Citation Nr: A25035886 Decision Date: 04/18/25 Archive Date: 04/18/25 DOCKET NO. 241212-497544 DATE: April 18, 2025 ORDER Entitlement to a 100 percent rating for anxiety reaction with depressive features (anxiety disorder) from September 4, 1974, is granted. Entitlement to special monthly compensation (SMC) under 38 U.S.C. 1114(s) is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to May 20, 2011, having been rendered moot, is dismissed. FINDINGS OF FACT 1. Resolving any reasonable doubt in the Veteran's favor, for the entire period on appeal his anxiety disorder has resulted in symptoms that most closely approximate total occupational and social impairment. 2. From September 4, 1974, the Veteran's anxiety disorder is rated 100 percent and his fragment wounds of the right scapula and arm, right buttock, left thigh, and posterior neck, rated as a single disability, is rated as 60 percent, qualifying him for SMC at the housebound rate. 3. As a 100 percent ("total") schedular rating for the Veteran's service-connected anxiety disorder is awarded for the entire rating period on appeal based on a finding of total occupational and social impairment, leaving no rating period under appeal where the schedular rating is "less than total," the issue of entitlement to a TDIU is rendered moot for the entire rating period. CONCLUSIONS OF LAW 1. The criteria for a 100 percent rating for anxiety disorder from September 4, 1974, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.2500, 4.1, 4.3, 4.7, 4.126, 4.129, 4.130, 4.132, Diagnostic Code (DC) 9400. 2. For the period beginning September 4, 1974, the criteria for SMC pursuant to 38 U.S.C. § 1114(s)(1) are met. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). 3. For the entire period on appeal, entitlement to a TDIU is rendered moot. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 4.15, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1966 to December 1968, to include service in the Republic of Vietnam. This appeal comes before the Board of Veterans' Appeals (Board) on appeal of a July 2024 supplemental claim rating decision by a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). In December 2024, the Veteran filed a timely VA Form 10182 Decision Review Request, Board Appeal, Notice of Disagreement, under the Appeals Modernization Act (AMA), and selected evidence submission. The Board notes the Veteran has the right to select a different Board review option by submitting a new VA Form 10182 within one year from the date the AOJ mailed the decision on appeal, or within 60 days of the date the Board received the VA Form 10182, whichever date is later. 38 C.F.R. § 20.202(c)(2); see Williams v. McDonough, 37 Vet. App. 305 (2024). Although the period to change dockets per 38 C.F.R. § 20.202(c)(2) has not elapsed, the Veteran, through his authorized representative, explicitly waived his right to select a different Board review option and requested that a decision be expedited on the claim. See VA Form 10182, December 2024. As such, there is no prejudice to the Veteran in proceeding to adjudicate the appeal. Under the AMA Evidence Submission docket, the Board may only consider the evidence of record at the time of the AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. The Board cannot consider (1) evidence submitted during the period after the AOJ issued the decision on appeal and before the VA Form 10182 was received, or (2) evidence submitted more than 90 days after the VA Form 10182 was received. 38 C.F.R. § 20.303. If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision on the claim. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, the Veteran may file a supplemental claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision. The Board notes that any favorable findings made by an AOJ or any other prior VA adjudicator, is binding on the Board. The July 2024 supplemental claim rating decision did not specifically address whether new and relevant evidence had been received to readjudicate the claim. However, as the AOJ took up the merits of the issues, the Board infers that the AOJ made favorable findings that new and relevant evidence was indeed submitted. Therefore, the Board will not address the issue of new and relevant evidence to readjudicate the claims, as it is acknowledged that favorable findings of sufficient new and relevant evidence is of record to proceed to the merits of the issues. This appeal has been advanced on the docket pursuant to 38 U.S.C. § 7107(b); 38 C.F.R. § 20.902(c). Increased Rating Entitlement to a 100 percent rating for anxiety disorder from September 4, 1974 Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. This appeal has an extensive procedural history that has been exhaustively described in previous Board decisions. Most pertinent to the matters currently before the Board is that a September 2022 Board decision determined that the Veteran's September 4, 1974, claim for an increased rating for his anxiety disorder remained pending before the Board. The Board did not adjudicate the issue but remanded the issue of entitlement to an earlier effective date prior to February 12, 1996, for the award of an increased rating for the anxiety disorder, with consideration of the open and pending status of the September 4, 1974, claim that led to the remanded appeal. In November 2022, the AOJ issued a supplemental statement of the case denying an earlier effective date prior to February 12, 1996, for the award of an increased rating for the anxiety disorder and denying an earlier effective date for the grant of a TDIU prior to May 20, 2011. The appeal returned to the Board, and in December 2022 the Board remanded the appeal to the AOJ for further development. The AOJ issued a supplemental statement of the case in December 2022. The appeal returned to the Board, and in June 2023 the Board remanded the appeal for further development. In February 2024, the AOJ issued a supplemental statement of the case continuing a 30 percent rating from September 4, 1974, to February 12, 1996, for anxiety disorder, a 50 percent rating for anxiety disorder from February 12, 1996 to May 20, 2011, and a TDIU from May 20, 2011. In March 2024, the Veteran submitted a request for higher level review. In March 2024, the AOJ identified a duty to assist error and moved the appeal to supplemental claim review. In July 2024, the AOJ issued a supplemental claim rating decision, and the Veteran submitted the appeal presently before the Board in December 2024, as noted above. Under AMA, if a claimant continues to request an available review option within one year of each prior decision on an issue, the claimant can preserve the effective date associated with the initial claim. In order to use supplemental claims to continuously pursue review of an issue and thereby protect the earliest possible effective date in the event of an award of benefits, the supplemental claims must be filed within one year of notification of the last AOJ or Board decision. See 38 C.F.R. § 3.2500(h). In this case, the Veteran has continued to pursue his claim for an increased rating for his anxiety disorder since submission of his increased rating claim on September 4, 1974. Therefore, the period on appeal is from September 4, 1974, the date of receipt of the claim for an increased rating for anxiety disorder, to May 20, 2011, the date on which entitlement to a 100 percent rating for anxiety disorder, a TDIU, and SMC were granted. The Board notes the criteria for rating mental disabilities were revised several times since the Veteran was service connected for his anxiety disorder in December 1968. Veterans are entitled to a rating under the revised criteria from their effective dates. The Board may not apply a regulation prior to its effective date unless the regulation explicitly provides otherwise. See VBA Fast Letter 8-36 (October 24, 2008); VAOPGCPREC 7-2003 (Nov. 19, 2003); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003) (overruling Karnas v. Derwinski, 1 Vet. App. 308 (1991) to the extent it conflicts with the precedents of the United States Supreme Court and the Federal Circuit). However, this rule does not prohibit the Board from applying the earlier criteria to the period on or after the effective dates of the new rating criteria if the prior versions were in effect during the pendency of the appeal, as is the case here. Therefore, the Board may evaluate the Veteran's anxiety disorder under the earlier DCs and the current DCs, as of their effective dates, to determine which version would afford the highest rating. Under the law and regulations in effect at the time of the Veteran's September 1974 increased rating claim, disability ratings were determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The Veteran's diagnosed anxiety disorder was rated under 38 C.F.R. § 4.132, DC 9400 (1961 & 1968), under the General Rating Formula for Psychoneurotic Disorders, as follows: A noncompensable (0 percent) rating was assigned for neurotic symptoms that may somewhat adversely affect relationships with others, but which did not cause impairment of working ability. A 10 percent rating was assigned for criteria which were less than the criteria for the 30 percent rating, with emotional tension or other evidence of anxiety productive of moderate social and industrial impairment. A 30 percent rating was assigned for definite impairment in the ability to establish or maintain effective or favorable relationships with people. The psychoneurotic symptoms would result in such a reduction in initiative, flexibility, efficiency, and reliability levels as to produce considerable industrial impairment. A 50 percent disability rating was assigned where the evidence showed that the ability to establish or maintain effective or favorable relationships with people was substantially impaired. By reason of psychoneurotic symptoms, the reliability, flexibility and efficiency levels were so reduced as to result in severe industrial impairment. A 70 percent disability rating was assigned when the ability to establish and maintain effective or favorable relationships with people was seriously impaired. The psychoneurotic symptoms were of such severity and persistence that there was pronounced impairment in the ability to obtain or retain employment. A 100 percent disability rating was assigned when the attitudes of all contacts except the most intimate were so adversely affected as to result in virtual isolation in the community; when the individual had totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality, with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic and explosions of aggressive energy resulting in profound retreat from mature behavior. Demonstrably unable to obtain or retain employment. Note 1 to the General Rating Formula for Psychoneurotic Disorders provided that "[s]ocial impairment per se will not be used as the sole basis for any specific percentage evaluation, but is of value only in substantiating the degree of disability based on all of the findings." Id. at Note 1. 38 C.F.R. § 4.129 also provided: Social integration is one of the best evidences of mental health and reflects the ability to establish (together with the desire to establish) healthy and effective interpersonal relationships. Poor contact with other human beings may be an index of emotional illness. However, in revaluating impairment resulting from the ratable psychiatric disorders, social inadaptability is to be evaluated only as it affects industrial adaptability. The principle of social and industrial inadaptability as the basic criterion for rating disability from the mental disorders contemplates those abnormalities of conduct, judgment, and emotional reactions which affect economic adjustment, i.e., which produce impairment of earning capacity. Effective February 3, 1988, and November 7, 1996, VA amended the rating criteria for mental health disorders, with more significant amendments in 1996, along with renumbering the regulation as 38 C.F.R. § 4.130. The criteria from the November 1996 General Rating Formula for Mental Disorders are currently in effect. See 61 Fed. Reg. 52695 (October 8, 1996) (amending the sections of the VA schedule for rating mental disorders); see also 38 C.F.R. § 4.130 (General Rating Formula for Mental Disorders). As such, the Veteran's claim must be considered under all of the rating amendments during the period on appeal. Effective February 3, 1988, the General Rating Formula for Psychoneurotic Disorders was revised, in applicable part, as follows: A 0 percent rating was warranted where there are neurotic symptoms which may somewhat adversely affect relationships with others but do not cause impairment of working ability. A 10 percent rating was warranted where there was evidence of anxiety productive of mild [revised from "moderate"] social and industrial impairment. A 30 percent was warranted for definite impairment in the ability to establish or maintain effective and wholesome relationships with people. The psychoneurotic symptoms result in such reduction in initiative, flexibility, efficiency and reliability levels as to produce definite [revised from "considerable"] industrial impairment. A 50 percent was warranted for ability to establish or maintain effective or favorable relationships with people is considerably [revised from "substantially"] impaired. By reason of psychoneurotic symptoms, the reliability, flexibility and efficiency levels are so reduced as to result in considerable [revised from "severe"] industrial impairment. A 70 percent rating was assigned where ability to establish and maintain effective or favorable relationships with people is severely [revised from "seriously"] impaired. The psychoneurotic symptoms are of such severity and persistence that there is severe [revised from "pronounced"] impairment in the ability to obtain or retain employment. A 100 percent rating was assigned where the attitudes of all contacts except the most intimate are so adversely affects as to result in virtual isolation in the community. Totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic, and explosions of aggressive energy resulting in profound retreat from mature behavior. Demonstrably unable to obtain or retain employment. 38 C.F.R. § 4.132 (1988). In addition, the version of 38 C.F.R. § 4.129 then in effect provided: social integration is one of the best pieces of evidence of mental health and reflects the ability to establish (together with the desire to establish) healthy and effective interpersonal relationships. Poor contact with other human beings may be an index of emotional illness. However, in revaluating impairment resulting from the ratable psychiatric disorders, social inadaptability is to be evaluated only as it affects industrial adaptability. The principle of social and industrial inadaptability as the basic criterion for rating disability from the mental disorders contemplates those abnormalities of conduct, judgment, and emotional reactions which affect economic adjustment, i.e., which produce impairment of earning capacity. The United States Court of Appeals for Veterans Claims (Court) has held that the rating criteria in effect prior to November 1996 each contain separate, independent clauses, and that a given rating is warranted if the evidence satisfies any one of them. See Johnson v. Brown, 7 Vet. App. 95, 99 (1994); Diorio v. Nicholson, 20 Vet. App. 193, 198 (2006), vacated on other grounds, 216 F. App 974 (Fed. Cir. 2007). Thus, by way of example, the criteria for a 30 percent disability rating that were in effect at the start of the period on appeal would be met if the evidence shows either (1) definite impairment in the ability to establish or maintain effective and wholesome relationships with people, or (2) the Veteran's psychoneurotic symptoms result in such reduction in initiative, flexibility, efficiency and reliability levels as to produce considerable industrial impairment. In addition, the Court has held that the term "definite" in 38 C.F.R. § 4.132 (as then in effect) was qualitative in nature, whereas the other terms, e.g., "considerable" and "severe," were quantitative. Hood v. Brown, 4 Vet. App. 301, 303 (1993). Thereafter, VA's Office of General Counsel issued a precedent opinion concluding that the term "definite," as used in 38 C.F.R. § 4.132 to describe a 30 percent disability rating for purposes of rating claims under the General Rating Formula for Psychoneurotic Disorders, should be construed to mean "distinct, unambiguous, and moderately large in degree," and that the term "considerable" was to be construed as "rather large in extent or degree." VAOPGCPREC 9-93. Effective November 7, 1996, the evaluation criteria for mental disorders substantially changed in that the criteria focused on the individual symptoms as manifested throughout the record, rather than on medical opinions characterizing overall social and industrial impairment as mild, definite, considerable, severe, or total. In this regard, anxiety disorder is evaluated under DC 9400, which provides that such disability is evaluated pursuant to the General Rating Formula for Mental Disorders (General Rating Formula). 38 C.F.R. § 4.130. The General Rating Formula provides 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. A 10 percent rating for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. A 30 percent rating is assigned when there is 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 conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is assigned when there is occupational and social impairment with reduced reliability and productivity due to such symptoms 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; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas such as work, family relations, judgment, thinking, or mood, due to such items as: suicidal ideation; obsessional rituals which interfere with routine activity; speech intermittently illogical, obscure or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances and inability to establish and maintain effective relationships. A 100 percent disability evaluation requires total occupational and social impairment, due to symptoms such as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or name. In addition, the language previously contained in 38 C.F.R. § 4.129 regarding social inadaptability was deleted in its entirety from that section, and replacement language was added as 38 C.F.R. § 4.126(b), which provides that "[w]hen evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment." The post-amended criteria may be applied only prospectively from the effective date of the change forward unless the regulatory change specifically permits retroactive application. 38 U.S.C. § 5110 (g); VAOPGCPREC 7-03; VAOPGCPREC 3-00; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Therefore, the appeal prior to 1996 will be evaluated under the pre-amended criteria. The use of the term "such as" in the general rating formula for mental disorders in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). It is not required to find the presence of all, most, or even some, of the enumerated symptoms recited for particular ratings. Id. The use of the phrase "such symptoms as," followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant's social and work situation. Id. In Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013), the Federal Circuit stated that "a Veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." It was further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." When evaluating an acquired psychiatric disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. The focus of the rating process is on industrial impairment from the service-connected psychiatric disorder, and social impairment is significant only insofar as it affects earning capacity. 38 C.F.R. §§ 4.126, 4.130. The specified factors for each incremental psychiatric rating are not requirements for a particular rating but are examples providing guidance as to the type and degree of severity, or their effects on social and work situations. Analysis should not be limited to whether the symptoms listed in the rating scheme are exhibited; rather, consideration must be given to factors outside the rating criteria in determining the level of occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Under the General Rating 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 January 1975 medical note indicates that the Veteran was hearing voices, had visual hallucinations, and would become aggressive. In May 1975, the Veteran was afforded a VA psychiatric examination. It was noted that he was somewhat cooperative and moderately attentive, quietly seated in a slouched position with his arms crossed on his chest, and breathing deeply. He displayed some theatric gestures. His facial expression was of anger, and psychomotor slightly slow. His behavior was somewhat passive, and he spoke in a low pitched voice. His stream of thought was mildly diminished and verbal productivity was coherent and relevant. He showed symptoms of anxiety and hostility. The Veteran reported that he suffered headaches, nightmares, was ill-humored, uneasy at times, fearful, had weakness, and pains of mortar wounds. He also stated that he did not hear or pay attention to what people say to him. The examiner determined that the Veteran had mild disability. An April 1974 statement from a potential employer reveals that the Veteran was rejected for a job because he was in no condition to perform any useful work due to his physical and mental conditions. A June 1975 medical note demonstrates that the Veteran was disoriented about time, was very irritable, despondent, ill-tempered, prone to lose control of himself, to beat his wife, and to go out and wander away. He had difficulty concentrating and would forget everything. An October 1990 psychiatric report shows that the Veteran was depressed, sad, without energy, had frequent crying spells, high levels of anxiety, little motivation, hardly socialized, and usually remained at home isolated and withdrawn. In January 1991, the Veteran was afforded a VA psychiatric examination. The Veteran was noted to have symptoms of anxiety, chest palpitations, in tranquility, and irritability. He provided vague descriptions of hearing voices and seeing things, which the examiner determined were not true hallucinatory experiences. The Veteran reported that he would wake up agitated and was sometimes unable to go back to sleep. The examiner observed that the Veteran had a rather constricted affect; his mood was tense and apprehensive; he was oriented; his memory and intellect were preserved; his judgement was fair; and his insight was poor. It was determined that his level of functioning was fair to poor. In July 1992, the Veteran was provided another VA psychiatric examination. The Veteran reported that he had episodes of anxiety and would develop a sensation of fatigue when under stress and he would have to go to sleep. He also stated that he had episodes in which he felt like he could not breathe, with a lot of shortness of breath, chest oppression, and episodes of sudden crying. It was noted that sudden noises tended to provoke anxiety and a startle reaction. A March 1995 psychiatric report reveals that the Veteran had psychomotor retardation, lack of energy to do anything, was sad looking, and expressed feelings of worthlessness and hopelessness. It was also noted that he was usually uncommunicative, avoided eye contact, would dwell on his condition, was irritable, and had crying spells. His condition was determined to be severe. In March 1996, the Veteran was provided another VA psychiatric examination. The examiner noted that the Veteran looked somewhat retarded, rather down, and angry underneath. The Veteran underwent another VA psychiatric examination in September 1997. The Veteran reported that he would forget what he was doing, he had to bathe many times a day, and he had to stay home. The Veteran was afforded a VA psychiatric examination in February 2003. The Veteran reported that he would have emotional crises, suffered anxiety, could not sleep, had flashbacks of Vietnam, if he saw helicopters he would think they were coming for him, and he was unable to stand crowded places. An October 2006 psychiatric report indicates that the Veteran had psychomotor retardation and lack of energy to do anything. He continued to be anxious, restless, highly irritable, and did not sleep well. The Veteran expressed feelings of hopelessness and worthlessness. He stated that he was "all the time at home, isolative. I feel anxious, intolerant to noises and crowds. I am having difficulties sleeping at night, I feel angry at everyone..." He complained about chest palpitations and tightness, forgetfulness, neglect of personal hygiene, weight loss, frequent crying spells, and reported hearing voices. In October 2007, the Veteran was afforded a VA psychiatric examination. His symptoms included depression, anxiety, trouble sleeping, social withdrawal, hearing voices, and fear. In January 2008, the Veteran was afforded another VA psychiatric examination. The Veteran reported that he had undergone psychiatric treatment for more than 20 years due to nerves. His symptoms included social withdrawal, intolerance to crowds, anxiety, worrying, and hearing voices. A February 2008 social worker note indicates that the Veteran had issues with anger, anxiety, panic attacks, and stress. He was also revealed to have compulsions in normal everyday routines such as turning off the faucet and bathing due to unusual smells emanating from his body. He reported an inability to cook as he feared forgetting to turn off the stove. He also was unable to go outside on rainy days. In March 2011, the Veteran was afforded a VA psychiatric examination. It was noted that the Veteran had moderate to severe symptomology on a daily basis since 1968. The examiner determined that although the Veteran had been provided a diagnosis of schizophrenia, there was no diagnosis other than the anxiety disorder because the Veteran never met the criteria for a diagnosis of schizophrenia. The symptoms were indicated to be frustration, insomnia, intrusive distressing recollections of the event, including images, efforts to avoid thoughts, feelings, or conversations associated with trauma. It was noted that he avoided activities, places, or people that would arouse recollections of trauma, he had difficulty falling or staying asleep, irritability or outbursts of anger, and hopelessness. The March 2011 examiner opined that that the Veteran's anxiety disorder was severe enough to preclude gainful employment. However, later in the examination report it was indicated that the anxiety disorder would not preclude gainful employment. As such, a clarification opinion was provided in May 2012. The Mach 2011 examiner opined in the May 2012 addendum opinion that the Veteran's only diagnosis is generalized anxiety disorder, which started in service after being hit by several mortar fragments. The Veteran never met the criteria for a diagnosis of schizophrenia. The March 2011 examiner explained that examiners since 1974 to 2011 concur with generalized anxiety disorder as the Veteran's prominent psychiatric condition. It was opined that the Veteran's anxiety disorder was severe enough to preclude the Veteran totally and completely from a gainful job. It was emphasized that the condition had been chronic, persistent and partially disabling. Therefore, the anxiety had precluded and continued to preclude him from a gainful job. The Board notes that the Veteran was provided VA psychiatric examinations in July 2016, October 2017, and August 2023. However, none of those examinations addressed the Veteran's anxiety disorder symptomology prior to May 20, 2011. Therefore, those examinations are not probative as to the severity of the Veteran's anxiety disorder prior to May 20, 2011. In December 2024, a private employability evaluation was submitted. The vocational specialist thoroughly and exhaustively reviewed the Veteran's medical records. Based on the vocational specialists' review of the facts and expertise it was opined that the Veteran's service connected anxiety disorder at least as likely as not precluded the Veteran from securing and following substantially gainful employment, to include sedentary work, since at least September 1974 and continuing to the present. This opinion is consistent with the findings of the March 2011 VA examiner and is consistent with the totality of the evidence throughout the period on appeal. Therefore, the Board finds that the Veteran's anxiety disorder symptomology most closely approximate total occupational and social impairment as defined by the criteria under the General Rating Formula for Psychoneurotic Disorders that were applicable in 1974. 38 C.F.R. § 4.132, DC 9400. The Veteran's anxiety disorder symptomology demonstrates that he was in virtual isolation in the community. His anxiety, depression, fear, anger, irritability, low motivation, lack of energy, panic, confusion, intolerance of people, psychomotor retardation, sleep problems, flashbacks, explosive behavior, and visual and auditory hallucinations, among other symptoms, exhibited in the medical evidence throughout the period on appeal, clearly establish that the Veteran was demonstrably unable to obtain or retain employment since September 1974, consistent with a 100 percent rating under 38 C.F.R. § 4.132, DC 9400. This finding is supported by the opinions of the March 2011 VA examiner and the private opinion of a vocational specialist. It is also substantiated by the fact that the Veteran was rejected for employment by a potential employer because the employer found him to be mentally unfit to perform employment. See April 1974 statement. Based on the foregoing, the Board finds that there is at least an approximate balance of positive and negative evidence with respect to the question of whether entitlement to a 100 percent rating for anxiety disorder throughout the period on appeal is warranted. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Accordingly, having resolved doubt in favor of the Veteran, entitlement to a 100 percent rating for anxiety disorder from September 4, 1974, is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. SMC at the Housebound Rate The United States Court of Appeal for Veterans Claims (Court) has held that VA has a "well-established" duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2010); Bradley v. Peake, 22 Vet. App. 280 (2008). This duty to maximize benefits requires VA to assess all the claimant's disabilities to determine whether any combination of disabilities establishes entitlement to SMC under 38 U.S.C. §1114. According to 38 U.S.C. § 1114(s)(1), when a Veteran has a service-connected disability rated as total (i.e., 100 percent) and has additional service-connected disability or disabilities independently ratable at 60 percent or more, he is entitled to SMC payable at the housebound rate. In this case, the Veteran met these requirements, per this decision, effective September 4, 1974. Per this decision, the Veteran was granted a 100 percent rating for his anxiety disorder from September 4, 1974. Moreover, his fragment wounds of the right scapula and posterior arm, right buttock, left thigh, and posterior neck are combined as a single disability because the disabilities result from a common etiology or a single accident. 38 C.F.R. § 4.16(a). The Veteran's fragment wound disabilities have been combined for a single rating of 60 percent since December 1968. Therefore, his disabilities meet the criteria set forth in 38C.F.R. §3.350(i) for the additional award of SMC at the housebound rate for the period beginning September 4, 1974. Accordingly, SMC at the housebound rate is granted effective September 4, 1974. Dismissal of the appeal for TDIU prior to May 20, 2011 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, as here, VA has found a Veteran to be totally disabled because of a particular service-connected disability 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) (finding a request for TDIU moot where 100 percent schedular rating was awarded for the same period); 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 4.15, 4.16. The Board acknowledges that the Court has held that the receipt of a 100 percent schedular rating for a service-connected disability does not necessarily render moot any pending claim for a TDIU. Bradley v. Peake, 22 Vet. App. 280 (2008). Although no additional disability compensation may be paid when a total schedular disability rating is already in effect, the Court's decision in Bradley appreciates that a separate award of a TDIU predicated on a single disability may form the basis for an award of SMC. In the Bradley case, the Court found that TDIU was warranted in addition to a schedular 100 percent evaluation where the TDIU had been granted for a disability other than the disability for which a 100 percent rating was in effect. Under those circumstances, there was no "duplicate counting of disabilities." Bradley, 22 Vet. App. at 293. Here, the Veteran has been granted SMC effective September 4, 1974. Thus, a TDIU could not assist the Veteran in meeting the criteria for SMC under 38 U.S.C. § 1114(s) and the issue of entitlement to a TDIU is moot. In addition, because his anxiety disorder is rated 100 percent for the entire appeal period, the claim for TDIU benefits is moot for the entire period covered by this claim. Accordingly, the appeal seeking TDIU is dismissed. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Temple, 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.