Citation Nr: 25005661 Decision Date: 04/25/25 Archive Date: 04/25/25 DOCKET NO. 19-32 988 DATE: April 25, 2025 ORDER From February 24, 2016, to November 5, 2018, entitlement to a 70 percent rating, but not higher, for posttraumatic stress disorder (PTSD) with alcohol use disorder, is granted. From November 6, 2018, to March 23, 2025, entitlement to a rating in excess of 50 percent for PTSD in partial or complete remission is denied. From March 24, 2025, entitlement to a 100 percent rating for PTSD is granted. From February 24, 2016, to March 23, 2025, entitlement to a total disability rating based on individual unemployability (TDIU) is granted. From March 24, 2025, but not earlier, entitlement to special monthly compensation at the housebound rate (SMC) is granted. The issue of further entitlement to a TDIU during the appeal period is dismissed. From February 24, 2016, basic eligibility for Dependents' Educational Assistance (DEA) is granted. FINDINGS OF FACT 1. From February 24, 2016, to November 5, 2018, the severity, frequency, and duration of the Veteran's symptoms of PTSD with alcohol use disorder did not more closely approximate total occupational and social impairment. 2. From November 6, 2018, to March 23, 2025, the severity, frequency, and duration of symptoms associated with the Veteran's PTSD in partial or complete remission (as distinguished from alcohol use disorder) did not more closely approximate occupational and social impairment with deficiencies in most areas. 3. From March 24, 2025, the Veteran's PTSD symptoms more closely approximated total occupational and social impairment. 4. From February 24, 2016, to March 23, 2025, the combined physical and mental effects of the Veteran's service-connected disabilities precluded substantially gainful employment. 5. From March 24, 2025, but not earlier, the Veteran had a single service-connected disability rated at 100 percent (i.e., PTSD) and additional service connected disabilities rated at least 60 percent (i.e., musculoskeletal and dermatological residuals of gunshot and punji wounds), which were anatomically separate and distinct from his PTSD. 6. From March 24, 2025, the Veteran has been granted a 100 percent rating for PTSD and entitlement to SMC at the housebound rate. Prior to that, he did not have a permanent and total rating based on a single service-connected disability. 7. From February 24, 2016, the entire period on appeal, the Veteran, who was honorably discharged from service, has had a permanent and total disability rating. CONCLUSIONS OF LAW 1. From February 24, 2016, to November 5, 2018, the criteria for a disability rating in excess of 70 percent for PTSD with alcohol use disorder were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.20, 4.126, 4.130, Diagnostic Code (DC) 9499-9411. 2. From November 6, 2018, to March 23, 2025, the criteria for a disability rating in excess of 50 percent for PTSD in complete or partial remission were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, DC 9411. 3. From March 24, 2025, the criteria for a 100 percent rating for PTSD were met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, DC 9411. 4. From February 24, 2016, to March 23, 2025, the criteria for a grant of a TDIU were met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. 5. From March 24, 2025, but not earlier, the criteria for SMC based on one service-connected disability rated as total and additional service-connected disability independently ratable at 60 percent or more were met. 38 U.S.C. §§ 1114(s), 5107; 38 C.F.R. §§ 3.102, 3.350. 6. From March 24, 2025, a claim of entitlement to a TDIU is dismissed as moot. 38 U.S.C. §§ 1155, 5107, 7105; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 19.22. 7. From February 24, 2016, criteria for basic eligibility for DEA were met. 38?U.S.C. §§?3501, 3510, 5113;?38?C.F.R. §§?3.807, 21.3021. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Army from October 1966 to November 1968. His awards and decorations include the Bronze Star Medal, Purple Heart (2), Combat Infantryman Badge, Parachutist Badge, Vietnam Service Medal, Armed Forces Expeditionary Medal, Vietnam Campaign Medal, National Defense Service Medal, Sharpshooter Marksmanship Qualification Badge (M-14), and Overseas Service Bar. These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2017 rating decision issued by the Agency of Original Jurisdiction (AOJ), a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the AOJ issued a decision that increased the Veteran's PTSD rating to 50 percent, effective November 6, 2018. However, because higher ratings are still available, the issues herein remain properly before the Board. A.B. v. Brown, 6 Vet. App. 35, 38 (1993). The Veteran attended a Board hearing in June 2022. However, part of the written transcript of the hearing was unavailable due to technical issues. Consequently, the Board requested clarification as to whether the Veteran wanted another hearing. In March 2023, he indicated that he did not. The case was before the Board in March and May 2023, when it was remanded for further development. The matter has since returned and the Board finds substantial compliance with its directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only "substantial" rather than strict or exact compliance with the Board's remand directives is required under Stegall); accord Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Most recently, the Board issued an April 2024 decision, which denied the claim in its entirety. The Veteran then appealed the denial to the United States Court of Appeals for Veterans Claims (Court). Pursuant to a January 2025 Joint Motion for Remand (JMR), the Court vacated the April 2024 Board decision and remanded the matter for further action consistent with the terms of the JMR. Increased Ratings Generally, disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a question as to which of two evaluations apply, assigning a higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person's ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). It is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified; findings sufficiently characteristic to identify the disease and the disability there from are sufficient; and above all, a coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. In general, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, when the current appeal arises from the initially assigned rating, consideration must be given as to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999). Moreover, staged ratings are appropriate in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505 (2007). Benefit of the Doubt VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 3.102. In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each, and every piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). That is to say that where the Board is silent as to a specific piece of evidence it must be presumed "that the Board considered this evidence and found it too scant to warrant comment." See Robinson v. Peake, 21 Vet. App. 545, 555 (2008). The Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to them. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). A. Entitlement to an increased rating for PTSD from February 24, 2017 The Veteran maintains that he is entitled to at least a 70 percent rating for PTSD during the entire period on appeal. See April 2025 Appellate Brief. The Veteran's increased rating claim for PTSD was received on February 24, 2017, as part of his claim for a TDIU. Consequently, the appeal period before the Board begins on February 24, 2016, the date VA received the increased rating claim, which includes the one-year look-back period. See Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). The issues on appeal are whether the Veteran is entitled to a rating for PTSD (1) in excess of 30 percent prior to November 6, 2018; (2) in excess of 50 percent from November 6, 2018, to March 23, 2025; and (3) in excess of 70 percent from March 24, 2025. Legal Criteria Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. 38 C.F.R. § 4.130, General Formula. A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. Id. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). Id. A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. Id. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Id. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. Id. 1. From February 24, 2016, to November 5, 2018, entitlement to a 70 percent rating, but not higher, for PTSD with alcohol use disorder, is granted. The first issue is whether the Veteran's associated PTSD symptoms caused the level of impairment required for a disability rating of 50 percent or more prior to November 6, 2018. Prior to November 6, 2018, the Board concludes that the Veteran's symptoms did not cause the impairment level required for a 100 percent rating. During that time, his symptoms more closely approximated those associated with a 70 percent rating and resulted in a level of impairment most closely approximate to the same. The March 2017 VA examination and contemporaneous evidence reflect that the Veteran's PTSD was manifested by symptoms including persistent irritability, chronic sleep disturbance, impaired concentration, hypervigilance, and unprovoked angry outbursts. Notably, he reported involvement in a physical altercation as recently as the summer of 2016. These symptoms are consistent with impaired impulse control and difficulty adapting to stressful circumstances. He also reported recurrent distressing memories, physiological reactivity, and a pattern of social withdrawal. Aside from that, the Veteran estimated 4 to 6 hours of broken sleep per night. Although the Veteran was voluntarily laid off in 2009, he reported that he enjoyed working in the steel industry and expressed a readiness to return to work. However, he also acknowledged turning down a subsequent desk job due to an inability to tolerate interpersonal interactions, which he attributed to PTSD. The March 2017 VA examiner diagnosed both PTSD and alcohol use disorder but did not distinguish between the effects of each. When it is not possible to distinguish the effects of a service-connected mental disorder (here, PTSD) from a non-service-connected disorder (here, alcohol use disorder) VA must attribute all symptoms to the service-connected condition. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). Therefore, the Board attributes all of the Veteran's psychiatric symptoms to his service connected PTSD for rating purposes during the relevant period. While the Veteran experienced symptoms consistent with significant occupational and social impairment, the record does not demonstrate total impairment. He was oriented, communicative, maintained hygiene, and did not report suicidal or homicidal ideation. He retained the ability to perform activities of daily living independently, and there was no evidence of gross impairment in thought processes, persistent delusions or hallucinations, disorientation, or memory loss for names of close relatives or his own occupation. See March 2017 VA Examination. Accordingly, the Board concludes that the Veteran's PTSD symptoms more nearly approximated the criteria for a 70 percent rating, which reflected deficiencies in most areas, but did not result in total occupational and social impairment during the applicable period. Prior to November 6, 2018, the criteria for a 100 percent rating were not met. In relevant part, the appeal for a higher rating must be denied. 2. From November 6, 2018, to March 23, 2025, entitlement to a rating in excess of 50 percent for PTSD in partial or complete remission is denied. The next issue is whether the Veteran's associated PTSD symptoms caused the level of impairment required for a disability rating of 70 percent or higher from November 6, 2018, to March 23, 2025. The Board concludes that they did not. From November 6, 2018, to March 23, 2025, the Board concludes that the Veteran's symptoms did not cause the level of impairment required for a 70 percent rating or higher. During that time, his symptoms more closely approximated those associated with a 50 percent rating, and resulted in a level of impairment most closely approximate to the same. The November 2018 VA examination showed where the Veterans PTSD, as distinguished from alcohol use disorder, was in partial remission. He denied suicidal or homicidal ideation, appeared cooperative and talkative, and was noted to be circumstantial but not disorganized and thought. The examiner acknowledged chronic sleep impairment, fear of the unknown, and mild anxiety, but the Veteran denied significant worry. The record reflected that the Veteran continued to live alone, managed his daily routine, and engaged in outdoor activities such as yardwork. See November 2018 VA Examination. Although the Veteran described difficulty dealing with people and a refusal to accept a sedentary job that involved interpersonal contact, these symptoms were not accompanied by consistent reports of impaired impulse control, suicidal ideation, or near continuous panic. VA treatment records through April 2023 show a stable mood, orientation to time and place, and the absence of delusions or hallucinations. In his April 2023 statement, he asserted that his PTSD symptoms had remained unchanged since his original claim, but this assertion is inconsistent with treatment records and examinations, which documented remission and limited functional interference during this period. At the January 2024 VA examination, the Veteran reported continued sleep disturbances and frustration but denied depression or anxiety. He attributed his unemployability to physical limitations, not psychiatric symptoms. Significantly, the examiner concluded that the Veteran no longer met full diagnostic criteria for PTSD and found that his symptoms did not interfere with occupational or social functioning. Ratings on account of diseases subject to temporary or episodic improvement, e.g., manic depressive or other psychotic reaction, epilepsy, psychoneurotic reaction, arteriosclerotic heart disease, bronchial asthma, gastric or duodenal ulcer, many skin diseases, etc., [here, PTSD] will not be reduced on any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. 38 C.F.R. § 3.344(a). Though material improvement in the physical or mental condition is clearly reflected the rating agency will consider whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life. Id. Although material improvement in the Veteran's PTSD symptoms was clearly shown during the January 2024 VA examination, the Board concludes that sustained improvement was not shown under the ordinary conditions of life and work from November 6, 2018, to March 23, 2025. In other words, the evidence clearly did not reflect deficiencies in most areas such as judgment, thinking, mood, work, or family relations. While his PTSD was temporarily in partial or complete remission, resolving reasonable doubt in the Veteran's favor, the Board approximates that his symptoms resulted in reduced reliability and productivity during the relevant period. That is to say that the severity, frequency, and duration of the Veteran's symptoms at that time more nearly approximated a 50 percent rating, and not higher. Accordingly, from November 6, 2018, to March 23, 2025, entitlement to a rating in excess of 50 percent for PTSD is denied. 3. From March 24, 2025, entitlement to a 100 percent rating for PTSD is granted. The issue becomes whether the Veteran's PTSD symptoms caused the level of impairment required for a disability rating of 100 percent from March 24, 2025. The Board concludes that they did. From March 24, 2025, the severity, frequency, and duration of the Veteran's PTSD symptoms caused the level of impairment required for a 100 percent rating. VA treatment records, a VA examination (conducted March 24, 2025), and the Veterans lay statements, show where his PTSD manifested by symptoms associated with a 100 percent rating, to include unprovoked irritability, significant cognitive and sleep impairment, persistent negative beliefs about himself in the world, a history of angry outbursts, and complete social withdrawal. The examiner stated that the Veteran's symptoms resulted in total occupational and social impairment and attributed those symptoms exclusively to PTSD. These symptoms more nearly approximated total social and occupational impairment because they caused the Veteran to live in isolation, to depend on others for transportation, and to avoid engagement with others due to persistent psychological distress. See March 2025 VA Examination. As the most probative evidence of record showed total occupational and social impairment beginning March 24, 2025, the Board concludes that the maximum 100 percent rating for PTSD is warranted from that date. In relevant part, the full benefit sought on appeal is hereby granted. B. From February 24, 2016, to March 23, 2025, entitlement to a TDIU is granted. The Veteran seeks a TDIU and contends that his service-connected PTSD and orthopedic disabilities render him unemployable. Specifically, he asserts that he has not worked since 2009 due to chronic right thigh pain and PTSD symptoms. A TDIU may be assigned, where the schedular rating is less than total, where a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). To qualify for schedular consideration of a TDIU, if there is only one such disability, this disability shall be ratable at 60 percent or more, and, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. Id. For the purposes 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, 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. See 38 C.F.R. § 4.16(a); see also Moody v. Wilkie, 30 Vet. App. 329, 339 (2018) (combining disabilities as "one disability" to meet the rating threshold of § 4.16(a) requires the use of the combined rating table). The Veteran has the following disabilities that are service connected: PTSD (rated 70 percent, from February 24, 2016, to November 5, 2018; 50 percent from November 6, 2018, to March 23, 2025; and 100 percent thereafter); residuals of a gunshot wound of the right thigh (rated 50 percent from November 17, 1969); residuals of adenocarcinoma of the prostate, s/p EBRT (rated 20 percent from November 1, 2014); residuals of punji wound, through and through, with damage to muscle group XI, left leg (rated 10 percent from November 17, 1969); painful scars of the left leg and right lower extremity (rated 10 percent from February 24, 2017); residuals of shell fragment wound, right scapula (rated 0 percent from November 17, 1969); ED (rated 0 percent from December 16, 2013); scars from gunshot wound of right lower extremity (rated 0 percent from February 24, 2017); and scars from punji wound on left leg (rated 0 percent from February 24, 2017). Notably, the Veteran's service-connected disabilities all share a common etiology. That is to say that they are all tied to his combat experience during service in the Republic of Vietnam. Prior to March 24, 2025, the Veteran's combined rating remained at 90 percent. From February 24, 2016, to November 5, 2018, he had one disability rated 60 percent or more. From November 6, 2018, to March 23, 2025, he had at least one disability rated at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. Therefore, the Board may consider the claim for a TDIU on a schedular basis. 38 C.F.R. § 4.16(a). The Board concludes that a TDIU is warranted from February 24, 2016, to March 23, 2025. The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component refers to 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. Id. The noneconomic component requires a determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to the veteran's history, education, skills, and training; whether the veteran has the physical ability (both exertional and non-exertional) to perform the types of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Id. An award of TDIU is an individualized determination, specific to a veteran's particular circumstances, e.g., their history, education, skills, and training. See Todd v. McDonald, 27 Vet. App. 79, 85 (2014). It does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether they are capable of performing the physical and mental acts required by employment, not whether they can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). With respect to the economic component in Ray, the Board notes that the Veteran has not worked since 2009. With respect to the noneconomic component in Ray, the evidence indicates that the Veteran's service-connected disabilities impacted his ability to perform the duties of his previous occupation in steel fabrication or any occupational task. The Veteran's ability to secure and follow a substantially gainful occupation was impacted by the mental effects of his PTSD. He had a two-year college degree and work experience in steel fabrication. He voluntarily accepted a layoff in 2009 and declined a subsequent sedentary position. He explained that he could not tolerate the interpersonal stress of working around people due to PTSD symptoms. See March 2017 VA Examination. The March 2017 VA examiner noted symptoms, to include impaired impulse control, unprovoked irritability with periods of violence, sleep impairment, and hypervigilance. Id. The Board finds these symptoms consistent with impaired occupational reliability and the inability to function in an interpersonal or structured work environment. The Veteran's ability to secure and follow a substantially gainful occupation was also impacted by the physical effects of his service-connected musculoskeletal disabilities. See November 2018 VA Examination; July 2019 VA Treatment Records. He consistently reported chronic right leg pain, swelling, antalgic gait, and use of a prosthetic lift shoe. Muscle strength testing showed reduced function in the right hip and knee. He also used a rollator and was evaluated for a motorized scooter in 2019, which he ultimately received due to significant mobility deficits. He experienced difficulty walking more than 300 feet and required a modified shoe and vehicle accommodations to address leg length discrepancy and pain. In sum, during the applicable period, the Board finds that the combined physical and mental impairments caused by his service-connected disabilities precluded him from the ability to secure and follow a substantially gainful occupation consistent with his education, skills, training, and work history. Accordingly, from February 24, 2016, to March 23, 2025, entitlement to a TDIU is granted. 1. From March 24, 2025, but not earlier, entitlement to SMC is granted. 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. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). The Veteran is in receipt of a 100 percent disability rating for PTSD from March 24, 2025, as a result of this decision. As noted in the section above, he is also in receipt of other disability ratings which combine to 60 percent or more (i.e., residuals of a gunshot wound of the right thigh rated 50 percent; residuals of adenocarcinoma of the prostate rated 20 percent; residuals of punji wound, through and through, with damage to muscle group XI, left leg rated 10 percent; and painful scars of the left leg and right lower extremity rated 10 percent). As such, he is entitled to SMC at the statutory housebound rate from March 24, 2025. See 38 U.S.C. § 1114(s). Therefore, from March 24, 2025, entitlement to SMC is granted. 2. The issue of further entitlement to a TDIU during the appeal period is dismissed. The Court has recognized that a 100 percent rating under the Schedule for Rating Disabilities means that a Veteran is totally disabled. Holland v. Brown, 6 Vet. App. 443, 446 (1994). Thus, if VA has found a Veteran to be totally disabled as a result of a particular service-connected disability or combination of disabilities pursuant to the rating schedule, there is no need, and no authority, to otherwise rate that Veteran totally disabled on any other basis. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001). However, the grant of a 100 percent disability rating does not always render the issue of TDIU moot. VA's duty to maximize a claimant's benefits includes consideration of whether his disabilities establish entitlement to SMC under 38 U.S.C. § 1114. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). Specifically, SMC may be warranted if the Veteran has a 100 percent disability rating for a single disability, and VA finds that TDIU is warranted based solely on the disabilities other than the disability that is rated at 100 percent. See Bradley, 22 Vet. App. 280. Here, the Veteran is now in receipt of a 100 percent rating for PTSD, together with SMC, from March 24, 2025. As a result, the issue of entitlement to TDIU from March 24, 2025, is moot and must be dismissed. Additionally, the Board finds that, prior to March 24, 2025, TDIU is not warranted based solely on any disability other than the disability that is rated at 100 percent (i.e., PTSD). See Bradley, 22 Vet. App. 280; see also 75 Fed. Reg. 11,229-04 (March 10, 2010). In light of Buie and Bradley, and VA's obligation to maximize the Veteran's benefits, the Board has considered whether the Veteran met the criteria for TDIU based solely on the impact of any of his service-connected disabilities other than PTSD prior to March 24, 2025. However, neither the Veteran nor the evidentiary record suggested that any of his remaining disabilities alone would render him unemployable. Thus, the 100 percent schedular rating for PTSD in this case also moots any claimed entitlement to TDIU prior to March 24, 2025. 3. From February 24, 2016, basic eligibility for DEA is granted. For the purposes of educational assistance for dependents under 38 U.S.C. Chapter 35, the child or surviving spouse of a veteran will have basic eligibility if the following conditions are met: (1) the veteran was discharged from service under conditions other than dishonorable, or died in service; and (2) the veteran has a permanent total service-connected disability; or (3) a permanent total service connected disability was in existence at the date of the veteran's death; or (4) the veteran died as a result of a service-connected disability. 38 U.S.C. §§ 3501, 3510; 38 C.F.R. §§ 3.807 (a), 21.3021. Here, the Veteran was honorably discharged from service. For the entire period on appeal, he has had a permanent and total disability rating. See Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). Therefore, from February 24, 2016, entitlement to eligibility to DEA is warranted. Cory M. Picton Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Skinner 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.