Case A26040561

Summary

The veteran, who served in the United States Marine Corps from January 1979 to December 1982, appeals the agency of original jurisdiction's (AOJ) rating decision. The veteran sought an earlier effective date for service connection for vascular headaches, a total disability rating based on individual unemployability (TDIU), and special monthly compensation (SMC) based on housebound criteria. The Board granted entitlement to service connection for vascular headaches with an effective date of August 22, 2011, finding that the evidence was in approximate balance and affording the veteran the benefit of the doubt. The Board also granted entitlement to TDIU, effective February 11, 2015, concluding that the veteran's combined service-connected disabilities, including vascular headaches, heart problems, syncope, cerebral arteriosclerosis, and hypertension, precluded him from securing or following substantially gainful employment. The Board denied entitlement to an earlier effective date for SMC housebound, finding that the veteran only met the disability percentage criteria for this benefit on July 14, 2020, the date his depressive disorder was rated at 100 percent. The Board also noted insufficient evidence to support a finding of being permanently housebound.

Rationale

Evidence in approximate balance; Benefit of the doubt afforded; Grant of earlier effective date

Full Decision Text

Citation Nr: A26040561
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250926-590291
DATE: April 30, 2026

ORDER

Entitlement to an effective date of August 22, 2011, but no earlier, for entitlement to service connection for vascular headaches is granted.

Entitlement to a total disability rating based on individual unemployment is granted, effective February 11, 2015.

Entitlement to an effective date prior to July 14, 2020, for special monthly compensation based on housebound criteria (SMC) being met is denied.

FINDINGS OF FACT

1. When resolving doubt in favor of the Veteran, the most probative evidence supports a finding that the Veteran's headaches, associated with his cerebral arteriosclerosis, should be effective the date of the associated cerebral arteriosclerosis.

2. The most probative evidence shows that the Veteran's combined service-connected disabilities did preclude him from securing or following a substantially gainful occupation and that he met schedular criteria on February 11, 2015.

3. The criteria for SMC was first met on July 14, 2020, when the Veteran obtained a disability of 100 percent plus a total rating of at least 60 percent of other disabilities associated with his active duty service.

4. There has been no evidence provided that there is a facts found basis of the Veteran being permanently bedridden and unable to leave the house.

CONCLUSIONS OF LAW

1. The criteria for an effective date of August 22, 2011, but no earlier, for entitlement to service connection for vascular headaches have been met.  38 U.S.C. §§ 5110, 5107; 38 C.F.R. § 3.400.

2. The criteria for entitlement to a TDIU, effective February 11, 2015, have been met.  38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.15, 4.16, 4.18, 4.19.

3. The criteria for an earlier effective date, prior to July 14, 2020, for entitlement to SMC housebound have not been met. 38 U.S.C. §§ 1114(s), 5110; 38 C.F.R. §§ 3.350(i), 3.400.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty with the United States Marine Corps from January 1979, until December 1982.

The rating decision on appeal was issued in August 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In May 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a March 2025, rating decision.  In August 2025, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior March 2025, rating decision.

In the September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On December 23, 2025, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the March 2025, agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 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.
 subsequently subject to higher-level review and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 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. 

1. Entitlement to an effective date of August 22, 2011, but no earlier, for entitlement to service connection for vascular headaches is granted.

The Veteran asserts that he is entitled to an effective date prior to July 14, 2020, for entitlement to an increased 50 percent disability rating for vascular headaches because these headaches have been present in medical treatment records prior to the current effective date.

The question(s) for the Board are:

(1)	Whether VA received an informal or formal claim for an increased disability rating for this disability prior to July 14, 2020;

(2)	If the increase in disability occurred after the claim was filed, the date that the increase is shown to have occurred (date entitlement arose), was it prior to July 14, 2020 (38 C.F.R. § 3.400(o)(1));

(3)	If the increase in disability preceded the claim by a year or less, was the date that the increase was shown to have occurred (factually ascertainable) prior to July 14, 2020 (38 C.F.R. § 3.400(o)(2)); or

(4)	If an increase in disability preceded the claim by more than a year, was the date that the claim was received (date of claim) prior to July 14, 2020 (38 C.F.R. § 3.400(o)(2))?

The Board initially concludes that, based on the evidence of record, a claim for headaches can be inferred from August 22, 2011, the date of the Veteran's claim for cerebral arteriosclerosis. Second, the Board finds that the Veteran has experienced symptoms similar to those diagnosed formally by the January 2020, VA examiner. Third, the Board finds that there is no evidence that the Veteran's headache disability predated August 22, 2011, by a year or less. Lastly, the Board finds that since the Veteran's headache disability preceded the date of the August 22, 2011, claim, by more than one year, the date of entitlement is the date of the August 22, 2011, claim. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2). 

In rendering this decision, the Board has reviewed all evidence of record whether or not discussed in detail. See Newhouse v. Nicholson, 497 F.3d 1298, 1302 (Fed. Cir. 2007) (holding the Board must only discuss the evidence which is relevant to the issues on appeal). Based on the discussion above, the Board finds that the evidence is in approximate balance, and the Veteran is afforded the benefit of the doubt. Lynch v. McDonough, 21 F. 4th 776 (Fed, Cir. 2021) (holding that exact equipoise is not required for the benefit of the doubt to be applied, but rather the Veteran is entitled to the benefit of the doubt when the evidence is in approximate balance or "nearly equal").

Accordingly, the claim for an earlier effective date is granted, effective August 22, 2011, but no earlier, for entitlement to service connection for vascular headaches.  There is no doubt to resolve.  38 U.S.C. § 5107(b).

2. Entitlement to a total disability rating based on individual unemployment is granted, effective February 11, 2015.

The Veteran seeks a TDIU and asserts that multiple service-connected disabilities affect his ability to maintain gainful employment.

A TDIU may be assigned, where the schedular rating is less than total, where a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). To qualify for schedular consideration of a TDIU, if there is only one such disability, this disability shall be ratable at 60 percent or more, and, if there are two or more disabilities
. § 5107(b).

2. Entitlement to a total disability rating based on individual unemployment is granted, effective February 11, 2015.

The Veteran seeks a TDIU and asserts that multiple service-connected disabilities affect his ability to maintain gainful employment.

A TDIU may be assigned, where the schedular rating is less than total, where a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). To qualify for schedular consideration of a TDIU, if there is only one such disability, this disability shall be ratable at 60 percent or more, and, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. Id. 

For the purposes of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disabilities of one or both upper extremities, one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from common etiology or a single accident; (3) disabilities affecting a single body system, e.g., orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric; (4) multiple injuries incurred in action; or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a); see Moody v. Wilkie, 30 Vet. App. 329, 339 (2018) (combining disabilities as "one disability" to meet the rating threshold of § 4.16(a) requires the use of the combined rating table).

The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component refers to an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Id. The noneconomic component requires a determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to the veteran's history, education, skills, and training; whether the veteran has the physical ability (both exertional and nonexertional) to perform the types of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Id.

An award of TDIU is an individualized determination, specific to a veteran's particular circumstances, e.g., their history, education, skills, and training. See Todd v. McDonald, 27 Vet. App. 79, 85 (2014). It does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether they are capable of performing the physical and mental acts required by employment, not whether they can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993).

The Veteran has the following disabilities that are service connected: depressive disorder, rated at 100 percent since July 14, 2020; vascular headaches rated at 50 percent since August 22, 2011 (as addressed above); syncope associated with hypertension, rated at 30 percent from August 22, 2011; cerebral arteriosclerosis, rated at 10 percent since August 22, 2011, and hypertension, rated at a noncompensable rate since August 22, 2011.

Based on the forgoing, the Veteran has at least one disability rated at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more, as of August 22, 2011. However, the Veteran provided evidence to VA in a letter received on April 10, 2019, that he was gainfully employed until February 10, 2015. Accordingly, the Board may consider the claim for a TDIU on a schedular basis. 38 C.F.R. § 4.16(a).

For the reasons that follow, the Board finds that a TDIU is warranted.

The Veteran has a GED, and worked as a fork-lift operator, carpenter and truck driver
 the forgoing, the Veteran has at least one disability rated at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more, as of August 22, 2011. However, the Veteran provided evidence to VA in a letter received on April 10, 2019, that he was gainfully employed until February 10, 2015. Accordingly, the Board may consider the claim for a TDIU on a schedular basis. 38 C.F.R. § 4.16(a).

For the reasons that follow, the Board finds that a TDIU is warranted.

The Veteran has a GED, and worked as a fork-lift operator, carpenter and truck driver during his relevant working history. The Veteran provided information related to his employment history in his VA Forms 21-8940 and the Board also reviewed SSA records related to the Veteran's employment and disability history.

The Veteran's ability to secure and follow a substantially gainful occupation is impacted by the physical effects of his service-connected vascular headaches, heart problems, including hypertension and syncope, and cerebral arteriosclerosis. The Veteran has received VA examinations related to these service-connected disabilities showing that as a result of the disabilities, the Veteran has suffered significant functional loss to his cognitive abilities and fine motor skills.

These examinations show that the Veteran's ability to secure and follow a substantially gainful occupation is impacted by both mental and physical limitations.

Given the forgoing, service-connected disabilities preclude the Veteran from the ability to secure and follow a substantially gainful occupation consistent with the Veteran's education, skills, training, and work history. 

The Board finds that it is a combination of all of Veteran's service-connected disabilities that resulted in the Veteran's inability to maintain gainful employment. Additionally, as stated above, the Veteran has at least one disability rated at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more, as of August 22, 2011, which is the earliest date of entitlement to TDIU on a schedular basis. However, as stated above, the Veteran was employed, making him ineligible for TDIU, until February 10, 2015.

The evidence of record does not support a finding of TDIU on an extraschedular basis, as the Veteran's disability compensation for his current disabilities have all been within the contemplated rating criteria. Accordingly, referral of the claim for an extraschedular TDIU is not warranted.

Accordingly, a TDIU is warranted, effective February 11, 2015, the earliest date in which the Veteran met the schedular criteria and was unemployed due to service-connected disabilities.

3. Entitlement to an effective date prior to July 14, 2020, for special monthly compensation based on housebound criteria (SMC) being met is denied.

Under 38 U.S.C. § 1114(s), SMC is payable at the housebound rate where the Veteran has a single service-connected disability rated as 100 percent disabling and, in addition, (1) has a service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. See 38 C.F.R. § 3.350 (i).

VA has a duty to maximize benefits and should consider any SMC that is raised by the record. Bradley v. Peake, 22 Vet. App. 280, 294 (2008); AB v. Brown, 6 Vet. App. 35, 38-39 (1993).

The Veteran's VA Form 10182 noted the area of disagreement as "denial of special monthly compensation based on housebound criteria prior to July 14, 2020."

The Veteran must have the requisite evaluations of service-connected disabilities to qualify for SMC. As stated above, the VA has a duty to maximize benefits and consider any SMC that is raised by the record. In this case, SMC was raised by the record once the Veteran was evaluated at 100 percent for a single disability and 60 percent for the remaining disabilities. The Veteran met the SMC housebound criteria on the basis of his disability percentage ratings and not on the basis of being permanently housebound.

In this case the Veteran has the following disabilities: depressive disorder, rated at 100 percent since July 14, 2020; vascular headaches rated at 50 percent since August 22, 2011 (as addressed above); syncope associated with hypertension, rated at 30 percent from August 22, 2011; cerebral arteriosclerosis, rated at 10 percent since August 22, 2011, and hypertension, rated at a noncompensable rate since
 the record once the Veteran was evaluated at 100 percent for a single disability and 60 percent for the remaining disabilities. The Veteran met the SMC housebound criteria on the basis of his disability percentage ratings and not on the basis of being permanently housebound.

In this case the Veteran has the following disabilities: depressive disorder, rated at 100 percent since July 14, 2020; vascular headaches rated at 50 percent since August 22, 2011 (as addressed above); syncope associated with hypertension, rated at 30 percent from August 22, 2011; cerebral arteriosclerosis, rated at 10 percent since August 22, 2011, and hypertension, rated at a noncompensable rate since August 22, 2011.

Based on the criteria for SMC, the Veteran only met these criteria on the effective date of his depressive disorder, which is July 14, 2020.

The Board in this decision has already granted entitlement to vascular headaches at a rating of 50 percent, effective August 22, 2011, and TDIU, effective February 11, 2015. 

The requirement of "a service-connected disability rated as total" for SMC at the housebound rate under 38 U.S.C. § 1114(s) can only be met through a single disability; it cannot be met by a TDIU based on multiple disabilities, or a combination of disabilities that could be considered "one disability" under 38 C.F.R. § 4.16(a). Based on the required criteria, to include that the Board cannot combine the TDIU with other disabilities prior to July 14, 2020, the Veteran is not entitled to an earlier effective date for SMC Housebound.

The Board has reviewed the evidence of record and there is insufficient evidence to grant SMC housebound on a factual basis as there is no evidence that the Veteran is unable to leave the house. Additionally, there is insufficient evidence to support a finding of another SMC.

Accordingly, the Veteran is not entitled to SMC housebound prior to July 14, 2020.

 

 

Cynthia M. Bruce

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R. Liggitt, Associate 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.