Citation Nr: 21062080 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 16-58 134 DATE: October 6, 2021 ORDER Entitlement to a higher rating than 10 percent prior to December 23, 2019 and higher than 40 percent thereafter for a lumbar spine condition is denied. Entitlement to a 10 percent rating for left lower extremity radiculopathy associated with a lumbar spine condition from April 30, 2015 is granted. Entitlement to a higher rating than 20 percent for right lower extremity radiculopathy associated with a lumbar spine condition from April 30, 2015 is denied. Entitlement to special monthly compensation (SMC) at the housebound rate from December 23, 2019 is granted. FINDINGS OF FACT 1. Prior to December 23, 2019, the Veteran's lumbar spine condition was manifested by forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees and painful motion; thereafter, the Veteran's lumbar spine condition is manifest by forward flexion of the thoracolumbar spine 30 degrees or less and painful motion. 2. From April 20, 2015, the Veteran's left lower extremity radiculopathy is manifest by mild incomplete paralysis. 3. Throughout the appeal period, the Veteran's right lower extremity radiculopathy is manifest by moderate incomplete paralysis. 4. The evidence shows that the Veteran is in receipt of a 100 percent schedular rating for his service-connected posttraumatic stress disorder (PTSD) and his combined rating for his remaining service-connected disabilities totals 60 percent beginning August 8, 2018. CONCLUSIONS OF LAW 1. The criteria for entitlement to a higher rating than 10 percent prior to December 23, 2019 and higher than 40 percent thereafter for a lumbar spine condition have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237. 2. The criteria for entitlement to a 10 percent rating for left lower extremity radiculopathy associated with a lumbar spine condition from April 30, 2015 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8520. 3. The criteria for entitlement to a rating higher than 20 percent for right lower extremity radiculopathy associated with a lumbar spine condition from April 30, 2015 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8520. 4. The criteria for entitlement to SMC at the housebound rate from December 23, 2019 have been met. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the Army from September 2007 to March 2011. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a Board hearing in October 2019. A transcript of the proceeding has been associated with the claims file. The Veteran's claim was remanded by the Board in December 2019 for a contemporaneous VA examination. VA examinations were completed in December 2019 and June 2021. The Board finds that the RO has substantially complied with the December 2019 Board remand directive. See Stegall v. West, 11 Vet. App. 268 (1998). During the pendency of the appeal, in an August 2021 rating decision, the RO granted the Veteran an increased rating of 40 percent for his service-connected lumbar spine condition effective December 23, 2019. Additionally, the Veteran was awarded separate compensable evaluations for both right and left lower extremity radiculopathy associated with his lumbar spine condition. He was awarded a 20 percent rating for his right lower extremity radiculopathy associated with his lumbar spine condition effective April 30, 2015 and a 10 percent rating for his left lower extremity radiculopathy associated with his lumbar spine condition effective June 28, 2021. Finally, the Veteran was awarded special monthly compensation based on housebound criteria effective June 28, 2021. As the RO's actions do not constitute a full grant of the benefit sought and the Veteran has not expressed satisfaction with the increased ratings, the issue remains on appeal. Ab v. Brown, 6 Vet. App. 35, 39 (1993). 1. Entitlement to a higher rating than 10 percent prior to December 23, 2019 and higher than 40 percent thereafter for a lumbar spine condition 2. Entitlement to a 10 percent rating for left lower extremity radiculopathy associated with a lumbar spine condition from April 30, 2015 3. Entitlement to a rating higher than 20 percent for right lower extremity radiculopathy associated with a lumbar spine condition from April 30, 2015 The Veteran contends that his current ratings do not adequately represent the severity of his service-connected conditions. Disability ratings are determined by the application of the facts presented to VA's Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. In rating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). 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 the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). A claim for increased rating remains in controversy when less than the maximum available benefit is awarded AB v. Brown, 6 Vet. App. 35 (1993). Reasonable doubt as to the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the Veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). The Veteran's lumbar spine condition is currently evaluated under Diagnostic Code 5243 for intervertebral disc syndrome (IVDS). 38 C.F.R. § 4.71a. Prior to December 2019, the Veteran's lumbar spine condition was evaluated under Diagnostic Code 5237 for lumbosacral or cervical strain. Id. The Board notes that the assignment of a particular diagnostic code to evaluate a disability is dependent on the facts of a particular case. See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the diagnosis, and demonstrated symptomatology. Any change in a diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). In this case, the Board finds that Diagnostic Code 5237 is more appropriate to the facts of the Veteran's lumbar spine condition for reasons which will be discussed in further detail below. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). It is important to note that portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021. However, the Veteran's disability is currently rated under Diagnostic Code 5237, which was unchanged. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. Unfavorable ankylosis is defined as "a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching." Id. at Note 5. Additionally, fixation of a spinal segment in neutral position (zero degrees) is "always" considered favorable ankylosis. Id. The Veteran filed an Intent to File, which was received by the VA on December 31, 2015; and subsequently completed his claim for increased evaluation, which was received by the VA on April 30, 2015. Thus, the Board has considered the evidence of record since December 31, 2014 in conjunction with this decision. See 38 C.F.R. §§ 3.155 (b), 3.400 (o). The medical evidence relevant to the Veteran's claim includes VA treatment records and VA examinations. The Veteran's VA treatment records include a February 2015 emergency room visit for low back pain and a subsequent follow-up appointment with a primary care provider. The Veteran reported chronic low back pain with weekly flare-up. The Veteran denied any numbness, tingling, or radiation as well as bowel or bladder issues during these visits. VA treatment records also include a March 2015 primary care noted where the Veteran was diagnosed with acute sciatica on the right side. During a September 2015 pain consultation, it was noted that the Veteran's lumbar range was functional although limited in extension. His straight leg test was painful on the right at 50 degrees and negative on the left side. A diagnosis of right sciatica was given. An August 2018 case management note indicates that the Veteran has significant calf spasms in the right leg with numbness of both feet, and chronic aching and soreness of the lower back with periodic stabbing pain. The Veteran was afforded a VA examination in June 2015. The Veteran was diagnosed with lumbosacral strain, degenerative arthritis of the spine, and IVDS. During the examination, the Veteran reported that he does plumbing for work, but he would miss work almost once per week due to his back condition. He has not been working since Fall 2013. The Veteran stated that he cannot feel his feet on both sides, and he has shooting pains down his right leg intermittently. He indicated that his radiculopathy symptoms began in Fall 2014. The Veteran stated that he has flare-ups when kneeling, getting down onto the floor, and reaching overhead, but denied experiencing any functional loss. Upon range of motion testing, his forward flexion was limited to 90 degrees and his combined range of motion was 220 degrees with pain noted. The Veteran was able to perform observed repetitive use testing without additional loss of function. The examiner estimated that pain, weakness, fatigue, and lack of endurance would significantly limit functional ability after repeated use over a period of time and during a flare-up, but the examiner could not describe the loss in terms of range of motion. The examiner did not observe any guarding or muscle spasms. The Veteran's muscle strength was normal with no signs or symptoms of muscle atrophy or ankylosis. Decreased sensation at the foot/toes on both the right and left side were noted by the examiner. The Veteran's straight leg raise test was positive on the right and negative on the left. The examiner noted that the Veteran had signs and symptoms of radiculopathy with mild intermittent pain on the right lower extremity, mild paresthesias and/or dysesthesias on both lower extremities, and mild numbness on both extremities. The mild radicular symptoms were noted to involve the sciatic nerve on both the right and left lower extremities. The examiner also diagnosed the Veteran with IVDS, but found that the Veteran did not have any episodes requiring bed rest prescribed by a physician. At the conclusion of the examination report, the examiner opined that the Veteran's diagnoses of degenerative disc disease and IVDS are not related to his service-connected lumbar strain and are not a progression of the lumbar strain. The examiner further stated that the examination did not have any radiculopathy symptoms, and they believe that the Veteran injured his back on the job after service. The Veteran underwent another VA examination is November 2016. The examiner diagnosed the Veteran with lumbosacral strain, degenerative arthritis of the spine, and IVDS. The Veteran reported receiving epidural injections every 4 months. He noted that he has been performing sedentary work and has difficulty performing duties such as power washing, chopping wood, and weed whacking as these activities cause flare-ups lasting days. He described his pain as constant, varying in intensity. He also reported achy pain that shoots down his right leg and calf. The Veteran further indicated that he has flare-ups every few months that last do 2 to 3 days before he is functional again. Upon range of motion testing, his forward flexion was limited to 70 degrees and his combined thoracolumbar range of motion was 185 degrees with pain noted. The Veteran was able to perform observed repetitive use testing without additional loss of function or range of motion. As for repeated use over time and flare-ups, the examiner opined that they were unable to say without speculation whether pain, weakness, fatigability, or incoordination would significantly limit functional ability. The examiner observed guarding and muscle spasm not resulting in abnormal fait or abnormal spinal contour. The Veteran has full muscle strength with no muscle atrophy and no signs or symptoms of ankylosis. The Veteran's sensation to light touch was decreased at foot/toes bilaterally. His straight leg test was positive on the right side and negative on the left. The examiner opined that the Veteran had signs and symptoms of radiculopathy including, moderate intermittent pain on the right lower extremity, moderate paresthesias and/or dysesthesias on the right lower extremity, and moderate numbness on the right lower extremity. The Veteran's moderate radiculopathy was found to involve the sciatic nerve of the right lower extremity. The examiner determined that the Veteran's diagnosis of IVDS did not result in any episodes requiring bed rest prescribed by a physician. In December 2019, the Veteran had another VA examination. He was diagnosed with lumbosacral strain. He reported worsening symptoms, constant pain, and decreased range of motion. The Veteran noted severe flare-ups lasting for week, and with worsening pain and range of motion after repetitive use. Upon range of motion testing, the Veteran's forward flexion was limited to 20 degrees with pain noted on the examination. The Veteran was able to perform observed repetitive use testing without additional loss of function or range of motion. After repeated use over time and during flare-ups, the examiner opined that pain and lack of endurance would significantly limit the Veteran's functional ability, but would not decrease his range of motion. The examiner noted guarding and muscle spasm resulting in abnormal gait or abnormal spinal contour. The Veteran had full muscle strength with no muscle atrophy. He had a normal sensory examination, a negative straight leg raise test, and no signs or symptoms of radiculopathy, ankylosis, or IVDS. In September 2020, an addendum opinion was issued as to the December 2019 VA examination. The examiner opined that the Veteran's radiculopathy and IVDS are not caused by or related to the service-connected back condition, but a work injury, as noted in the June 2015 opinion. Most recently, the Veteran underwent a VA examination in June 2021. The examiner diagnosed the Veteran with degenerative arthritis, degenerative disc disease, lumbosacral strain, IVDS, and lumbar radiculopathy. The examiner noted that the Veteran's developed bilateral sciatica in 2015 with the right side worse than the left. He has had several epidural injections with only temporary relief and his symptoms have persisted. During the examination, the Veteran reported severe, frequent flare-ups of the back lasting days. The flare-ups are precipitated by overuse and alleviated with time. Upon range of motion testing, the Veteran's forward flexion was limited to 30 degrees with evidence of pain. He was able to perform observed repetitive use testing with no additional loss of function or range of motion. The examiner opined that pain significantly limits functional ability with repeated use over time and during flare-ups; however, the Veteran's range of motion would remain the same. There was no evidence of guarding or muscle spasm, muscle atrophy, or ankylosis. The examiner noted the Veteran's signs and symptoms of radiculopathy including moderate intermittent pain on the right, mild paresthesias and/or dysesthesias bilaterally, moderate numbness on the right and mild numbness on the left. The Veteran's symptoms involve the sciatic nerve bilaterally with the right extremity moderately severe and the left extremity mildly severe. The examiner also noted the Veteran's diagnosis of IVDS, but determined that the Veteran did not have any episodes resulting in bed rest prescribed by a physician. In June 2021, a medical opinion accompanied the June 2021 VA examination where the examiner opined that the Veteran's diagnoses of degenerative arthritis, IVDS, and lumbar radiculopathy are at least as likely as not proximately due to or the result of his service-connected lumbar strain. The rationale provided was that the injuries to the low back, which were initially diagnosed as lumbar strain, commonly degenerate into more serious conditions. Also, diagnoses are delayed because an individual usually does not have a lumbar MRI on their initial presentation of low back pain. In the Veteran's case he was diagnosed with significant low back pathology in 2015 after a lumbar spine MRI was completed. Other evidence relevant to the Veteran's service-connected lumbar spine condition includes the October 2019 Board hearing testimony. The Veteran testified that he undergoes painful epidural injections, he cannot exercise, and has frequent sleep interruptions due to his back condition. He also stated that he has difficulty with activities of daily living including getting dressed, mowing the lawn, doing dishes, and sweeping the floor. The Veteran stated that these activities inflame his injury and then he cannot walk the next day. The Veteran testified that he primarily stays in the house because he is in so much pain. After careful consideration of the evidence, the Board finds that the preponderance of the evidence is against a rating in excess of 10 percent prior to December 23, 2019, and 40 percent thereafter for the Veteran's lumbar spine condition. The Veteran's June 2015 and November 2016 VA examination indicated that the Veteran's forward flexion was not limited to less than 60 degrees, warranting only a 10 percent evaluation. Although the Veteran was noted to have guarding and muscle spasms, the examiners opined that the guarding and muscle spasms did not result in abnormal gait or spinal contour. From December 23, 2019, the December 2019 and June 2021 VA examinations found that the Veteran's forward flexion was limited to less than 30 degrees, which warrants a 40 percent evaluation. The evidence did not indicate that the Veteran's condition is manifest by unfavorable ankylosis of the entire thoracolumbar spine. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain and decreased range of motion during flare-ups. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that the Veteran is unable to perform activities of daily living for a couple of days would not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees or the combined range of motion of the thoracolumbar spine not greater than 120 degrees. Prior to December 23, 2019, the objective evidence indicates that the Veteran suffered from constant and chronic lumbar spine pain. But the evidence does not suggest that this pain or pain during flare-ups would more nearly approximate symptoms warranting a 20 percent rating. Significantly, during the June 2015 VA examination, the Veteran denied experiencing any functional loss. After December 23, 2019, even when considering the Veteran's October 2019 Board testimony, December 2019 statements, and June 2021 statements regarding the duration, frequency, and severity of his flare-ups, the degree of additional limitation reflected by the statements would not result in symptoms more nearly approximating unfavorable ankylosis of the entire thoracolumbar spine. There is no objective evidence of record that the Veteran has difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching, which are symptoms reflective of unfavorable ankylosis. Consideration has also been given to assigning a rating under the Formula for Rating IVDS Based on Incapacitating Episodes. However, although the Veteran has been diagnosed with IVDS, none of the VA examinations nor the VA treatment records indicated that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a compensable rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. The Board also acknowledges that the Veteran contends that his symptoms have worsened throughout the duration of the appeal warranting a higher evaluation. Although the Veteran is competent to report his observable symptoms, the competent medical evidence offering detailed determination pertinent to the claims are the most probative evidence with regard to evaluating the disability on appeal. Layno v. Brown, 6 Vet. App. 465 (1994). For the foregoing reasons, the preponderance of the evidence is against the Veteran's claim for a rating in excess of 10 percent prior to December 23, 2019 and a rating in excess of 40 percent thereafter for a lumbar spine condition. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Regarding neurological abnormalities associated with the Veteran's lumbar spine condition, the Board again notes that the Veteran was awarded separate compensable ratings for radiculopathy of both the right and left lower extremities in the August 2021 rating decision. The Veteran was awarded a 20 percent rating for right lower extremity radiculopathy effective April 30, 2015 and a 10 percent for left lower extremity radiculopathy effective June 28, 2021. The Veteran's radiculopathy is rated under Diagnostic Code 8520. 38 C.F.R. § 4.124a. Under Diagnostic Code 8520, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). As for the right lower extremity, the Board finds that the preponderance of the evidence is against awarding a rating in excess of 20 percent from April 30, 2015. Although the Veteran reported experiencing radiculopathy beginning Fall 2014 during the June 2015 VA examination, the Veteran's VA treatment records first indicate that the Veteran suffered from radiculopathy in March 2015 when the Veteran was first diagnosed with "acute" sciatica on the right side. Prior to March 2015, February 2015 treatment records note the Veteran's denial of any radicular symptoms. Beginning in June 2015, the Veteran's radicular symptoms were noted to include intermittent pain, paresthesias and/or dysesthesias, and numbness of moderate severity. In August 2018, the Veteran reported significant spasms in the right leg along with numbness and a periodic stabbing pain. Although the Veteran has consistently reported pain, the evidence does not suggest that the Veteran suffers from significant impairment of his motor function tropic changes, sensory disturbance, or loss of reflexes to warrant a moderately severe rating. As for the left lower extremity, the Board notes that the RO awarded the Veteran a 10 percent rating for his radiculopathy effective June 28, 2021. However, the evidence suggests that the Veteran has been experiencing radicular symptoms of the left lower extremity since at least June 2015. In fact, the June 2021 VA examiner opined that the Veteran was experiencing radiculopathy of the left lower extremity related to his lumbar strain since 2015. Throughout the appeal, the evidence indicates that the Veteran's left radicular symptoms included intermittent pain, paresthesias and/or dysesthesias, and numbness of mild severity. Based on the preponderance of the evidence, the Board finds that the Veteran is entitled to a 10 percent rating for left lower extremity radiculopathy from April 30, 2015. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.400 (o), 4.3. 4. Entitlement to SMC at the housebound rate from December 23, 2019 SMC is payable at a specified rate under 38 U.S.C. § 1114 (s) when a Veteran has a single service-connected disability rated as 100 percent and: (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, 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 C.F.R. § 3.350 (i). For the purpose of meeting the first criterion, a rating of 100 percent may be based on any of the following grants of total disability: on a schedular basis, on an extraschedular basis, or on the basis of a temporary total rating pursuant to 38 C.F.R. §§ 4.28 (pre-stabilization rating), 4.29 (temporary total hospital rating) or, 4.30 (temporary total convalescence rating). Additionally, a TDIU may meet the criterion, but only if assigned for a single disability. See Bradley v. Peake, 22 Vet. App. 280 (2008); Buie v. Shinseki, 24 Vet. App. 242 (2011). While the separate disabilities rated as 60 percent disabling must involve separate and distinct anatomical segments or body systems, the fact that the total disability and the independent 60 percent disabilities result from a common etiological agent will not preclude entitlement. 38 C.F.R. § 3.350 (i). With regard to the permanently housebound requirement, this is met where a Veteran is substantially confined as a direct result of a service-connected disability to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinic areas, and it is reasonably certain that the disability or disabilities and resulting confinement will continue throughout his or her lifetime. Id. Here, as of December 23, 2019, the Veteran is in receipt of a 100 percent schedular rating for his service-connected PTSD effective August 8, 2018. As for his other service-connected disabilities, from December 23, 2019 the Veteran established service connection for a lumbar spine condition rated as 40 percent disabling, right lower extremity radiculopathy rated as 20 percent disabling and left lower extremity radiculopathy rated as 10 percent disabling. The combined evaluation for the Veteran's remaining disabilities is 60 percent. 38 C.F.R. §§ 4.25, 4.26. Consequently, the Board finds that the Veteran meets the requirements for SMC at the housebound rate from December 23, 2019. Accordingly, entitlement to SMC at the housebound rate from December 23, 2019 is granted. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Hartford, 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.