Citation Nr: 21014855 Decision Date: 03/15/21 Archive Date: 03/15/21 DOCKET NO. 15-14 436A DATE: March 15, 2021 ORDER Entitlement to an increased rating of 100 percent for service-connected posttraumatic stress disorder (PTSD) is granted. Entitlement to an increased rating exceeding 10 percent prior to May 23, 2016, exceeding 20 percent from May 23, 2016 to May 18, 2019, and exceeding 30 percent thereafter, for service-connected right shoulder strain and impingement syndrome (“right shoulder disability”) is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is dismissed. Entitlement to special monthly compensation (SMC) based on housebound status is denied. FINDINGS OF FACT 1. Resolving all reasonable doubt in favor of the Veteran, throughout the entire rating period on appeal, the Veteran’s service-connected PTSD symptoms have manifested to a degree that most closely approximates 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 close relatives, own occupation, or own name. 2. Prior to May 23, 2016, the Veteran’s right shoulder disability has not manifested to result in limitation of motion at the shoulder level. 3. From May 23, 2016 to May 18, 2019, the Veteran’s right shoulder disability has not manifested to result in limitation of motion to midway between the side and shoulder level. 4. Beginning May 18, 2019, the Veteran’s right shoulder disability has not manifested to intermediate between favorable and unfavorable ankylosis of the right shoulder scapulohumeral articulation, or limitation of motion to 25 degrees from side. 5. The award of a rating of 100 percent for PTSD throughout the entire period on appeal renders the issue of entitlement to TDIU moot. 6. The Veteran has not met the statutory criteria or factual finding for an award of SMC based on housebound status. CONCLUSIONS OF LAW 1. The criteria for entitlement to an increased rating of 100 percent for service-connected posttraumatic stress disorder (PTSD), throughout the rating period on appeal, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.125, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for entitlement to an increased rating exceeding 10 percent, prior to May 23, 2016, exceeding 20 percent from May 23, 2016 to May 18, 2019, and exceeding 30 percent thereafter, for service-connected right shoulder strain and impingement syndrome (“right shoulder disability”) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.71a, Diagnostic Code (DC) 5003-5201, 5201-5200. 3. The issue of entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is dismissed. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.15, 4.16. 4. The criteria for entitlement to special monthly compensation (SMC) based on housebound status have not been met. 38 U.S.C. §§ 1141(s), 5107; 38 C.F.R. §§ 3.102, 3.350, 3.351, 3.352. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Navy from April 1984 to January 1996; and in the Army from October 2001 to October 2002, from August 2004 to February 2006, and from September 2007 to March 2009, with service in Southwest Asia. This case comes before the Board of Veterans’ Appeals (Board) on appeal from various rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board recognizes that the Veteran requested a Board hearing by way of his substantive appeal. The hearing was scheduled for a date in August 2018. The Veteran was sent notification of the hearing by VA in a June 2018 letter; however, a review of the record reveals the Veteran failed to appear for said hearing, and has not provided a reason for failure to appear or requested that the hearing be rescheduled. Therefore, the Board deems the Veteran’s hearing request as withdrawn. These matters were previously before the Board in November 2018, where they were remanded for additional development. The Board notes that there was substantial compliance with its November 2018 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). Increased Rating Disability ratings are determined by applying the criteria set forth in the schedule of ratings. The percentage ratings are based on the average impairment of earning capacity, and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When a question arises as to which of two ratings apply under a single diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. As such, the Board must consider all potentially applicable diagnostic codes when rating a Veteran’s disability. However, evaluation of the same manifestation of the same disability under various diagnoses, otherwise known as “pyramiding” is to be avoided. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261 (1994). While the Veteran’s entire history is reviewed when making a disability determination, where service connection has already been established and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). However, staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Additionally, if the positive evidence supporting a claim and the negative evidence indicating a denial of the claim is relatively equal, the Veteran is entitled to the benefit of the doubt. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102, 4.3. Accordingly, any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. Id. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. When evaluating musculoskeletal disabilities based on limitation of motion, the Veteran is entitled to at least the minimum compensable evaluation if motion is accompanied by painful motion with joints. The joints involved should be tested for pain on both active and passive motion, in weight bearing and non-weight bearing and, if possible, with the range of the opposite undamaged joint. See 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011). Additionally, pain is also relevant to assignment of a rating in excess of the minimum compensable rating, but only if that pain results in demonstrated functional impairment. Mitchell, 25 Vet. App. at 37–38; see 38 C.F.R. §§ 4.40, 4.45. Functional impairment as contemplated by 38 C.F.R. §§ 4.40 and 4.45 includes less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Joint pain alone, without evidence of decreased functional ability, does not warrant a higher rating. See generally Mitchell, 25 Vet. App. 32 Moreover, the Board must consider functional loss caused by pain or other factors listed in 38 C.F.R. §§ 4.40 and 4.45 that could occur during flare-ups or after repeated use and, therefore, may not be reflected on range-of-motion testing. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, despite the relevance of the background factors delineated in § 4.40 or 4.45 when evaluating a disability, the rating to be assigned is based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); therefore, a separate or higher rating predicated solely on §§ 4.40 or 4.45 is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a [or § 4.73] criteria.”). 1. Entitlement to an increased rating of 100 percent for service-connected posttraumatic stress disorder (PTSD). The Veteran contends that an increased rating is warranted throughout the entire period on appeal, as his symptoms have worsened. The Veteran’s PTSD has been appropriately rated under DC 9411, to which the Veteran has been given a 30 percent disability rating prior to September 3, 2014, a 50 percent disability rating from September 3, 2014 to November 26, 2019, and a 70 percent disability rating thereafter. During the course of the appeal in an August 2020 rating decision an increased 70 percent rating for PTSD was granted effective November 26, 2019 forward. Under DC 9411, a 30 percent rating is assigned for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is assigned for 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. A higher 70 percent rating is assigned for 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 of 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); and an inability to establish and maintain effective relationships. The highest rating of 100 percent is assigned 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 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. 38 C.F.R. § 4.130, DC 9411. The list of symptoms under the rating criteria above are meant to be examples of symptoms that would warrant the respective rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-42 (2002). However, a veteran may only qualify for a given disability rating under § 4.130 by demonstrating particular symptoms associated with that percentage, or others of similar severity, frequency, and duration, and that those symptoms have resulted in the type of occupational and social impairment associated with that percentage. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117-18 (Fed. Cir. 2013). Medical treatment records throughout the appeal period reflect that the Veteran has continuously received treatment for his PTSD, and experienced symptoms of depression, anxiety, flashbacks, nightmares, crying spells, decreased energy, restless sleep/insomnia, distant and emotional detachment from others, difficulty concentrating, mild memory loss, hypervigilance, exaggerated startle response, decreased energy and self-esteem, fleeting suicidal ideations with no plan or intent, mild paranoia, persistent auditory hallucinations, and homicidal ideations towards the voices he hears when hallucinating. Additionally, the Veteran was prescribed medications for his PTSD. In a December 2014 VA examination, the examiner noted the Veteran’s mental health treatment consisted of prescribed medication, counseling and psychiatric care. Additionally, the examiner further noted the Veteran’s reports of suicidal thoughts without attempt, assaultive behavior and/or violence due to mental disorder, and paranoia and delusional behavior while working previously. Upon examination, the Veteran’s current psychiatric symptoms were depressed mood, anxiety, panic attacks three times or more a week, chronic sleep impairment, mild memory loss, 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 work like setting), hypervigilance, irritable behavior and angry outbursts (with little or no provocation), problems with concentration, and feelings of detachment or estrangement from others. The examiner concluded that the Veteran’s symptoms equivalent to occupational and social impairment with reduced reliability and productivity. See C&P Exam, December 2014. In a June 2015 lay statement, the Veteran noted that he experiences visual and auditory hallucinations, memory loss due to anxiety, difficulty sleeping, suicidal thoughts, isolation to avoid getting mad and hurting others, and difficulty being around other people. See Buddy/Lay Statement, June 2015. In a June 2017 VA examination, the examiner noted the Veteran’s current mental health treatment consisted of intensive outpatient treatment in house program. The examiner noted that the Veteran was admitted inpatient in April 2017 for psychiatric hospitalization after he was arrested due to an anger episode at home. A review of treatment records from May 2015 notes increasing paranoia and hallucinations and that the Veteran believes his neighbors are at times recording his daily activities and he is actively psychotic. Upon examination, the Veteran’s current psychiatric symptoms were depressed mood, anxiety, suspiciousness, panic attacks three times or more a week, chronic sleep impairment, gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), hypervigilance, exaggerated startle response, problems with concentration, and feelings of detachment or estrangement from others. The examiner concluded that the Veteran’s symptoms equivalent to occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. See C&P Exam, June 2017. In a November 2019 VA examination, the examiner noted the Veteran’s current mental health treatment consisted of prescribed medication and counseling. Upon examination, the Veteran’s current psychiatric symptoms were depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, 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 work like setting), suicidal ideation, hypervigilance, irritable behavior and angry outbursts (with little or no provocation), problems with concentration, and feelings of detachment or estrangement from others. The examiner concluded that the Veteran’s symptoms equivalent to occupational and social impairment with reduced reliability and productivity. See C&P Exam, November 2019. Treatment records note that the Veteran was seen for ongoing treatment and medication management. April 2017 treatment records note that the Veteran was admitted for psychiatric inpatient hospitalization after he was arrested due to an anger episode at home. Treatment records note that at times the Veteran has impairment in his thought process, and his ability to effectively communicate with others is impaired. Further, at times the Veteran has reported increased hypervigilance, paranoia and auditory hallucinations. The Veteran reports that he believes his neighbors are recording his daily activities, tapping his windows and putting pressure on the walls of his house. Based on the totality of the evidence above, and resolving all reasonable doubt in favor of the Veteran, the Board finds that a rating of 100 percent is warranted for the Veteran’s psychiatric disability throughout the entire rating period on appeal. The Veteran’s psychiatric disability has continuously shown symptoms of depressed mood, chronic sleep impairment, anger outbursts, difficulty in establishing and maintaining relationships, isolation, memory loss, hypervigilance, impaired concentration and/or communication, paranoia, suicidal ideations, and auditory hallucinations. Further, treatment records note a psychiatric hospitalization, and periods of increased instances of significant hallucinations and delusions. The totality of the Veteran’s PTSD symptoms has resulted in total occupational and social impairment and as such an increased rating is warranted during the appeal. Therefore, based on the probative evidence of record (to include the Veteran’s VA examinations, VA treatment records, and competent and credible lay statements), which reflect that the Veteran’s psychiatric symptoms more closely proximate a frequency and severity of a 100 percent evaluation throughout the entire rating period on appeal, the Board finds that the criteria for an increased rating of 100 percent has been met. The Board notes that a 100 percent evaluation is the maximum schedular rating for psychiatric disability under DC 9411, and a higher rating is not possible under this diagnostic code. Therefore, this decision constitutes a full grant of benefits under this claim. 2. Entitlement to an increased rating exceeding 10 percent, prior to May 23, 2016, exceeding 20 percent from May 23, 2016 to May 18, 2019, and exceeding 30 percent thereafter, for service-connected right shoulder strain and impingement syndrome ("right shoulder disability"). The Veteran contends that an increased rating is warranted throughout the entire rating period on appeal, as his symptoms have worsened. During the course of the appeal in an August 2020 rating decision an increased 20 percent rating was granted effective May 23, 2016 and an increased 30 percent rating was granted effective May 18, 2019 forward. Disabilities of the shoulder and arm are evaluated under rating criteria contemplated in DCs 5200 through 5203. Hyphenated DCs are used when a rating under one diagnostic code requires 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. The Veteran’s right shoulder disability is currently rated as 10 percent disabled, prior to May 23, 2016, and 20 percent disabled from May 23, 2016 to May 18, 2019, under DC 5201-5010. Thereafter, the AOJ assigned a 30 percent rating for right shoulder disability with ankylosis of scapulohumeral articulation under DC 5201-5200. The record reflects the Veteran is right hand dominant, thus his disability is rated for that of the major arm under 38 C.F.R. § 4.69. Under DC 5010 (governing traumatic arthritis), which directs the rater to DC 5003 (governing degenerative arthritis), degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joints involved. When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 pct is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactorily evidence of painful motion. In the absence of limitation of motion, x-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations warrants a 20 percent evaluation; with x-ray evidence of involvement of two or more major joints or two or more minor joint warranting a 10 percent evaluation. 38 C.F.R. § 4.71a, DC 5003. Under DC 5200, a 30 percent rating is warranted for favorable ankylosis of the scapulohumeral joint with abduction to 60 degrees and the ability to reach mouth and head; a 40 percent rating is warranted for intermediate between favorable and unfavorable ankylosis of the scapulohumeral joint; and the highest rating of 50 percent is warranted for unfavorable ankylosis of the scapulohumeral joint with abduction limited to 25 degrees from one side. 38 C.F.R. § 4.71a, DC 5200. Under DC 5201, a 20 percent rating is warranted for limitation of motion at the shoulder level or limitation; a 30 percent rating is warranted for limitation of motion midway between the side and shoulder level; and the highest rating of 40 percent is warranted for limitation of motion to 25 degrees to the side. 38 C.F.R. § 4.71a, DC 5201. In considering the applicability of other diagnostic codes, the Board finds that DC 5202, which pertain to impairment of the humerus does not apply. Specifically, VA examinations do not show the presence of this condition during the appeal periods. Accordingly, the criteria pertaining to this condition is not applicable. 38 C.F.R. § 4.71a, Diagnostic Codes 5202. Additionally, while the Board acknowledges that the Veteran has impairment of the clavicle or scapula, which would warrant consideration under DC 5203, the Board finds that the evidence of record does not reflect the severity of this impairment to warrant compensable consideration. During the course of the appeal, effective February 7, 2021, 38 C.F.R. § 4.71a Schedule of Ratings-Musculoskeletal System including Diagnostic Code 5201 was amended. Diagnostic Code 5201 notes arm limitation of motion at the shoulder level (flexion and/or abduction limited to 90 degrees) is rated as 20 percent disabling. Flexion and/or abduction limited to 25 degrees from the side as rated as 40 percent disabling on major and 30 minor joints. Then for flexion and/or abduction limited to 25 degrees from the side a 40 percent rating is warranted for a major joint and a 30 percent rating for a minor joint. As a result, the Board has considered the updated Diagnostic Code, and herein applies the most favorable rating criteria from February 7, 2021 forward. The application of the updated Diagnostic Code will be discussed in greater detail below. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5257). Normal motion of the shoulder is from 0 to 180 degrees of forward elevation and 0 to 180 degrees abduction, both measured with 0 degrees the position of the straight arm at the side with fingers pointing to the floor and with 180 degrees the position of a straight arm overhead with fingers pointing to the ceiling. Normal external rotation is from a position with the upper arm bent at the elbow and starting at a position parallel to the floor, defined as 0 degrees, and rotated upward to a position perpendicular to the floor, defined as 90 degrees. Normal internal rotation is from that same starting position but rotated downward to a position perpendicular to the floor, also defined as 90 degrees. 38 C.F.R. § 4.71a, Plate I. Medical treatment records during the appeal period reveal continuous complaints and treatment for right shoulder pain and frequent popping sensation, mainly with abduction lifting and elevation, and decreased range of motion; with receipt of periodic right shoulder injections for treatment. In a January 2010 VA examination, the examiner noted the Veteran currently has constant right shoulder pain that causes some weakness, stiffness, swelling, and periods of popping, locking, and shifting that gives a sense of instability; with a history of dislocation but no subluxation. The Veteran denied fatigability or lack of endurance. Upon examination, the Veteran’s right shoulder range of motion testing resulted in a forward flexion of 150 degrees (pain at 145 degrees), extension of 50 degrees without pain, abduction of 160 degrees (pain at 90 degrees), adduction of 90 degrees with pain, internal rotation of 45 degrees with pain, and external rotation of 90 degrees (pain at 75 degrees). After repetitive testing, there was no change in range of motion due to pain, fatigue, weakness, or lack of endurance. See VA Examination, January 2010. In a March 2010 VA medical treatment record, it was noted that the Veteran’s right shoulder has no effusion or deformity, with abduction limited to 110 degrees. In a July 2013 VA treatment records, the examiner noted the Veteran’s right shoulder joint was tender over the lateral rotator cuff and long head of biceps. Upon examination, the Veteran’s right shoulder range of motion testing resulted in active external rotation of 60 degrees (with internal rotation to just past back pocket with pain), forward flexion of 160 degrees and abduction of 150 degrees. Muscle strength testing was 5 out of 5 with forward flexion, abduction, and internal and external rotation. See VA treatment record, July 2013. In a January 2015 VA examination, the examiner noted that the Veteran continues to have limitation of abduction and pain in the right shoulder, with reports of functional loss/impairment (as described as the inability to extend above the head without significant pain). Upon examination, the Veteran’s right shoulder range of motion testing resulted in flexion of 0 to 160 degrees, abduction of 0 to 160 degrees, external rotation of 0 to 70 degrees, and internal rotation of 0 to 90 degrees; with range of motion itself contributing to functional loss. Pain was noted on exam with abduction and causes functional loss, with objective evidence of localized tenderness or pain on palpation of the right AC joint; however, no evidence of pain with weight-bearing. After repetitive use testing, there was no additional limitation in range of motion; nor was there any pain, weakness, fatigability or incoordination that significantly limited functional ability after repetitive use over time or with flare-ups. Muscle strength testing was a 5 out of 5 for forward flexion and abduction; with no evidence of muscle atrophy or ankylosis. There was a clavicle, scapula, AC joint or sternoclavicular joint condition suspected noted as degenerative disease with tenderness on palpation. See C&P Exam, January 2015. In a May 2015 VA examination, the examiner noted that the Veteran does not report experiencing any flare-ups or functional loss/impairment of the right shoulder. Upon examination, the Veteran’s right shoulder range of motion testing resulted in flexion of 0 to 160 degrees, abduction of 0 to 160 degrees, external rotation of 0 to 75 degrees, and internal rotation of 0 to 90 degrees; with range of motion itself contributing to functional loss. Pain was noted on exam with abduction and causes functional loss, with objective evidence of moderate localized tenderness or pain on palpation of the right AC joint; however, no evidence of pain with weight-bearing or crepitus. After repetitive use testing, there was no additional limitation in range of motion; but pain significantly limited functional ability after repeated use over time, with range of motion testing being unchanged, and contributed by less movement than normal. Muscle strength testing was a 5 out of 5 for forward flexion and abduction; with no evidence of muscle atrophy or ankylosis. There was right shoulder instability noted with no history of recurrent dislocation of the scapulohumeral joint; as well as, a clavicle, scapula, AC joint or sternoclavicular joint condition suspected noted as degenerative changes with tenderness on palpation. See C&P Exam, May 2015. In a May 2017 VA examination, the examiner noted that the Veteran still experiences right shoulder pain especially when he tries to move his arm above 70 degrees, with reports of flare-ups due to increase in pain on certain movements and lifting and functional loss/impairment due to the inability to do some daily activities. Upon examination, the Veteran’s right shoulder range of motion testing resulted in flexion of 0 to 120 degrees, abduction of 0 to 65 degrees, external rotation of 0 to 55 degrees, and internal rotation of 0 to 65 degrees; with range of motion itself contributing to functional loss. Pain was noted on exam with abduction and causes functional loss, with evidence of pain with weight-bearing and objective evidence of moderate localized tenderness or pain on palpation of the right AC joint; however, no evidence of crepitus. After repetitive use testing, there was no additional limitation in range of motion; but pain significantly limited functional ability after repeated use over time and with flare-ups, with range of motion testing being unchanged, and contributed by less movement than normal. Muscle strength testing was a 5 out of 5 for forward flexion and abduction; with no evidence of muscle atrophy or ankylosis. The examiner specifically addressed the Correia criteria (Correia v. McDonald, 28 Vet. App. 158 (2016)), as the Veteran showing evidence of right shoulder pain with passive range of motion testing or with non-weight bearing. See C&P Exam, May 2017. In an April 2019 VA treatment record, it was noted that the Veteran experiences right shoulder soreness and stiffness, with flexion limited to 105 degrees, abduction to 160 degrees, and external rotation to 30 degrees. See Capri, April 2019. In a November 2019 VA examination, the examiner reported the Veteran experiences flare-ups that occur once a week if he picks up something heavy or with repetitive use, stiffness, and constant pain; as well as, functional loss/impairment of the inability to lift more than 40 pounds. Upon examination, the Veteran’s right shoulder range of motion testing resulted in flexion of 0 to 88 degrees, abduction of 0 to 112 degrees, external rotation of 0 to 30 degrees, and internal rotation of 0 to 26 degrees; with range of motion itself contributing to functional loss. Pain was noted on exam with abduction and causes functional loss, with evidence of pain with weight-bearing and objective evidence of moderate localized tenderness or pain on palpation; however, no evidence of crepitus. After repetitive use testing, there was an additional limitation in range of motion, as described as flexion of 0 to 85 degrees, abduction of 0 to 112 degrees, external rotation of 0 to 26 degrees, and internal rotation of 0 to 31 degrees; with pain, weakness, lack of endurance, and incoordination significantly limiting functional ability after repeated use over time and with flare-ups; contributed by less movement than normal, instability of station, and disturbance of locomotion. Muscle strength testing was a 5 out of 5 for forward flexion and abduction; with no evidence of muscle atrophy. There was favorable ankylosis of the right shoulder shown with abduction up to 60 degrees and the ability to reach mouth and head. There was right shoulder instability noted with no history of recurrent dislocation of the scapulohumeral joint; as well as, a clavicle, scapula, AC joint or sternoclavicular joint condition suspected noted as arthritis, bone cyst, thinning tendons and frozen shoulder that affects range of motion and has tenderness on palpation. The examiner specifically addressed the Correia criteria (Correia v. McDonald, 28 Vet. App. 158 (2016)), as the Veteran showing evidence of right shoulder pain with passive range of motion testing or with non-weight bearing. See C&P Exam, November 2019. Considering the foregoing, to include consideration of the provisions of 38 C.F.R. §§ 4.40 and 4.45, and DeLuca, the Board finds that an increased rating during any period on appeal is not warranted. Prior to May 18, 2019, the Veteran’s right shoulder disability has not shown to objectively increase in severity to warrant a higher rating. In fact, the evidence of record during this time period does not reflect an evaluation under any applicable DCs related to the Veteran’s right shoulder. However, given that X-ray results noted degenerative arthritis changes in the Veteran’s right shoulder with limitation of motion findings rendering a noncompensable evaluation, the Veteran was properly assigned a 10 percent rating for painful motion pursuant to DC 5003 and 38 C.F.R. § 4.59. Nevertheless, effective May 23, 2016, VA’s policy in evaluating joints changed as a result of Sowers v. McDonald, 27 Vet. App. 472 (2016), which held that 38 C.F.R. § 4.59 is limited by the specific diagnostic code most applicable to the claimant’s disability, and the minimum rating under the specific diagnostic code must be assigned when painful motion is demonstrated under 38 C.F.R. § 4.59. This policy particularly affects painful motion of the shoulder evaluated under DC 5201, in which painful motion of the shoulder warrants assignment of a 20 percent rating, the minimum compensable rating. Therefore, as this policy became effective May 23, 2016, the Veteran’s increased evaluation of 20 percent already assigned specifically for his painful motion of the right shoulder under DC 5201, beginning May 23, 2016, was proper. Additionally, beginning May 18, 2019, the Veteran’s right shoulder disability manifested to reflect favorable ankylosis of the right shoulder scapulohumeral articulation shown with abduction up to 60 degrees and the ability to reach mouth and head, which is commensurate of the 30 percent evaluation already assigned under DC 5200. However, as the evidence of record does not reflect intermediate between favorable and unfavorable ankylosis of the right shoulder scapulohumeral articulation or limitation of motion of the arm midway between side and shoulder, the Board finds that an increased rating exceeding 30 percent from May 18, 2019 is not warranted. The Board notes that the lay assertions of the Veteran have been considered. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). To the extent that the Veteran has argued that a higher rating for a right shoulder disability is warranted, these assertions are outweighed by more probative evidence provided by the examination of a qualified medical professional. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, his lay statements do not provide any basis upon which to assign any higher rating. Further, the Board had considered application of the updated Diagnostic Code effective February 7, 2021 to apply the rating criteria most favorable to the Veteran from this date forward. However, under updated Diagnostic Code 5201 for the major joint an increased 40 percent rating is warranted for limitation of motion with flexion and/or abduction limited to 25 degrees from side. However, the evidence of record does not support that the Veteran’s right shoulder was limited under flexion and/or abduction to 25 degrees from the side during this period. Further, an increased rating is not warranted under additional applicable Diagnostic Codes for the right shoulder. As such the updated Diagnostic Code does not warrant an increased rating. Therefore, as the evidence of record during these periods are not sufficient to meet the criteria under DC 5200, 5201 or DC 5203 for an evaluation higher than the ratings already assigned, the Board concludes that an increased rating exceeding 10 percent prior to May 23, 2016, exceeding 20 percent from May 23, 2016 to May 18, 2019, and exceeding 30 percent thereafter, for service-connected right shoulder disability is not warranted; and the claim is denied. The Board has considered the doctrine of giving the benefit of the doubt to the Veteran, under 38 U.S.C. § 5107 and 38 C.F.R. § 3.102, but does not find the evidence is of such approximate balance to warrant its application. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 3. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities. The Board’s decision herein grants a 100 percent rating for PTSD for the entire period on appeal. Typically, the award of a 100 percent disability rating does not render TDIU moot. See Bradley v. Peake, 22 Vet. App. 280, 294 (2008) (holding that a separate TDIU rating predicated on one disability (although perhaps not ratable at the schedular 100 percent level) when considered together with another disability or disabilities separately rated at 60 percent or more could warrant special monthly compensation (SMC) under 38 U.S.C. § 1114(s)). However, in the present case, as this Board decision grants the Veteran a 100 percent disability rating for his service-connected PTSD throughout the entire period on appeal, with the Veteran’s additional service connected disabilities of right shoulder strain, tinnitus, right foot neuroma, and right shoulder residual scar not satisyfing the schedular criteria for TDIU, the Board finds that the issue of entitlement to TDIU is therefore moot. 4. Entitlement to special monthly compensation (SMC) based on housebound status. Regarding housebound status, under 38 U.S.C. § 1114(s), SMC is payable if the 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, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) is permanently housebound due to service-connected disability or disabilities. Here, the Board notes that even though the Veteran has been granted a 100 percent disability rating for his service-connected PTSD throughout the entire rating period on appeal, he does not have an additional service-connected disability independently rated as 60 percent disabled, nor does the evidence of record factually reflect that the Veteran is permanently housebound due to his service-connected disability or disabilities. As to whether SMC is warranted under 38 U.S.C. § 1114(s) at the housebound rate, the Veteran is not in receipt of a single service-connected disability rated as 100 percent disabling and does not have additional separate disabilities rated as 60 percent disabling. Thus, the question is whether the Veteran is permanently housebound by reason of a service-connected disabilities. Clearly, the Veteran is not confined to his home as a result of his service-connected PTSD, right shoulder strain, tinnitus, right foot neuroma ans shoulder scar. Treatment records note that the Veteran regularly attends VA appointments without assistance. Further treatment records note that the Veteran was ambulatory without assistive devices, completes tasks in his home including cleaning, garden and yardwork. Further, the Veteran was regularly attending VA and private provider appointments. Thus, the evidence does not suggest that his service connected disabilities prevented the Veteran from leaving his home. As such entitlement to SMC at the housebound rate is not warranted. Therefore, as the preponderance of the evidence of record is against the claim, with no evidence to the contrary, the Board finds that an award of SMC based on housebound status is not warranted; and the claim is denied. The Board has considered the doctrine of giving the benefit of the doubt to the Veteran, under 38 U.S.C. § 5107 and 38 C.F.R. § 3.102, but does not find the evidence is of such approximate balance to warrant its application. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). K.R. Kardian Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Hodges, 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.