HYPERTENSION

Summary

The veteran, who served in the Air Force from January 1966 to October 1969 with subsequent National Guard service, appealed the denial of service connection for erectile dysfunction and earlier effective dates for TDIU and SMC housebound benefits. The Board granted service connection for hypertension on a presumptive basis due to herbicide exposure in Thailand, noting the veteran's service at Nakhon Phanom Royal Thai AFB and his diagnosed hypertension. The Board then granted service connection for erectile dysfunction as secondary to the newly service-connected hypertension, finding a nexus established despite a prior VA opinion suggesting otherwise. Regarding the TDIU claim for an earlier effective date prior to May 9, 2012, the Board denied it, finding that while the veteran was unemployed, his service-connected PTSD and tinnitus did not solely render him unable to obtain or maintain substantially gainful employment during that period. The Board also denied entitlement to SMC housebound benefits for an earlier effective date prior to May 23, 2013, because the veteran did not meet the criteria of having a single 100% disabling service-connected condition with additional disabilities rated at 60% or more, nor was he permanently housebound by reason of service-connected disabilities.

Rationale

Hypertension presumed due to herbicide exposure in Thailand; Service records confirm service at Nakhon Phanom Royal Thai AFB; Hypertension is a presumptive condition under 38 U.S.C. § 1116

Full Decision Text

Citation Nr: A26029511
Decision Date: 04/01/26	Archive Date: 04/01/26

DOCKET NO. 260303-634856
DATE: April 1, 2026

ORDER

Service connection for hypertension is granted.

Service connection for erectile dysfunction is granted.

An earlier effective date prior to May 9, 2012, for the award of a total disability rating due to individual unemployability (TDIU) is denied.

An earlier effective date prior to May 23, 2013, for the award of special monthly compensation (SMC) based on housebound criteria is denied.

FINDINGS OF FACT

1. The Veteran's hypertension is presumed to have resulted from in-service exposure to herbicide agents during active-duty service in Thailand.

2. Resolving all reasonable doubt in the Veteran's favor, his erectile dysfunction is proximately and etiologically due to his hypertension. 

3. The Veteran is not shown to have been unable to obtain or maintain substantially gainful employment due solely to service-connected disabilities prior to May 9, 2012. 

4. Prior to May 9, 2012, the Veteran did not have a single service-connected disability rated at 100 percent, or the equivalent TDIU. 

5. From May 9, 2012, to May 23, 2013, the Veteran was in receipt of a TDIU based solely on his service-connected posttraumatic stress disorder (PTSD), but he did not have additional service-connected disabilities independently ratable at 60 percent and was not shown to be permanently housebound by reason of service-connected disability or disabilities.

CONCLUSIONS OF LAW

1. The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1116, 1168, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309; DeLisio v. Shinseki, 25 Vet. App. 45, 55 (2011).

2. The criteria for service connection for erectile dysfunction have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310.

3. The criteria for an effective date prior to May 9, 2012, for the award of a TDIU have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 3.340, 3.341, 4.15, 4.16.

4. The criteria for an effective date prior to May 23, 2013, for award of SMC based on housebound criteria have not been met. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 1966 to October 1969 with subsequent service in the Ohio Air National Guard and West Virginia Air National Guard. 

These matters come before the Board of Veterans' Appeals (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

In November 2023, the Veteran filed a Supplemental Claim requesting readjudication of a claim for service connection for erectile dysfunction and for earlier effective dates for the award of a TDIU and SMC based on housebound status. The claims were denied in a March 2024 rating decision. The Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR) in March 2025, and earlier effective dates for a TDIU and SMC were denied in a November 2025 HLR decision. This decision also found a duty-to-assist error during the higher-level review of the erectile dysfunction claim and moved the issue to the Supplemental Claim lane. A December 2025 rating decision continued the denial of service connection for erectile dysfunction.  

In the March 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran appealed the November 2025 and December 2025 rating decisions and elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the March 2024 agency of original jurisdiction (AOJ) decision, which was subject to higher-level review, with regard to the earlier effective date appeals, and the September 2025 AOJ decision with regard to the service connection appeal. 38 C.F.R. § 20.301. Evidence
 to the Supplemental Claim lane. A December 2025 rating decision continued the denial of service connection for erectile dysfunction.  

In the March 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran appealed the November 2025 and December 2025 rating decisions and elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the March 2024 agency of original jurisdiction (AOJ) decision, which was subject to higher-level review, with regard to the earlier effective date appeals, and the September 2025 AOJ decision with regard to the service connection appeal. 38 C.F.R. § 20.301. Evidence submitted after these decisions was not considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Finally, a claimant is entitled to a one-year window within which the claimant may switch Board review dockets, if desired, by submitting a new, completed VA Form 10182. A claimant may also waive this docket switch window. See Williams v. McDonough, 37 Vet. App. 205 (2024). Here, the Veteran has not submitted such a waiver. However, in correspondence attached to the March 2026 VA Form 10182, the Veteran's attorney stated that the Veteran maintained he was entitled to the benefits sought, as they had outlined in previous argument submitted with the March 2025 VA Form 20-0996, Request for HLR, which suggests neither he nor the Veteran had more evidence or argument to submit that would require a docket switch for submission. Further, it was requested that the Board "adjudicate the appeal as soon as possible." Based on these statements, the Board determines that the Veteran has implicitly waived his right to switch Board dockets and will honor his request to have his appeal adjudicated under the Direct Review docket at this time.

Service Connection

The Veteran has claimed entitlement to service connection for erectile dysfunction as secondary to his service-connected PTSD. The Board will consider all theories of entitlement. 

Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service.?See 38?C.F.R. §§?3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).? 

Service connection may be granted on a presumptive basis for diseases listed in 38?C.F.R. § 3.309?under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. 

Service connection for hypertension is granted.? 

As an initial matter, it is observed that service connection for hypertension has never been claimed by the Veteran or adjudicated by the AOJ, including in either of the rating decisions appealed herein. However, the United States Court of Appeals for Veterans Claims (Court) has held that when a claim is pending and information obtained reasonably indicates that the claimed condition is caused by a disease or other disability that may be associated with service, the Secretary generally must investigate the possibility of secondary service connection; and, if that causal disease or disability is, in fact, related to service, the pending claim reasonably encompasses a claim for benefits for the causal disease or disability, such that no separate filing is necessary to initiate a claim for benefits for the causal disease or disability, and such that the effective date of benefits for the causal disability can be as early as the date of the pending claim. DeLisio v. Shinseki, 25 Vet. App. 45, 
 Court of Appeals for Veterans Claims (Court) has held that when a claim is pending and information obtained reasonably indicates that the claimed condition is caused by a disease or other disability that may be associated with service, the Secretary generally must investigate the possibility of secondary service connection; and, if that causal disease or disability is, in fact, related to service, the pending claim reasonably encompasses a claim for benefits for the causal disease or disability, such that no separate filing is necessary to initiate a claim for benefits for the causal disease or disability, and such that the effective date of benefits for the causal disability can be as early as the date of the pending claim. DeLisio v. Shinseki, 25 Vet. App. 45, 55 (2011). As discussed below, the Veteran's erectile dysfunction has been associated with hypertension, which in turn, is related to his military service. Therefore, the Board has sua sponte broadened the scope of the erectile dysfunction claim to include hypertension.

The relevant regulations provide that service connection may be granted on a presumptive basis for diseases associated with exposure to herbicide agents under 38 C.F.R. § 3.309 if a veteran served in Thailand at a U.S. or Royal Thai Air Force Base (AFB) between January 9, 1962, and June 30, 1976. 38 U.S.C. § 1116. Moreover, hypertension is among the disabilities presumed to be related to exposure to herbicide agents. 

VA treatment notes show that the Veteran has had a diagnosis of hypertension throughout the appeal period. See, e.g., VA treatment records dated in February 2021, February 2022, and August 2023. Further, the Veteran's service records reflect that he served in Thailand at Nakhon Phanom Royal Thai AFB during his active service. See Service treatment records (STRs) received November 23, 2014. Therefore, the Veteran is presumed to have been exposed to herbicide agents. 38 U.S.C. § 1116. 

Thus, the Board finds that the Veteran's hypertension is presumed to be the result of his exposure to herbicide agents in Thailand. Service connection for hypertension is granted on a presumptive basis. 

Service connection for erectile dysfunction is granted.

Establishing service connection on a secondary basis requires evidence sufficient to show that (1) a current disability exists and (2) the current disability was either (a) caused by or (b) aggravated by a service-connected disability.?38 C.F.R. §?3.310. Secondary causation exists when, but for the service-connected disability, the non-service-connected disability was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer?v. McDonough,?61 F.4th 1360, 1365?(Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364.?For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability. Id. 

By way of background, a March 2022 rating decision denied an original claim for service connection for erectile dysfunction. In April 2022, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the March 2022 rating decision. Later in April 2022, the AOJ issued the HLR decision which identified a difference of opinion during the higher-level review of the claim for service connection for erectile dysfunction and moved the issue to the Supplemental Claim lane to allow for further development. 

The Supplemental Claim decision was issued in September 2022 and continued the denial of service connection erectile dysfunction. The Veteran filed a VA Form 10182 in October 2022 and appealed, in pertinent part, the September 2022 denial of service connection for erectile dysfunction. In a November 2022 Board decision, service connection for erectile dysfunction was denied. 

In February 2023, the Veteran filed a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the claim for service connection for erectile dysfunction. The claim was denied in a September 2023 rating decision. In November 2023, the Veteran filed another Supplemental Claim requesting readjudication of the claim for service connection for erectile dysfunction. The claim was denied in a March 2024 rating decision. A request for higher-level review of that decision was filed in March 2025 and a November 2025 HLR decision found a duty-to-assist error in the adjudication of the erectile dysfunction claim
 2022 Board decision, service connection for erectile dysfunction was denied. 

In February 2023, the Veteran filed a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the claim for service connection for erectile dysfunction. The claim was denied in a September 2023 rating decision. In November 2023, the Veteran filed another Supplemental Claim requesting readjudication of the claim for service connection for erectile dysfunction. The claim was denied in a March 2024 rating decision. A request for higher-level review of that decision was filed in March 2025 and a November 2025 HLR decision found a duty-to-assist error in the adjudication of the erectile dysfunction claim and moved the issue to the Supplemental Claim lane. The December 2025 rating decision on appeal then continued the denial of service connection for erectile dysfunction.

Initially, the criterion of a current disability is established. The March 2022, September 2022, September 2023, March 2024, November 2024, and December 2025 rating decisions all rendered a favorable finding of a current diagnosis of erectile dysfunction. The Board is generally bound by favorable findings made by the AOJ. Further, such diagnosis is present in treatment notes and the relevant VA examinations. Therefore, the first element of service connection is met. 

In addition, the criterion of a current primary disability is met in the form of both PTSD and hypertension (as of the date of this decision for hypertension). 

Regarding the question of whether the Veteran's erectile dysfunction is etiologically related to his PTSD, a June 2022 VA opinion found that the Veteran had a current diagnosis of erectile dysfunction and a history of PTSD with depressive symptoms with medication use, but stated that medical records provided no supporting evidence that the current erectile dysfunction was the result of the PTSD with depressive symptoms with medication use or that the erectile dysfunction was aggravated by the PTSD with depressive symptoms with medication use. 

However, the June 2022 VA opinion also noted that the Veteran's hypertension was a risk factor for erectile dysfunction.  A December 2025 VA examination similarly indicated that erectile dysfunction was commonly associated with many things, including hypertension. Therefore, the Board resolves all reasonable doubt in the Veteran's favor and finds that a nexus is established between the Veteran's erectile dysfunction and his now service-connected hypertension. The appeal is granted.

Effective Dates

The effective date of an award based on a claim for increase of compensation "shall be fixed in accordance with the facts found but shall not be earlier than the date of receipt of application." 38 U.S.C. § 5110(a). The effective date for an increased rating shall be the earliest date of which it is factually ascertainable that an increase in disability had occurred, if the claim is received within one year from such date; otherwise, the effective date for increased ratings shall be the date of receipt of claim or date entitlement arose, whichever is later. 38 C.F.R. § 3.400(o)(1).

An effective date for an increased rating may be assigned later than the date of receipt of the claim, if the evidence shows that the increase in disability actually occurred after the claim was filed, but never earlier than the date of receipt of the claim for increase. In general, "date of receipt" means the date on which a claim, information or evidence was received in VA. 38 C.F.R. § 3.1(r). A claim is a "written or electronic communication requesting a determination of entitlement or evidencing a belief in entitlement to a benefit." 38 C.F.R. § 3.1(p).

If VA receives a complete application form appropriate to the benefit sought within one year of receipt of the intent to file a claim, VA will consider the complete claim filed as of the date the intent to file a claim was received. 38 C.F.R. § 3.155(b).

An earlier effective date, prior to May 9, 2012, for the award of a total disability rating due to individual unemployability (TDIU) is denied.

By way of background, service connection for posttraumatic stress disorder was granted in a February 2012 rating decision, and a 30 percent rating was assigned, effective October 13, 2004. In June 2012, the Veteran appealed the initial rating assigned to the Board. 

Meanwhile, in April 2012 and June 2012, the Veteran filed formal applications for a TDIU. A September 2013 rating decision increased the rating assigned to PTSD to 70 percent, effective May 9, 2012, and denied a TDIU. 

In November 2013, the Veteran appealed the September 2013 rating decision to the Board. A September 2021 Board decision granted, in pertinent part, an increased rating of 50 percent
traumatic stress disorder was granted in a February 2012 rating decision, and a 30 percent rating was assigned, effective October 13, 2004. In June 2012, the Veteran appealed the initial rating assigned to the Board. 

Meanwhile, in April 2012 and June 2012, the Veteran filed formal applications for a TDIU. A September 2013 rating decision increased the rating assigned to PTSD to 70 percent, effective May 9, 2012, and denied a TDIU. 

In November 2013, the Veteran appealed the September 2013 rating decision to the Board. A September 2021 Board decision granted, in pertinent part, an increased rating of 50 percent for PTSD, prior to May 9, 2012, and denied a rating in excess of 70 percent thereafter. A TDIU was also denied. 

A December 2021 rating decision, issued in February 2022, implemented the September 2021 Board decision and assigned an effective date of October 13, 2004, for the grant of the 50 percent rating for PTSD. A TDIU and eligibility for Dependents' Educational Assistance were granted from May 9, 2012. 

In April 2022, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the December 2021 rating decision with respect to the effective dates assigned to PTSD, and TDIU, as well as an unadjudicated inferred claim for SMC. See Akles v. Derwinski, 1 Vet. App. 118, 121 (1991). Later in April 2022, the AOJ issued the HLR decision, in which entitlement to SMC based on housebound status was granted, from May 23, 2013.

The Veteran filed a VA Form 10182 in October 2022 on which he appealed the initial effective date assigned for SMC based on housebound criteria. In a November 2022 decision, the Board denied earlier effective dates for a TDIU, and for SMC based on housebound criteria. 

In November 2023, the Veteran filed a Supplemental Claim requesting readjudication of the effective dates for a TDIU and SMC. The claims were denied in a March 2024 rating decision. A request for higher-level review of that decision was filed in March 2025, and earlier effective dates for a TDIU and SMC were denied in a November 2025 HLR decision, which was then appealed to the Board.

Formal applications for a TDIU were received in April 2012 and June 2012; however, pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009), a claim for a TDIU is part and parcel of an appeal for an increased rating. Accordingly, the claim for entitlement to a TDIU is considered part of the appeal of the PTSD rating filed on June 19, 2012, and the Board will consider whether the evidence establishes that entitlement to a TDIU arose prior to May 9, 2012. 

It is the established policy of VA that all veterans who are unable to secure and follow a?substantially gainful?occupation by reason of service-connected disabilities shall be rated as totally disabled. 38?C.F.R. §?4.16.?Substantially gainful?employment is that employment that is ordinarily followed by the nondisabled to earn their livelihoods with earnings common to the?particular occupation?in the community where the veteran?resides.?Moore v.?Derwinski, 1?Vet. App.?356 (1991). Marginal employment will not be considered?substantially gainful?employment. 38?C.F.R. §?4.16(a).?? 

A TDIU may be assigned, if the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability it is ratable at 60 percent or more, and that if there are two or more such disabilities at least one is ratable at 40?percent or more and the combined rating is 70 percent or more. 38?C.F.R. §?4.16(a).?? 

In cases where the above schedular rating criteria are not met, an extra-schedular rating may be assigned. Recently, in?Witkowski?v. Collins, 38 Vet. App. (2025), the Court held that the Board can, in the first instance, decide an "extra-schedular"
 or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability it is ratable at 60 percent or more, and that if there are two or more such disabilities at least one is ratable at 40?percent or more and the combined rating is 70 percent or more. 38?C.F.R. §?4.16(a).?? 

In cases where the above schedular rating criteria are not met, an extra-schedular rating may be assigned. Recently, in?Witkowski?v. Collins, 38 Vet. App. (2025), the Court held that the Board can, in the first instance, decide an "extra-schedular" TDIU under?38 C.F.R. §?4.16(b) without referral to the Director of Compensation even if the Board is granting in the first instance. The Court therein held that the Board is not a "rating board," but instead an appellate tribunal and, therefore, has broader jurisdictional authority under section 4.16(b). The administerial task of getting an opinion from the Director, therefore, is not necessary for the Board to render an "extra-schedular" TDIU decision in the first instance. 

The central inquiry is whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability.?Hatlestad v. Brown, 5?Vet. App.?524 (1993). Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38?C.F.R. §§?3.341, 4.19;?Van Hoose v. Brown, 4?Vet. App.?361 (1993). "Substantially gainful employment" is not currently defined in VA regulations; however, the term has been defined as having two components: one economic and one noneconomic.?? 

The economic?component?means an occupation earning more than marginal income (outside of a protected environment) as?determined?by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the veteran's history, education, skill, and training, whether the veteran has the physical ability to perform the type of activities required by the occupation at issue, and whether the veteran has the mental ability to perform the activities required by the occupation at issue. In other?words, the noneconomic?component?requires consideration of a veteran's ability to secure or follow that type of employment.?Ray v. Wilkie,?31?Vet. App.?58?(2019). 

From March 29, 2012, to May 9, 2012, service connection was in effect for PTSD rated as 50 percent disabling, and tinnitus, rated as 10 percent disabling. The combined rating was 60 percent. Prior to March 29, 2012, the only service-connected disability was PTSD, rated at 50 percent. Therefore, the schedular requirements for a TDIU were not met prior to May 9, 2012, and the Board will consider whether a TDIU was warranted on an extra-schedular basis.

The Board notes that the AOJ will assign initial ratings and effective dates for the grants of service connection for hypertension and erectile dysfunction herein, and that the ratings assigned to service-connected disabilities are pertinent to the question of whether the schedular criteria for a TDIU are met. However, the criteria for determining whether a veteran is unemployable due solely to service-connected disabilities are the same regardless of whether the schedular criteria are met or the issue is being considered on an extra-schedular basis.  

The Veteran filed the original claim for service connection for erectile dysfunction in December 2021, and unless the claim was filed within a year of discharge from service, the date of claim is the earliest effective date available for a grant of service connection. 38 C.F.R. § 3.400. However, even if the AOJ were to assign an effective date to the hypertension and/or erectile dysfunction within the period prior to May 9, 2012, there is no indication that these disabilities caused impairment of the Veteran's ability to obtain or maintain employment. In this regard, VA treatment notes dated during the period prior to May 9, 2012, reflect regular follow-up for his hypertension and reports that he was taking his medication regularly and findings that his blood pressure was stable. There was no diagnosis or treatment for erectile dysfunction in these treatment notes. 

Accordingly, the Board finds that it may proceed with adjudicating the issue of entitlement to a TDIU prior to May 9, 2012, on the merits at this time, prior to the assignment of the initial ratings and effective dates for the grants of service connection for hypertension and erectile dysfunction by the AOJ
2012, there is no indication that these disabilities caused impairment of the Veteran's ability to obtain or maintain employment. In this regard, VA treatment notes dated during the period prior to May 9, 2012, reflect regular follow-up for his hypertension and reports that he was taking his medication regularly and findings that his blood pressure was stable. There was no diagnosis or treatment for erectile dysfunction in these treatment notes. 

Accordingly, the Board finds that it may proceed with adjudicating the issue of entitlement to a TDIU prior to May 9, 2012, on the merits at this time, prior to the assignment of the initial ratings and effective dates for the grants of service connection for hypertension and erectile dysfunction by the AOJ.   

In the April 2012 VA Form 21-8940, Application for Increased Compensation Based on Unemployability, the Veteran indicated that he last worked in December 2008, and in the June 2012 VA 21-8940, he stated that he last worked in 2009. Treatment notes reflect that he retired in 2008, having worked for the same retail company since 1985. Therefore, the Veteran was unemployed prior to May 9, 2012. Moreover, review of the September 2021 decision reflects that while tinnitus was mentioned as a service-connected disability, the Board granted a TDIU based solely on the Veteran's PTSD symptoms. 

In this regard, the May 2012 VA Hearing Loss and Tinnitus Disability Benefits Questionnaire (DBQ), noted that the Veteran's tinnitus impacted his daily life, including work, but in describing the impact, the Veteran stated that he "[did not] pay much attention to it anymore other than [the] fact its [sic] there." Therefore, the record does not reflect that the Veteran's tinnitus to any degree rendered him unemployable during the period from March 29, 2012, to May 9, 2012.

Moreover, the record also does not establish that the Veteran was unable to obtain or maintain substantially gainful employment due his service-connected PTSD prior to May 9, 2012. Review of lay and medical evidence during the years leading up to his retirement shows that the Veteran experienced anger and irritability at work but not that these symptoms rendered him unemployable. In a November 2003 VA treatment note, he reported that he was often irritable and easily provoked to anger. A December 2003 treatment note documented that his job was stressful and he was looking forward to when he could retire. 

In a statement received in May 2005, the Veteran indicated that he did not want to work some days but would go in anyway and do the best he could. He also reported that he was finding it harder to deal with people and was having anxiety every day. He related that he had been on Prozac but had gotten violent again so he had to take a different medication.  

In September 2005, he reported that he had been recently passed up for store manager, did not react as violently as in the previous summer. An October 2005 VA treatment note stated that he was considering retiring so that he could ensure he would not "go off" on a customer or manager. Nevertheless, in July 2006, the Veteran described his work as a method of stress relief. In August 2006, he denied anger and was less irritable but continued to have difficulty tolerating day-to-day contact with others, which was an issue in the workplace.

The record reflects that during this time he was also a member of the Ohio Air National Guard and retired from service in December 2006. The evidence does not show that his service-connected disabilities impaired his ability to meet the requirements of this service.  

In a March 2007 treatment note, the Veteran described increased stress that he thought was due in part to increased responsibility and workload. However, he reported that he was managing so far without incident as he was making an effort to take his medication as ordered. In October 2007, he was noted to be less irritable with no episodes of "behavioral dyscontrol." In a January 2009 VA treatment note, the Veteran indicated that he had retired and no longer had to deal with the public, saying that he was easily frustrated and had trouble dealing with others.

When questioned about employment at the December 2011 VA PTSD examination, he stated that he kept the retail position until 2008 when he retired, indicating that he was old enough to get social security and military retirement and he was sick of his job as the job was "not fun" and he had issues with the management. He reported that he got along well with most of his co-workers. 

The Board notes that the PTSD symptoms noted by the examiner included depressed mood, anxiety, suspiciousness, mild memory loss, and difficulty in establishing and maintaining
 a January 2009 VA treatment note, the Veteran indicated that he had retired and no longer had to deal with the public, saying that he was easily frustrated and had trouble dealing with others.

When questioned about employment at the December 2011 VA PTSD examination, he stated that he kept the retail position until 2008 when he retired, indicating that he was old enough to get social security and military retirement and he was sick of his job as the job was "not fun" and he had issues with the management. He reported that he got along well with most of his co-workers. 

The Board notes that the PTSD symptoms noted by the examiner included depressed mood, anxiety, suspiciousness, mild memory loss, and difficulty in establishing and maintaining work and social relationships, but the examiner did not find that the PTSD caused difficulty adapting to work or work-like setting. The examiner described the impact of the Veteran's symptoms as moderate, noting that the Veteran's symptoms contributed to his decision to retire at age 62 because he found interpersonal work stresses related to management and authority figures distressing enough that he no longer enjoyed work.

Based on the above, the Board finds that the Veteran's PTSD symptoms, particularly anger, irritability, and anxiety, impacted his work by increasing the likelihood that he would become angry or irritated when interacting with others. However, the record does not reflect that these incidents were of such frequency or severity that he was in danger of losing his job. In fact, while a September 2005 treatment note indicates that he had been passed over for store manager, in March 2007, he reported increased responsibilities. On the April 2012 VA Form 21-8940, he stated he was an assistant manager when he retired. 

Thus, while the Veteran's PTSD impacted his ability to interact with others, the evidence suggests that he could otherwise fulfill his work responsibilities without difficulty. Accordingly, although his PTSD affected his work, it alone did not render him unable to obtain or maintain substantially gainful employment. Therefore, the appeal for an effective date prior to May 9, 2012, for the award of a TDIU is denied.    

Entitlement to SMC at the housebound rate.

A veteran is presumed to be seeking the maximum benefit allowed by law or regulation, and such a claim remains in controversy, even if partially granted, where less than the maximum benefit available is awarded. AB v. Brown, 6 Vet. App. 35, 28 (1993). Moreover, VA has a duty to fully and sympathetically develop a veteran's claim to its optimum, which includes determining all potential claims raised by the evidence and applying all relevant laws and regulations. Moody v. Principi, 360 F.3d 1306, 1310 (Fed. Cir. 2004). Relevant to this appeal, a claim for increased disability compensation may include the "inferred issue" of entitlement to SMC even where the veteran has not expressly placed entitlement to SMC at issue. Akles v. Derwinski, 1 Vet. App. 118, 121 (1991).

SMC is payable at the "s" rate (also referred to as 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). This requirement is met when the Veteran is substantially confined as a result of service-connected disabilities to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime. See 38 C.F.R. § 3.350(i)(1)-(2).

A "single service-connected disability rated as total" under 38 U.S.C. § 1114(s) is not limited to cases where a 100 percent rating has been assigned via the application of one or more diagnostic codes in the rating schedule; rather, entitlement to a TDIU may serve as the "total" rating for the purposes of SMC at the "s" rate if the TDIU is predicated upon a single disability. Bradley v. Peake, 22 Vet. App. 280 (2008).

Thus, an award of TDIU, if based upon a single service-connected disability, is sufficient to satisfy § 1114(s) requirement of a service-connected disability rated as 100 percent disabling. Bradley v. Peake, 22 Vet. App. 
.S.C. § 1114(s) is not limited to cases where a 100 percent rating has been assigned via the application of one or more diagnostic codes in the rating schedule; rather, entitlement to a TDIU may serve as the "total" rating for the purposes of SMC at the "s" rate if the TDIU is predicated upon a single disability. Bradley v. Peake, 22 Vet. App. 280 (2008).

Thus, an award of TDIU, if based upon a single service-connected disability, is sufficient to satisfy § 1114(s) requirement of a service-connected disability rated as 100 percent disabling. Bradley v. Peake, 22 Vet. App. 280, 293 (2008); see also Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); however, a TDIU rating that is based on multiple underlying disabilities cannot satisfy the § 1114(s) requirement of "a service-connected disability" because that requirement must be met by a single disability.

As discussed above, while evidence indicates that the Veteran was awarded TDIU solely on the basis of his service-connected PTSD as of May 9, 2012, the evidence does not establish entitlement to a TDIU prior to that date. Thus, as he was only in receipt of a 50 percent rating for PTSD throughout the appeal period prior to that date and a 10 percent rating for tinnitus as of March 29, 2012, he did not have a single service-connected disability rated at 100 percent or the equivalent prior to May 9, 2012. 

In addition, while a TDIU was granted based solely on the Veteran's PTSD, and so he had the equivalent of a single service-connected disability rated as total as of May 9, 2012, he did not have additional other service-connected disabilities independently rated at 60 percent or more prior to May 23, 2013. From May 9, 2012, to May 23, 2013, tinnitus was the only other service-connected disability and the rating assigned was 10 percent. The first date on which the Veteran service-connected disabilities other than PTSD that were rated at 60 percent or more was May 23, 2013, when service connection went into effect for sleep apnea, rated at 50 percent. The 50 percent rating for sleep apnea and the 10 percent rating for tinnitus when combined equals 60 percent. 

Thus, an effective date prior to May 23, 2013, for the award of SMC based on housebound criteria based on a single service-connected disability rated as 100 percent disabling and additional service-connected disability or disabilities independently ratable at 60 percent must be denied as a matter of law. Sabonis v. Brown, 6 Vet. App. 426 (1994).

Moreover, the evidence does not reflect that the Veteran was permanently housebound by reason of service-connected disability or disabilities as of May 9, 2012. The May 2012 PTSD DBQ noted that he was experiencing greater inactivity and failure to leave home. He stated that he did not wish to leave the security of his home. He indicated that he was spending less time helping his brother with the horses because he did not want to be bothered and that they argued every time they were together. He reported avoiding his uncle's phone calls because his uncle often called for help with transportation, and the Veteran now wished not to deal with anything or be around anyone. Nevertheless, he also stated that he and his brother would go to the flea market on a weekly basis and that he had gone to the pharmacy with his uncle the day before the examination.

The Veteran described having greater difficulty tolerating church, stating that he would show up early to get the seat he wanted but often would leave before the service started because he could not tolerate waiting. He also denied socializing with friends. He reported spending time working on the farm, although he had been clearing some land but made little progress because he had recently lost interest.

Hence, while the Veteran had experienced a decrease in the desire and ability to leave home, the Board determines that he was not permanently housebound as a result of service-connected disabilities. In this regard, he was still going to church, even if he did not always stay and still went out with his brother on a weekly basis, as well as with his uncle to some degree. Moreover, it is not apparent that his increased preference for isolation and staying home was reasonably certain to continue throughout his lifetime. 

Accordingly, entitlement to payment of SMC based on housebound criteria was also not warranted prior to May 23, 2013, on the basis of having a single service-connected disability rated as 100 percent disabling and being permanently house
Hence, while the Veteran had experienced a decrease in the desire and ability to leave home, the Board determines that he was not permanently housebound as a result of service-connected disabilities. In this regard, he was still going to church, even if he did not always stay and still went out with his brother on a weekly basis, as well as with his uncle to some degree. Moreover, it is not apparent that his increased preference for isolation and staying home was reasonably certain to continue throughout his lifetime. 

Accordingly, entitlement to payment of SMC based on housebound criteria was also not warranted prior to May 23, 2013, on the basis of having a single service-connected disability rated as 100 percent disabling and being permanently housebound by reason of service-connected disability or disabilities. The appeal is denied.      

 

 

A. ISHIZAWAR

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. M. Schaefer, 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.