Citation Nr: 18151567 Decision Date: 11/20/18 Archive Date: 11/19/18 DOCKET NO. 15-27 301A DATE: November 20, 2018 ORDER The petition to reopen the claim of entitlement to service connection for bilateral hearing loss based on the submission of new and material evidence is granted. The petition to reopen the claim of entitlement to service connection for hypertension (HTN) based on the submission of new and material evidence is granted. Entitlement to an effective date earlier than June 28, 2013, for grant of service connection for left lower extremity (LLE) peripheral neuropathy is denied. Entitlement to an effective date earlier than June 28, 2013, for grant of service connection for right lower extremity (RLE) peripheral neuropathy is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection, to include on a secondary basis, for HTN is denied. Entitlement to an initial increased rating in excess of 10 percent for coronary artery disease (CAD) is denied. Entitlement to a rating in excess of 60 percent disabling as of July 1, 2018, for CAD (following temporary 100 percent rating for myocardial infarction) is denied. Entitlement to an initial increased rating in excess of 10 percent disabling for insomnia is denied. REMANDED Entitlement to an initial increased rating in excess of 10 percent disabling for left lower extremity (LLE) peripheral neuropathy is remanded. Entitlement to an initial increased rating in excess of 10 percent disabling for right lower extremity (RLE) peripheral neuropathy is remanded. Entitlement to service connection for left upper extremity (LUE) diabetic peripheral neuropathy is remanded. Entitlement to service connection for right upper extremity (RUE) diabetic peripheral neuropathy is remanded. Entitlement to an effective date earlier than August 20, 2015, for grant of special monthly compensation (SMC) is remanded. Entitlement to a separate compensable rating for erectile dysfunction (ED) associated with diabetes mellitus, type II (DM) is remanded. Entitlement to service connection, to include on a secondary basis, for dental disability is remanded. Entitlement to service connection for an eye disability is remanded. Entitlement to service connection for a skin disorder, to include as due to exposure to Agent Orange (AO) is remanded. Entitlement to service connection for residuals of stroke. Entitlement to service connection for LUE disability (other than diabetic peripheral neuropathy) is remanded. Entitlement to service connection for RUE disability (other than diabetic peripheral neuropathy) is remanded. Entitlement to service connection for cervical spine disability. FINDINGS OF FACT 1. A May 2011 rating decision most recently denied, in pertinent part, the claim of entitlement to service connection for bilateral hearing; the Veteran did not perfect an appeal with respect to this issue. 2. The evidence received since the most recent May 2011 rating decision, by itself, or in conjunction with previously considered evidence, is new and relates to an unestablished fact necessary to substantiate the underlying claim of entitlement to service connection for bilateral hearing loss. 3. A June 2005 rating decision denied, in pertinent part, the claim of entitlement to service connection for HTN; the Veteran did not perfect an appeal with respect to this issue. 4. The evidence received since the most recent June 2005 rating decision, by itself, or in conjunction with previously considered evidence, is new and relates to an unestablished fact necessary to substantiate the underlying claim of entitlement to service connection for HTN. 5. In June 2013, the Veteran filed an original claim of compensation for DM. 6. The Veteran has been diagnosed with bilateral lower extremity peripheral neuropathy associated with his DM. 7. The Veteran’s bilateral hearing loss is not incurred in, caused by, or otherwise etiologically related to service. 8. The Veteran’s HTN is not incurred in, caused by, or otherwise etiologically related to service; nor is it proximately due to or aggravated by his service-connected DM and/or CAD. 9. Prior to March 8, 2018, the Veteran’s CAD did not result in workload of less than 7 metabolic equivalents (METs) resulting in dyspnea, fatigue, angina, dizziness or syncope, nor was there evidence of cardiac hypertrophy or dilation. 10. As of July 1, 2018, the Veteran’s CAD did not result in chronic congestive heart failure, or; workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. 11. For the entirety of the appeal, the Veteran’s insomnia manifested by transient symptoms such as sleep impairment and anxiety resulting in occupational and social impairment akin to a 10 percent disability rating. CONCLUSIONS OF LAW 1. The May 2011 rating decision denying service connection for bilateral hearing loss is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2018). 2. New and material evidence sufficient to reopen the claim of service connection for bilateral hearing loss has been received. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2018). 3. The June 2005 rating decision denying service connection for HTN is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2018). 4. New and material evidence sufficient to reopen the claim of service connection for HTN has been received. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2018). 5. The criteria for an effective date earlier than June 28, 2013, for grant of service connection for LLE peripheral neuropathy have not been met. 38 U.S.C. § 1114(l), (s), 5103, 5103A, 5107(b), 5110 (2012); 38 C.F.R. § 3.400 (2018). 6. The criteria for an effective date earlier than June 28, 2013, for grant of service connection for RLE peripheral neuropathy have not been met. 38 U.S.C. § 1114(l), (s), 5103, 5103A, 5107(b), 5110 (2012); 38 C.F.R. § 3.400 (2018). 7. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.385 (2018). 8. The criteria for service connection for HTN have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2018). 9. Prior to March 8, 2018, the criteria for an initial disability rating in excess of 10 percent for CAD have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.104, DC 7005 (2018). 10. As of July 1, 2018, the criteria for an increased disability rating in excess of 60 percent for CAD have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.104, DC 7005 (2018). 11. The criteria for an initial disability rating in excess of 10 percent for the Veteran’s service-connected insomnia disorder have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.130, Diagnostic Code 9413 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1966 to December 1968. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an November 2014, April 2015, February 2016, July 2016, and October 2016 rating decisions, respectively, by the Department of Veterans Affairs (VA) Regional Office (RO). Lastly, the Board notes that additional VA medical evidence pertinent to the Veteran’s claims were added to the record subsequent to the most recent August 2015, June 2016, March 2017, and July 2017 statements of the case (SOCs), respectively, without waiver of Agency of Original Jurisdiction (AOJ) consideration. The Veteran was notified that additional evidence which was not previously considered in a decision by the AOJ has been received, and that he had a right to have the AOJ review them prior to the Board’s review of the case, or alternatively, he could waive his right to AOJ review. In response, the Veteran, through his attorney, notified the Board via letter dated in September 2018, that he wished to waive AOJ consideration. New and Material Evidence In any case involving a finally denied claim, the Board must address whether new and material evidence has been received to reopen before addressing the merits of the claim. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001); Wakeford v. Brown, 8 Vet. App. 237, 239–40 (1995). VA must reopen a previously and finally disallowed claim when “new and material evidence” is presented or secured. 38 U.S.C. §§ 5108, 7104(b); 38 C.F.R. § 3.156(a). In order to satisfy these requirements, the evidence “must be both new and material.” Smith v. West, 12 Vet. App. 312, 314 (1999). “New and material evidence” is defined as follows: New evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In making the determination of materiality, the “credibility of the evidence is to be presumed.” Justus v. Principi, 3 Vet. App. 510, 513 (1992). The Board notes that the threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). When evaluating the materiality of newly submitted evidence, the focus must not be solely on whether the evidence remedies the principal reason for denial in the last prior decision; rather the determination of materiality should focus on whether the evidence, taken together, could at least trigger the duty to assist or consideration of a new theory of entitlement. 1. Whether new and material evidence has been submitted to reopen a previously denied claim of service connected for bilateral hearing loss The Board has considered whether the evidence submitted since the May 2011 rating decision, i.e., the last prior final decision, constitutes new and material evidence sufficient to reopen the claim of service connection for bilateral hearing loss, and finds that it does. The evidence was not of record at the time of the prior denial and relates to an unestablished fact, by itself or when considered with other evidence, necessary to substantiate the claim. For instance, the Veteran submitted a statement dated in July 2014 regarding ongoing hearing impairment since service. Based on these statements, the Veteran was provided with a new VA examination in November 2014. Additionally, the Veteran submitted medical literature regarding the acceleration of age-related hearing loss by early noise exposure. Accordingly, the Board finds that new and material evidence has been submitted and the petition to reopen the claim for service connection for bilateral hearing loss must be granted. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 2. Whether new and material evidence has been submitted to reopen a previously denied claim of service connected for HTN As a preliminary matter, the Board notes that the Veteran’s claim of entitlement to service connection for HTN was previously denied in June 2005. In September 2015, the Veteran filed a petition to reopen the previously denied claim. However, the RO did not address the issue of new and material evidence in its July 2016 rating decision. Notwithstanding, the Board notes it must address the threshold question of whether new and material evidence sufficient to reopen the previously denied claim has been received, as it goes to the Board’s jurisdiction to reach the underlying merits of the claim. See Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996). The Board has considered whether the evidence submitted since the June 2005 rating decision constitutes new and material evidence sufficient to reopen the claim of service connection for HTN, and finds that it does. The evidence was not of record at the time of the prior denial and relates to an unestablished fact, by itself or when considered with other evidence, necessary to substantiate the claim. For instance, the Veteran submitted medical abstracts discussing the relationship between DM and the development of HTN. Additionally, the Board was provided with a new VA examination in June 2016. Accordingly, the Board finds that new and material evidence has been submitted and the petition to reopen the claim for service connection for bilateral hearing loss must be granted. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). Effective Date The applicable law and regulations concerning effective dates provide that, except as otherwise provided, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be on the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. §§ 3.400, 3.400(o)(2). 3. Entitlement to an effective date earlier than June 28, 2013, for grant of service connection for left lower extremity (LLE) peripheral neuropathy As a preliminary matter, the Board notes that a July 2016 rating decision granted, in pertinent part, entitlement to service connection for LLE peripheral neuropathy with a 10 percent evaluation effective January 13, 2015 (the date of claim). In December 2016, the Veteran timely filed a notice of disagreement with the effective date assigned, thereby placing the issue in appellate status. The Veteran did not identify what he believed to be the proper effective date for this disability. A July 2017 statement of the case (implemented by a rating decision that same month) granted an earlier effective date of June 28, 2013, for grant of service connection for LLE peripheral neuropathy. The Veteran timely submitted a substantive appeal indicating he wished to appeal all issues listed on the statement of the case. As such, the Board finds this issue is still in appellate status. The Board has considered the propriety of the June 28, 2013, effective date for the Veteran’s grant of service connection for LLE peripheral neuropathy, and finds that there is no legal entitlement to an earlier effective date in this case. As indicated, it is well established that the effective date for a claim shall be the date of receipt of the new claim or date entitlement arose, whichever is later. In this case, the Board notes that VA regulations indicate complications of DM, e.g., diabetic peripheral neuropathy, are intertwined with the underlying malady. The Veteran has been diagnosed with bilateral lower extremity peripheral neuropathy associated with his DM. The Veteran filed an original claim for compensation for DM on June 28, 2013. The Board notes that the evidence of record reflects the presence of symptoms associated with peripheral neuropathy prior to June 28, 2013. However, the Board finds no communication was received from the Veteran or any representative seeking service connection for DM or an associated disability prior to such date. As such, there is no legal entitlement to an earlier effective date in this case. 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 an effective date earlier than June 28, 2013, for grant of service connection for LLE peripheral neuropathy. Accordingly, the appeal is denied. 4. Entitlement to an effective date earlier than June 28, 2013, for grant of service connection for right lower extremity (RLE) peripheral neuropathy The Board notes that the facts set forth above are incorporated by reference herein. The Board has considered the propriety of the June 28, 2013, effective date for the Veteran’s grant of service connection for RLE peripheral neuropathy, and finds that there is no legal entitlement to an earlier effective date in this case. As indicated above, the Veteran filed an original claim for compensation for DM on June 28, 2013. The Veteran has been diagnosed with bilateral lower extremity peripheral neuropathy associated with his DM. The Board finds no communication was received from the Veteran or any representative seeking service connection for DM or an associated disability prior to such date. 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 an effective date earlier than June 28, 2013, for grant of service connection for RLE peripheral neuropathy. Accordingly, the appeal is denied. Service Connection Establishing service connection generally requires (1) evidence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 281 F.3d 1163, 1167 (Fed. Cir. 2004). The current disability requirement 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), or “when the record contains a recent diagnosis of disability prior to... filing a claim for benefits based on that disability,” Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2018). In addition, service connection for certain chronic diseases, including organic diseases of the nervous system, e.g., sensorineural hearing loss, may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. Although the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Alternatively, service connection may be proven on a secondary basis. In this instance, the evidence must demonstrate an etiological relationship between a service-connected disability or disabilities on the one hand and the condition said to be proximately due to the service-connected disability or disabilities on the other. 38 C.F.R. § 3.310 (a); Wallin v. West, 11 Vet. App. 509 (1998). While the applicable laws and regulations do not provide a definition of “proximate cause,” generally it is defined as “[t]hat which, in a natural and continuous sequence, unbroken by any efficient intervening cause, produces injury, and without which the result would not have occurred.” BLACK’S LAW DICTIONARY 1103 (5th ed. 1979); Forshey v. West, 12 Vet. App. 71, 74 (1998), aff’d sub nom. Forshey v. Principi, 284 F.3d 1335 (Fed. Cir. 2002), rev’d on other grounds by Morgan v. Principi, 327 F.3d 1357 (Fed. Cir. 2003). Otherwise, evidence must demonstrate that a non-service-connected disability is aggravated by a service-connected disability. 38 C.F.R. § 3.310 (a). 5. Entitlement to service connection for bilateral hearing loss The record in this case is clear as to whether the Veteran has a current disability for VA purposes. Indeed, medical treatment records dated in February 2003 reflect the Veteran was diagnosed with bilateral sensorineural hearing loss of combined (mixed) type. This is consistent with report of the November 2014 VA audiological examination. Thus, the first element of service connection—the existence of a current disability—is satisfied. The Board also observes that the Veteran has consistently reported he was exposed to acoustic trauma in service as a result of his military occupational specialty (MOS). In particular, the Veteran reported taking priority equipment parts out to the airfield and making sure it got onto the cargo planes.” Since the description of the Veteran’s acoustic trauma is consistent with the places and circumstances of his service, VA concedes that the Veteran has, at the very least, moderate probability of noise exposure during service. As such, the Veteran’s in-service noise exposure is conceded. In this case, the central issue that must be resolved is whether the Veteran’s current disability was incurred in, caused by, or otherwise etiologically related to service. Based upon a review of the record, the Board finds that service connection for bilateral hearing loss is not warranted in this case because the evidence does not show a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. In making this finding, the Board notes the Veteran’s service treatment records are negative for any complaints and/or treatment for, or diagnosis of hearing loss during service. On the authorized audiological evaluation in November 1968, i.e., Veteran’s separation examination, pure tone thresholds, in decibels, were as follows (after thresholds were converted to International Standards Organization-American National Standards Institute (ISO-ANSI) units): HERTZ 500 1000 2000 3000 4000 RIGHT 20 15 15 -- 10 LEFT 20 15 15 -- 10 Parenthetically, the Board notes the threshold for normal hearing is from 0 to 20 decibels; and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The Board notes that various lay statements are of record. In a statement dated in August 2010, the Veteran reported a history of acoustic trauma in service, and that he began experiencing hearing impairment in and since service but thought “this was normal and thought nothing of it at the time.” This is echoed by an August 2010 statement by the Veteran’s spouse wherein she reported having first hand observations of the Veteran’s hearing impairment since service. The Board notes that the Veteran and his spouse are clearly competent to report observable symptomatology, i.e., hearing impairment. Once evidence is determined to be competent, the Board must determine whether the evidence is also credible. The former, the Court has held, is a legal concept, which is useful in determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Credibility can be generally evaluated by considering interest, bias, or inconsistent statements, the demeanor of the witness, facial plausibility of the testimony, and the consistency of the witness testimony. Caluza v. Brown, 7 Vet. App. 498, 510-511 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996). In that regard, the Board notes that the lay statements regarding onset and continuity of symptomatology are not supported by the evidence of record. Medical treatment records dated in December 1998 reflect, in pertinent part, the Veteran presented for numerous other ailments, however, is notably silent for any complaints of, treatment for, or diagnosis of hearing impairment. The first evidence of record since service, other than the Veteran’s own statements, is medical treatment records dated in February 2003. The absence of post-service findings, diagnoses, or treatment for decades after service is one factor that tends to weigh against a finding of continuous symptoms after separation. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (holding that the Board may weigh the absence of contemporaneous medical evidence as one factor in determining credibility of lay evidence, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical documentation of a claimed disability is one factor to consider as evidence against a claim of service connection). It is important to point out that the Board does not find that the lay statements lack credibility merely because they are unaccompanied by contemporaneous medical evidence. Rather, the current lay statements are also found to lack credibility because they are inconsistent with other evidence of record. For instance, the Veteran reported experiencing hearing impairment in service. STRs reflect the Veteran presented for numerous ailments. Notably, however, the records are negative for any complaints and/or treatment for hearing impairment. In his November 1968 separation report of medical history, the Veteran denied any difficulty hearing. As indicated above, medical treatment records dated in December 1998 are notably silent for any complaints of, treatment for, or diagnosis of hearing impairment. Additionally, medical treatment records dated in March 2004 reflect a history of bilateral hearing loss for approximately one year. Considering the totality of the evidence, the Veteran’s inconsistencies tend to undermine is credibility as an accurate historian. Next, the Board turns to the VA examination of record. The Board accords significant probative weight to the November 2014 VA examination and medical opinion. 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 November 2014 VA examination reflects, in pertinent part, the Veteran’s statements regarding a history of noise exposure in service and difficulty hearing since. The Veteran also acknowledged significant recreational noise exposure, i.e., guns. The Veteran was diagnosed with bilateral sensorineural hearing loss. The examiner opined that the Veteran’s bilateral hearing loss is less likely than not caused by or a result of service. In doing so, the examiner highlighted the Veteran’s November 1968 audiological examination reflecting normal hearing, as well as the lack of significant shift in auditory threshold since the Veteran’s September 1965 enlistment audiological examination. The examiner noted the Veteran medical evidence of record are medical treatment records dated in February 2003. The examiner intimated that the Veteran’s bilateral hearing loss is attributable to other factors such as aging, health issues, and recreational noise exposure. Parenthetically, the Board notes that medical treatment records dated in December 2003 reflect bilateral hearing loss “likely due to chronic cerumen impaction and allergic rhinitis.” This is consistent with medical treatment records dated in June 2003 and March 2004. Medical treatment records dated in March 2004 reflect, in pertinent part, a diagnosis of eustachian tube dysfunction—occurring when the eustachian tube gets inflamed or mucus/fluid builds up, and causes pain, hearing difficulties, and feeling of fullness in the ears (commonly caused by sinus infection and/or allergies). In light of the Board’s credibility determination, the examiner’s sparse discussion regarding the lay statements is inconsequential in this case. The Board also notes that there is no evidence that the Veteran’s disability manifested to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. §§ 3.307, 3.309(a). To the extent the Veteran is addressing questions of the medical nature and etiology of his bilateral hearing loss, the Board finds his statements are not competent lay evidence. In the absence of competent positive evidence of causation, a nexus cannot be established. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board sympathetically finds that the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for bilateral hearing loss. 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 entitlement, that doctrine is not helpful to the Veteran. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 6. Entitlement to service connection, to include on a secondary basis, for HTN As a preliminary matter, the Board finds that service connection is not warranted for the Veteran’s claimed HTN on a direct basis. In making this finding, the Board notes that the Veteran’s service treatment records are negative for any complaints and/or treatment for or diagnosis of HTN in service. The Board further noted that the Veteran first evidence of HTN or associated symptomatology is in or around 1998, i.e., nearly three decades after separation from service. More importantly, the Veteran has not contended (nor does the medical evidence otherwise reflect) that the Veteran’s HTN was incurred in, caused by, or a result of his military service. Rather, the Veteran has consistently claimed his HTN is secondary to his service-connected DM and/or CAD. 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 of service connection for HTN on a direct basis. Next, the Board turns to whether entitlement to service connection for HTN is warranted on a secondary basis. Based on a review of the record, the Board finds that service connection is not warranted for the Veteran’s claimed HTN on a secondary basis because the evidence of record does not demonstrate that the Veteran’s HTN is proximately due to or a result of his service-connected DM and/or CAD. In making this finding, the Board initially notes that medical treatment records reflect a history of HTN which antedated any diagnosis of DM and/or CAD. For instance, medical treatment records dated in January 2005 reflect a history of HTN with onset in 1998. Of note, contemporaneous medical records are negative for any history or diagnoses of either DM or CAD. Medical records dated in March 2007 reflect the Veteran denied any history of DM or CAD. The first evidence of a diagnosis of DM or CAD appears in or around 2013. This is consistent with medical treatment records dated in January 2015 which reflect the Veteran was diagnosed with DM approximately 2 years prior. An addendum medical opinion was obtained in June 2016, following a January 2016 VA examination. Report of the June 2016 medical opinion reflects, in pertinent part, the examiner’s opinion that the Veteran’s HTN is less likely than not proximately due to or a result of the Veteran’s service-connected DM and/or CAD. In doing so, the examiner indicated there is no evidence of record or other indicia that the Veteran’s HTN is secondary to service-connected DM and CAD, or any medication for such disabilities. He further indicated that this is consistent with well-known medical principles that 95 percent of HTN cases have no organic etiology. The Board recognizes that the RO did not obtain an aggravation opinion related to the Veteran’s HTN. In that regard, the Board notes the record does not reflect (nor has the Veteran contended) any aggravation of the Veteran’s HTN due to service-connected disabilities. For instance, medical treatment records overwhelming reflect the Veteran’s HTN is stable. The Board also recognizes the April 2017 statement by the Veteran’s attorney wherein he references medical articles (from WebMD) indicating an association between HTN and DM. However, the Board finds this evidence neither invalidates the opinion provided, nor does it create equipoise. Rather, the statement simply acknowledges that DM “can cause high blood pressure.” As developmental actions on a secondary theory have already been taken, the Board also finds this does not trigger VA’s duty to assist. The Board has considered the lay evidence of record. To the extent the Veteran is addressing questions of the medical nature and etiology of his HTN, the Board finds his statements are not competent lay evidence. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board sympathetically finds that the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for HTN. 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 entitlement, that doctrine is not helpful to the Veteran. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Increased Rating 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. 7. Entitlement to an initial increased rating in excess of 10 percent for CAD prior to March 8, 2018 Legal Principles Prior to March 8, 2018, the Veteran’s disability was rated as 10 percent disabling under Diagnostic Code (DC) 7005. Under DC 7005, a 10 percent rating is assigned where the evidence shows heart disease resulting in workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; when continuous medication is required. A next-higher 30 percent rating is assigned where the evidence shows heart disease resulting in workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. A 60 percent rating is assigned where the evidence shows heart disease resulting in 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 highest 100 percent rating is assigned where the evidence shows heart disease resulting in 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. Discussion Based upon a review of the evidence, the Board finds that an initial increased rating in excess of 10 percent disabling for CAD prior to March 8, 2018, is not warranted because the evidence does not reflect the Veteran satisfies the criteria for a higher rating. As a preliminary matter, the Board notes that the Veteran failed to appear for a scheduled March 2015 VA examination without good cause. The Board acknowledges that in July 2015, the Veteran submitted a statement indicating he never received notice for any scheduled appointment. However, the record reflects notification of this examination was sent to the Veteran’s last known address, i.e., the same address listed on the Veteran’s notice of disagreement (on another appeal) less than two months prior. The Board finds the VA is entitled to the presumption of regularity in finding that the Veteran was provided with sufficient notification of his scheduled examination, and the Veteran’s mere denial of receipt neither rebuts this presumption nor rises to the level of good cause. As such, the claim is rated based on the evidence of record. See 38 C.F.R. § 3.655. Medical treatment records prior to March 8, 2018, reflect ongoing treatment for CAD requiring continuous medication. However, these records are overwhelmingly negative for any evidence of chest pain, shortness of breath, fatigue, dizziness, or syncope. There is no evidence of cardiac hypertrophy or dilatation. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (lay statements found in medical records when medical treatment was being rendered may be afforded greater probative value; statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). For instance, treatment records dated in April 2005 reflect the Veteran denied any chest pain, shortness of breath, wheezing, lightheadedness and/or dizziness. Medical treatment records dated in June 2013 reflect, in pertinent part, a history of CAD for which the Veteran is “taking an over the counter Aspirin prescription.” Medical treatment records dated in December 2014 reflect the Veteran denied any chest pain, shortness of breath, palpitations or syncope. Medical treatment records dated in February 2015 reflect the Veteran was given an exercise stress test. At that time, the Veteran denied any exertional chest pain, but admitted occasional dyspnea. The examiner noted abnormal stress test reflecting a progression of CAD compared to an April 2013 stress test. However, no METs were provided. Medical treatment records dated in July 2015 reflect the Veteran reported “intermittent chest pain which last a few seconds.” Report of the June 2016 VA examination (pertaining to insomnia) reflects the Veteran maintains a good diet and exercises. Physical examination consistently revealed regular rate and rhythm of the Veteran’s heart. Report of the January 2016 VA examination (pertaining to HTN) reflects, in pertinent part, regular rate, rhythm, and auscultation of the heart. Chest x-rays were performed and found to be normal. The electrocardiogram revealed no signs of cardiac hypertrophy or dilation. As indicated, the next-higher 30 percent rating is assigned where the evidence shows heart disease resulting in workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. Based on a review of the available evidence of record, the Board does not find the Veteran met these criteria at any point prior to March 8, 2018. The Board has considered the Veteran’s statements. While the Veteran is competent to report symptoms associated with CAD, questions of the medical nature and severity of such disability is a matter suited to the realm of medical expertise. 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 an initial rating in excess of 10 percent disabling for CAD at any point prior to March 8, 2018; and therefore, the claim must be denied. Gilbert, 1 Vet. App. at 53-56. 8. Entitlement to a rating in excess of 60 percent disabling as of July 1, 2018, for CAD (following temporary 100 percent rating for myocardial infarction) For clarity, a March 2018 rating decision by the RO granted a temporary 100 percent rating from March 8, 2018 until June 30, 2018, following myocardial infarction. Thereafter, the Veteran is rated as cardiovascular residuals under DC 7005. As indicated above, a 60 percent rating is assigned where the evidence shows heart disease resulting in 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 highest 100 percent rating is assigned where the evidence shows heart disease resulting in 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. Based upon a review of the evidence, the Board finds that an initial increased rating in excess of 60 percent disabling for CAD as of July 1, 2018, is not warranted because the evidence does not reflect the Veteran satisfies the criteria for a higher rating. In making this finding, the Board accords significant probative weight to the VA examination conducted in April 2018. 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, supra; see also Barr, supra. Report of the April 2018 VA examination reflects, in pertinent part, a history of CAD and myocardial infarctions in March 2013 and March 2018. Based on the Veteran’s reported activity, the examiner noted CAD resulting in workload of greater than 3 METs but not greater than 5 METs with presence of dyspnea, fatigue, and angina. The examiner also noted there is no evidence of cardiac hypertrophy or dilation. Diagnostic testing revealed left ventricular dysfunction with an ejection fraction of 65 percent. This is consistent with contemporaneous medical evidence of record. Again, the Board has considered the Veteran’s statements. While the Veteran is competent to report symptoms associated with CAD, questions of the medical nature and severity of such disability is a matter suited to the realm of medical expertise. 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 an initial rating in excess of 60 percent disabling for CAD as of July 1, 2018; and therefore, the claim must be denied. Gilbert, 1 Vet. App. at 53-56. 9. Entitlement to an initial increased rating in excess of 10 percent disabling for insomnia Legal Principles The Veteran’s insomnia (claimed as sleep disorder) is currently rated as 10 percent disabling under 38 C.F.R. § 4.130, Diagnostic Code 9413. Under the General Rating Formula for Mental Disorders, a 10 percent rating is warranted where evidence shows occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. A next-higher 30 percent rating is warranted where a mental disability results in: [o]ccupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal) due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted where a mental disability results in: [o]ccupational and social impairment with reduced reliability and productivity due to symptoms such as: flattened affect, circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted where a mental disability results in: [o]ccupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); and inability to establish and maintain effective relationships. A 100 percent rating is warranted where a mental disability results in: [t]otal occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); and disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9413 (2018). The symptoms listed in the rating formula are examples, not an exhaustive list. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002) (finding that “any suggestion that the Board was required... to find the presence of all, most, or even some of the enumerated symptoms is unsupported by a reading of the plain language of the regulation”). However, “a Veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). “The regulation’s plain language highlights its symptom-driven nature” and “symptomatology should be... the primary focus when deciding entitlement to a given disability rating.” Id. at 116-17. As such, consideration is given to the frequency, severity, and duration of psychiatric symptoms, the length of remission, and the veteran’s capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment to the extent specified in the rating criteria; rather than solely on the examiner’s assessment of the level of disability at the moment of examination. See 38 C.F.R. § 4.126(a). Discussion Based on a review of the evidence, the Board finds that an initial increased rating in excess of 10 percent disabling for the Veteran’s insomnia is not warranted in this case because the Veteran does not demonstrate particular symptoms associated with a higher 30 percent rating, or others of similar severity, frequency, and duration that would more closely approximate the criteria for the higher rating. In making this finding, the Board accords significant probative weight to the VA examination conducted in June 2016. 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, supra; see also Barr, supra. Report of the June 2016 VA examination reflects, in pertinent part, the Veteran’s statements regarding sleep disturbance since his myocardial infarction in March 2013 and subsequent ischemic stroke in 2015. He indicated he wakes up 3-4 times per night. The Veteran denied any nightmares, intrusive thoughts, lack of interest, impaired memory, irritability, or depressed mood. The Veteran described himself as a “happy-go-lucky guy.” The Veteran did, however, admit feeling anxious after his heart attack and stroke. Medical evidence reflects a prior diagnosis of anxiety disorder considered stable without medication. The examiner noted the Veteran does not have any difficulty maintaining work and social relationships. The Veteran reported “good relationships with [his] family members.” The Veteran reported that he retired when he turned 67, but continues to work on a part-time basis. He reported no problems at work. Based on the Veteran’s reported symptoms, the Veteran was diagnosed with insomnia disorder resulting in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. This is overall consistent with the Veteran’s medical treatment records. For instance, records dated in June 2014 reflect the Veteran denied symptoms such as anxiety, depression, or memory impairment. Medical treatment records dated in April 2015 reflect a negative depression screening. Records also dated in April 2015 reflect the Veteran reported “occasional difficulty sleeping.” At that time, the Veteran was diagnosed with insomnia disorder and prescribed medication, i.e., Zolpidem, to help alleviate symptoms. Records dated in June 2015 reflect the Veteran reported occasional difficulty sleeping. Medical treatment records dated in January 2016 again reflect a negative depression screening. There is no evidence that the Veteran experiences symptoms such as depressed mood, suspiciousness, panic attacks, chronic sleep impairment, or memory impairment, symptoms also associated with a higher 30 percent rating. Recognition is paid to the fact that the presence of these symptoms is not outcome determinative. However, the Veteran also failed to show other such symptoms of similar severity, frequency, and duration. By the Veteran’s own admission, he experiences “occasional difficulty sleeping.” Any intermittent symptoms of anxiety were considered stable without medication. Based on the facts of this case, the intermittent nature of the Veteran’s sleep impairment and anxiety does not more nearly approximate occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, but rather reflects a lesser degree of impairment that is contemplated by the 10 percent rating currently assigned. 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 an initial increased rating in excess of 10 percent at any point during the appeal period. 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 10 percent, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53-56. Accordingly, an increased disability evaluation in excess of 10 percent disabling is denied. REASONS FOR REMAND A review of the record reveals that these claims must be remanded prior to appellate consideration. 1. Entitlement to an initial increased rating in excess of 10 percent disabling for LLE peripheral neuropathy is remanded. The Board notes that the Veteran was most recent provided with a VA examination pertaining to this issue in June 2016. A review of the record since the June 2016 VA examination indicates a discernable worsening of the Veteran’s symptoms. In December 2017, the Veteran indicated his neuropathy symptoms have worsened since the last examination. Specifically, the Veteran reported “stabbing sharp pain” unlike ever before. The Veteran indicated he “noticed it getting worse in the last few months,” and that his bilateral toes “lock up 3 or more times a week.” In a statement submitted that same month, the Veteran’s attorney indicated the Veteran is unable to walk unassisted due to pain in his bilateral lower extremities that has increased exponentially over the last several months. In light of evidence of worsening, see Snuffer v. Gober, 10 Vet. App. 400, 403 (1997), the Board finds that the medical evidence of record does not adequately address the Veteran’s current level of impairment, see generally Weggenmann v. Brown, 5 Vet. App. 281, 284 (1993). As such, the Board finds that a remand is necessary to obtain new examination addressing the current nature and severity of the Veteran’s LLE peripheral neuropathy. 2. Entitlement to an initial increased rating in excess of 10 percent disabling for RLE peripheral neuropathy is remanded. The Board notes that the facts set forth above are incorporated by reference herein. In light of evidence of worsening, the Board finds that the medical evidence of record does not adequately address the Veteran’s current level of impairment. As such, the Board finds that a remand is necessary to obtain new examination addressing the current nature and severity of the Veteran’s RLE peripheral neuropathy. See Snuffer, supra. 3. Entitlement to service connection for LUE diabetic peripheral neuropathy is remanded. 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, 21 Vet. App. at 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”). As indicated, the Veteran was provided with a VA neurologic examination in June 2016. Report of the June 2016 VA examination reflects, in pertinent part, reported numbness, tingling, and itchiness on the bilateral elbows—right more than left. The examiner noted mild intermittent pain, dysesthesias, and numbness attributable to diabetic peripheral neuropathy of the left and right upper extremity. In a subsequent section, however, the examiner indicated the Veteran does not have upper extremity diabetic peripheral neuropathy. Diagnostic testing was not performed. No further opinion or rationale pertinent to the Veteran’s upper extremity was provided. In a statement dated in January 2017, the Veteran, through his attorney, challenged the adequacy of the June 2016 VA examination as it relates to upper extremity diabetic peripheral neuropathy. In doing so, the examiner highlighted the apparent inconsistency in the June 2016 examiner’s findings. The attorney intimated that a remand is warranted to provide the Veteran with an adequate examination. Under the surrounding circumstances, the Board agrees. Given the symptomatology described by the Veteran and documented by the June 2016 examiner, the seemingly inconsistent evidence and the examiner’s failure to provide an adequate rationale is significant. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Here, the Board is strained to make assumptions and draw inferences as to the examiners’ reasoning. Bolton, supra. 4. Entitlement to service connection for RUE diabetic peripheral neuropathy is remanded. For the reasons set forth above, this issue must be remanded prior to appellate consideration. See Barr, supra. 5. Entitlement to an effective date earlier than August 20, 2015, for grant of SMC is remanded. A February 2016 rating decision by the RO granted, in pertinent part, entitlement to SMC based on loss of a creative organ effective August 20, 2015. In March 2016, the Veteran timely filed a notice of disagreement with the effective date assigned, thereby placing the issue in appellate status. See Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). A statement of the case (SOC) has not yet been issued; therefore, a remand is required for the issuance of a SOC. Id. 6. Entitlement to service connection, to include on a secondary basis, for dental disability is remanded. A February 2016 rating decision by the RO denied, in pertinent part, entitlement to service connection for dental disability. In March 2016, the Veteran timely filed a notice of disagreement with that decision, thereby placing the issue in appellate status. Id. A SOC has not yet been issued for the February 2016 denial; therefore, a remand is required for the issuance of a SOC. Id. 7. Entitlement to service connection for an eye disability is remanded. A February 2016 rating decision by the RO denied, in pertinent part, entitlement to service connection for eye disability. In March 2016, the Veteran timely filed a notice of disagreement with that decision, thereby placing the issue in appellate status. Id. A SOC has not yet been issued for the February 2016 denial; therefore, a remand is required for the issuance of a SOC. Id. 8. Entitlement to service connection for a skin disorder, to include as due to exposure to AO is remanded. A February 2016 rating decision by the RO denied, in pertinent part, entitlement to service connection for a skin disorder as due to AO exposure. In March 2016, the Veteran timely filed a notice of disagreement with that decision, thereby placing the issue in appellate status. Id. A SOC has not yet been issued for the February 2016 denial; therefore, a remand is required for the issuance of a SOC. Id. 9. Entitlement to a separate compensable rating for ED associated with DM is remanded. A February 2016 rating decision by the RO denied, in pertinent part, entitlement a compensable rating for ED associated with DM. In doing so, the RO continued the Veteran’s 20 percent disability rating for DM and denied a separate compensable rating for ED. In March 2016, the Veteran timely filed a notice of disagreement as it relates to the issue of ED, thereby placing the issue in appellate status. Id. Although the Veteran indicated he was seeking an earlier effective date for ED, the Board finds that under the facts and surrounding circumstances, the Veteran is, in fact, seeking a separate compensable rating for ED. As such, the issue has been recharacterized as it appears above. A SOC has not yet been issued for the February 2016 denial; therefore, a remand is required for the issuance of a SOC. Id. 10. Entitlement to service connection for residuals of ischemic stroke is remanded. An October 2016 rating decision by the RO denied, in pertinent part, entitlement to service connection for residuals of ischemic stroke. In November 2016, the Veteran timely filed a notice of disagreement with that decision, thereby placing the issue in appellate status. Id. A SOC has not yet been issued for the November 2016 denial; therefore, a remand is required for the issuance of a SOC. Id. Parenthetically, the Board notes that report of the June 2016 VA medical opinion reflects the examiner’s opinion that the Veteran’s ischemic stroke is at least as likely as not proximately due to or the result of his service-connected CAD and/or DM. In doing so, the examiner noted it is medically well-known that CAD and/or DM can cause embolic or ischemic strokes by causing a vaso-occlusive event. 11. Entitlement to service connection cervical spine disability is remanded. An October 2016 rating decision by the RO denied, in pertinent part, entitlement to service connection for a cervical spine disability (claimed as neck condition). In November 2016, the Veteran timely filed a notice of disagreement with that decision, thereby placing the issue in appellate status. Id. A SOC has not yet been issued for the November 2016 denial; therefore, a remand is required for the issuance of a SOC. Id. 12. Entitlement to service connection for LUE disability (other than diabetic peripheral neuropathy) is remanded. An October 2016 rating decision by the RO denied, in pertinent part, entitlement to service connection for a LUE disability (other than diabetic peripheral neuropathy). In November 2016, the Veteran timely filed a notice of disagreement with that decision, thereby placing the issue in appellate status. Id. A SOC has not yet been issued for the November 2016 denial; therefore, a remand is required for the issuance of a SOC. Id. 13. Entitlement to service connection for RUE disability (other than diabetic peripheral neuropathy) is remanded. An October 2016 rating decision by the RO denied, in pertinent part, entitlement to service connection for a RUE disability (other than diabetic peripheral neuropathy). In November 2016, the Veteran timely filed a notice of disagreement with that decision, thereby placing the issue in appellate status. Id. A SOC has not yet been issued for the November 2016 denial; therefore, a remand is required for the issuance of a SOC. Id. The matters are REMANDED for the following action: 1. Issue a SOC to the Veteran and his attorney addressing the issues of entitlement to an earlier effective date for grant of SMC, entitlement separate compensable rating for ED, and entitlement to service connection for dental disability, eye disability, skin disorder, cervical spine disability, residuals of stroke and disability of the right and left upper extremities (other than diabetic peripheral neuropathy). If necessary, inform the Veteran and his attorney of the time-period in which to submit a timely substantive appeal as to those matters. If, and only if, the Veteran perfects his appeal, the AOJ should return the case to the Board, if otherwise in order. 2. Obtain all relevant outstanding post-service medical treatment records from VA treatment facilities. 3. Thereafter, schedule the Veteran for VA neurologic examination by an appropriate medical professional to prepare an opinion with respect to the nature and severity of the Veteran’s service-connected LLE and RLE peripheral neuropathy, and claimed LUE and RUE peripheral neuropathy. The electronic claims file must be made accessible to the examiner for review, and such review should be noted in the examination report. Following a review of the claims file and medical history, the VA examiner must: (a.) Document all signs and/or symptoms necessary for evaluating the Veteran’s LLE and RLE peripheral neuropathy, including whether such neurologic manifestation results in complete or incomplete paralysis of the affected nerve. If incomplete paralysis is identified, the examiner must provide an opinion as to whether it is mild, moderate, or severe. (b.) Identify whether the Veteran has LUE and RUE peripheral neuropathy. (c.) If so, the examiner must offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such disorder is proximately due to or the result of the Veteran’s service-connected DM. 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. (Continued on the next page)   4. Thereafter, readjudicate the issues on appeal. If the benefits sought on appeal remain denied, issue a supplemental statement of the case (SSOC) and provide the Veteran and his attorney with an opportunity to respond. Then return the case to the Board, if otherwise in order. THOMAS H. O'SHAY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Kalolwala, Associate Counsel