Citation Nr: 21010507 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 13-17 935 DATE: February 25, 2021 ORDER Entitlement to service connection for erectile dysfunction is denied. Entitlement to service connection for a right foot disability is denied. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance, or at the housebound rate, is denied. From October 18, 2012 to January 8, 2014, entitlement to an extraschedular total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. The Veteran’s erectile dysfunction did not originate in service or until years thereafter, is not otherwise etiologically related to service, and was not proximately due to or aggravated by a service-connected disability. 2. The Veteran’s right foot disability was noted at entrance into service, and the right foot disability did not undergo aggravation during service and was not aggravated by a service-connected disability beyond the natural progression of the disability. 3. The preponderance of the evidence is against a finding that the Veteran’s service-connected disabilities render him so helpless as to need regular aid and attendance. 4. During the period on appeal, the Veteran has not had a service-connected disability rated as total. 5. From October 18, 2012 to January 8, 2014, the Veteran’s service-connected disabilities did not prevent him from obtaining or maintaining a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for entitlement to service connection for a right foot disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 3. The criteria for entitlement to special monthly compensation (SMC) based on the need for aid and attendance, or at the housebound rate, have not been met. 38 U.S.C. §§ 1114(s), 1541, 5103, 5103A, 5107, 5121; 38 C.F.R. §§ 3.102, 3.159, 3.350, 3.352, 3.1000. 4. From October 18, 2012 to January 8, 2014, the criteria for entitlement to an extraschedular total disability rating based on individual unemployability (TDIU) have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1976 to January 1979 and from March 1979 to January 1998. This case comes before the Board of Veterans’ Appeals (Board) on appeal from January 2014, August 2016, and February 2019 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). The appeal was last remanded by the Board in July 2018 for additional development. A review of the claims file shows that there has been substantial compliance with the Board’s prior remand directives and thus, no further action in this regard is warranted. See Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection generally requires evidence satisfying three criteria: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (“nexus”) between the current disability and the disease or injury incurred or aggravated during service. Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). Secondary service connection may be granted when a disability is proximately due to or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 447-48 (1995). At the time of the service entrance examination, every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111. Only such conditions as are recorded in examination reports are considered as “noted.” 38 C.F.R. § 3.304 (b). When determining whether a defect, infirmity, or disorder is “noted” at entrance into service, supporting medical evidence is needed. Crowe v. Brown, 7 Vet. App. 238 (1994). Congenital or developmental defects are not diseases or injuries within the meaning of the applicable legislation. 38 C.F.R. §§ 3.303 (c), 4.9. Service connection may, however, be granted for disability due to in-service aggravation of such a condition due to superimposed disease or injury. See VAOPGCPREC 82-90 (July 18, 1990); VAOPGCPREC 67-90 (July 18, 1990). A preexisting disease or injury will be found to have been aggravated by service only if the evidence shows that the underlying disability underwent an increase in severity; the occurrence of symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (a); Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002). Evidence of the veteran being asymptomatic on entry into service, with an exacerbation of symptoms during service, does not constitute evidence of aggravation. Green v. Derwinski, 1 Vet. App. 320, 323 (1991). A temporary or intermittent flare-up of a preexisting disease does not constitute aggravation. unless the underlying condition, as contrasted to symptoms, is permanently worsened. Jensen v. Brown, 4 Vet. App. 304, 306-307 (1993), citing Hunt v. Derwinski, 1 Vet. App. 292 (1991). If the disorder becomes worse during service and then improves due to in-service treatment to the point that it was no more disabling than it was at entrance into service, the disorder has not been aggravated by service. Verdon v. Brown, 8 Vet. App. 529 (1996). 1. Entitlement to service connection for erectile dysfunction The Veteran contends that he lost his sexual desire and has no interest in sex and that this may be due to his psychiatric disability. Factual Background Service treatment records and post-service treatment records are negative for any evidence of complaints, treatment or a diagnosis related to an erectile dysfunction disability. In fact, during a July 2013 VA examination for a central nervous system condition, the Veteran reported that he had no erectile dysfunction. An April 2015 statement from the Veteran’s late wife explained that the Veteran showed a loss of interest and pleasure in being sexual and physical. The Veteran was afforded a VA examination in September 2019. The September 2019 VA examiner’s report noted a diagnosis of erectile dysfunction with an unknown etiology. The examiner noted that diagnostic testing, such as testosterone level testing and hormone level testing, was not conducted. The September 2019 VA examiner’s report determined that the Veteran’s erectile dysfunction was less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service-connected disabilities, to include his service-connected psychiatric disability. The examiner explained that there were multiple medical reasons for erectile dysfunction including the normal aging process, medical conditions, and medications. The examiner cited to medical literature and concluded that the likely cause of the Veteran’s erectile dysfunction was the normal aging process and possibly a progression of the Veteran’s diabetes. Analysis The Veteran does not allege, nor does the evidence suggest, that his erectile dysfunction was directly caused by his military service. Accordingly, service connection based on a direct theory of entitlement is not warranted. Instead, the Veteran contends that his service-connected disabilities, to include his psychiatric disability, caused his erectile dysfunction. The September 2019 VA examiner’s report did note that the Veteran had erectile dysfunction; however, the report found that the Veteran’s erectile dysfunction was less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service connected-disabilities, to include his service-connected psychiatric disability. Instead, the examiner explained that the Veteran’s erectile dysfunction was likely caused by the normal aging process and progression of the Veteran’s non-service-connected diabetes. No medical evidence contained in the record supports a positive nexus between the Veteran’s erectile dysfunction and any of his service-connected disabilities. The Board affords the uncontradicted September 2019 VA examiner’s opinion high probative value. The Board acknowledges the April 2015 statement made by the Veteran’s late wife, as well as the veteran’s statements concerning the etiology of the erectile dysfunction. Inasmuch as the Veteran’s late wife attempted, and the veteran attempts. to establish a nexus between the Veteran’s erectile dysfunction and his service-connected disabilities, the Board finds that, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the cause of the Veteran’s erectile dysfunction, it falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). This is because there are multiple possible etiologies to account for the dysfunction, and expecting a layperson to have the capability of distinguishing among them to determine the most likely etiology is not reasonable. Accordingly, the Veteran and his late wife are not competent to provide an etiology opinion and their statements are again afforded low probative value. The Board finds the evidence described above provides probative evidence against this claim. In sum, the record does not contain probative lay or medical evidence sufficient to establish a medical nexus between the Veteran’s erectile dysfunction and his military service or his service-connected disabilities. The preponderance of the evidence is against the claim. 2. Entitlement to service connection for a right foot disability The Veteran contends that pain in his right foot is caused or aggravated by his service-connected disabilities, to include his service-connected left foot disability or his service-connected psychiatric disability. Factual Background A December 1975 entrance examination noted that the Veteran had pes planus. A December 1975 report of medical history noted that the Veteran did not have foot trouble. A November 1978 report of medical examination noted that the Veteran’s feet were normal. A September 1986 service treatment record notes that the Veteran had mild, asymptomatic pes planus. A November 1988 service treatment record notes that the Veteran had marked swelling, burning, and itching of both feet. A September 1990 report of medical examination noted that the Veteran’s feet were normal. An August 1997 report of medical history notes that the Veteran had foot trouble. A November 1997 report of medical history noted that at the time of the Veteran’s retirement he reported foot trouble and stated that his foot goes numb and hurts after running or a long period of walking or standing. A November 1997 report of medical examination notes that the Veteran’s feet were abnormal and that he had asymptomatic pes planus. The Veteran was afforded a VA examination in June 2016. The June 2016 VA examiner’s report noted that the Veteran had right foot pes planus. The VA examiner considered the Veteran’s contention that his service-connected left foot disability caused his right foot disability. The examiner’s etiology opinion was confusing but noted that paresthesia is a known causative factor for the development of pes planus in the same foot. However, the examiner did not note a diagnosis of paresthesia in the right foot. The June 2016 VA examiner’s opinion determined that the Veteran right foot disability was less likely than not proximately due to or the result of a service-connected disability. A subsequent August 2016 VA addendum opinion clarified that that there is no evidence that left foot paresthesia can cause pes planus in the contralateral foot. The August 2016 addendum opinion concluded that the Veteran’s right foot disability was less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service-connected left foot disability. The Veteran was afforded another VA examination in September 2019. The September 2019 VA examiner’s report noted right foot diagnoses of pes planus, hallux valgus, and arthritis conditions. The September 2019 VA examiner’s report cited the December 1975 entrance examination which noted that the Veteran had bilateral pes planus upon entrance into the military and the November 1997 separation examination which noted that the Veteran’s pes planus was asymptomatic and without any change in severity. The report concluded that the Veteran’s right foot disability clearly and unmistakably existed prior to service and was not aggravated beyond its natural progression by an in-service event, injury, or illness. The September 2019 VA examiner’s report also addressed the Veteran’s contentions that his service-connected psychiatric disability caused or worsened his right foot disability but explained that medical literature did not support such a connection. Instead, the VA examiner explained that the most likely etiology of the Veteran’s right foot pain was mild degenerative changes noted on a June 2016 x-ray, which was likely due to the normal aging process and overuse post-service. The report also concluded that the Veteran’s right foot disability was less likely than not (less than 50 percent probability) proximately due to, the result of, or aggravated beyond the natural progression by the Veteran’s service-connected disabilities. Analysis The December 1975 entrance examination specifically identified pes planus. Since the disorder was noted at entrance, the presumption of soundness is not for application. The Veteran does not dispute that his pes planus was present at entrance into active duty service. The Board must first evaluate whether the Veteran’s military service aggravated his right foot disability. While the Veteran did report problems with his feet on a few occasions during his more than two decades of active duty military service, the Board notes that exacerbation of symptoms during service, temporary or intermittent flare-ups, and worsening during service that then improves to the point that it was no more disabling that it was at entrance int to service, does not constitute aggravation. See Green v. Derwinski, 1 Vet. App. 320, 323 (1991). See also Jensen v. Brown, 4 Vet. App. 304, 306-307 (1993), citing Hunt v. Derwinski, 1 Vet. App. 292 (1991), and Verdon v. Brown, 8 Vet. App. 529 (1996). Here the service treatment records indicate that the Veteran’s right foot pes planus was asymptomatic upon both entrance into active duty service and separation from active duty service. The evidence shows that reports of in-service symptoms and flares were minimal and resolved prior to separation from active duty service. The September 2019 VA examiner’s report confirmed that the Veteran’s right foot disability did not undergo a change in severity during service and was not aggravated beyond its natural progression by an in-service event, injury, or illness. Accordingly, the presumption of aggravation does not apply, aggravation was not otherwise demonstrated, and thus service-connection based on aggravation during service must be denied. As to the other right foot disorders, the September 2019 examiner concluded that the disorders were due to factors other than service, such as the normal aging process. Next the Board must consider whether the Veteran’s service-connected disabilities have aggravated his right foot disability. June 2016 and August 2016 VA examiner’s reports both found that the Veteran’s left foot disability less likely than not caused his right foot disability. The Board notes that the reports did not address the fact that the right foot pes planus was noted on entry into service. The September 2019 VA examiner’s opinion noted right foot diagnoses of pes planus, hallux valgus, and arthritis. The uncontradicted September 2019 VA examiner’s report found that the Veteran’s service-connected disabilities did not aggravate the Veteran’s right foot disability. Instead, the September 2019 VA examiner’s report attributed the Veteran’s right foot pain to the normal aging process and post-service overuse. In other words, the examiner found no link between the current right foot disorders and service-connected disability. The Board affords high probative value to the September 2019 VA examiner’s report. The Board finds that determining whether the right foot disorders were aggravated by already service-connected disorders is not a matter susceptible to lay expertise in this case. In other words, the Board finds the veteran is not competent to opine as to whether service-connected disability caused or aggravated the right foot disability. In sum, the record does not contain probative lay or medical evidence sufficient to establish that the Veteran’s active duty service or service-connected disabilities aggravated his right foot disability. The preponderance of the evidence is against the claim. Accordingly, while the Board is very sympathetic to the appellant’s situation, service connection for aggravation of the Veteran’s right foot disability must be denied. 3. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance, or at the housebound rate The Veteran contends that he is unable to perform activities of everyday living, such as ambulation, cooking, driving, and performing general hygiene because of foot pain, blindness, and a psychiatric disability. SMC is payable at a specified rate if a veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of both feet, or of one hand and one foot; is blind in both eyes, with visual acuity of 5/200 or less; is permanently bedridden; or is so helpless as to be in need of regular aid and attendance. 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.350 (b). The criteria for determining that a veteran is so helpless as to be in need of “regular aid and attendance” include: (1) the inability of the claimant to dress or undress himself or herself or to keep himself or herself ordinarily clean and presentable; (2) the frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without assistance; (3) the inability of the claimant to feed himself or herself through loss of coordination of upper extremities or through extreme weakness; (4) the inability to attend to the wants of nature; or (5) incapacity, either physical or mental, that 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). Being “bedridden” will also be a proper basis for finding that a VA claimant is in need of regular aid and attendance. The term “bedridden” means a condition which, through its essential character, actually requires that the claimant remain in bed. However, the fact that someone 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 is not sufficient. 38 C.F.R. § 3.352 (a). Under 38 U.S.C. § 1114(s), SMC is also payable at the housebound rate where the claimant has a single service-connected disorder rated as total and one or more distinct service-connected disabilities, which are independently ratable at 60 percent or more and involve different anatomical segments or bodily systems. 38 U.S.C. § 1114 (s)(1); 38 C.F.R. § 3.350 (i). For purposes of section 1114(s), a TDIU may meet the 100 percent criterion, but only if assigned for a single disability. See Bradley v. Peake, 22 Vet. App. 280 (2008); Buie v. Shinseki, 24 Vet. App. 242 (2011). Factual Background The Veteran was afforded a VA examination for housebound status or permanent need for regular aid and attendance in October 2012. The October 2012 VA examiner’s report noted that the Veteran became blind following the removal of a brain tumor and needed help with bathing and tending to other hygiene, ambulating, medication management, paying bills and writing checks, and driving to doctors’ appointments. A November 2012 letter from the Veteran’s treating physician contained in the VA treatment records notes the Veteran’s need for aid and assistance. The letter explains that the Veteran is legally blind following a meningioma surgery in 2010 and has since relied on caregivers for assistance with activities of daily living to assist with bathing, eating, grooming, and transportation. The letter further explains that the Veteran is housebound and unable to seek employment due to his permanent blindness. A November 2012 buddy statement from T.A. explains that the Veteran is housebound and unable to work so T.A. assists the Veteran in his everyday living and transportation. Another November 2012 buddy statement from T.A. notes that T.A. assists the Veteran in picking out his clothing, preparing his meals, assisting him to the restroom, providing transportation, and escorting him to doctor appointments. An April 2015 statement from the Veteran’s late wife explained that she took the Veteran to all his appointments. The Veteran was afforded another VA examination in May 2015. The May 2015 VA examiner’s report again noted that the Veteran was legally blind following the removal of a brain tumor. The examiner noted that the Veteran needed assistance in bathing and tending to other hygiene needs, dressing himself, managing his medication, managing his finances, and ambulating. The Veteran was also afforded a VA examination for his service-connected acquired psychiatric disability in December 2015. The December 2015 VA examiner found that the Veteran’s acquired psychiatric disability resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. Noted symptoms included depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, flattened affect, speech intermittently illogical, obscure, or irrelevant, difficulty in understanding complex demands, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a worklike setting, inability to establish and maintain effective relationships, neglect of personal appearance and hygiene, and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. However, the Veteran was found capable of managing his financial affairs. The Veteran was afforded a VA examination in June 2016. The June 2016 VA examiner’s report again noted that the Veteran was legally blind due to the removal of a brain tumor. The examiner noted that the Veteran need assistance with bathing and tending to other hygiene needs, dressing, medication management, writing checks and paying his bills, ambulating, cooking, and driving to doctor appointments. Identical buddy statements dated in June 2016 from J.P. and T.A. explained that the Veteran’s children take care of him. The letter explains that the Veteran has permanent optic nerve damage, a left foot and ankle disability, acid reflux, a right shoulder disability, a left shoulder disability, irritable bowel syndrome, high cholesterol, diabetes, keloids, PTSD, and is still recovering from the removal of a brain tumor. The statement further explains that the Veteran’s blindness affects his ability to dress, feed, shave, and groom himself and to attend to the wants of nature. The statement further explains that the Veteran’s late wife previously assisted with these tasks until her death. The Veteran was afforded another VA examination for his acquired psychiatric disability in January 2017 during which the Veteran was determined to have total occupational and social impairment. The Veteran was also found to be uncapable of managing his financial affairs. A November 2017 buddy statement from C.S. explained that the Veteran’s daughter made sure that the Veteran ate, would take care of his house, and would shop for him. Another November 2017 buddy statement from J.W. explained that the Veteran’s depression and anxiety make it hard for the Veteran to leave his home and go to the store for things he needs. And, a December 2017 buddy statement from M.C. explains that the Veteran has to have someone to shop, run errands, perform housework, and make sure he takes his medicine. The Veteran also obtained a January 2018 private opinion addressing the level of impairment caused by his acquired psychiatric disability. The January 2018 private opinion found that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The private provider also noted that the Veteran was capable of managing his financial affairs but that the Veteran’s adult children handled his household finances for him. The January 2018 private opinion noted that the Veteran’s symptoms included depressed mood, anxiety, suspiciousness, panic attacks more than once a week, near-continuous pain or depression affecting the ability to function independently, appropriately, and effectively, chronic sleep impairment, mild memory loss, such as forgetting names, directions, or recent events, impairment of short and long term memory, flattened affect, disturbance of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a worklike setting, inability to establish and maintain effective relationships, persistent delusions or hallucinations, neglect or personal appearance and hygiene, and intermittent inability to perform activities of daily living including maintenance of minimal personal hygiene. In regard to activities of daily living, the private opinion noted that the Veteran’s children assisted him with shopping, cooking, household chores, managing his finances, and reminding him about personal hygiene. T.A. submitted another buddy statement in September 2020 in which T.A. asserted that the Veteran struggles with memory, motivation, isolation, frustration, sleep and depression. She stated that she reminds the Veteran to take his medications, writes his appointments in a calendar and reminds the Veteran when they are scheduled, takes the Veteran to appointments, pays his bills on his behalf, and takes the Veteran to perform errands such as grocery shopping and getting fast food. T.A. also alleged that the Veteran had trouble sleeping and she would sometimes stay at the Veteran’s house until he fell asleep at approximately 2 or 3 o’clock in the morning. She admitted that the Veteran takes care of his hygiene but that she has to set out his clothes for him because he cannot match colors together. She also claimed that her niece lives with the Veteran and helps him with cooking and other needs. In addition, she stated that the Veteran has someone perform yard work for him because the Veteran is unable to do so himself. M.A. submitted a buddy statement in September 2020 in which she stated that she witnessed the Veteran struggle with memory, motivation, sleep, mood swings, frustration, isolation, and depression. M.A. confirmed that T.A. assists the Veteran with tasks such as ensuring that he has taken his medication. M.A. also asserted that the Veteran will call her at 3 or 4 o’clock in the morning and talk to her but that she will not know what he is talking about. M.A. also explained that the Veteran’s poor eyesight causes difficulty navigating rooms if it is cloudy or dark and that the Veteran has to have someone lay out his clothes for him so that everything is matching and clean. She also reported that the Veteran needs someone to drive him and perform yardwork and household chores since he cannot do them himself. During the period on appeal, the Veteran has been awarded service connection for a right shoulder disability, a left ankle disability, a left foot disability, a psychiatric disability, neck keloids, headaches, scars, irritable bowel syndrome (severed in December 2018), and chronic fatigue syndrome (severed in December 2017). The Veteran has not been awarded a 100 percent rating for any single disability; however, the Veteran was awarded TDIU effective January 2014 due to several of his service-connected disabilities. Analysis In this matter, the evidence of record does not reflect that service-connected disabilities have resulted in the Veteran being permanently bedridden, with the anatomical loss or loss of use of both feet or one hand and one foot, or blind in both eyes. See 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.350 (b). While the record indicates that the Veteran is legally blind following the removal of a brain tumor, the Veteran has not been awarded service connection for any disability related to his brain tumor or blindness. Furthermore, while the Veteran contends that he has difficulty walking due to a bilateral foot disability, he has not been awarded service connection for any right lower extremity disability. Accordingly, the Veteran does not have anatomical loss of or loss of use of both feet due to service-connected disabilities in both feet. Therefore, the remaining questions before the Board are whether the Veteran is so helpless as to be in need of regular aid and attendance due to his service-connected disabilities and whether the Veteran qualifies for SMC at the housebound rate. The Board acknowledges the November 2012, April 2015, December 2017, and September 2020 buddy statements indicating that the Veteran needs aid and attendance; however, these buddy statements do not indicate that any of the Veteran’s service-connected disabilities are the cause for such a need. The Board acknowledges the June 2016 buddy statements indicate that the Veteran’s service-connected disabilities affect him, however, these statements only indicate that the Veteran’s blindness, a non-service-connected disability, affects his ability to care for himself. And, while the November 2017 buddy statement indicates that the Veteran’s service-connected psychiatric disability impacts his ability to leave his home and shop for himself and the September 2020 buddy statements indicate that the Veteran has psychiatric symptoms including problems with memory, motivation, isolation, frustration, sleep, and depression, the overwhelming evidence shows that the Veteran’s non-service-connected blindness is the predominant disorder impacting his ability to drive, cook, dress himself, perform yardwork, and perform household chores. Furthermore, the Board emphasizes that the October 2012, May 2015, and June 2016 VA examiner’s reports, as well as the November 2012 letter from the Veteran’s treating physician, all indicate that the Veteran’s non-service-connected blindness creates the need for regular aid and attendance, not the Veteran’s service-connected disabilities. The Board acknowledges the December 2015 and January 2017 VA examiner’s reports noting that the Veteran had occupational and social impairment due to his service-connected acquired psychiatric disability. And, that the January 2017 VA examiner found the Veteran to be uncapable of managing his financial affairs. The Board also acknowledges the January 2018 private opinion that found that in regard to activities of daily living, the Veteran’s children assisted him with shopping, cooking, household chores, managing his finances, and reminding him to maintain his personal hygiene, however, the Board notes that the private opinion did not acknowledge the Veteran’s blindness and did not specify whether the Veteran’s need for assistance with activities of daily living was due to his service-connected acquired psychiatric disability or other non-service connected disabilities such as his blindness. The Board finds that the preponderance of the evidence shows that the Veteran does not require the aid of another person in the performance of activities of daily living; primarily his blindness and bilateral foot disability are responsible. However, the Veteran’s blindness and right foot disability have not been awarded service connection, and the Board finds that the left foot disorder, alone, does not result in the need for aid and attendance. Special monthly compensation for aid and attendance cannot be awarded for occupational impairment caused by non-service-connected disabilities. The Veteran’s service-connected disabilities to include a right shoulder disability, a left ankle disability, a left foot disability, a psychiatric disability, neck keloids, headaches, scars, irritable bowel syndrome (severed in December 2018), and chronic fatigue syndrome (severed in December 2017) have not been shown to cause the Veteran to be so helpless as to be in need of regular aid and attendance due to his service-connected disabilities. Lastly, SMC at the housebound rate is not available to the Veteran because he does not have a single service-connected disorder rated as total. While the Veteran has been awarded a 100 percent rating based on TDIU, the Veteran’s TDIU was not assigned for a single disability. Accordingly. SMC at the housebound rate is not for application. 38 U.S.C. § 1114 (s)(1); 38 C.F.R. § 3.350 (i). See Bradley v. Peake, 22 Vet. App. 280 (2008); Buie v. Shinseki, 24 Vet. App. 242 (2011). Accordingly, SMC is denied. 4. Entitlement to total disability based on individual unemployability (TDIU) from October 18, 2012 to January 8, 2014 The Veteran asserts that after service he worked in shipping and receiving but that he has not been able to work since 2010 as a result of his physical disabilities and blindness. Entitlement to a TDIU requires the presence of impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. See 38 U.S.C. § 1155; 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.” See 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 in arriving at a conclusion, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. Where the schedular rating is less than total, a total disability rating for compensation purposes may be assigned when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one ratable at 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, 4.16(a). However, a total rating may nonetheless be granted on an extraschedular basis in exceptional cases (and pursuant to specifically prescribed procedures) when the veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. See 38 C.F.R. § 4.16 (b). Factual Background A February 2011 Social Security Administration (SSA) determination indicates that the Veteran was retroactively awarded SSA disability benefits from May 2010 when primary and secondary diagnoses of visual disturbances and blindness prevented the Veteran from working. As of October 18, 2012, the Veteran was service connected for a right shoulder disability (20 percent); a left ankle disability (20 percent); and a left foot disability (20 percent) with a combined rating of 60 percent. A November 2012 letter from the Veteran’s treating physician explains that the Veteran is housebound and unable to seek employment due to his permanent blindness. A December 2012 VA examination for the Veteran’s left ankle disability noted that the disability impacted the Veteran’s ability to work because chronic ankle pain limited his ability to walk. A December 2012 VA examiner’s report for the Veteran’s left foot disability noted that the disability impacted the Veteran’s ability to work because he experienced pain with standing and weight bearing. A December 2012 VA general medical examination noted that the Veteran’s left ankle and left foot prevented him from maintaining gainful employment in the physical environment but that he was able to maintain sedentary employment. The December 2012 VA examiner’s report continued stating the Veteran was going to return to work in 2010 but could not because of his eyesight. Analysis From October 18, 2012 to January 8, 2014, the Veteran did not qualify for schedular TDIU because he did not have any one service-connected disability rated at 60 percent or more. In addition, the combined rating of all the Veteran’s service-connected disabilities was only 60 percent. As a result, schedular TDIU is not for application. However, TDIU may nonetheless be granted on an extraschedular basis in exceptional cases (and pursuant to specifically prescribed procedures) when the veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. See 38 C.F.R. § 4.16 (b). From October 18, 2012 to January 8, 2014, the Veteran was only awarded service connection for a right shoulder disability, a left ankle disability, and a left foot disability. While the December 2012 VA examiner found that the Veteran’s service-connected left ankle disability prevented the Veteran from physical labor, the examiner also found that the Veteran was capable of sedentary work. The Board notes that “sedentary work”, as the term is used by the December 2012 VA examiner, is not defined in the relevant statues, regulations, or caselaw, and that the Board must provide a definition on a case-by-case basis. See Withers v. Wilkie, 30 Vet. App. 139 (2018). In this case, the Board defines “sedentary work” as work that is performed mostly in a sitting position and requires no more than 2 hours of standing and/or walking in an 8-hour workday. Occupations representative of sedentary work include clerical work, inspection work, and assembly work. Such work is performed mostly in a sitting position and would not require the type of demanding physical work or persistent strenuous activity, such as carrying and lifting, that is precluded by the Veteran’s service-connected disabilities. The evidence of record also shows that the Veteran had the mental ability to perform the activities required to perform sedentary work. As such, the probative evidence of record does not show that from October 18, 2012 to January 8, 2014 the Veteran was unable to secure or follow a substantially gainful occupation due to his service-connected disabilities. Rather, due to his service-connected disabilities, the Veteran was limited to sedentary work, as the Board has defined that term above. Moreover, the February 2011 SSA determination indicates that the Veteran was awarded SSA disability benefits due to his visual disturbances and blindness. The November 2012 letter from the Veteran’s treating physician is consistent with the Veteran’s reports that his blindness prevented him from working. And, the December 2012 VA examiners’ report notes that the Veteran had intended to return to work in 2010 but could not because of his blindness. The Board again notes that the Veteran’s blindness is not a service-connected disability and cannot be the reason for an award of TDIU. While the evidence shows that the Veteran’s right shoulder disability, left ankle disability, and left foot disability impacted the Veteran’s ability to engage in physical labor, the evidence shows that the Veteran’s service-connected disabilities did not impact sedentary work. Rather, the evidence shows that the Veteran’s non-service-connected blindness was the primary factor impacting the Veteran’s ability to maintain substantially gainful employment. Extraschedular TDIU cannot be awarded for occupational impairment caused by non-service-connected disabilities. Based on the foregoing, the Board finds that the preponderance of the evidence is against the appeal assignment of TDIU due to service-connected disabilities from October 18, 2012 to January 8, 2014. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. Because the record does not show that the Veteran was unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities, the Board finds no reason to refer the Veteran’s claim to the Director of VA Compensation and Pension Service for extraschedular TDIU consideration. The claim for entitlement to extraschedular TDIU must be denied. As of January 9, 2014, the Veteran was awarded schedular TDIU by the RO. As a result, the Veteran received a full grant of the benefit sought as of January 9, 2014 and, therefore, the period from January 9, 2014 is not on appeal. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Palombi, 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.