Case A26040124

W. DAKNIS · 2026 · Case ID: A26040124

GRANTED

Summary

The veteran, who served in the United States Army from September 1983 to July 1986 and April 1987 to April 1990, appeals the denial of entitlement to a Total Disability based on Individual Unemployability (TDIU) and statutory Special Monthly Compensation (SMC) at the housebound rate. The Board granted entitlement to TDIU based solely on the Veteran's service-connected left hip disability for specific periods: June 2, 2016, to November 13, 2018; January 1, 2020, to April 27, 2023; and from September 1, 2023. The Board found that the Veteran's left hip condition, considered alone, rendered him unable to secure or follow substantially gainful employment since at least November 2013, resolving reasonable doubt in his favor. The Board also granted statutory SMC at the housebound rate for the same periods. This was based on the Veteran having a single service-connected disability rated as total (TDIU for left hip) and an additional service-connected disability, atrial fibrillation, rated at 60 percent, which satisfied the criteria for housebound benefits. The Board noted that claims for TDIU prior to June 2, 2016, were moot as the Veteran was already receiving a 100 percent rating and SMC during those periods.

Rationale

Left hip disability considered alone rendered Veteran unable to secure or follow substantially gainful employment.; Evidence regarding Veteran's left hip limitations and unemployability was in approximate balance.; Reasonable doubt resolved in Veteran's favor.

Service Branch

ARMY

Special Benefit

SMC - HOUSEBOUND; TDIU

Docket No.

250905-587749

Full Decision Text

Citation Nr: A26040124
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 250905-587749
DATE: April 29, 2026

ORDER

Entitlement to a total disability rating based on individual unemployability (TDIU) due to solely to the Veteran's service-connected left hip disability, exclusive of periods the Veteran was in receipt of statutory special monthly compensation (SMC) based on housebound status, is granted from June 2, 2016 to November 13, 2018; from January 1, 2020 to April 27, 2023; and from September 1, 2023.

Entitlement to statutory SMC at the housebound rate is granted from June 2, 2016 to November 13, 2018; from January 1, 2020 to April 27, 2023; and from September 1, 2023.

FINDINGS OF FACT

1. The Veteran has been in receipt of a total disability rating (100 percent) during the entire period on review.

2. The issue of the Veteran's entitlement to a TDIU based on a single disability from November 14, 2018 to December 31, 2019 and from April 28, 2023 to August 31, 2023 is moot because he was in receipt of a total disability rating and statutory SMC based on housebound status.

3. The Veteran was unable to secure or follow a substantially gainful occupation due solely to his service-connected left hip disability during the entire period on review.

4. The Veteran's self-employment constituted a protected work environment, and therefore, was marginal employment.

5. From June 2, 2016 to November 13, 2018; from January 1, 2020 to April 27, 2023; and from September 1, 2023, the Veteran has one disability rated as total and an additional disability rated at 60 percent.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a TDIU based solely on the Veteran's left hip disability, exclusive of periods the Veteran was in receipt of statutory SMC based on housebound status, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 4.16.

2. The criteria for entitlement to statutory SMC at the housebound rate from June 2, 2016 to November 13, 2018; from January 1, 2020 to April 27, 2023; and from September 1, 2023 have been met. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i)(1).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from September 1983 to July 1986 and from April 1987 to April 1990.

This matter comes before the Board of Veterans' Appeals (Board) on an appeal from a September 2024 higher-level review decision, following a June 2023 rating decision by the Department of Veterans Affairs (VA) Regional Office, which is the Agency of Original Jurisdiction (AOJ).

In the September 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Board's evidence submission docket. This restricts the Board's review to the evidence of record at the time of the June 2023 rating decision and evidence submitted with, or within 90 days of filing of, the Notice of Disagreement initiating appellate review. 38 C.F.R. § 20.303.

For the claim of entitlement to a TDIU, 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.

In the September 2025 VA Form 10182, the Veteran's attorney styled the issue on appeal as entitlement to a TDIU prior to June 2, 2016 because the Veteran has been in receipt of a 100 percent combined schedular rating since June 2, 2016. However, VA has a duty to maximize benefits. Therefore, the Board must consider whether an award of TDIU based on a single disability is warranted, for the sole purpose of determining eligibility to a special monthly compensation (SMC) at the housebound rate. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2010). SMC is payable where a veteran has a single service-connected disability rated as 100 percent disabling and has additional service-connected disability or disabilities independently rated at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems. See 38 C.F.R. § 3.350 (i)(1) (2019). A separate award of a TDIU predicated on a single disability may form the basis for an award of SMC. Bradley v. Peake, 22 Vet. App. 280 (2008).

In this case, the Veteran has been in receipt of a total disability rating (100 percent) since June 2, 2016. Moreover, he was in receipt of both a total disability rating and SMC at the housebound rate from November 14, 2018 to December 31, 2019 and from April 28, 2023 to August 31, 2023. Therefore, the issue of his entitlement to a TDIU during these periods is moot. However, the issue of his entitlement to a TDIU predicated on a single disability for the periods of June 2, 2016 through November 13, 201, from January 1, 2020 through April 27, 2023, and from September 1, 2023 is not moot because the Veteran was not in receipt of SMC at the housebound rate during these time periods. Thus, the Board has restyled the issue on appeal accordingly.

Furthermore, the Veteran's attorney's argument concerning the Veteran's entitlement to a TDIU prior to June 2, 2016 is without merit. The Veteran's attorney argues that even though the Veteran is in receipt of a total disability rating since June 2, 2016, the issue of his entitlement to a TDIU prior to June 2, 2016 remains in controversy. Id. She contends that the issue is intertwined with the issue of entitlement to an earlier effective date for service connection for his left hip because schedular requirements for TDIU prior to June 2016 may depend on the assignment of such an earlier effective date. Id. However, the issue of entitlement to an increased rating for the Veteran's left hip disability is not on appeal in this case. Thus, the Veteran's left hip service connection effective date does not cause entitlement to a TDIU prior to June 2, 2016 to be in controversy, or on appeal, in this matter.

1. Entitlement to a TDIU due solely to a single disability, exclusive of periods the Veteran was in receipt of statutory SMC based on housebound status

The present appeal of the claim for entitlement to a TDIU arose in connection with the Veteran's June 16, 2016 claim for, among other service connection claims, an increased rating for his bilateral knee disability, which the Veteran has continuously pursued since. Thus, the appeal period in this case starts on June 2, 2016, and ends on September 6, 2024, the date of the rating decision on appeal.

Legal Criteria

A TDIU may be assigned when a claimant 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 be considered for assignment of a TDIU under 38 C.F.R. § 4.16(a), the Veteran's service-connected disabilities must meet the following criteria: (1) if there is only one service-connected disability, the disability must be rated at 60 percent or more; or (2) if there are two or more service-connected disabilities, at least one disability must be rated at 40 percent or more, and the total combined disability rating must be 70 percent or more
appeal.

Legal Criteria

In this case, the Veteran is service-connected for atrial fibrillation rated at 60 percent from December 15, 2008; left knee revision (total knee replacement) rated at 10 percent from November 8, 2013, 100 percent from November 14, 2018, 60 percent from January 1, 2020, 100 percent from April 28, 2023, and 60 percent from September 1, 2023; total left hip replacement rated at 50 percent from June 2, 2016; obstructive sleep apnea rated at 50 percent from October 6, 2016; low back strain rated at 20 percent from December 21, 2005; sciatic nerve dysfunction, lower right extremity rated at 20 percent from September 17, 2012; sciatic nerve dysfunction, lower left extremity rated at 20 percent from September 17, 2012; left and right elbow condition each rated at 20 percent from June 2, 2016; painful or unstable left knee scar rated at 20 percent from April 28, 2023; arterial hypertension rated at 10 percent from 1990; right knee strain, with painful motion and limited flexion rated at 10 percent from November 8, 2013; right and left elbow limited flexion of the forearm each rated at 10 percent from June 2, 2016; erectile dysfunction rated as noncompensable from June 24, 2010; right and left elbow condition (limited extension of the forearm) each rated as noncompensable from June 2, 2016; left elbow scars rated as noncompensable from June 2, 2016; left hip scar rated as noncompensable from June 2, 2016; right knee strain with limitation in extension rated as noncompensable from July 24, 2021; any visual defect (claimed as vision loss) rated as noncompensable from August 10, 2022; and left knee scar rated a noncompensable from November 14, 2018.

Based on this, the Veteran met the schedular TDIU criteria because he was in receipt of a single disability rating of at least 60 percent throughout the entire period on appeal.

In the context of a TDIU, unemployability means an inability to secure or follow a substantially gainful occupation. 38 C.F.R. 4.16(a). Consideration is given to the claimant's level of education, skills and training, and previous work experience, but not to age or impairment caused by non-service-connected disabilities. Ray v. Wilkie, 31 Vet. App. 58, 72-73 (2019); 38 C.F.R. §§ 3.341, 4.16, 4.19. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. The question is whether the claimant has the physical and mental ability to perform the types of activities required by the occupation at issue, rather than whether he can find employment. Ray, 31 Vet. App. 58 at 72-73; 38 C.F.R. § 4.16(a). The question of whether a veteran is capable of substantial gainful employment is not a medical one but rather a determination for the adjudicator. 38 C.F.R. § 4.16(a); Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013).

A substantially gainful occupation is one earning more than marginal income, as determined by the U.S. Department of Commerce as the poverty threshold for one person. 38 C.F.R. § 4.16(a); Ray, at 72-73. Even if earned annual income exceeds the poverty threshold, marginal employment may be found to exist on a facts-found basis where there is evidence including, but not limited to, employment in a protected environment such as a family business or sheltered workshop. Id. The phrase "employment in a protected environment" is "unambiguous" and means, "a lower-income position that, due to the veteran's service-connected disability or disabilities, is shielded in some respect from competition in the employment market." LaBruzza v. McDonough, 37 Vet. App. 11 (2024). Whether a veteran is capable of substantially gainful employment is a determination ultimately made by the Board. Moore v. Nicholson, 21 Vet. App. 211, 218 (2007).

Factual Background

A July 2016 VA knee examination report indicates that the Veteran's chronic knee pain did not make him unable to work a sedentary job.

A July 2016 VA elbow examination shows that the Veteran's elbow conditions did not impact his ability to perform occupational tasks.

During a July 2016 VA ankle examination, the Veteran reported that he was unable to be on his feet or run for his employment in service and repair work. He was also unable to reach high on his toes. However, the examiner noted that the Veteran's left ankle did not impact his ability to perform occupational tasks.

A July 2016 VA male reproductive systems conditions examination report indicates that the Veteran's erectile dysfunction does not impact his ability to perform occupational tasks.

An October 2017 VA heart conditions examination indicates that extensive physical work would cause fatigue and shortness of breath during arrhythmia flare-ups due to the Veteran's paroxysmal atrial fibrillation heart condition.

A November 2018 VA knee examination report shows that the Veteran's left knee condition impacts his occupational functioning because it causes pain, stiffness, limited range of motion, difficulty with bending, prolonged standing, and climbing stairs.

In a June 2019 statement, the Veteran reported that he has to use medications, heating pads, and ice packs daily due to his hip, ankle, and elbow pain. He also uses a cane to walk. He has trouble getting in and out of his truck, is unable to sit with his legs crossed, has trouble getting up and down to go to the bathroom, getting out of bed, and going up and down stairs due to his hip pain. He has constant ankle pain, and walking more than 100 feet aggravates his ankle pain. His ankles buckle or give out, particularly when using the stairs. His elbow pain makes it painful to carry groceries, lift light objects, and walk his dog.

In a June 2019 statement, the Veteran's sister reported that the Veteran has back, leg, elbow, hip, and ankle pain. He is unable to participate in physical activities as he once had. He uses a cane. He has problems doing everyday activities, such as chores, lifting groceries, getting in and out of his truck, and walking long distances.

In a July 2019 private medical report, a private orthopedic physician opined that since at least 2016, the Veteran's left knee has caused him a significant loss of function and severe disability. The Veteran reported that he can only walk approximately 100 yards due to his knee pain, limited range of motion, tightness, and swelling. He cannot do work around the house. He lives by himself and needs to hire someone to help clean his house and do yardwork. He gets out of the house approximately three times per week, but his quality of life is very limited. When he goes out in public, he has trouble moving around and cannot sit for long periods of time without getting very stiff. Overall, he has a low level of function and severe disability related to his left knee. The private physician also opined that since at least 2016, the Veteran's bilateral elbow conditions have caused him a loss of function and moderate disability. He has limited range of motion and cannot fully extend or flex either elbow. He has trouble picking up objects, gripping, lifting, or squeezing with both hands. The combination of his orthopedic conditions significantly limits his functional activity. He cannot work full-time and is very limited in his ability to exercise. Overall, he has a moderate level
his quality of life is very limited. When he goes out in public, he has trouble moving around and cannot sit for long periods of time without getting very stiff. Overall, he has a low level of function and severe disability related to his left knee. The private physician also opined that since at least 2016, the Veteran's bilateral elbow conditions have caused him a loss of function and moderate disability. He has limited range of motion and cannot fully extend or flex either elbow. He has trouble picking up objects, gripping, lifting, or squeezing with both hands. The combination of his orthopedic conditions significantly limits his functional activity. He cannot work full-time and is very limited in his ability to exercise. Overall, he has a moderate level of disability related to his bilateral elbow conditions. The private physician further opined that since at least 2008, the Veteran's left hip has impacted his level of function. His hip is painful and tight. He walks with a limp and uses a cane. Overall, his left hip has caused a moderate level of disability since at least 2008. Finally, the July 2019 private physician opined that since at least 2016, the Veteran's left ankle condition has impacted his level of function and caused him a mild level of disability. He experiences tightness and pain posteriorly around the Achilles. He has difficulty with any walking. The Veteran reported that this left ankle did not bother him as much as his left knee and hip.

In April 2020, the Veteran provided a statement that his left knee condition is aggravated by climbing stairs, walking, or standing for long periods of time. He experienced stiffness and swelling with flare-ups and when walking long distances. His range of motion in both knees was reduced, and he had pain, fatigue, weakness, and lack of endurance, which affected his ability to stand or move.

In May 2020, the Veteran submitted a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability. The Veteran indicated that his knees prevented him from securing or following any substantially gainful employment. He stated that he had been self-employed since 2010, worked 20 to 25 hours per week, and had made up to $2,500 per month. He stated that he had made a total of $21,000 in earned income over the previous 12 months. However, he also stated that he became too disabled to work in 2018.

A July 2020 VA scars examination report shows that the Veteran's left knee scar did not cause any functional impairment.

A July 2020 VA knee examination report shows that the Veteran's knee disabilities caused difficulty with descending stairs and riding a bike. The Veteran reported limited range of motion while descending stairs.

In July 2020, the Veteran submitted a statement that he worked as a service technician for fitness equipment and as an events coordinator setting up and running weightlifting events. He worked 8 to 10 hours per week. He lost approximately 1,500 hours of work in the previous 12 months due to service-connected disabilities. His gross income was $16,000 and his net income was $9,000.

A January 2021 VA knee examination report shows that the Veteran reported that he had limited range of motion and difficulty with heavy lifting, prolonged standing, walking, light jogging, and climbing stairs. The examiner noted that the Veteran's knee conditions caused pain, stiffness, limited range of motion, and difficulty with bending and prolonged walking over 1 mile.

In September 2021, the Veteran submitted a private TDIU vocational assessment report. The private certified rehabilitation counselor opined that the Veteran's service-connected paroxysmal atrial fibrillation, arterial hypertension, low back strain, and bilateral lower extremity sciatic nerve dysfunction rendered him unable to secure or follow substantially gainful employment outside of a sheltered capacity, in any occupation regardless of skill or exertional level, since at least December 2008.

The Veteran reported that he obtains "4 to 6 hours" of intermittent sleep each night due to pain and discomfort associated with his service-connected orthopedic conditions. He has difficulty falling and remaining asleep because of orthopedic pain. Due to impaired sleep, the Veteran endorsed daytime fatigue and subsequent need for, "about 3" naps daily with each lasting, "30 to 60" minutes.

The Veteran's service-connected orthopedic pain and increased fatigue due to his service-connected cardiac conditions impacts his ability to concentrate. He is unable to maintain concentration throughout the day, even with simple activities such as remaining engaged in a conversation.

The Veteran cannot drive for very long because sitting and operating the pedals causes pain, and he has to hire contractors to do his housework, laundry, yardwork, and grocery shopping.

The Veteran worked 8 to 25 hours per week performing event director duties. He was physically unable to
asleep because of orthopedic pain. Due to impaired sleep, the Veteran endorsed daytime fatigue and subsequent need for, "about 3" naps daily with each lasting, "30 to 60" minutes.

The Veteran cannot drive for very long because sitting and operating the pedals causes pain, and he has to hire contractors to do his housework, laundry, yardwork, and grocery shopping.

The Veteran worked 8 to 25 hours per week performing event director duties. He was physically unable to set up events due to his disabilities and must subcontract out the work. He worked part time as a fitness equipment service technician. It takes him 2 to 3 hours to complete what would take others 30 minutes to complete. He has to take breaks. He is only able to do 4 or 5 service calls a week and no more than 20 hours of work "during a good week." He refuses larger jobs or will hire additional technicians to help him. He has to cancel or reschedule appointments due to orthopedic pain and will take a few days off to rest in between service calls.

The rehabilitation counselor opined that the Veteran's part-time work for his own business since 2008 has been performed in a sheltered work environment. He is able to create his own schedule, receive assistance from other workers, decline work without being reprimanded, and work minimal hours as dictated by the limitations associated with his service-connected conditions. Additionally, he hired subcontractors to perform all of the physical labor associated with setting up equipment for events. He has been able to perform his job tasks at his own pace, with assistance from others, and within a flexible schedule as his service-connected conditions permit. The Veteran has not been required to adhere to strict pace, attendance, or productivity standards, as are customarily expected in the competitive workforce. According to the counselor, this is not typically tolerated in the competitive workforce outside of a sheltered capacity. In the competitive workforce, an inability to meet these standards and expectations is overwhelmingly likely to lead to termination. Therefore, the counselor concluded that the Veteran's part-time employment for his own business since 2008 should not be considered substantially gainful.

The rehabilitation counselor opined that the Veteran's physical limitations are inconsistent with the full range of physical requirements of the sedentary exertional level. Sedentary work requires sitting for most of the work shift, as well as standing and walking for up to one third of an eight-hour workday. However, as a result of his low back strain condition, since at least December 2008, right lower extremity sciatic nerve dysfunction, since at least May 2010 and left lower extremity sciatic nerve dysfunction, since at least September 2012 respectively, the Veteran has been precluded from meeting the minimum sitting, standing, and walking requirements of even sedentary employment. Additionally, the Veteran is unable to fulfill the full range of physical requirements of sedentary employment on a consistent and reliable basis due to his service-connected paroxysmal atrial fibrillation and arterial hypertension since at least December 2008. Specifically, his cardiac conditions cause him to experience fatigue and shortness of breath with even minimal exertion, including brief periods of standing and walking.

The rehabilitation counselor opined that the combination of limitations from the Veteran's service-connected back and cardiac conditions since at least December 2008, as well as his service-connected bilateral lower extremity sciatic nerve dysfunction since at least May 2010 and September 2012, compromised his ability to meet employer expectations of adequate pace and productivity.

In September 2021, the Veteran submitted a private back disability benefits questionnaire (DBQ). The private examiner noted that the Veteran is unable to stand more than 20 minutes, sit more than 10 minutes, walk more than 150 feet, or lift and carry more than 20 pounds, and he can lift only from the waist to the shoulders and not overhead. The Veteran requires a change of position from sit to stand or stand to sit every 20 minutes and the ability to lay down flat with increased symptoms. The Veteran is unable to traverse uneven terrain, or climb, crawl, stoop or bend repetitively. He also requires a cane or crutches.

In September 2021, the Veteran submitted a private elbow DBQ. The examiner indicated that the Veteran's elbow disabilities limited his ability to lift, carry, push, and pull a maximum of 10 pounds.

In September 2021, the Veteran submitted a summary of Federal Insurance Contributions Act (FICA) earnings. The statement shows that the Veteran's FICA earnings for 2016 were $1,050; for
overhead. The Veteran requires a change of position from sit to stand or stand to sit every 20 minutes and the ability to lay down flat with increased symptoms. The Veteran is unable to traverse uneven terrain, or climb, crawl, stoop or bend repetitively. He also requires a cane or crutches.

In September 2021, the Veteran submitted a private elbow DBQ. The examiner indicated that the Veteran's elbow disabilities limited his ability to lift, carry, push, and pull a maximum of 10 pounds.

In September 2021, the Veteran provided a statement that in the 1990s, he started working for Fitness Depot as a fitness equipment technician. He worked with them for about six years. He also worked as a self-employed fitness trainer during the 1990s and early 2000s. He started working as a self-employed fitness equipment technician after he left Fitness Depot. His work remained similar to the duties he had with Fitness Depot but this way he had the ability to manage his own disabilities if he needed a day off or needed to take more time on a job. He no longer had the pressure of getting a certain number of jobs done or completing jobs in a specific amount of time. When he left Fitness Depot, he really could no longer keep up with the work. He was scared to explain to them that he could no longer handle the bigger jobs. Towards the end of his employment with them, he probably called off at least three to four times per month.

Beginning in 2015, he took a break from service calls as a technician for almost two years because he had hip surgery and tried to regain some function. He could not keep up with it anymore even after the surgery. He started working as a technician again in 2020, working only when he could. Additionally, he has worked as a self-employed event director on and off over the last ten years. He started putting on weightlifting events again in 2018. These events happen about once every three months. He used to be able to do these by himsef but now he needed to have people lined up to help. He had surgery on his left knee in November 2018 but still had limited range of motion with pain and stiffness, which further impacts his ability to work.

Since leaving the regular workforce, he has had intermittent employment. He will turn down jobs if they involve too much heavy equipment, working on the floor a lot, or too much time because of his physical limitations. He has tried to take on jobs like these that he would have had no problem with before 2008, but he ends up being unable to finish the job. With the events, he no longer travels either and sticks with those that are local. His disabilities have significantly interfered with his work over the years despite being able to make his own accommodations. He only handles about four to five calls per week compared to the ten calls per day the he used to complete before 2008. He can no longer assemble machines unless he knows someone will be able to assist, but he used to do it all by himself. He is very limited with respect to his knee and back. He cannot bend down or kneel on the floor despite having a knee replacement. He cannot stand for long periods of time, maybe ten to fifteen minutes at the most, before he has more severe back pain. He has pain that radiates into both of his legs and sometimes feels like his legs will give out. He notices weakness, tingling, and numbness in his lower extremities too.

He has to have people help him with his jobs, which can also take away from any income. Mostly, he works with guys who he has helped train and then they will help with some of the jobs. Without help from former trainees, he would not be able to do these jobs. He cannot afford to have anyone help regularly or on stand-by, so if he thinks a job may be too physically intense, he has to hire people ahead of time for the specific job. Usually, he needs help with jobs that involve assembling equipment, heavy lifting/carrying, or installations. Trying to lift anything over about 20 pounds is extremely difficult. He cannot bend very far either, so he has to be careful about certain movements or positions while working. But, if he does not suffer through some of the pain, then his bills will not get paid. He has had to make numerous accommodations to his schedule and job duties as a result of the limitations and symptoms associated with his service-connected conditions.

be able to do these jobs. He cannot afford to have anyone help regularly or on stand-by, so if he thinks a job may be too physically intense, he has to hire people ahead of time for the specific job. Usually, he needs help with jobs that involve assembling equipment, heavy lifting/carrying, or installations. Trying to lift anything over about 20 pounds is extremely difficult. He cannot bend very far either, so he has to be careful about certain movements or positions while working. But, if he does not suffer through some of the pain, then his bills will not get paid. He has had to make numerous accommodations to his schedule and job duties as a result of the limitations and symptoms associated with his service-connected conditions.

He has tried epidural injections in the past but currently only has Tylenol to help with the pain as he is no longer able to get other pain medications through the VA. He takes Tylenol every four hours on a daily basis for his constant back pain. Without regular medication, he would not be able to get any work done. Sometimes he has to completely stop working because the pain in his back and lower extremities becomes too much and he picks back up the next day. This happens at least two to three times per week. Other times, he tries to work too long or too much, for a couple of hours, and his back gets really stiff, and everything hurts to the point that he can hardly stand up straight. It has been this bad at least over the last two to three years but steadily getting worse. Since all of his physical problems started after the military, everything just gets worse and worse as the years go on.

He still has heart palpitations and atrial fibrillation episodes despite his current medications. He cannot have caffeine and drinks straight water. He experiences chest pain, weakness, fatigue, and shortness of breath which makes working consistently more difficult. He continues to take blood pressure medications as well. But if he has to bend down a lot on a job or have his head down, he becomes dizzy. He has episodes of dizziness approximately three to four times per week and sometimes more depending on the type of work. These episodes last an average of five to ten minutes and take away from his work since he has to relax until the dizziness subsides.

He has only worked for himself since leaving Fitness Depot so that he can manage his schedule and workload to accommodate his physical limitations. He takes a lot of breaks and sometimes takes three hours for jobs that he used to complete in thirty to forty-five minutes because of how often he has to stop and rest. That is why he had to switch to self-employment and cut back on how many service calls and events he accepts. Most of the time, he tries to finish each call in the same day but there have been times that he has to come back over the course of a week to finish. The only reason he can keep up with the weightlifting events now is because he coordinates everything on the computer and then delegates the physical responsibilities. It takes away from his income having to do it this way and hire outside help, but he needs something to keep going.

Aside from his employment, his conditions impact his daily activities as well. He hires people for home maintenance projects and yardwork. He is limited in simple day to day activities. He continues to have difficulties walking, bathing, sleeping, and getting in and out of his bed and truck.

An October 2021 VA sleep apnea examination report shows that the Veteran's OSA does not impact his ability to work.

In a January 2022 VA knee examination report, the examiner indicated that the Veteran's knee disabilities interfered with his ability to perform job duties because they prevented him from standing, walking, or running for a prolonged period of time.

In a January 2022 VA scars examination report, the examiner noted that the Veteran's left knee scar did not impact his ability to work.

In March 2022, the Veteran submitted a statement that he has pain in all of his joints. His knees, in particular, prevent him from doing the things he used to do and are extremely painful. Bending, squatting, and bearing weight on them is painful. The Veteran stated that this issue has been one thing that has led him to being unemployable.

In April 2023, the Veteran submitted a Social Security Administration earnings statement. The statement showed that the Veteran earned $1,050 in 2016; $1,517 in 2017; $6,685 in 2018; $3,118 in 2019; $4,413 in 2020; and $0 in 2021.

In April 2023, the Veteran submitted a VA Form 21-8940. He indicated that his bilateral knee disabilities prevented him from securing or following any substantially gainful occupation. The Veteran reported that he became too
ting, and bearing weight on them is painful. The Veteran stated that this issue has been one thing that has led him to being unemployable.

In April 2023, the Veteran submitted a VA Form 21-8940. He indicated that his bilateral knee disabilities prevented him from securing or following any substantially gainful occupation. The Veteran reported that he became too disabled to work in June 2018. He reported that he earned $300,000 in 2022 as an event director. He had been self-employed as an event director since January 2010 and works between 20 and 25 hours per week. He indicated that he earned $300,000 over the prior 12 months.

Later that month, the Veteran submitted a statement that before he began his self-employment, he worked in the mechanical industry where he worked on fitness equipment, which was labor intensive, he was unable to keep up with the labor demand due to his bad knees. Eventually, in 2010, he created Goggins Force LLC, where he works independently as an event coordinator. He can only manage to work a maximum of 20 to 25 hours per week. He tries his best to stay off of his feet to avoid being in as much pain as possible. Since he started, he typically earns under $6,000 a year. However last year, he won a bid to host a national event. He earned $300,000 hosting that event, but most of earnings went to paying the nearly 100 employees that worked the event, and other fees associated with setting up an event that large. Overall, he only earned about $40,000 in 2022.

The same month, the Veteran also submitted Internal Revenue Service (IRS) records. The records included mortgage statements for 2013, 2014, 2015, 2016, 2017, and 2018. The records for these years did not include taxable income. However, the records did include the Veteran's income for 2019, 2020, 2021, and 2022. The Veteran's taxable income for 2019 was $3,118; for 2020 was $4,413; for 2021 was $0; and for 2022 was $40,326.

In a November 2025, the Veteran submitted another private TDIU vocational assessment report. The private certified rehabilitation counselor opined that considering the medical records from multiple service providers as it relates to limitations solely of the Veteran's service-connected left hip condition, considered alone without consideration of any other service-connected or non-service-connected conditions, the Veteran has been unable to secure or follow substantially gainful employment, regardless of skill or exertional level, since at least between November 2013 and June 2016. The rehabilitation counselor interviewed the Veteran, provided his educational background, his occupational background, including his income from 2013 through 2021, and reviewed his VA claims file in its entirety. Based on the Veteran's service-connected hip-related functional limitations, the rehabilitation counselor concluded that it is at least as likely as not that the Veteran has been unable to meet the full range of physical requirements of even the sedentary exertional level on a consistent and reliable basis. The Veteran's left hip condition causes limitations in sitting, standing, and walking that are inconsistent with the physical requirements of sedentary employment. Due to his left hip condition, he is unable to sit for the majority of the workday or stand and walk for up to one-third the duration of an eight-hour workday, or up to two and two-thirds hours per day, as is required of even sedentary employment. The Veteran's service-connected left hip condition has at least as likely as not compromised his ability to meet employer expectations of adequate pace and productivity since at least between November 2013 and June 2016. The Veteran experiences flare-ups of pain that require him to rest in attempt to alleviate pain, which would require him to pause work tasks throughout the day. The Veteran needs to pause work tasks throughout the workday to tend to episodes of flare-ups would at least as likely as not slow the pace at which he is able to complete work tasks. In a work setting, the Veteran's distracting pain and discomfort would at least as likely as not cause periods of off-task behavior, during which time he would not be focused on work assignments. These pauses occur at a frequency that would slow the pace at which he is able to complete work tasks. His reduced pace
expectations of adequate pace and productivity since at least between November 2013 and June 2016. The Veteran experiences flare-ups of pain that require him to rest in attempt to alleviate pain, which would require him to pause work tasks throughout the day. The Veteran needs to pause work tasks throughout the workday to tend to episodes of flare-ups would at least as likely as not slow the pace at which he is able to complete work tasks. In a work setting, the Veteran's distracting pain and discomfort would at least as likely as not cause periods of off-task behavior, during which time he would not be focused on work assignments. These pauses occur at a frequency that would slow the pace at which he is able to complete work tasks. His reduced pace due to these limitations would at least as likely as not preclude his ability to produce a sufficient minimum amount of work to meet employer expectations of adequate pace and productivity on a consistent and reliable basis. Regardless of his education and work history, the Veteran's reduced pace and productivity, inability to meet the demands of even unskilled sedentary work consistently and reliability, and impaired concentration would not be tolerated in even simple, unskilled sedentary occupations. As a result, he has been precluded from securing and following any substantially gainful occupation due to his service-connected left hip since at least between November 2013 and June 2016.

Analysis

Upon review of the record, the Board finds that the evidence supporting and against a finding that the Veteran was unable to secure or follow substantially gainful employment based solely on his left hip disability is in at least approximate balance. Thus, affording the Veteran the benefit of the doubt, entitlement to a TDIU based solely on his left hip disability from June 2, 2016 to November 13, 2018; from January 1, 2020 to April 27, 2023; and from September 1, 2023, is warranted.

Regarding the TDIU functional component, the medical, vocational, and lay evidence demonstrate that the Veteran had several service-connected disabilities that affected his ability to work during the appeal period. The Veteran has stated that his service-connected back, left hip, bilateral knee, bilateral elbow, left ankle, and heart disabilities affect his ability to work to varying degrees. In September 2021 a private certified rehabilitation counselor opined in a TDIU vocational assessment report that the Veteran was unable to secure or following substantially gainful employment, including sedentary employment, due to his service-connected heart, hypertension, back, and bilateral lower extremity sciatic nerve dysfunction disabilities. However, this report was submitted prior to the May 2024 rating decision eventually granting the Veteran's claim for service connection for his left hip, which he had pursued since 2013. Furthermore, in November 2025, a little over a year after he was awarded service connection for his left hip, the Veteran submitted a private TDIU vocational assessment report from another private certified rehabilitation counselor. This report establishes that due solely to the Veteran's service-connected left hip condition, considered alone without consideration of any other service-connected or non-service-connected conditions, he has been unable to secure or follow substantially gainful employment, regardless of skill or exertional level, since at least between November 2013 and June 2016. In other words, notwithstanding any other disabilities that may otherwise render the Veteran unemployable, his service-connected left hip disability has otherwise solely prevented him from securing or following substantially gainful employment, including sedentary employment, since at least between November 2013 and November 2016. The rehabilitation counselor's opinion specifically encompassed the Veteran's occupational functional limitations due to his left hip currently and during the 2013 to 2016 timeframe. Thus, to the extent that the evidence regarding whether the Veteran's left-hip disability independently limited his physical and mental ability to perform the types of activities required by an occupation consistent with his level of education, skills and training, and previous work experience is in at least approximate balance, the Board resolves any reasonable doubt in the Veteran's favor.

Regarding the TDIU economic component, the evidence shows that the Veteran earned $1,050 in 2016; $1,517 in 2017; $6,685 in 2018; $3,118 in 2019; $4,413 in 2020; and $0 in 2021. Therefore, his yearly income was well below the applicable federal poverty threshold in 2016 ($12,486), 2017 ($12,752), 2018 ($13,064), 2019 ($13,300), 2020 ($13,465), and 2021 ($14,097). Therefore, his employment during these periods was marginal. Although his income in 2022 was well above the $15,225 federal poverty threshold, the Veteran stated that
earned $1,050 in 2016; $1,517 in 2017; $6,685 in 2018; $3,118 in 2019; $4,413 in 2020; and $0 in 2021. Therefore, his yearly income was well below the applicable federal poverty threshold in 2016 ($12,486), 2017 ($12,752), 2018 ($13,064), 2019 ($13,300), 2020 ($13,465), and 2021 ($14,097). Therefore, his employment during these periods was marginal. Although his income in 2022 was well above the $15,225 federal poverty threshold, the Veteran stated that his annual income was typically about $6,000. His unusually higher income in 2022 was due to an atypical contract award.

Regardless, the evidence demonstrates that he was working in a protected work environment during the entire appeal period. The Veteran was self-employed as a part-time fitness equipment service technician, completing about 4 or 5 calls per week, and as a weightlifting event planner, completing one event about every three months. He was only physically able to work part time for up to 25 hours a week, but often less than that. He must take time off work to rest in between fitness equipment service calls, which also take him much longer to complete than typically expected (in 2008, he completed 10 calls per day) due to his disability-related physical and concentration limitations. He requires several naps a day. Sometimes he must cancel or reschedule service calls. He must refuse some physically demanding service call jobs or hire additional technicians to help him, which limits his income. He must subcontract the labor to perform physical duties associated with weightlifting event planning jobs, which also limits the Veteran's income. His self-employment has allowed him to create his own schedule, receive assistance from other workers, decline work without being reprimanded, and work minimal hours as dictated by the limitations associated with his service-connected conditions. His self-employment has allowed him to perform his job tasks at his own pace, with assistance from others, and within a flexible schedule to accommodate his disability-related limitations. The Veteran has not been required to adhere to strict pace, attendance, or productivity standards, as are customarily expected in the competitive workforce. Vocational rehabilitation evidence demonstrates that this is not typically tolerated in the competitive workforce outside of a sheltered capacity. In the competitive workforce, an inability to meet these standards and expectations is overwhelmingly likely to lead to termination. Thus, the Veteran's employment is shielded in some respect from competition in the employment market. Accordingly, the Board finds that the Veteran's employment was marginal throughout the review period because his earnings were either below the applicable federal poverty threshold or he was otherwise self-employed in a protected work environment.

Based on this, resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran's left hip disability prevented him from securing or following a substantially gainful occupation. Therefore, a TDIU based solely on his left hip disability is warranted from June 2, 2016 to November 13, 2018; from January 1, 2020 to April 27, 2023; and from September 1, 2023, and the claim is granted.

2. Entitlement to statutory SMC at the housebound rate, from June 2, 2016 to November 13, 2018; from January 1, 2020 to April 27, 2023; and from September 1, 2023.

Although the Veteran has not explicitly claimed SMC at the housebound rate, VA has a duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); see also Bradley v. Peake, 22 Vet. App. 280, 294 (2008) (finding that SMC "benefits are to be accorded when a veteran becomes eligible without need for a separate claim").

SMC at the housebound rate is payable when a veteran has a single service-connected disability rated as 100 percent (based on the rating criteria or a TDIU rating) and (1) has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the total disability rating and involves different anatomical segments or bodily systems, or (2) is permanently housebound by reason of a service-connected disability or disabilities. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). A TDIU rating may satisfy the requirement for a single disability rated as total
be accorded when a veteran becomes eligible without need for a separate claim").

SMC at the housebound rate is payable when a veteran has a single service-connected disability rated as 100 percent (based on the rating criteria or a TDIU rating) and (1) has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the total disability rating and involves different anatomical segments or bodily systems, or (2) is permanently housebound by reason of a service-connected disability or disabilities. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). A TDIU rating may satisfy the requirement for a single disability rated as total, if awarded on the basis of a single disability. See Bradley, supra.

In this case, the Board has granted TDIU based solely on the Veteran's service-connected left hip disability from June 2, 2016 to November 13, 2018; from January 1, 2020 to April 27, 2023; and from September 1, 2023. Thus, for SMC purposes, the Veteran's left hip disability satisfies the requirement of a service-connected disability rated as total. See Buie, 24 Vet. App. 251; Bradley, 22 Vet. App. 293. As previously discussed, the Veteran is service connected for atrial fibrillation rated at 60 percent from December 15, 2008. Therefore, the Veteran meets the statutory housebound criteria and is entitled to SMC at the housebound

rate from June 2, 2016 to November 13, 2018; from January 1, 2020 to April 27, 2023; and from September 1, 2023.

W. Daknis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Heely, J.

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.

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