Citation Nr: 21071815 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 18-07 631 DATE: December 1, 2021 ORDER Service connection for an acquired psychiatric disorder is denied. Entitlement to a total disability based on unemployability due to service-connected disabilities is denied. Entitlement to special monthly compensation based upon the need for aid and attendance is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that an acquired psychiatric disorder began during active service or is otherwise related to an in-service injury or disease. 2. The Veteran's service-connected disabilities do not render him unable to secure and follow a substantially gainful occupation. 3. The Veteran was not, as the result of service-connected disabilities, with such significant disabilities as to be in need of regular aid and attendance and was not, by reason of service-connected disabilities, permanently housebound. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 2. The criteria for entitlement to a total disability rating based on individual unemployability (TDIU) have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16 (2020). 3. The criteria for SMC based on the need for aid and attendance or housebound status have not been met. 38 U.S.C. §§ 1114(l), 5121 (2012); 38 C.F.R. §§ 3.350, 3.352, 3.1000 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty in the United States Army from February 1957 to December 1958. These matters come before the Board of Veterans' Appeals (Board) from a July 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran submitted a Notice of Disagreement (NOD) in August 2017 and a Statement of the Case (SOC) was issued in November 2017. The Veteran perfected an appeal by submitting a timely VA Form 9 in January 2018. The issue was previously before the Board. Most recently, in November 2020, the Board remanded the appeal to the agency of original jurisdiction (AOJ) for additional development. Specifically, the Board directed the AOJ to refer the Veteran's claims folder to the examiner who provided the January 2020 VA examination to obtain an addendum opinion as to the etiology of the Veteran's acquired psychiatric disorder and discuss the Veteran's December 2016 statement in his/her opinion. In November 2020, the Veteran was afforded a VA examination by the same VA examiner who provided the January 2020 VA examination and the examiner discussed the Veteran's "2016 statement" in his opinion. Thus, the Board finds that the AOJ substantially complied with the remand directives and no further action is necessary in this regard. Stegall v. West, 11 Vet. App. 268 (1998). Following evidentiary development, the VA Appeals Management Center (AMC) continued the previous denials in a supplemental statement of the case (SSOC) issued in December 2020. The Veteran's VA claims file has been returned to the Board for further appellate proceedings. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.902(c). 38 U.S.C. § 7107(b). Service Connection Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in the line of duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. Service connection may also be granted for a disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. Id.; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). "It is in recognition of our debt to our veterans that society has [determined that,] [b]y tradition and by statute, the benefit of the doubt belongs to the veteran." Gilbert, 1 Vet. App. at 54. 1. Service connection for an acquired psychiatric disorder The Veteran stated that he experienced "psychological and mental changes" that were "very severe" during basic training at Fort Buchanan and that he has suffered from insomnia, mental, and hearing problems. The Veteran also stated that he experienced panic attacks and depression while in Korea. He contends that these experiences caused his current acquired psychiatric disorder. After reviewing the evidence of record, the Board finds that the Veteran's acquired psychiatric disorder was not caused by his active service, to include his contended panic attacks and depression while in Korea. The Veteran's service treatment records do not show any complaints of, treatment for, or diagnoses of an acquired psychiatric disorder. In an October 1958 separation examination, the examiner found no abnormalities other than a tattoo on his left forearm and history of tonsilitis in May 1958. In a concurrent medical history questionnaire, the Veteran denied trouble sleeping, frequent nightmares, depression or excessive worry, and nervous trouble. Service treatment records, however, show the Veteran receiving treatment for a variety of other ailments, to include burned hands, chest pain, headaches, and flu symptoms. VA medical treatment records from August 1969 show that the Veteran reported multiple phobias over the past year and was diagnosed as having phobic neurosis. The Veteran reported that he liked his employment but was frustration and noise at work caused him to be irritable. Outpatient therapy was provided over the next two months. Records mention domestic and family problems with no mention of events in service. VA Medical Center treatment records from New York show the Veteran asking for medication in July 1996, three months after his wife's niece committed suicide. The Veteran reported that he has never been hospitalized for a psychiatric problem, but that he had seen a VA psychiatrist at the Manhattan VA for about three months for "panic attacks/nerves" and was given medication. In July 1997, the Veteran complained of depressed mood, tearfulness, insomnia, anxiety, and poor sex drive. In April 1998, the Veteran again complained of depression and assessed as having dysthymia. In May 1998, the Veteran reported that he was at the VA Medical Center about 20 to 30 years ago for a similar presentation. His spouse claimed that the Veteran was depressed and "crying a lot" since "about a year ago" with poor sleeping and poor eating. In March 1999, the Veteran reported that the reason for his depression was the accusation of child molestation from July 1997 for which he has had court appearances. The Veteran complained of depression and panic attacks in January 2001, and the medical practitioner noted that "in view of prior non-compliance, decision to treat was postponed." VA Medical Center treatment records from Puerto Rico show that the Veteran complaining of symptoms of depression and anxiety in October 2002. He reported that he was previously treated at a VA in New York City. The diagnostic impressions were anxiety by history and adjustment disorder with mixed features. In March 2003, the Veteran was diagnosed as having mild anxiety and no other psychopathology. In March 2007, the Veteran complained of depression and being frustrated while trying to become a lawyer. He also complained of poor motivation and sleepiness. In November 2009, the Veteran reported that he has suffered from panic attacks since 1969, or more than a decade after discharge. The Veteran also reported that he could not identify a trigger and that his mother suffered from depression and panic attacks. He worked as a legal assistant and social worker at a legal office since discharge, until 1998. He reported earning a bachelor's degree and completed several courses for a master's degree. The Veteran was diagnosed as having panic disorder without agoraphobia. In March 2010, he was diagnosed as having adjustment disorder with anxiety and depressive mood. The diagnosis was modified to add bereavement in August 2010 and remained unchanged in November 2013. In March 2015, the Veteran received a depression screening where he scored a 2, which is a negative screen for depression. Although the Veteran's VA Medical Center treatment record show the Veteran receiving treatment for his acquired psychiatric disorder, the Veteran did not cite his active military service as the cause nor that he has had continuous symptoms since service. In December 2016, the Veteran submitted a Spanish statement regarding his experience in Korea. The translated document was associated with the Veteran's file in September 2018. Regarding his acquired psychiatric disorder claim, the Veteran stated that he experienced panic attacks, depression, and burned one of his hands. The Veteran also reported other problems for which he was hospitalized. In June 2017, the Veteran was afforded a VA examination for his acquired psychiatric disorder. The Veteran was not diagnosed as having posttraumatic stress disorder (PTSD) but rather diagnosed with panic disorder and situational specific phobia. The Veteran reported that he received training in Korea but did not report any stressors during military service. The examiner opined that the Veteran's acquired psychiatric disorder was less likely than not caused by service as he did not report any experience related to his military service and the Veteran himself did not attribute it to military service. The examiner also opined that the phobic neurosis in 1969 was caused by multiple events unrelated to his active duty such as marital difficulties. In November 2018, the Board remanded the claim as the Veteran reported experiencing psychological and mental changes during basic training in a December 2016 statement, written in Spanish, that the June 2017 VA examiner did not consider. The Board also observed that the examiner did not examine the Veteran's treatment records from New York City VA Medical Center. The Veteran was afforded another VA examination in January 2020. The Veteran reported that he went to a VA hospital in 1969 and that he developed anxiety with panic attacks, insomnia, and sadness. The Veteran also reported that his wife was diagnosed as having cancer in 2002, moved to Puerto Rico, and that she passed away in 2012. The examiner observed that the Veteran's "first mental complaint" was in 1969 and that the stressor was poor communication with family members that eventually resolved. There was no evidence of his stressor being related to his military service. Regarding the December 2016 statement, the examiner found that they were not supported by the medical evidence of record. The examiner opined that the Veteran presents an "unspecified depressive disorder" that is "not related to, nor aggravated by, nor secondary to his military service." In November 2020, the Board found that the January 2020 VA examiner did not address the etiology of the Veteran's psychiatric disorders of panic disorder, phobia, anxiety, PTSD, and adjustment disorder with mixed anxiety and depressed mood as directed by the Board in its November 2018 decision. In the same month, the Veteran was afforded another VA examination for his acquired psychiatric disorder. The examiner opined, again, that the Veteran's acquired psychiatric disorders were not caused by his military service based on the medical evidence of record and attributed the Veteran's 1969 neurosis to the stressful situation that the Veteran reported at the time. The examiner reviewed the history of the symptoms from which the variety of previous diagnoses had arisen. The examiner also diagnosed the Veteran as having unspecified depressive disorder per DSM-V criteria and that it was not related to, nor aggravated by, nor secondary to his military service. As an initial matter, the Board finds that the November 2020 VA examination and opinion is adequate although it does not follow the Board's directions literally. Instead of providing an etiological opinion on each of the psychiatric disorders enumerated by the Board's November 2020 decision, the examiner instead diagnosed the Veteran as having a single psychiatric disorder per DSM-V criteria and gave an etiological opinion supported by rationale. It included consideration of all the symptoms from which the previous diagnoses arose. Thus, the Board finds that the directives were substantially followed, and that the opinion is adequate. The Board also finds that there is no other medical opinion of record attributing the Veteran's unspecified depressive disorder to his military service. Moreover, to the extent the Veteran asserts that a relationship exists between his unspecified depressive disorder and his purported panic attacks and depression in service, the Board finds that such assertions do not provide persuasive evidence in support of the claim. The matter of the medical etiology of the disability here at issue is one within the province of trained medical professionals. Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). Although lay persons are competent to attest to matters within their own personal knowledge, to include symptoms experienced or observed (as appropriate), as well as to provide opinions on some medical issues, such as those perceived through the senses (see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011)), here, the etiology of the Veteran's unspecified depressive disorder is a complex medical matter that falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Thus, lay assertions as to the etiology of the Veteran's unspecified depressive disorder have low probative value. Rarely did the Veteran report his Army experiences (other than being stationed in Korea) to his attending clinicians during the long history of psychiatric treatment. Most often, the clinicians discussed post-service symptoms and causes that started not earlier than 1969. In summary, the absence of competent medical or scientific evidence documenting a relationship between the Veteran's unspecified depressive disorder and his purported panic attacks and depression, service connection on a direct basis must be denied. Prior to his December 2016 statement, the Veteran also consistently stated that his panic attacks did not occur prior to 1969 and did not submit a claim until September 1969, a decade after discharge. The Board finds that had the Veteran experienced symptoms of phobic reaction, he would have reported it in a clinical setting prior to 1969. Cf. Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (Lance, J., concurring) (holding that silence in a medical record can be weighed against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated by the fact finder (citing Fed. R. Evid. 803(7))); see AZ v. Shinseki, 731 F.3d 1301 (Fed. Cir. 2013) (recognizing the widely held view that the absence of an entry in a record may be considered evidence that the fact did not occur if it appears that the fact would have been recorded if present). It is also well established that internal inconsistency, bias, facial plausibility, and consistency with other evidence submitted on behalf of the Veteran may be considered. Caluza v. Brown, 7 Vet. App. 498, 511-12, aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curium) (table); Madden v. Gober, 125 Fed. Cir. 1477, 1481 (Fed. Cir. 1997) (holding that the Board has the "authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence"). As discussed at length above, the contemporaneous medical evidence of record show that the Veteran reported other ailments during service, did not complain of any psychiatric disorders until August 1969 and that he attributed them to factors unrelated to his military service. In addition, medical evidence from 1996 show that the Veteran was affected by a multitude of incidents unrelated to his service in Korea in 1958. Lastly, the Board observes that the Veteran did not attribute his unspecified depressive disorder to his service in Korea until December 2016 despite complaining of psychiatric symptoms since August 1969. Put another way, the Veteran complained of psychiatric symptoms for nearly half a century before he contended that he had panic attacks and depression while in service. Given the inconsistencies and contradictions in the record, including the examples discussed above, the record does not establish symptoms of panic attacks and depression since service. Therefore, the evidence in this case is not so evenly balanced as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 54. The preponderance of the evidence is against the Veteran's claim, and as such entitlement to service connection for an acquired psychiatric disorder is denied. 2. Entitlement to a total disability based on unemployability due to service-connected disabilities The Veteran is currently in receipt of a combined 10 percent rating from June 20, 2016. His service-connected disabilities are tinnitus for 10 percent and bilateral hearing loss for 0 percent, both effective June 20, 2016. Thus, the Veteran does not satisfy the threshold rating percentage requirements set forth in 38 C.F.R. § 4.16(a) for a total disability based on unemployability (TDIU) throughout the period on appeal. After reviewing the evidence of record, the Board finds that the Veteran is not entitled to a TDIU. VA disability ratings are based, as far as practicable, on the average impairment of earning capacity attributable to disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.10. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. Id. Where the schedular rating is less than total, a total disability rating may nonetheless be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disability; provided that, in pertinent part, if there is only one such disability, the disability shall be rated at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability rated 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341(a), 4.16(a). Regardless, it is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Thus, in any case where the veteran is unemployable by reason of service-connected disabilities but has failed to meet the percentage standards discussed above, rating boards will submit the case to the Director, Compensation and Pension Service, for extra-schedular consideration under 38 C.F.R. § 4.16(b). In determining whether a veteran can secure and follow a substantially gainful occupation, attention must be given to: 1) the veteran's history, education, skill, and training; 2) whether the veteran has the physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy, or very heavy) required by the occupation at issue, considering factors that may be relevant that include, but are not limited to, the veteran's limitations, if any, concerning lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, as well as auditory and visual limitations; and 3) whether the veteran has the mental ability to perform the activities required by the occupation at issue, with factors that may be relevant that include, but are not limited to, the veteran's limitations, if any, concerning memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity. Ray v. Wilkie, 31 Vet. App. 58 (2019). Entitlement to a total rating must be based solely on the impact of service-connected disabilities on the ability to keep and maintain substantially gainful employment. See 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is whether the Veteran's service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). For VA purposes, the term unemployability is synonymous with an inability to secure and follow a substantially gainful occupation. VAOPGPREC 75-91; 57 Fed. Reg. 2317 (1992). Consideration may be given to the level of education, special training, and previous work experience in arriving at a conclusion. Individual unemployability, however, must be determined without regard to any nonservice-connected disabilities or advancing age. 38 C.F.R. §§ 3.341(a), 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). A high rating in itself is recognition that the impairment makes it difficult to obtain or maintain employment, but the ultimate question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose, 4 Vet. App. at 363. Although the Veteran does not meet the schedular criteria for TDIU for the entire period on appeal, as discussed above, in any case where the Veteran is unemployable by reason of service-connected disabilities but has failed to meet the percentage standards discussed above, rating boards will submit the case to the Director, Compensation Service, for extra-schedular consideration under 38 C.F.R. § 4.16(b). In this case, however, referral for extra-schedular consideration is not warranted because, upon weighing the evidence, the most probative evidence of record establishes that the Veteran's service-connected disabilities do not preclude substantially gainful employment for any period on appeal. Specifically, there is no evidence of record suggesting that the Veteran's tinnitus and bilateral hearing loss, rated at 10 percent and 0 percent disabling respectively, prevent the Veteran from obtaining and maintaining gainful employment. After discharge, the Veteran worked as a social worker and a legal assistant and aspired to become a lawyer with no difficulties presented by his tinnitus or bilateral hearing loss for 20 years from 1978 to 1998. In November 2009, he reported having earned a bachelor's degree with some courses for a master's degree. Moreover, although the Veteran indicated that "hearing" prevented him from obtaining gainful employment, he also cited "PTSD, nerves, operations, back, [and] shoulders" as well, none of which are connected to service. The Board also notes that in February 2020, the Veteran himself reported that, while tinnitus bothers him, it did not affect him occupationally. Regarding hearing loss, the Veteran also stated that it did not affect him occupationally although he has difficulty understanding conversations. The Board notes that the Veteran is diagnosed as having sensorineural hearing loss that does not warrant a compensable rating and that his speech discrimination score using the Maryland CNC word list was 98 percent for the right ear and 100 percent for the left ear. While the Board recognizes the limitations the Veteran faces due to his service-connected disabilities, these limitations were considered in the disability ratings he receives for those disabilities. Again, the assignment of the schedular ratings is recognition of the functional limitations caused by his disabilities, and those ratings contemplate the severity and overall impact the symptoms have on his life. However, despite these limitations, the Board finds that the most probative evidence shows that the Veteran is not unable to secure or maintain substantially gainful employment due solely to his service-connected disabilities. Rather, the Board finds that the Veteran was capable of performing the physical and mental acts required for employment had he not already been affected by the nonservice-connected disabilities he cited as limiting his ability to find gainful employment. Accordingly, the Board finds that the preponderance of the evidence is against the claim of TDIU and there is no doubt to be otherwise resolved. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 49. Therefore, the appeal is denied. 3. Entitlement to special monthly compensation based upon the need for aid and attendance "SMC is available when, 'as the result of service-connected disability,' a veteran suffers additional hardships above and beyond those contemplated by VA's schedule for rating disabilities." Breniser v. Shinseki, 25 Vet. App. 64, 68 (2011) (citing 38 U.S.C. § 1114 (k)-(s)). Section 1114(l) provides five distinct ways for a veteran, "as the result of service-connected disability," to qualify for this rate of SMC: (1) anatomical loss or loss of use of both feet; (2) anatomical loss or loss of use of one hand and one foot; (3) blindness in both eyes with 5/200 visual acuity or less; (4) being permanently bedridden; or (5) having "such significant disabilities as to be in need of regular aid and attendance." 38 U.S.C. § 1114(l). The following basic considerations are critical in determining the need for the regular aid and attendance of another person: inability of the veteran to dress or undress him or herself, or to keep him or herself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of claimant to feed him or herself through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment. 38 C.F.R. § 3.352(a). Determinations as to the need for aid and attendance must be based on actual requirements of personal assistance from others. Id. It is not required that all of the disabling conditions enumerated in 38 C.F.R. § 3.352(a) be found to exist before a favorable rating may be made. The particular personal functions which a veteran is unable to perform should be considered in connection with his or her condition as a whole. It is only necessary that the evidence establish that a veteran is so helpless as to need regular aid and attendance, not that there is a constant need. Id. "Bedridden" will be a proper basis for the determination for the need for aid and attendance. "Bedridden" will be that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that a claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. 38 C.F.R. § 3.352(a). In Turco v. Brown, 9 Vet. App. 222, 224-25 (1996), the United States Court of Appeals for Veterans Claims (Court) held that it was not required that all of the disabling conditions enumerated in the provisions of 38 C.F.R. § 3.352(a) be found to exist to establish eligibility for aid and attendance and that such eligibility required at least one of the enumerated factors be present. The evidence of record does not demonstrate that the Veteran's service-connected disabilities render him unable to feed himself, attend to the wants of nature, keep himself ordinarily clean and presentable, or that he has a physical or mental disorder which requires care or assistance on a regular basis to protect him from hazards or dangers incident to his daily environment. As recently as in January 2020, the Veteran received surgery at a VA Medical Center for erectile dysfunction. After the operation, the medical practitioner found that the Veteran was alert and oriented, had no mobility limitations, no bladder impairment, and was discharged without companion. Nor does the evidence indicate that the Veteran is bedridden, as the Veteran received an in-person VA examination as recently as in January 2020. The Board, accordingly, finds that the weight of the competent and probative evidence is against finding that the Veteran's service-connected disabilities render him so incapable of performing the activities of daily living that he requires care or assistance on a regular basis to protect him from hazards or dangers incident to his daily environment. SMC based on the need for aid and attendance is therefore not warranted. If a veteran does not qualify for increased benefits for aid and attendance, increased compensation benefits may still be payable if the veteran is able to establish entitlement to SMC based on housebound status under 38 U.S.C. § 1114(s). Under 38 U.S.C. § 1114(s), SMC is payable at the housebound rate if a veteran has a single service-connected disability rated as 100 percent and either of the following are met: (1) there is 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) he or she is permanently housebound by reason of service-connected disability or disabilities. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). The requirement of "permanently housebound" will be considered to have been met when the veteran is substantially confined to his or her house (ward or clinical areas, if institutionalized) or immediate premises due to a service-connected disability or disabilities which it is reasonably certain will remain throughout his or her lifetime. Id. Initially, the Board notes that the Veteran does not have a service-connected disability rated at 100 percent nor in receipt of a 100 percent rating based on TDIU. His service-connected disabilities only combine for a 10 percent rating. See 38 C.F.R. § 4.25. Thus, the criteria for SMC based on statutory housebound status have not been met. See 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). The Board further finds that the weight of the competent and probative evidence is against finding that the Veteran is substantially confined to his home due to his service-connected disabilities. The Veteran does not contend that he is housebound nor does the evidence suggest that he is, as seen by his regular visits to the VA Medical Center without a companion. Thus, SMC based on housebound status is therefore not warranted. See 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H.S. Yun, 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.