Citation Nr: 21075094 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 17-48 500 DATE: December 17, 2021 ORDER Entitlement to a disability rating in excess of 10 percent for the Veteran's service-connected right lower extremity sciatic nerve peripheral neuropathy, is denied. Entitlement to a disability rating in excess of 10 percent for the Veteran's service-connected left lower extremity sciatic nerve peripheral neuropathy, is denied. Entitlement to a disability rating in excess of 10 percent for the Veteran's service-connected right lower extremity femoral nerve peripheral neuropathy, is denied. Entitlement to a disability rating in excess of 10 percent for the Veteran's service-connected left lower extremity femoral nerve peripheral neuropathy, is denied. Entitlement to a disability rating in excess of 40 percent for the Veteran's service-connected prostate cancer residuals, is denied. Entitlement to a disability rating in excess of 20 percent for the Veteran's service-connected type II diabetes mellitus, is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) based on posttraumatic stress disorder (PTSD) with depressive disorder alone from August 3, 2015 is granted. Entitlement to special monthly compensation (SMC) at the housebound rate from August 3, 2015 is granted. Entitlement to an earlier effective date for an increased rating for diabetes mellitus, is denied. Entitlement to an effective date prior to August 3, 2015, for the Veteran's entitlement to service connection for prostate cancer residuals, is denied. FINDINGS OF FACT 1. For the period on appeal the Veteran's right lower extremity sciatic nerve peripheral neuropathy was most closely approximated by mild incomplete paralysis. 2. For the period on appeal the Veteran's left lower extremity sciatic nerve peripheral neuropathy was most closely approximated by mild incomplete paralysis. 3. For the period on appeal the Veteran's right lower extremity femoral nerve peripheral neuropathy was most closely approximated by mild incomplete paralysis. 4. For the period on appeal the Veteran's left lower extremity femoral nerve peripheral neuropathy was most closely approximated by mild incomplete paralysis. 5. The competent and probative evidence demonstrates that throughout the period on appeal, the Veteran's prostate cancer residuals manifest in voiding dysfunction resulting in urine leakage requiring absorbent materials which must be changed two to four times per day. 6. The Veteran's diabetes mellitus has required only restricted diet and an oral glycemic agent during the entire period on appeal. 7. From August 3, 2015, the Veteran's service-connected PTSD with depressive disorder alone has rendered him unable to secure and follow a substantially gainful occupation. 8. From August 3, 2015, the Veteran has a total disability evaluation due solely to his service-connected PTSD with depressive disorder, and additional service-connected disabilities independently rated at least 60 percent disabling. 9. The Veteran filed an August 3, 2015 claim for increased rating for his diabetes mellitus disability. However, the preponderance of the evidence is against affording the Veteran a higher disability rating for any period on appeal. 10. The Veteran's claim for entitlement to service connection for prostate cancer residuals was received August 3, 2015. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to a disability rating in excess of 10 percent for the Veteran's service-connected right lower extremity sciatic nerve peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5017; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.71a, Diagnostic Code 8520. 2. The criteria for establishing entitlement to a disability rating in excess of 10 percent for the Veteran's service-connected left lower extremity sciatic nerve peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5017; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.71a, Diagnostic Code 8520. 3. The criteria for establishing entitlement to a disability rating in excess of 10 percent for the Veteran's service-connected right lower extremity femoral nerve peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5017; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.71a, Diagnostic Code 8526. 4. The criteria for establishing entitlement to a disability rating in excess of 10 percent for the Veteran's service-connected left lower extremity femoral nerve peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5017; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.71a, Diagnostic Code 8526. 5. The criteria for establishing entitlement to a disability rating in excess of 40 percent for the Veteran's service-connected prostate cancer residuals have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.115a, 4.115b, Diagnostic Code 7528. 6. The criteria for establishing entitlement to a disability rating in excess of 20 percent for the Veteran's service-connected type II diabetes mellitus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.119, Diagnostic Code 7913. 7. Effective August 3, 2015, the criteria for TDIU due to service-connected PTSD with depressive disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 4.16. 8. Effective August 3, 2015, the criteria for entitlement to SMC at the housebound rate, on a statutory basis, have been met. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350. 9. The criteria for establishing entitlement to an earlier effective date for an increased rating for diabetes mellitus have not been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 3.155, 3.400. 10. The criteria for establishing entitlement to an effective date prior to August 3, 2015, for the Veteran's entitlement to service connection for prostate cancer residuals have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army May 1968 to December 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). When this case was before the Board in April 2019, it was remanded for additional development. Specifically, the RO was instructed to provide the Veteran with VA examinations to address the severity of his claimed increased rating disabilities. The Veteran was provided with relevant examinations. As such, the Board finds that the AOJ substantially complied with the directives in the April 2019 remand regarding these claims. See Stegall v. West, 11 Vet. App. 268, 271 (1998). However, as part of the Board's April 2019 remand the RO was instructed to provide the Veteran with a statement of the case regarding the Veteran's claims for entitlement to earlier effective dates for an increased rating for diabetes mellitus and for service connection for residuals of prostate cancer. The RO was instructed the "if and only if" the Veteran perfected an appeal with respect to one or both of those claims the AOJ should ensure that any indicated development was completed before the issues were certified for appellate consideration. Instead of issuing a statement of the case and providing the Veteran time to properly perfect an appeal, the RO issued an April 2020 supplemental statement of the case which informed the Veteran that he did not need to respond and that after a 30 day period the claim would be sent to the Board for consideration. The RO then certified the earlier effective date issues to the Board in a February 2021 VA Form 8. Although a proper substantive appeal was never received, the Board finds that under the facts of this case, it has jurisdiction to decide the earlier effective date claims on the merits. Specifically, the RO certified the claim to the Board and the Veteran relied on the RO's interpretation that the appeal was properly perfected. See Percy v. Shinseki, 23 Vet. App. 37 (2009) (noting that the Board's exercise of jurisdiction over a matter is derived from the notice of disagreement). The Board finds that in light of the above, failing to provide the Veteran with a statement of the case does not prejudice him, and therefore does not require a remand under Stegall. The Court of Appeals for Veteran's Claims (Court) has held that a claim for a TDIU is part of an increased rating claim when such claim is expressly raised by the Veteran or reasonably raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009). The Board finds that the issue of TDIU has been raised by the record and is, thus, properly before the Board by virtue of the Veteran's increased rating claims, pursuant to Rice. The Board notes that the Veteran has been awarded a maximum 100 percent combined disability rating from September 16, 2020. Nevertheless, the issue of entitlement to a TDIU both before and after this date is still on appeal. In this regard, the United States Court of Appeals for Veterans Claims (Court) held in Bradley v. Peake, 22 Vet. App. 280 (2008), that there could be a situation where a veteran has a schedular total rating for a particular service-connected disability, and could establish a TDIU rating for another service-connected disability in order to qualify for special monthly compensation (SMC) under 38 U.S.C. § 1114 (s) by having an "additional" disability of 60 percent or more ("housebound" rate). See 38 U.S.C. § 1114 (s). Thus, under Bradley, as in the instant case, even with the assignment of a total schedular rating, the issue of TDIU was potentially not moot. In this case, as discussed further below, the Board finds that as of August 3, 3015, a TDIU is warranted based on PTSD with depressive disorder alone and, in turn, the Veteran meets the requirements for SMC as of that date. As SMC has been awarded throughout the course of the appeal, entitlement to a TDIU based on any other service-connected disabilities is rendered moot. Increased RatingLegal Criteria Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of the two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. In both initial rating claims and normal increased rating claims, the Board must discuss whether "staged ratings" are warranted, and if not, why not. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. 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. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must weigh against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996) (citing Gilbert, 1 Vet. App. At 54). The Board notes that it has reviewed all of the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, with regard to the Veteran's claims. Bilateral Sciatic and Femoral Peripheral NeuropathyLegal Criteria Lower extremity peripheral neuropathy of the sciatic nerve is evaluated under the general rating formula for diseases of peripheral nerves. See 38 C.F.R. § 4.124a, Diagnostic Code 8520. An evaluation of 10 percent is assigned for incomplete paralysis of the sciatic nerve which is mild. A higher evaluation of 20 percent is not warranted unless there is incomplete paralysis which is moderate. Moderately severe incomplete paralysis merits a 40 percent rating. A rating of 60 percent requires severe incomplete paralysis with marked muscle atrophy. The maximum rating of 80 percent is reserved for complete paralysis shown by manifestations such as: the foot dangles and drops, no active movement possible of muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Lower extremity peripheral neuropathy of the femoral nerve is evaluated under 38 C.F.R. § 4.124a, Diagnostic Code 8526. An evaluation of 10 percent is assigned for incomplete paralysis of the femoral nerve which is mild. A higher evaluation of 20 percent is not warranted unless there is incomplete paralysis which is moderate. Severe incomplete paralysis of the femoral nerve merits a 30 percent rating. The maximum rating of 40 percent is reserved for complete paralysis of the quadriceps extensor muscles. 38 C.F.R. § 4.124a, Diagnostic Code 8526. The term "incomplete paralysis" with peripheral nerve injuries indicates a degree of loss or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to the varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. See 38 C.F.R. § 4.124a, Note Diseases of the Peripheral Nerves. The Board observes that the words "mild," "moderate" and "severe" as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Analysis At the outset, the Board notes that the essential facts of the Veteran's claims for an increased rating for his bilateral lower extremity sciatic and femoral peripheral neuropathies are essentially identical. In addition, the resolution of these claims involves the application of nearly identical law to similar facts. As such, in the interest of judicial economy these issues will be addressed together. The Veteran contends that he is entitled to disability evaluations in excess of 10 percent for his service-connected bilateral sciatic and femoral peripheral neuropathy disabilities. In response to his increased rating claim for his service-connected diabetes, the Veteran afforded a December 2015 Diabetes Mellitus examination which diagnosed bilateral lower extremity peripheral neuropathy. The Veteran was also provided with a December 2015 VA Diabetic Sensory-Motor Peripheral Neuropathy examination. During the examination, the examiner noted that the Veteran had bilateral lower extremity diabetic peripheral neuropathy. The examiner reported that the Veteran's bilateral lower extremities experienced mild intermittent pain, normal deep tendon reflexes, decreased light touch testing in the feet/toes, and decreased vibration sensation. The examiner reported that the Veteran's sciatic and femoral nerve roots were impacted and that they experienced mild incomplete paralysis bilaterally. The Veteran submitted a February 2018 lay statement from his son. In this statement the Veteran's son reported that the Veteran's neuropathy affects his balance and mobility and that the Veteran had difficulties with activities such as walking and cleaning. Further, the Veteran's son reported that the Veteran's neuropathy and diabetes cause him to be sluggish and tired throughout the day. The Board in its April 2019 decision remanded the Veteran's bilateral lower extremity neuropathy claims for an examination to determine the current severity of his disabilities. In response to the April 2019 remand, the Veteran was provided with a September 2020 VA Diabetic Sensory-Motor Peripheral Neuropathy examination and a September 2020 Peripheral Nerves Conditions examination. During these examinations the Veteran reported mild constant pain, mild intermittent pain, mild paresthesias/dysesthesias, and mild numbness. Deep tendon reflexes and light touch testing were all normal. The Veteran had decreased vibration sensation bilaterally. The examiner indicated that the Veteran's sciatic and femoral nerve roots were impacted and that he experienced incomplete paralysis which was mild bilaterally. The Veteran's medical treatment records do not record symptoms which would indicate that the Veteran's bilateral lower extremity peripheral neuropathy was more severe that what was reported by the above noted VA examiners. Thus, upon careful consideration of the evidence, the Board determines that disability ratings in excess of 10 percent for the Veteran's bilateral lower extremity sciatic and femoral diabetic peripheral neuropathies for the period on appeal, are not warranted. The 10 percent ratings contemplate the Veteran's mild incomplete paralysis of his sciatic and femoral nerves. A higher, 20 percent rating for this period is not warranted as the evidence of the record does not reflect that the Veteran had moderate incomplete paralysis of his lower extremities in either his sciatic or femoral nerve. The Board has considered the Veteran's, and his son's, lay contentions and finds the lay statements are competent insofar as they report observable symptoms, such as pain and numbness. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, to the extent the Veteran asserts that the current severity of his bilateral lower extremity peripheral neuropathies entitles him to higher disability ratings, such statements are inconsistent with the medical evidence of record. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995). For these reasons, the Board finds that ratings in excess of 10 percent for the Veteran's bilateral lower extremity sciatic and femoral diabetic peripheral neuropathies for the period on appeal are not warranted. The evidence of the record preponderates against the claims for increased rating. The claim is, therefore, denied. Prostate Cancer ResidualsLegal Criteria The Veteran's prostate cancer residuals are rated pursuant to 38 C.F.R. § 4.115b, Diagnostic Code 7528, for malignant neoplasms of the genitourinary system. Diagnostic Code 7528 instructs to rate as voiding dysfunction or renal dysfunction, whichever is predominant. The criteria for voiding dysfunction and renal dysfunction are found in § 4.115a. Initially, the Veteran has not been shown to have renal dysfunction. As such, the Veteran's residuals are most appropriately rated under voiding dysfunction. Under 38 C.F.R. § 4.115a, voiding dysfunction can be rated according to urine leakage, frequency, or obstructed voiding. Regarding urine leakage, a 60 percent rating is warranted for requiring the use of an appliance or wearing of absorbent materials which must be changed more than four times per day. A 40 percent rating is warranted for requiring the wearing of absorbent materials which must be changed two to four times per day. A 20 percent rating for voiding dysfunction is warranted for requiring the wearing of absorbent materials which must be changed less than two times per day. 38 C.F.R. § 4.115a. Voiding dysfunction that manifests as urinary frequency warrants a 40 percent rating when daytime voiding intervals are less than one hour or awakening to void (nocturia) occurs five or more times per night. A 20 percent rating contemplates daytime voiding intervals between one and two hours, or nocturia occurs three to four times per night. A 10 percent rating is warranted when daytime voiding intervals are between two and three hours, or nocturia occurs twice per night. Id. Voiding dysfunction that manifests as obstructed voiding warrants a 30 percent rating when urinary retention requires intermittent or continuous catheterization. A 10 percent rating contemplates marked obstructive symptomatology, such as hesitancy, slow or weak stream, decreased force of stream, with any one or combination of the following: (1) post-void residuals greater than 150 cc.; (2) uroflowmetry; markedly diminished peak flow rate, less than 10 cc./second; (3) recurrent urinary tract infections secondary to obstruction; (4) stricture disease requiring periodic dilatation every two to three months. A noncompensable rating is warranted when obstructive symptomatology with or without stricture disease requires dilatation one to two times per year. Analysis For the reasons addressed below, the Board finds that a disability rating in excess of 40 percent for the Veteran's service-connected prostate disability is not warranted during the period on appeal. The Veteran's VA treatment notes indicate that he has received treatment for his prostate condition throughout the period on appeal. Specifically, the Board notes an October 2015 urology outpatient treatment record where the Veteran reported urinary incontinence, a May 2016 treatment note indicating post prostatectomy incontinence, and an April 2016 treatment note indicating the Veteran uses 4 pads per day with heavy flow. The Board also notes that there have been periods where the Veteran denied experiencing bowel or bladder incontinence. The Veteran submitted a February 2018 lay statement from his son. In this statement, the Veteran's son reported that the Veteran was losing control of his bowel movements due to his prostate cancer. In that regard, the Board notes that a May 2016 VA treatment record noted that the Veteran reported a brief history of more liquid stool that made it difficult to remain continent, but the treatment record did not attribute this to his prostate cancer disability. As such, in April 2019 the Board remanded the Veteran's claim for an increased rating for prostate cancer residual in order to obtain a VA examination which addressed the severity of the Veteran's condition. In response to the April 2019 remand, the Veteran was afforded a September 2020 VA Prostate Cancer examination which assessed the severity of his disability. The Veteran's prostate cancer was noted to be in remission as the Veteran had a radical prostatectomy. The examiner further diagnosed the Veteran with urinary incontinence and erectile dysfunction. The examiner noted that the Veteran had voiding dysfunction that caused urine leakage which required absorbent material which must be changed 2 to 4 times per day. The Veteran's voiding dysfunction did not require the use of an appliance nor did it increase his urinary frequency. Further, the examiner noted that the Veteran's voiding dysfunction did not cause signs or symptoms of obstructed voiding. The Veteran did not have a history of recurrent symptomatic urinary tract of kidney infections. After a review of the evidence, the Board finds that a rating in excess of 40 percent is not warranted at any time during the appeal. The VA examination, as well as the VA treatment records, do not document any complaints of continual urine leakage or urinary incontinence requiring the use of an appliance or wearing absorbent materials which must be changed more than four times per day, as required for a 60 percent rating based on voiding dysfunction. For the entire rating period on appeal, all possible diagnostic codes were considered, but the Veteran could not receive a higher disability rating for his prostate cancer residuals. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991); 38 C.F.R. §§ 4.115a, 4.115b, Diagnostic Code 7528. The Board has applied the benefit of the doubt where appropriate. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Consideration has been given to assigning a staged rating; however, the evidence does not suggest that the severity has fluctuated during the period of this appeal, so a staged rating is not appropriate for this claim. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Diabetes MellitusLegal Criteria The Veteran's diabetes is rated under Diagnostic Code 7913 which provides a structured scheme of specific, successive, cumulative criteria. Each higher rating includes the same criteria as the lower rating plus distinct new criteria. Middleton v. Shinseki, 727 F.3d 1172, 1178 (Fed. Cir. 2013). A 10 percent rating is warranted when diabetes is manageable by restricted diet only. A 20 percent rating is warranted when diabetes requires one or more daily injection of insulin and restricted diet, or an oral hypoglycemic agent and restricted diet. A 40 percent rating is warranted when it requires one or more daily injection of insulin, restricted diet, and regulation of activities. Regulation of activities is defined as avoidance of strenuous occupational and recreational activities. A 60 percent rating is warranted when diabetes requires one or more daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A 100 percent rating is warranted when diabetes requires more than one daily injection of insulin, restricted diet, and regulation of activities, with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. Compensable complications of diabetes are evaluated separately unless they are part of the criteria used to support a 100-percent evaluation. Noncompensable complications of diabetes are considered part of the diabetic process. 38 C.F.R. § 4.119, Diagnostic Code 7913 (Note 1). Because Diagnostic Code 7913 contains successive criteria, the criteria for the lower rating must be met before a higher disability rating may be awarded. A higher rating cannot be granted based on a finding that the Veteran's disability picture more nearly approximates the criteria for the next higher rating. However, reasonable doubt regarding the presence of a criterion may be resolved in the Veteran' favor. Johnson v. Wilkie, 30 Vet. App. 245 (2018). Analysis The Veteran claims that he is entitled to a disability rating in excess of 20 percent for his service-connected diabetes. As Diagnostic Code 7913 contains successive criteria, the Board notes that the question in this appeal is whether the Veteran's diabetes mellitus required one or more daily injections of insulin, restricted diet, and regulation of activities. Regulation of activities is defined as avoidance of strenuous occupational and recreational activities. This criterion requires medical evidence. Camacho v. Nicholson, 21 Vet. App. 360, 364-65 (2007). The Board finds that the Veteran's diabetes mellitus required only restricted diet, and an oral hypoglycemic agent during the period on appeal. As part of his increased rating claim, the Veteran was provided a December 2015 VA Diabetes Mellitus examination. The examiner noted that the Veteran's treatment consisted of metformin (an oral hypoglycemic agent). No regulation of activities was required as part of the medical management of the Veteran's diabetes. In addition, no regulation of activities is noted in the Veteran's treatment records regarding his diabetes. The Veteran submitted a February 2018 lay statement from his son. In this statement the Veteran's son reported that the Veteran's neuropathy affects his balance and mobility and that the Veteran had difficulties with activities such as walking and cleaning. Further, the Veteran's son reported that the Veteran's neuropathy and diabetes cause him to be sluggish and tired throughout the day. The Board in its April 2019 decision remanded the Veteran's increased rating for diabetes claim for an examination to determine the current severity of his disability. In response to the Board remand the Veteran was provided with a September 2020 VA Diabetes Mellitus examination. The examiner indicated that the Veteran's treatment for his diabetes required only a prescribed oral hypoglycemic agent. No regulation of activities was required as part of the medical management of the Veteran's diabetes. Further, the Veteran's medical treatment records do not show regulation of activities is required regarding his diabetes. The Veteran, and his son, are competent to report what the directly observe. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the medical evidence of record as outlined above is against a finding that regulation of activities or daily insulin injections were required during the period on appeal. Thus, the elements for a 40 percent disability rating for diabetes mellitus are not shown. Accordingly, the preponderance of the evidence is against assigning a rating in excess of 20 percent during the period on appeal as such, the claim must be denied. Since the evidence for this period preponderates against an increase the reasonable doubt provisions are inapplicable. 38 C.F.R. § 3.102. TDIU based on PTSD with depressive disorder alone The Veteran has been awarded a 70 percent disability rating for his PTSD with depressive disorder, effective August 3, 2015, the date of award of service connection. As such, he meets the schedular criteria for TDIU under 38 C.F.R. § 4.16 (a) as of that date. Based on the evidence and when resolving the benefit of the doubt in favor of the Veteran, the Board finds that the Veteran's service-connected PTSD with depressive disorder precluded him from obtaining or maintaining substantially gainful employment from the date of award of service connection, August 3, 3015. The Veteran has not worked since his last employment at a staffing company in 2005. See August 2021 VA Form 21-8940 Application for Increased Compensation Based on Unemployability. This job, and virtually any other job, require the Veteran to be able to attend normal workday hours, as well as interact and communicate effectively with others. Additionally, the Veteran has four years of high school education and denied any additional education or training before and after becoming disabled. In this case, the Board must determine the value of all evidence submitted, including medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a 3-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303 (2007) (Observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. The Board notes that the Veteran has been afforded VA examinations over the years. Further, the Veteran submitted an April 2021 private medical opinion concerning his ability to work. The examinations come from competent examiners who support their conclusions with evidence and sound medical reasoning. As such their medical opinions meet the first and second step of the inquiry. Throughout the record the VA examiners as well as the private examiner indicated that the Veteran would have multiple difficulties associated with employment due to his service-connected PTSD with depressive disorder. Significantly, the December 2020 VA examiner found that the Veteran had difficulty in establishing and maintaining effective work and social relationship. He also had difficulty in adapting to stressful circumstances, including work or a work-like setting. The examiner specifically found that the Veteran's PTSD limited his ability to function in an occupational environment. His functional impairments that affected his ability to work also included emotional instability and chronic sleep impairment. The Veteran's medical records reflect persistent irritability; difficulty concentrating; sleep disturbance; depression; angry outbursts; near continuous panic/depression; memory impairment due to his psychiatric disability. Thus, his service-connected PTSD with depressive disorder not only caused significant work impairment but also substantially impaired his capacity to gain work experience following service. The Board has also considered the Veteran's lay statements in support of his claim. He is competent to report symptoms associated with his psychiatric disability. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Additionally, the Veteran's lay statements are consistent with other medical evidence in the record, notably the VA examination reports. Accordingly, the lay evidence provided by the Veteran is unquestionably competent evidence. Affording the Veteran the benefit of the doubt; the Board finds that his significant impairment due to service-connected PTSD with depressive disorder combined with limited educational achievement rendered him incapable of obtaining or retaining substantially gainful employment, or that the evidence is at least in equipoise. As noted above, the Veteran's PTSD with depressive disorder met the schedular requirement for TDIU since August 3, 2015, the date of award of service connection, and the Veteran provided competent evidence addressing his symptoms and limitations. The Court has held that the effective date of an award of TDIU cannot be earlier than the effective date of the award of service connection for the disability or disabilities on which the award of TDIU is based. See Delrio v. Wilkie, 32 Vet. App. 232, 236 (2019). In conclusion, when resolving all benefit of the doubt in the Veteran's favor, the Board must conclude that the Veteran is unemployable due to his service-connected PTSD with depressive disorder and, in turn, entitlement to TDIU is warranted based on this disability alone from August 3, 3015. 38 U.S.C. § 5107 (b). SMC at the Housebound Rating from August 3, 3015 Special Monthly Compensation is payable for housebound status on a statutory basis where the claimant has a single service-connected disorder rated as totally disabling and one or more distinct service-connected disabilities, which are independently ratable at 60 percent and involve different anatomical segments or bodily systems. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). Alternatively, such compensation may be granted when the claimant is permanently housebound by reason of service-connected disability or disabilities. Id. As discussed above, the Board has granted entitlement to TDIU based solely on PTSD with depressive disorder from August 3, 2015. Further, the Veteran has additional service-connected disabilities independently ratable at 60 percent or more. Thus, from August 3, 3015, the schedular criteria for entitlement to SMC due to housebound status on a statutory basis have been met. However, the Board finds that the issue of entitlement to SMC for aid and attendance has not been raised by the record and is not before the Board at this time, as the evidence of record does not indicate that the Veteran is rendered so helpless due to his service-connected disabilities so as to require regular aid and attendance of another person during this period. See Akles v. Derwinski, 1 Vet. App. 118 (1991) (the issue of entitlement to SMC is part and parcel of a claim for increased compensation and does not require submission of a separate claim) In sum, SMC based on housebound status on a statutory basis is warranted from August 3, 2015. Earlier Effective DateLegal Criteria Regarding service connection claims, the assignment of effective dates of awards is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Unless specifically provided otherwise, the effective date of an award based on an original claim for service connection or a claim reopened after final adjudication, "shall be fixed in accordance with the facts found but shall not be earlier than the date of receipt of application therefore." 38 U.S.C. § 5110(a). The implementing regulation clarifies this to mean that the effective date of an evaluation and an award of compensation based on an original claim or a claim reopened after final disallowance, "will be the date of receipt of the claim or the date entitlement arose, whichever is the later." 38 C.F.R. § 3.400. Prior to March 24, 2015, the VA administrative claims process recognized formal and informal claims. A formal claim is one that has been filed in the form prescribed by VA. See 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). An informal claim was considered to be any communication or action indicating an intent to apply for one or more benefits under VA law. See Thomas v. Principi, 16 Vet. App. 197 (2002); see also 38 C.F.R. §§ 3.1(p), 3.155(a). An informal claim needed to be written, see Rodriguez v. West, 189 F. 3d. 1351 (Fed. Cir. 1999), and it had to identify the benefit being sought. Brannon v. West, 12 Vet. App. 32, 34-5 (1998). Effective March 24, 2015, a change in regulation requires claims be filed on standard forms, eliminating constructive receipt of claims and informal claims. See 38 C.F.R. §§ 3.1(p), 3.150, 3.155, 3.160(a). Regarding increased rating claims: generally, the effective date of an award of an increased rating is the date of receipt of a claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The pertinent criteria for the effective date of an award for an increase in disability compensation are found in 38 U.S.C. § 5110(b)(2) and 38 C.F.R. §§ 3.400(o)(1), 3.400(o)(2). However, 38 U.S.C. § 5110(b)(2) and 38 C.F.R. § 3.400(o)(2) are applicable only where an increase in disability precedes a claim for an increased disability rating. Otherwise, the general default rule for earlier effective dates applies. See 38 C.F.R. § 3.400(o)(1); Harper v. Brown, 10 Vet. App. 125, 126 (1997). Thus, three possible dates may be assigned depending on the facts of the case, in the context of claims for an earlier effective date for an increased rating: (1) if an increase in disability occurs after the claim is filed, the date that the increase is shown to have occurred (date entitlement arose) 38 C.F.R. § 3.400(o)(1); or (2) if an increase in disability precedes the claim by a year or less, the date that the increase is shown to have occurred (factually ascertainable) 38 C.F.R. § 3.400(o)(2); or (3) if an increase in disability precedes the claim by more than a year, the date that the claim is received (date of claim) 38 C.F.R. § 3.400(o)(2); see also Harper v. Brown, 10 Vet. App. 125, 126 (1997). Determining the appropriate effective date for an increased rating under the effective date regulations involves an analysis of the evidence to determine (1) when a claim for an increased rating was received and, if possible, (2) when the increase in disability actually occurred. 38 C.F.R. §§ 3.155, 3.400(o)(2). Diabetes Mellitus On August 3, 2015, the Veteran filed a claim for an increased rating for his service-connected diabetes mellitus. However, as noted above in the increased rating for diabetes section of this decision, the Veteran has been afforded a 20 percent disability rating for his service-connected diabetes throughout the entirety of the appeal, and the evidence does not show an increase is warranted. The Board finds the preponderance of the evidence shows an earlier effective date for the Veteran's diabetes mellitus is not warranted. The Veteran submitted his claim for an increased rating on August 3, 2015, and an increase in disability is not factually ascertainable within a year of that date. Indeed, an increased rating is not factually ascertainable at all. Accordingly, the claim for an earlier effective date for an increased rating for the Veteran's diabetes mellitus is denied. Prostate Cancer Residuals The Veteran was discharged from service in December 1969. He filed his initial claim for service connection for "prostate cancer" on August 3, 2015. The Board cannot find that an informal or formal claim existed for the Veteran's prostate cancer residuals, prior to the receipt of the August 3, 2015 claim. In a December 2015 rating decision, the RO assigned August 3, 2015, the date the Veteran's claim, as the effective date for the Veteran's disability in this case. As noted above, since the claim was filed more than a year from when the Veteran left service, the effective date will be the date of claim or the date entitlement arose, whichever is later. The effective date assigned to the Veteran for his service-connected prostate cancer residuals was the date of the Veteran's claim. There is no statutory or regulatory authority which would allow for an effective date earlier than August 3, 2015, based on the above facts. In sum, the Board finds that there is no legal basis to assign an effective date prior to August 3, 2015, for the award of service connection for the Veteran's prostate cancer residuals disability. The Board is sympathetic to the Veteran's claim, but it is bound by the laws and regulations that apply to veterans claims and it has no discretion in this regard. 38 U.S.C. § 7104(c); 38 C.F.R. §§ 19.5, 20.101(a). The claim is denied. J.N. Moats Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Gresham 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.