Citation Nr: 21004233 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 17-13 270 DATE: January 26, 2021 ORDER New and material evidence has been received to reopen the claim of entitlement to service connection for a low back disability. Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for rheumatoid arthritis is denied. Entitlement to service connection for osteoarthritis of his bilateral hands is denied. Entitlement to service connection for Raynaud’s syndrome is denied. Entitlement to service connection for anemia is denied. Entitlement to service connection for a cervical strain is denied. Entitlement to service connection for erectile dysfunction is denied. Entitlement to an effective date earlier than June 30, 2014, for the grant of service connection for an acquired psychiatric disorder to include somatic syndrome disorder with depression is denied. Entitlement to an initial rating in excess of 30 percent for an acquired psychiatric disorder to include somatic syndrome disorder with depression for the period prior to May 25, 2016 is denied. Entitlement to a 70 percent rating, but no higher, for an acquired psychiatric disorder to include somatic syndrome disorder with depression for the period since May 25, 2016 is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) for the period since May 25, 2016 is granted. REMANDED Entitlement to service connection for a lumbar spine disability is remanded. Entitlement to service connection for a bilateral ankle disability is remanded. Entitlement to service connection for irritable bowel syndrome (IBS) is remanded. Entitlement to an earlier effective date than January 25, 2016 for a 30 percent rating for bilateral flexible pes planovalgus with history of stress fracture is remanded. Entitlement to special monthly compensation (SMC) at the housebound rate is remanded. Entitlement to a TDIU for the period prior to May 26, 2015 is remanded. FINDINGS OF FACT 1. In a September 2007 rating decision, the RO denied the Veteran’s claim for service connection for a lumbar spine disability. The Veteran did not timely perfect an appeal of this determination, and no new and material evidence was received within one year of notice of this decision. 2. Evidence received since the September 2007 rating decision including VA treatment records that demonstrate a current low back disability, is not cumulative or redundant of evidence previously of record, and raises a reasonable possibility of substantiating the claim of entitlement to service connection for a low back disability. 3. Diabetes mellitus was not shown in service, did not manifest to a compensable degree within one year of service separation, and is not otherwise related to service. 4. Rheumatoid arthritis was not shown in service, did not manifest to a compensable degree within one year of service separation, and is not otherwise related to service. 5. Osteoarthritis of his bilateral hands was not shown in service, did not manifest to a compensable degree within one year of service separation, and is not otherwise related to service. 6. Raynaud’s syndrome was not shown in service and is not otherwise related to service. 7. Anemia was not shown in service and is not otherwise related to service. 8. A cervical strain was not shown in service and is not otherwise related to service. 9. Erectile dysfunction was not shown in service, is not otherwise related to service and is not caused or aggravated by a service-connected disability. 10. A January 2015 rating decision granted service connection for an acquired psychiatric disorder to include somatic syndrome disorder with depression, effective June 30, 2014. The effective date was the date of the claim for service connection. 11. There is not clear evidence of any administrative irregularity by the agency of original jurisdiction, and VA received no communication from the Veteran, or any authorized representative, that constitutes a formal claim for an acquired psychiatric disorder to include somatic syndrome disorder with depression prior to June 30, 2014. 12. For the period prior to May 25, 2016, the Veteran’s symptoms of an acquired psychiatric disorder to include somatic syndrome disorder with depression were indicative of occupational and social impairment with no more than occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks; occupational and social impairment with reduced reliability and productivity is not shown at any time during the appeal. 13. For the period since May 25, 2016, the Veteran’s symptoms of an acquired psychiatric disorder to include somatic syndrome disorder with depression more closely approximates deficiencies in most areas. 14. With full consideration of the Veteran’s educational and occupational background, the evidence of record supports a finding that his service-connected acquired psychiatric disorder to include somatic syndrome disorder with depression disability renders him unable to secure and follow substantially gainful employment for the period since May 25, 2016. CONCLUSIONS OF LAW 1. New and material evidence has been received since the September 2007 denial, and the claim of entitlement to service connection for low back disability is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2020). 2. Diabetes mellitus was not incurred in service, nor may it be presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1131, 5103, 5103(A) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). 3. Rheumatoid arthritis was not incurred in service, nor may it be presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1131, 5103, 5103(A) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). 4. Osteoarthritis of his bilateral hands was not incurred in service, nor may it be presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1131, 5103, 5103(A) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). 5. Raynaud’s syndrome was not incurred in active military service. 38 U.S.C. §§ 1101, 5107 (2012); 38 C.F.R. § 3.303 (2020). 6. Anemia was not incurred in active military service. 38 U.S.C. §§ 1101, 5107 (2012); 38 C.F.R. § 3.303 (2020). 7. A cervical strain was not incurred in active military service. 38 U.S.C. §§ 1101, 5107 (2012); 38 C.F.R. § 3.303 (2020). 8. Entitlement to service connection for erectile dysfunction, to include as secondary to a service-connected disability, is not warranted. 38 U.S.C. §§ 1110, 1131 (2012) 38 C.F.R. §§ 3.303, 3.304, 3.310, (2020). 9. The criteria for an effective date, earlier than June 30, 2014, for the grant of service connection for an acquired psychiatric disorder to include somatic syndrome disorder with depression are not met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.102, 3.114(a), 3.400 (2020). 10. The criteria for entitlement to an initial disability rating in excess of 30 percent for an acquired psychiatric disorder to include somatic syndrome disorder with depression for the period prior to May 25, 2016 are not met. 38 U.S.C. § 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.130, Diagnostic Code 9411 (2020). 11. The criteria for an initial 70 percent disability evaluation, but no higher, for an acquired psychiatric disorder to include somatic syndrome disorder with depression for the period since May 25, 2016 are met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411 (2020). 12. The criteria for a TDIU for the period since May 25, 2016 have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1989 to February 1990. These matters come to the Board of Veterans’ Appeals (Board) on appeal from June 2013, January 2015, January 2016, January 2017 and October 2017 rating decisions from a Department of Veterans Affairs Regional Office (RO). In March 2020, the Veteran testified at a videoconference hearing in front of the undersigned Veteran’s Law Judge. A transcript of the hearing has been associated with the electronic claim file. A claim for a TDIU is part and parcel of an increased rating claim where, as here, a claimant asserts that his service-connected disabilities prevent him from working. See Rice v. Shinseki, 22 Vet. App. 447, 454-55 (2009). In the Veteran’s March 2020 hearing, the Veteran indicated that he was not employable due to his service-connected disabilities. The Board has therefore characterized the issues on appeal to include a claim for a TDIU. The Board notes that in October 2019, the Veteran selected a higher level review (HLR) under the new regulations of the Appeals Modernization Act (AMA) for the issues of entitlement to ratings in excess of 30 percent for bilateral flexible pes planovalgus, entitlement to a rating in excess of 10 percent for left knee tendonitis, entitlement to a rating in excess of 10 percent for right knee tendonitis and entitlement to service connection for a right wrist disability, a left wrist disability and retinitis pigmentosa. As a result, these issues are now being developed under the AMA and will be the subject of a separate Board decision. Service Connection Laws and Regulations Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.” Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain diseases, to include type II diabetes mellitus, ischemic heart disease and hypertension may be presumed to have been incurred in service when manifest to a compensable degree within one year of discharge from active duty. 38 U.S.C. § 1112 (2012); 38 C.F.R. §§ 3.307, 3.309 (2020). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden for certain chronic disabilities such as type II diabetes mellitus and arthritis is through a demonstration of continuity of symptomatology. In relevant part, 38 U.S.C. § 1154(a) requires that the VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim to disability or death benefits. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed.Cir.2007). In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency (“a legal concept determining whether testimony may be heard and considered”) and credibility (“a factual determination going to the probative value of the evidence to be made after the evidence has been admitted”). 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). Under 38 C.F.R. § 3.310(a), service connection may be granted for disability that is proximately due to or the result of a service- connected disease or injury. Such permits a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation to a nonservice- connected disability by a service- connected disability. Id. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310(b). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Factual Background and Analysis When considering the pertinent evidence of record in light of the above-noted legal authority, the Board finds that service connection for diabetes mellitus, rheumatoid arthritis, osteoarthritis of the bilateral hands, Raynaud’s syndrome, anemia, a cervical strain and erectile dysfunction is not warranted. As there are current diabetes mellitus, rheumatoid arthritis, osteoarthritis of the bilateral hands, Raynaud’s syndrome, anemia, a cervical strain and erectile dysfunction disabilities, the first element of service connection is satisfied. However, a veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); D’Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000). Regarding the Veteran’s diabetes mellitus, rheumatoid arthritis and osteoarthritis of the bilateral hands claims, as noted above, service connection may be granted on a presumptive basis for certain chronic diseases, including diabetes mellitus and arthritis, if such disabilities are shown to be manifest to a degree of 10 percent or more within one year following the Veteran’s separation from active military service. See 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. In this instance however, service connection for diabetes mellitus, rheumatoid arthritis and osteoarthritis of the bilateral hands on a presumptive basis is not warranted as the record does not show evidence of diabetes mellitus, rheumatoid arthritis or osteoarthritis of the bilateral hands within one year of the Veteran’s separation from active duty. To the extent that the Veteran is asserting that he experienced continuing symptoms of diabetes mellitus, rheumatoid arthritis or osteoarthritis of the bilateral hands thereafter, the Board acknowledges that a layperson is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). Furthermore, lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (finding that the Board’s categorical statement that “a valid medical opinion” was required to establish nexus, and that a layperson was “not competent” to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). However, as the Veteran was not diagnosed with diabetes mellitus, rheumatoid arthritis or osteoarthritis of the bilateral hands until many years after service and there was a significant period between his service and his post-service complaints where the medical record was silent for complaints of diabetes mellitus, rheumatoid arthritis or osteoarthritis of the bilateral hands, the Board concludes that the weight of the evidence is against a finding of any continuity of symptomatology. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); Shaw v. Principi, 3 Vet. App. 365 (1992). Regarding service connection on a direct basis for all of the claimed disabilities, the Board notes that the Veteran’s service treatment records are negative for complaints or treatments of diabetes mellitus, rheumatoid arthritis, osteoarthritis of the bilateral hands, Raynaud’s syndrome, anemia, a cervical strain and erectile dysfunction. Further, there is no competent evidence or opinion even suggesting that there exists a medical nexus between current diabetes mellitus, rheumatoid arthritis, osteoarthritis of the bilateral hands, Raynaud’s syndrome, anemia, a cervical strain and erectile dysfunction disabilities and the Veteran’s service and neither the Veteran nor his representative have presented or identified any such existing medical evidence or opinion. The Board finds that the competent evidence of record, while showing the currently diagnosed diabetes mellitus, rheumatoid arthritis, osteoarthritis of the bilateral hands, Raynaud’s syndrome, anemia, a cervical strain and erectile dysfunction disabilities, does not demonstrate that the Veteran’s diabetes mellitus, rheumatoid arthritis, osteoarthritis of the bilateral hands, Raynaud’s syndrome, anemia, a cervical strain and erectile dysfunction disabilities are related to the Veteran’s service. Finally, the Veteran is also claiming service connection for an erectile dysfunction disability as secondary to his diabetes mellitus. As noted above, service connection may be granted for a disability that is proximately due to or the result of an established service-connected disability. 38 C.F.R. § 3.310 (2020). However, the Veteran is not currently service connected for a type II diabetes mellitus disability. As addressed above, the Board is denying the Veteran’s claim for service connection for a TBI disability on the basis that there is no competent evidence that this disability is related to his service. Hence, as a matter of law, the claim for service connection for an erectile dysfunction disability as secondary to a type II diabetes mellitus disability is without legal merit, and must be denied as a matter of law. See 38 C.F.R. § 3.310(a); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). As a result, the Board finds that service connection for an erectile dysfunction disability on a secondary basis is not warranted. In sum, for the reasons and bases expressed above the Board finds that the preponderance of the evidence is against the Veteran’s claims of entitlement to service connection for diabetes mellitus, rheumatoid arthritis, osteoarthritis of the bilateral hands, Raynaud’s syndrome, anemia, a cervical strain and erectile dysfunction. The benefit-of-the-doubt rule does not apply, and the claims must be denied. 38 U.S.C. § 5107(b). The Board also notes that the Veteran was not provided with VA examinations and opinions to assess the current nature and etiology of his claimed diabetes mellitus, rheumatoid arthritis, osteoarthritis of the bilateral hands, Raynaud’s syndrome, anemia, a cervical strain and erectile dysfunction disabilities. However, VA need not conduct an examination with respect to the claims on appeal, as information and evidence of record contains sufficient competent medical evidence to decide the claims. See 38 C.F.R. § 3.159(c) (4). Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in disability compensation (service connection) claims, the VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. Simply stated, the standards of McLendon are not met in this case as there is no credible evidence that the diabetes mellitus, rheumatoid arthritis and osteoarthritis of the bilateral hands disabilities manifested in service or within a year of separation from service, there is no credible evidence that the Raynaud’s syndrome, anemia and a cervical strain manifested in service and no credible evidence that the erectile dysfunction was caused or aggravated by a service-connected disability. There is also no competent evidence suggesting that these disabilities are otherwise associated to service. Thus, remand for VA examinations is not necessary. The Board notes the Veteran and his representative’s contentions regarding the etiology of his claimed diabetes mellitus, rheumatoid arthritis, osteoarthritis of the bilateral hands, Raynaud’s syndrome, anemia, a cervical strain and erectile dysfunction disabilities. To the extent that the Veteran and his representative themselves contend that a medical relationship exists between his claimed diabetes mellitus, rheumatoid arthritis, osteoarthritis of the bilateral hands, Raynaud’s syndrome, anemia, a cervical strain and erectile dysfunction disabilities and his service, the Board acknowledges that the Veteran is competent to testify as to his observations. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Furthermore, lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (finding that the Board’s categorical statement that “a valid medical opinion” was required to establish nexus, and that a layperson was “not competent” to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). In the instant case, however, the Board finds that diabetes mellitus, rheumatoid arthritis, osteoarthritis of the bilateral hands, Raynaud’s syndrome, anemia, a cervical strain and erectile dysfunction disabilities are not disabilities subject to lay diagnosis as these diagnoses require medical training. More significantly, the Veteran and his representative do not have the medical expertise to provide an opinion regarding the claimed diabetes mellitus, rheumatoid arthritis, osteoarthritis of the bilateral hands, Raynaud’s syndrome, anemia, a cervical strain and erectile dysfunction disabilities etiologies. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. West, 12 Vet. App. 460, 465 (1999). Thus, the Veteran and his representative’s assertions that there is a relationship between his claimed diabetes mellitus, rheumatoid arthritis, osteoarthritis of the bilateral hands, Raynaud’s syndrome, anemia, a cervical strain and erectile dysfunction disabilities and his service are not sufficient in this instance and are outweighed by other probative evidence of record. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In sum, for the reasons and bases expressed above the Board finds that the preponderance of the evidence is against the Veteran’s claims of entitlement to service connection. The benefit-of-the-doubt rule does not apply, and the claims must be denied. 38 U.S.C. § 5107(b). Earlier Effective Date Laws and Regulations Generally, the effective date of an evaluation and award of compensation based on a claim for increase will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The terms “claim” and “application” mean a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). Any communication or action that demonstrates intent to apply for an identified benefit may be considered an informal claim. 38 C.F.R. § 3.155(a). VA or uniformed services medical records may form the basis of an informal claim for increased benefits where a formal claim for service connection has already been allowed. 38 C.F.R. § 3.157. Under the provisions of 38 C.F.R. § 3.157(b)(1), the date of outpatient or hospital examination or date of admission to a VA or uniformed services hospital will be accepted as the date of receipt of a claim. The provisions of this regulation apply only when such reports relate to examination or treatment of a disability for which service connection has previously been established or when a claim specifying the benefit sought is received within one year from the date of such examination, treatment or hospital admission. 38 C.F.R. § 3.157(b). Any communication or action, indicating an intent to apply for one or more benefits under the laws administered by the Department of Veterans Affairs, from a claimant, his or her duly authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui juris may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155. Generally, the date of receipt of a claim is the date on which a claim, information, or evidence is received by VA. 38 C.F.R. § 3.1(r). Factual Background and Analysis The earliest document that can be construed as a claim for service connection for an acquired psychiatric disorder to include somatic syndrome disorder with depression is the formal application for benefits, VA Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526) which is date-stamped as having been received by the RO on June 30, 2014. The January 2015 rating decision granted service connection for acquired psychiatric disorder to include somatic syndrome disorder with depression an initial 30 percent disability evaluation, effective June 30, 2014 which was the date that the claim was received. Based on the evidence, the Board finds that an effective date earlier than June 30, 2014 for service-connected acquired psychiatric disorder to include somatic syndrome disorder with depression is not warranted as the claims file does not reflect that any communication filed prior to that date could be construed as a formal or informal claim for this specific benefit. As the Veteran’s claim for service connection for acquired psychiatric disorder to include somatic syndrome disorder with depression was not received within one year of his February 1990 separation from service, the effective possible effective date is the date of receipt of the Veteran’s claim, June 30, 2014. 38 C.F.R. § 3.400(b) (2) (i). Accordingly, the Board finds that there otherwise is no basis for the assignment of an effective date earlier than June 30, 2014, for the award of entitlement to service connection for an acquired psychiatric disorder to include somatic syndrome disorder with depression. The claims file does not reflect that any communication filed prior to that date could be construed as a formal or informal claim for this specific benefit. Under these circumstances, the claim for an earlier effective date must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against assignment of an effective date earlier than June 30, 2014, for the award of entitlement to service connection for an acquired psychiatric disorder to include somatic syndrome disorder with depression, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53- 56 (1990). Higher Initial Ratings Laws and Regulations The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claims or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claims, in which case, the claims are denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2020). Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2019). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2020). The Veteran’s entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1 (2020). Where service connection has already been established, and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, in Fenderson v. West, 12 Vet. App. 119 (1999), it was held that evidence to be considered in the appeal of an initial assignment of a disability rating was not limited to that reflecting the then current severity of the disorder. The Court also discussed the concept of the “staging” of ratings, finding that, in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. See also Hart v. Mansfield, 21 Vet. App. 505 (2008). The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14 (2020). The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261- 62 (1994). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2020). In this case, the Veteran is competent to testify on factual matters of which he has first-hand knowledge. Washington v. Nicholson, 19 Vet. App. 362 (2005). He is also competent to report symptoms of his acquired psychiatric disorder. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). The Veteran is competent to describe his symptoms and their effects on employment or daily activities. His statements have been consistent with the medical evidence of record and are probative for resolving the matters on appeal. The Board will consider not only the criteria of the currently assigned diagnostic codes, but also the criteria of other potentially applicable diagnostic codes. In a January 2015 rating decision, the RO granted service connection for an acquired psychiatric disorder to include somatic syndrome disorder with depression at an initial 30 percent disability rating, effective June 30, 2014 under Diagnostic Code 9411. In the October 2017 rating decision, the RO granted an initial 50 percent rating for an acquired psychiatric disorder to include somatic syndrome disorder with depression, effective May 25, 2016. The Board notes that psychiatric disabilities other than eating disorders are rated pursuant to the criteria for General Rating Formula. See 38 C.F.R. § 4.130. Under the general rating formula for mental disorders, a noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. A 10 percent evaluation is warranted if there is occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication. A rating of 30 percent is assigned when the Veteran exhibits occupational and social impairment with occasional decreases in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating requires 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 (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating requires 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 affected 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 worklike setting); and inability to establish and maintain effective relationships. A 100 percent rating is assigned when there is 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; memory loss for names of close relatives, own occupation, or own name. Id. The evidence considered in determining the level of impairment for psychiatric disorders under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in the rating code. Disability ratings are assigned according to the manifestation of particular symptoms, but the use of the term “such as” in the General Rating Formula demonstrates that the symptoms after the phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Accordingly, the evidence considered in determining the level of impairment from psychiatric disorder under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in Diagnostic Code 9411. See Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436 (2002). When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126 (2020). One factor for consideration is the Global Assessment of Functioning (GAF) score, which is a scale reflecting the “psychological, social, and occupational functioning in a hypothetical continuum of mental health-illness.” Carpenter v. Brown, 8 Vet. App. 240, 242 (1995) (citing Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)). According to the DSM-IV, GAF scores ranging between 61 to 70 reflect some mild symptoms [e.g., depressed mood and mild insomnia] or some difficulty in social, occupational, or school functioning [e.g., occasional truancy, or theft within the household], but generally functioning pretty well, and has some meaningful interpersonal relationships. GAF scores ranging from 51 to 60 reflect more moderate symptoms [e.g., flat affect and circumstantial speech, occasional panic attacks] or moderate difficulty in social, occupational, or school functioning [e.g., few friends, conflicts with peers or co- workers]. Scores ranging from 41 to 50 reflect serious symptoms [e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting] or any serious impairment in social, occupational or school functioning [e.g., no friends, unable to keep a job]. Scores ranging from 31 to 40 reflect some impairment in reality testing or communication [e.g., speech is at times illogical, obscure, or irrelevant] or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood [e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up other children, is defiant at home, and is failing at school]. VA has changed its regulations, and now requires use of DSM-5 effective August 4, 2014. Among the changes, DSM-5 eliminates the use of the GAF score in evaluation of psychiatric disorders. The change was made applicable to cases certified to the Board on or after August 4, 2014; and is not applicable to cases certified to the Board prior to that date. 79 Fed. Reg. 45093 (Aug. 4, 2014). As the Veteran’s case was certified to the Board after August 4, 2014, DSM-5 applies, and GAF scores are no longer used in evaluation of psychiatric disorder. Id. However, the examiner’s discussion of symptoms associated with any assigned score would still be useful in evaluation of psychiatric disabilities. Factual Background and Analysis The Veteran underwent a VA examination in January 2015. The examiner indicated that a mental condition had t been formally diagnosed but that the symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. The Veteran had been married to his wife of 20 years and described their relationship as “going well”. He currently worked for the Postal Service. While he worked full time currently he described this as a struggle due to his walking. He had active medical restrictions due to how far he could walk due to his physical ailments. He noted social withdrawal and a lowered appetite as he had lost 20 pounds in the past year. He denied current thoughts of self-harm. He had depressed mood. On examination, he was appropriately dressed and responded appropriately throughout the examination. The examiner provided a diagnosis of somatic symptom disorder which resulted in symptoms that were distressing and resulted in significant disruption of daily life, persistent thoughts about symptoms, anxiety about health and excessive energy devoted to health concerns. The Veteran underwent a VA examination in May 2016. The examiner noted that the Veteran had moderate somatic symptom disorder as well as depressive disorder. He had a chronic depressed mood that was accompanied by lack of interest and motivation. The examiner described the Veteran’s social and occupational impairment as occupational and social impairment with reduced reliability and productivity. The Veteran reported that he continued to live with his wife of 21 years and described their relationship as “pretty decent”. He described being short-tempered as he was in pain all of the time. He had a good relationship with his adult children but did not have many friends and did not engage in social activities often. In April 2015 the Veteran retired from his job as a mail carrier due to the pain of walking and physical concerns. The examiner noted that the Veteran reported experiencing excessive and ruminating thoughts about the seriousness of his physical health concerns and pain. He also reported ongoing mood disturbances and a chronically depressed mood. He had pain related sleep difficulty and was constantly embarrassed by his lack of mobility. He had low appetite as he lost 10 to 15 pounds since his retirement. He denied homicidal or suicidal ideation. The Veteran’s symptoms included depressed mood, chronic sleep impairment, flattened affect, disturbance of motivation and mood, difficulty in establishing and maintaining effective work and social relationships and an intermittent inability to perform activities of daily living. In a June 2020 correspondence, a private physician noted that the Veteran was alert and oriented in all spheres. He had a variable demeanor and his speech was plodding. He had no significant day structure and he had no required activities or any significant responsibilities during the day which resulted in him having plenty of time to ruminate over his pain and the difficulties in his life. His mood was down and he was periodically tearful throughout the evaluation. He was noted to be extremely pessimistic about his future and he endorsed difficulties with worthlessness as he felt he was a burden to others. He had poor sleep as he only got about 2 hours of good sleep a night. He endorsed considerable passive suicidal ideation but denied current active suicidal ideation and denied any history or attempts. He denied homicidal ideation. His examination revealed moderately severe levels of depression. He tended to isolate from others. His interpersonal functioning was limited as he was in a cycle where had limitations of his activities due to pain which resulted in him feeling guilty. He avoided people which only reinforced his feelings of guilt and worthlessness. He did not have auditory or visual hallucinations. His thought processes were clear and linear although some reduced production was noted. Short and longterm memory were grossly intact. Insight and judgment were poor. Impulse control was good. The physician noted that the Veteran demonstrated persistent and significant depression symptoms. These symptoms included easily becoming tearful, excessive guilt, poor sleep and passive suicidal ideation. He was highly isolative and only had a few, if any, meaningful relationships in his life. He remained preoccupied to an excessive degree with his physical health as he was hypervigilant to even the most minor physical change. He had difficulties with concentration and short-term memory due to his anxiety. The physician found that the Veteran was totally unemployable as a result of his psychiatric conditions as his anxiety over his health impaired his ability to maintain adequate and reliable attendance at work. They further reduced his concentration and attention to the degree that they precluded his ability to reliably and adequately complete multi-step or complex tasks. His anxiety and depression also severely impaired his ability to establish and maintain effective relationships at home and in a work environment. His mood and anxiety difficulties also impaired his sleep to a degree that resulted in an erratic circadian rhythm and as a result he was unable to reliably maintain a daily schedule that would permit work. Period prior to May 25, 2016 After reviewing the evidence of record as a whole, the Board finds that the assignment of a disability rating greater than 30 percent for the Veteran’s service-connected acquired psychiatric disorder to include somatic syndrome disorder with depression is not warranted for the period prior to May 25, 2016 as the Veteran’s impairment more nearly approximates the occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks contemplated by a 30 percent disability rating. Notably, the evidence does not show that the occupational and social impairment from the disability more nearly approximates the reduced reliability and productivity contemplated by a 50 percent rating. The collective evidence shows that the Veteran generally functioned satisfactorily, with routine behavior, self-care, and normal conversation, all of which is consistent with the criteria for a rating of 30 percent. The medical evidence does not show the Veteran to have flattened affect; difficulty in understanding complex commands; impaired judgment; impaired abstract thinking; or other symptoms that are characteristic of the next higher, 50 percent rating. The Board finds that the Veteran’s symptoms do not show that he had deficiencies in most of the areas in the criteria for a 50 percent rating nor has he been shown to have most of the symptoms listed as examples in the criteria. In this regard, the medical evidence again does not show the Veteran to have flattened affect; difficulty in understanding complex commands; impaired judgment; impaired abstract thinking; or other symptoms that are characteristic of the next higher, 50 percent rating. Additionally, as noted above, the January 2015 VA examiner determined that the Veteran had a mental condition had been formally diagnosed but that the symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication which fits squarely for the criteria for a noncompensable evaluation under the General Rating Formula. Despite the fact that this description actually corresponds squarely with a lesser disability rating, the Board will not disturb the Veteran’s current 30 percent disability rating for the period prior to May 25, 2016. However, a rating in excess of 30 percent is clearly not available based on these findings. In sum, the preponderance of the evidence establishes that the social and occupational impairment from the Veteran’s acquired psychiatric disorder disability for the period prior to May 25, 2016 most nearly approximates occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. Accordingly, the Board concludes that an initial rating in excess of 30 percent for an acquired psychiatric disorder to include somatic syndrome disorder with depression for the period prior to May 25, 2016 is not warranted. As the preponderance of the evidence is against the claim for an increased rating, the benefit-of-the-doubt rule does not apply, and the claim for an initial rating in excess of 30 percent for the period prior to May 25, 2016 must be denied. 38 U.S.C. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Period since May 25, 2016 Under the circumstances of this case, and with resolution of all reasonable doubt in the Veteran’s favor, the Board concludes that an initial 70 percent disability rating, but no higher, for an acquired psychiatric disorder to include somatic syndrome disorder with depression is warranted for the period from May 25, 2016. The Board finds that the Veteran’s symptoms more nearly approximate a degree of occupational and social impairment consistent with deficiencies in most areas. The Board notes that both the May 2016 VA examiner determined that the Veteran’s psychiatric symptoms were best summarized as “occupational and social impairment with reduced reliability and productivity.” This description fit squarely for the criteria for a 50 percent evaluation under the General Rating Formula. See 38 C.F.R. § 4.130. However, the Board notes that the Veteran has demonstrated depressed mood, chronic sleep impairment, flattened affect, disturbance of motivation and mood, difficulty in establishing and maintaining effective work and social relationships and an intermittent inability to perform activities of daily living. Additionally, the private physician in a June 2020 correspondence noted that the Veteran had passive suicidal ideation. Notably, the United States Court of Appeals for Veterans Claims (Court) has held that suicidal ideation generally rises to the level contemplated in a 70 percent evaluation. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). Accordingly, the evidence currently of record can be read as showing deficiencies in most of the areas listed under the criteria for a 70 percent rating. As a result, a rating of 70 percent is granted. The Board acknowledges that the results of the VA examination and the symptoms described in the mental health treatment notes do not indicate that the Veteran experiences all of the symptoms associated with a 70 percent disability rating for an acquired psychiatric disorder. However, the Court has held that the symptoms enumerated under the schedule for rating mental disorders are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular disability rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). Thus, a finding that there are deficiencies in most areas is sufficient to warrant a 70 percent disability rating, even though all the specific symptoms listed for a 70 percent rating are not manifested. Thus, for all the foregoing reasons, the Board finds that an initial 70 percent rating for an acquired psychiatric disorder to include somatic syndrome disorder with depression is warranted for the period from May 25, 2016. However, after reviewing evidence of record as a whole, the Board finds that the assignment of a disability rating greater than 70 percent for the Veteran’s acquired psychiatric disorder to include somatic syndrome disorder with depression is not warranted. While treatment records demonstrate that the Veteran experienced significant occupational and social impairment, the Board again notes that the maximum rating of 100 percent requires total occupational and social impairment. Significantly, at no point did any VA examiner or treating physician find that the Veteran’s acquired psychiatric disorder caused total occupational and social impairment, as is required for the assignment of a 100 percent rating. In not granting a 100 percent schedular rating for the Veteran’s service-connected an acquired psychiatric disorder to include somatic syndrome disorder with depression, the Board is not minimizing the severity of the Veteran’s symptoms. The Board notes that the evidence demonstrates that the Veteran experienced significant social impairment as a result of his acquired psychiatric disorder to include somatic syndrome disorder with depression as he is socially withdrawn, was highly isolative and only had a few, if any, meaningful relationships in his life. However, as noted above, the maximum rating of 100 percent requires total occupational and social impairment. The VA treatment records and VA examination show no gross impairment in thought processes or communication, grossly inappropriate behavior, persistent danger of hurting self or others, disorientation to time or place, or memory loss for names of own relatives, own occupation, or own name. Additionally, there were no reports of homicidal ideation. Furthermore, the January 2016 VA examiner did not find that the Veteran’s acquired psychiatric disorder caused a total occupational and social impairment as again, the examiner indicated that the Veteran had reduced reliability and productivity, which fits squarely for the criteria for a 50 percent evaluation under the General Rating Formula. Despite the fact that this description actually corresponds squarely with a lesser disability rating, the Board will still assign the 70 percent disability rating for an acquired psychiatric disorder to include somatic syndrome disorder with depression for the period since May 25, 2016. However, a rating in excess of 70 percent is clearly not available based on these findings. Accordingly, in this case, the overall evidence of record does not reflect that the Veteran’s symptomatology is so severe as to merit an initial 100 disability rating. Thus, for all the foregoing reasons, the Board finds that an initial rating of 70 percent, but no higher, for an acquired psychiatric disorder to include somatic syndrome disorder with depression is warranted for the period since May 25, 2016. TDIU Laws and Regulations Total disability will be considered to exist where there is present any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340 (2019). Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that the Veteran meets the schedular requirements. If there is only one service-connected disability, this disability should be rated at 60 percent or more; if there are two or more disabilities, at least one should be rated at 40 percent or more with sufficient additional service-connected disability to bring the combination to 70 percent or more. 38 C.F.R. § 4.16(a) (2020). To meet the requirement of “one 60 percent disability” or “one 40 percent disability,” the following will be considered as one disability: (1) disability of one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from one common etiology; (3) disabilities affecting a single body system; (4) multiple injuries incurred in action; and (5) multiple disabilities incurred as a prisoner of war. Id. Substantially gainful employment is defined as work which is more than marginal and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). In determining whether unemployability exists, consideration may be given to the Veteran’s level of education, special training, and previous work experience, but it may not be given to his or her age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19 (2020). Factual Background and Analysis In this case, the Veteran has argued that he has been unable to work a result of his service-connected disabilities. For the period since May 25, 2016, the Veteran is currently service-connected for an acquired psychiatric disorder to include somatic syndrome disorder with depression (rated as 70 percent disabling), for residuals of prostate cancer (rated as 60 percent disabling); erectile dysfunction (rated as 0 percent disabling) and for a scar associated with residuals of prostate cancer (rated as 0 percent disabling). Therefore, since May 25, 2016, the Veteran’s service-connected disabilities meet the rating percentage threshold for a TDIU. 38 C.F.R. § 4.16(a). Having met the objective criteria for a TDIU, the remaining question before the Board is whether the Veteran’s service-connected disabilities preclude him from securing or following substantially gainful employment. 38 C.F.R. § 3.321, 3.340, 3.341, 4.16. Here, the central inquiry is whether the Veteran’s service-connected disabilities, alone, are of sufficient severity to preclude him from obtaining and maintaining all forms of substantially gainful employment. See Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). As an initial matter, the Board notes that while the Veteran meets the percentage requirements for a schedular award of a TDIU based on a combined rating for his acquired psychiatric disorder to include somatic syndrome disorder with depression, residuals of prostate cancer, erectile dysfunction and scar associated with residuals of prostate cancer, during the appeal period the Veteran possibly became eligible for entitlement to SMC benefits. As will be detailed below, SMC benefits may be obtained on the basis of TDIU being awarded for a single disability. Thus, the Board has awarded a grant of TDIU for the Veteran’s acquired psychiatric disorder to include somatic syndrome disorder with depression disability to sufficiently and appropriately follow the spirit of AB v. Brown, and allow for the Veteran to obtain the maximum benefit possible. Namely, TDIU for an acquired psychiatric disorder to include somatic syndrome disorder with depression as well as the possibility of SMC benefits. After careful consideration and resolving reasonable doubt in his favor, the Board finds that the Veteran meets the requirements for a total disability evaluation based on individual unemployability due to his service-connected acquired psychiatric disorder to include somatic syndrome disorder with depression for the period since May 25, 2016. As reflected above, in a June 2020 correspondence, a private physician found that the Veteran was totally unemployable as a result of his psychiatric conditions as his anxiety over his health impaired his ability to maintain adequate and reliable attendance at work. The anxieties further reduced his concentration and attention to the degree that they precluded his ability to reliably and adequately complete multi-step or complex tasks and his anxiety and depression also severely impaired his ability to establish and maintain effective relationships at home and in a work environment. The physician also noted that the Veteran’s mood and anxiety difficulties also impaired his sleep to a degree that resulted in an erratic circadian rhythm and as a result he was unable to reliably maintain a daily schedule that would permit work. The record shows that the Veteran previously worked as a mail carrier for the United States Postal Service. The record also demonstrates that the Veteran’s ability to work has been impacted by his service-connected psychiatric disability as he has notable occupational impairment from his psychiatric impairments as demonstrated by his current 70 percent disability rating for his service-connected acquired psychiatric disorder to include somatic syndrome disorder with depression for the period since May 25, 2016. Additionally, the Board finds that the Veteran’s symptoms of depressed mood, chronic sleep impairment, flattened affect, disturbance of motivation and mood, difficulty in establishing and maintaining effective work and social relationships and an intermittent inability to perform activities of daily living support a finding that the Veteran is unable to successfully secure and maintain substantially gainful employment. Therefore, in light of the totality of the record, and giving due consideration to the Veteran’s description of the functional effects of his service-connected acquired psychiatric disorder to include somatic syndrome disorder with depression as his disorder relates to his occupational experience, the Board finds that the Veteran is unable to secure and follow a substantially gainful occupation by reason of a single service-connected disability for the period since May 25, 2016. A remand for a new VA examination is not necessary because the evidence of record is sufficient to grant the Veteran’s claim, and a remand would only serve to unnecessarily delay final adjudication of the claim. As such, a TDIU is granted due to the Veteran’s an acquired psychiatric disorder to include somatic syndrome disorder with depression for the period since May 25, 2016. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS FOR REMAND The Board finds that more development is necessary prior to final adjudication of the claims remaining on appeal. The Board notes that VA is obligated to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service; and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A (d) (2012). The threshold for finding a link between current disability and disease or injury in service is low. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Regarding the Veteran’s claims for service connection for a lumbar spine disability and bilateral ankle disability, at the March 2020 hearing, the Veteran indicated this current lumbar spine and bilateral ankle disabilities were related to his service-connected bilateral foot and knee disabilities. Additionally, the Veteran testified that his current IBS resulted from medications he takes for his service-connected disabilities. Accordingly, the Board finds that a VA examination is needed to determine whether the Veteran has current lumbar spine disability and bilateral ankle disabilities that are related to service to include as being caused or aggravated by service-connected disabilities and whether the Veteran has a current IBS disability that is caused or aggravated by medication taken for service-connected disabilities. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c) (4). Regarding the Veteran’s claim for entitlement to an earlier effective date than January 25, 2016 for a 30 percent rating for bilateral flexible pes planovalgus with history of stress fracture, as noted above, the issue of entitlement to a rating in excess of 30 percent for bilateral flexible pes planovalgus is being developed under the AMA and will be the result of a separate Board decision. As a result, the claim of entitlement to an earlier effective date than January 25, 2016 for a 30 percent rating for bilateral flexible pes planovalgus with history of stress fracture is inextricably intertwined with the issue of entitlement to a rating in excess of 30 percent for bilateral flexible pes planovalgus, and adjudication of this claim must be deferred pending the proposed development. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (the adjudication of claims that are inextricably intertwined is based upon the recognition that claims related to each other should not be subject to piecemeal decision-making or appellate litigation). Regarding a claim for entitlement to SMC, the Board must consider entitlement to SMC if raised by the issue on appeal. Akles v. Derwinski, 1 Vet. App. 118 (1991). SMC at the housebound (s) rate is payable if a Veteran has a single service-connected disability rated at 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); 38 C.F.R. § 3.350 (i). For the purpose of meeting the first criterion (a single service-connected disability rated at 100 percent), ratings of 100 percent may be based on any of the following grants of a total rating: on a schedular basis; on an extraschedular basis; on the basis of a TDIU if granted for a single disability; or, on the basis of a temporary total rating. As discussed above, the Board has awarded entitlement to a 100 percent disability rating on the basis of a TDIU granted for an acquired psychiatric disorder to include somatic syndrome disorder with depression for the period since May 25, 2016. As such, the first element of entitlement to SMC at the statutory housebound (s) rate is shown. Service connection has again also been established for bilateral flexible pes planovalgus with history of stress fracture rated as 30 percent disabling); right knee tendonitis (rated as 10 percent disabling), left knee tendonitis (rated as 10 percent disabling) and for tendonitis of both knees (rated as 0 percent disabling). When combined under 38 C.F.R. § 4.25, these additional service-connected disabilities do not yet have a combined evaluation of 60 percent or more. Accordingly, the second element of entitlement to SMC at the statutory housebound (s) rate is currently not shown. However, as noted above, the Veteran’s service connection claims for are being remanded for additional development while the Veteran’s claim entitlement to a rating in excess of 30 percent for bilateral flexible pes planovalgus for is being developed through AMA. As a result, the Board finds that the SMC claim is also inextricably intertwined with the pending claims for service connection and an increased rating because, if these claims are granted, it could potentially affect whether the Veteran is eligible to receive SMC. Finally, the Board notes that for the period prior to May 25, 2016, the Veteran did not have one service-connected disability rated at least 60 percent, or two or more disabilities with a combined rating of at least 70 percent, with one disability rated at 40 percent. As such, the criteria for a schedular TDIU under 38 C.F.R. § 4.16 (a) are not met. However, further development and adjudication of these claims may provide evidence in support of his claim for TDIU for the period prior to May 25, 2016. See Henderson v. West, 12 Vet. App. 11 (1998), citing Harris v. Derwinski, 1 Vet. App. 180 (1991), for the proposition that where a decision on one issue would have a “significant impact” upon another, and that impact in turn could render any review of the decision on the other claim meaningless and a waste of appellate resources, the claims are inextricably intertwined. The Board has therefore concluded that it would be inappropriate at this juncture to enter a final determination on that issue. The matters are REMANDED for the following action: 1. The Veteran should be requested to provide the names, addresses and approximate dates of treatment of all medical care providers, VA and non-VA, who have treated him for the disabilities on appeal. After the Veteran has signed the appropriate releases, those records should be obtained and associated with the claims folder. 2. Schedule the Veteran for a VA examination to determine the etiology of the claimed lumbar spine and bilateral ankle disabilities. Based on a review of the record and an examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran has current lumbar spine or bilateral ankle disabilities that are related to any incident of the Veteran’s service. The examiner should also opine as to whether if it is at least as likely as not (at least a 50 percent probability) that the Veteran has current lumbar spine or bilateral ankle disabilities that are caused or aggravated by a service-connected disability. If the examiner finds that the Veteran has a lumbar spine or bilateral ankle disability that has been permanently aggravated/worsened by a service-connected disability, to the extent feasible, the degree of worsening should be identified. All opinions expressed by the examiner must be accompanied by a complete rationale. Adequate reasons and bases for any opinion rendered must be provided. All studies deemed appropriate in the medical opinion of the examiner should be performed, and all the findings should be set forth in detail. The claims file should be made available to the examiner, who should review the entire claims folder in conjunction with this examination. 3. After the development requested above has been completed to the extent possible, the Veteran should also be scheduled for a VA examination to determine the etiology of the claimed IBS disability. Based on a review of the record and an examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s has a current IBS disability that is related to any incident of the Veteran’s active duty service. The examiner should also provide an opinion as to whether if it is at least as likely as not (at least a 50 percent probability) that any such current IBS disability is caused or aggravated by a service-connected disability or is cause or aggravated by the medication for treatment of a service-connected disability. If the examiner finds that the Veteran has a current IBS disability that has been permanently aggravated/worsened by a service-connected disability or medication for a service-connected disability, to the extent feasible, the degree of worsening should be identified. All opinions expressed by the examiner must be accompanied by a complete rationale. Adequate reasons and bases for any opinion rendered must be provided. All studies deemed appropriate in the medical opinion of the examiner should be performed, and all the findings should be set forth in detail. The claims file should be made available to the examiner, who should review the entire claims folder in conjunction with this examination. 4. Thereafter, readjudicate the issues on appeal. If any benefit sought on appeal remains denied, the Veteran and his representative should be provided with a Supplemental Statement of the Case and be afforded a reasonable opportunity to respond. The case should then be returned to the Board for further appellate review, if otherwise in order. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board James A. DeFrank, 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.