Citation Nr: 21015770 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 20-07 137 DATE: March 18, 2021 ORDER The reduction of the rating for radiculopathy of the left leg from 20 percent to noncompensable, effective July 1, 2019, was not proper and is void ab initio. Entitlement to a rating higher than 20 percent for service-connected radiculopathy of the left lower extremity is denied. Entitlement to an extension of a temporary total evaluation due to treatment for a service-connected condition requiring convalescence for the period from October 1, 2018 to January 31, 2019 is granted. Entitlement to a total disability rating based on individual unemployability is granted. FINDINGS OF FACT 1. An April 2019 rating decision, which reduced the disability rating for radiculopathy of the left leg from 20 percent to noncompensable effective July 1, 2019 did not reflect consideration of the provisions of 38 C.F.R. § 3.344 and is void ab initio. 2. The Veteran’s left leg radiculopathy was manifested by pain, numbness, and periodic decreased sensation and reflexes of the extremity. Symptoms indicative of moderately severe incomplete paralysis of the sciatic nerve are not shown. 3. The Veteran underwent lumbar spine surgery on June 6, 2018, and experienced severe post-operative residuals requiring convalescence until January 31, 2019. 4. The Veteran’s service-connected disabilities prevent him from obtaining and maintaining substantially gainful employment consistent with his educational and vocational experience. CONCLUSIONS OF LAW 1. The reduction of the rating for service-connected radiculopathy of the left leg from 20 percent to noncompensable was improper and restoration of the 20 percent disability rating effective July 1, 2019 is warranted. 38 U.S.C. § 1155, 5103; 38 C.F.R. § 3.102, 3.105, 3.344. 2. The criteria for a rating higher than 20 percent for radiculopathy of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.103, 3.159, 3.321, 3.327, 4.1, 4.2, 4.3, 4.7, 4.21, 4.124a, Diagnostic Code 8520. 3. The criteria for entitlement to an extension of a temporary total convalescent rating for the lumbar spine disability from October 1, 2018 to January 31, 2019 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.30. 4. The criteria for entitlement to TDIU have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 4.16(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from September 1987 to February 1997. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2018 rating decision of the Department of Veterans’ Affairs (VA) Regional Office (RO) (hereinafter agency of original jurisdiction or AOJ). In pertinent part, the August 2018 rating decision continued a 20 percent disability rating for radiculopathy of the left lower extremity. The Board notes that while the claim for an increased rating for radiculopathy of the left lower extremity was pending, the AOJ, in a December 2018 rating decision, proposed to decrease the Veteran’s rating for radiculopathy of the left lower extremity from 20 percent to 0 percent, effective July 1, 2019. An April 2019 rating decision implemented this decision. The Veteran has expressed disagreement with this reduction and as such, it has bene included in the claim seeking an increased rating for radiculopathy of the left lower extremity. The Veteran testified before the undersigned Veterans Law Judge in January 2021 by way of a virtual Board hearing. A copy of the hearing transcript is of record. Rating Reduction The Veteran appeals the disability rating reduction from 20 percent to noncompensable for service-connected left leg radiculopathy. When determining whether a reduction was proper, there are two sequential questions that must be addressed. First, whether the AOJ satisfied the procedural requirements for a reduction, as set forth in 38 C.F.R. § 3.105. If so, the second question concerns whether the evidence shows an improvement in the severity of the service-connected disability, as defined in 38 C.F.R. § 3.344. With regard to the initial question, the Board observes that the rating reduction did result in a reduction of VA compensation being paid to the Veteran as the overall, combined disability rating was reduced from 90 percent to 80 percent. When a reduction in the evaluation of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments, a rating decision proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. The Veteran must be notified at his latest address of record of the contemplated action and furnished detailed reasons therefore. Additionally, a veteran must be given notice that he has (1) 60 days to present additional evidence to show that compensation payments should be continued at the present level, and (2) 30 days to request a predetermination hearing. 38 C.F.R. § 3.105(e), (i). If additional evidence is not received within that period, final rating action will be taken and the award will be reduced or discontinued effective the last day of the month in which a 60-day period from the date of notice to a veteran of the final rating action expires. Also, if a predetermination hearing is not requested or if a veteran failed without good cause to report for a scheduled predetermination hearing, the final action will be based solely upon the evidence of record. If a predetermination hearing was conducted, the final action will be based on evidence and testimony adduced at the hearing as well as the other evidence of record, including any additional evidence obtained following the hearing pursuant to necessary development. If a reduction is then found warranted, the effective date of such reduction shall be the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final action expires. 38 C.F.R. § 3.105. In the present case, as a preliminary matter, the Board finds that the procedural requirements of 38 C.F.R. § 3.105 were satisfied in this rating reduction. Notice was sent in a December 2018 rating decision and letter, both of which informed the Veteran of the proposed rating reduction. The December 2018 letter further explained the affect the proposed rating reduction would have on the Veteran’s combined disability evaluation and informed the Veteran of his options to submit additional evidence and request a personal hearing. By way of an April 2019 rating decision, the AOJ reduced the Veteran’s disability rating, effective July 1, 2019. The AOJ satisfied the procedural requirements by allowing a 60-day period to expire before assigning the reduction effective date. 38 C.F.R. § 3.105. Accordingly, the remaining question is whether the reduction in a disability rating is warranted based on the medical and lay evidence of record. A veteran’s disability rating shall not be reduced unless an improvement in the disability is shown to have occurred. See 38 U.S.C. § 1155. Prior to reducing a veteran’s disability rating, VA is required to comply with several general VA regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect. See 38 C.F.R. §§ 4.1, 4.2, 4.10, 4.13; see also Brown v. Brown, 5 Vet. App. 413, 420 (1993). Such review requires VA to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. Thus, in any rating-reduction case, not only must it be determined that an improvement in a disability has actually occurred, but also that that improvement actually reflects an improvement in the veteran’s ability to function under the ordinary conditions of life and work. See Faust v. West, 13 Vet. App. 342, 350 (2000). It is essential, both in the examination and in the evaluation of the disability, that each disability be viewed in relation to its history. 38 C.F.R. § 4.1. If an examination report does not contain sufficient detail, or the diagnosis is not supported by the findings on the examination report, it must be returned as inadequate for rating purposes. 38 C.F.R. § 4.2. When any change in evaluation is to be made, the rating agency should assure itself that there has been an actual change in the conditions, for better or worse, and not merely a difference in thoroughness of the examinations or in use of descriptive terms. 38 C.F.R. § 4.13. Finally, it must be considered that the basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. As to the propriety of the reduction, for reductions in rating to be properly accomplished, specific requirements must be met. See 38 C.F.R. § 3.344; see also Dofflemyer v. Derwinski, 2 Vet. App. 277 (1992). In this case, the 20 percent rating had been in effect for less than 5 years. Accordingly, the provisions under 38 C.F.R. § 3.344(a) and (b) do not apply in this case. As to disability ratings in effect for less than five years, adequate reexamination that discloses improvement in the condition will warrant reduction in rating. See 38 C.F.R. § 3.344(c). Initially, the AOJ initially granted service connection for radiculopathy of the left leg in November 2015 and assigned a 20 percent disability rating. The Veteran filed a claim for an increased rating in June 2018; he was afforded a lumbar spine VA examination in August 2018. At the time, the examiner noted that the Veteran had normal reflexes throughout the left lower extremity; however, there was evidence of decreased sensation in the left thigh and knee along with mild intermittent pain and numbness. The examiner opined that the Veteran’s left leg radiculopathy was manifested by mild incomplete paralysis of the left sciatic nerve. Subsequently, at the November 2018 VA examination, the examiner found that the Veteran did not have any signs or symptoms of radiculopathy. Based on this examination, the AOJ reduced the Veteran’s disability rating to noncompensable, effective July 2019. After thorough review of the evidence, the Board finds that the AOJ failed to properly make findings in this case as to both prongs of the Faust test for rating reduction cases. The adjudicatory documents do not demonstrate that the AOJ made a finding with respect to whether the improvement noted reflected “an improvement in the Veteran’s ability to function under the ordinary conditions of life and work” to support the rating reduction. Without such explicit findings, the Board cannot properly analyze the ratings-reduction issue currently on appeal. The Board additionally notes that, from a factual point of view, the AOJ’s rating reduction is also not supportable. The Board can find no evidence suggesting why the Veteran’s left leg radiculopathy would improve from a medical point of view. Rather, within six months of the reduction, the AOJ restored the 20 percent rating for the Veteran’s left leg radiculopathy as he demonstrated further disability. Accordingly, the action to reduce the rating is void, and the 20 percent evaluation for left leg radiculopathy under Diagnostic Code 8520 is restored effective July 1, 2019 as though the reduction had not occurred. See Faust, supra. In so reaching that conclusion, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Increased Rating Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Increased Rating for Nerve Disabilities In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. Under 38 C.F.R. § 4.124a, a disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a. For the entire appeal period, the Veteran’s service-connected radiculopathy of the left sciatic nerve was rated 20 percent disabling pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8520. Diagnostic Code 8520 provides that mild incomplete paralysis is rated 10 percent disabling. Moderate incomplete paralysis is rated 20 percent disabling. Moderately severe incomplete paralysis is rated 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy, is rated 60 percent disabling. Complete paralysis of the sciatic nerve, the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost, is rated 80 percent disabling. Diagnostic Code 8620 refers to neuritis of the sciatic nerve while Diagnostic Code 8720 refers to neuralgia of the sciatic nerve. Descriptive words such as “slight,” “moderate” and “severe” are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The use of descriptive terminology by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision. 38 U.S.C. § 7104(a); 38 C.F.R. §§ 4.2, 4.6. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. In rating peripheral nerve disability, neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. 38 C.F.R. § 4.124a. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate, incomplete paralysis. The maximum rating which may be assigned for neuritis not characterized by organic changes as noted above will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.124. Turning to the facts of the case, the Veteran filed an increased rating claim for his left leg radiculopathy in June 2018. Contemporaneous treatment records reflect that the Veteran’s left leg radiculopathy was manifested by pain and numbness in the left leg down to the big toe. He reported increased numbness and tingling with movement. He used heating pads, prescription medication, and physical therapy to manage his symptoms. At the August 2018 VA examination, the Veteran reported having flares of sharp back pain that traveled down the left leg to his thigh and behind the calf. Upon examination, there was no evidence of muscle atrophy and the Veteran demonstrated full muscle strength throughout the left leg. While he maintained normal deep tendon reflexes in the left knee and ankle, there was decreased sensation to light touch in the left thigh and knee. Straight leg raising test yielded positive results in the left leg, indicative of the presence of radiculopathy. The Veteran also endorsed mild intermittent pain and numbness in the left lower extremity. The examiner opined that the Veteran’s radiculopathy was manifested by mild incomplete paralysis of the left sciatic nerve. In contemporaneous treatment records, the Veteran reported pain, numbness, tingling, and weakness of the left leg, which he rated an 8/10 in severity. He used prescription pain medication to alleviate his symptoms. At the November 2018 VA examination, the Veteran described having excruciating back pain that extended down his left lower leg into the foot. There was no evidence of muscle atrophy and the Veteran demonstrated normal muscle strength in the left leg. Deep tendon reflexes were hypoactive in the left knee and ankle; however, the Veteran’s sensation in the left leg was normal and straight leg raising test was negative. The examiner found that the Veteran did not have any radicular pain or any other signs or symptoms due to radiculopathy. At the March 2020 VA examination, the Veteran reported having intermittent severe pain down his left leg into his foot. He used pain medication daily to alleviate his pain. Upon examination, there was no evidence of muscle atrophy and the Veteran demonstrated normal muscle strength and normal sensation to light touch. However, the Veteran was unable to perform straight leg raising testing and the examiner noted the Veteran had severe intermittent pain, numbness and paresthesias/dysesthesias in the left lower extremity. The examiner ultimately opined that the Veteran’s radiculopathy was manifested by moderate incomplete paralysis of the left sciatic nerve. Upon consideration of the evidence, the Board finds that a rating in excess of 20 percent is not warranted for radiculopathy of the left leg. Throughout the appeal period, the Veteran’s radiculopathy was manifested by severe pain, numbness, tingling, and at times, slight reflex and sensation abnormality. The medical evidence demonstrates that while the Veteran did indeed report pain, sensation remained intact, albeit decreased. There were no trophic changes or atrophy of the left leg. While considering these objective findings of radiculopathy absent atrophy or trophic changes, the Board finds that the Veteran’s radiculopathy of the left leg has been manifested by no more than moderate incomplete paralysis of the sciatic nerve. In so finding, the Board has considered the Veteran’s lay descriptions of the severity of his left leg radiculopathy but finds that the symptoms described by the Veteran are adequately contemplated by the currently assigned 20 percent disability rating. Given the entire disability picture of the Veteran’s left leg radiculopathy, the Board finds that the severity of the Veteran’s symptoms more nearly approximate that which is contemplated by the currently assigned 20 percent rating, indicative moderate incomplete paralysis of the left sciatic nerve. Accordingly, the claim for a higher rating for radiculopathy of the left leg is denied. Extension of 38 C.F.R. § 4.30 Convalescence Benefits It is the established policy of the VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated as totally disabled. 38 C.F.R. §§ 4.15, 4.16(b). In the case of disability which is temporary in nature, such as that period of convalescence following surgery, governing regulation provides for temporary total disability ratings during convalescence. 38 C.F.R. § 4.30. Temporary total ratings will be assigned from the date of hospital admission and continue for 1, 2, or 3 months from the first day of the month following hospital discharge when treatment of a service-connected disability results in: (1) Surgery (including outpatient surgery after March 1, 1989) necessitating at least one month of convalescence, (2) Surgery with severe postoperative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited); or (3) Immobilization by cast, without surgery, of one major joint or more. 38 C.F.R. § 4.30(a). Total ratings for convalescence may be extended for one, two, or three months beyond the initial three months for any of the three reasons set forth above. Extensions of one or more months up to six months beyond the initial six months period may be made for reasons (2) or (3) above. 38 C.F.R. § 4.30(b). The Veteran underwent a transforaminal lumbar interbody fusion of the lumbar spine in June 2018. A temporary total rating for convalescence has been assigned following the surgery through October 1, 2018. The Veteran asserts the temporary rating should be extended beyond October 2018. Upon review of the record, the Board agrees with the Veteran and finds that the temporary total rating until January 31, 2019 is warranted. Following the Veteran’s June 2018 surgery and three-month convalescence period, the Veteran continued to experience constant and unrelenting low back pain. Upon range of motion testing, the Veteran demonstrated “excruciating pain” and was only able to flex to 10 degrees. The Veteran experienced both muscle spasms and guarding of the lumbar spine, both of which resulted in abnormal gait and spinal contour. He regularly used a cane and a walker in order to ambulate. The examiner found that the Veteran’s lumbar spine condition prohibited him from performing activities related to all forms of work. See November 2018 VA Examination. In a January 2019 letter, the Veteran’s surgeon indicated that convalescence for the Veteran’s specific surgery could take six months to a year to fully heal. In the Veteran’s case, the physician indicated that the Veteran’s most recent diagnostic testing revealed that the hardware and alignment in his spine was stable and the Veteran experienced “just a slight irritation” from the surgery. Ultimately, the physician found that the Veteran was no longer restricted in his activity or movement due to his June 2018 surgery. Based on the above, the Board finds that the criteria for an additional three months of a temporary total rating for convalescence for the June 2018 spine surgery is warranted. Here, the Veteran underwent lumbar spine surgery in June 2018 requiring an extensive period of convalescence according to his surgeon. The surgery did not resolve his symptoms; rather, subsequent treatment records after the three-month convalescence period reflect that the Veteran experienced increases in his pain, limitation of motion, and functional impairment. Furthermore, the Veteran’s surgeon indicated that the Veteran remained in convalescence until the middle of January 2019. He continued to require the assistance of a cane or walker to assist in ambulation. In sum, the record demonstrates that the Veteran underwent lumbar spine surgery in June 2018 and experienced severe post-operative residuals requiring convalescence until January 31, 2019. Thus, the Board finds that the Veteran is entitled to a convalescence rating for an additional time period from October 1, 2018 to January 31, 2019. TDIU Total disability ratings for compensation may be assigned where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation because of service-connected disabilities. If there is only one such disability, this disability shall be ratable as 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability 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. For TDIU purposes, marginal employment is not to be considered substantially gainful employment. 38 C.F.R. § 4.1. Factors to be considered, however, will include the Veteran’s employment history, educational attainment, and vocational experience. 38 C.F.R. § 4.16. The current appeal stream stems from an application for increased compensation benefits received on July 2018. The Veteran claimed unemployability, in part, due to his left lower extremity. As such, the TDIU claim attaches to this appeal. Rice v. Shinseki, 22 Vet. App. 447 (2009). Here, the Veteran’s compensable service-connected disabilities are as follows: PTSD, rated 50 percent disabling prior to February 2, 2020 and 70 percent thereafter; degenerative disc disease of the lumbosacral spine, rated 40 percent disabling; migraine headaches, rated 30 percent disabling; radiculopathy of the left leg, rated 20 percent disabling; and painful lumbosacral spine scar, rated 10 percent disabling; radiculopathy of the right lower extremity rated as 20 percent disabling prior to March 1, 2019 and noncompensable thereafter, for a combined disability rating of 80 percent or greater since July 27, 2016. The Veteran meets the criteria for a schedular TDIU rating under 38 C.F.R.ds § 4.16(a) In Moore v. Derwinski, 1 Vet. App. 356, 359 (1991), the U.S. Court of Veterans Appeals (now the U.S. Court of Appeals for Veterans Claims) (Court) discussed the meaning of “substantially gainful employment.” In this context, it noted the following standard announced by the United States Federal Court of Appeals in Timmerman v. Weinberger, 510 F.2d 439, 442 (8th Cir. 1975): It is clear that the claimant need not be a total ‘basket case’ before the courts find that there is an inability to engage in substantial gainful activity. The question must be looked at in a practical manner, and mere theoretical ability to engage in substantial gainful employment is not a sufficient basis to deny benefits. The test is whether a particular job is realistically within the physical and mental capabilities of the claimant. However, to receive TDIU, the Veteran’s service-connected disabilities, alone, must be sufficiently severe to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The CAVC has defined being unable to secure and follow a substantially gainful occupation as having an 1) an economic component of earning more than marginal income (outside of a protected environment as determined by the U.S. Department of Commerce as the poverty threshold for one person and 2) a non-economic component of the individuals ability to secure or follow that type of employment; factors to consider include: the Veteran’s history, education, skill, and training; whether the veteran has the physical ability (both exertional and nonexertional) to perform the type of activities (e.g., sedentary, light, medium, heavy, or very heavy) required by the occupation at issue. Ray v. Wilkie, 31 Vet. App. 58, 62 (2019). Factors that may be relevant include, but are not limited to, the Veteran’s limitations, if any, concerning lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, as well as auditory and visual limitations; and whether the Veteran has the mental ability to perform the activities required by the occupation at issue. Factors that may be relevant include, but are not limited to, the veteran’s limitations, if any, concerning memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity.) The record reflects that the Veteran has an associate’s degree in computer science. The Veteran worked as a school administrator for 20 years until 2015. Upon review of the record, the Board finds that TDIU is warranted. Notably, the 50 and 70 percent disability ratings for PTSD, in and of itself, is indicative of significant occupational mental impairment. During the appeal period, the Veteran experienced weekly panic attacks and high anxiety and hypervigilance around others. He also endorsed difficulty establishing and maintaining effective relationships with others. VA examinations and medical treatment records during the appeal period reflect that the Veteran’s lumbar spine disability impaired his ability to stand or sit for prolonged periods of time. The Veteran used a cane, wheelchair and walker to assist in ambulation. He continued to have migraine headaches localized at the right temple which radiated across the forehead to the back of the neck. The Veteran described being unable to function or concentrate during his migraine attacks, which occurred several times per week. As noted in Moore, the Board must address the TDIU question as a practical manner. Here, the record reflects that the Veteran’s primary area of employment was administration in the school system. Such employment requires both physical and sedentary aspects of the job. Given the evidence, the Board finds that realistically, the combined effective of the Veteran’s disabilities would preclude him from obtaining and maintaining substantially gainful employment. The 50 and 70 percent disability ratings for the Veteran’s PTSD along with the 30 percent rating for his migraines are indicative of significant impairment to his ability to focus and concentrate along with impairment to his ability to effectively work with others. Moreover, the Veteran’s physical disabilities likely preclude him from pursing gainful employment in a different line of work. Given these facts, and affording the Veteran the benefit of the doubt, the Board finds that the Veteran does not practically possess the ability to obtain or maintain substantially gainful employment consistent with his vocational background. The claim, therefore, is granted. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. Additional Considerations Issuance of a TDIU in turn raises the issue of entitlement to special monthly compensation (SMC). In that regard, the Board has considered the decision of the Court in Bradley v. Peake, 22 Vet. App. 280 (2008). In Bradley, the Court held that, SMC might be warranted when a separate award of a TDIU rating, predicated on a single disability (perhaps not ratable at the schedular 100 percent level), is considered together with another disability separately rated at 60 percent or more. See 38 U.S.C. § 1114(s); see also Buie v. Shinseki, 24 Vet. App. 242, 25 (2011). The Board does not find that an SMC rating is for application. The above grant of TDIU was predicated upon the collective effect of the Veteran’s disabilities. Additionally, the Veteran has not specifically reported, nor does the record reflect, that he has been rendered housebound. As such, the concerns addressed in Bradley and Buie are not present, and the Board needs not further address whether SMC ratings are warranted during the pendency of the appeal. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Orie, 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.