Citation Nr: 21032555 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 18-16 295 DATE: May 27, 2021 ORDER An initial disability rating of 100 percent for an acquired psychiatric disorder is granted. A total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. The severity, frequency, and duration of the Veteran's psychiatric symptoms most closely approximate total occupational and social impairment. 2. During the entire appellate period, the Veteran is in receipt of a total (100 percent) schedular rating for an acquired psychiatric disorder, and his other service-connected disabilities do not individually or in combination preclude him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for an initial 100 percent rating for an acquired psychiatric disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9413. 2. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from September 1966 to July 1970 and from January 1971 to November 1984. These matters are before the Board of Veterans' Appeals (Board) on appeal from a May 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The May 2016 rating decision on appeal effectuated a March 2016 Board decision that granted service connection for "a variably diagnosed psychiatric disability, to include posttraumatic stress disorder (PTSD) and anxiety disorder." However, in the May 2016 rating decision, the RO characterized the Veteran's service-connected disability only as an "anxiety disorder", and the subsequent increased rating claim has been characterized as the same. To account for the Veteran's various and, oftentimes, changing psychiatric diagnoses of record, the Board has herein recharacterized his increased rating claim to "an acquired psychiatric disorder." The Board remanded these matters in May 2019 for additional development. As the actions specified in the remand have been substantially completed, the case has been properly returned to the Board for appellate consideration. See Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). Duties to Notify and Assist With respect to the Veteran's claims herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A; 38 C.F.R. § 3.159. Neither the Veteran nor his representative have advanced any procedural arguments in relation to VA's duties to notify and assist; therefore, the Board will proceed with appellate review. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015). Increased Rating Disability ratings are determined by application of the criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; see generally 38 C.F.R. § Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's entire history is to be considered when making disability evaluation determinations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where, as here, the question for consideration is the propriety of the initial rating assigned, evaluation of the medical evidence since the effective date of the grant of service connection and consideration of the appropriateness of the assignment of different ratings for distinct periods of time, based on the facts found, is required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999); Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). When all 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 preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. Gilbert, 1 Vet. App. at 53. 1. Entitlement to an initial rating in excess of 70 percent for an acquired psychiatric disorder The Veteran generally contends that he should be assigned a higher initial rating for his service-connected acquired psychiatric disorder, which is currently rated 70 percent disabling from April 29, 2008. For the reasons specified below, the Board finds that an initial 100 percent rating is warranted for the entire duration of the appeal. The Veteran's acquired psychiatric disorder is rated under Diagnostic Code 9413. Pursuant to a General Rating Formula for Mental Disorders, specified in 38 C.F.R. § 4.130, a 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals that interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting ability to function independently, appropriately, and effectively; impaired impulse control (e.g., unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (e.g., work or work like setting); inability to establish and maintain effective relationships. A maximum 100 percent rating is warranted for total occupational and social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9411, General Rating Formula for Mental Disorders. The symptoms associated with each rating under the General Rating formula do not constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Thus, the evidence considered in determining the appropriate rating of a psychiatric disorder is not restricted to the symptoms set forth in the General Rating formula. See id. When rating a mental disorder, VA must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. 38 C.F.R. § 4.126; Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). VA shall assign a rating based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a). When rating the level of disability from a mental disorder, VA will consider the extent of social impairment, but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126(b). In other words, VA must engage in a holistic analysis that assesses the severity, frequency, and duration of the signs and symptoms of the psychiatric disability; quantifies the level of occupational and social impairment caused by those symptoms; and assigns an evaluation that most nearly approximates the level of occupational and social impairment. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). VA no longer recognizes Global Assessment of Functioning (GAF) scores as an effective method of evaluating the severity of psychiatric disabilities. See 38 C.F.R. § 4.125 (incorporating by reference the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)). Therefore, the Board will not rely on any GAF scores in adjudicating the present claim. See Golden v. Shulkin, 29 Vet. App. 221, 224-26 (2018). The Board has reviewed the Veteran's extensive VA treatment records, which show that he has received regular mental health treatment, including psychiatry, counseling, psychotherapy, and medication management, throughout the duration of the appeal period, which begins April 29, 2008, the effective date of the grant of service connection. Although just outside the appeal period, the Board finds it pertinent to note that mental health records reflect that the Veteran was hospitalized on two occasions, in November 2007 and March 2008, for attempting suicide. In November 2007, his son took his gun away from him after he attempted to shoot himself. In March 2008, the Veteran purposefully crashed his car into a tree, resulting in significant physical injuries, when he suffered a hallucination of a deceased friend from Vietnam telling him to kill himself. In an April 2008 VA psychiatry note, the Veteran reported crushing feelings of guilt and remorse related to experiences he had in Vietnam, in addition to hopelessness, intrusive thoughts, flashbacks, recurrent nightmares, and chronic depressive and anxiety symptoms. He admitted that a recent motor vehicle accident was a suicide attempt. He described auditory and visual hallucinations in which he hears his deceased friend calling to him and sees shadows in the trees that appear to be the enemy. The Veteran admitted to ongoing suicidal ideation without plan or intent. He denied symptoms of mania, psychosis, compulsions, or obsessions. The VA clinician noted that the Veteran presented with "minimal attention to hygiene." The clinician found his PTSD to be chronic and severe, with recurrent major depressive disorder. In May 2008, the Veteran reported to his VA doctor that he hears voices and sees things in his garden on a continuous basis. He has a gun and shoots at things at night in his garden. He sees a friend who died in Vietnam and a Viet Cong soldier who he shot and they speak to him. The Veteran reported that his deceased friend told him to crash his car into a tree last month. He also reported that he has tried to hurt his wife in the past. The Veteran stated that he is always depressed; always feels like killing himself; and always hears voices. The voices get worse when he sleeps and he drinks alcohol in an attempt to drown them out. A few days later, also in May 2008, the Veteran was hospitalized following a suicide attempt. He reported that he had gotten into a verbal altercation with his wife after binge drinking and he took a gun he had under his bed and cocked it "just to see if it was loaded." His son heard this, took the gun away, and called 911. The Veteran then took several prescription medications in an attempt to take his own life. The Veteran reported to the VA psychiatrist that he had watched a war movie earlier in the day that triggered flashbacks about Vietnam. He reported that he felt guilty about being alive when so many others were not. He stated that he has not had a single moment in the past few years when he has not felt depressed and that sometimes his "PTSD gets out of control." He also stated that from time to time, while he is under the influence of alcohol, he hears and sees demons and they tell him to kill himself. The Veteran was stabilized on medications and upon discharge, he denied suicidal ideation, auditory or visual hallucinations, delusions, or psychosis. The Veteran underwent a VA examination in April 2009. Upon examination, he reported symptoms of depressed mood, interrupted sleep, and poor concentration, energy, and self-esteem. He denied current suicidal ideation, though prior suicide attempts in 2006 and 2008 were noted. The Veteran described his relationship with his wife as "going great," and he expressed close attachments with all three of his sons. He reported that he has no current friendships. His hobbies include fishing, gardening, and spending time with family. The Veteran endorsed a history of violence, stating that he had been in a few physical fights with his son in the past. The VA examiner noted that the Veteran was neatly groomed and appropriately dressed; his psychomotor activity, speech, and thought processes and content were unremarkable; affect was normal; there was no evidence of delusions or hallucinations; and his behavior was appropriate. The VA examiner found that the Veteran met the diagnostic criteria for PTSD and determined that it causes the Veteran occasional decrease in work efficiency with intermittent periods of inability to perform occupational tasks, but with generally satisfactory functioning with routine behavior, self-care, and conversation normal. At another VA examination in September 2009, the Veteran endorsed symptoms of depressed mood, anxiety, sleep impairment and nightmares, poor energy and concentration, and irritability. The Veteran reported that he was cited for driving under the influence of alcohol in May, after which his wife threatened to divorce him and he attempted suicide. He reported that he had not had a drink for three months. He denied current suicidal ideation. The VA examiner diagnosed the Veteran with anxiety disorder not otherwise specified and alcohol abuse in early full remission. On mental status examination, the Veteran was noted to be oriented to person, place, and time; he was clean, well groomed, and appropriately dressed; his speech was unremarkable, spontaneous, clear, and coherent; he had full affect and an attentive attitude; thought processes and content were unremarkable; there were no delusions, hallucinations, or inappropriate behavior. Overall, the VA examiner determined that the Veteran's psychiatric signs and symptoms are transient or mild with decreased work efficiency and ability to perform occupational tasks only during periods of significant stress. In March 2011, a VA primary care doctor noted that the Veteran became tearful and incoherent during their visit. He told her that during a recent surgery and hospitalization for an unrelated medical condition, he suffered PTSD and nightmares where he saw himself at his own funeral and in Vietnam. He also told the doctor that he was going to get on a plane to Vietnam and that "the world is all at war." The doctor sent a note to the Veteran's psychiatrist that he was suffering from an episode of delusions. The Veteran was afforded another VA examination in May 2011. Upon examination, the Veteran reported a frequent depressed mood that sometimes lasts weeks at a time, especially after viewing situations on television or after a distressing dream. He also endorsed sleep impairment and nightmares, avoidance behaviors, hypervigilance, irritability and anger, poor concentration, and memory problems. He reported having a great relationship with his wife since he stopped drinking one year ago. His only social relationship is going fishing with his uncle. His hobbies are fishing and gardening. The Veteran's grooming, behavior, speech, thought content and processes, memory, and orientation were all unremarkable or within normal limits. He denied current suicidal or homicidal ideation. The Veteran reported auditory and visual hallucinations, stating that he "sees and hears things outside in the yard that his wife doesn't." In a September 2013 statement, the Veteran's wife described how the Veteran's nightmares are so severe, he has choked her several times in his sleep thinking she is Viet Cong; they can no longer sleep in the same bed. She also explained how the Veteran enjoys growing plants but that he can no longer work in his garden during the day because he sees Viet Cong in the trees watching him. They installed a bright light so that he can work outside at night. The Veteran's wife recounted an incident where the Veteran put on his military uniform and got his rifle because he thought he was on patrol in Vietnam. He laid "in wait" outside all night ready to shoot anyone who passed by. He eventually passed out and only realized in the morning where he was. She described how the Veteran avoids going places or being around a lot of people and lamented that he does not have a close relationship with his sons or other family members because of his isolation, withdrawal, anxiety, nervousness, and mood. In June 2014, the Veteran underwent a mental health assessment with a private psychologist. In her report, the psychologist noted that the Veteran lives with his wife and adult son. His wife is his only support system as he is socially isolated and withdrawn. The Veteran requires assistance from his wife in performing tasks of daily living, such as food shopping, cooking, maintaining the household, cleaning, laundry, and paying bills. His wife reminds him to shower, shave, and get a haircut. He showers approximately every two to three days. At the assessment, the Veteran reported passive suicidal ideation but denied plan or intent. He reported experiencing auditory and visual hallucinations and paranoid delusions consisting of hearing command voices and seeing images of people he knows to be dead. He is no longer able to work in his garden because he sees and hears things when no one is there and is too scared to work outside. The Veteran and his wife now sleep in separate beds because of chronic sleep impairment, nightmares, and flashbacks, during which he has tried to choke his wife. The Veteran reported impaired short and long term memory. He keeps to himself and does not leave his house unless he has to. He does not attend family functions and no longer goes fishing or hunting. The psychologist noted that he described symptoms such as: experiencing near-continuous panic or depression that affects his ability to function effectively; difficulty in establishing and maintaining relationships; difficulty adapting to stressful circumstances including work; gross impairment of thought processes, and impaired impulse control. The Veteran has a history of self-medicating with alcohol, however he reported that he has been sober for two to three years. In an accompanying mental disorders disability benefits questionnaire (DBQ), the examining psychologist determined that the Veteran's psychiatric disorder causes occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and mood. She further noted that the Veteran exhibits gross impairment in thought processes and communication, inability to establish and maintain effective relationships, persistent delusions or hallucinations, neglect of personal appearance and hygiene, grossly inappropriate behavior, and persistent danger of hurting self or others. In a September 2014 VA psychology consultation, the Veteran reported experiencing both visual and auditory hallucinations about two to three times per week, which he finds so frightening that he is unwilling to go to sleep. He reported that he thinks about committing suicide often, but feels that he will not act on those thoughts because he believes he would not be forgiven by God for doing so. The staff psychologist noted that the Veteran presented with a severely depressed mood. He was well-groomed; his affect was generally sad and tearful; he cried throughout most of the session; and his speech was coherent with no excessive tangentiality. In an October 2014 VA psychology consultation, the Veteran reported experiencing worsening symptoms of depression. He reported that he has begun experiencing thoughts of killing himself more often and has a plan to hang himself in his greenhouse, but stated that he would not act as he wants to see his son get into college. At the appointment, he was noted to be adequately groomed, made good eye contact, but with sad and anxious affect. In November 2014, at a VA psychiatry consultation, the Veteran was noted to have a four month onset of worsening depression with hypersomnia, poor appetite, energy, and concentration, and increased anxiety and irritability. He endorsed suicidal ideation without plan or intent. At a psychiatry consultation a few weeks later, the Veteran reported that his mood and sleep has improved since switching medications. He stated that he continues to take his current medication regime with benefit for his chronic emotional symptoms. No manic or psychotic symptoms were noted. During a December 2014 hospitalization for an unrelated medical condition, the Veteran endorsed severe anxiety and requested to speak with psychiatry. He stated that he had been experiencing constant restlessness, excessive worry, and crying spells that day after having a nightmare about Vietnam. He reported that on average he has three to four nightmares a month; he denied flashbacks but endorsed hypervigilance. He was further noted to have paranoid ideation and delusions; he relayed to his examining physician that he believes the government is going to try to kill him to make his VA compensation claim go away. At a March 2015 VA neuropsychology consultation, the Veteran reported having problems with memory and concentration over the past six years and feels his cognitive symptoms have worsened since onset. He noted particular difficulty recalling conversations and appointments. He loses train of thought and experiences occasional word-finding difficulty. His wife reported that he repeats questions and statements, and misplaces items at home. His wife was noted to manage the Veteran's medications due to his memory problems. According to a September 2017 VA psychology note, the Veteran reported to his VA psychologist that his mood was much the same. He related that he feels his best times are when he is working in his greenhouse; he loves to grow plants and it gives him positive feelings and helps him to avoid thinking about his experiences in Vietnam. Pursuant to the May 2019 Board remand, the Veteran was afforded another VA examination in August 2019. At that time, the Veteran endorsed current symptoms of anxiety, depression, nightmares, intrusive thoughts, frequent panic attacks, flattened affect, and disturbances of motivation and mood. The Veteran reported that he has been married to his wife for 53 years with three children; one of his sons lives with them. He spends his time fishing. The VA examiner found the Veteran to be oriented to person, place, and time; he was engaged in the evaluation; and he denied any current suicidal ideation or psychosis. His memory and cognition were noted as intact. The examiner determined that the Veteran's psychiatric signs and symptoms cause occupational and social impairment with reduced reliability and productivity. Based on the foregoing, and in consideration of the above legal criteria, the Board concludes that the evidence of record is sufficient to show that the severity, frequency, and duration of the Veteran's acquired psychiatric disorder more nearly approximate the criteria for an initial 100 percent rating. Throughout the relevant period, the Veteran's most severe psychiatric symptoms have included persistent delusions or hallucinations, gross impairment in thought processes or communication, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living, persistent suicidal ideation, near-continuous depression affecting ability to function independently, appropriately, and effectively; impaired impulse control, neglect of personal appearance and hygiene, difficulty in adapting to stressful circumstances, and inability to establish and maintain effective relationships. Although the medical evidence does not show symptomatology such as disorientation to time or place or memory loss for names of close relatives, own occupation, or own name, the Board notes that the symptoms noted in the rating schedule are not intended to constitute an exhaustive list, but rather are designed to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular disability rating. Mauerhan, 16 Vet. App. at 436. Thus, even though not all the listed symptoms commensurate with a 100 percent rating are shown, the Board concludes that the actual severity, frequency, and duration of symptomatology contemplated for a 100 percent rating are sufficiently demonstrated. Bowling v. Principi, 15 Vet. App. 1, 11 (2001); Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). Moreover, the Board notes that the Veteran's VA mental health treatment records show that some of the Veteran's symptoms have fluctuated in severity, frequency, and duration throughout the relevant period. However, any improvement in symptoms appear to the Board to be temporary or attributed by the Veteran and his physicians to his adherence to an extensive medication regime. The ameliorative effects of medications used to treat a disability may not be considered when evaluating the severity of that disability, and any such effects have not been considered by the Board here. See Jones v. Shinseki, 26 Vet. App. 56 (2012). Accordingly, the Board finds that the preponderance of the evidence weighs in favor of assigning an initial 100 percent rating for the Veteran's acquired psychiatric disorder for the entire period of appeal. In making this finding, the Board has resolved all reasonable doubt in favor of the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 53. 2. Entitlement to a TDIU Pursuant to the Board's decision herein, the Veteran is in receipt of a total (100 percent) schedular rating for an acquired psychiatric disorder for the entire period on appeal. Generally, a TDIU may be assigned only where the schedular rating is less than total. 38 C.F.R. § 4.16(a). However, the United States Court of Appeals for Veterans Claims (Court) has held that VA has a "well-established" duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); see also Bradley v. Peake, 22 Vet. App. 280 (2008). This duty to maximize benefits requires VA to assess all of a claimant's disabilities to determine whether any combination of disabilities establishes entitlement to special monthly compensation (SMC) under 38 U.S.C. § 1114. Bradley, 22 Vet. App. at 294 (finding that SMC "benefits are to be accorded when a veteran becomes eligible without need for a separate claim"). Of relevance here, the Court has specifically held that there could be a situation where a veteran has a schedular total rating for a single service-connected disability, but could establish entitlement to a TDIU rating for another service-connected disability or disabilities in order to qualify for SMC under 38 U.S.C. § 1114(s) by having an "additional" disability of 60 percent or more. See 38 U.S.C. § 1114(s); Bradley, 22 Vet. App. at 293; Buie, 24 Vet. App. at 248. Here, the Veteran is in receipt of a total schedular rating, but he is not in receipt of SMC. As such, the issue of entitlement to a TDIU is not rendered moot and the Board must determine whether, excluding the disability for which a 100 percent rating is in effect, the Veteran has an additional service-connected disability (or disabilities) that individually renders him unemployable. The Veteran's other service-connected disabilities are coronary artery disease, rated 30 percent disabling; diabetes mellitus, rated 20 percent disabling; and erectile dysfunction, rated noncompensable. For the purposes of establishing entitlement to SMC, and excluding the disability for which a 100 percent rating is in effect, the Board does not find that the Veteran's coronary artery disease, diabetes mellitus, and erectile dysfunction, either individually or collectively, establish entitlement to a TDIU during this period. First, the Veteran's combined rating for these disabilities do not meet the threshold percentage requirements under 38 C.F.R. § 4.16(a) for entitlement to a schedular TDIU. Moreover, the Board can find no basis to consider this issue on an extraschedular basis under 38 C.F.R. § 4.16(b) as there is insufficient evidence to establish that the Veteran's other service-connected disabilities cause such an exceptional or unusual disability picture so as to render him unemployable. In this respect, although the Veteran has expressed to VA examiners that he is unable to work due to fatigue from his heart condition, the Board notes that the evidence of record reflects that his heart disability does not prevent him from working for several hours a day in his greenhouse and garden tending to his plants. Even assuming that the Veteran's coronary artery disease and diabetes mellitus cause symptoms such as fatigue and weakness, there is no evidence that these disabilities would preclude him from following substantially gainful employment of a sedentary nature. Moreover, the Board notes that in an August 2018 medical opinion, a vocational consultant concluded that that Veteran is totally occupationally disabled as a result of his service-connected psychiatric disorder, coronary artery disease, diabetes mellitus, and erectile dysfunction. However, notably, the vocational consultant only referenced the Veteran's psychiatric impairments and symptoms when describing how his disabilities would impact his employment prospects. Simply put, the Board finds that there is no other competent medical evidence to indicate that the Veteran's service-connected disabilities of coronary artery disease, diabetes mellitus, and erectile dysfunction, either individually or in combination, completely preclude the Veteran from obtaining or maintaining substantially gainful employment, or that they prohibit the Veteran from engaging in the physical or mental tasks required of employment. In fact, the preponderance of the lay and medical evidence reflects that the Veteran's acquired psychiatric disorder is the primary reason for his unemployability. In light of the above, for the purposes of maximizing the Veteran's benefits and considering entitlement to SMC, the Board does not find that the Veteran meets the criteria for entitlement to a TDIU based solely on his service-connected coronary artery disease, diabetes mellitus, and erectile dysfunction. As such, no additional benefits can be awarded at this time and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 53. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Melissa Barbee, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.