie, the Court defined the term “unable to secure and follow a substantially gainful occupation” in § 4.16(b) to have two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the veteran’s history, education, skill, and training, whether the veteran has the physical ability to perform the type of activities required by the occupation at issue, and whether the veteran has the mental ability to perform the activities required by the occupation at issue. See Ray v. Wilkie, 31 Vet. App. 58 (2019). As to the economic component of a substantially gainful occupation, the evidence shows that the Veteran has been unemployed since June 1, 2013. See June 2014 VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability; May 2014 letter from Veteran’s former employer. Thus, the Board finds that the Veteran has not worked in a gainful capacity since June 1, 2013. As to the non-economic component of a substantially gainful occupation, the Veteran’s work history was entirely in construction, which required the physical ability to participate in manual labor. See VA examination reports dated September 2006, August 2013, July 2014, November 2016, August 2018, and February 2019. The Veteran’s physical ability to perform the type of activities required by his former occupation was severely impacted by his service-connected IHD and its associated symptoms of dyspnea, fatigue, angina, and dizziness. Notably, the VA examiner who completed the December 2010 IHD examination report determined that the Veteran’s IHD impacted his ability to work, noting that the Veteran fatigues very readily, has symptoms with exertion, and “has trouble with energy to do job.” Furthermore, the Board finds that the Veteran’s 8th grade education and lack of any additional education or training limits his capacity for sedentary employment. See June 2014 VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability. Based on the foregoing, and for the purpose of establishing entitlement to SMC at the housebound rate, the Board finds that a TDIU predicated on unemployability stemming solely from Veteran’s service-connected IHD is warranted. 3. Entitlement to SMC at the housebound rate As previously mentioned, SMC at the housebound rate is payable where a veteran has a single service-connected disability rated as 100 percent and: (1) has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems; or (2) is permanently housebound by reason of service-connected disability or disabilities. 38 U.S.C. § 1114(s). This requirement is met when a veteran is substantially confined as a direct result of service-connected disabilities to his or her dwelling and the immediate premises, or if institutionalized, to the ward or clinical areas and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime. 38 C.F.R. § 3.350(i). A TDIU rating can satisfy the need for a rating of 100 percent if it can be sustained by a single disability. Buie, 24 Vet. App. at 250-51. Herein, pursuant to VA’s duty to maximize a claimant’s benefits, the Veteran is awarded a TDIU based solely on his service-connected IHD beginning June 1, 2013. The Veteran also has additional service-connected disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability (IHD) and involving different anatomical segments or bodily systems. Apart from his disability rating for IHD, the Veteran is also in receipt of a 20 percent rating for left lower extremity radiculopathy with diabetic peripheral neuropathy of the sciatic and posterior tibial nerves prior to February 8, 2018 and a 40 percent rating thereafter, a 30 percent disability rating for peripheral neuropathy with carpal tunnel syndrome of the left upper extremity (effective December 6, 2017), a 20 percent rating for diabetes mellitus (effective March 26, 2015), a 20 percent rating for right lower extremity peripheral neuropathy of the femoral nerve (effective March 26, 2015), a 20 percent rating for left lower extremity peripheral neuropathy of the femoral nerve (effective March 26, 2015), a 10 percent rating for right lower extremity peripheral neuropathy of the posterior tibial nerve (effective March 26, 2015), a 10 percent rating for a lumbar spine disability (effective June 1, 2012), and a 10 percent rating for tinnitus (effective March 3, 2006). Beginning March 26, 2015, these additional service-connected disabilities combine to a rating in excess of 60 percent and are separate and distinct from the Veteran’s IHD, as they involve different anatomical segments or bodily systems. Accordingly, as the Veteran has a single service-connected disability rated as total (IHD), and he has additional service-connected disabilities that are independently rated as at least 60 percent disabling, the criteria for SMC at the housebound rate have been met beginning March 26, 2015. (Continued on the next page) Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. M. Gill, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.