Citation Nr: 21057599 Decision Date: 09/16/21 Archive Date: 09/16/21 DOCKET NO. 16-54 163 DATE: September 16, 2021 ORDER Entitlement to an initial compensable rating for mild swallowing difficulties prior to January 26, 2017, is denied. Entitlement to a rating higher than 10 percent for hoarseness with mild swallowing difficulties as of January 26, 2017, is denied. Entitlement to an initial rating higher than 10 percent for voiding dysfunction is denied. Entitlement to an initial rating higher than 30 percent for right upper extremity weakness is denied. Entitlement to an initial rating higher than 40 percent for left upper extremity weakness is denied. Entitlement to an initial rating higher than 10 percent for left lower extremity loss of sensation prior to January 26, 2017, is denied. Entitlement to a rating higher than 40 percent for left lower extremity loss of sensation as of January 26, 2017, is denied. Entitlement to an effective date earlier than April 17, 2013, for special month compensation (SMC) based on housebound status is denied. REMANDED Entitlement to an initial rating higher than 10 percent for optic neuritis is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. Entitlement to a higher level of special month compensation (SMC) is remanded. FINDINGS OF FACT 1. Prior to January 26, 2017, the Veteran's swallowing difficulties were mild without hoarseness; the 10th cranial nerve had mild neuralgia. 2. As of January 26, 2017, the Veteran's swallowing difficulties manifested with hoarseness, choking, and coughing with food and liquids. 3. Throughout the appeal period, the Veteran's voiding dysfunction was manifested by daytime voiding interval between two and three hours. 4. Throughout the appeal period, the Veteran's right upper extremity weakness symptomatology has more nearly has approximated moderate incomplete paralysis of all radicular groups. 5. Throughout the appeal period, the Veteran's bilateral upper extremity weakness symptomatology has more nearly has approximated moderate incomplete paralysis of all radicular groups. The Veteran is left hand dominant. 6. Prior to January 26, 2017, the Veteran's left lower extremity loss of sensation symptomatology has more nearly has approximated mild incomplete paralysis of the sciatic nerve 7. As of January 26, 2017, the Veteran's left lower extremity loss of sensation symptomatology has more nearly has approximated moderately severe incomplete paralysis of the sciatic nerve. 8. Prior to April 17, 2013, the Veteran's combined disability rating was 100 percent; the Veteran did not have a single service-connected disability rated 100 percent with separate service-connected disabilities rated at 60 percent or more. CONCLUSIONS OF LAW 1. Prior to January 26, 2017, the criteria for a compensable rating for hoarseness with mild swallowing difficulties have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8018-8410. 2. As of January 26, 2017, the criteria for a rating in excess of 10 percent for hoarseness with mild swallowing difficulties were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code 8018-6516. 3. Throughout the appeal period, the criteria for a rating higher than 10 percent for voiding dysfunction have not been met or more nearly approximated. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.115b, Diagnostic Code 8018-7542. 4. Throughout the appeal period, the criteria for a rating higher than 30 percent for right upper extremity weakness y were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6. 4.7, 4.10, 4.71a, 4.124a, Diagnostic Code 8018-8613. 5. Throughout the appeal period, the criteria for a rating higher than 40 percent for left upper extremity weakness were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6. 4.7, 4.10, 4.71a, 4.124a, Diagnostic Code 8018-8613. 6. Prior to January 26, 2017, the criteria for a rating higher than 10 percent for left lower extremity loss of sensation with sciatic nerve involvement were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6. 4.7, 4.10, 4.71a, 4.124a, Diagnostic Code 8018-8520. 7. As of January 26, 2017, the criteria for a rating higher than 40 percent for left lower extremity loss of sensation with sciatic nerve involvement were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6. 4.7, 4.10, 4.71a, 4.124a, Diagnostic Code 8018-8520. 8. The criteria for an effective date prior to April 17, 2013, for special monthly compensation based on housebound status have not been met. 38 U.S.C. §§ 1114, 5107; 38 C.F.R. §§ 3.350, 3.351, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1976 to June 1978. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2016 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) that effectuated the Board's November 2015 decision granting service connection for multiple sclerosis (MS) and optic neuritis. The Veteran's MS residuals were granted service connection in the March 2016 rating decision. In March 2019, the Board remanded the case for further development. Increased Ratings Disability ratings are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 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 assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A claimant may experience multiple distinct degrees of disability that may result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The following analysis is undertaken with consideration of the possibility that different ratings may be warranted for different time periods. The rating of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. That does not preclude the assignment of separate ratings for separate and distinct symptomatology where none of the symptomatology justifying a rating under one diagnostic code is duplicative of or overlapping with the symptomatology justifying a rating under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259 (1994). 1. Entitlement to increased ratings for hoarseness with mild swallowing difficulties. The Veteran reports difficulty swallowing and spot on the left side of his neck that affects his voice and causes coughing. In a May 2017 rating decision, the Veteran was granted a compensable rating of 10 percent as of January 26, 2017. The Diagnostic Code was changed from 8410 to 6516 to account for the additional symptomatology of hoarseness. Diagnostic Code 6516 provides a 10 percent rating for hoarseness with inflammation of cords or mucous membrane. A 30 percent rating is warranted for hoarseness, with thickening or nodules of cords, polyps, submucous infiltration, or pre-malignant changes on biopsy. 38 C.F.R. § 4.97. Diagnostic Code 8410 provides a 10 percent rating for moderate incomplete paralysis of the sensory and motor loss to organs of voice, respiration, pharynx, stomach and heart. A 30 percent rating is warranted for severe incomplete paralysis. A 50 percent rating is warranted for complete paralysis. 38 C.F.R. § 4.124a. A review of the record prior to January 26, 2017 shows that the Veteran had mild swallowing difficulties at the January 2016 VA multiple sclerosis examination. VA treatment records showed minimal swallowing difficulties. On a private treatment record dated January 26, 2017, the Veteran denied issues with speech or swallowing. He reported that he would aspirate and start coughing if he did not think about swallowing. In addition, he stated that he was choking and coughing with food and liquids. In March 2017, he described a spot in the left side of his neck that affects his voice and causes coughing. He also mentions difficulty swallowing for the past few months, noting that he will choke if he is not careful when swallowing. At the March 2017 VA multiple sclerosis examination, the Veteran reported worsening dysphagia. The examiner noted mild swallowing difficulties. The Veteran reported moderate swallowing difficulties at the December 2019 VA examination. Prior to January 26, 2017, the Board finds the Veteran's disability manifested with mild swallowing difficulties. VA and private medical records showed mild difficulties of swallowing with no hoarseness. His speech had a normal tone. Further, there was no indication of moderate incomplete paralysis of the 10th cranial nerve. As such, the Board finds a higher rating is not warranted prior to January 26, 2017. As of January 26, 2017, the Board finds the Veteran's disability manifested with mild swallowing difficulties with hoarseness. The Veteran reported worsening dysphagia in March 2017. The Veteran's symptoms have not manifested with thickening or nodules of cords, polyps, submucous infiltration, or pre-malignant changes on biopsy or severe incomplete paralysis of the 10th cranial nerve. As such, the Board finds a higher rating is not warranted. The Board finds that the Veteran's GERD did not rise to the level of severe impairment of health. Therefore, a rating in excess of 30 percent is not warranted at any point during the appeal period. The Board finds that a rating higher than 10 percent for the hoarseness with mild swallowing difficulties is not warranted under Diagnostic Code 6516 or 8410 at any point during the appeal period. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of a compensable rating prior to January 26, 2017, and a rating higher than 10 percent as of January 26, 2017, and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to an initial rating higher than 10 percent for voiding dysfunction. The Veteran's voiding dysfunction is rated 10 percent under Diagnostic Code 7542 for a neurogenic bladder. Diagnostic Code 7542 instructs the rater to evaluate the disability as a voiding dysfunction. Voiding dysfunctions are rated under the criteria applicable to urine leakage, urinary frequency, or obstructed voiding. For urine leakage, a 20 percent rating is warranted when the wearing of absorbent materials which must be changed less than two times per day is required. A 40 percent rating is warranted when absorbent materials must be changed two to four times per day. A 60 percent rating is assigned when the use of an appliance is required, or absorbent materials must be changed more than four times per day. 38 C.F.R. § 4.115a. For urinary frequency, a 10 percent rating is assigned with a daytime voiding interval between two and three hours, or; awakening to void two times per night. A 20 percent rating is assigned with a daytime voiding interval between one and two hours, or; awakening to void three to four times per night. A 40 percent rating requires a daytime voiding interval of less than one hour, or; awakening to void five or more times per night. 38 C.F.R. § 4.115a. For obstructed voiding, a 0 percent rating is assigned for obstructive symptomatology with or without stricture disease requiring dilation one to two times per year. A 10 percent rating is assigned for marked obstructive symptomatology (hesitancy, slow or weak stream, decreased force of stream), with any one or combination of the following: (1) post-void residuals greater than 150cc; (2) uroflowmetry; markedly diminished peak flow rate (less than 10cc/second); (3) recurrent urinary tract infections secondary to obstruction; or (4) stricture disease requiring periodic dilation every two to three months. A 30 percent rating applies to urinary retention requiring intermittent or continuous catheterization. 38 C.F.R. § 4.115a. The Board finds that a rating higher than 10 percent is not warranted during the appeal period. The Veteran has undergone several VA and neurological examinations. VA treatment records show complaints of weakened stream, urinary frequency and urgency with occasional leakage. A September 2014 private treatment record noted frequent urination. However, the frequency was not indicated. In June 2011, he reported bladder function was stable. At the January 2016 VA multiple sclerosis examination, the Veteran had voiding dysfunction with daytime voiding interval between two and three hours. At the February 2017 VA urinary tract examination, the Veteran reported difficulty voiding and emptying his bladder. The voiding dysfunction did not cause urine leakage, require use of an appliance, or urinary frequency. He had obstructed voiding that manifested with a marked slow and weak stream, and a markedly decreased force of stream. There was no evidence of catheterization. The Board notes no records were reviewed. At the December 2019 VA MS examination, the Veteran reported a weak urine stream with some incontinence. He did not require absorbent material. The voiding dysfunction did not cause obstructed voiding or urinary tract infections. His disability did not require the use of an appliance. On review of the evidence, the Board finds that the Veteran's disability warrants a 10 percent rating based on urinary frequency for the entire appeals period. The record shows the Veteran's disability does not approximate a higher rating under urine leakage, urine frequency, or obstructed voiding. For urine leakage, warranted when the wearing of absorbent materials which must be changed less than two times per day is required. However, the evidence does not indicate the Veteran required wearing of absorbent materials at any time. Thus, a higher rating on the basis of urine leakage is not warranted. For urine frequency, a higher rating is warranted when the daytime voiding interval between one and two hours, or awakening to void three to four times per night. The evidence does not demonstrate urinary leakage of that severity. Therefore, the Veteran's condition does not warrant a higher rating under either of those criteria. A higher rating based on obstructed voiding is also not warranted. While the record indicates a marked slow and weak stream, and a markedly decreased force of stream. However, there was no evidence of catheterization. This evidence of obstructed voiding warrants a 10 percent rating, but a higher rating requires intermittent or continuous catheterization. A review of both the medical and lay evidence does not demonstrate any evidence that the Veteran's urinary retention required any type of catheterization. 38 C.F.R. § 4.115a. Therefore, a 30 percent rating under that diagnostic code is not warranted. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of a rating higher than 10 percent during the appeals period, and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to an initial rating higher than 30 percent for right upper extremity weakness. 4. Entitlement to an initial rating higher than 40 percent for left upper extremity weakness. The Veteran's bilateral upper extremity weakness is rated 30 percent disabling for the right upper extremity and 40 percent disabling for the left upper extremity under Diagnostic Code 8018-8613. The Veteran is left hand dominant. Paralysis of all radicular groups is rated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8613. Under those criteria, mild incomplete paralysis is rated 20 percent. Moderate incomplete paralysis is rated 30 percent in the minor extremity, and 40 percent in the major extremity. Severe incomplete paralysis is rated 60 percent in the minor extremity, and 70 percent in the major extremity. Complete paralysis, with all shoulder and elbow movements lost or severely affected; adduction, abduction and rotation of arm, flexion of elbow, and extension of wrist lost or severely affected; all intrinsic muscles of hand, and some or all of flexors of wrist and fingers, paralyzed (substantial loss of use of hand) is rated 60 percent in the minor extremity, and 70 percent in the major extremity. 38 C.F.R. § 4.124a. The rating schedule provides guidance for rating neurological disabilities. With regard to rating neurological disabilities, cranial or peripheral neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. 38 C.F.R. § 4.123 The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. A review of the evidence showed continued complaints in VA and private treatment records of chronic right hand numbness with tingling. At the January 2016 VA multiple sclerosis examination, the Veteran's strength testing, deep tendon reflexes, and sensation testing was normal. However, the right hand/fingers showed decreased sensation. There was no muscle weakness in the upper extremities. A February 2016 VA neurological consultation showed normal strength testing and deep tendon reflexes. At the March 2017 VA multiple sclerosis examination, the Veteran's strength testing, deep tendon reflexes, and sensation testing was normal. There was no muscle weakness in the upper extremities. At the December 2019 VA MS examination, the Veteran's shoulder extension and flexion demonstrated no movement against resistance in both extremities. The elbow flexion and extension, wrist flexion and extension, grip, and pinch demonstrated no movement against gravity in both extremities. Deep tendon reflexes were decreased in the biceps, triceps, and brachioradialis for both extremities. Sensation testing was normal in the shoulder area, inner/outer forearm, and hand/fingers for both extremities. There was no muscular atrophy. The examiner determined there was moderate muscle weakness in both extremities. At the December 2019 VA peripheral nerves examination, the Veteran had no constant pain, intermittent pain, or numbness in the upper extremities. There was mild paresthesia and/or dysesthesias in the right upper extremity, and none in the left upper extremity. The elbow flexion and extension, wrist flexion and extension, grip, and pinch demonstrated active movement with gravity eliminated in both extremities. The examiner noted general whole body atrophy. Deep tendon reflexes were hypoactive in the biceps, triceps, and brachioradialis for both extremities. Sensation testing was normal in the shoulder area, inner/outer forearm, and hand/fingers for both extremities. The examiner found the nerves in the upper extremities normal. Throughout the appeal period, the Board finds a rating higher than 30 percent for the right upper extremity and higher than 40 percent for the left upper extremity is not warranted as the evidence does not show more than moderate incomplete paralysis. To warrant a higher rating, complete paralysis must be shown. Although the Veteran experienced decreased strength and sensations, the evidence indicated no muscle atrophy. The January 2016 and March 2017 VA MS examinations indicated no muscle weakness in the upper extremities. While the December 2019 VA MS examination showed there was moderate muscle weakness in both extremities, the December peripheral nerves examination indicated normal sensations and no constant pain, intermittent pain, or numbness. Thus, complete paralysis has not been demonstrated and a higher rating is not warranted. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Again, the current diagnostic code encompasses all radicular groups. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. Accordingly, the Board finds that the preponderance of the evidence is against a rating higher than 30 percent for the right upper extremity and higher than 40 percent for the left upper extremity, and the claims must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Entitlement to increased ratings for left lower extremity loss of sensation. The Veteran's lower left extremity disability had a 10 percent rating prior to January 26, 2017. In a May 2017 rating decision, the Veteran was granted an increased rating to 40 percent as of January 26, 2017. Paralysis of the sciatic nerve is rated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under those criteria, mild incomplete paralysis is rated 10 percent. Moderate incomplete paralysis is rated 20 percent. Moderately severe incomplete paralysis is rated 40 percent. Severe incomplete paralysis, with marked muscular atrophy is rated 60 percent. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated 80 percent. 38 C.F.R. § 4.124a. The words mild, moderate, moderately severe, and severe as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. 38 C.F.R. §§ 4.123, 4.124. The term incomplete paralysis indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement. When bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum rating for conditions that are wholly sensory, as opposed to a minimum rating for conditions that are more than wholly sensory. Miller v. Shulkin, 28 Vet. App. 376 (2017). The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. 38 C.F.R. § 4.123. A review of the evidence showed left leg and hip pain and complaints for increased weakness. VA treatment records show complaints of numbness and spasms. An April 2011 private record showed left hip pain with pain at a 4/10. In June 2011, he reported continued left leg pain where the leg would catch and cause him to fall. A November 2011 record showed muscle spasms at night, and increased weakness with some paresthesias. An April 2012 record showed strength at no movement against resistance and deep tendon reflexes were increased without clonus. In April 2015, neurological testing showed decreased strength in the left lower extremity. At the January 2016 VA multiple sclerosis examination, the Veteran's strength testing and deep tendon reflexes were normal. Sensation testing was normal for the thigh/knee, and decreased in lower leg/ankle and foot/toes. There was no muscle weakness in the left lower extremity. A February 2016 VA neurological consultation showed normal strength testing and decreased pinprick sensations. The Veteran used a cane and his knee was slightly flexed with decreased hip flexion and extension. On a private treatment record dated January 26, 2017, the Veteran reported increased weakness in the left lower extremity. Strength and reflexes were decreased with absent sensation in the left ankle. At the March 2017 VA multiple sclerosis examination, the Veteran's strength testing showed hip flexion demonstrated no movement against resistance and hip extension, knee extension, ankle plantar flexion, and ankle dorsiflexion showed less movement than normal. Sensation testing was normal in the thigh/knee and lower leg/ankle, and decreased in the foot/toes. There was moderate muscle weakness in the left lower extremity. At the December 2019 VA multiple sclerosis examination, the Veteran reported increasing weakness in the left leg, hip pain, and his feet were numb. Strength testing showed hip flexion and extension demonstrated no movement against gravity. The knee extension, ankle plantar flexion, and ankle dorsiflexion demonstrated no movement against resistance. Deep tendon reflexes were absent in the knee and ankle. Sensation testing was decreased in the thigh/knee and feet/toes, and it was absent in the lower leg/ankle. There was no muscular atrophy. The examiner determined there was moderate muscle weakness. The Veteran could not walk without a walker. At the December 2019 VA peripheral nerves examination, the Veteran reported tingling, weakness, and a sensation band around his feet. There was no constant pain, but there was mild intermittent pain, and moderate paresthesia and/or dysesthesias and numbness. The knee extension, ankle plantar flexion, and ankle dorsiflexion demonstrated active movement against gravity. The examiner noted general whole body atrophy. Deep tendon reflexes were absent in the knee and ankle. Sensation testing was decreased in the thigh/knee and feet/toes, and it was absent in the lower leg/ankle. There were tropic changes and an abnormal gait. The examiner concluded there was moderately severe incomplete paralysis. In reviewing the record, the Board finds that the Veteran's left lower extremity loss of sensation has not more nearly approximated a rating higher than 10 percent prior to January 26, 2017. Although the Veteran reported increased weakness, objective testing reflected a limited decrease in strength. The January 2016 VA multiple sclerosis examination showed no muscle weakness and normal strength testing and deep tendon reflexes. As a moderate incomplete paralysis is not demonstrated, a higher rating is not warranted. Thus, the Board finds that prior to January 26, 2017, the level of impairment is shows mild incomplete paralysis of the sciatic nerve. As of January 26, 2017, the Board finds that the Veteran's left lower extremity weakness warrants a 40 percent rating. The Veteran's reported increased weakness was reflected in testing showing decreased strength and reflexes and absent sensation in the left ankle. The March 2017 VA examination showed moderate muscle weakness and decreased strength and reflexes. The December 2019 VA examinations demonstrated absent reflexes in the knee and ankle and sensation testing was decreased in the thigh/knee and feet/toes, and it was absent in the lower leg/ankle. To warrant a higher rating, Severe incomplete paralysis, with marked muscular atrophy must be shown. Thus, severe incomplete paralysis has not been demonstrated and a higher rating is not warranted. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of a rating higher than 10 percent prior to January 26, 2017, and a rating higher than 40 percent as of January 26, 2017, and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Earlier Effective Date In order for benefits to be paid to any individual under the laws administered by VA, a specific claim in the form prescribed by VA must be filed. 38 C.F.R. § 3.151(a). A claim or application is defined by VA regulation as a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). An informal claim is any communication or action, indicating intent to apply for one or more benefits. 38 C.F.R. § 3.155(a). Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. 38 C.F.R. § 3.155(a). The general rule regarding the assignment of effective date for an award based on an original claim for VA benefits is that the effective date shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. An exception to the general rule applies if an application for benefits is received within one year from the date of a Veteran's separation from active service, and an award is made on the basis of that application. In that limited situation, the effective date of the award is made retroactive to the day following the date of separation from service. 38 U.S.C. § 5110(b)(1); 38 C.F.R. § 3.400(b)(2). Otherwise, the effective date will be the later of the date of receipt of claim or the date entitlement arose. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2). 6. Entitlement to an effective date earlier than April 17, 2013, for special month compensation (SMC) based on housebound status. In a March 2016 rating decision, the RO granted special monthly compensation based on housebound status, effective April 17, 2013. SMC at the housebound rate is payable when a Veteran has a single service-connected disability rated 100 percent and (1) has 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; 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)(1). The requirements of 38 U.S.C. § 1114(s)(2) are met when a Veteran is substantially confined as a direct result of service-connected disabilities to his dwelling and the immediate premises or, if institutionalized, to the ward or clinical area, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his lifetime. 38 C.F.R. § 3.350(i)(2). Prior to April 17, 2013, the Veteran's combined disability rating was 100 percent. The Veteran was service-connected for major depression disorder, rated 50 percent; multiple sclerosis with right lower extremity, rated 40 percent; left upper extremity weakness, rated 40 percent; right upper extremity weakness, rated 30 percent; chronic constipation, rated 30 percent; left lower extremity loss of sensation, rated 10 percent; bilateral optic neuritis, rated 10 percent; voiding dysfunction, rated 10 percent; migraines, rated 10 percent; mild swallowing difficulties, rated 0 percent; and erectile dysfunction, rated 0 percent. Thus, the Veteran did not meet the criteria for SMC at the housebound rate prior to April 17, 2013. A veteran may still receive housebound-rate SMC if, by reason of the service-connected disabilities, he is "housebound." A veteran will be determined to be permanently housebound when he is substantially confined to the house (or ward or clinical areas, if institutionalized) or immediate premises due to disability or disabilities which it is reasonably certain will remain throughout his or her lifetime. 38 U.S.C. § 1502(c); 38 C.F.R. § 3.351(d)(2). However, the evidence does not show such limitations prior to June 1, 2016. As the grant of SMC is based on the Veteran's 100 percent rating for major depression disorder, effective April 17, 2013, is the earliest that the Veteran met the criteria for SMC. Because the Veteran did not have a single service-connected rated 100 percent prior to April 17, 2013, the Board finds that an earlier effective date cannot be assigned. Accordingly, the Board finds that the preponderance of the evidence is against the claim for an earlier effective date for the assignment of SMC at the housebound rate. Therefore, the appeal is denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to an initial rating higher than 10 percent for optic neuritis is remanded. The Board finds an additional examination is needed prior to adjudication. At the February 2020 VA examination, the examiner found the optic neuritis led to optic atrophy in both eyes and caused visual field defects and some loss of visual acuity. The Board notes that the visual field on the Goldmann charts exceeded the normal degree measurements for both eyes at down nasally. While the Board appreciates the examiner's efforts, the Board finds the February 2020 examination incomplete and additional testing is required to assess the Veteran's visual fields. In addition, the February 2020 VA examiner noted there were more visual field defects in the right eye. A May 2020 VA treatment records showed the Veteran complaining of left eye issues. As such, the Board finds the February 2020 VA examination no longer reflects the severity of the Veteran's bilateral eye disability. Therefore, the Board finds it necessary to remand this matter for VA examination. Snuffer v. Gober, 10 Vet. App. 400 (1997). 2. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. 3. Entitlement to a higher level of special month compensation (SMC) is remanded. The claims for TDIU and a higher level of SMC are inextricably intertwined with the claim for an increased rating. Where a claim is inextricably intertwined with another claim, the claims must be adjudicated together. Harris v. Derwinski, 1 Vet. App. 180 (1991). Therefore, further consideration of the claims for a TDIU and a higher level of SMC must be deferred. The matters are REMANDED for the following action: 1. With any necessary authorization from the Veteran, obtain any outstanding VA and private treatment records, to specifically include all VistA records relating the eyes. 2. Schedule the Veteran for a VA examination to determine the current severity of the service-connected optic neuritis. The examiner must review the claims file and should note that review in the report. Any and all studies or tests deemed necessary should be performed. Visual field testing results must be included. The examiner should describe the nature and severity of all manifestations of the Veteran's eye disability and address whether they are attributable to the service-connected eye disability when present, even if not present at the time of the examination, including dry eyes, visual field defects, and diplopia. If for any reason the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, the examiner should clearly explain why that is so. The examiner should provide information to allow application of all applicable rating criteria during the appeal period, including the versions of the eye rating criteria effective prior to and as of May 13, 2018. Richard Kettler Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Kass, 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.