Citation Nr: 21005934 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 20-01 720 DATE: February 2, 2021 ORDER Entitlement to an effective date earlier than February 16, 2012 for the establishment of service connection for mood disorder is denied. Entitlement to an effective date earlier than April 14, 2010 for the establishment of service connection for heart disability is denied. Entitlement to an effective date earlier than October 6, 2013 for the establishment of service connection for a scar related to heart surgery is denied. Entitlement to an effective date earlier than June 1, 2009 for the establishment of service connection for left knee degenerative joint disease (hereafter “left knee disability”) is denied. Entitlement to an effective date earlier than October 6, 2013 for the establishment of entitlement to SMC based on housebound status is denied. Entitlement to an initial rating higher than 60 percent for heart disability from April 14, 2010 to October 5, 2013 is denied. Entitlement to an initial rating higher than 70 percent for mood disorder is denied. Entitlement to increased rating for SMC based on housebound status is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) from April 14, 2010 to February 15, 2012 is granted. Entitlement to a TDIU from February 16, 2012 is denied. REMANDED Entitlement to an initial rating higher than 60 percent for heart disability from January 1, 2014 is remanded. Entitlement to an initial compensable disability rating for scar related to heart surgery is remanded. Entitlement to an initial rating higher than 10 percent for left knee disability is remanded. Entitlement to a TDIU from June 1, 2009 to April 13, 2010 is remanded. FINDINGS OF FACTS 1. The evidence of record does not show that a claim for service connection for mood disorder was received earlier than February 16, 2012. 2. The evidence of record does not show that a claim for service connection for heart disability was received earlier than April 14, 2010. 3. The evidence of record does not show that entitlement for service connection for scar related to heart surgery arose earlier than October 6, 2013. 4. The evidence of record does not show that a claim for service connection for left knee disability was received earlier than June 1, 2009. 5. The evidence of record does not show that entitlement to SMC based on housebound status arose earlier than October 6, 2013. 6. The Veteran’s heart disability has not been manifested by chronic congestive heart failure; a workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction of less than 30 percent from April 14, 2010 to October 5, 2013. 7. The Veteran's mood disorder does not result in total occupational and social impairment. 8. SMC based on housebound status is a non-variable amount set by statute. Neither the Veteran nor the record have raised any theory of entitlement to a higher level of SMC. 9. Resolving reasonable doubt in the Veteran’s favor, his service-connected disabilities preclude employment for the appeal period from April 14, 2010 to February 15, 2012. 10. Effective February 16, 2012, the Veteran has a combined 100 percent disability rating and TDIU is not based on a single service-connected disability. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than February 16, 2012, for the grant of service connection for mood disorder have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.114, 3.400, 3.816. 2. The criteria for an effective date earlier than April 14, 2010, for the grant of service connection for heart disability have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.114, 3.400, 3.816. 3. The criteria for an effective date earlier than October 6, 2013 for the grant of service connection for scar related to heart surgery have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.114, 3.400, 3.816. 4. The criteria for an effective date earlier than June 1, 2009 for the grant of service connection for left knee disability have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.114, 3.400, 3.816. 5. The criteria for an effective date earlier than October 6, 2013 for the grant of SMC have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.114, 3.400, 3.816. 6. The criteria for an evaluation in excess of 60 percent for heart disability have not been met from April 14, 2010 to October 5, 2013. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.100, 4.104, Diagnostic Code (DC) 7018-7011. 7. The criteria for an initial rating higher than 70 percent for mood disorder have not been met. 38 U.S.C. §1155; 38 C.F.R. §4.130, DC 9413. 8. Entitlement to an increased rating for SMC have not been met. 38 U.S.C. §§ 1114 (s), 5107(b); 38 C.F.R. §§ 3.102, 3.350(i). 9. The criteria for entitlement to a TDIU have been met from April 14, 2010 to February 15, 2012. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§3.341, 4.16, 4.19. 10. The criteria for entitlement to a TDIU from February 16, 2012 are not met. 38 U.S.C. § 1114 (s); 38 C.F.R. § 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1969 to March 1973. This appeal comes to the Board from rating decisions issued by a U.S. Department of Veterans Affairs (VA) Regional Office in February 2012, February 2017, and October 2017. The claim for TDIU was denied by way of a February 2012 rating decision. The Veteran did not appeal that decision. The Board of Veteran’s Appeals (Board), however, took jurisdiction of the issue as part and parcel of the increased rating claim for right knee disability in an August 2015 decision, which implicitly remanded the issue. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Thereafter, the claim was remanded in September 2017. The February 2017 rating decision granted service connection for left knee and assigned an initial 10 percent rating effective June 1, 2009. The Veteran disagreed with the evaluation and the effective date assigned. The October 2017 rating decision granted service connection for mood disorder, heart disability, and surgical scar and granted SMC based on housebound criteria. The Veteran disagreed with the evaluations assigned and the effective dates of the benefits. Subsequent rating decisions granted higher initial ratings such that the Veteran’s mood disorder is currently rated 70 percent; and his heart disability is rated 60 percent from April 14, 2010 to October 5, 2013, 100 percent from October 6, 2013 to December 31, 2013, and 60 percent from January 1, 2014. The issues, however, remain on appeal where the maximum rating is not assigned. AB v. Brown, 6 Vet. App. 35. (1993). The 100 percent stage for the heart disability is the maximum rating, so the Board will not discuss that stage further. 1. Entitlement to an effective date earlier than February 16, 2012 for the establishment of service connection for mood disorder is denied. 2. Entitlement to an effective date earlier than April 14, 2010 for the establishment of service connection for heart disability is denied. 3. Entitlement to an effective date earlier than October 6, 2013 for the establishment of service connection for scar related to heart surgery is denied. 4. Entitlement to an effective date earlier than June 1, 2009 for the establishment of service connection for left knee disability is denied. The effective date of an award of disability compensation, in conjunction with a grant of entitlement to service connection, shall be the day following separation from active service or the date entitlement arose, if the claim is received within one year of separation from service. Otherwise, the effective date shall be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400 (b)(2)(i). Notably, neither the Veteran nor his representative have presented any specific evidence or argument to indicate entitlement to an earlier effective date for service connection for mood disorder, heart disability, surgical scar, left knee disability, or SMC based on housebound criteria. The Veteran did not file a claim for disability compensation within a year of his separation from service. The Veteran initially filed claims for service connection for mood disorder, heart disability, and left knee disability, on February 16, 2012, April 14, 2010, and June 1, 2009, respectively. There is no indication that claims for these issues were received earlier than that those dates. Therefore, the claims were assigned an effective date based on the date of receipt of the claim. Even if entitlement arose prior to these dates, an earlier effective date would not be warranted because the date of claim would still be the later date. The Veteran did not file a claim for surgical scar, but service connection was granted as part and parcel of the rating for the service-connected heart disability. Thus, the applicable date of claim in the same as the heart disability: April 14, 2010. However, entitlement to the benefit did not arise until October 15, 2013, the date the Veteran’s pacemaker was implanted, creating the scar. In this case, the October 15, 2013 date entitlement arose is the later of the two dates, so an effective date prior to October 6, 2013 is not warranted. For the foregoing reasons, the preponderance of the evidence is against the Veteran’s claims for earlier effective dates for his service-connected mood disorder, heart disability, surgical scar, and left knee disability. Accordingly, the benefit-of-the-doubt doctrine is not for application, and the claims must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. 5. Entitlement to an effective date earlier than October 6, 2013 for the establishment of entitlement to SMC based on housebound status is denied. Effective dates for SMC are governed by the regulations for increases in disability compensation under 38 C.F.R. § 3.400(o). The effective date is the date of receipt of the claim or the date entitlement arose, whichever is later. Special monthly compensation 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). The Veteran did not file a claim for SMC, but it was granted as part and parcel of the rating for the service-connected heart disability. Thus, the applicable date of claim in the same as the heart disability: April 14, 2010. However, entitlement to the benefit did not arise until October 6, 2013, the date that the Veteran’s heart disability was rated 100 percent disabling and the Veteran had additional service-connected disability that was rated as 60 percent or more. Meeting these criteria warranted assignment of SMC at the housebound rate under 38 U.S.C. § 1114(s). 38 C.F.R. § 3.350(i). Prior to this date, the Veteran did not have a single service-connected disability rated at 100 percent to meet the criteria. In this decision, the Board grants entitlement to a TDIU effective April 14, 2010 to February 15, 2012. A TDIU may serve as the single 100 percent rating if it based on a single disability. See Bradley v. Peake, 22 Vet. App. 280 (2008); Buie v. Shinseki, 24 Vet. App. 242 (2011). However, as explained later in this decision, the TDIU is granted on the basis of the combined effects of the Veteran’s service-connected knee and psychiatric disabilities. Because it is not based on a single disability, it cannot serve as single service-connected disability rated as 100 percent. As no single service-connected disability rated at 100 percent existed prior to October 6, 2013, entitlement first arose on that date and an earlier effective date is not warranted. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate DCs. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, present level of disability is the primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). 6. Entitlement to an initial rating higher than 60 percent for heart disability from April 14, 2010 to October 5, 2013 is denied. The Veteran contends that an increased rating for his service-connected heart disability is warranted. The Veteran’s heart disability is rated as 60 percent throughout the relevant appeal period under DC 7018-7011. Hyphenated DCs are used when a rating under one DC requires the use of an additional DC to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27 DC 7018 provides that an evaluation of 100 percent should be assigned for an implantable cardiac pacemaker for two months following hospital admission for implantation or reimplantation. 38 C.F.R. § 4.104, DC 7018. Thereafter, the Veteran should be evaluated for supraventricular arrhythmias (DC 7010), ventricular arrhythmias (DC 7011), or atrioventricular block (DC 7015). Id. Under DC 7011 for ventricular arrhythmias (sustained), a 60 percent evaluation is warranted for more than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction (LVEF) of 30 to 50 percent. Id. A 100 percent evaluation, the maximum available, is warranted for chronic congestive heart failure, or; workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; LVEF of less than 30 percent. Id. In this case, the preponderance of the evidence of record weighs against rating higher than 60 percent for the appeal period from April 14, 2010 to October 5, 2013. The Board has considered the rating criteria for DCs 7010 (supraventricular arrhythmias), 7011 (ventricular arrhythmias), and 7015 (atrioventricular block); however, a higher evaluation is not warranted under any of these DCs. The Veteran has not been found to have chronic congestive heart failure; a workload of three METs or less that results in dyspnea, fatigue, angina, dizziness, syncope; or a LVEF of less than 30 percent during this stage. In fact, the Veteran underwent a VA examination in October 2010, where the examiner estimated that his MET would be 7. That examination noted no congestive heart failure. The Veteran’s LVEF was 45-49 percent. The Board recognizes that the Veteran believes that his heart disability should be assigned an evaluation higher than 60 percent for the relevant appeal period. However, the probative evidence of record, the October 2010 VA examination report, does not reflect disability picture that is consistent with or that approximates a level of impairment contemplated by a 100 percent rating. For the foregoing reasons, the preponderance of the evidence is against the Veteran’s claims for increased rating for heart disability for the appeal period from April 14, 2010 to October 5, 2013. Accordingly, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 7. Entitlement to an initial rating higher than 70 percent for mood disorder is denied. The Veteran is seeking an increased rating for his service-connected mood disorder, which is currently assigned 70 percent rating under DC 9413. Under DC 9413, a 70 percent disability rating is warranted when the Veteran experiences occupational and social impairment, with deficiencies in most area, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure or irrelevant; near- continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or work like setting); inability to establish and maintain effective relationships. A 100 percent disability rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of closest relatives, own occupation, or own name. 38 C.F.R. § 4.130. The "such symptoms as" language means "for example," and does not represent an exhaustive list of symptoms that must be found before granting the rating of that category. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). The list of examples provides guidance as to the severity of symptoms contemplated for each rating. Id. Accordingly, the evidence considered in determining the level of impairment under § 4.130 is not restricted to the symptoms provided in the DC. However, this fact does not make the provided list of symptoms irrelevant. See Vasquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). The Veteran must still demonstrate either the particular symptoms associated with the rating sought, or other symptoms of similar severity, frequency, and duration. Id. at 117. Therefore, VA must consider all symptoms of a veteran's condition that affect the level of occupational and social impairment, including, if applicable, those identified in the DSM-5. Id. The Board finds that for the entire appeal period, a rating of 100 percent is not warranted, as the evidence does not show total social and occupational impairment at any time. To that end, the Veteran submitted private medical opinion from Dr. A.H.F, who evaluated him in February 2012. Dr. A.H.F. reviewed the claims file and interviewed the Veteran, as well as his mother. Dr. A.H.F wrote that the Veteran’s mood disorder is manifested by symptoms, such as persistent mood disturbance, irritability, as well as impaired memory and concentration. Dr. A.H.F. noted that the Veteran is fully oriented, his judgment and insight were intact, his speech was logical with no indication of unusual thought process. During the evaluation, the Veteran reported that he lacks motivation to go out or do “much of anything.” The examiner, however, noted that the Veteran enjoys fishing and he attempts to help with household tasks. Overall, Dr. A.H.F concluded that the Veteran’s mood disorder results in occupational and social impairment with reduced reliability and productivity. The Veteran also underwent VA examination in October 2013, where the examiner concluded that he has no mental disorder. That examiner, however, noted that the Veteran reported “transient depression related to his recent hospitalization” and “intermittent anxiety.” The Veteran otherwise denied having other symptoms such as irritability, difficulty concentrating, suicidal or homicidal ideation. Although the Veteran was provided a VA examination in September 2016, the examination report does not provide relevant information. The Veteran submitted a statement in March 2020 indicating that he “completely shut down and wouldn’t open up to [the September 2016 examiner] about his thoughts and feelings.” In that communication, he described experiencing depression, and being frustrated because of his declining physical condition. He indicated that he has “no desire to get out and do anything.” Notably, VA treatment records from February 2013 found no anxiety, depression or suicidal or homicidal ideation. In addition, a September 2019 VA treatment records reflect that the Veteran is fully oriented. While a November 2019 VA treatment records shows that the Veteran has depression, anxiety, hallucinations, and suicidal ideation, a December 2019 VA treatment found normal mood and affect. Overall, the Veteran’s symptoms of depression, irritability, anxiety, as well as difficulty with memory and concentration are fully contemplated with the 70 percent rating assigned. To the extent the Veteran describes not wanting to leave his home or engage in activities outside of his home, he has some social impairment and disturbances of motivation are contemplated by even a 50 percent rating. He also has occupational impairment as Dr. A.H.F found that the Veteran’s symptoms result in difficulty with his ability to work independently, stay focused on tasks, and interact appropriately with supervisors and coworkers. But, Dr. A.H.F concluded that the Veteran’s occupational and social impairment has produced no more than reduced reliability and productivity. VA treatment records show that the Veteran’s wife and mother are regularly involved in his medical care. The current 70 percent rating contemplates a very high level of social impairment (inability to form and maintain relationships). There is no indication that he is totally socially impaired. The Veteran’s VA treatment records reflect a report of suicidal ideation and hallucinations in November 2019. However, the medical and lay evidence of record does not show that these symptoms were persistently present. For example, in December 2019 VA treatment record the Veteran attested that in the last two weeks he had “not at all” been bothered by suicidal thoughts or thoughts of hurting himself. Therefore, the Board concludes that the frequency of the Veteran’s suicidal ideation and hallucinations do not to rise to the level contemplated by a 100 percent rating. While the Veteran has some memory issues, the evidence does not show that he cannot remember his own name, names of close relatives, or his own occupation. Furthermore, the evidence does not show grossly inappropriate behavior, or gross impairment of thought process or communication. For these reasons, the Veteran's disability picture taken as a whole does not show symptomatology of the severity, frequency, or duration consistent with a 100 percent disability rating. Thus, the evidence does not support a finding of a rating higher than 70 percent. The Veteran believes that his mood disorder should be assigned an evaluation higher than 70 percent. However, the probative evidence of record does not reflect a disability picture that is consistent with or that approximates a level of total social and occupational impairment contemplated by a 100 percent rating. For the foregoing reasons, the preponderance of the evidence is against the Veteran’s claim for increased rating for mood disorder. Accordingly, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 8. Entitlement to increased rating for SMC based on housebound status is denied. The Veteran was granted SMC at the housebound rate from October 6, 2013 to January 2014. The Veteran appealed “increased rating” for SMC but has provided no explanation or argument for what level of SMC is sought or why an increased rating is warranted. As explained in the earlier effective date analysis, SMC at the housebound rate under 38 U.S.C. § 1114(s) (“statutory housebound” status) is granted when a veteran has a single disability rated totally disabling, and additional disabilities independently rated a combined 60 percent disabling or more. The regulations provide for the payment of SMC at the housebound rate. 38 C.F.R. § 3.350 (i). Thus, the amount payable to the Veteran for SMC based on housebound status is a fixed amount set forth under 38 U.S.C. § 1114 (s). Because the compensation is non-variable amount set by statute, the Board cannot award an increased rating. Therefore, there is no legal basis for the Veteran to obtain increased evaluation for SMC based on housebound status. Neither the record nor the Veteran has raised any theory for a higher level of SMC. The claim is denied. 8. Entitlement to TDIU from April 14, 2010 to February 15, 2012 is granted. The Veteran contends that he is entitled to a TDIU. A TDIU rating may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more.38U.S.C. §1155; 38 C.F.R. §§3.340, 3.341, 4.16(a). The central inquiry for TDIU 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). Consideration may be given to the veteran’s level of education, special training, and previous work experience, but advancing age and the impairment caused by non-service-connected disabilities are not for consideration in determining whether such a total disability rating is warranted. See 38C.F.R. §§3.341, 4.16, 4.19. Here, as of April 2010, the Veteran has a combined disability rating of 80 percent and a single disability, mood disorder, rated as 70 percent. Therefore, the Veteran’s service-connected disabilities meet the threshold for schedular TDIU consideration from April 14, 2010 to February 15, 2012. The Veteran reported that he has completed three years of high school and he last worked as small engine repair man in 2005. See October 2018 VA Form 21-8940. Review of the medical evidence of record reflects that the Veteran’s service-connected disabilities significantly limit physical activities. Specifically, because of his service-connected bilateral knee disability, the evidence shows that the Veteran has difficulty with prolonged walking, standing, climbing, and squatting. See February 2010 VA knee examination; see also August 2011 VA knee examination. In addition, an August 2011 VA examination shows that the Veteran’s diabetes causes “fatigue impacting all general activities.” Moreover, the Veteran is unable to lift his right arm over his right shoulder due to his service-connected right shoulder disability. See August 2011 Shoulder VA examination. The Board recognizes that in addition to the Veteran’s physical limitations, he also has psychiatric condition, mood disorder, that causes some occupational impairment. As previously noted, the record has an opinion from Dr. A.H.F that shows that the Veteran’s mood disorder causes significant difficulty working independently, concentrating on a task, interacting appropriately with supervisors and coworkers, or adjusting to changes at work. In sum, the Veteran’s occupational history reflects experience in work that would require physical labor. When the Veteran filed a claim with Social Security Administration, he reported that his work as small engine repairman requires using his hands, bending, and crawling. He estimated that his work required walking and standing for hours. The evidence of record reflects that the Veteran has significant difficulty with mobility. Combined with his psychiatric disability, his physical limitations cause impairment that will likely preclude employment. Reviewing the totality of the evidence of record in light most favorable to the Veteran, and resolving reasonable doubt in his favor, the Board finds that the Veteran is precluded from securing or following a substantially gainful occupation due to his service-connected disabilities during the appeal period from April 14, 2010 to February 15, 2012. Therefore, the Board finds that a TDIU is warranted for this period. 9. Entitlement to a TDIU effective February 16, 2012 is denied The Veteran’s combined rating is 100 percent beginning February 16, 2012. A 100 percent rating under the Schedule for Rating Disabilities means that a Veteran is totally disabled. Holland v. Brown, 6 Vet. App. 443, 446 (1994), citing Swan v. Derwinski, 1 Vet. App. 20, 22 (1990). As a TDIU rating may only be assigned where the schedular rating is less than total, a TDIU is not available from February 16, 2012. 38 C.F.R. § 4.16. As explained in the earlier effective date analysis for SMC, a grant of 100 percent rating does not always render the issue of TDIU moot. Specifically, a TDIU may be granted for the purpose of serving as the single 100 percent disabling disability for SMC at the housebound rate under 38 U.S.C. § 1114(s). 38 C.F.R. § 3.350(i). However, TDIU must be warranted based solely on a single disability. Bradley, 22 Vet. App. 280; Buie, 24 Vet. App. 242. As explained above, the Veteran’s TDIU is granted on the basis of the combined effects of the Veteran’s service-connected knee and psychiatric disabilities. Because it is not based on a single disability, it cannot serve as single service-connected disability rated as 100 percent for the purpose of SMC. Thus, a TDIU is denied from February 16, 2012. REASONS FOR REMAND 10. Entitlement to rating higher than 60 percent from January 1, 2014 for heart disability is remanded. 11. Entitlement to an initial compensable disability rating for surgical scar related to heart disability is remanded. The Veteran is seeking an increased rating for his heart disability. The Veteran was provided VA examinations in October 2018 and January 2017. Since that time, he underwent a procedure to update his pacemaker in May 2019. Considering this procedure, the Board cannot be sure that the examinations of record reflect an accurate picture of the severity of the Veteran’s current disability. Furthermore, both examinations do not show the Veteran’s LVEF. As such, the Board does not have information regarding the Veteran’s LVEF for the appeal period after January 1, 2014. Therefore, the Board finds that a remand to obtain another examination is necessary before the claim can be adjudicated. Because the heart examination that will be provided on remand may provide additional information regarding the Veteran’s scar, the issues are inextricably intertwined. Therefore, a remand of the claim for entitlement for an initial compensable disability rating for surgical scar related to heart surgery is required. 13. Entitlement to rating higher than 10 percent for left knee disability is remanded. The most recent VA examination for the left knee is from August 2011. To the extent the examination does not contain information regarding weight and nonweight bearing testing, it does not comply with the requirements of Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Furthermore, the Veteran reported experiencing flare-ups, but the examiner did not comment on whether there is additional functional loss or additional range of motion loss during flare-ups. Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). Therefore, a remand to obtain another examination is necessary before the claim can be adjudicated. 14. Entitlement to a TDIU from June 1, 2009 to April 13, 2010 is remanded. Finally, because the TDIU claim is part and parcel of the claim for increased rating for right knee disability that was received on June 1, 2009, the appeal period for TDIU starts on the same date. Prior to April 14, 2010, the Veteran’s service-connected disabilities did not meet the requirements of 38 C.F.R. § 4.16(a), as he did not have a single service-connected disability ratable at 60 percent or more, or a combined rating of 70 percent or more. However, as the appeal period for the increased rating for the left knee also begins on June 1, 2009, a decision on that issue could significantly impact a decision on the issue of entitlement to a TDIU from June 1, 2009 to April 13, 2010. As such the issues are inextricably intertwined. Therefore, a remand of the claim for entitlement for TDIU prior to April 14, 2010 is required. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected heart disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria, including LVEF and METS. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected surgical scar related to heart disability. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left knee disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. In so doing, the examiner must test the Veteran’s range of active motion, range of passive motion, and indicate whether there is pain with weight-bearing and without weight-bearing. The degree to which pain limits active and passive motion should be indicated. In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. After the above development, and any additionally indicated development, has been completed, readjudicate the inextricably intertwined issue of TDIU for the appeal period prior to April 14, 2010. LAURA E. COLLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Solomon 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.