Citation Nr: A25106984 Decision Date: 12/11/25 Archive Date: 12/11/25 DOCKET NO. 240812-463947 DATE: December 11, 2025 ORDER Entitlement to special monthly compensation (SMC) under 38 U.S.C. § 1114(s) based on statutory housebound criteria (SMC housebound) is granted. FINDING OF FACT For the period of appeal, the Veteran was awarded TDIU based upon a single disability of PTSD with additional service-connected disabilities independently ratable at 60 percent. CONCLUSION OF LAW For the period of appeal, the criteria for entitlement to SMC housebound under 38 U.S.C. § 1114(s) are met. 38 U.S.C. § 1114(s); 38 C.F.R. §§ 3.350. INTRODUCTION The Veteran served on active duty in the United States Army from September 2008 to February 2013. This matter comes before the Board of Veterans' Appeals (Board) on an appeal from an August 2023 Higher Level Review (HLR) decision by the Department of Veterans Affairs (VA) Veterans Benefits Administration, the agency of original jurisdiction (AOJ). In the Veteran's August 2024 VA Form 10182, Decision Review Request: Board Appeal, the appellant elected the evidence docket. Therefore, the Board may only consider the evidence of record before the AOJ at the time of its decision on the issue(s) on appeal, as well as any evidence submitted by the appellant or his or her representative with the NOD (VA Form 10182) or within 90 days following receipt of the NOD. 38 C.F.R. §§ 20.300(a), 20.303. If additional evidence was submitted between the dates of the AOJ decision and VA's receipt of the NOD, the Board will not consider it unless it is resubmitted during the 90 days following VA's receipt of the NOD. If evidence is not resubmitted, the appellant is welcome to file a supplemental claim to have this evidence considered. Id.; Cook v. McDonough, 36 Vet. App. 175 (2023). REASONS AND BASES FOR FINDING AND CONCLUSION 1. Entitlement to special monthly compensation (SMC) under 38 U.S.C. § 1114(s) based on statutory housebound criteria (SMC housebound) The Veteran contends that her symptoms due to her PTSD are so severe that they prevented her from maintaining substantially gainful employment without consideration of her other service connected disabilities, and that she would be entitled to a TDIU based solely based on her impairment due to PTSD. See August 2024 VA Form 10182, Notice of Disagreement. She also claims that she would be entitled to an award of SMC(s) based on statutory housebound criteria. Id. Under 38 U.S.C. § 1114(s), SMC is payable at the housebound rate where the Veteran has a single service-connected disability rated as 100-percent disabling and, in addition, (1) has a 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. See 38 C.F.R. § 3.350(i). Permanently housebound means the Veteran is substantially confined, as a direct result of service-connected disabilities, to his dwelling or the immediate premises (or, if institutionalized, to the ward or clinical areas), and it is reasonably certain that the disabilities and resultant confinement will continue throughout his lifetime. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). 38 C.F.R. § 3.350(i) permits a TDIU rating based on a single disability to satisfy the statutory requirement of the 100 percent rating. Bradley v. Peake, 22 Vet. App. 280 (2008); see also Buie v. Shinseki, 24 Vet. App. 242, 249-250 (2011). On and after February 18, 2013, the Veteran was service connected for PTSD, rated at 70 percent, effective February 18, 2013; headaches, rated 50 percent, effective February 18, 2013, dermatitis, rated 30 percent, effective February 18, 2013, a right knee strain, rated 10 percent, effective February 18, 2013, and rated 20 percent, effective June 14, 2021, and tinnitus, rated 10 percent, effective February 18, 2013. On and after February 18, 2013, the Veteran had a combined evaluation of 90 percent. The Veteran appeals a decision which awarded a TDIU based on all of her service-connected disabilities on and after February 18, 2013. In her June 2021 application for a TDIU, the Veteran indicated that all of her service-connected conditions prevented her from maintaining employment. See June 2021 Application for Increased Compensation based on Unemployability. During an August 2021 VA examination for TDIU based on PTSD, the Veteran reported that she stopped working in 2014 due to her mental health concerns and her non-service-connected lupus diagnosis. See August 2021 VA Examination. In addition, her July 2021 VA examination for TDIU in relation to her migraine condition indicated that she would be unable to perform even sedentary work due to the severity of her migraine symptoms. Finally, her July 2021 VA examination for TDIU in relation to her knee condition indicated that she would be limited to sedentary work due to her knee condition. In a January 2022 decision, the AOJ granted a schedular TDIU after finding that the Veteran's combined symptoms from all of her service-connected disabilities, including her PTSD and migraines, prevented her from maintaining substantially gainful employment. See also August 2023 HLR Decision (Individual unemployability is based on all service connected disabilities). While the Veteran was granted a TDIU based on the combined symptoms due to all her service-connected disabilities, the first question for the Board is whether the Veteran would be entitled to a TDIU based on her service-connected PTSD symptoms alone. As stated above, during an August 2021 VA examination for TDIU based on PTSD, the Veteran reported that she stopped working in 2014 due to her mental health condition and her non-service-connected lupus diagnosis. See August 2021 VA Examination. The examiner stated the Veteran's PTSD caused difficulty in maintaining concentration and focus on work, caused significant difficulty in functioning around other people or as part of a team, had significant sleep disruption causing fatigue at work, panic attacks three times a week, irritability, and hypervigilance. Id. During an August 2021 VA examination for PTSD, the Veteran reported she only slept 4 hours a night, had nightmares, night sweats and panic attacks. The examiner confirmed the diagnosis of PTSD and opined the condition caused occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran's symptoms included depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships and adapting to stressful circumstances. The examiner stated they could not differentiate between the mental health symptoms of her PTSD and Lupus because her Lupus symptoms could be worsened by PTSD creating a cyclical effect between her PTSD and Lupus. Id. In a September 2024 private vocational opinion, J.G. (J.G., MS, CRC) opined that the Veteran was unable to secure and follow substantially gainful employment, including unskilled sedentary employment, due to her symptoms from PTSD. See October 2024 Private Medical Treatment Records. In support of their opinion, J.G. provided an overview of their interview with the Veteran regarding her symptoms, education and employment history, in addition to a detailed review of her medical history and reported symptoms associated with her PTSD noted in her VA examinations and medical treatment records. They explained that utilizing the Dictionary of Occupational Titles (DOT), a resource developed by the U.S. Department of Labor to classify and identify the physical demands of various occupations in the national economy, they were able to determine the likely required skills necessary for the Veteran to sustain competitive employment at any exertional or skill level, to include sedentary unskilled work. J.G. then provided a detailed analysis of the specific skills the Veteran would need to perform while considering the Veteran's specific symptoms and mental and physical limitations associated with her PTSD. They concluded that based on the medical and lay evidence available, the Veteran was unable to satisfy the basic requirements to maintain employment specifically due to her PTSD. Id. The Board finds the evidence of record supports that the Veteran's symptoms due to her PTSD alone prohibited her from obtaining and maintaining employment. The Veteran was rated at 70 percent for her PTSD effective February 18, 2013. During her August 2021 VA examination for PTSD, she reported symptoms including depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships and adapting to stressful circumstances. The VA examiner opined the condition caused occupational and social impairment with deficiencies in most areas. In addition, they explained that her mental health symptoms due to her PTSD could cause her non-service-connected Lupus symptoms to worsen, creating a cyclical effect between the conditions and therefore prevented the examiner from differentiating between the symptoms. Id. The Board acknowledges that during an August 2021 VA examination for a TDIU, the Veteran reported that she stopped working in 2014 due to both her mental health concerns and her non-service-connected Lupus diagnosis. See August 2021 VA Examination. However, as the August 2021 examiner stated they were unable to differentiate between the impact of her mental health symptoms associated with her PTSD and the mental health symptoms associated with Lupus, the Board will resolve any doubt in the Veteran's favor and attribute all such impairment found to her service-connected PTSD. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). In discussing her difficulties with employment, the August 2021 examiner stated the Veteran's PTSD caused difficulty in maintaining concentration and focus on work, caused significant difficulty in functioning around other people or as part of a team, had significant sleep disruption causing fatigue at work, panic attacks three times a week, irritability, and hypervigilance. Id. Finally, in the September 2024 private vocational opinion, J.G. opined that the Veteran was unable to secure and follow substantially gainful employment, including unskilled sedentary employment, due to her symptoms from PTSD. See October 2024 Private Medical Treatment Records. As discussed above, J.G. provided a thorough analysis of the specific skills the Veteran would need to perform for employment while considering the Veteran's specific symptoms and mental and physical limitations associated with her PTSD. They concluded that based on the medical and lay evidence available, the Veteran was unable to satisfy the basic requirements to maintain employment specifically due to her PTSD. Id. The Board finds the evidence of record demonstrates persuasively that on and after February 18, 2013, the Veteran was precluded from securing and maintaining substantially gainful employment due to her service-connected PTSD. Therefore, for the period of appeal, the Veteran has a single service-connected disability rated as 100-percent disabling. 38 C.F.R. § 3.350(i); Bradley, 22 Vet. App. 280; see also Buie, 24 Vet. App. 249. The second question for the Board is whether the Veteran's remaining service connected disabilities are independently ratable at 60 percent, and separate and distinct from the 100 percent service-connected PTSD. On February 18, 2013, the Veteran was service connected for headaches, rated at 50 percent, dermatitis, rated at 30 percent, a right knee strain, rated at 10 percent, and tinnitus, rated 10 percent. Based on these disabilities, on and after February 18, 2013, the Veteran had a combined evaluation of 72 percent. See August 2023 Rating Codesheet. The Veteran's PTSD is rated under diagnostic code (DC) 9411 in accordance with 38 C.F.R. §§ 4.130 for mental disorders. The Veteran's headaches are separately rated under DC 8100 as a neurological condition, her dermatitis is rated under DC 7806 as a skin condition, her knee condition is rated under DC 5261 as a musculoskeletal condition, and her tinnitus is rated under DC 6260 as an ear condition. See 38 C.F.R. §§ 4.71(a), 4.87(a), 4.118, 4.124(a). Therefore, the Board finds her remaining disabilities involve different anatomical segments or bodily systems. The Board finds the Veteran has a single service-connected disability rated at 100-percent disabling and additional service-connected disabilities independently ratable at 60 percent as required for SMC at the housebound rate. As such, the basic criterion for entitlement to SMC pursuant to 38 U.S.C. § 1114(s) are met. Accordingly, after resolving all doubt in favor of the Veteran, the Board concludes that the evidence supports entitlement to SMC at the housebound rate under 38 U.S.C. § 1114(s), is warranted and the claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. J. B. FREEMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Aubee, 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.