Citation Nr: 21020769 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 19-29 618 DATE: April 8, 2021 ORDER Restoration of a 100 percent disability rating for prostate cancer as of May 1, 2018, is denied. Entitlement to a rating in excess of 20 percent for residuals of prostate cancer, to include a voiding dysfunction, as of May 1, 2018, is denied. Restoration of special monthly compensation (SMC) based on housebound criteria, as of May 1, 2018, is denied. FINDINGS OF FACT 1. As of May 1, 2018, the prostate cancer disability rating had been in effect for less than five years, and an adequate reexamination indicated an improvement in the severity of the Veteran’s service-connected prostate cancer, specifically that it had entered remission. 2. From May 1, 2018, the Veteran did not continue to receive surgical, X-ray, antineoplastic chemotherapy, or other therapeutic procedure; have any continued active malignancy of his genitourinary system; or, have any local recurrence or metastasis of his prostate cancer. 3. Since May1, 2018, the Veteran’s prostate cancer was inactive with residual symptoms of voiding dysfunction, including urine leakage requiring the use of absorbent material which must be changed less than two times per day, urinary frequency requiring daytime voiding interval between two to three hours and nighttime awakening to void two times; and signs or symptoms of obstructed voiding, to include marked hesitancy, markedly slow stream, markedly weak stream, and markedly decreased force of stream. 4. Beginning May 1, 2018, the Veteran does not have a single service-connected disability rated at 100 percent and additional service-connected disability ratable at 60 percent. 5. The Veteran is not permanently housebound by reason of his service-connected disabilities. CONCLUSIONS OF LAW 1. The reduction in the rating for the Veteran’s residuals of prostate cancer from 100 percent to 20 percent, effective May 1, 2018, was proper. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.105(e), 3.343(a), 3.344(c), 4.1-4.7, 4.115b, Diagnostic Code 7528. 2. The criteria for an increased disability rating higher than 20 percent for prostate cancer residuals are not met from May 1, 2018. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.3, 4.7, 4.115a, 4.115b, Diagnostic Code 7528. 3. The termination of an award of SMC based on housebound status, effective May 1, 2018, was proper. 38 U.S.C. §§ 1114(s), 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.105, 3.159, 3.350(i), 4.16, 4.25. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from February 1968 to February 1971. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a January 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2021, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. Law and Analysis Neither the Veteran nor his representative has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). 1. Propriety of the reduction of the 100 percent evaluation for prostate cancer The Veteran contends that the reduction in rating for prostate cancer was improper and that he is entitled to a 100 percent evaluation. In this regard, the Veteran acknowledges that his prostate cancer is in remission; however, he contends that he still has cancer based on his prostate-specific antigens (PSA). After a review of the record, the Board finds that the Veteran’s prostate cancer had improved and he was in remission as there was no active malignancy, and thus the reduction in rating was proper. Initially, the Board concludes that the RO complied with the procedural requirements of a rating reduction. Specifically, under 38 C.F.R. § 3.105(e), where a reduction in an evaluation of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance must be prepared setting forth all material facts and reasons. In addition, the RO must notify the Veteran that he has 60 days to present additional evidence showing that compensation should be continued at the present level. The Veteran must be informed that he may request a predetermination hearing, provided that the request is received by VA within 30 days from the date of the notice. If no additional evidence is received within the 60-day period and no hearing is requested, 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 the Veteran expires. Id. The RO satisfied the due process notification requirements under 38 C.F.R. § 3.105(e). Specifically, the Veteran underwent a VA examination for his prostate cancer in June 2016. In a September 2016 rating decision, the Veteran’s 100 percent evaluation for that disability was increased to 100 percent, effective June 1, 2016, and it was proposed to be reduced to 20 percent for the residuals of prostate cancer on the basis of that examination. The Veteran was informed of his rights, including to a predetermination hearing and to submit additional evidence, in a September 2016 VA letter. In February 2017, the Veteran had an informal conference with a Decision Review Officer (DRO) at the RO. The Veteran indicated that he felt overwhelmed by the proposal to reduce his compensation and the DRO explained that medical evidence was needed that showed a diagnosis and/or treatment for active prostate cancer to continue the 100 percent rating. Based on his argument and evidence, the RO provided the Veteran with VA examinations in April 2017, then finalized the discontinuance of the Veteran’s 100 percent evaluation for prostate cancer in a January 2018 rating decision, reducing the rating to 20 percent, effective May 1, 2018. The effective date of the reduction, May 1, 2018, was the day after the last day of the month after expiration of the 60-day period from the date of notice of the January 2018 final rating action, as set forth in the applicable VA regulation. In light of these facts, the particularized procedure for discontinuing the Veteran’s 100 percent evaluation for his prostate cancer was appropriately and adequately completed in this case. The criteria governing certain rating reductions for certain service-connected disabilities is found in 38 C.F.R. § 3.344. This regulation applies to ratings that had been continued for long periods of time at the same level (five years or more). Brown v. Brown, 5 Vet. App. 413 (1993). In the present case, the RO initially granted service connection for prostate cancer in an October 2014 rating decision and assigned a 100 percent disability rating, effective from July 28, 2013. In the January 2018 rating decision, the RO effectuated a reduction to 20 percent, effective May 1, 2018. Consequently, the rating was in effect for less than five years, and thus the provisions of 38 C.F.R. § 3.344 pertaining to stabilization of disability evaluations do not apply; reexamination disclosing improvement will warrant a rating reduction. 38 C.F.R. § 3.344(c). Further, 38 C.F.R. § 3.343(a), which applies to reductions of 100 percent ratings, similarly requires an examination showing material improvement in physical or mental condition, and consideration of whether the Veteran attained improvement under the ordinary conditions of life. There are several other general VA regulations that apply to all rating reductions regardless of whether the rating has been in effect for five years or more. Brown, 5 Vet. App. at 420-421. Specifically, 38 C.F.R. § 4.1 requires that each disability be viewed in relation to its history. Furthermore, 38 C.F.R. § 4.13 provides that the rating agency should assure itself that there has been an actual change in the condition, for better or worse, and not merely a difference in the thoroughness of the examination or in use of descriptive terms. Additionally, in any rating reduction case, not only must it be determined that an improvement in a disability has actually occurred, but that such improvement reflects improvement in ability to function under ordinary conditions of life and work. Brown, at 420-21; see 38 C.F.R. §§ 4.2, 4.10. A claim as to whether a rating reduction was proper must be resolved in the Veteran’s favor unless the Board concludes that a fair preponderance of evidence weighs against the claim. Id. The 100 percent and 20 percent evaluations were assigned under 38 C.F.R. §§ 4.115a, 4.115b, Diagnostic Code 7528, malignant neoplasms of the genitourinary system, which assigns a 100 percent for active malignancy and then assigns an evaluation for residuals following active malignancy under the appropriate genitourinary dysfunction which predominates, in this case, is voiding dysfunction. A note after Diagnostic Code 7528 provides that, following the cessation of surgical, X-ray, antineoplastic chemotherapy, or other therapeutic procedure, the rating of 100 percent shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 C.F.R. § 3.105(e). If there has been no local reoccurrence or metastasis, the disability is to be rated on residuals, as voiding dysfunction or renal dysfunction, whichever is predominant. See 38 C.F.R. § 4.115b, Diagnostic Code 7528, Note. In considering the evidence of record under the laws and regulations as set forth above, there that is no evidentiary basis for continuance of the 100 percent rating for prostate cancer under Diagnostic Code 7528 after May 1, 2018. See 38 C.F.R. § 4.7. The evidence of record, including pertinent VA treatment records and VA genitourinary examinations, does not reveal local recurrence or metastasis of the Veteran’s malignant neoplasm of the genitourinary system-prostate cancer after May1, 2018. In particular, the reduction was based on a July 2015 VA examination, which showed prostate cancer was in remission, with no active malignancy, and had improved, with permanent slow urinary stream, urinary urgency, and fatigue noted. In all, the Veteran underwent VA examinations for his prostate cancer in July 2015 and April 2017. Each examination noted the Veteran had a diagnosis of prostate cancer from 2014, treated with external radiation which had been completed, that was currently in remission. Each examination also noted that the only residuals of prostate cancer were a voiding dysfunction and erectile dysfunction. The Veteran’s treatment records reflect the same manifestations and current status of prostate cancer. In support of his claim for a continued 100 percent rating, the Veteran submitted statements from a VA neurologist in which she stated that the Veteran was being followed for prostate adenocarcinoma. The Veteran also testified as to her statements. January 2021 Hearing (Hr’g) Transcript (Tr.) at 3. She stated that, although the PSAs were declining, it was not undetectable, and urology could not determine if the Veteran was free of prostate cancer. See March 2016, March 2017, September 2018, and September 2019 statements. However, his prostate cancer was still considered in remission. Further, in a June 2016 VA medical opinion, a VA examiner reviewed his July 2015 VA examination report and all VA treatment records through April 2016, including the VA neurologist’s March 2016 statement, and concluded that the Veteran’s prostate cancer was in remission. The June 2016 VA examiner noted that his review found some residual prostate cancer cells at the histologic level, but no cancer at the tissue or organ levels. In addition, the June 2016 VA examiner noted that serial PSA measurements from September 2015 to March 2016 showed declining results, which confirmed that the Veteran’s prostate cancer was in remission. The April 2017 VA examiner also considered the declining PSA findings in finding that the Veteran’s prostate cancer was still in remission. The Board emphasizes that the diagnostic criteria for prostate cancer do not require a finding that the Veteran is cancer free to reduce the rating from 100 percent. Instead, the criteria are based on the end of anti-neoplastic therapy and the absence of local recurrence or metastasis of the cancer. As a result, the neurologist’s opinion that the Veteran cannot be considered cancer-free does not directly address the medical determinations on which the rating is to be reduced. The Board cannot, therefore, afford it significant probative value. Thus, there is no evidence of record of local recurrence or metastasis of prostate cancer, and no evidence of record the Veteran underwent further surgical procedure, radiation, chemotherapy, or other therapeutic procedure after May 1, 2018. Given the July 2015 VA examination, contemporaneous VA treatment records, and later VA examinations, the evidence demonstrates that a material improvement in the Veteran’s physical condition. Moreover, this improvement has in fact continued under the ordinary conditions of life. Thus, the requirements of 38 C.F.R. § 3.343(a) for a rating reduction have been satisfied. The Board concludes that the reduction from 100 percent to 20 percent met the provisions of 38 C.F.R. §§ 3.344(c) and 3.343(a). Consequently, the RO’s rating action to reduce the Veteran’s disability rating for prostate cancer from 100 percent to 20 percent, effective May 1, 2018, was proper as his prostate cancer is in remission. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.343(a), 3.344(c). Accordingly, this appeal as to the propriety of the reduction is denied. 38 C.F.R. §§ 4.3, 4.7. 2. Since May 1, 2018, entitlement to a rating in excess of 20 percent for residuals of prostate cancer, to include voiding dysfunction Having determined that the process required to reduce the Veteran’s rating was correctly followed by the RO, the next question to be addressed is whether, given the available evidence, a rating higher than 20 percent for the Veteran’s prostate cancer is warranted since May 1, 2018. Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38C.F.R. §4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38C.F.R. §4.7. Separate ratings can be assigned for separate periods based on the facts found—a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. Under Diagnostic Code 7528, if there has been no local reoccurrence or metastasis, then a Veteran’s cancer is rated based on residuals as voiding dysfunction or renal dysfunction, whichever is the predominant disability. 38 C.F.R. § 4.115b, Diagnostic Code 7528. Based on the evidence of record that includes the VA examination reports above, and the Veteran’s statements regarding symptomatology, the predominant residual dysfunction of the Veteran’s prostate cancer is voiding dysfunction. Voiding dysfunction is rated as either urine leakage, frequent, or obstructed voiding. Only the predominant area of dysfunction shall be considered for rating purposes. In cases of continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence, a 20 percent evaluation is assigned in cases requiring the wearing of absorbent materials which must be changed less than two times per day. A 40 percent evaluation is assigned in cases requiring the wearing of absorbent materials which must be changed two to four times per day. A maximum schedular rating of 60 percent is assigned in cases requiring the use of an appliance or the wearing of absorbent material which must be changed more than four times per day. 38 C.F.R. § 4.115a. In this regard, the evidence does not show that the Veteran had urine leakage requiring the wearing of absorbent materials which must be changed two to four times per day. In fact, during the July 2015 VA examination, the Veteran was noted to have voiding dysfunction that caused urine leakage requiring the use of absorbent material which must be changed less than two times per day. The examiner noted that the voiding dysfunction did not require the use of an appliance. During the April 2017 VA examination, the VA examiner noted that the Veteran’s voiding function did not cause urine leakage or require the use of an appliance. Thus, the Veteran does not warrant an increased rating based on urine leakage. In cases of urinary frequency, a 20 percent evaluation is warranted in cases of a daytime voiding interval one and two hours or awakening to void three to four times a night. A 40 percent evaluation is the maximum schedular rating and is assigned in cases of a daytime voiding interval less than one hour or awakening to void five or more times per night. 38 C.F.R. § 4.115a. The evidence does not show that the Veteran had urinary frequency with a daytime voiding interval less than one hour or awakening to void five or more times per night. During the July 2015 VA examination, the Veteran was noted to have voiding dysfunction that caused increased urinary frequency with a daytime voiding interval between one to two hours and nighttime awakening to void two times. During the April 2017 VA examination, the VA examiner noted that the Veteran had voiding dysfunction that caused increased urinary frequency with a daytime voiding interval between two to three hours and nighttime awakening to void two times. Therefore, the Veteran does not warrant an increased evaluation based on urinary frequency. In cases of obstructed voiding, a maximum schedular evaluation of 30 percent is warranted where there is urinary retention requiring intermittent or continuous catheterization. The evidence does not show urinary retention requiring intermittent or continuous catheterization. During the July 2015 VA examination, the Veteran was noted to have voiding dysfunction that caused signs or symptoms of obstructed voiding, to include marked hesitancy, markedly slow stream, markedly weak stream, and markedly decreased force of stream. The examiner indicated that there were no other obstructive symptoms. The April 2017 VA examiner noted that the Veteran’s voiding dysfunction did not cause signs or symptoms of obstructed voiding and that there were no other obstructive symptoms. Thus, the Veteran does not warrant an increased evaluation based on obstructed voiding. Additionally, the Veteran’s treatment records do not reflect more severe symptoms, or more frequent voiding, nor has the Veteran reported more severe symptoms. Consequently, the Board finds that an evaluation in excess of 20 percent for the Veteran’s residuals of prostate cancer, rated as a voiding dysfunction, is not warranted. In this regard, the record reflects that during the period on appeal the Veteran’s voiding dysfunction resulted in a daytime voiding frequency between two and three hours and awakening to void two times per night, without symptoms of urinary frequency of a severity consistent with a higher rating. In addition, the Veteran has testified he had renal problems. Hr’g Tr. at 5. An October 2020 VA treatment note also showed renal disease. In cases with renal dysfunction, a 30 percent evaluation is assigned for albumin constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema or hypertension at least 10 percent disabling under Diagnostic Code 7101. A 60 percent evaluation is assigned for constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under Diagnostic Code 7101. An 80 percent evaluation is assigned for persistent edema and albuminuria with BUN 40 to 80mg%; or, creatinine 4 to 8mg%; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion. A 100 percent evaluation is assigned for renal dysfunction requiring regular dialysis, or precluding more than sedentary activity from one of the following: persistent edema and albuminuria; or, BUN more than 80mg%; or, creatinine more than 8mg%; or, markedly decreased function of kidney or other organ systems, especially cardiovascular. Under Diagnostic Code 7101, hypertensive vascular disease (hypertension and isolated systolic hypertension) warrants a 10 percent evaluation where diastolic pressure is predominantly 100 or more, or; systolic pressure is predominantly 160 or more, or; the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 40 percent evaluation is assigned for diastolic pressure predominantly 120 or more. 38 C.F.R. § 4.104. During the January 2021 hearing, the Veteran indicated that he had kidney problems and that he had lost 60 percent of his kidney function, but he was unsure whether it was related to his prostate cancer. He related that a nephrologist advised him to be careful about his diet and prescribed medications to keep his sodium, potassium, and nephrons in balance; however, he also stated that she told him that his remaining kidney function was not problematic and that he would not need dialysis. Hr’g Tr. at 5. In an October 2020 VA treatment note, the examining nephrologist noted that the Veteran’s renal history included a December 2016 kidney biopsy which showed ATN with mild to moderate interstitial fibrosis suspected from mesalamine with peak creatinine 2.8 with recovery to 1.6. The Veteran reported that he continued to have low energy and he indicated that his blood pressure at home ranged from 115 to 120s systolic over 60 to 70s diastolic, but that it was as high as 175/80 occasionally. He noted that his weight had been stable. Notably, the Board finds that there is no evidence showing that the Veteran’s renal dysfunction was caused or aggravated by his prostate cancer; rather, the October 2020 VA treatment note indicates that the Veteran’s kidney interstitial fibrosis was suspected from mesalamine, which is a medication used to treat ulcerative colitis. The Veteran has not proffered any evidence that the course of his kidney disease was in any way affected by his prostate cancer or the treatment for it. Therefore, the rating criteria pertaining to renal dysfunction is not the predominant residual dysfunction of the Veteran’s prostate cancer and no further discussion is necessary. The Board has also considered whether an additional staged rating under Fenderson, supra, is appropriate for the Veteran’s service-connected prostate disability; however, such symptomatology has been stable throughout the period on appeal. Therefore, assigning staged ratings is not warranted. Accordingly, a rating in excess of 20 percent for residuals of prostate cancer, manifested as a voiding dysfunction, is not warranted. In reaching this decision, the preponderance of the evidence is against an increased rating for such disability. Therefore, the benefit of the doubt doctrine is not applicable, and his claim for an increased rating must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Termination of SMC (Housebound) SMC benefits by reason of being housebound are payable under 38 U.S.C. § 1114(s) if the Veteran has a single disability rated as 100 percent disabling, and has either: (1) additional service-connected disability or disabilities independently ratable at 60 percent or more, or (2) is “permanently housebound” by reason of service-connected disability or disabilities. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). Housebound benefits are not available to a Veteran whose 100 percent disability rating is based on multiple disabilities, none of which is rated at 100 percent disabling. Guerra v. Shinseki, 642 F.3d 1046 (Fed. Cir. 2011). In addition, the disabilities independently ratable at 60 percent or more must be separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems. 38 C.F.R. § 3.350(i)(1). In a December 2014 rating decision, the RO awarded the Veteran SMC based on the housebound rate due to having one disability (prostate cancer) rated at 100 percent disabling and other service-connected disabilities combined to 60 percent disabling, effective from July 28, 2013. In the September 2016 rating decision, the RO informed the Veteran that his service-connected prostate cancer was increased to 100 percent, effective from June 1, 2016, and proposed a reduction to 20 percent for the residuals of prostate cancer, effective from May 1, 2018. The RO also reinstated SMC based on the housebound rate, effective from June 1, 2016, and proposed a lower SMC level, effective from May 1, 2018. In the January 2018 rating decision, the RO decreased the Veteran’s prostate cancer evaluation to 20 percent, effective from May 1, 2018, and terminated SMC, effective from May 1, 2018, sixty days after notification of the rating decision. At the outset, the Board finds that the RO satisfied the due process notification requirements under 38 C.F.R. § 3.105(f). Specifically, after the proposed discontinuance of SMC at the housebound rate in the September 2016 rating decision, the Veteran was given 60 days to present additional evidence and was notified at his address of record. The Veteran filed a Notice of Disagreement (NOD) following the September 2016 rating decision and he had an informal conference with a DRO at the RO in February 2017. The effective date of the discontinuance, May 1, 2018, was proper as it followed the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expired. See 38 C.F.R. § 3.105(f), (i)(2). Thus, all procedural requirements were met here pursuant to 38 C.F.R. § 3.105(f) and (i). As a result of the reduction of the residuals of prostate cancer from 100 percent to 20 percent, effective May 1, 2018, the Veteran did not meet the schedular rating criteria for SMC at the housebound rate, based on one service-connected disability rated as 100 percent disabling and a separate disability rated at 60 percent or higher. See 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). As such, beginning May 1, 2018, the Veteran no longer had a single disability rated as 100 percent disabling. His residuals of prostate cancer were rated as 20 percent disabling. His service-connected coronary artery disease was rated as 60 percent disabling and his erectile dysfunction was noncompensable at that time. Therefore, the Veteran clearly did not meet the statutory requirements for the payment of SMC at the housebound rate beginning May 1, 2018. See 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). Finally, the Board has also considered whether beginning May 1, 2018, the Veteran met the alternative housebound in fact criteria with regard to being “permanently housebound” as the result of his service-connected disabilities. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i)(2). A veteran is permanently housebound when he or she is substantially confined to his or her house (ward or clinical areas, if institutionalized) or immediate premises as a direct result of his or her service-connected permanent disability or disabilities, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime. Id. Upon review of the evidence with regard to the factual housebound criteria, the Veteran was not “permanently housebound” by reason of service-connected disability or disabilities. Id. There is no support in the record for the Veteran being permanently housebound or substantially confined to his house or immediate premises as a direct result of his service-connected permanent disability or disabilities, let alone any evidence showing it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his lifetime. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i)(2). The July 2015 VA examiner did find that the Veteran’s prostate cancer impacted his ability to work due to exhaustion from residuals of radiation therapy. However, the April 2017 VA examiner reported that the Veteran retired in 2013, before he began radiation treatment for prostate cancer in 2014, and that his prostate cancer did not impact his ability to work. Consequently, for the multiple reasons cited above, the Board finds that the termination of the award of SMC based on the housebound rate, effective May 1, 2018, was proper. 38 U.S.C. §§ 1114(s), 5107(b); 38 C.F.R. § 3.350(i). J. B. FREEMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Osegueda, 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.