Citation Nr: 21015608 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 15-06 415 DATE: March 17, 2021 ORDER Entitlement to special monthly compensation (SMC) at the housebound rate from April 29, 2016 is granted. REMANDED Entitlement to an increased rating in excess of 70 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to an increased rating in excess of 30 percent for coronary artery disease (CAD) is remanded. Entitlement to an increased rating in excess of 20 percent for diabetes mellitus type II is remanded. Entitlement to an evaluation in excess of 10 percent for left lower extremity peripheral neuropathy is remanded. Entitlement to an evaluation in excess of 10 percent for right lower extremity peripheral neuropathy is remanded. Entitlement to an evaluation in excess of 10 percent for left upper extremity peripheral neuropathy is remanded. Entitlement to an evaluation in excess of 10 percent for right upper extremity peripheral neuropathy is remanded. Entitlement to a compensable evaluation for a scar that is a residual of a CAD bypass graft is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to April 29, 2016 is remanded. FINDINGS OF FACT 1. From April 29, 2016, the Veteran’s PTSD alone prevented him from securing and maintaining substantially gainful occupation. 2. From April 29, 2016, because he is entitled to TDIU based on a single service-connected disability, the Veteran has one service-connected disability rated at 100 percent and additional service-connected disabilities rated at 60 percent. CONCLUSION OF LAW The criteria for entitlement to SMC at the housebound rate from April 29, 2016 have been met. 38 U.S.C. §§ 1114(s), 5107 (2012); 38 C.F.R. §§ 3.102, 3.350(i) (2020); Bradley v. Peake, 22 Vet. App. 280 (2008). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from October 1965 to August 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from May 2014, November 2015, and July 2016 rating decisions by the Department of Veterans Affairs (VA). All issues other than entitlement to TDIU were denied (or partially granted) by the Board in a July 2018 Board decision. The Veteran appealed that decision to the Court of Appeals for Veterans Claims (Court), which vacated the decision pursuant to a June 2019 Joint Motion for Remand. The Board remanded the issues in December 2019; they are once again before the Board. The Board must consider entitlement to SMC when fairly raised by the record. See Akles v. Derwinski, 1 Vet. App. 118 (1991). The issue of entitlement to SMC at the housebound rate has been raised by the record in the context of whether the Veteran is entitled to TDIU based on a single service-connected disability from April 29, 2016. The Board has accordingly added entitlement to SMC as an issue on appeal. Entitlement to SMC at the housebound rate from April 29, 2016. SMC at the housebound rate is payable if a Veteran has a single service-connected disability rated at 100 percent and has an 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). A TDIU rating based on a single disability is permitted to satisfy the statutory requirement of a 100 percent rating. Bradley v. Peake, 22 Vet. App. 280, 293 (2008). The Agency of Original Jurisdiction (AOJ) granted entitlement to TDIU from April 29, 2016 based on consideration of all the Veteran’s service-connected disabilities. See January 2017 rating decision. While this decision renders the appeal of entitlement to TDIU from April 29, 2016 moot, the Board can still consider whether a single service-connected disability can be the basis of a TDIU rating for SMC purposes. TDIU may be assigned, where the schedular rating is less than total, when the veteran is unable to secure or follow substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. In order to meet the schedular criteria for entitlement, the veteran must have either: (i) one disability rated at 60 percent or more; or (ii) two or more disabilities, with at least one disability rated at 40 percent or more and sufficient additional disability bringing the combined rating to at least 70 percent. 38 C.F.R. § 4.16(a). The Veteran’s service-connected PTSD is currently rated at 70 percent during the period from April 29, 2016. He is a high school graduate and retired from his work at a telephone company in 2002. He reported that, after he retired, he started a little company to help senior citizens with fixing up their apartments, but it does not appear that this work generated income or was otherwise consistent. See, e.g., August 2013 VA treatment records. He tried to return briefly as a maintenance supervisor in a nursing home, but he gave up after four days, saying he could not tolerate working inside or “put up with others.” His work at the telephone company was mostly outside and by himself. See June 2016 VA treatment records. In September 2016, the Veteran’s VA treating psychiatrist, Dr. F. Eljarrah, MD, opined that the Veteran’s PTSD alone prevented him from securing or keeping substantially gainful employment. Dr. Eljarrah noted that the Veteran’s PTSD symptoms negatively affected all domains of his life including motivation, perseverance, mood, ability to relate to others, ability to process information and make correct self-promoting decisions, ability to manage anger and interpersonal conflicts, and ability to set goals or follow established plans. See September 2016 opinion. Dr. Eljarrah’s opinion is corroborated by a June 2016 VA PTSD examiner’s opinion that the Veteran’s PTSD symptoms followed a negative trend in terms of continued progression. The examiner opined that the Veteran had occupational impairment with deficiencies in most areas and noted that triggering stressors increased his sense of vulnerability, hypervigilance, and reactivity marked by explosive episodes of rage with verbal and physical aggression toward others and his cognitive decline in terms of his ability to retain information or maintain concentration and attention without adaptive techniques and prompts from his wife. An October 2020 VA PTSD examiner also opined that the Veteran had occupational impairment with deficiencies in most areas. Dr. Eljarrah’s opinion that the Veteran’s PTSD alone prevented him from securing and maintaining employment is uncontradicted by the record and supported by later VA examinations. As a result, the Board finds that, from April 29, 2016, the Veteran’s PTSD alone prevented him from securing and maintaining substantially gainful occupation. As such, the first element of entitlement to SMC at the housebound rate is shown. The Veteran is service-connected for numerous additional disabilities involving different anatomical segments or bodily systems that are ratable at least at 60 percent, to include: CAD, rated at 30 percent; diabetes mellitus, rated at 20 percent; peripheral neuropathy of the left and right lower extremities, each rated at 10 percent; and peripheral neuropathy of the left and right upper extremities, each rated at 10 percent. Because the Veteran is entitled to TDIU based solely on his PTSD from April 29, 2016 and he has additional disabilities ratable at 60 percent, the requirements for SMC at the housebound rate have been met, and SMC is warranted from April 29, 2016. REASONS FOR REMAND All remaining issues are remanded. The Veteran asserted that his disabilities have worsened. See October 2020 correspondence. Because he has not undergone any VA examinations since his report of worsening symptoms, remand for contemporaneous examinations is required to assess the current severity of his service-connected disabilities. See Green v. Derwinski, 1 Vet. App. 121 (1991); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). The Veteran’s October 2020 correspondence also indicated that he received private medical treatment after private records were last sought. Thus, on remand, the AOJ should also seek updated private treatment records. The matters are REMANDED for the following action: 1. The AOJ should obtain copies of VA treatment records from September 2020 to the present. 2. The AOJ should obtain, if possible, records of relevant private evaluations and treatment the Veteran has received. The Veteran must assist in the matter by identifying his private healthcare providers and by submitting releases for VA to obtain any private records identified. 3. After the development in the first two directives is completed, the AOJ should arrange for examinations of the Veteran to assess the current severity of his service-connected bilateral upper and lower peripheral neuropathy, PTSD, CAD, diabetes, and scar. The examiner(s) must review the entire record (including this remand) in conjunction with the examination and note such review was conducted. The examiner(s) should provide a full description of the disability and report all signs and symptoms associated with the Veteran’s disabilities. 4. If upon completion of the above action the issues remain denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Sandler, 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.