Citation Nr: 21010840 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 15-46 659 DATE: February 25, 2021 ORDER A rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) with depression, anxiety and alcohol use disorder prior to April 26, 2017 is granted, subject to the law and regulations governing the payment of monetary benefits. A total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is granted prior to January 16, 2019, subject to the law and regulations governing the payment of monetary benefits. Special monthly compensation (SMC) under 38 U.S.C. § 1114 (s) is granted subject to the law and regulations governing the payment of monetary benefits. FINDINGS OF FACT 1. Resolving doubt in favor of the Veteran, the severity, frequency, and duration of his PTSD with depression, anxiety and alcohol use disorder symptoms more closely approximated by reduced reliability and productivity in “most areas” such as work, school, family relations, judgment, thinking or mood, and did not more closely approximate total occupational and social impairment prior to April 26, 2017. 2. The most probative evidence of record reflects that the Veteran is unable to secure or follow a substantially gainful occupation due solely to his service-connected disabilities prior to January 16, 2019. 3. The Veteran has a single service-connected disability rated as 100 percent disabling and an additional service-connected disability independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability. CONCLUSIONS OF LAW 1. The criteria for a disability rating of 70 percent, but no higher, for PTSD have been met prior to April 26, 2017. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.126, 4.130, diagnostic code 9411. 2. The criteria for entitlement to a TDIU due to service-connected disability have been met prior to January 16, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. 3. The criteria for entitlement to SMC under 38 U.S.C. § 1114 (s) have been met. 38 U.S.C. § 1114 (s); 5103, 5107; 38 C.F.R. § 3.102, 3.350. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1966 to April 1968. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In December 2019, the Board denied the appeal of entitlement to an increased rating in excess of 50 percent for service-connected PTSD with depression, anxiety and alcohol use disorder prior to April 26, 2017. The Veteran appealed to the Court of Appeals for Veteran’s Claims (CAVC). In August 2020, the CAVC granted a Joint Motion for Partial Remand (JMPR), which vacated, in part, the December 2019 Board decision and remanded the matters to the Board for action consistent with the JMPR. The JPMR specifically indicated that the Veteran did not wish to challenge the denial of an increased rating from April 26, 2017; thus, the Board finds this issue has been abandoned. In an April 2019 rating decision, the RO granted TDIU due to service-connected disabilities, effective January 16, 2019. The Veteran explicitly raised entitlement to a TDIU due to service-connected disabilities during the pendency of his increased rating claim for PTSD with depression, anxiety and alcohol use disorder, thus entitlement to a TDIU, to include consideration of entitlement to SMC, is part of the increased rating claim herein and is properly included in the list of matters before the Board. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Increased Rating Disability ratings are determined by the application of a schedule of ratings that is based on average impairment of earning capacity. 38 U.S.C. § 1155. Percentage ratings are determined by comparing the manifestations of a particular disability with the requirements contained in VA’s Schedule for Rating Disabilities. The percentage ratings contained in the Rating Schedule represent, as far as can practically be determined, the average impairment in earning capacity resulting from a disease or injury and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). Under diagnostic code (DC) 9411, a 50 percent rating is assigned when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, DC 9411. A 70 percent rating is assigned when the psychiatric condition produces occupational and social impairment, with deficiencies in most areas, 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 a work-like setting); inability to establish and maintain effective relationships.). Id. A maximum 100 percent rating is assigned when there is total occupational or 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 inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place, memory loss for names of close relatives, own occupation, or own name. Id. When determining the appropriate disability evaluation to assign, the Board’s primary consideration is a veteran’s symptoms, but it must also make findings as to how those symptoms impact a veteran’s occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436 (2002). Because the use of the term “such as” in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Id. at 442; see also Sellers v. Principi, 372 F.3d 1318 (Fed. Cir. 2004). Nevertheless, all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the veteran’s impairment must be “due to” those symptoms, a veteran may only qualify for a given disability rating by demonstrating the symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. The Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); As such, the Board will conduct a “holistic analysis” considering the severity, frequency and duration of all the Veteran’s PTSD with depression, anxiety and alcohol abuse disorder symptoms, as well as his associated occupational and social impairment associated to determine whether an increased evaluation in excess of 50 percent is warranted. As with all claims for VA disability compensation, the Board must assess the credibility and weigh all the evidence, including lay and medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert denied, 523 U.S. 1046 (1998). 1. Entitlement to an increased rating for service-connected PTSD with depression, anxiety and alcohol use disorder prior to April 26, 2017. The Veteran contends that his PTSD with depression, anxiety and alcohol use disorder is more severe than reflected by the 50 percent disability rating assigned for the appeal period prior to April 26, 2017. The Veteran, through his attorney, asserts that he is entitled to a rating of 100 percent, or at least 70 percent. See written correspondence dated and received in December 2020. The Board finds that prior to April 26, 2017, the frequency, duration and severity of the Veterans PTSD with depression, anxiety and alcohol use disorder symptoms are most consistent with the symptoms associated with reduced reliability and productivity in most areas, such as work, school, family relations, judgment, thinking or mood. Preliminarily, the Veteran, through his attorney, cites to evidence well outside the appeal period, including the October 2007 and July 2010 VA examination reports, in support of his assertion that the Veteran is entitled to a rating of 100 percent, or at least 70 percent, for PTSD with depression, anxiety and alcohol use disorder prior to April 26, 2017. Such evidence was previously considered by the RO in the November 2007 and August 2010 rating decisions, respectively. Although these records are outside the appeal period for the Veteran’s claim for an increased rating for PTSD, by regulation, VA is specifically required to assess a disability “in relation to its history,” in addition to the present level of disability, when making disability rating determinations. See 38 C.F.R. §§ 4.1, 4.2. The Board has reviewed all the evidence in the Veteran’s claims file, 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) (noting that VA must review the entire record but does not have to discuss each piece of evidence). The adjudicator is charged with interpreting the competent and credible evidence of record as a whole and reconciling such to accurately reflect the disability. Moore v. Shinseki, 555 F.3d 1369, 1373 (Fed. Cir. 2009); 38 C.F.R. § 4.2. Hence, the Board will summarize the relevant evidence as appropriate and the analysis will focus specifically on what the evidence shows, or fails to show, as to the issue on appeal. Turning to the evidence of record, in October 2013, the Veteran underwent a VA Review Posttraumatic Stress Disorder (PTSD) Disability Benefits Questionnaire (DBQ). The examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. Regarding relevant social, marital and family history, the examiner noted that the Veteran lives with his wife of 42 years and that his 7-year-old granddaughter stays with them during the week and 5 or 6 grandchildren visit them nearly every weekend. The Veteran stated that his wife typically looks after the children and he stays away. He stated that his oldest son is an alcoholic who has no place to stay and that his youngest son was recently released from prison and that he often calls asking for money. He stated that his daughter has an apartment but lost her job. He stated that his wife tells him that he is “mean” and his behavior is a source of marital strife. The Veteran stated that he feels that he and his wife are being used. He stated that he has a childhood friend who sometimes visits and that they drink together. Regarding hobbies and activities, he stated that he mostly stays at home and sleeps during the day. He reported that he used to work on cars, but he is no longer interested in doing that and he does not go out much, primarily due to lack of money. The examiner acknowledged the Veteran’s diagnoses of chronic PTSD mild to moderate severity, depressive disorder NOS, and alcohol abuse. The examiner opined that the Veteran had occupational and social impairment with reduced reliability and productivity. The VA examiner found that the Veteran had the following symptoms: anxiety, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Regarding current suicidal and homicidal ideation, the examiner reported that the Veteran sees himself dying in his dreams and sometimes forgets to maintain minimum personal hygiene. See October 2013 VA PTSD DBQ. The Veteran had a private psychiatric examination by R. S. Ph. D in November 2020. The examiner reviewed the Veteran’s records and interviewed the Veteran and his wife via video. The examiner noted that the Veteran and his wife have been married for 50 years and have been together for over 60 years. He noted that the Veteran was casually dressed and groomed. The Veteran reported having intrusive recollections of traumatic events. He stated that he is aggravated by anything out of place. His wife added that he is very fanatical about the bathroom and doesn’t like that doesn’t smell good or is out of place. He becomes scared and paranoid after hearing guns in his neighborhood. He reported that he calls the police so much that the police know their telephone number. He reported having “road rage” and his passengers tell him not to honk the horn. The Veteran’s wife reported that he fights with the neighbors, sometimes screaming and swearing. She stated that he had ruined her life. In an interview separate from the Veteran, the Veteran’s wife reported that they don’t go anywhere and that he is very jealous and controlling and doesn’t believe anything she says. She reported that the Veteran only has one childhood friend. She stated that she had to retire at age 62 because the Veteran kept coming to her job because he needed her all the time and that this began in 2009 or 2010. The Veteran reported that he had no friends, and had lost interest in friends. He stated that he only talks to his cousin on the phone. The examiner cited to VA treatment records on or before July 25, 2007, well outside the appeal period, which documented suicidal and homicidal ideation. The examiner also noted that in September 2012, the Veteran was referred to anger management for an inability to modulate his behavior, mood lability, psychomotor agitation, irritability and hostility. The examiner further noted that September 2012 VA treatment records document the Veteran’s difficulties being around his grandchildren and his inability to tolerate the noise they make and that he has an inability to modulate his behavior, which is consistent with his wife’s statement during his interview of her. He also cited a March 2013 VA treatment record where the Veteran endorsed having constant nightmares and that he was depressed and had a desire to isolate. Finally, he noted that an October 2013 VA treatment record states that the Veteran reporting having auditory hallucinations. The examiner found that the Veteran had PTSD, major depressive disorder with moderate psychotic features and unspecified anxiety disorder. The examiner noted finding the following symptoms beginning December 3, 2012: deficiencies in family relations, persistent irrational fears, persistent delusions or hallucinations, persistent danger of hurting self or others, deficiencies in work or school, panic or depression affecting the ability to function independently, appropriately, and effectively, neglect of personal appearance and hygiene, chronic sleep impairment, deficiencies in mood, difficulty in adapting to stressful circumstances, intrusive recollections of a traumatic experience, unprovoked hostility and irritability, inability to establish and maintain effective relationships, deficiencies in judgment, suicidal and homicidal ideation, poor frustration tolerance, tearfulness, paranoia, hypervigilance, “road rage,” insomnia and nightmares. The examiner noted that the Veteran presently reported auditory hallucinations and he reported having auditory hallucinations during the appeal period. The examiner opined that the Veteran was totally impaired in all areas beginning December 3, 2012. The following VA treatment records during the appeal period show that the Veteran’s PTSD with depression, anxiety and alcohol use disorder symptoms are most consistent with no more than those associated with reduced reliability and productivity in most areas, such as work, school, family relations, judgment, thinking or mood, and that they do not reflect 100 percent, total impairment. On January 27, 2012, the Veteran underwent a mental status examination which did not show confusion, impaired memory and/or judgment, disorientation to person, place, time or situation, that he lacked familiarity with his immediate surroundings or had an inability to understand or follow directions. On September 17, 2012, the Veteran reported that he was continuously angry. He described some frustration with physical problems, as well as with the noise his grandchildren made at his house every weekend and sometimes during the week. He reported that he lives near a train track and described how it is not a good thing considering his inability to tolerate loud noises. Upon mental status examination, the Veteran was adequately groomed, made appropriate eye contact and had minimal spontaneous speech/mood. His affect was blunted and his mood congruent. He denied suicidal and homicidal ideation or any history of auditory or visual hallucinations. He was goal directed, his insight and judgment were fair and there were no gross cognitive deficits noted. The Veteran stated that he had had thoughts of suicide and the evaluator noted that such thoughts were remote. He had no plan to take his life and had never made a suicide attempt. As a result of the depression screen, the Veteran was referred for a non-urgent mental health evaluation. An October 5, 2012 Brief suicide screen notes that the Veteran does not have thoughts or a plan to kill or hurt himself, that he has not tried to hurt or kill himself in the past, he sees hope for the future and his estimated suicide risk level is low. A November 27, 2012 Mental Health intake report notes that, upon mental status examination, the Veteran was oriented to time, place, person and purpose and did not appear to be in any acute psychological distress. There was no indication of mental content symptoms, perceptual disturbance or gross cognitive confusion. Speech and thinking were somewhat slowed, and he often had long pauses before responding to questions. The evaluator performed an assessment of violence and the Veteran acknowledged occasional suicidal ideation. He stated that occasionally he has thoughts of walking in front of the train near his house but denies any intent to do this. He denied any previous suicide attempts. The evaluator assessed that the Veteran was a at low risk for imminent self-harm. A January 10, 2013 VA treatment record reflects that the Veteran denied having problems, endorsed continued irritability, nightmares, chronic sleep impairment, depression and a desire to isolate. A brief suicide screen showed that the Veteran did not have thought or plan to kill or hurt himself, had not tried to hurt or kill himself in the past, had no recently had a major loss, saw hope for the future, was not drinking more than usual or using drugs. His overall estimated suicide risk was deemed to be low. January, February and March 2013 VA treatment records reflect that there was no indication of any current suicidal or homicidal ideation, plan or intent. The Veteran did not have VA treatment for his PTSD with depression, anxiety and alcohol use disorder for the time period between March 15, 2013 and November 4, 2015. A November 4, 2015 mental status examination reflects that the Veteran had appropriate grooming and attire, was a little restricted but was overall polite and cooperative. His speech had appropriate rate, volume and prosody. He had no psychomotor agitation. His affect was congruent, restricted without lability. His thought process was logical and goal oriented. He denied current suicidal or homicidal ideation, denied hallucinations and there was no observed disorganized thinking or behavior. His insight and judgment were fair, his sensorium and cognition, short term and remote memory were grossly intact. His concentration and attention span were sufficient to cooperate with the interview. The assessment was that the Veteran had mood and anxiety symptoms with some marital conflict and stressors. The Veteran denied current harmful ideation, plan or intent. The Veteran stated that he was very uncomfortable being out in public and coming to the VA. The evaluator indicated that there were no advisories at that time and to follow up with his psychiatrist, Dr. Patton in 3-4 months, or sooner if indicated. The Veteran agreed to a suicide/homicide prevention safety plan. An April 6, 2016 psychiatry note states that the Veteran stated he continued to have nightmares about 3-4 nights per week. He endorsed continued irritability and temper problems and denied problems with physical violence. He stated that he sleeps during the day and that his depression is exacerbated due to his prostate cancer diagnosis and he continues to desire to isolate himself. An August 8, 2016 psychiatry note states that the Veteran and his wife participated in a therapy session. The Veteran stated that he has nightmares every day. He endorsed continued irritability and temper problems. He denied any problems with physical violence. He reported chronic sleep disturbance, continued depression and a desire to isolate. He reported that he tends to get mad or frustrated when around his grandchildren, who make a lot of noise. He lives near a train track and stated that the noise bothers him. A suicide risk screen noted that the Veteran denied currently having any thoughts of suicide, stated that he had never attempted suicide. A brief homicide screen noted that the Veteran denied having any thoughts of hurting or killing anyone. A November 9, 2016 psychiatry note states that the Veteran endorses nightly nightmares, irritability and temper. He reported a physical altercation with his son recently, but denied police involvement or injuries. He endorsed continued depression and a desire to isolate. A suicide risk screen noted that the Veteran denied currently having any thoughts of suicide, stated that he had never attempted suicide. A brief homicide screen noted that the Veteran denied having any thoughts of hurting or killing anyone. Upon mental status examination, the Veteran had appropriate grooming and attire, was a little restricted, but overall polite and cooperative. His speech was normal, his mood as above. His affect was congruent, restricted with no observed lability. His thought process was logical and goal directed. He denied suicidal or homicidal ideation, hallucinations and there was no observed disorganized thinking or behavior. His insight and judgment were fair and his sensorium and cognition, short term and remote memory were grossly intact. His concentration and attention span were sufficient to cooperate with the interview. He was noted to be abusing alcohol and using cannibis and advised to stop, but he declined. The VA treatment records show symptoms such as near-continuous depression affecting independent, appropriate or effective function, difficulty adapting to stress circumstances and an inability to establish and maintain effective relationships. They do not reflect gross impairment in thought or communication, peristent delusions or hallucinations, that the Veteran is a persistent danger to himself or others, that he has an intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene, disorientation to time or place, or that he forgets the names of close relatives or his own name. Thus, resolving doubt in favor of the Veteran, the Board finds that the Veteran’s PTSD with depression, anxiety and alcohol use disorder is characterized by symptomatology more closely approximated by a 70 percent rating for the period on appeal prior to April 26, 2017. The Board finds that the most probative evidence reflects that the Veteran has obsessional rituals interfering with routine activities, suicidal ideation, neglect of appearance and hygiene, near-continuous panic/depression affecting independent, appropriate or effective function, difficulty adapting to stress circumstances and an inability to establish and maintain effective relationships. In addressing 38 C.F.R. § 4.130, the United States Court of Appeals for Veteran’s Claims held in Bankhead that “… the language of the regulation indicates that the presence of suicidal ideation alone, that is, a [V]eteran’s thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment with deficiencies in most areas.” Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). With regard to the holding in Bankhead, the Board does not find that the Veteran’s reported suicidal ideations are controlling evidence in the Veteran’s particular situation, but rather, that considering the Veteran’s occasional passive suicidal ideations, near-continuous depression, difficulty adapting to stress circumstances and inability to establish and maintain effective relationships his PTSD with depression, anxiety and alcohol use disorder most closely approximates reduced reliability and productivity in most areas, and thus, a rating of 70 percent. A 100 percent rating is not warranted throughout the entire appeal period, as the preponderance of the probative evidence of record does not more closely approximate total occupational and social impairment during the appeal period. Although the Board finds that the evidence during the appeal period shows persistent auditory hallucinations, the probative evidence of records does not show symptoms of gross impairment in thought or communication, grossly inappropriate general behavior, persistent danger to self or others, disorientation to time or place, or that he forgets the names of close relatives, or his own name. While the private examiner found that the Veteran was a persistent danger to himself or others, the Board finds that the evidence of suicidal ideation is not shown to be of such severity that he is a persistent danger to himself or others. The evidence shows that during the appeal period, the Veteran had passive suicidal ideation and that although his “road rage” may sometimes scare his passengers, and he has occasional profanity-laden fights with neighbors, the frequency, duration and severity of the incidents described are more akin to passive suicidal ideation and having impaired impulse control, and do not rise to the level of his being a persistent danger to himself or others. Although the private examiner found that the Veteran PTSD symptomatology was “total,” he stated that he based his decision, in part, on the following symptoms, which are primarily associated with a 70 percent rating, namely near-continuous depression and anxiety and passive suicidal ideation, and one symptom which is primarily associated with a 50 percent rating, namely, inappropriate affect. Further, most of the clinical findings the private examiner made are associated with a 70 percent rating, and not with a 100 percent rating. Thus, the Board finds that the evidence does not more nearly approximate total occupational and social impairment during the appeal period. Once again, a review of the Veteran’s VA treatment records during the appeal period shows that his PTSD with depression, anxiety and alcohol use disorder symptoms are consistent with no more than those associated with reduced reliability and productivity in most areas, such as work, school, family relations, judgment, thinking or mood. The Board finds that the Veteran’s contemporaneous VA treatment records discussed above, showing symptomatology consistent with no more than reduced reliability and productivity in most areas, are the most probative evidence of record. The VA treatment records reflect that the Veteran’s PTSD with depression, anxiety and alcohol use disorder is worse than the reduced reliability and productivity endorsed by the October 2013 VA examiner, due to the Veteran’s near-continuous depression affecting independent, appropriate or effective function, difficulty adapting to stress circumstances and an inability to establish and maintain effective relationships. The Veteran’s VA treatment records are more probative than the November 2020 retroactive opinion of R. S. PhD that the Veteran’s symptoms are consistent with 100 percent, total impairment, as the examiner’s opinion is not consistent with the evidence shown in the VA treatment records during the appeal period. Thus, resolving doubt in the Veteran’s favor, the Board finds that the most probative evidence of record reflects that the Veteran’s PTSD with depression, anxiety and alcohol use disorder has been productive of occupational and social impairment with deficiencies in most areas, warranting an increase to a 70 percent rating, but no higher, prior to April 26, 2017. In making this determination, the Board considered the application of staged ratings, but found no additional distinctive period(s) where the Veteran’s service-connected PTSD with depression, anxiety and alcohol use disorder met or nearly approximated the criteria for a higher rating than that already granted. 2. Entitlement to a TDIU due to service-connected disabilities prior to January 16, 2019 As previously noted, the Veteran raised a TDIU claim within the increased rating claim for service-connected PTSD with depression, anxiety and alcohol use disorder. The Veteran sought entitlement to a TDIU due to service connected disabilities in the March 2014 letter accompanying the notice of disagreement with the November 2013 rating decision. The RO granted TDIU effective January 16, 2019, thus the Board must determine whether the Veteran is entitled to a TDIU during the appeal period prior to January 16, 2019 and to SMC during the entire period under 38 U.S.C. § 1114 (s). A TDIU claim is a form of increased rating. In Hurd v. West, 13 Vet. App. 449 (2000), the U.S. Court of Appeals for Veterans Claims (Court) held that” “a TDIU claim is a claim for increased compensation, and the effective date rules for increased compensation apply to a TDIU claim.” Id. at 450. As such, a grant of a TDIU is an award of increased disability compensation for purposes of assigning an effective date. Dalton v. Nicholson, 21 Vet. App. 23 (2007); Wood v. Derwinski, 1 Vet. App. 367, 369 (1991). The relevant period for consideration on appeal for entitlement to a TDIU is from one year prior to the date of receipt of the underlying increased rating claim for PTSD on December 3, 2012, namely, December 3, 2011, to January 16, 2019, when the RO granted entitlement to a TDIU. Total disability ratings for compensation 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. Consideration is given to such factors as the extent of the service-connected disability, and employment and educational background, and it must be shown that the service-connected disability produces unemployability without regard to intercurrent disability or advancing age. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16, 4.19. Substantially gainful employment is defined as work that is more than marginal and that permits the individual to earn a living wage. See Moore v. Derwinski, 1 Vet. App. 356 (1991). The claim of entitlement to a TDIU from the period from March 27, 2017 to January 16, 2019, when the RO granted TDIU, has been rendered moot because the Veteran is in receipt of a 100 percent schedular evaluation for prostate cancer during that period on appeal. See Bradley v. Peake, 22 Vet. App. 280 (2008). The United States Court of Appeals for Veterans Claims (Court) has recognized that 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). Thus, if VA has found a Veteran to be totally disabled as a result of a particular service-connected disability or combination of disabilities pursuant to the rating schedule, there is no need, and no authority, to otherwise rate that Veteran totally disabled on any other basis. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (finding a request for TDIU moot where 100 percent schedular rating was awarded for the same period). Thus, the Board will consider whether the Veteran is entitled to a TDIU prior to March 27, 2017. As a result of this decision, the Veteran meets the schedular requirements for TDIU during such appeal period, as he has a single service-connected disability rated at 60 percent or more, namely PTSD, rated at 70 percent disabling. The Veteran is also service connected for recurrent internal hemorrhoids, rated as non-compensable from November 23, 2010 and erectile dysfunction, rated as non-compensable from March 27, 2017. The Board finds that, based on the medical evidence of record, the Veteran’s hemorrhoid disability does not impact his ability to work, but rather, has a mild impact on his activities of daily living pertaining to toileting, and that the Veteran’s erectile dysfunction does not impact his ability to work. In the Veteran’s Application for Increased Compensation Based on Unemployability, VA Form 21-8940 received in January 2019, the Veteran stated that he had last worked full-time as a heating, ventilation and air conditioning (HVAC) mechanic in July 2006. He reported that he has a high school degree and two years of college education. The Board finds that the Veteran’s service-connected PTSD with depression, anxiety and alcohol use disorder precludes him from securing or following a substantially gainful occupation. As noted above, the Veteran had a private psychiatric examination in November 2020. After reviewing the Veteran’s records and evaluating the Veteran, the examiner opined that Veteran was unable to function in any job due to his PTSD, major depressive disorder and unspecified anxiety disorder since “at least” December 3, 2012 and that substance abuse, including alcohol and/or drugs was not a contributing factor. The November 2013 VA examiner found that the Veteran experienced occupational and social impairment with reduced reliability and productivity. Additionally, although not binding on VA, the Board finds it probative that during the appeal period, the Veteran was in receipt of Social Security Administration (SSA) disability benefits based primarily on his service-connected PTSD and depression. As such, the Board finds that the evidence is at least in equipoise as to whether the Veteran is entitled to a TDIU prior to January 16, 2019. Therefore, with resolution of doubt in the Veteran’s favor, entitlement to a TDIU is granted for the period on appeal prior to January 16, 2019, other than for the period from March 27, 2017 to February 20, 2019, which, as discussed above, is moot due to the Veteran’s 100 percent rating for prostate cancer during that period. The Board again notes that the AOJ will set an effective date for the award of a TDIU. This preserves the Veteran’s right to appeal the effective date awarded by the AOJ. See DAV v. Secretary of Veterans Affairs. 3. Entitlement to SMC under 38 U.S.C. § 1114 (s) The Board has considered the issue of entitlement to SMC, as VA has a “well-established duty” to maximize a claimant’s benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2010); see also Bradley v. Peake, 22 Vet. App. 280 (2008). In pertinent part, SMC at the housebound rate is payable where a veteran has a single service-connected disability rated at 100 percent and has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). The Veteran has a disability at 100 percent and an additional disability at 70 percent. Thus, SMC at the housebound rate is granted. The Board again notes that the AOJ will set an effective date for the award of SMC at the housebound rate. This preserves the Veteran’s right to appeal the effective date awarded by the AOJ. See DAV v. Secretary of Veterans Affairs. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Susan Leary, 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.