Citation Nr: 21003184 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 13-26 861 DATE: January 19, 2021 ORDER Entitlement to an initial 70 percent disability rating, but not higher, for the period prior to April 10, 2012 for major depressive disorder (MDD) is granted subject to the laws and regulations controlling the award of monetary benefits. Entitlement to a total disability rating due to individual unemployability (TDIU) for the period prior to April 10, 2012 is denied. Entitlement to special monthly compensation (SMC) based on aid and attendance, or housebound status is denied. FINDINGS OF FACT 1. For the period prior to April 10, 2012, the Veteran’s MDD symptomatology more nearly approximated occupational and social impairment with deficiencies in most areas, but not total social and occupational impairment. 2. Prior to April 10, 2012, the Veteran’s service connected disabilities did not preclude him from securing and following a substantially gainful occupation, and his employment was not shown to have been marginal. 3. The evidence of record reflects that the Veteran has not been housebound, does not require assistance in accomplishing the activities of daily living, and is not unable to protect himself from the hazards and dangers of his daily environment due to his service-connected disability. CONCLUSIONS OF LAW 1. For the period prior to April 10, 2012, the criteria for an initial rating of 70 percent, but not higher, for service connected MDD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.130, Diagnostic Code (DC) 9434. 2. For the period prior to April 10, 2012, the criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.16. 3. The criteria for SMC based on the regular need for the aid and attendance of another person and/or housebound status have not been met. 38 U.S.C. §§ 1114 (l), 1114 (s), 5107; 38 C.F.R. §§ 3.102, 3.350(b), 3.352(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1971 to July 1976. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a November 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) which, among one other thing, granted service connection for MDD, evaluating it as 30 percent disabling from October 27, 2003, and 70 percent disabling from April 10, 2012, creating a staged rating. In January 2013, the Veteran filed a notice of disagreement with the 70 percent rating for his MDD, with the effective date assigned, and contended that he was entitled to a TDIU, and in September 2013 was issued a statement of the case and perfected his appeal to the Board. In a June 2016 decision, the Board granted a 50 percent disability rating for the Veteran’s MDD prior to April 10, 2012 and a 100 percent rating thereafter, denied entitlement to a TDIU prior to April 10, 2012, and remanded the Veteran’s claim for SMC based on housebound status, or on the need of regular aid and assistance. The RO denied entitlement to SMC based on the need of regular aid and attendance or housebound status, and notified the Veteran in an August 2016 supplemental statement of the case. In August 2017, the Board, among one other thing, remanded the Veteran’s claim for entitlement to SMC based on the need for regular aid and attendance, or based on housebound status to afford the Veteran with proper notice of the evidence and information necessary to establish his claim. The Veteran appealed the Board decision to the Court of Appeals for Veteran’s Claims (Court) which in November 2017 granted a Joint Motion for Partial Remand filed by the parties, vacating and remanding that part of the Board’s June 2016 decision that denied entitlement to a disability rating in excess of 50 percent for MDD prior to April 10, 2012, an effective date prior to April 10, 2012 for the 10 percent rating for MDD, and a TDIU prior to April 10, 2012, finding that the Board failed to provide adequate reasons and basis by failing to fully consider the Veteran’s symptoms prior to April 10, 2012. The RO again denied entitlement to SMC based on the need of regular aid and attendance or housebound status, and notified the Veteran in a December 2017 supplemental statement of the case. In July 2018, the Board remanded the Veteran’s claims of entitlement to a disability rating higher than 50 percent for MDD prior to April 10, 2012, an effective date prior to April 10, 2012 for the 100 percent disability rating for MDD, and TDIU prior to April 10, 2012 for an addendum medical opinion to determine the severity of the Veteran’s MDD, considering the Veteran’s symptoms dating back to service. The RO denied entitlement to higher than a 50 percent rating for MDD prior to April 10, 2012, an effective date prior to April 10, 2012 for the Veteran’s 100 percent rating for MDD, and TDIU prior to April 10, 2012, and notified the Veteran in an April 2019 supplemental statement of the case. In August 2019, the Board, among other things, remanded the Veteran’s claims of entitlement to a rating higher than 50 percent for MDD prior to April 10, 2012, an effective date prior to April 10, 2012 for the 100 percent rating for MDD, a TDIU prior to April 10, 2012, and entitlement to SMC based on need of regular aid and attendance, or housebound status for a new medical opinion in light of a new service connected disability, and for new employment information. Increased Rating Disability ratings are determined by applying the criteria set forth in the 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. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as “staged” ratings. See Fenderson v. West, 12 Vet. App. 119 (1999). 1. Major Depressive Disorder The Veteran’s MDD is currently rated 50 percent disabling prior to April 10, 2012 under DC 9434. The criteria for rating MDD are found at 38 C.F.R. § 4.130, DC 9434. MDD is rated under the General Rating Formula for Mental Disorders. Under this formula, a 50 percent evaluation is warranted where there is occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands, impairment of short and long-term memory; impaired judgment; impaired abstract thinking; disturbance of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent evaluation is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); and inability to establish and maintain effective relationships. A 100 percent evaluation requires total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Symptoms listed in the VA’s general rating formula for mental disorders serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating, and are not intended to constitute an exhaustive list. See Mauerhan v. Principi, 16 Vet. App. 436, 442-44 (2002). The U.S. Court of Appeals for the Federal Circuit (Federal Circuit) has emphasized that the list of symptoms under a given rating is a non-exhaustive list, as indicated by the words “such as” that precede each list of symptoms. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115 (Fed. Cir. 2013). In Vazquez-Claudio, the Federal Circuit held “that a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage or others of similar severity, frequency, and duration.” Id. at 117. Other language in the decision indicates that the phrase “others of similar severity, frequency, and duration,” can be thought of as symptoms of like kind to those listed in the regulation for a given disability rating. Id. at 116. When evaluating a mental disorder, the frequency, severity, duration of psychiatric symptoms, length of remissions, and the Veteran’s capacity for adjustment during periods of remission must be considered. See 38 C.F.R. § 4.126 (a). In addition, the evaluation must be based on all the evidence of record that bears on occupational and social impairment, not solely on the examiner’s assessment of the level of disability at the moment of the examination. Id. Further, when evaluating the level of disability from a mental disorder, the extent of social impairment is considered, but the rating cannot be assigned solely on the basis of social impairment. See 38 C.F.R. § 4.126 (b). In his April 2016 brief, the Veteran’s representative stated that Veteran’s symptoms, which included underlying suicidal ideation, show that he suffered from severe school and social deficiencies prior to filing his claim in 2003. The representative also noted the Veteran’s failed attempts at a higher education, inability to maintain employment, and inappropriate behavior towards co-workers and friends to support his contention. October 2001 post-service ambulatory mental health clinic notes reflect that the Veteran had a “breakdown” at work which included anxiousness and crying, and that the Veteran subsequently checked himself into St. Anthony’s Hospital for 5 days. He denied suicidal or homicidal ideation. In a November 2003 stressor questionnaire, the Veteran reported that he was unable to interact with others, suffered panic attacks, extreme anxiety and depression, and insomnia and paranoia due to his psychiatric disability. A December 2005 psychiatric note reflects that the Veteran reported that he was “doing reasonably well”, eating and sleeping well, was less depressed with occasional anxiety, and that he took medication including Paxil for his psychiatric disability symptomatology which he tolerated well. The Veteran’s April 2012 VA examination report reflects that he had a diagnosis of MDD which resulted in occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgement, thinking and/or mood, and that the Veteran reported symptoms of depressed mood, anxiety, panic attacks more than once a week, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances including work or a work-like setting, inability to establish and maintain effective relationships, suicidal ideation, persistent delusion or hallucinations, and neglect of personal appearance and hygiene. The Veteran also reported anhedonia, variable appetite, insomnia, hopelessness, and a feeling of being defeated. In a November 2012 note, the Veteran reported that according to his girlfriend/spouse, he has been screaming in his sleep for as long as she has known him, and that he also suffers from chronic insomnia. In a March 2013 statement, the Veteran reported that he “has trouble with his mind” stating that the cannot focus well, has anxiety and depression, “hates everything”, and that his mind is fatigued. He stated that it is harder to keep up with everyday things and has someone who helps him with the things he needs. The Veteran also noted that he has been having trouble with his mind since he resigned from his job in August 2004, and indicated that he has a problem with relationships, having not seen his immediate family since he was discharged from service. In a separate March 2013 statement, the Veteran’s wife reported that she has been with the Veteran since February 1978 and that at that time the Veteran was struggling, and she wanted to help him. She stated that financially, the Veteran could not take control of his bills, and indicated that she pays all of the bills and has done so for more than 30 years. The Veteran’s wife reported that the Veteran’s hygiene has worsened and that she has to let him know ahead of time before she gives him a haircut so that he can mentally prepare. She also reported that for about the last 10 years, the Veteran “cusses and screams” in his sleep, and must be awakened in order to stop. She stated that the Veteran hears noises that she does not hear such as people talking and running outside of the house. An April 2013 disability benefits questionnaire (DBQ) reflected that the Veteran was admitted to St. Anthony hospital in September 2001 due to depression, poor concentration, difficulty sleeping, poor appetite, and passive suicidal ideation. He was prescribed medication for MDD. The Veteran reported mental health problems in 1974 during service, but reported that he was able to maintain functioning after discharge until the 1980s when he received treatment at a community mental health center. He reported that his wife of over 30 years handles all of the finances and is responsible for household maintenance, described their relationship as a close one, but reported that he has difficulty making friends due to trust issues. He stated that he was not currently employed having most recently worked at Hobby Lobby about 3 or 4 years prior, but stated it was too physically demanding, and that he felt confused and had difficulty concentrating on tasks. The Veteran reported that he requires reminders to shower and tend to other personal hygiene activities. In a March 2019 addendum opinion, the psychologist reported that the Veteran’s mental health disorder contributed to mild and transient social and occupational impairment, often controlled by medication between 1976 and about 2001, noting that problems with decreasing work efficiency or ability to perform tasks only occurred during periods of significant stress. The opinion indicated that between about 2001 and April 2012, the Veteran’s mental health disorder contributed to an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, with the Veteran generally functioning in a satisfactory manner, with normal routine behavior, self-care, and conversation. The psychologist noted during this period, the Veteran’s social and occupational functioning declined temporarily at times which was less likely as not related to his mental health condition, and more related to his sporadic problems with cocaine abuse. The Board finds that for the period prior to April 10, 2012, the evidence of record reflects that the Veteran’s MDD symptoms have included panic attacks, extreme anxiety and depression, insomnia and paranoia, and suicidal ideation. The Veteran reported a “breakdown” at work, poor concentration, and described inappropriate behavior towards co-workers and friends, and an inability to maintain employment due to his MDD symptomatology. Therefore, the evidence is at least evenly balanced as to whether the Veteran’s MDD symptomatology more nearly approximates occupational and social impairment with deficiencies in most areas as contemplated by a 70 percent rating for the period prior to April 10, 2012 under DC 9434. However, for the period prior to April 10, 2012, the evidence of record does not suggest that the Veteran’s MDD symptomatology and overall impairment more nearly approximates total occupational and social impairment; thus, a higher 100 percent evaluation is not warranted. The medical and lay evidence does not show gross impairment in thought process or communication, disorientation to time and place, or considerable memory loss such as the names of the Veteran’s close relatives, former occupation, or own name, or any other symptomatology resulting in total occupational and social impairment. While the Veteran reported an inability to handle his finances and problems with relationships as he had not spoken to his immediate family in decades, he has been able to maintain a relationship with his wife of over 40 years, and as will be discussed further, reported spending a considerable amount of time with his nieces. Additionally, while the March 2019 addendum opinion indicated that the Veteran’s MDD contributed to an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, the psychologist noted that this social and occupational functioning decline was more related to his sporadic problems with cocaine abuse rather than due to his MDD. The evidence of record indicates that the Veteran’s MDD symptomatology has worsened over the years, but there is no evidence prior to April 10, 2012 that his symptoms have worsened to the point that they result in total occupational and social impairment. Therefore, the Veteran’s level of social and occupational impairment due to his MDD symptomology, while substantial, does not more nearly approximate total social impairment as required for a 100 percent rating under DC 9434 prior to April 10, 2012. As to consideration of referral for an extraschedular rating, the Veteran has not contended, and the evidence does not reflect, that he has experienced symptoms outside of those listed in the rating criteria. Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (the Board is not obligated to analyze whether remand for referral for extraschedular consideration is warranted if “§ 3.321(b) (1) [is] neither specifically sought by [the claimant] nor reasonably raised by the facts found by the Board” (quoting Dingess v. Nicholson, 19 Vet. App. 473, 499 (2006), aff’d, 226 Fed. Appx. 1004 (Fed. Cir. 2007)). For the foregoing reasons, the evidence is at least evenly balanced as to whether the Veteran’s symptoms of MDD more closely approximate occupational and social impairment with deficiencies in most areas prior to April 10, 2012. Accordingly, entitlement to a rating of 70 percent, but no higher, for MDD is warranted for the period prior to April 10, 2012. As the preponderance of the evidence is against a rating higher than 70 percent, the benefit of the doubt doctrine is not otherwise for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 2. TDIU A TDIU is provided where the combined schedular evaluation for service-connected disabilities is less than total, or 100 percent. 38 C.F.R. § 4.16 (a). VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that the veteran is precluded from obtaining or maintaining any gainful employment, by reason of his or her service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. Under 38 C.F.R. § 4.16 (a), if there is only one such disability, it must be rated at 60 percent or more to qualify for benefits based on individual unemployability. If there are two or more such disabilities, there shall be at least one disability rated at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent. 38 C.F.R. § 4.16 (a). In Ray v. Wilkie, 31 Vet. App. 58, 73 (2019), the Court defined the term “unable to secure and follow a substantially gainful occupation” as having 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 following: 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. The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough. See Van Hoose, 4 Vet. App. at 363. “A high rating in itself is a recognition that the impairment makes it difficult to obtain or keep employment.” Id. The ultimate question, however, is “whether the veteran is capable of performing the physical and mental acts required by employment, not whether the veteran can find employment.” Id. The Veteran’s VA Form 21-8940 reflected that he worked for VA, but became too disabled to work in August 2004, and the Veteran noted that his psychiatric disability prevents him from securing or following any substantially gainful occupation. The Veteran reported finishing 1 year of college, and stated that he had 2 mental breakdowns, was unable to focus over long periods of time, and that he worked 1 year until he was no longer able to do so. The form also indicates that the Veteran was uncertain as to the date he last worked full-time, but earned $42,780 in 2012. The Veteran submitted an additional VA Form 21-8940 which reflected that the Veteran reported that his psychiatric disability affected his full time employment in May 1993. In light of the current decision, prior to April 10, 2012, the Veteran is service connected solely for MDD, rated 70 percent disabling. As the Veteran has one disability rated at least 60 percent disabling, he meets the schedular criteria for a TDIU under 38 C.F.R. § 4.16(a). Nonetheless, to grant TDIU it must be found that the Veteran is unable to secure or follow a substantially gainful occupation due to his service-connected disabilities. In October 2003, the Veteran submitted a VA Form 21-527 which indicated that he became totally disabled in 1973, completed 1 year of college, and has been under a doctor’s care for depression, anxiety and panic attacks. In his November 2003 stressor questionnaire, the Veteran reported that he missed approximately 5 years of work due to his psychiatric disability, and stated that he was unable to cope with the pressure of keeping up with his job as a cook, kept missing work, and was unable to learn his job as a clerk. In a March 2013 statement, the Veteran reported that he tried to work in 2011, but only worked for 1 year due to his health, and restated that he has not worked for a year since 2004. The preponderance of the evidence reflects that prior to April 10, 2012, the Veteran’s service connected MDD did not preclude him from obtaining and maintaining substantially gainful employment. While the Veteran has reported being unable to cope with the pressure of his job as a cook, and stated that he kept missing work due to his MDD, he has indicated that his highest income from employment was earned in 2012. The fact that he was able to make appropriate and necessary adjustments to perform his duties to the point that he was able to earn a significant income prior to April 10, 2012 reflects that he was capable of obtaining and maintaining employment. The Board notes the Veteran’s reports that he became too disabled to work in 2004 and has not worked for a year since 2004. However, considering the specificity with which the Veteran reported his highest annual income in his VA Form 21-8940 and statements as to employment a few years prior to 2013, the Board finds that the evidence provided in the VA Form-21 outweighs the Veteran’s statements regarding not having worked since 2004. There is also no allegation or evidence that the Veteran’s employment as reported in 2012 was marginal, as that term is defined in 38 C.F.R. § 4.16 (a). As the Veteran was capable of maintaining substantially gainful employment, entitlement to a TDIU must be denied for the period prior to April 10, 2012. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 3. SMC In and April 2016 brief, the Veteran’s representative indicated that the Veteran is in need of regular aid and attendance as he had been ruled incompetent as he lacks the mental capacity to contract or manage his own affairs in a January 2013 rating decision due to his mental condition. SMC provides for additional levels of compensation above the basic levels of compensation afforded by the schedular rating criteria in 38 C.F.R. Part 4. These additional levels of compensation are awarded for various types of losses or levels of impairment, due solely to service-connected disabilities, and for specific combinations of such impairments. The different types of SMC available are commonly referred to by their alphabetic designations, such as SMC(k), SMC(l), etc., which correspond to the paragraphs of 38 U.S.C. § 1114 which provides the statutory authority for SMC. These same paragraphs are codified in VA regulations, predominantly at 38 C.F.R. § 3.350 (a) - (i). SMC at the aid and attendance rate is payable when a veteran, due to service-connected disability, has suffered the anatomical loss or loss of use of both feet or one hand and one foot, or is blind in both eyes, or is permanently bedridden or so helpless as to need regular aid and attendance. See 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.350 (b). In this matter, the record does not reflect that the Veteran has the anatomical loss, or loss of both feet, or one hand and one foot, or is blind in both eyes. See 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.350 (b). Thus, the question is whether he is permanently bedridden or so helpless as to be in need of regular attendance due to his service-connected disabilities. In addition, special monthly compensation is payable at a specified rate if the Veteran, as the result of service-connected disability, has a service-connected disability rated as total, and (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, or, (2) by reason of such veteran’s service-connected disability or disabilities, is permanently housebound. For the purpose of this subsection, the requirement of “permanently housebound” will be considered to have been met when the veteran is substantially confined to such veteran’s house (ward or clinical areas, if institutionalized) or immediate premises due to a service-connected disability or disabilities which it is reasonably certain will remain throughout such veteran’s lifetime. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (b). Pursuant to 38 C.F.R. § 3.350 (b)(3) and (4), the criteria for determining that a veteran is so helpless as to need regular aid and attendance, including a determination that he is permanently bedridden, are contained in 38 C.F.R. § 3.352 (a). That regulation provides that the following will be accorded consideration in determining the need for regular aid and attendance: inability of a claimant to dress or undress himself, or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid; inability to feed himself through the loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect him from hazards or dangers incident to his daily environment. “Bedridden” is defined as that condition, which, through its essential character, requires that a claimant remain in bed, and is a proper basis for this determination. The fact that a claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. It is not required that all the above disabling conditions be found to exist before a favorable rating may be made. The particular personal functions that a veteran is unable to perform should be considered in connection with his condition as a whole. It is only necessary that the evidence establish that a veteran is so helpless as to need regular aid and attendance, not that there is a constant need. Determinations that a veteran is so helpless as to need regular aid and attendance will not be based solely upon an opinion that his condition is such as would require him to be in bed. They must be based on the actual requirement of personal assistance from others. See 38 C.F.R. § 3.352 (a). The Veteran is now service connected for MDD, evaluated as 70 percent disabling from October 27, 2003, and 100 percent disabling from April 10, 2012; and coronary artery disease, evaluated as 30 percent disabling from January 16, 2018. An August 2016 VA examination report reflect that the Veteran was not bedridden nor currently hospitalized, was able to travel beyond his current domicile, and did not use an orthopedic or prosthetic appliance. The Veteran reported that he did not suffer from dizziness, but did suffer mild memory loss. The examining physician noted that there were no other body parts or system impairments that affected the ability of the Veteran to protect himself from the daily environment, and that the Veteran can perform all self-care functions. The report indicated that the Veteran was able to walk without assistance of another person up to ½ a mile, and did not need an aid for ambulation. The report also reflected that the Veteran did not have any restrictions as far as circumstances when he could leave his home. The report indicated that the Veteran’s best corrected vision was not 5/200 or worse in both eyes, he did not have cervical or thoracolumbar spine limitation of motion or deformity, and the function of the upper and lower extremities was normal. The examining physician reported that any impairment of function related to a service connected condition would be due to a psychological condition, thus the physician deferred her opinion regarding the need for aid and attendance to the expertise of the examining psychologist. A separate August 2016 VA examination report indicated that the Veteran has diagnoses of MDD and generalized anxiety disorder, but it was not possible to differentiate what symptoms are attributable to each diagnosis as they share common symptoms of anxious and depressed mood, restlessness, irritability, difficulties concentrating and falling asleep, reduced energy and interest in activities, and feelings of worthlessness and helplessness. The Veteran was independently mobile, and reported while having some pain in his feet, that he is capable of walking and standing for periods of time. He also described having mild problems keeping up with hygiene, needing reminders to shower and help with shaving, but is capable of getting dressed, feeding, and toileting independently. He described a good relationship with his wife of more than 40 years, and stated that typical chores included cutting the grass, helping with the dishes, and some cleaning. The Veteran reported no real problems completing tasks around his home, although he often relies on his wife to drive him places because he is “not that good a driver.” He spent free time visiting with his nieces, watching television, and denied problems getting along with people he is close to, but reported few friendships that he attempted to maintain. The examining psychologist noted symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances including work or a worklike setting, and neglect of personal appearance and hygiene. The psychologist reported that the Veteran has mild problems working cooperatively with his wife and other people he feels close to, but more moderate problems working cooperatively with people he does not know or coworkers and supervisors. The Veteran additionally described having mild problems independently following written instructions, or communicating effectively, and described having moderate problems retaining information, and solving problems without help. He indicated that he is capable of asking other people for help when problems increase, and described more severe problems with being motivated to start tasks, maintaining persistence on tasks, and maintaining a persistent schedule. The psychologist opined that while the Veteran benefits from assistance in many areas of his life, he is less likely as not to be housebound, or in need of regular aid and assistance of another person. The psychologist also noted that the Veteran’s service connected mental health disorders are less likely as not to render him unable to protect himself from the hazards or dangers incident to his daily environment. In a September 2016 letter, the Veteran reported that due to his psychosis his wife handles all of his medicines, and stated that she has to drive him everywhere. He reported episodes of confusion which cause him to panic and render him unable to do daily tasks and chores like driving and taking care of himself. He stated his wife handles all of the business because he cannot do it right, and reported that he also cannot “control things” on his own. The Veteran stated that his wife has to be with him all of the time to assist him as his condition has worsened. He reported that everyday situations are very hard for him and that his wife has been helping him since 2004. He also stated that his wife says he screams in his sleep at night. In an August 2017 statement, the Veteran’s wife reported that she bathes the Veteran, cooks all the meals, and helps the Veteran dress as his ability to do everyday tasks has diminished over the years. She stated that when the Veteran drives, he gets lost and has to call her for directions. She also reported that the Veteran has episodes of fear which almost paralyze him, that he screams every night in his sleep, and is not the same as when he first met him, noting that she has been with him since 1978. She stated that he is now housebound and only goes out when she can take or accompany him. The Veteran’s wife also reported that she handles all of the finances and has always been the Veteran’s fiduciary. In a September 2017 letter, the Veteran’s friend reported that he has known the Veteran since the 1980s, and that when he is around the Veteran, the Veteran is fidgety and loses focus in conversations with him. The Veteran’s friend also noted that the Veteran greatly depends on his wife for almost everything. A January 2020 DBQ reflected that the Veteran’s posttraumatic stress disorder and MDD impair functioning in an occupational environment, and his coronary artery disease hinders aggressive physical work. The physician opined that it is less likely than not that any of the functional impairments, alone or in combination, render the Veteran housebound or in need of regular aid and attendance of another person, to include whether his service connected disabilities render him unable to protect himself from the hazards or dangers incident to his daily environment. The physician reported that based on the 2019 mental health examination report and his examination, while the Veteran’s PTSD and depression may interfere with his functioning in an occupational environment, he is physically capable of performing tasks of daily living, such as self-feeding, walking to a restroom with a cane, dressing, undressing, brushing teeth, combing an showering. The physician reported that the Veteran is well oriented in space and time, and capable of protecting himself from hazards or dangerous incidents. The physician also noted that due to the Veteran’s service connected coronary artery disease, he has difficulty performing aggressive physical tasks. She concluded that it is less likely than not that any of the functional impairments, alone or in combination, render the Veteran housebound or in need of regular aid and attendance of another person, to include whether his service connected disabilities render him unable to protect himself from the hazards or dangers incident to his daily environment. The physician noted that the Veteran is restricted to his home or its immediate vicinity, and required an attendant in reporting for the examination. The physician noted that the Veteran had not been hospitalized, was not permanently bedridden, did not use an orthopedic or prosthetic appliance, but often felt dizzy and sometimes fell due to unsteadiness, and had short term memory lapses. The Veteran also reported feeling unsteady, using a cane to ambulate, staying home and watching television, going shopping with wife, and going out to put gas in the car with his wife. The Veteran was able to dress, feed, bathe himself, and undress. The Veteran was able to walk 100 yards without assistance of another person, and was able to leave the home once or twice a week to go shopping or take out the trash. The physician noted that the Veteran’s best corrected vision was not worse than 5/200 in both eyes, was not capable of managing his financial affairs as his wife had done so for at least 30 years, and would not be able to do so due to his short term memory loss. The Board notes that the January 2020 examining physician noted that the Veteran is restricted to his home or its immediate vicinity, but also reported that the Veteran was able to go shopping or take out the trash. In this instance, the Board will afford more weight to the Veteran’s reports than the notation on the DBQ, as the Veteran detailed the activities he participated in which required leaving his home, whereas it is reasonable to conclude that the notation may have been made in error considering the evidence of record to the contrary that the Veteran is restricted to his home. For the following reasons, the requirements for SMC based on aid and attendance or housebound status have not been met for any period on appeal. There is no evidence of record indicating the Veteran is in need of aid and attendance due to his service-connected disability. While the evidence reflects that the Veteran’s MDD causes a depressed mood, anxiety, chronic sleep impairment, difficulty in establishing and maintaining effective work and social relationships, and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene, he is able to handle his household chores, and perform tasks of daily living such as dress, feed, and bath himself. While the Veteran’s friend has stated that the Veteran depends on his wife for everything, and has provided evidence that his wife has to drive him everywhere, handle his medicine, cook meals, and help him bathe, the January 2020 DBQ indicated that the Veteran was able to dress, feed, and bathe himself, walk 100 yards unassisted, and leave the home to go shopping or take out the trash. The January 2020 physician also noted that the Veteran was well oriented in space and time, was not permanently bedridden, and was capable of protecting himself from hazards or dangerous incidents. Both the August 2016 psychologist and January 2020 physician opined that the Veteran was less likely as not to be housebound, or in need of regular aid and assistance of another person, and provided a thorough rationale to support their opinions based on an accurate characterization of the evidence of record. Therefore, the opinions are afforded significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). The preponderance of the evidence thus reflects that the Veteran does not require the care or assistance of another on a regular basis other than to handle financial responsibilities, or that the Veteran required care or assistance on a regular basis to protect him from the hazards or dangers incident to his daily environment. Therefore, the above evidence reflects that the Veteran does not meet the criteria for aid and attendance. Moreover, while the Veteran is service-connected for a single disability rated as 100 percent disabling from April 10, 2012, he does not have an additional service-connected disability or disabilities independently ratable at 60 percent or more, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems; nor does the record reflect that he is permanently housebound by reason of his service-connected disabilities as the January 2020 DBQ indicated that the Veteran accompanies his wife shopping and assists with chores such as taking out the trash. 38 C.F.R. § 3.350 (i). Therefore, the Veteran does not meet the criteria for the award of SMC based upon housebound status. The Board is sympathetic to the Veteran’s contentions that SMC for aid and attendance or housebound status is warranted, but is bound by the laws and regulations that apply to veterans claims. 38 U.S.C. § 7104(c); 38 C.F.R. §§ 19.5, 20.101(a). Those laws and regulations make clear that entitlement to SMC based on the need for the aid and attendance of another or housebound status is an individual benefit and the person seeking it must require the aid and attendance. In this case, the evidence reflects that the Veteran does not meet the criteria to receive the benefit. For the foregoing reasons, the preponderance of the evidence is against the claim for SMC based on aid and attendance. The benefit of the doubt doctrine is therefore not for application and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Maddox, 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.