Citation Nr: 21031259 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 16-38 575 DATE: May 21, 2021 ORDER Entitlement to an evaluation in excess of 30 percent prior to July 12, 2017 for posttraumatic stress disorder (PTSD) is denied. Entitlement to an evaluation of 70 percent, but no higher, from July 12, 2017 to January 31, 2021 for PTSD is granted. Entitlement to an evaluation in excess of 70 percent from February 1, 2021 for PTSD is denied. Entitlement to a total disability rating based on individual unemployability due to a service-connected disability (TDIU) prior to October 15, 2018 is denied. Entitlement to TDIU from October 15, 2018 is granted. Entitlement to special monthly compensation at the housebound rate from October 15, 2018 is granted. FINDINGS OF FACT 1. Prior to July 12, 2017, the Veteran's PTSD manifested in symptoms more closely approximating occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, but generally functioning satisfactorily, with routine behavior, self-care, and conversation normal. 2. From July 12, 2017, the Veteran's PTSD manifested in occupational and social impairment with deficiencies in most areas. 3. The Veteran's service-connected disabilities did not prevent him from securing and maintaining substantially gainful occupation prior to October 15, 2018. 4. After resolving reasonable doubt in the Veteran's favor, his PTSD prevented him from securing and maintaining substantially gainful occupation from October 15, 2018. 5. From October 15, 2018, the Veteran's PTSD is effectively rated at 100 percent due to the grant of entitlement to TDIU herein, and he has additional service-connected disabilities independently ratable at 60 percent. CONCLUSIONS OF LAW 1. The criteria for entitlement to an evaluation in excess of 30 percent prior to July 12, 2017 for PTSD have not been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.130, Diagnostic Code (Code) 9411 (2020). 2. The criteria for entitlement to an evaluation of 70 percent, but no higher, from July 12, 2017 to January 31, 2021 for PTSD have been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.130, Code 9411 (2020). 3. The criteria for entitlement to an evaluation in excess of 70 percent from February 1, 2021 for PTSD have not been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.130, Code 9411 (2020). 4. The criteria for entitlement to TDIU prior to October 15, 2018 have not been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.16 (2020). 5. The criteria for entitlement to TDIU from October 15, 2018 have been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.16 (2020). 6. The criteria for entitlement to SMC at the housebound rate from October 15, 2018 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 CONCLUSIONS The Veteran served on active duty from April 1996 to June 1999 and January 2000 to October 2000, with additional periods of active duty for training (ACDUTRA). This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision by the Department of Veterans Affairs (VA). This case was remanded in March 2019 and December 2020 for further development. In July 2017, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge; a transcript of that hearing is of record. Since the Board's last remand, the Agency of Original Jurisdiction (AOJ) assigned an increased rating of 70 percent for the Veteran's PTSD, effective February 1, 2021. See February 2021 rating decision. The issue has been recharacterized accordingly. 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 the grant of entitlement to TDIU based on a single service-connected disability. The Board has accordingly added entitlement to SMC as an issue on appeal. 1. Entitlement to an evaluation in excess of 30 percent prior to February 1, 2021 and in excess of 70 percent thereafter for PTSD. Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular Code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including degree of disability, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). In any claim for an increased rating, "staged" ratings may be warranted where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App, 119 (1999). The Veteran's PTSD is currently rated at 30 percent under the General Rating Formula for Mental Disorders (General Formula) prior to February 1, 2021 and at 70 percent thereafter. A 30 percent rating is warranted 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). This may be due to such symptoms as: depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; and/or mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, Code 9411. A 50 percent evaluation is warranted where there is occupational and social impairment with reduced reliability and productivity. This may be 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; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation is warranted where there is occupational and social impairment, with deficiencies in most areas (such as work, school, family relations, judgment, thinking, or mood). This may be due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. Id. A 100 percent evaluation is warranted for total occupational and social impairment. This may be due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. The list of symptoms in the General Formula is not intended to constitute an exhaustive list, but provides examples of the type and degree of symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). However, a Veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). Furthermore, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126. As relevant to this case, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), states that it was recommended that the use of Global Assessment of Functioning (GAF) scores be dropped for several reasons, including their conceptual lack of clarity and questionable psychometrics in routine practice. The Board recognizes the Court's holding in Carpenter v. Brown, 8 Vet. App. 240, 242 (1995) regarding the importance of GAF scores, however, as the medical community has determined that GAF scores are an unreliable measure of a psychiatric disability, the Board assigns the GAF scores mentioned in the record no probative value, and will not discuss them specifically. See also Golden v. Shulkin, 29 Vet, App. 221 (2018). In January 2013 Social Security Administration (SSA) records, the Veteran reported that he had no problems with personal care and needed no reminders for grooming or medication. His social activities included talking when friends were available but only participating minimally in social gatherings. He reported difficulty with concentration. He was able to follow instructions and get along with authority. He did not handle routine changes well. A psychologist opined that, although the Veteran may have felt he could not return to the type of work done in the past, the evidence reflected that he had the capacity to perform some types of less strenuous work that did not expose him to hazardous environments. During an August 2014 VA examination, the Veteran reported that he lived with his second wife of 10 years and his three children. He worked in information systems and security and had the job for about a year. Prior to that job, he worked as a contractor for the government doing the same type of work for about a year and prior to that time, he was unemployed for about 10 months due to an error when he was being transferred from one position to another within the federal system. He could not name any close friends and complained of difficulty falling asleep. He was reluctant to go on errands such as to the grocery store because he felt that he needed to watch his surroundings. He felt he must be on alert at all times. See August 2014 VA examination. The August 2014 VA examiner opined the Veteran had occupational and social impairment due to mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. He had somewhat of a paranoid stance but denied overt auditory or visual hallucinations. Paranoia and safety concerns were easily magnified by factual security concerns he was exposed to at his work. His overall mood was mildly anxious for the interview process. His affect was somewhat guarded and aloof. His symptoms consisted of depressed mood, anxiety, suspiciousness, panic attacks that occurred weekly or less often, chronic sleep impairment, and flattened affect. Id. The Veteran described that he was able to recall and retain high-level IT security related information but had difficulty recalling entry level information. He could not focus on his daily duties and his career was suffering. See December 2014 notice of disagreement. During a June 2016 VA examination, the Veteran described the following symptoms: intrusive events, hypervigilance, distrust of individuals of certain cultural descent, fluctuations in mood, including anxiety and depression, occasional panic attacks, and anger or irritability. He reported some difficulty at work, loss of interest in activities, and "zoning out" to prior traumatic events that affected his cognitive functioning and attention and resulted in errors on the job due to missing details. He reported that he was still married to his second wife and endorsed a small group of friends. He continued in the same line of work and stated that he had a very good job, which allowed him to provide for his family and pay off their debts. See June 2016 VA examination. The June 2016 VA examiner opined the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. His symptoms consisted of depressed mood, anxiety, suspiciousness, panic attacks that occurred weekly or less often, chronic sleep impairment, and mild memory loss, such as forgetting names, directions, or recent events. He was appropriately interactive and exhibited normal comprehension and expression, as evidenced by following simple directions and by responding to questions directly and on point. Id. In April 2017 VA vocational readiness and employment (VR&E) records, the Veteran reported no significant aggravation of his service-connected disabilities while performing job requirements, but he was noted to have some vocational impairment due to his disability: working in crowds, potentially violent situations, enclosed spaces, and chaotic or highly stimulating environment. However, the VR&E specialist noted that the Veteran had overcome these vocational impairments by obtaining successful employment. During his Board hearing on July 12, 2017, the Veteran reported severe memory issues and cognition problems, such as slurring. He recently had a panic attack and called the veteran's crisis hotline. He reported about five panic attacks a week, during which he was sometimes incapacitated, did not move, zoned out, or cried for many hours. He would forget things such as where he put his sunglasses. He reported nightmares every night. He would get panic attacks due to the stress from his work. Socially, he did not have many friends, but was close to two of his neighbors. Prior to meeting his neighbors, he would not go outside or be social. See July 2017 Board hearing. The Veteran testified that he was on short-term disability leave because of his PTSD, although the record does not reflect when he went on short-term leave and when he returned to work. He reported that he could not take his children to the zoo because of the psychological stress. He would have to take off work every couple of weeks to recharge at least one day. The Veteran's spouse testified that the Veteran could not handle large groups but felt safe within his small circle of friends. Id. Later in July 2017, the Veteran reported he was becoming increasingly impaired in his ability to function, focus, and remember his work. He reported frequent re-experiencing of symptoms, anxiety, panic attacks, and hypervigilance. His VA social worker opined that his level of impaired function required him to take a leave of employment. The Veteran reported that his psychological symptoms interfered with his necessary functioning at work and that he functioned well in the past until the previous four to five months. See July 2017 correspondence. In August 2017 SSA records, the Veteran reported that he would forget to change into clean clothes, bathe, and feed himself due to his PTSD. In December 2018 SSA records, the Veteran reported that he stopped working in October 2018. In March 2019 SSA records, the Veteran reported he had difficulty completing tasks due to flashbacks. He stated he needed reminders to take care of hygiene. His wife would lay out his medications. He did not cook or do household chores. He would not go out alone and reported he was unable to retain information. In June 2020 VA treatment records, the Veteran reported that he had been struggling with worsening PTSD symptoms for the past two and a half years and that it had gotten to the point where he would rarely leave the house. In later June 2020 records, he reported he did not leave the home because he did not feel safe. In October 2020 VA treatment records, he reported that his PTSD symptoms interfered with his relationship with his wife, stating, "There's not a lot of happiness with me." During a February 2021 VA examination, the Veteran reported that he worked in computer security until 2018 when he quit, as he was on the verge of getting fired for poor performance. At the end of his work he went on unpaid emergency leave. His performance had diminished due to significant difficulties with memory and concentration. He had been unemployed since approximately December 2018. He denied any friendships, but reported several acquaintances, none of whom he spent time with. He had no social activities, but his marital relationship was "good." He used to have hobbies but stopped as of December 2018 due to lack of motivation, disinterest, and self-doubt. He was more withdrawn and rarely left the house. He reported that the events he experienced in the military "finally caught up with me," as a result of job stress in 2018. In order to obtain an evaluation in excess of 30 percent, the Veteran would need to show that his PTSD manifested in at least occupational and social impairment with reduced reliability and productivity. Prior to July 12, 2017, the day of the Veteran's Board hearing, his symptoms more closely approximated occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, but he was generally functioning satisfactorily, with routine behavior, self-care, and conversation normal. However, from July 12, 2017, the Board finds that his PTSD symptoms manifested in occupational and social impairment with deficiencies in most areas. The most probative evidence that the Veteran had only occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks is that he was working during the period prior to July 12, 2017 with only few reported difficulties in concentration and memory. Indeed, he reported that he was able to recall and retain high-level IT security related information, despite difficulty recalling entry level information; such mild memory loss is compatible with only occasional decrease in work efficiency. The Veteran's report that his career was suffering in 2014 is outweighed by his other reports that his service-connected disability did not aggravate his job, such as in April 2017, and the VA examiners' opinions regarding his occupational and social impairment. Additionally, although the Veteran did not have many friends and was noted to have a flattened affect, it appears that his marriage was stable and he was able to have normal conversation and routine behavior around other people, even if he preferred to be only in small groups. As a result, the preponderance of the evidence reflects that the Veteran did not have occupational impairment with reduced reliability and productivity or more severe impairment prior to July 12, 2017. The Board acknowledges that the Veteran went on short-term disability leave sometime prior to July 12, 2017, which indicates a worsening of symptoms prior to his Board hearing. However, the record does not reflect when he was placed on leave and the only additional evidence that suggests worsening prior to July 12, 2017 is a post-dated estimate that his symptoms worsened in approximately February or March 2017. See July 2017 correspondence. The AOJ asked the Veteran to provide more employment information in December 2020 correspondence, but he did not respond. The duty to assist is not a one-way street. VA's duty must be understood as a duty to assist a veteran in developing his or her claim, rather than a duty on the part of VA to develop the entire claim with the veteran performing a passive role. Wood v. Derwinski, 1 Vet. App. 190 (1991). The Board also notes that the Veteran still ultimately bears some burden of production. 38 U.S.C. § 5107(a). Because the Board is unable to find specific evidence to determine if and when the Veteran's symptoms worsened prior to July 12, 2017, the Board finds that the evidence first reflects a worsening of symptoms on July 12, 2017. Thus, July 12, 2017 is the best date available in the record to assign a staged rating. As noted above, from July 12, 2017, the Veteran's PTSD symptoms manifested in occupational and social impairment with deficiencies in most areas. During his Board hearing, he reported severe memory and concentration problems. He also reported panic attacks five times a week. His reported difficulties with hygiene and self-care also reflect a worsening of symptoms after July 2017 and these symptoms are consistent with the February 2021 VA examiner's opinion that the Veteran had difficulty in adapting to stressful circumstances, including at work or a work like setting. Thus, the Veteran is entitled to a 70 percent rating for PTSD from July 12, 2017. A rating of 100 percent is not warranted from July 12, 2017 because the record does not reflect total social impairment. Even if the Board were to concede occupational impairment, the record reflects that the Veteran continued to have friends, such as his neighbors, and a stable relationship with his spouse. Such evidence outweighs the Veteran's reluctance to leave the house. Additionally, although the February 2021 VA examiner opined that the Veteran had gross impairment in thought processes or communication and the Veteran had some problems with activities of daily living, such evidence is outweighed by his stable social relationships. Thus, the Veteran does not have total social impairment, and a rating of 100 percent is not warranted. 2. Entitlement to TDIU. 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). Entitlement to TDIU requires impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Substantially gainful employment is defined as work which is more than marginal and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). The central inquiry is whether the Veteran's service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). In making this determination, consideration may be given to the Veteran's level of education, special training, and previous work experience, but not to his age or the impairment caused by non-service-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. The Veteran worked as a senior analyst throughout the appeal period until approximately May 2018; although there was a period of time when he did not work early in the appeal period, he reported that it was because of bureaucratic error. See August 2017 SSA records; undated SSA records; August 2014 VA examination. As discussed in part above, in April 2017 VA VR&E records, the Veteran reported that he was employed as a senior analyst earning approximately $10,000 per month. He reported no significant aggravation of his service-connected disabilities while performing job requirements, but he was noted to have some vocational impairment due to his disability: working in crowds, potentially violent situations, enclosed spaces, and chaotic or highly stimulating environment. However, the VR&E specialist noted that the Veteran had overcome the vocational impairments by obtaining successful employment. During his July 2017 Board hearing, the Veteran reported that he was on short-term disability leave; it is unclear when the Veteran began to work again. By August 2017, he reported inability to retain basic to high level information, and an inability to write clearly and effectively, including verbal briefings. See August 2017 SSA records. As discussed above, the Veteran reported that he worked in computer security until 2018 when he quit, as he was on the verge of getting fired for poor performance. See February 2021 VA examination. He then worked as an assistant manager in retail from May 2018 to October 2018. He reported that he was unable to work because of his disabilities as of October 15, 2018 and stopped working the same day. See December 2018 SSA records. The Veteran applied for SSA disability compensation in January 2013. An SSA examiner opined that the Veteran could alternate the activities of sitting, standing, and walking as needed for his comfort for a total of eight hours per day. He could lift and carry about 20 pounds (lbs.). He was unable to bend and able to squat on a one-time basis. The Veteran's wife reported that he was unable to sit or stand for long periods of time and unable to lift over 10 lbs. The SSA determined that the Veteran was able to perform some types of less strenuous work that did not expose him to hazardous environments and denied his claim. See January 2013 SSA records. The SSA again denied that he was disabled in April 2019. See April 2019 SSA determination. It appears that the Veteran had three years of college before starting to attend classes in August 2020 to become a technical writer. See June 2020 VR&E correspondence. He reported that school was going well, and he received good grades despite noticing memory and concentration difficulties. See February 2021 VA examination. Prior to October 15, 2018 The Veteran is not entitled to TDIU because his service-connected disabilities did not prevent him from securing and maintaining substantially gainful occupation prior to October 15, 2018. Notably, the Veteran worked throughout the appeal period until October 15, 2018. Although he was on short-term leave and was having difficulties prior to when he quit work, the evidence reflects clearly that he was working full-time and continued to work after he returned from leave. The Board acknowledges that the Veteran worked only a short amount of time in retail from May 2018 to October 15, 2018. However, he has not asserted that he was unable to work during that time and the evidence does not otherwise reflect that he was unable to maintain occupation due to his service-connected disabilities during that time. Indeed, the evidence reflects that he believed he was unable to work starting on October 15, 2018. See SSA records. Once again, the Veteran still ultimately bears some burden of production, 38 U.S.C. § 5107(a), and the evidence before the Board, including lay statements, reflects that he was able to work until October 15, 2018. Thus, the preponderance of the evidence reflects that the Veteran was able to secure and follow substantially gainful occupation prior to October 15, 2018, and entitlement to TDIU is denied. From October 15, 2018 After resolving reasonable doubt in the Veteran's favor, the Board finds that, from October 15, 2018, his PTSD prevented him from securing and maintaining substantially gainful occupation. Notably, the February 2021 VA examiner opined that the Veteran had difficulty (i) attending to or was easily distracted from the task at hand, (ii) maintaining concentration and focus on work over a period of time, tending to skip from one task to another without completing the prior task, and (iii) remembering instructions and details of work assignments. The VA examiner's opinion is supported by the Veteran's lay reports of difficulty concentrating and forgetfulness. See, e.g., February 2019 SSA records. Additionally, a VR&E specialist opined that the Veteran's service-connected disabilities contributed to significant vocational impairment, as he was unable to obtain or maintain employment in the labor market that did not aggravate his service connected disabilities. See June 2020 VR&E records. The Board acknowledges that the Veteran has been taking college classes since August 2020 and that he is doing well. See February 2021 VA examination. The Board also notes that the SSA found the Veteran was not disabled in April 2019. See April 2019 SSA determination. However, the Board finds that the Veteran's lay reports of difficulty working and the report by the VR&E specialist are compelling, probative evidence. As a result, the Board will resolve reasonable doubt in his favor and finds that the Veteran's service-connected PTSD prevented him from securing and maintaining substantially gainful occupation since October 15, 2018. Thus, entitlement to TDIU is warranted. 3. Entitlement to SMC at the housebound rate from October 15, 2018. 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 Board has awarded TDIU due to the Veteran's service-connected PTSD from October 15, 2018. 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 60 percent, to include: lumbosacral strain, rated at 40 percent; left knee patellar tendonitis, rated at 10 percent; left lower extremity sciatic nerve radiculopathy, rated at 10 percent; and tinnitus, rated at 10 percent. Thus, the requirements for SMC at the housebound rate have been met from October 15, 2018, and SMC is warranted. 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.