Citation Nr: 0811150 Decision Date: 04/04/08 Archive Date: 04/14/08 DOCKET NO. 05-29 287 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to an increased disability rating for service-connected peripheral neuropathy and carpal tunnel syndrome of the left arm, currently evaluated as 20 percent disabling effective March 31, 2004. 2. Entitlement to an increased disability rating for service-connected coronary artery disease (CAD), currently evaluated as 10 percent disabling effective March 26, 2002. 3. Entitlement to a compensable initial disability rating for nonproliferative diabetic retinopathy, currently evaluated as noncompensably (0 per cent) disabling effective March 7, 2002. REPRESENTATION Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J. Alsup, Associate Counsel INTRODUCTION The veteran served on active duty from May 1968 to August 1970. Service in Vietnam is evidenced in the record. This matter comes before the Board of Veterans' Appeals (the Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The veteran's January 2003 claim was partially granted in an August 2003 rating decision which granted service connection for peripheral neuropathy for bilateral arms, CAD, and retinopathy, and denied service connection for renal cancer and renal failure. The veteran disagreed with the disability evaluations. In an August 2005 rating decision, the RO increased the veteran's initial disability ratings for bilateral upper extremities peripheral neuropathy, diabetes Type II, and granted service connection for peripheral neuropathy for bilateral lower extremities. The veteran's September 2005 substantive appeal addressed only the issues of entitlement to an increased disability rating for left arm peripheral neuropathy, CAD and retinopathy. The veteran waived his right to present evidence before a Veterans Law Judge. Issues not on appeal As noted above, the August 2003 rating decision denied service connection for renal cancer and renal failure. However, the veteran did not raise that issue in his April 2004 notice of disagreement (NOD). Thus, the issue is not in appellate status and will be addressed no further herein. See Archbold v. Brown, 9 Vet. App. 124, 130 (1996) [pursuant to 38 U.S.C.A. § 7105(a), the filing of a NOD initiates appellate review in the VA administrative adjudication process, and the request for appellate review is completed by the claimant's filing of a substantive appeal after a statement of the case is issued by VA]. The August 2005 rating decision granted service connection for bilateral lower extremity peripheral neuropathy, evaluating each as 10 percent disabling effective April 20, 2005. The veteran did not raise the disability ratings in any NOD of record. Thus, the issues are not in appellate status. See Archbold supra. The August 2005 rating decision denied an increased disability rating for service-connected diabetes Type II. The veteran did not raise the issue in any NOD of record. Thus, the issue is not in appellate status. See Archbold supra. The veteran was granted entitlement to individual unemployability (TDIU) effective May 11, 2004, and basic eligibility to Dependent's Educational Assistance effective from May 11, 2004. There is no NOD of record regarding either issue. Thus, they are also not in appellate status. See Archbold supra. FINDINGS OF FACT 1. The veteran's left arm peripheral neuropathy is manifested by weakness and some symptoms of carpel tunnel syndrome. 2. The veteran's CAD is manifested by complaints of inability to walk a distance greater than 3 blocks without rest. 3. The veteran's service-connected nonproliferative diabetic retinopathy is manifested by corrected distant visual acuity of 20/25 for the right eye and 20/30 for the left eye, with no evidence of a deficit in field vision. CONCLUSIONS OF LAW 1. Entitlement to an increased disability rating for service-connected left arm peripheral neuropathy is not warranted. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.124a, Diagnostic Code 8515 (2007). 2. The criteria for an increased disability rating for service-connected CAD are met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.104, Diagnostic Code 7005 (2007). 3. Entitlement to an increased disability rating for service-connected nonproliferative diabetic retinopathy is not warranted. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.84a, Diagnostic Code 6079 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran is service-connected for diabetes Type II due to exposure to herbicides during his service in Vietnam. His service-connected left arm peripheral neuropathy, CAD and retinopathy conditions are secondary to his diabetes disability. The veteran essentially contends that the disabilities are worse than recognized by VA. As noted above, the RO granted an increased disability rating for the veteran's left arm peripheral neuropathy disability. However, because it was not a grant of full benefits, the Board will address the merits of the issue. See AB v. Brown, 6 Vet. App. 35, 38 (1993) [when a veteran is not granted the maximum benefit allowable under the Rating Schedule, the pending appeal as to that issue is not abrogated]. The Board will address certain initial matters and then analyze the merits of the issues. Duties to notify and assist Upon receipt of a substantially complete application for benefits, VA must notify the claimant what information or evidence is needed in order to substantiate the claim and it must assist the claimant by making reasonable efforts to get the evidence needed. 38 U.S.C.A. §§ 5103(a), 5103A; 38 C.F.R. § 3.159(b); see Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The notice required must be provided to the claimant before the initial unfavorable decision on a claim for VA benefits, and it must (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; (3) inform the claimant about the information and evidence the claimant is expected to provide; and (4) request or tell the claimant to provide any evidence in the claimant's possession that pertains to the claim. 38 U.S.C.A. §§ 5103(a); 38 C.F.R. § 3.159(b)(1); Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004). In this case, the RO did provide the appellant with notice of the evidence needed to establish service connection, VA's obligation to obtain records and other evidence in support of the veteran's claim, and notice that any necessary medical examination would be provided prior to the initial decision on the claim in a letter dated September 2005. Moreover, the veteran was informed of the evidence necessary to establish an increased disability rating for the issues raised in his notice of disagreement in a letter dated September 2005. Specifically, the letters stated that the evidence must show that his service connected disabilities have increased in severity. Additionally, the statement of the case (SOC) notified the veteran of the reasons for the denial of his application and, in so doing, informed him of the evidence that was needed to substantiate his claim. In addition, the RO notified the veteran in that reasonable efforts would be made to help him obtain evidence necessary to support his claim, including that VA would request any pertinent records held by Federal agencies, such as military records, and VA medical records. The veteran was also informed that a medical examination would be provided or that a medical opinion would be obtained if it was determined that such evidence was necessary to make a decision on his claim. Finally, in the notice letter, the RO informed the claimant to submit any evidence in his possession that pertains to the claim. Thus, because each of the four notice requirements has been fully satisfied in this case, any error in not providing a single notice to the appellant covering all content requirements is harmless error. Further, during the pendency of this appeal, the United States Court of Appeals for Veterans Claims (Court) issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473, noted above, which held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 1) veteran status; 2) existence of a disability; (3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. The Court held that upon receipt of an application for a service- connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Additionally, this notice must include notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. In this case, the first three elements are not in dispute since the veteran's claimed disabilities were service- connected. As noted above, the veteran received adequate notice of those elements. With regard to elements (4) and (5), because the veteran's claims were denied, any failure to notify could not result in any prejudice to the veteran. Moreover, the veteran's representative's informal briefs submitted in April 2006 and June 2007 make clear that the veteran, through his representative, had knowledge of the requirements of elements (4) and (5). Thus, the Board finds that any failure to notify the veteran of those elements did not result in any prejudice to the veteran. In addition, the duty to assist the appellant has also been satisfied in this case. The veteran's service medical records as well as all available VA treatment records are in the claims file and were reviewed by both the RO and the Board in connection with his claim. He was also afforded VA examinations in connection with his claims for peripheral neuropathy, CAD and diabetic retinopathy. VA has further assisted the veteran and his representative throughout the course of this appeal by providing them with a SOC, which informed them of the laws and regulations relevant to the veteran's claim. For these reasons, the Board concludes that VA has fulfilled the duty to assist the veteran in this case. Additionally, the Board finds that the veteran received appropriate notice, with respect to the increased rating claims, under Vazquez-Flores v. Peake, No. 05-0355 (U.S. Vet. App. January 30, 2008). Specifically, the SOC informed the veteran of the specific diagnostic code criteria which applied to his case. Significantly, the veteran's representative has submitted briefs in support of the veteran's claim dated April 2006 and June 2007. In the briefs, the veteran's representative addressed the diagnostic codes pertaining to the veteran's claims for all disabilities, and noted relevant symptomatology for those disabilities. Such statements make clear that the veteran through his representative had actual knowledge of the information required under Vazquez-Flores. The Board additionally observes that all appropriate due process concerns have been satisfied. See 38 C.F.R. § 3.103 (2007). The record reveals that the veteran waived his right to a hearing before a local hearing officer and did not seek a hearing before a Veterans Law Judge. See veteran's VA Form 9 dated September 2005. The Board will therefore proceed to a decision on the merits of each issue. 1. Entitlement to an increased disability rating for service-connected peripheral neuropathy and carpal tunnel syndrome of the left arm, currently evaluated as 20 percent disabling effective March 31, 2004. Relevant law and regulations Increased ratings - in general Disability evaluations are determined by the application of the VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4 (2007). The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual disorders in civil occupations. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 3.321(a), 4.1 (2007). Assignment of diagnostic code The veteran's service-connected left arm peripheral neuropathy is rated under 38 C.F.R. § 4.124a, Diagnostic Code 8515 [The median nerve; Paralysis of]. The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the diagnosis and demonstrated symptomatology. Any change in a diagnostic code by a VA adjudicator must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). Diagnostic Code 8515 is deemed by the Board to be the most appropriate primarily because it pertains specifically to the primary diagnosed disability in the veteran's case (peripheral neuropathy with symptoms of carpal tunnel syndrome). The Board can identify nothing in the evidence to suggest that another diagnostic code would be more appropriate, and the veteran has not requested that another diagnostic code be used. Accordingly, the Board concludes that the veteran is appropriately rated under Diagnostic Code 8515. Specific scheduler criteria Diagnostic Code 8515 provides that when the veteran's hand presents with: complete paralysis; the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances . . . . . . . 70 percent for major (dominant) hand; 60 percent for minor hand. Incomplete: Severe . . . . 40 major - 30 minor; Moderate . . . . 30 major - 20 minor. Analysis An April 2005 VA medical examiner reported that the veteran's left arm peripheral neuropathy is manifested by weakness and some symptoms of carpel tunnel syndrome. An x-ray report, also dated April 2005, indicates that there were "very minimal cystic changes in the carpal bones and slight calcification of cartilage around some of the lateral carpel bones." The impression was states as "chondrocalcinosis laterally with potential of deposition disease." The April 2005 examiner noted the veteran is right-handed, and that the veteran reported that he had progressive numbness for which he wears a wrist support. Carpal tunnel tests revealed numbness and the veteran stated he experienced a tingling sensation when his blood sugar levels were elevated. The April 2005 report states that the veteran's left-hand grip was weak and that the veteran said he occasionally drops pickups with the left hand. No tremor was detected. The examiner noted the peripheral neuropathy was consistent with moderately severe diabetes and that some symptoms of carpal tunnel syndrome were superimposed on the neuropathy symtoms. The examiner did not note any paralysis of the left hand, and did not note that the veteran's dexterity and flexion was compromised beyond the noted grip weakness. As stated above, in order to meet the criteria for an increased disability rating, the evidence must show the veteran's left arm peripheral neuropathy to be "severe" incomplete paralysis. Terms such as "severe" and "moderate" are not defined in VA criteria. However, the Board observes that moderate is defined as "of medium quality." See Merriam-Webster's Dictionary 11th Edition, at page798 (2003). Severe is defined as "grievous and of a great degree." Id at page 1140. After review of the entire record, the Board finds that the veteran's disability does not meet a condition approaching severe. He has not lost use of the hand and complains that he only occasionally drops items from his weak left hand grip. His hand has no tremor or paralysis, and there is no evidence his dexterity or flexion has been compromised beyond a weak grip. For those reasons, the Board finds that the veteran's left hand peripheral neuropathy disability more closely approximates a moderate condition, and further finds that the criteria for an increased disability rating have not been met. Fenderson consideration The Court has held that an appeal from an initial rating is a separate and distinct claim from a claim for an increased rating. At the time of an initial rating, separate ratings can be assigned for separate periods of time based on facts found, a practice known as "staged ratings." See Fenderson v. West, 12 Vet. App. 119, 126 (1999). After review of the entire record, the Board finds that there is no evidence that the veteran's peripheral neuropathy disability has met the criteria for an increased rating during the period from one year prior date of the claim to the April 2005 examination. For those reasons, the Board finds that staged ratings are not appropriate in this case. Extraschedular concerns Extraschedular concerns will be addressed at the end of the decision. 2. Entitlement to an increased disability rating for service-connected coronary artery disease (CAD), currently evaluated as 10 percent disabling effective March 26, 2002. The pertinent law and regulations for increased disability ratings is stated above and will not be repeated here. Assignment of diagnostic code The veteran's service-connected left arm peripheral neuropathy is rated under 38 C.F.R. § 4.104, Diagnostic Code 7005 [Arterioscirotic heart disease (Coronary artery disease)]. As before, the assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts supra. Factors as an individual's relevant medical history, the diagnosis and demonstrated symptomatology determine the appropriate diagnostic code, and any change in a diagnostic code by a VA adjudicator must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). The veteran was diagnosed with CAD in a July 2003 VA medical examination and was diagnosed with arteriosclerotic heart disease in the April 2005 examination. Thus, Diagnostic Code 7005 is deemed by the Board to be the most appropriate primarily because it pertains specifically to the primary diagnosed disability in the veteran's case. The Board can identify nothing in the evidence to suggest that another diagnostic code would be more appropriate, and the veteran has not requested that another diagnostic code be used. Accordingly, the Board concludes that the veteran is appropriately rated under Diagnostic Code 7005. Specific scheduler criteria Under Diagnostic Code 7005, a 100 percent disability rating will be granted when evidence establishes chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. A 60 percent disability rating is provided when the evidence shows more than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 30 percent disability rating is warranted when the evidence shows a workload of greater than 5 METs but not greater than 7 METs results in dyspnea, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. A 10 percent disability rating is warranted when evidence shows workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required. Analysis The veteran's CAD is manifested by complaints of inability to walk a distance greater than 3 blocks without rest. The April 2005 examiner noted that the veteran's heart condition included "no particular shortness of breath" and noted no evidence of atrial fibrillation. The examiner did state that "[T]he METS as noted is evaluated as 2, as this patient has been taking nitroglycerin for chest pain and irregularities of the pulse on occasion . . . medication [is required] two to three times a month." In a July 2005 opinion, the examiner stated the following: The arteriosclerotic heart disease has worsened as evidenced by increased angina and use of nitroglycerin tablets the last 2 years. . . . These are permanent changes. Additionally, in the April 2005 examination report, the examiner also stated that the veteran "cannot do activity, which would entitle him to higher METS level." As stated above, the criteria for an increased disability rating include a workload of greater than 5 METs but not greater than 7 METs results in dyspnea, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. In this case, x-ray evidence revealed no cardiac abnormalities; however, the examiner did state that the veteran was entitled to a higher MET level than 2 because of his inability to do activity. Given the medical opinion that the veteran's condition has worsened and viewing the evidence in the light most favorable to the veteran, the Board finds that the criteria for an increased disability rating of 30 percent disabling is warranted. The claim will be granted to that extent. Fenderson consideration As above, the Board will consider whether "staged ratings" are appropriate in this case pursuant to Fenderson supra. After review of the entire record, the Board finds that there is no evidence that the veteran's CAD disability has met the criteria for an increased rating beyond the 30 percent disability rating granted above during the period from one year prior date of the claim to the April 2005 examination. The record includes medical examination reports dated February 2003 and July 2003 which both indicate no cardiac abnormalities. For those reasons, the Board finds that staged ratings are not appropriate in this case. Extraschedular concerns Extraschedular concerns will be addressed at the end of the decision. 3. Entitlement to a compensable initial disability rating for nonproliferative diabetic retinopathy, currently evaluated as noncompensably (0 per cent) disabling effective March 7, 2002. The pertinent law and regulations for increased disability ratings is stated above and will not be repeated here. Assignment of diagnostic code The veteran's service-connected nonproliferative diabetic retinopathy is rated under 38 C.F.R. § 4.84a, Diagnostic Code 6079 [Impairment of Central Visual Acuity]. As before, the assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts supra. Factors as an individual's relevant medical history, the diagnosis and demonstrated symptomatology determine the appropriate diagnostic code, and any change in a diagnostic code by a VA adjudicator must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). In an April 2005 examination report, the examiner diagnosed the veteran with mild, stable diabetic retinopathy, which resulted in limited visual acuity. Thus, Diagnostic Code 6079 is deemed by the Board to be the most appropriate primarily because it pertains specifically to the primary diagnosed disability in the veteran's case. The Board can identify nothing in the evidence to suggest that another diagnostic code would be more appropriate, and the veteran has not requested that another diagnostic code be used. Accordingly, the Board concludes that the veteran is appropriately rated under Diagnostic Code 6079. Specific rating criteria The veteran is currently assigned a noncompensable or 0 percent disability rating for his service-connected diabetic retinopathy by analogy to 38 C.F.R. § 4.84a, Diagnostic Codes 6099-6079 [Impairment of Central Visual Acuity]. See 38 C.F.R. § 4.27 (2007) [hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen]; see also 38 C.F.R. § 4.27 [unlisted disabilities requiring rating by analogy will be coded first the numbers of the most closely related body part and "99"]. The diagnostic criteria pertinent to diseases of the eye (38 C.F.R. § 4.84a, Diagnostic Codes 6000 through 6035) do not specifically set forth rating criteria pertinent to retinopathy. With regard to impairment of central visual acuity, Diagnostic Code 6079 allows for a 10 percent disability rating when corrected vision in one eye is no better than 20/50, and corrected vision in the other eye is no better than 20/40. A noncompensable disability rating is assigned where corrected vision in both eyes is 20/40 or better. 38 C.F.R. § 4.84a, Diagnostic Codes 6078, 6079 (2007). With regard to impairment of field vision, Diagnostic Code 6080 allows for a 10 percent disability rating when field vision is limited to 60 degrees but not 45 degrees in one eye. 38 C.F.R. § 4.84a, Diagnostic Code 6080 (2007). Analysis The veteran's service-connected nonproliferative diabetic retinopathy is manifested by uncorrected distant visual acuity of 20/200 for the right eye and 20/100 for the left eye. Corrected distant visual acuity was 20/25 for the right eye and 20/30 for the left eye. There was no evidence of a deficit in field vision. As stated above, Diagnostic Code 6079 allows for a 10 percent disability rating when corrected vision in one eye is no better than 20/50, and corrected vision in the other eye is no better than 20/40. In this case, the medical evidence indicates that the veteran's diabetic retinopathy condition more closely meets the criteria for a noncompensable rating; where corrected vision in both eyes is 20/40 or better. The Board notes that the veteran has contended that he believes he is entitled to an increased rating because he cannot see as well as he would like and requires corrective lenses. However, the medical evidence of record outweighs the veteran's contentions. It is well established that lay persons without medical training, such as the veteran, are not competent to attribute symptoms to a particular cause, or to assess severity of a disability in medical terms. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-5 (1992); see also 38 C.F.R. § 3.159 (a)(1) [competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions]. For those reasons, the Board finds that the claim for a compensable disability rating for the veteran's service- connected diabetic retinopathy is not warranted. Fenderson consideration As above, the Board will consider whether "staged ratings" are appropriate in this case pursuant to Fenderson supra. After review of the entire record, the Board finds that there is no evidence that the veteran's visual acuity was any worse than that reported in the April 2005 examination. Indeed it appears no other eye examination results are in the record or were identified by the veteran. For those reasons, the Board finds that staged ratings are not appropriate in this case. Extraschedular concerns Ordinarily, the VA Schedule will apply unless there are exceptional or unusual factors which would render application of the schedule impractical. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). An extraschedular disability rating is warranted only upon a finding that the case presents an exceptional or unusual disability that causes marked interference with employment or frequent periods of hospitalization which renders impractical the application of the regular schedular standards. See 38 C.F.R. § 3.321(b)(1) (2007). The record shows that the veteran has not requested an extraschedular rating, and RO did not in fact consider the matter of an extraschedular rating. Under Floyd v. Brown, 9 Vet. App. 88, 95 (1996), the Board cannot make a determination as to an extraschedular evaluation in the first instance. See also VAOPGCPREC 6-96 [finding that the Board may deny extraschedular ratings, provided that the RO has fully adjudicated the issue and followed appropriate appellate procedure]; see also Bernard v. Brown, 4 Vet. App. 384 (1993) [when the Board addresses in a decision a question that has not been addressed by the RO, it must consider whether the claimant has been given adequate notice and opportunity to respond and, if not, whether the claimant will be prejudiced thereby]. Thus, the Board does not have jurisdiction over the matter of an extraschedular rating. If the veteran believes that such is in fact warranted, he should raise that matter with the RO. ORDER Entitlement to an increased disability rating for service- connected peripheral neuropathy and carpal tunnel syndrome of the left arm is denied. An increased disability rating of 30 percent is granted for service-connected CAD, subject to controlling regulations governing the payment of monetary benefits. Entitlement to a compensable initial disability rating for nonproliferative diabetic retinopathy is denied. ____________________________________________ Frank J. Flowers Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs