Citation Nr: 22016245 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 10-21 887 DATE: March 21, 2022 ORDER Entitlement to a total disability based on individual unemployability (TDIU) due to service-connected disabilities, from April 1, 2007, is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to special monthly compensation (SMC) pursuant to 38 U.S.C. § 1114 (s), prior to June 9, 2009 and since October 2, 2009, is denied. FINDINGS OF FACT 1. The evidence is in equipoise as to whether the Veteran's service-connected disabilities have precluded him from securing and following substantially gainful employment since April 1, 2007. 2. During the claim periods prior to June 9, 2009, and since October 2, 2009, the Veteran does not have a service-connected disability rated as total, nor does the evidence demonstrate that the Veteran is permanently bedridden as a result of service-connected disabilities. CONCLUSIONS OF LAW 1. With reasonable doubt resolved in favor of the Veteran, the criteria for a TDIU due to service-connected disabilities, from April 1, 2007, have been met. 38 U.S.C. § 1155, 7105; 38 C.F.R. §§ 3.340, 3.341, 4.16. 2. The criteria for entitlement to SMC pursuant to 38 U.S.C. § 1114 (s), prior to June 9, 2009 and since October 2, 2009, have not been met. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from March 1987 to March 2007. His awards include the Army Commendation Medal. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from a February 2009 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before an Acting Veterans Law Judge (AVLJ) at a June 2011 videoconference hearing, and a transcript of this hearing is of record. The Veteran was informed that the AVLJ who conducted the hearing was no longer employed by the Board. He did not respond to an offer to testify at another hearing. This matter last appeared before the Board in September 2016, at which time the Board noted that in February 2008, the Veteran submitted an application for a TDIU. As noted in the September 2016 Board remand portion of the instant issue, the Board expanded the appeal to include the issue of entitlement to a TDIU as part and parcel of the other higher rating issues on appeal. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). TDIU and SMC In this case, the Veteran contends that he has met the criteria to establish a TDIU from April 1, 2007, because his service-connected disabilities have caused pain and subsequent limitations with standing, walking, sitting and keyboarding, and he has not worked in a gainful capacity since his discharge from service in March 2007. The Veteran's attorney argues that the Veteran has continuously prosecuted his TDIU and SMC claim since an October 2007 rating decision. The Veteran's attorney contends that the Veteran's contact with VA in February 2008 and submission of a VA Form 21-8940 should have been construed as a timely notice of disagreement (NOD) to the October 2007 rating decision, or in the alternative, as new and material evidence. Additionally, the Veteran's attorney argues that VA construed the Veteran's VA Form 21-8940 as a new claim in September 2008, in which VA denied entitlement to an increased rating for his right elbow disability, brought the combined rating to 100 percent disabling from February 2008, and declared the issue of TDIU moot. The Board reiterates as noted in the September 2016 remand, that the Veteran has been in receipt of a 100 percent combined evaluation, effective February 15, 2008. Even so, in Bradley v. Peake, 22 Vet. App. 280 (2008), the United States Court of Appeals for Veterans Claims (Court) held that there could be a situation where a veteran has a schedular total rating for a particular service-connected disability, and could establish a TDIU rating for another service-connected disability in order to qualify for SMC under 38 U.S.C. § 1114(s) by having an "additional" disability of 60 percent or more ("housebound" rate). While the Veteran here has been awarded SMC, the award is only for a small portion of the claim period, specifically from June 9, 2009, through October 1, 2009. The issue of entitlement to a TDIU rating be reasonably inferred from the evidence of record. Rice, 22 Vet. App. at 453-54. A request for a TDIU, whether expressly raised by the Veteran or reasonably raised by the record, is not a separate "claim" for benefits, but rather, can be part and parcel of a claim for an initial or increased rating for a disability. Id. The first question before the Board is whether the claim period dates back to the initial award of service connection for service-connected disability on April 1, 2007. To answer, the Board turns to the procedural and lay evidence of record. Here, VA received the Veteran's claim of entitlement to service connection for claimed disabilities in March 2007. In July 2007, the RO issued a rating decision that summarily awarded a combined rating of 40 percent for the service-connected disabilities, effective April 1, 2007. In July 2007, a VA notification letter was provided to the Veteran notifying him of such. In August 2007, the Veteran requested to reopen his claims and to schedule him for VA examinations, as he received a claim stating that he was entitled to a 40 percent disability but that he had not received any of his specialty appointments as VA had him down as a no show and cancelled the appointments. He then asked for his claim to be reopened and to schedule him for appointments in the specialty clinics. In October 2007, the RO issued an October 2007 rating decision which summarily granted an 80 percent combined rating for the service-connected disabilities, effective April 1. 2007. In October 2007, a VA notification letter was provided to the Veteran notifying him of such. In a December 2007 rating decision, the RO then granted the Veteran service connection for a left hip disability which brought the Veteran's combined rating to 90 percent, effective April 1, 2007. In December 2007, a VA notification letter was provided to the Veteran notifying him of such. Although the claims file appears to have had new and material medical records associated with the claims file on January 22, 2008, particularly medical records from the Social Security Administration (SSA) at least starting in January 2008, these records also contain medical records from April 2008. Nonetheless, in this regard, the Board notes that a rating decision noting review of this evidence at this time was not issued. VA then received the Veteran's claim for a TDIU on February 15, 2008. Then, VA received the Veteran's claim of service connection for posttraumatic stress disorder (PTSD) on April 1, 2008. The RO then issued a September 2008 rating decision granting entitlement to service connection for PTSD which brought the Veteran's combined rating total to 100 percent. In September 2008, a VA notification letter was provided to the Veteran notifying him of such. In December 2008, VA received the Veteran's claim for an increased rating for his neck, right shoulder, sleeping, right elbow, right wrist, and right-hand service-connected disabilities. In February and March 2009, the RO issued a rating decision denying the claims. In July 2009, VA received the Veteran's Notice of Disagreement (NOD) and in April 2010 an SOC was issued denying the claims. VA then received the Veteran's substantive appeal to the Board in May 2010. During the pendency of the appeal, by way of a July 2010 rating decision, the Veteran was granted increased evaluations, including a temporary evaluation of 100 percent from June 9, 2009 through September 30, 2009, based on surgical or other treatment necessitating convalescence for carpal tunnel syndrome and SMC(s) effective June 9, 2009 through September 30, 2009. In a March 2020 supplemental statement of the case (SSOC), the RO denied entitlement to a TDIU as it did not find that the Veteran was unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities and considered him capable of gainful employment prior to February 15, 2008. The RO determined that the evidence of record did not show that his service-connected disabilities prevented him from securing a substantial gainful occupation on April 1, 2007. The RO further found that the evidence did not show that he met the criteria for SMC due to housebound. The Board agrees with the Veteran's representative and finds that the claim period on appeal dates back to the initial assignment of the award of service connection. VA must consider whether a TDIU award is warranted whenever a veteran submits evidence of a medical disability and makes a claim for the highest rating possible, and additionally submits evidence of unemployability. Harper v. Wilkie, 30 Vet. App. 356, 361 (2018). Under 38 C.F.R. § 3.157(b), an informal claim for an increase in rating percent is created with each VA examination report and additionally, each informal claim for a rating increase includes a claim for the highest rating possible, all the way up to 100 percent. Roberson v. Principi, 251 F.3d 1378, 1383 (2001). At the time of the July 2007 rating decision, the evidence reflects that the Veteran failed to report for VA examinations of many his disabilities, but was still awarded service connection as the evidence revealed disabilities incurred in service. Although the Veteran's August 2007 statement does not reveal evidence of unemployability, the Veteran's statements made during his September and October 2007 VA examinations reveal that he was currently employed, but also that his service-connected disabilities affected his occupation. At the time, the Veteran consistently reiterated that he had to change positions frequently and that the pain affected his concentration, which affected him performing administrative work and his activities of daily living. Even though the Veteran was employed at the time of the 2007 VA examinations, proving an inability to secure and follow "substantially gainful occupation" does not require proving 100 percent unemployability. Roberson, 251 F.3d at 1385. A decision as to individual unemployability was not adjudicated in the July, October, or December 2007 or February 2009 rating decisions, and was not adjudicated in the September 2008 rating decision, as the RO found the issue to be moot. Further, the record reflects that SSA records were associated with the claims file in January 2008 that suggested the Veteran interview for SSA benefits. Thus, as the record demonstrates that the medical evidence and lay statements revealed the Veteran's evidence of unemployability, the Board finds that the claim period starts from the April 1, 2007 initial assignment of service connection. A TDIU rating may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). If there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. Id. If a Veteran fails to meet the threshold minimum percentage standards enunciated in 38 C.F.R. § 4.16(a), rating boards should refer to the Director of Compensation and Pension Service for extraschedular consideration all cases where the Veteran is unable to secure or follow a substantially gainful occupation by reason of service-connected disability. 38 C.F.R. § 4.16(b); See also Fanning v. Brown, 4 Vet. App. 225 (1993). The ultimate question of whether a veteran is capable of substantial gainful employment is not a medical one; that determination is for the adjudicator. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). Thus, while a VA examiner's opinion is not dispositive, the observations of the examiner regarding functional impairment due to the service-connected disability goes to the question of physical or mental limitations that may impact a Veteran's ability to obtain and maintain employment. Additionally, any determination made by SSA as to a Veteran's eligibility for SSA disability is not binding on the Board in reaching its determination of whether a TDIU is warranted. See Collier v. Derwinski, 1 Vet. App. 412 (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). Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. §§ 3.341, 4.19. In Ray v. Wilkie, 31 Vet. App. 58 (2019), the Court defined the term "unable to secure and follow a substantially gainful occupation" as having two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of: the Veteran's history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. The Board notes that a grant of a 100 percent schedular rating does not necessarily render the issue of entitlement to individual unemployability moot, as the claim could in certain circumstances render the Veteran eligible for special monthly compensation (SMC). SMC may be warranted if the Veteran has a 100 percent disabling rating for a single disability, and VA finds that individual unemployability is warranted based solely on disabilities other than the disability that is rated at 100 percent. See Bradley v. Peake, 22 Vet. App. 280 (2008). The SMC provided by 38 U.S.C. § 1114(s) is payable where the veteran has a single service-connected disability rated as 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. This requirement is met when the veteran is substantially confined as a direct result of service-connected disabilities to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime. 38 C.F.R. § 3.350(i). The Veteran's above noted single body system argument is guided by 38 C.F.R. § 4.16. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. Id. Here, the Board finds that the Veteran's cervical spine and lumbosacral strain disabilities, separately rated, affect the single body system of the spinal orthopedic origin, to become one disability only for the purposes of 38 C.F.R. § 4.16. The Board notes that the December 2007 rating decision reflects that the Veteran was in receipt of compensable service connected disabilities, effective April 1, 2007, of cervical spine degenerative disc disease at 30 percent, left hip bursitis, right elbow traumatic arthritis, chronic lumbosacral strain, left knee retropatellar syndrome, right knee retropatellar syndrome, posttraumatic right ankle degenerative joint disease, bilateral plantar fascitis, right shoulder rotator cuff impingement, left shoulder rotator cuff impingement, tinnitus, gastroesophageal reflux disease (GERD), residuals of left wrist TFC complex tear with carpal tunnel syndrome, residuals of right wrist injury carpal tunnel syndrome, and obstructive sleep apnea (OSA) at 10 percent disabling, for a combined total rating of 90 percent, and noncompensable service connected disabilities of hypertension and erectile dysfunction disorder. The September 2008 rating decision reflects that he was awarded service connection for PTSD at 30 percent, and increased ratings for some of his service-connected disabilities to bring his combined ratings total to 100 percent. His highest rating for any service-connected disability was still 30 percent. The December 2020 rating decision reflects that the Veteran has been in receipt of a 30 percent rating for his cervical spine disability, effective April 1, 2007, a 10 percent rating for his lumbosacral disability, effective April 1, 2007, and a 20 percent rating effective February 15, 2008. Thus, for his orthopedic disability, the Veteran was in receipt of a 40 percent rating since April 1, 2007, and a 40 percent rating effective February 15, 2008. However, the Veteran was not in receipt of a total disability rating under any Diagnostic Code for his service-connected disabilities. As such, because 38 C.F.R. § 4.25 next guides the combined rating, the Veteran was not rated at a 100 percent combined evaluation effective April 1, 2007. Pursuant to 38 C.F.R. § 4.25, except as otherwise provided in this schedule, the disabilities arising from a single disease entity, e.g., arthritis, multiple sclerosis, cerebrovascular accident, etc., are to be rated separately as are all other disabling conditions, if any. Hence, the Veteran has been in receipt of at least one disability ratable at 40 percent or more, and had sufficient additional disability to bring the combined rating to 70 percent or more since April 1, 2007, and a 100 percent combined rating evaluation since February 15, 2008. Thus, the Board must determine whether the evidence demonstrates that the Veteran was unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities since April 1, 2007, and whether the Veteran is entitled to SMC. The service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue will be addressed in both instances. 38 C.F.R. § 4.16(a), (b). 1. Entitlement to a TDIU rating since April 1, 2007 During the pendency of the appeal, pursuant to 38 U.S.C. § 1114(k), the RO granted the Veteran SMC for erectile dysfunction, effective June 22, 2020, the date VA received the Veteran's claim, in a July 2020 rating decision. 38 U.S.C. § 1114(k); 38 C.F.R. § 3.350. Erectile dysfunction is tantamount to loss of use of a creative organ. See 38 C.F.R. § 4.115b, Diagnostic Code 7522. The RO noted that there was no documentation of loss of use of a creative organ that met the criteria to receive SMC (k) for loss of use of a creative organ at the time of a July 2007 rating decision. The Board further notes that this special compensation is payable in addition to the basic rate of compensation otherwise payable on the basis of degree of disability, provided that the combined rate of compensation does not exceed the monthly rate set forth in 38 U.S.C. § 1114(l) when authorized in conjunction with any of the provisions of 38 U.S.C. § 1114 (a) through (j) or (s). 38 C.F.R. § 3.350(a). The Board further notes that in December 2020, also during the course of the appeal, the Veteran was granted an increased evaluation of 70 percent for PTSD with depression to now include traumatic brain injury (TBI), effective August 7, 2020, the date of the Veteran's claim of entitlement to service connection for a TBI. Turning to the medical evidence of record, at a September 2007 VA neurological disorders examination, the examiner found that upon physical examination, the Veteran demonstrated as alert with no language disturbance or cranial nerve impairment, but found that the Veteran had frequent tension type headache, but not a migraine, and further found that his frequent headaches did not seem to interfere with his required employment activities. In regard to his GERD, the Veteran reported experiencing intermittent dysphagia, daily pyrosis, having to avoid spicy foods, regurgitation or water brash on a daily basis. At an October 2007 VA foot examination, the Veteran reported that he was currently employed as a youth counselor. He reported constant moderate pain of 5/10, denied weakness or fatigability, but standing was affected to less than 30 minutes or walking less than three miles, flareup pain was severe (9/10), and occurred every day and would last at least an hour. In regard to his joints, during his October 2007 VA joints examination, the Veteran reported that he was currently employed, but that the conditions affected his occupation as he had to change positions frequently and it limited his mobility, which affected his keyboarding, lifting and activities of daily living, such as chores, sleeping, bathing and dressing. The examiner found that the range of motion of his right elbow as measured was not additionally limited following repetitive use. In regard to his knees, at the October 2007 VA examination, the Veteran reported that he had to change positions frequently and it limited his weightbearing, he had severe pain, and used assistive devices of bilateral knee braces and a cane. The examiner found that as measured, that the Veteran's range of motion was not additionally limited following repetitive use. In regard to his wrists, at the October 2007 VA examination, the Veteran reported that he had constant, moderate pain of 5/10 and had carpal tunnel syndrome of the right wrist and got severe flares of 7/10 and 10/10 on the left pain nightly. The Veteran reported that his wrists affected him occupationally because they limited his keyboarding and slowed him down which affected his concentration. The examiner found that the range of motion of the bilateral wrists as measured was not additionally limited following repetitive use. In regard to his shoulder pain, at the October 2007 VA examination, the Veteran reported that he was employed as an abuse counselor and also did administrative work and that his condition affected his occupation and limited the use of his shoulders. He reported severe flareups pain of 7/10. The examiner found that the range of motion as measured was not additionally limited following repetitive use. In regard to his left hip, at the October 2007 VA examination, the Veteran denied constant pain but that the condition affected his occupation as he had to change positions frequently with pain affecting his concentration. The examiner found that the range of motion was not additionally limited following repetitive use. In regard to his cervical spine, at the October 2007 VA spine examination, the Veteran reported that he had constant severe 8/10 pain and 10/10 pain upon flareups that radiated to his arms, but did not affect his ability to walk. There were no incapacitating episodes requiring prescribed bed rest, but he had to use a cane. He reported being employed and performing sedentary work, but that the condition affected him occupationally because he had to change positions frequently and it affected his keyboarding. The Veteran also reported that it affected his activities of daily living. The examiner found that the range of motion as measured was not additionally limited following repetitive use. In regard to his lumbar spine, at the October 2007 spine examination, the Veteran reported he had constant severe pain of 8/10 and daily 10/10 upon flare-ups that radiated to his lower trunk affecting his ability to walk to less than three miles, but he denied having incapacitating episodes requiring prescribed bed rest. The Veteran reported that the condition affected him occupationally as he had to change positions frequently and the pain affected his concentration, which affected him performing administrative work and his activities of daily living. The examiner found that the range of motion of the lumbar spine was not additionally limited by pain, fatigue, weakness or lack of endurance. In regard to his ankles, at the October 2007 VA examination, the Veteran reported that he had constant, moderate pain of 5/10 and 7/10 upon flare-ups with instability. He reported being employed, but the condition affected him occupationally as he had to change positions frequently, it limited his mobility and activities of daily living, and he had to use braces. The examiner reported that the range of motion was not additionally limited following repetitive use. Here, at this point, the Board has not factored in the Veteran's noncompensable rated service-connected disabilities. However, in regard to his hypertension, at the September 2007 VA examination, the Veteran reported that he awakened in the night with choking and coughing sensations on occasion, but ordinarily he did not have a cough that was productive. He did report experiencing mild dyspnea with exertion. He reported that he was employed, but that his skin condition affected his occupation and that he was constantly fighting the bumps and was embarrassed by its unsightliness. Further, the Veteran's service-connected PTSD is not considered prior to the effective date of the award of service connection, of April 7, 2008. Turning to the Veteran's earning statements, an earnings report received in March 2008 reflects that the Veteran earned $17,398 from June 2007 to December 2007. The Board notes, marginal employment shall not be considered substantially gainful employment. 38 C.F.R. § 4.16. Marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Id. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination. In this regard, the Board notes that the poverty threshold guideline was $10,120 for a household of one and the Veteran's income was thus above the poverty threshold. The most the Veteran earned was in 2006, on active duty, earning $42,195. However, in taking a closer look at the Veteran's employment, turning to the Veteran's history of employment, while in the military, he was a recruiter in 2007. Then, post military, he stated that he was employed as a youth counselor and instructor in 2007. Based on his statements during the 2007 examinations, the Veteran's service-connected disabilities affected him occupationally to the point that he had to change positions frequently and limit his mobility and his activities of daily living, and his last date of full-time employment was December 20, 2007. Academically, the evidence reflects that the Veteran reported that he began taking college courses while in the military in 2003, completed three years, but did not obtain a degree. In August 2008, the Veteran reported to the Social Security Administration (SSA) that he was unable to work due to pain and was not performing any substantial work. The SSA determined that the evidence showed that the Veteran's pain in the neck, back, ankles, knees, hips, migraines, carpel tunnel, sleep apnea, memory, PTSD, irritable bowel syndrome, blood pressure, shoulder and hearing conditions caused some work-related restrictions, but did not prevent the Veteran from doing all types of work. It was determined that his current work restrictions may prevent him from performing any work he may have done in the past, however, when considering his age, education, and past work experience. He was found to be capable of performing a significant number of jobs in the national economy. In May 2010, the SSA found that the Veteran's residual functional capacity was markedly reduced and precluded sustained performance of all work at a substantial gainful level of activity, including the minimal physical requirements of sedentary work. The medical evidence showed that a combination of impairments, including pain, significantly reduced the Veteran's residual functional capacity, and that the impairments prevented him from engaging in sustained work activity, including work at a sedentary level, as of March 1, 2008. In sum, the Veteran was discharged from the Army in 2007 as a recruiter and then began work and ended in 2007 as a youth counselor and instructor. The Board finds that since April 1, 2007, the Veteran's employment history, and educational and vocational attainment allowed him to obtain physical and sedentary work, but such work was impinged by his service-connected disabilities. The service-connected disabilities, employment history, educational and vocational attainment, and all other factors have a bearing on the issue. 38 C.F.R. § 4.16(a), (b). That is, the Board finds that in a physical setting, the Veteran was limited by his service-connected disabilities, as he had to change positions frequently, of which his mobility and activities of daily living were limited. Then in a sedentary setting, the Veteran has reported that his service-connected disabilities restricted his keyboarding, which many sedentary opportunities require. Although the 2007 examiners found that the Veteran's range of motion was not further limited upon repetitive use, the Board finds that the examiners also noted that the Veteran reported severe lumbar pain of 10/10 upon flare-ups daily, which the Board finds highly persuasive. Here, the Board notes, the crux of question is whether the symptoms of the Veteran's service-connected disabilities alone were so exacerbated as to show sufficient severity to preclude him from securing and following substantially gainful employment. The more narrowly tailored question is whether the Veteran's disabilities manifested in sufficient severity to render him incapable of maintaining more than marginal employment. The Board turns to the 2007 examination indications from the Veteran's statements, which the Board finds to be the most probative evidence of record. Here, although the ultimate question is a legal question, the observations of the examiner regarding functional impairment goes to the question of physical limitations that may impact the Veteran's ability to secure and follow employment, for which a medical examiner may provide the most probative insight. See Geib, 733 F.3d at 1354. Specifically, the examiner consistently noted that the Veteran reported that his service-connected joints disabilities caused him to change positions frequently, of which the pain affected his concentration, which affected him performing administrative work and his activities of daily living. Essentially, the Veteran consistently endorsed these symptoms, and the Board finds these lay accounts to be plausible, consistent, and credible and credits these statements. Caluza v. Brown, 7 Vet. App. 498, 512 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). The Board finds such effects caused by his service-connected disabilities have impacted both physical and sedentary job settings. Although all doubt is not eliminated as to whether the Veteran was incapable of keeping up with the tasks assigned to him specifically, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107. Considering the Veteran's educational and occupational history in light of the symptoms noted above, the Board therefore concludes that the evidence is in equipoise as to whether the Veteran's service-connected disabilities precluded him from securing and following substantially gainful employment since April 1, 2007. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, a TDIU is warranted since April 1, 2007. 38 U.S.C. § 5107. Accordingly, the full benefit sought on appeal is therefore granted. 38 C.F.R. § 4.16(a). 2. Entitlement to SMC pursuant to 38 U.S.C. § 1114 (s), prior to June 9, 2009 and since October 2, 2009. At the outset, the Board notes that the Veteran has a pending claim under the Appeals Modernization Act (AMA) for SMC housebound status. VA received the Veteran's VA Form 20-0995, a supplemental claim VA Form 21-2680, and an Examination for Housebound Status or Permanent Need for Regular Aid and Attendance in November 2021. The claim has not yet been adjudicated by the RO and is thus not on appeal before the Board at this time. (CONTINUED ON NEXT PAGE) Although, the Veteran is in receipt of a service-connected disability rating of 70 percent for PTSD, effective August 7, 2020, he has not been in receipt of a service-connected disability rated as total, except for his temporary total evaluation of 100 percent for right ulnar neuropathy and carpal tunnel syndrome, residuals of right wrist injury, of which he is in receipt of 38 U.S.C. § 1114(s) compensation from June 9, 2009 through September 30, 2009. 38 U.S.C. § 1114(s). Further, as explained above, the Veteran has been awarded a TDIU since April 1, 2007 on account of a combination of his service-connected disabilities, as opposed to any one single disability. Therefore, entitlement to SMC pursuant to 38 U.S.C. § 1114 (s) is not warranted at any time prior to June 9, 2009 or since October 2, 2009. Brian J. Elwood Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Alli, 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.