Citation Nr: 18154313 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 14-08 689 DATE: November 29, 2018 ORDER A rating in excess of 20 percent for diabetes mellitus, type II, is denied. An initial rating in excess of 40 percent for peripheral neuropathy right upper extremity is denied. An initial rating in excess of 30 percent for left upper extremity is denied. An initial rating in excess of 10 percent prior June 18, 2014, and 20 percent thereafter for peripheral neuropathy left lower extremity is denied. An initial rating in excess of 10 percent prior to June 18, 2014, and 20 percent thereafter for peripheral neuropathy right lower extremity is denied. An earlier effective date for peripheral neuropathy bilateral upper extremities is denied. An earlier effective date for peripheral neuropathy bilateral lower extremities is denied.   FINDINGS OF FACT 1. The Veteran’s diabetes mellitus type II is manifested by a prescribed insulin; it is not manifested by medical evidence of regulation of activities. 2. The competent and probative evidence weighs against finding severe incomplete paralysis of the right upper extremity. 3. The competent and probative evidence weighs against finding severe incomplete paralysis of the left upper extremity. 4. The competent and probative evidence weighs against finding severe incomplete paralysis of the left lower extremity. 5. The competent and probative evidence weighs against finding severe incomplete paralysis of the right lower extremity. 6. The Veteran did not appeal the rating decision of August 2014 that denied service connection for neuropathy of the bilateral upper extremities. 7. The record contains no informal claim, formal claim, or written intent to file a claim for entitlement to service connection for neuropathy of the upper extremities prior November 24, 2015. 8. The record contains no informal claim, formal claim, or written intent to file a claim for entitlement to service connection for neuropathy of the upper extremities prior to September 19, 2012. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 20 percent for diabetes mellitus type II have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.119, DC 7913. 2. The criteria for an initial rating in excess of 40 percent for peripheral neuropathy right upper extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.124a, DC 8513. 3. The criteria for an initial rating in excess of 30 percent for left upper extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.124a, DC 8513. 4. The criteria for an initial rating in excess of 10 percent prior June 18, 2014, and 20 percent thereafter for peripheral neuropathy left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.124a, DC 8620. 5. The criteria for an initial rating in excess of 10 percent prior to June 18, 2014, and 20 percent thereafter for peripheral neuropathy right lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.124a, DC 8620. 6. The criteria for an effective date prior to November 24, 2015 for the grant of service connection for neuropathy of the upper extremities have not been met. 38 U.S.C. §§5107, 5110; 38 C.F.R. §§ 3.102, 3.400. 7. The criteria for an effective date prior to September 19, 2012 for the grant of service connection for neuropathy of the lower extremities have not been met. 38 U.S.C. §§5107, 5110; 38 C.F.R. §§ 3.102, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Army from August 1969 to March 1971. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a January 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In a January 2013 rating decision, the RO granted service connection for right and left lower extremity diabetic neuropathy and assigned each a 10 percent rating effective September 19, 2012. In a December 2015 rating decision, the RO granted service connection for bilateral upper extremity diabetic neuropathy and assigned a 40 percent and 30 percent ratings for dominant and non-dominant extremity effective November 24, 2015. Therefore, the issues of increased ratings for upper and lower bilateral extremities neuropathy is part-and-parcel of the claim for increased rating for diabetes mellitus, type II. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentages are based on the average impairment of earning capacity as a result of service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509–10 (2007). Staged ratings are not appropriate in this matter as the evidence establishes that the Veteran’s service-connected disability remained largely stable and constant during the appeal. Hart v. Mansfield, 21 Vet. App. 505, 509–10 (2007). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other. Esteban v. Brown, 6 Vet. App. 259, 262 (1994); 38 C.F.R. § 4.14. The Veteran is competent to report symptoms and experiences observable by her senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). 1. Entitlement to a rating in excess of 20 percent for diabetes mellitus, type II. The Veteran filed a claim for increased compensation for his service-connected diabetes in September 2012. The diabetes has been rated as 20 percent disabling since January 2005. The next-higher rating of 20 percent is warranted for diabetes requiring insulin and restricted diet; or oral hypoglycemic agent and restricted diet. A 40 percent rating is warranted for diabetes requiring insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities). A 60 percent rating requires the use of insulin, a restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A total rating of 100 percent is warranted when the disability requires more than one daily injection of insulin, a restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. 38 C.F.R. § 4.119, Diagnostic Code 7913. Note 1 to Diagnostic Code 7913 provides that compensable complications from diabetes mellitus are to be evaluated separately unless they are part of the criteria used to support a 100 percent evaluation; however, noncompensable complications are considered part of the diabetic process under Diagnostic Code 7913. The Veteran underwent a VA examination in November 2012. He had a restricted diet, insulin pump, and more than one insulin injection per day. The examiner reported that the Veteran had regulation of activities; however, under that portion of the report, the examiner recorded that the Veteran attends the gym three to four times per week for 90 minutes, walks, lifts weight, and also golfs twice per week. The Veteran visited his diabetic care provided for episodes of ketoacidosis and hypoglycemia less than two times per month. He also had zero episodes of ketoacidosis or hypoglycemia that required hospitalization over the past year. An additional VA examination was performed in June 2014. He used insulin more than one time per day as well as an insulin pump. The examiner again noted that the Veteran required regulation of his activities in that he required three times per day glucose monitoring, adjustments to diet and exercise, and monitoring work flow to avoid mistakes related to low blood sugar. The Veteran visited his diabetic care provider for episodes of ketoacidosis less than two times per month, but visited his diabetic care provider for hypoglycemia weekly. He also had zero episodes of ketoacidosis or hypoglycemia that required hospitalization over the past year. The most recent VA examination was provided in November 2015. He used insulin injections more than once per day. No regulation of activities was recorded. The Veteran visited his diabetic care provider for episodes of ketoacidosis and hypoglycemia less than two times per month. He also had zero episodes of ketoacidosis or hypoglycemia that required hospitalization over the past year. The Veteran submitted lay testimony that he was no longer able to go to the gym as often as he wished, but this was due to asthma related difficulties. However, records in 2013 indicate that he was very physically active. In 2015, the Veteran was able to maintain frequenting the gym. After review of the totality of the relevant competent and probative evidence, the Board finds that a rating in excess of 20 percent for diabetes mellitus type II is not warranted. The Board finds that the evidence weighs against showing that Veteran has had regulation of activities as contemplated by the rating criteria. In this regard, the U.S. Court of Appeals for Veterans Claims has explained that the term “regulation of activities” means that a claimant must have a medical need to avoid not only strenuous occupational activity, but also strenuous recreational activity. Camacho v. Nicholson, 21 Vet. App. 360, 363 (2007). Medical evidence is required to show that occupational and recreational activities have been restricted. Id. at 364. The Board acknowledges that the Veteran’s VA examinations in November 2012 and June 2014 report regulation of activities. However, in the November 2012 VA examination, the examiner listed the Veteran’s activities that he participates in including walking, going to the gym, golfing biweekly, and lifting weights. The activities that he participated in do not amount to regulation of activities for VA purposes. Indeed, the Board finds that when looking at the plain meaning of this words, they show that the Veteran was active in many pursuits, such as walking and golfing. The Board also acknowledges that the June 2014 VA examination report indicated the Veteran had regulation of activities. Yet, the pertinent section merely noted that the Veteran monitored his glucose, and had diet and exercise adjustment. The Board has taken a liberal read of this description, but finds that this also does not amount to regulation of activities as it does not show that the Veteran had to reduce strenuous recreational or occupational activities. The Board has also reviewed the Veteran’s medical treatment records. Some of these medical records indicate that any reduction in physical activity was due to his nonservice-connected asthma. Additionally, in 2013 and 2015, his medical records indicate that he was able to frequently go to the gym, and that he was very physically active. The Board acknowledges that the Veteran uses insulin daily and has had a restricted diet. However, the competent and probative medical evidence does not establish that the Veteran had regulation of his activities as the evidence shows that the Veteran was able to maintain a physically active lifestyle. As such, the weight of the competent and probative evidence weighs against a finding of regulation of activity. Therefore, the Board finds that a rating in excess of 20 percent is not warranted. 38 C.F.R. § 4.3. 2. Entitlement to an initial rating in excess of 40 percent for peripheral neuropathy right upper extremity (URE). The Veteran is rated as 40 percent disabled for URE peripheral neuropathy under DC 8513. The rating criteria does not include an entry for diabetic peripheral neuropathy. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. Diseases affecting the nerves are rated on the basis of degree of paralysis, neuritis, or neuralgia under 38 C.F.R. §§ 4.123, 4.124, and 4.124a. Under Diagnostic Code 8513, a 20 percent rating is warranted for mild incomplete paralysis of all radicular groups. For moderate incomplete paralysis of all radicular groups, a 40 percent rating is warranted for the major extremity, and a 30 percent rating is warranted for the minor extremity. For severe incomplete paralysis of all radicular groups, a 70 percent rating is warranted for the major extremity, and a 60 percent rating is warranted for the minor extremity. For complete paralysis of all radicular groups, the maximum schedular rating of 90 percent is warranted for the major extremity, and an 80 percent rating is warranted for the minor extremity. 38 C.F.R. § 4.124a, DC 8513. The terms “major” and “minor” are used in the rating criteria to refer to the dominant or non-dominant upper extremity. 38 C.F.R. § 4.69. 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. 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves, Note. When the involvement is wholly sensory, the rating for incomplete paralysis should be for the mild, or, at most, the moderate degree. Id. VA guidance indicates that moderate incomplete paralysis will likely be described by the Veteran and medically graded as significantly disabling and may be demonstrated by combinations of significant sensory changes and reflex or motor changes of a lower degree, or motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate. The Court recently held in Miller v. Shulkin that, “[a]lthough the note preceding § 4.124a directs the claims adjudicator to award no more than a 20% disability rating for incomplete paralysis of a peripheral nerve where the condition is productive of wholly sensory manifestations, it does not logically follow that any claimant who also exhibits non-sensory manifestations must necessarily be rated at a higher level.” 28 Vet. App. 376, 380 (2017). The term “incomplete paralysis,” with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with 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. Words such as “severe,” “moderate,” and “mild” are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6 Neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe incomplete paralysis. 38 C.F.R. § 4.123. The maximum rating which may be assigned for neuritis not characterized by such organic changes will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. Id. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. 38 C.F.R. § 4.124. Tic douloureux may be rated up to complete paralysis of the affected nerve. The Board notes that the record reflect that the Veteran is right hand dominant. In June 2014, the Veteran had a VA examination for his diabetes. He had mild intermittent pain, paresthesias and/or dysesthesias, and numbness in his URE and ULE. He had normal muscle strength and deep tendon reflexes. He had normal light touch testing. He had normal position sense, vibration sensation, and cold sensation, and did not have muscle atrophy. An additional VA examination was provided in November 2015. It was reported that he had a diagnosis of bilateral upper extremity diabetic peripheral neuropathy from 2013. He did not have constant pain in either extremity, but did have moderate intermittent pain, paresthesias and/or dysesthesias, and numbness in all extremities. He had normal muscle strength, and deep tendon reflexes. He had normal light touch testing. He had normal position sense, vibration sensation and cold sensation in both extremities. He did not have muscle atrophy. The examiner characterized found the Veteran’s neuropathy of all extremities as moderate incomplete paralysis. After review of the competent and probative evidence, the Board finds that a rating in excess of 40 percent is not warranted. The Veteran’s medical records document mild intermittent pain and numbness that eventually progressed to moderate intermittent pain, paresthesias and/or dysesthesias. He has had moderate numbness in his extremities. However, he has had normal muscle strength and deep tendon reflexes throughout the period on appeal, as well as normal light touch. As such, the Board finds that the competent and probative evidence weighs against a rating higher than 40 percent for moderate incomplete paralysis in the dominant hand. Accordingly, the Board finds that the preponderance of the evidence is against the appeal for a rating in excess of 40 percent, and the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to an initial rating in excess of 30 percent for left upper extremity (ULE). After review of the competent and probative evidence, the Board finds that a rating in excess of 30 percent is not warranted. The Board notes that the Veteran’s upper left extremity is his minor extremity. In the Veteran’s June 2014 VA examination, the examiner notes mild intermittent pain and numbness. His November 2015 VA examination records moderate intermittent pain, paresthesias and/or dysesthesias. He has had moderate numbness in his extremities. However, he has had normal muscle strength and deep tendon reflexes throughout the period on appeal, as well as normal light touch. As such, the Board finds that the competent and probative evidence weighs against a rating higher than 30 percent for moderate incomplete paralysis in the non-dominant extremity. Accordingly, the Board finds that the preponderance of the evidence is against the appeal for a rating in excess of 30 percent, and the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7. 4. Entitlement to an initial rating in excess of 10 percent prior June 18, 2014, and 20 percent thereafter for peripheral neuropathy left lower extremity (LLE). The Veteran is currently rated as 10 percent disabling prior to June 18, 2014, and 20 percent thereafter for LLE peripheral neuropathy under DC 8620. Complete paralysis of the sciatic nerve is demonstrated by foot dangles and drops, no active movement possible of the muscles below the knee, flexion of the knee weakened or very rarely lost. Complete paralysis is rated as 80 percent disabling. Severe incomplete paralysis with marked muscular atrophy is rated as 60 percent disabling. Moderately severe is rated 40 percent disabling, and moderate incomplete paralysis is rated 20 percent disabling. The Veteran underwent a VA examination in November 2012 for his service-connected diabetes mellitus. At that examination, he was diagnosed with diabetic peripheral neuropathy. His LLE had mild intermittent pain, and both his RLE and LLE had mild paresthesias and/or dysesthesias. He had mild numbness, decreased vibration and cold sensitivity in both extremities. The examiner reported normal nerve severity for his bilateral lower extremities. In June 2014, the Veteran had another VA examination for his diabetes. He had moderate constant and intermittent pain in his RLE and LLE. Both his RLE and LLE had moderate paresthesias and/or dysesthesias and numbness. He had normal muscle strength. He had decreased deep tendon reflexes in his ankle. His light touch testing was decreased in his feet and toes. He had normal position sense, vibration sensation, and cold sensation, and did not have muscle atrophy. A VA examination was provided in November 2015. He did not have constant pain in either extremity, but did have moderate intermittent pain, paresthesias and/or dysesthesias, and numbness in both extremities. He had normal muscle strength, and deep tendon reflexes. He had decreased light touch testing in his feet and toes. He had normal position sense, vibration sensation in both extremities, but had decreased cold sensation in his LLE. He did not have muscle atrophy. He had moderate incomplete paralysis. His medical records indicate that his diabetic neuropathy affects his ability to walk for long periods of time. Prior to June 18, 2014 After review of the competent and probative evidence, the Board finds that a rating in excess of 10 percent is not warranted. The Veteran’s VA examinations indicate that his symptoms were mild during this period on appeal. Moreover, the examiner reported that the Veteran had normal nerve severity for his lower extremity. There is no indication during this period that the Veteran had decreased tendon reflexes or reduced light touching. As such, a rating higher than 10 percent prior to June 18, 2014, is not warranted.   June 18, 2014 onward After review of the competent and probative evidence, the Board finds that a rating in excess of 20 percent is not warranted. The Veteran’s VA examination shows no worse than moderate intermittent pain. The Board acknowledges that the June 2014 VA examination documented decreased reflexes in his ankle, as well as decreased cold sensation. However, in the November 2015 VA examination, the Veteran had normal reflexes. He did not have muscle atrophy and he had normal muscle strength and deep tendon reflexes. Accordingly, the Board finds that the preponderance of the evidence is against the appeal for a rating in excess of 20 percent, and the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. 5. Entitlement to an initial rating in excess of 10 percent prior to June 18, 2014, and 20 percent thereafter for peripheral neuropathy right lower extremity (RLE). The Veteran is currently rated as 10 percent disabling prior to June 18, 2014, and 20 percent thereafter for RLE peripheral neuropathy under DC 8620. Prior to June 18, 2014 After review of the competent and probative evidence, the Board finds that a rating in excess of 10 percent is not warranted. The Veteran’s VA examinations indicate that his symptoms were mild during this period on appeal. The examiner documented mild numbness, decreased vibration and cold sensitivity in the extremity. Moreover, the examiner reported that the Veteran had normal nerve severity for his lower extremity. There is no indication during this period that the Veteran had decreased tendon reflexes or reduced light touching. As such, the Board finds that the competent and probative evidence weighs against a rating higher than 10 percent prior to June 18, 2014, is not warranted.   June 18, 2014 onward After review of the competent and probative evidence, the Board finds that a rating in excess of 20 percent is not warranted. The Veteran’s VA examination shows no worse than moderate intermittent pain. The Board acknowledges that the June 2014 VA examination documented decreased reflexes in his ankle, as well as decreased cold sensation. However, in the November 2015 VA examination, the Veteran had normal reflexes. He did not have muscle atrophy and he had normal muscle strength and deep tendon reflexes. Accordingly, the Board finds that the preponderance of the evidence is against the appeal for a rating in excess of 20 percent, and the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Effective Date The assignment of effective dates of awards is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Except as otherwise provided, the effective date of an evaluation and an award of pension, compensation, or dependency and indemnity compensation based on an original claim or a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date the claim arose, whichever is later. 38 C.F.R. § 3.400. Any communication or action indicating an intent to apply for one or more benefits under the laws administered by VA from a claimant may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if the formal claim has not been filed, an application form will be forwarded to the claim for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of the receipt of the formal claim. 38 C.F.R. § 3.155. Additionally, the Court has noted that the filing of a claim is a voluntary act and Veterans are as free to withdraw claims as they are to file them. “When claims are withdrawn, they cease to exist.” Hanson v. Brown, 9 Vet. App. 29, 31–32 (1996). The withdrawal of a claim is only effective where the withdrawal is explicit, unambiguous, and done with a full understanding of the consequences of such action. Delisio v. Shinseki, 25 Vet. App. 45, 57 (2011). 6. Entitlement to an earlier effective date for peripheral neuropathy bilateral upper extremities. In a June 2006 rating decision, VA granted service connection for diabetes mellitus. In December 2015, the RO granted service connection for diabetic neuropathy of the bilateral upper extremities, effective November 24, 2015. The Veteran has since appealed, seeking an earlier effective date. In an October 2018 brief, the Veteran’s representative noted the belief that the Veteran is entitled to a 10 percent rating effective from June 2014, which is essentially a claim for an earlier effective date for service connection of upper extremity neuropathy. The Board notes that under 38 C.F.R. § 3.157, a report of examination or hospitalization will be accepted as an informal claim for benefits. However, the provisions of 38 C.F.R. § 3.157 only apply once a formal claim for compensation or pension has been allowed or compensation disallowed because the disability is not compensable. Thus, although some of the Veteran’s clinical records may document the existence of neuropathy, for example the June 2014 VA examination report as noted by the representative, such medical records cannot constitute an initial claim for service connection as no intent to file a claim was noted. See Criswell v. Nicholson, 20 Vet. App. 501, 504 (2006); Brannon v. West, 12 Vet. App. 32, 35 (1998) (finding that medical records alone cannot constitute an initial claim for service connection but rather there must be some intent by the claimant to apply for the benefit). In addition, although the Veteran’s neuropathy is secondary to his service-connected diabetes mellitus, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has repeatedly rejected the argument that a disability service connected as secondary to an underlying service-connected disability be entitled to the effective date of the underlying disability. See Manzanares v. Shulkin, 863 F.3d 1374, 1377-78 (Fed. Cir. 2017) (noting that a secondary service connection is not necessarily part of the primary claim for service connection.). There is nothing in the history of 38 C.F.R. § 3.310(a) to suggest that a claim for secondary service connection should be treated as part of a claim for primary service connection. Id. at 1374. Furthermore, a claim for secondary service connection is not an “ancillary benefit” within the meaning of 38 C.F.R. § 3.155(d). Id. at 1378. The Board has considered whether any evidence of record prior to November 24, 2015, could serve as an informal claim in order to entitle the Veteran to an earlier effective date for neuropathy of the upper extremities. In this regard, the Veteran submitted an informal claim for bilateral upper extremity disability that was received by the VA on July 17, 2013. The RO denied the claim in an August 2014 rating decision. The Veteran did not appeal, and the rating decision became final. The Board has reviewed the record but has not found any formal or informal communication that could be construed as a petition to reopen the claim of entitlement to service connection for bilateral upper extremity neuropathy prior to the grant of service connection of November 24, 2015, and after the prior final decision. In the instant case, given the governing legal authority, the Board finds that the effective date has been appropriately assigned. While sympathetic to the Veteran’s belief that an earlier effective date is warranted, for the reasons outlined above, the Board is precluded by law from assigning an effective date prior to November 24, 2015, for the grant of service connection for diabetic neuropathy of the bilateral upper extremities. Therefore, the Veteran’s claim for an earlier effective date must be denied. 7. Entitlement to an earlier effective date for peripheral neuropathy bilateral lower extremities. In a June 2006 rating decision, the Board granted service connection for diabetes mellitus. In January 2013, the RO granted service connection for diabetic neuropathy of the bilateral lower extremities, effective September 19, 2012. The Veteran has since appealed, seeking an earlier effective date. The Veteran’s representative noted that the earliest mention of neuropathy is noted in 2010 and again in 2011. The Board has considered whether any evidence of record prior to September 19, 2012, could serve as an informal claim in order to entitle the Veteran to an earlier effective date for neuropathy of the lower extremities. However, no document submitted prior to September 19, 2012, indicates intent by the Veteran to pursue a claim of service connection for neuropathy. As previously noted, an effective date is assigned based on the date of the claim or the date entitlement arose, whichever is later. Therefore, the September 19, 2012, the date selected by the RO (i.e., the date VA received the claim for increase) is the earliest possible effective date with regards to the claim for service connection for neuropathy. 38 C.F.R. § 3.400(b)(2). (Continued on the next page)   In the instant case, given the governing legal authority, the effective date has been appropriately assigned as the date of claim. While sympathetic to the Veteran’s belief that an earlier effective date is warranted, for the reasons outlined above, the Board is precluded by law from assigning an effective date prior to September 19, 2012, for the grant of service connection for diabetic neuropathy of the bilateral lower extremities. Therefore, the Veteran’s claim for an earlier effective date must be denied. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Morales, Associate Counsel