Citation Nr: 18147662 Decision Date: 11/05/18 Archive Date: 11/05/18 DOCKET NO. 09-12 812 DATE: November 5, 2018 ORDER Entitlement to a separate compensable rating for erectile dysfunction (ED) associated with service-connected diabetes mellitus, type II (DM) is denied. Entitlement to a separate compensable rating for onychomycosis of right great toe associated with service-connected DM is denied. Entitlement to an increased rating in excess of 20 percent disabling prior to September 18, 2013, for right upper extremity (RUE) peripheral neuropathy is denied. Entitlement to an increased rating in excess of 20 percent disabling prior to September 18, 2013, for left upper extremity (LUE) peripheral neuropathy is denied. Entitlement to an increased rating in excess of 20 percent disabling prior to September 18, 2013, for right lower extremity (RLE) peripheral neuropathy is denied. Entitlement to an increased rating in excess of 20 percent disabling prior to September 18, 2013, for left lower extremity (LLE) peripheral neuropathy is denied. Entitlement to an increased rating in excess of 40 percent disabling as of September 18, 2013, for RUE peripheral neuropathy is denied. Entitlement to an increased rating in excess of 30 percent disabling as of September 18, 2013, for LUE peripheral neuropathy is denied. Entitlement to an increased rating in excess of 40 percent disabling as of September 18, 2013, for RLE peripheral neuropathy is denied. Entitlement to an increased rating in excess of 40 percent disabling as of September 18, 2013, for LLE peripheral neuropathy is denied. REMANDED Entitlement to service connection for a skin disorder, to exclude service-connected seborrheic dermatitis is remanded. FINDINGS OF FACT 1. A March 2006 rating decision granted a noncompensable evaluation for ED and onychomycosis of right great toe associated with DM. 2. There is no evidence of deformity of the Veteran’s penis. 3. The Veteran has thickening and discoloration of the right great toe affecting less than 5 percent of the Veteran’s total and exposed body area; it is treated with topical medication. 4. Prior to September 18, 2013, the Veteran’s RUE peripheral neuropathy is characterized by mild incomplete paralysis of the affected nerves. 5. Prior to September 18, 2013, the Veteran’s LUE peripheral neuropathy is characterized by mild incomplete paralysis of the affected nerves. 6. Prior to September 18, 2013, the Veteran’s RLE peripheral neuropathy is characterized by mild incomplete paralysis of the sciatic nerve. 7. Prior to September 18, 2013, the Veteran’s LLE peripheral neuropathy is characterized by mild incomplete paralysis of the sciatic nerve. 8. As of September 18, 2013, the Veteran’s RUE peripheral neuropathy is characterized by moderate incomplete paralysis of the affected nerves. 9. As of September 18, 2013, the Veteran’s LUE peripheral neuropathy is characterized by moderate incomplete paralysis of the affected nerves. 10. As of September 18, 2013, the Veteran’s RLE peripheral neuropathy is characterized by moderately severe incomplete paralysis of the sciatic nerve. 11. As of September 18, 2013, the Veteran’s LLE peripheral neuropathy is characterized by moderately severe incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. The criteria for a separate compensable rating for ED have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.3, 4.7, 4.115(b), Diagnostic Code 7522 (2018). 2. The criteria for a separate compensable rating for onychomycosis of right great toe have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.3, 4.7, 4.118, Diagnostic Code 7813 (2018). 3. Prior to September 18, 2013, the criteria for a disability rating in excess of 20 percent for RUE peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.3, 4.7, 4.119, Diagnostic Code 8513 (2018). 4. Prior to September 18, 2013, the criteria for a disability rating in excess of 20 percent for LUE peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.3, 4.7, 4.119, Diagnostic Code 8513 (2018). 5. Prior to September 18, 2013, the criteria for a disability rating in excess of 20 percent for RLE peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.3, 4.7, 4.119, Diagnostic Code 8520 (2018). 6. Prior to September 18, 2013, the criteria for a disability rating in excess of 20 percent for LLE peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.3, 4.7, 4.119, Diagnostic Code 8520 (2018). 7. As of September 18, 2013, the criteria for a disability rating in excess of 40 percent for RUE peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.3, 4.7, 4.119, Diagnostic Code 8513 (2018). 8. As of September 18, 2013, the criteria for a disability rating in excess of 30 percent for LUE peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.3, 4.7, 4.119, Diagnostic Code 8513 (2018). 9. As of September 18, 2013, the criteria for a disability rating in excess of 40 percent for RLE peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.3, 4.7, 4.119, Diagnostic Code 8520 (2018). 10. As of September 18, 2013, the criteria for a disability rating in excess of 40 percent for LLE peripheral neuropathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.3, 4.7, 4.119, Diagnostic Code 8520 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1967 to December 1970, including service in the Republic of Vietnam (Vietnam). These matters come before the Board of Veterans’ Appeals (Board) on appeal from a July 2008 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. These matters were remanded by the Board in July 2017 for additional development. Such development has been completed and the matters returned to the Board for appellate consideration. Stegall v. West, 11 Vet. App. 268 (1998). A July 2018 rating decision by the RO granted, in pertinent part, entitlement to service connection for posttraumatic stress disorder (PTSD) with an evaluation of 30 percent disabling effective June 5, 2007, and entitlement to total disability rating by reason of individual unemployability (TDIU) effective August 4, 2004. The RO’s grant of this issue constitutes a full award of this benefit sought on appeal. Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997). Thus, this matter is no longer in appellate status. Id. (holding that a separate notice of disagreement must be filed to initiate appellate review of “downstream” elements such as the disability rating and/or the effective date assigned). Additionally, the July 2018 rating decision granted increased compensation for the Veteran’s bilateral lower and upper extremities, respectively. As these are not the maximum disability ratings possible, the appeals remain in appellate status and are properly before the Board. AB v. Brown, 6 Vet. App. 35 (1993). 1. Entitlement to a separate compensable rating for ED associated with service-connected DM The Veteran’s ED is currently rated as a noncompensable complication of his service-connected DM under Diagnostic Code 7913. Under Diagnostic Code 7913, the rater is directed to evaluate compensable complications of DM separately. 38 C.F.R. § 4.119, Diagnostic Code 7913. The Veteran has asserted he is entitled to a separate compensable rating for his ED. Under Diagnostic Code 7522, a single (and maximum) 20 percent disability rating is provided for penis deformity with loss of erectile power. Based upon a review of the record, the Board finds that a separate compensable rating is not warranted in this case. In making this finding, the Board accords significant probative weight to the VA examination provided in September 2017. The record reflects the examiner reviewed the Veteran’s pertinent medical history, documented his current complaints, and rendered findings and diagnoses consistent with the remainder of the evidence of record, and therefore, the examination is adequate for adjudication purposes. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Report of the September 2017 VA examination reflects, in pertinent part, a history of ED with difficulty achieving and maintaining an erection. The examiner noted the ED was a complication of the Veteran’s DM. The Veteran declined to have his genitals physically examined. He reported normal anatomy of his penis and scrotum, and denied any penile deformity and/or abnormality. As indicated above, a 20 percent disability rating is assigned where the evidence reflects penis deformity with loss of erectile power. The Board has considered the Veteran’s statements regarding inability to achieve or maintain an erection. However, in the absence of any penile deformity, the Board finds that a separate, compensable rating is not warranted for erectile dysfunction. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a separate compensable rating for ED. 2. Entitlement to a separate compensable rating for onychomycosis of right great toe associated with service-connected DM The Veteran’s onychomycosis is currently rated as a noncompensable complication of his service-connected DM under Diagnostic Code 7913. As indicated, Diagnostic Code 7913 directs the rater to evaluate compensable complications of DM separately. Id. The Veteran has asserted he is entitled to a separate compensable rating for his onychomycosis. Under Diagnostic Code 7815, a 10 percent rating is warranted when at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas are affected; or, intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of less than six weeks during the past 12-month period. Based upon a review of the record, the Board finds that a separate compensable rating is not warranted in this case. In making this finding, the Board accords significant probative weight to the VA examination provided in August 2017. Report of the August 2017 VA examination reflects, in pertinent part, a history of onychomycosis treated with topical anti-fungal medication. Physical examination revealed the onychomycosis is limited to the Veteran’s right great toe. The examiner estimated that less than 2 percent of the Veteran’s entire body is affected by the onychomycosis. This is consistent with the remaining evidence of record. As indicated above, a 10 percent rating is warranted when at least 5 percent of the entire body, or at least 5 percent of exposed areas are affected; or, intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of less than six weeks during the past 12-month period. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a separate compensable rating for onychomycosis. Increased Rating Legal Principles A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. 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 in or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155. The Veteran’s right and left upper extremity peripheral neuropathy is currently rated under Diagnostic Code 8613 for neuritis. The rater is directed to rate the disability under Diagnostic Code 8513 (all radicular groups). 38 C.F.R. § 4.123. Under Diagnostic Code 8513, evaluations of 20 percent, 30 percent, and 60 percent, respectively, are assigned where evidence shows mild, moderate, or severe incomplete paralysis of the minor extremity. Similarly, evaluations of 20 percent, 40 percent, and 70 percent, respectively, are assigned where evidence shows mild, moderate, or severe incomplete paralysis of the major, i.e., dominant, extremity. 38 C.F.R. § 4.124a, Diagnostic Code 8513. The terms “mild,” “moderate,” and “severe” as used under Diagnostic Code 8613 are not defined in the Schedule. Rather than applying a mechanical formula to determine when symptomatology is “mild,” “moderate” or “severe,” the Board must evaluate all of the evidence to ensure an “equitable and just” decision. 38 C.F.R. § 4.6. The Veteran’s right and left lower extremity peripheral neuropathy is currently rated under Diagnostic Code 8620 for neuritis of the sciatic nerve. The rater is directed to rate the disability under Diagnostic Code 8520. 38 C.F.R. § 4.123. Under Diagnostic Code 8520, a 10 percent rating is assigned where evidence shows mild incomplete paralysis of the sciatic nerve. A 20 percent rating is assigned where evidence shows moderate incomplete paralysis of the sciatic nerve. A 40 percent rating is assigned where evidence shows moderately severe incomplete paralysis of the sciatic nerve. A 60 percent rating is warranted where evidence shows severe incomplete paralysis of the sciatic nerve with marked muscular atrophy. A highest 80 percent rating is warranted where evidence shows complete paralysis of the sciatic nerve; the foot dangles and drops, no active movement of the muscles below the knee is possible, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520 (2018). Likewise, the term “mild,” “moderate,” “moderately severe,” and “severe” as used under Diagnostic Code 8520 are not defined in the Schedule. As such, the Board must evaluate all of the evidence to ensure an “equitable and just” decision. 38 C.F.R. § 4.6. The term “incomplete paralysis” indicates a degree of impaired function substantially less than the type of picture for “complete paralysis” given for each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id. 3. Entitlement to an increased rating in excess of 20 percent disabling prior to September 18, 2013, for RUE peripheral neuropathy Based on a review of the evidence, the Board finds that an increased disability rating in excess of 20 percent prior to September 18, 2013, for the Veteran’s service-connected RUE peripheral neuropathy is not warranted because the Veteran’s RUE symptoms are mild in nature. In making this finding, the Board notes that VA examinations and medical treatment records prior to September 18, 2013, reflect the Veteran’s RUE peripheral neuropathy was manifested by mild incomplete paralysis of the median nerve. For instance, report of the October 2007 VA examination reflects, in pertinent part, the Veteran reported experiencing “transient numbness and [tingling]” in his bilateral hands. Objectively, however, physical examination did not reveal weakness or other indicia of more than mild paralysis in the RUE. Specifically, the October 2007 examiner noted the absence of any effect on functioning as a result of the symptomatology reported by the Veteran. Report of the December 2009 VA examination reflects, in pertinent part, the Veteran’s statements denying current symptoms in his RUE. Clinical examination revealed deep tendon reflexes as 1+, i.e., reduced, in the Veteran’s RUE. At that time, the Veteran was diagnosed with “very mild” peripheral neuropathy of the upper extremities. This is overwhelmingly consistent with medical treatment records dated prior to September 18, 2013. For instance, medical treatment records dated in May 2008 reflect the Veteran’s sensation, reflexes, and strength were grossly normal. Medical treatment records dated in December 2011 reflect occasional numbness in bilateral hands, left more than right. Of note, the Veteran did not report (nor does the record reflect) any loss of function at that time due to such symptomatology. In light of the above, the Board finds that the Veteran’s symptoms are primarily sensory with no significant corresponding loss of muscle strength or function. In other words, the preponderance of the evidence reflects the Veteran’s RUE peripheral neuropathy is primarily sensory and not more than mild in nature prior to September 18, 2013. As indicated, under the applicable diagnostic code, mild incomplete paralysis of the dominant extremity is rated as 20 percent disabling. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 20 percent prior to September 18, 2013, for RUE peripheral neuropathy. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim for a rating higher than 20 percent, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Accordingly, the appeal is denied. 4. Entitlement to an increased rating in excess of 20 percent disabling prior to September 18, 2013, for LUE peripheral neuropathy Based on a review of the evidence, the Board finds that an increased disability rating in excess of 20 percent prior to September 18, 2013, for the Veteran’s service-connected LUE peripheral neuropathy is not warranted because the Veteran LUE symptoms are mild in nature. In making this finding, the Board notes that VA examinations and medical treatment records prior to September 18, 2013, reflect the Veteran’s LUE peripheral neuropathy was manifested by mild incomplete paralysis of the median nerve. As indicated above, report of the October 2007 VA examination noted the Veteran’s reports of experiencing “transient numbness and [tingling]” in his bilateral hands; however, examiner noted the absence of any effect on functioning as a result of the symptomatology reported by the Veteran. Report of the December 2009 VA examination reflects, in pertinent part, the Veteran’s statements regarding tingling in his left hand with occasional loss of grip. The examiner noted that the Veteran is right hand dominant. Clinical examination revealed deep tendon reflexes as 1+, i.e., reduced, in the Veteran’s LUE. At that time, the Veteran was diagnosed with “very mild” peripheral neuropathy of the upper extremities. This is overwhelmingly consistent with medical treatment records dated prior to September 18, 2013. For instance, medical treatment records dated in May 2008 reflect the Veteran’s sensation, reflexes, and strength were grossly normal. Medical treatment records dated in December 2011 reflect occasional numbness in bilateral hands, left more than right. Of note, the Veteran did not report (nor does the record reflect) any loss of function at that time due to such symptomatology. In light of the above, the Board finds that the Veteran’s symptoms are primarily sensory with no significant corresponding loss of muscle strength or function. In other words, the preponderance of the evidence reflects the Veteran’s LUE peripheral neuropathy is primarily sensory and not more than mild in nature prior to September 18, 2013. The Board has considered the singular notation of “loss of grip” reported by the Veteran in December 2009. However, the Board does not find such seemingly sporadic symptomatology is sufficient to rise to the level of moderate incomplete paralysis. As indicated, under the applicable diagnostic code, mild incomplete paralysis of the non-dominant extremity is rated as 20 percent disabling. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 20 percent prior to September 18, 2013, for LUE peripheral neuropathy. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim for a rating higher than 20 percent, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert, supra. Accordingly, the appeal is denied. 5. Entitlement to an increased rating in excess of 20 percent disabling prior to September 18, 2013, for RLE peripheral neuropathy Based on a review of the evidence, the Board finds that an increased disability rating in excess of 20 percent prior to September 18, 2013, for the Veteran’s service-connected RLE peripheral neuropathy is not warranted because the Veteran RLE symptoms are moderate in nature. In making this finding, the Board notes that VA examinations and medical treatment records prior to September 18, 2013, reflect the Veteran’s RLE peripheral neuropathy was manifested by moderate incomplete paralysis of the sciatic nerve. Report of the October 2007 VA examination reflects, in pertinent part, the Veteran’s statements regarding numbness, tingling, and a burning sensation in his bilateral feet, which is worse at night. The Veteran denied any claudication, i.e., cramping pain, in his legs. Clinical examination revealed deep tendon reflexes as 1+, i.e., reduced, in the Veteran’s bilateral knees and 2+, i.e., normal in the Veteran’s ankles. Sensation to vibration and pinprick was slightly diminished in the toes; however, light touch was intact in the toes. No muscle strength weakness was noted in the RLE. Similarly, report of the December 2009 VA examination reflects, in pertinent part, the Veteran’s statements regarding ongoing numbness and burning sensations in his bilateral feet, which is aggravated by prolonged walking and/or standing. Clinical examination revealed decreased pinprick sensations, monofilament testing, and vibratory sensations in the Veteran’s bilateral feet. Deep tendon reflexes were noted as 1+ in bilateral knees and 0+ in bilateral ankles. The examiner noted the Veteran’s RLE symptoms hinder the Veteran’s ability to walk or stand for prolong periods of time. At that time, the Veteran was diagnosed with mild peripheral neuropathy of the lower extremities. This is overall consistent with medical treatment records dated prior to September 18, 2013. For instance, medical treatment records dated in November 2012 reflect decreased sensation in bilateral feet. Medical treatment records do not reflect any additional weakness or other indicia of more than moderate paralysis in the RLE. In light of the above, the Board finds that the Veteran’s RLE peripheral neuropathy manifested with moderate symptoms with some corresponding loss function. In other words, the preponderance of the evidence reflects the Veteran’s RLE peripheral neuropathy was not more than moderate in nature prior to September 18, 2013. As indicated, under the applicable diagnostic code, moderate incomplete paralysis of the sciatic nerve is rated as 20 percent disabling. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 20 percent prior to September 18, 2013, for RLE peripheral neuropathy. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim for a rating higher than 20 percent, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert, supra. Accordingly, the appeal is denied. 6. Entitlement to an increased rating in excess of 20 percent disabling prior to September 18, 2013, for LLE peripheral neuropathy Based on a review of the evidence, the Board finds that an increased disability rating in excess of 20 percent prior to September 18, 2013, for the Veteran’s service-connected LLE peripheral neuropathy is not warranted because the Veteran LLE symptoms are moderate in nature. In making this finding, the Board notes that VA examinations and medical treatment records prior to September 18, 2013, reflect the Veteran’s LLE peripheral neuropathy was manifested by moderate incomplete paralysis of the sciatic nerve. As indicated above, the Veteran reported numbness, tingling, and a burning sensation in his bilateral feet at his October 2007 VA examination. Clinical examination revealed deep tendon reflexes as 1+, i.e., reduced, in the Veteran’s bilateral knees and 2+, i.e., normal in the Veteran’s ankles. Sensation to vibration and pinprick was slightly diminished in the toes; however, light touch was intact in the toes. The examiner noted slight weakness, i.e., 4/5, of the left toe dorsiflexion. No other decrease in muscle strength was noted. At that time, the Veteran was diagnosed with mild peripheral neuropathy of the lower extremities. As indicated above, similar findings were noted in the December 2009 VA examination. The Board finds these examinations to be consistent with medical treatment records dated prior to September 18, 2013. For instance, medical treatment records dated in November 2012 reflect decreased sensation in bilateral feet. Medical treatment records do not reflect any additional weakness or other indicia of more than moderate paralysis in the LLE. In light of the above, the Board finds that the Veteran’s LLE peripheral neuropathy manifested with moderate symptoms with some corresponding loss of muscle strength and function. In other words, the preponderance of the evidence reflects the Veteran’s LLE peripheral neuropathy was not more than moderate in nature prior to September 18, 2013. As indicated, under the applicable diagnostic code, moderate incomplete paralysis of the sciatic nerve is rated as 20 percent disabling. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 20 percent prior to September 18, 2013, for LLE peripheral neuropathy. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim for a rating higher than 20 percent, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert, supra. Accordingly, the appeal is denied. 7. Entitlement to an increased rating in excess of 40 percent disabling as of September 18, 2013, for RUE peripheral neuropathy Based on a review of the evidence, the Board finds that an increased disability rating in excess of 40 percent as of September 18, 2013, for the Veteran’s service-connected RUE peripheral neuropathy is not warranted because the Veteran’s RUE symptoms are moderate in nature. In making this finding, the Board accords significant probative weight to the VA examinations provided in September 2013 and September 2017. Report of the September 2013 VA examination reflects, in pertinent part, the Veteran’s statements regarding pain, numbness, and tingling in his bilateral hands. The examiner noted severe pain, paresthesias, and numbness in the RUE. Clinical examination revealed a slight decrease in muscle strength in the Veteran’s RUE grip and pinch; otherwise normal strength testing. Deep tendon reflexes were noted as normal. Light touch/monofilament testing revealed decreased inner/outer forearms, and were absent in hands and fingers. No muscle atrophy was noted. The examiner diagnosed mild incomplete paralysis of the radial, median, and ulnar nerves, respectively. However, the examiner also noted the Veteran had trouble with fine motor tasks such as buttoning shirts or picking up coins off a table. Report of the September 2017 VA examination reflects, in pertinent part, moderate pain, paresthesias, and numbness in the RUE. Clinical examination revealed a slight decrease in muscle strength throughout. Light touch/monofilament testing revealed decreased inner/outer forearms and hands/fingers. The examiner diagnosed moderate incomplete paralysis of the radial, median, ulnar, musculocutaneous, circumflex, long thoracic, upper, middle, and lower radicular nerves, respectively. In doing so, the examiner indicated that despite the manifestations and deficits noted, the Veteran still has substantial function in his RUE. This is consistent with medical treatment records since September 18, 2013. For instance, medical treatment records dated in July 2015 reflect the Veteran presented with pain and occasional numbness in his bilateral hands. At that time, the Veteran denied any trouble with fine motor tasks. In light of the above, the Board finds that the Veteran’s RUE peripheral neuropathy manifested with moderate symptoms with some corresponding loss of muscle strength and function. In other words, the preponderance of the evidence reflects the Veteran’s RUE peripheral neuropathy was not more than moderate in nature as of September 18, 2013. As indicated, under the applicable diagnostic code, moderate incomplete paralysis of the dominant extremity is rated as 40 percent disabling. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 40 percent as of September 18, 2013, for RUE peripheral neuropathy. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim for a rating higher than 40 percent, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert, supra. Accordingly, the appeal is denied. 8. Entitlement to an increased rating in excess of 30 percent disabling as of September 18, 2013, for left upper extremity peripheral neuropathy Based on a review of the evidence, the Board finds that an increased disability rating in excess of 30 percent as of September 18, 2013, for the Veteran’s service-connected LUE peripheral neuropathy is not warranted because the Veteran’s LUE symptoms are moderate in nature. In making this finding, the Board accords significant probative weight to the VA examinations provided in September 2013 and September 2017. Report of the September 2013 VA examination reflects, in pertinent part, the Veteran’s statements regarding pain, numbness, and tingling in his bilateral hands. The examiner noted moderate pain and numbness, and severe paresthesias in the LUE. Clinical examination revealed normal muscle strength testing in the Veteran’s LUE. Deep tendon reflexes were noted as normal. Light touch/monofilament testing revealed decreased inner/outer forearms, and were absent in hands and fingers. No muscle atrophy was noted. The examiner diagnosed mild incomplete paralysis of the radial, median, and ulnar nerves, respectively. However, the examiner also noted the Veteran had trouble with fine motor tasks such as buttoning shirts or picking up coins off a table. Report of the September 2017 VA examination reflects, in pertinent part, moderate pain, paresthesias, and numbness in the LUE. Clinical examination revealed a slight decrease in muscle strength throughout. Light touch/monofilament testing revealed decreased inner/outer forearms and hands/fingers. The examiner diagnosed moderate incomplete paralysis of the radial, median, ulnar, musculocutaneous, circumflex, long thoracic, upper, middle, and lower radicular nerves, respectively. In doing so, the examiner indicated that despite the manifestations and deficits noted, the Veteran still has substantial function in his LUE. This is consistent with medical treatment records since September 18, 2013. For instance, medical treatment records dated in July 2015 reflect the Veteran presented with pain and occasional numbness in his bilateral hands. At that time, the Veteran denied any trouble with fine motor tasks. In light of the above, the Board finds that the Veteran’s LUE peripheral neuropathy manifested with moderate symptoms with some corresponding loss of muscle strength and function. In other words, the preponderance of the evidence reflects the Veteran’s LUE peripheral neuropathy was not more than moderate in nature as of September 18, 2013. As indicated, under the applicable diagnostic code, moderate incomplete paralysis of the non-dominant extremity is rated as 30 percent disabling. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 30 percent as of September 18, 2013, for LUE peripheral neuropathy. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim for a rating higher than 30 percent, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert, supra. Accordingly, the appeal is denied. 9. Entitlement to an increased rating in excess of 40 percent disabling as of September 18, 2013, for RLE peripheral neuropathy Based on a review of the evidence, the Board finds that an increased disability rating in excess of 40 percent as of September 18, 2013, for the Veteran’s service-connected RLE peripheral neuropathy is not warranted because the Veteran’s RLE manifested with symptoms moderately severe in nature. In making this finding, the Board accords significant probative weight to the VA examinations provided in September 2013 and September 2017. Report of the September 2013 VA examination reflects, in pertinent part, the Veteran’s statements regarding pain, numbness, and tingling in his bilateral feet. The examiner noted moderate pain and numbness, and severe paresthesias in the RLE. Clinical examination revealed slightly decreased muscle strength testing throughout RLE. Deep tendon reflexes were decreased in the Veteran’s knees and ankles. Light touch/monofilament testing revealed decreased knee/thigh and ankles, and were absent in bilateral toes. Position and vibration sense in the RLE was absent. No muscle atrophy was noted. The examiner noted the Veteran “has to walk very slowly due to uncertainty of steps,” and that he experiences minor injuries to his feet and toes without realizing. The examiner diagnosed moderate incomplete paralysis of the sciatic nerve. Similar findings were noted in the September 2017 VA examination. VA medical treatment records since September 18, 2013, reflect ongoing complaints and treatment for symptoms associated with RLE peripheral neuropathy. These records do not, however, provide any evidence of additional weakness or loss of strength or function warranting a higher rating. In light of the above, the Board finds that the Veteran’s RLE peripheral neuropathy manifested with moderately severe symptoms with corresponding loss of muscle strength and function. For instance, the pain and numbness in the Veteran’s RLE results in abnormal gait and decreased movement. The Board finds the physical manifestations of the Veteran’s RLE peripheral neuropathy are adequately contemplated by the rating for moderately severe symptoms. As indicated, under the applicable diagnostic code, moderately severe incomplete paralysis of the sciatic nerve is rated as 40 percent disabling. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 40 percent as of September 18, 2013, for RLE peripheral neuropathy. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim for a rating higher than 40 percent, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert, supra. Accordingly, the appeal is denied. 10. Entitlement to an increased rating in excess of 40 percent disabling as of September 18, 2013, for left lower extremity peripheral neuropathy For brevity, the facts set forth above are incorporated by reference herein. Based on a review of the evidence, the Board finds that an increased disability rating in excess of 40 percent as of September 18, 2013, for the Veteran’s service-connected LLE peripheral neuropathy is not warranted because the Veteran’s LLE manifested with symptoms moderately severe in nature. As indicated above, the Veteran has consistently reported pain, numbness, and tingling in his bilateral feet of ranging from moderate to severe in severity. Physical examination of the Veteran revealed slight decreased muscle strength and deep tendon reflexes. These physical manifestations result in an abnormal gait and that minor injuries to his feet and toes without realization. Notwithstanding, the Veteran still has substantial function in his LLE. The Board finds the physical manifestations of the Veteran’s LLE peripheral neuropathy are adequately contemplated by the rating for moderately severe symptoms. As indicated, under the applicable diagnostic code, moderately severe incomplete paralysis of the sciatic nerve is rated as 40 percent disabling. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 40 percent as of September 18, 2013, for LLE peripheral neuropathy. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim for a rating higher than 40 percent, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert, supra. Accordingly, the appeal is denied. REASONS FOR REMAND 1. Entitlement to service connection for a skin disorder, to exclude service-connected seborrheic dermatitis is remanded. A review of the record reveals that the claim must be remanded prior to appellate consideration. Where, as here, VA undertakes to provide an examination or obtain an opinion when developing a claim, even if not statutorily obligated to do so, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Bolton v. Brown, 8 Vet. App. 185, 191 (1995) (emphasizing the Board’s duty to return an inadequate examination report “if further evidence or clarification of the evidence... is essential for a proper appellate decision”). For the reasons set forth below, the Board finds that the claim must again be remanded to the AOJ in order to obtain an adequate medical opinion. Pursuant to the Board’s July 2017 remand, the Veteran was provided with a new VA examination in September 2017. Report of the September 2017 VA examination reflects, in pertinent part, the Veteran does not have any visible skin condition, except onychomycosis associated with DM. Post-service medical treatment records reflect ongoing complaints of and treatment for skin conditions other than service-connected dermatitis. For instance, medical treatment records dated in October 2007 reflect a history of asteatotic dermatitis, furuncles, and rosacea. Report of the June 2011 VA examination reflects the Veteran experienced itchy, blistering skin around his neck and face. The Veteran reported onset of symptoms in and since service. At that time, the Veteran was diagnosed with actinic keratosis and psoriasis well-controlled on medication. Medical treatment records dated in July 2013 reflect the Veteran’s statements regarding seasonal flare-ups in cold weather. At that time, the Veteran was diagnosed with eczema. It is well-established that the current disability requirement for establishing entitlement to service connection is satisfied when a veteran “has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim.” McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Given the numerous diagnoses of skin conditions, the September 2017 VA examiner’s finding that the Veteran does not have any visible skin condition, except onychomycosis, requires clarification. For instance, it is not clear whether the examiner is expressing disagreement with the prior diagnoses or indicating a purported resolution of such disabilities. See Bolton, supra; Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). Without the requested clarification, the Board lacks the medical expertise necessary to adjudicate the claim. Assuming the latter, the Board notes that an apparent focus on the purported resolution of any claimed skin condition (other than seborrheic dermatitis and onychomycosis), rather than whether the Veteran’s current disability is caused by or otherwise etiologically related to service, is erroneous. As indicated, a disability during the pendency of that claim (even though the disability subsequently resolves) is considered current for VA purposes. As such, the examiner must offer an opinion as to whether it is as likely as not that the Veteran’s skin condition, to include actinic keratoses, eczema, and rosacea, is caused by or otherwise etiologically related to military service. The matter is REMANDED for the following action: 1. Arrange for the examiner who conducted the September 2017 VA examination, if available, to prepare an addendum opinion as to the nature and etiology of any claimed skin condition (other than seborrheic dermatitis and onychomycosis), and if deemed necessary, conduct a new examination of the Veteran. The electronic claims file must be made accessible to the examiner for review, and such review should be noted in the examination report. Given the September 2017 VA examiner found there to be no current disability (other than onychomycosis), yet numerous diagnoses of skin conditions, the examiner must: (a.) Provide a rationale for the September 2017 VA examination finding that the Veteran does not have a skin condition (other than onychomycosis). (b.) Discuss the prior diagnoses of skin conditions, including actinic keratoses, eczema, and rosacea, and whether such diagnoses are indicative of a current disability during the appeal period. The Board notes that a competent medical diagnosis of a disability during the pendency of the claim for such disability, even if the disability subsequently resolves, is considered a current disability. (c.) If so, the examiner should opine whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such disability is caused by or a result of the Veteran’s military service, including exposure to herbicide agents, i.e., Agent Orange, in service. (d.) If not, the examiner must explain why prior diagnoses of skin conditions are not indicative of a current diagnosis for VA purposes. The examiner must provide a rationale for all opinions provided. If an opinion cannot be made without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. THOMAS H. O'SHAY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Kalolwala, Associate Counsel