Citation Nr: 22017241 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 16-41 247 DATE: March 24, 2022 ORDER An effective date earlier than September 1, 1997 for an award of service connection for dyshidrotic eczema is denied. An initial evaluation of 60 percent, but not in excess thereof, for dyshidrotic eczema prior to March 21, 2011 is granted. An evaluation in excess of 60 percent for dyshidrotic eczema from March 21, 2011 is denied. Special monthly compensation (SMC) based on the need for aid and attendance effective October 1, 2008, but no earlier, is granted. SMC based on housebound status from May 1, 2004 is denied. FINDINGS OF FACT 1. The first communication from the Veteran indicating an intent to claim service connection for a skin disability was received by VA on September 1, 1997. 2. From September 1, 1997 to March 21, 2011, the Veteran's dyshidrotic eczema affected at least 40 percent of his total body area. 3. From March 21, 2011, the Veteran's dyshidrotic eczema affected at least 40 percent of his total body area. 4. From October 1, 2008, the Veteran's service-connected disabilities rendered him so helpless as to be in need of regular aid and attendance. 5. From May 1, 2004 to October 1, 2008, the Veteran was not in receipt of a 100 percent rating for any single service-connected disability, and thereafter he is in receipt of SMC based on the need for aid and attendance. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than September 1, 1997 for an award of service connection for dyshidrotic eczema are not met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.159, 3.400. 2. The criteria for an initial evaluation of 60 percent, but not in excess thereof, for dyshidrotic eczema prior to March 21, 2011 are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.118, Diagnostic Code 7806. 3. The criteria for an evaluation in excess of 60 percent for dyshidrotic eczema from March 21, 2011 are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.118, Diagnostic Code 7806. 4. The criteria for SMC based on the need for aid and attendance effective October 1, 2008, but no earlier, are met. 38 U.S.C. §§ 1114(l), 5107; 38 C.F.R. §§ 3.350(b), 3.352(a). 5. The criteria for SMC based on housebound status from May 1, 2004 are not met. 38 U.S.C. §§ 1114(s), 5107; 38 C.F.R. § 3.350(i). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1987 to November 1995. This appeal is before the Board of Veterans' Appeals (Board) from November 2009 and January 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in New York, New York. In May 2015, the Board remanded the issues of entitlement to an earlier effective date and increased ratings for eczema with instruction to provide the Veteran with a statement of the case. A statement of the case was issued in August 2016. In December 2018, the Board denied an earlier effective date for eczema and remanded the issues of entitlement to increased ratings for eczema and entitlement to SMC with instruction to obtain relevant records and provide a VA examination for skin disabilities. The appropriate records were obtained, and the Veteran underwent VA examinations in April 2019 and October 2020, with an additional addendum opinion obtained in December 2020. The Veteran appealed the denial of an earlier effective date for eczema to the United States Court of Appeals for Veterans Claims (Court), which vacated the denial in a November 2020 memorandum decision. In July 2021, the Board remanded the issues addressed in this decision with instruction to obtain a medical opinion relevant to his effective date appeal. Such an opinion was obtained in November 2021. The Board is therefore satisfied that the instructions in its remands of May 2015, December 2018, and July 2021 have been satisfactorily complied with. See Stegall v. West, 11 Vet. App. 268 (1998). The Board notes that in January 2021 the Veteran submitted another claim for an increased rating for dyshidrotic eczema. An increased rating was denied in a February 2021 rating decision under the modernized appeals system. The Veteran submitted a notice of disagreement in July 2021. In a March 2022 letter, the Board informed him that this appeal could not be addressed under the modernized system because of his pending appeal decided herein in the legacy system. As such, the issue will be addressed in full herein. The Veteran also has active appeal streams involving ratings for his left shoulder impingement syndrome and his allergic rhinitis. These issues are governed by the modernized appeals system, and they will be addressed in separate decisions. 1. Entitlement to an effective date earlier than September 1, 1997 for an award of service connection for dyshidrotic eczema The Veteran claims an earlier effective date for his award of service connection for eczema. Generally, the effective date of an award of a service connection claim, including a claim reopened after a final disallowance, is the date of receipt of a claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. Under regulations applicable prior to March 24, 2015, any communication or action indicating an intent to apply for one or more benefits under the laws administered by VA from a claimant may be considered an informal claim. An informal claim must identify the benefit sought. 38 C.F.R. § 3.155(a) (2014). The Veteran filed his first claim for VA compensation on October 24, 1995. His application included a claim for bilateral foot status post bunionectomy in addition to other claims. On November 1, 1995, VA informed the Veteran that his initial claims were denied because he was still on active duty. On July 8, 1996, the Veteran submitted a written statement requesting to reopen the claims from his initial October 1995 compensation application, but he did not provide any additional details regarding the nature of the claimed disabilities. On November 14, 1996, VA issued a rating decision granting service connection for bilateral bunionectomies. On September 1, 1997, the Veteran submitted a written statement acknowledging the grant of service connection for bilateral bunionectomies, but also asserting a skin condition affecting his feet needed to be evaluated and rated. In a September 2008 statement, the Veteran stated that he filed a claim for dermatosis of both feet on November 14, 1996. He repeated this account in multiple subsequent statements. In statements dated October 2010, March 2011, and September 2011, he requested retroactive payment since September 1997. In a September 2012 statement, the Veteran explained that his claim was submitted in September 1997, but the November 1996 rating decision which granted service connection for his bunionectomies overlooked and never rated his skin condition. After service connection was initially granted with an effective date of March 21, 2011, in his notice of disagreement received in July 2014 the Veteran stated the effective date should be in November 1995. The Court's November 2020 memorandum decision instructed that the Board failed to determine whether his September 1997 reports of eczema were new and material evidence submitted within one year of the November 1996 rating decision granting service connection for bunionectomies. See 38 C.F.R. § 3.156(b). VA obtained a November 2021 opinion from a VA examiner as to whether or not the Veteran's eczema was related to his bunionectomies. The examiner opined that the eczema was less likely than not caused or aggravated by the bunionectomies. This opinion was based on the rationale that the disability was the direct result of wearing combat boots in extreme weather conditions. In two January 2022 statements, the Veteran stated that he agreed that his effective date should not be prior to 1997. Specifically, the Veteran stated, that "VA continues to say that the Veteran is seeking earlier date than September 1, 1997 and that is not true absolutely false." The Board finds the Veteran's initial October 1995 compensation application did not include a service connection claim for a skin disability. The Veteran did not identify a skin condition on his application or provide any indication that he experienced symptoms related to a skin disability. The Veteran's October 1995 application identified an orthopedic disability affecting the feet. The first indication VA received from the Veteran that he desired to seek compensation for manifestations of a skin disability was the September 1997 written statement upon which the current effective date of service connection for dyshidrotic eczema is based. In reaching this conclusion, the Board fully acknowledges the Veteran's initial claim was not limited to bilateral bunionectomies; however, the October 1995 application and statements submitted by the Veteran prior to his September 1997 written statement failed to identify any symptoms related to a skin disability. The Board also acknowledges the September 1997 written statement was received in the appeal period of the November 1996 rating decision for bilateral bunionectomies, but this does not change the effective date of the separate and distinct claim for a skin disability. The November 2021 VA examiner found no relationship between the Veteran's eczema and his bunionectomies, and there is no medical evidence in the record to contradict this opinion. Moreover, in January 2022 the Veteran explicitly stated that he was no longer seeking an effective date earlier than September 1, 1997. He did not explicitly withdraw the claim, but his statement is probative to his intent in his earlier claims. For these reasons, the Board finds that an effective date of service connection prior to September 1, 1997 for dyshidrotic eczema is not warranted. 2. Entitlement to an initial compensable evaluation for dyshidrotic eczema prior to March 21, 2011 3. Entitlement to an evaluation in excess of 60 percent for dyshidrotic eczema from March 21, 2011 The Veteran claims a compensable rating for eczema prior to March 21, 2011. Disability evaluations are determined by application of the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. An evaluation of the level of disability present must also include consideration of the functional impairment of the Veteran's ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. "Staged" ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App 119 (1999). When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining 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 evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). The Veteran's dyshidrotic eczema is rated as eczema under 38 C.F.R. § 4.118, Diagnostic Code 7806. During the pendency of the appeal, the rating criteria for evaluating skin disabilities under 38 C.F.R. § 4.118 were amended twice, with amendments effective August 30, 2002 and August 13, 2018. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the claimant will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Prior to August 30, 2002, a noncompensable rating was warranted for eczema with slight, if any, exfoliation, exudation, or itching, if on a nonexposed surface or small area. A 10 percent rating was warranted for eczema with exfoliation, exudation, or itching, if involving an exposed surface or extensive area. A 30 percent rating was warranted for eczema with constant exudation or itching, extensive lesions, or marked disfigurement. A maximum 50 percent rating was warranted for eczema with ulceration or extensive exfoliation or crusting and systemic or nervous manifestations, or for exceptionally repugnant eczema. From August 30, 2002 to August 13, 2018, a noncompensable rating was assigned for less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and; no more than topical therapy required during the past 12 months. A 10 percent rating was assigned for at least 5 percent, but less than 20 percent, of the entire body, or; at least 5 percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. A 30 percent rating was assigned for 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly during the past 12-month period. A 60 percent rating was assigned for more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near- constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. The Veteran's disability may alternatively be rated as scars if such is the predominant disability. From August 13, 2018, eczema is rated on application of the General Rating Formula for the Skin. The Veteran is already in receipt of a 60 percent rating effective March 21, 2011. A maximum 60 percent rating under this formula is warranted for characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or for constant or near-constant systemic therapy including but not limited to corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over a 12-month period. This is the maximum schedular rating. For claims filed prior to August 13, 2018, the Court held that a systematic therapy was one that that affects the entire body in its treatment of the condition at issue, and that the Board must determine (1) whether a topical treatment affects the body as a whole in treating a veteran's skin condition; and (2) whether the given treatment is "like" a corticosteroid or other immunosuppressive drug." Burton v. Wilkie, 30 Vet. App. 286 (2018). Only the second question need be addressed if the treatment is clearly systemic. Id. VA treatment records reflect that in October 1998 the Veteran was diagnosed with tinea pedis and prescribed Lamisil cream. In November 2004, while being treated for genital warts, his dermatologist noted erythematous annular plagues with a scalloped raised border present in the groin and along the lateral medial aspects of the soles of the feet with light scaling. He was diagnosed with tinea pedis and tinea cruris. He was prescribed Loprox cream for four weeks. In January 2005, he presented to the emergency room reporting hemorrhoids, and his physician noted tinea cruris as well. In February 2005 his dermatologist noted improvement in the groin but the presence of tinea pedis. He was prescribed creams for his feet. In a December 2006 statement, the Veteran reported dry skin on his feet with cracking, dryness, and deep cuts that bleed. He reported treatment of his dermatosis with cream prescribed by VA and soaking in water. He made a similar statement in March 2007, adding that he was limited in daily activities and his ability to walk. VA treatment records reflect that in January 2007 the Veteran reported year-round dryness and scaling. He reported his feet would crack and become difficult to walk on. His dermatologist noted juvenile plantar dermatosis with more hyperkeratosis, with no erythema or vesicles to suggest contact dermatitis, irritant, or dyshidrotic dermatitis. In April 2007, there was overall much improvement with the use of urea 40 percent cream and Clobetasol ointment on the plantar surfaces. In July 2007, his dermatologist again noted hyperkeratotic plantar surfaces on both feet. He was instructed to continue Lamisil cream, Tazorac cream, and steroid and urea creams. In January 2008, he reported a flare over the prior one to two weeks that consisted of significant pain, burning, and fissuring. Physical examination showed macular erythema and thick hyperkeratotic scale with some fissuring on the bilateral feet. He was prescribed topical treatment. In a February 2008 letter, the Veteran's VA treating dermatologist stated that he presented with reports of painful fissuring in his feet. The dermatologist diagnosed a diffuse plantar keratoderma with fissuring suggestive of severe dyshidrosis. The dermatologist had been hesitant to use systemic therapies because of the Veteran's multiple medical problems, medications, and multifactorial diagnosis. VA treatment records reflect that in April 2008 the Veteran exhibited plantar hyperkeratotic scale with macular erythema and mild fissuring. His dermatologist noted slight improvement since his prior visit. Further improvement was noted in July 2008. He was prescribed topical treatment with soaks and use of crazy glue for fissures. In January 2009, he presented to the emergency room reporting foot pain due to his skin disability. His soles were noted to be extremely dry with several large, deep cracks. He was advised to continue to use his prescribed creams until he could follow up with his dermatologist. In March 2009, his podiatrist noted hyperkeratotic buildup on the heels with fissuring. He reported increased concern about his painful fissures in December 2009. In October 2010, he reported use of urea cream with improvement. On November 22, 2010, his dermatologist prescribed oral fluconazole weekly. He was using urea cream twice daily and soaking with vinegar nightly. In January 2011, was diagnosed with a history of dermatophytosis, currently plantar feet with hyperkeratotic plaques on the heels and forefeet. There were no clinical signs of tinea. He decided to stop fluconazole as he did not feel it was helping. He continued with topical treatment. In two statements dated January 2010 and January 2019, a person who served with the Veteran described the difficulties the Veteran had with his skin in service. The Veteran underwent a VA examination in October 2013. He was diagnosed with dyshidrotic eczema affecting more than 40 percent of his total body area and exposed areas and treated by constant or near-constant topical medications. In his notice of disagreement received in July 2014, as well as in multiple subsequent statements, the Veteran claimed a 60 percent rating for eczema in each foot. The Veteran underwent another VA examination in April 2019. The examiner noted constant or near-constant topical treatment for his dyshidrotic eczema affecting more than 40 percent of his body and more than 40 percent of exposed areas. In two December 2019 statements, the Veteran argued that he needed a separate rating for regular eczema in addition to his 60 percent rating for dyshidrotic eczema. The Veteran underwent another VA examination in October 2020. He was diagnosed with dyshidrotic eczema/xerosis, acne, and onychomycosis. Treatment was via topical creams. His eczema affected more than 40 percent of his total body area and 20 to 40 percent of exposed areas. In an addendum opinion issued later that month, the examiner reviewed all of the Veteran's prescription medication for his eczema since 1997 and found that none were systemic. The examiner reiterated this opinion in a December 2020 addendum The Veteran underwent another VA examination in February 2021 conducted via video telehealth. He was diagnosed with dyshidrotic eczema with constant or near-constant treatment with topical corticosteroids, retinoids, and other medications. The disability affected more than 40 percent of his total body area and caused functional impact through difficulty walking. The Board finds that staging is not appropriate for the Veteran's claim. He was originally assigned an initial rating of 60 percent effective March 21, 2011 based on what was believed to be his claim date. He appealed for an earlier effective date for service connection. This appeal was granted on account of the abovementioned informal claim that was received by VA on September 1, 1997 and was not adjudicated in the interim. The Board finds that the noncompensable rating currently assigned for the period from September 1, 1997 to March 21, 2011 is arbitrary. He was not afforded a VA examination during this time. The noncompensable rating assigned was based wholly on the lack of systemic medication. His 60 percent rating, however, was based on the October 2013 VA examiner's finding that he had eczema over more than 40 percent of his body. There is nothing in the record to show what percentage of the Veteran's body was affected by eczema between September 1997 and October 2013. VA should not arbitrarily assume that the Veteran's eczema worsened on the date that he decided to follow up on an unadjudicated service connection claim. Affording the Veteran all benefit of the doubt, the Board finds that the Veteran's eczema affected at least 40 percent of his body for the entirety of the appeal period. A 60 percent evaluation from September 1, 1997 to March 21, 2011 is therefore granted. The Board further finds that an evaluation in excess of 60 percent is not warranted at any point during the appeal period. A 60 percent rating is the maximum schedular rating available under two of the three sets of criteria applicable since 1997; the other set of criteria has a maximum rating of 50 percent. The Veteran has not argued that an extraschedular rating is warranted, nor does the evidence indicate an exceptional disability picture such that the available schedular evaluations are inadequate. The pain and discomfort reported by the Veteran is not exceptional or unusual, but rather is proportional to the amount of his body affected by his eczema and thus contemplated by the criteria. The Veteran has argued that a separate rating is warranted for eczema arising in service that is not dyshidrotic, but the evidence does not establish separate eczema disabilities. While his physicians have described his disability with terms such as dyshidrotic eczema, xerosis, and eczema, the evidence indicates that these are alternate terms to describe the same disability, not separate disabilities warranting separate compensation. Moreover, the Veteran is not qualified to differentiate between such diagnoses, and he is thus incompetent to report how many diagnoses were present in service and are therefore eligible for service connection. Finally, the Veteran has argued that he should be assigned two separate 60 percent ratings for dyshidrotic eczema in each lower extremity. The criteria are not to be applied as such. The Veteran's 60 percent rating is explicitly based on the percentage of his entire body affected by his disability. As such, separate ratings for the same eczema diagnosis on different parts of the body are not available. For these reasons, the Board finds that an evaluation in excess of 60 percent is not warranted at any point during the appeal period. 4. Entitlement to SMC based on the need for aid and attendance prior to November 29, 2010 The Veteran claims SMC based on the need for aid and attendance prior to November 29, 2010. He is already in receipt of such SMC effective that date. SMC provided by 38 U.S.C. § 1114(l) is payable for being so helpless as to be in need of regular aid and attendance due to service-connected disability or disabilities. 38 C.F.R. § 3.350(b). The following is accorded consideration in determining the need for regular aid and attendance: inability of claimant to dress or undress oneself, or to keep oneself ordinarily clean and presentable; inability to attend to the wants of nature; and incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment. It is not required that all of these disabling conditions be found to exist before a favorable rating may be made. The particular personal functions which a veteran is unable to perform should be considered in connection with his or her condition as a whole. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Determinations that a veteran is so helpless as to be in need of regular aid and attendance are based on the actual requirement of personal assistance from others. 38 C.F.R. § 3.352(a). In a June 2008 application for a total disability rating based on individual unemployability as a result of service-connected disabilities (TDIU), the Veteran reported that he was employed full-time until May 2008, at which time he became unemployable due to his bipolar disorder and migraine headaches. In February 2009, his employer determined that he was disabled for his position due to his bipolar disorder. In an October 1, 2008 statement, the Veteran stated that he was housebound due to 100 percent service connection and that there were many times that he needed the aid and attendance of another person. In an attached document, the Veteran argued that he required aid and attendance based on his service-connected migraine headaches. He reported that his headaches restricted him tremendously. On a good day, he stated that he woke up, showered, ate breakfast, and watched television. On bad days when he had a headache or felt anxious or depressed, however, he had been known to stay in bed all day. He stated that it was difficult to bend his head to put socks on; and when he had a migraine, he was unable to shower due to pain. He stated that when he had a headache he did not eat. His girlfriend prepared his meals for him because he could not cook. He went grocery shopping once per week with his girlfriend. The Veteran underwent a VA examination in March 2009. The examiner diagnosed degenerative joint disease of the feet with bilateral foot strain, scars from his bunionectomies, lumbosacral low back strain, degenerative joint disease of both ankles and knees, polycystic kidney disease with chronic renal insufficiency, and bilateral foot strain. These disabilities are all service connected. The examiner opined that the Veteran needed the regular assistance of another person in attending to the ordinary hazards of daily living and in protecting himself from the hazards of his daily environment. Additionally, he needed help financially managing his benefit payments. His girlfriend provided this help. In a March 2009 statement, the Veteran reported that he received aid and assistance every day in performing daily activities due to his severe disabilities. He stated that he did not leave the house apart from medical appointments. His girlfriend did grocery shopping, cleaned his house, managed his medications, dressed him, bathed him, cooked for him, and occasionally assisted him to eat in bed. He attributed his difficulties to severe hallux valgus and severe migraines. He stated that on some days he did not shower, shave, or get up. The Board finds that the evidence is at least in equipoise as to whether the Veteran's service-connected disabilities rendered him so helpless as to be in need of regular aid and attendance as of October 1, 2008. As discussed above, he has already been granted SMC based on the need for aid and attendance effective November 29, 2010. This effective date was determined based on the date where his rating for bipolar disorder was increased from 70 percent to 100 percent. SMC based on the need for aid and attendance, however, does not have any statutory or regulatory requirement of a 100 percent rating for a single disability, and the Veteran has been in receipt of a combined schedular rating of 100 percent since January 2002. On October 1, 2008 VA received the Veteran's statement claiming a need for aid and attendance, and in March 2009 a VA examiner found that his service-connected disabilities required the regular assistance of another person in attending to his activities of daily living. There is no evidence in the record to contradict this finding. The Board further finds that SMC based on the need for aid and attendance is not warranted prior to October 1, 2008. The Veteran has not provided evidence indicating such a need, and the fact that he had full-time employment as late as May 2008 is consistent with this finding. For these reasons, the Board finds that the evidence is at least in equipoise as to whether the Veteran's service-connected disabilities rendered him so helpless as to be in need of regular aid and attendance as of October 1, 2008. 5. Entitlement to SMC based on housebound status from May 1, 2004 The Veteran claims SMC based on housebound status from May 1, 2004. He is already in receipt of such SMC from March 26, 2004 to May 1, 2004. SMC provided by 38 U.S.C. § 1114(s) is payable where a veteran has a single service-connected disability rated as total and either (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, 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). The Veteran's SMC from March 26, 2004 to May 1, 2004 is based on a temporary 100 percent rating for convalescence from surgery on his service-connected right knee disability. See 38 C.F.R. § 4.30. Because of this temporary 100% rating, he was in receipt of a 100 percent rating for a single disability and a separate 70 percent rating for bipolar disorder with depression. Such a scenario warrants SMC based on housebound status. For the period from May 1, 2004 to October 1, 2008, the Veteran is not in receipt of a 100 percent rating for any single disability. As such, the Board finds that SMC based on housebound status is not available for this period. For the period beginning October 1, 2008 granted herein, the Veteran is in receipt of SMC based on the need for aid and attendance, which results in higher compensation than SMC based on housebound status. See 38 U.S.C. § 1114(l), (s). For these reasons, the Board finds that SMC based on housebound status from May 1, 2004 is not warranted. L. Chu Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Gallagher, 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.