Citation Nr: 18155096 Decision Date: 12/03/18 Archive Date: 12/03/18 DOCKET NO. 16-54 928 DATE: December 3, 2018 ORDER A rating in excess of 20 percent for type II diabetes mellitus is denied. For the period on appeal prior to July 26, 2018, a 20 percent rating for right lower extremity sciatic nerve peripheral neuropathy is granted. For the period on appeal from July 26, 2018, a rating in excess of 40 percent rating for right lower extremity sciatic nerve peripheral neuropathy is denied. For the period on appeal prior to July 26, 2018, a 20 percent rating for left lower extremity sciatic nerve peripheral neuropathy is granted. For the period on appeal from July 26, 2018, a rating in excess of 40 percent rating for left lower extremity sciatic nerve peripheral neuropathy is denied. A rating in excess of 20 percent for right upper extremity peripheral neuropathy for the period on appeal prior to June 20, 2017, and in excess of 30 percent for the period from June 20, 2017, is denied. A rating in excess of 20 percent for left upper extremity peripheral neuropathy is denied. A rating in excess of 60 percent for diabetic nephrology is denied. A total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted from August 17, 2011. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran’s type II diabetes mellitus with hypertension has required no more than insulin, the use of oral hypoglycemic agents, and restricted diet. 2. For the period on appeal prior to July 26, 2018, the Veteran’s right lower extremity sciatic nerve peripheral neuropathy was productive of moderate incomplete paralysis of the sciatic nerve. 3. For the period on appeal from July 26, 2018, the Veteran’s right lower extremity sciatic nerve peripheral neuropathy has been productive of no more than moderately severe incomplete paralysis. 4. For the period on appeal prior to July 26, 2018, the Veteran’s left lower extremity sciatic nerve peripheral neuropathy was productive of moderate incomplete paralysis of the sciatic nerve. 5. For the period on appeal from July 26, 2018, the Veteran’s left lower extremity sciatic nerve peripheral neuropathy has been productive of no more than moderately severe incomplete paralysis. 6. For the period on appeal prior to June 20, 2017, the evidence does not show more than mild incomplete paralysis of the radial nerve in the right upper extremity or a medial nerve disability of the right upper extremity; and for the period on appeal from June 20, 2017, no more than moderate incomplete paralysis of the median nerve of the right upper extremity has been shown. 7. Throughout the appeal period, more than moderate incomplete paralysis of the left upper extremity has not been shown. 8. Since diabetic nephrology was diagnosed on June 21, 2017, this condition has not been productive of a BUN of at least 40mg%, creatinine of at least 4mg%, or generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion; and it has neither required dialysis nor precluded more than sedentary activity. 9. The evidence is against finding that the Veteran has an eye condition or erectile dysfunction associated with his service-connected type II diabetes mellitus. 10. It is reasonably shown that the Veteran’s service-connected disabilities have precluded him from securing or following a substantially gainful occupation during the appeal period, or since August 17, 2011. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 20 percent for type II diabetes mellitus are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.114, Diagnostic Code 7913 (2017). 2. For the period on appeal prior to July 26, 2018, the criteria for a rating of 20 percent for right lower extremity sciatic nerve peripheral neuropathy are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.124a, Diagnostic Code 8520 (2017). 3. For the period on appeal from July 26, 2018, the criteria for a rating in excess of 40 percent for right lower extremity sciatic nerve peripheral neuropathy are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.124a, Diagnostic Code 8520 (2017). 4. For the period on appeal prior to July 26, 2018, the criteria for a rating of 20 percent for left lower extremity sciatic nerve peripheral neuropathy are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.124a, Diagnostic Code 8520 (2017). 5. For the period on appeal from July 26, 2018, the criteria for a rating in excess of 40 percent for left lower extremity sciatic nerve peripheral neuropathy are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.124a, Diagnostic Code 8520 (2017). 6. The criteria for a disability rating in excess of 20 percent for right upper extremity peripheral neuropathy for the period on appeal prior to June 20, 2017, and in excess of 30 percent for the period from June 20, 2017, are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.124a, Diagnostic Codes 8514, 8515 (2017). 7. The criteria for a disability rating in excess of 20 percent for left upper extremity peripheral neuropathy are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.124a, Diagnostic Codes 8514, 8515 (2017). 8. The criteria for a disability rating in excess of 60 percent for diabetic nephrology from June 21, 2017, are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.115a,, 4.115b, Diagnostic Code 7541 (2017). 9. The criteria for separate ratings for an eye condition and/or erectile dysfunction associated with service-connected type II diabetes mellitus are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.114, Diagnostic Code 7913 (2017). 10. The criteria for a grant of TDIU are met from August 17, 2011. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1966 to March 1971, including service in the Republic of Vietnam. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. In April 2017, the Veteran and his spouse testified at a videoconference hearing before the undersigned Veterans Law Judge. This matter was previously before the Board in August 2017, at which time it was remanded for further development. The Agency of Original Jurisdiction complied with the August 2017 remand directives, and thus, the Board will address the merits of the Veteran’s appeal. Stegall v. West, 11 Vet. App. 268, 271 (1998) (a remand by the Board confers on the Veteran, as a matter of law, the right to substantial compliance with the remand). 1. Entitlement to a disability rating in excess of 20 percent for type II diabetes mellitus. Disability ratings are determined by applying the rating criteria set forth in VA’s schedule for rating disabilities and represent the average impairment of earning capacity. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10 (2017). In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA compensation as well as the whole recorded history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2 (2017); see generally Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria for that rating. 38 C.F.R. § 4.7 (2017). Otherwise, the lower rating is assigned. Id. Notwithstanding the principle espoused in 38 C.F.R. § 4.7, the assignment of a higher rating requires that elements from the lower rating are met where a diagnostic code uses successive rating criteria. Tatum v. Shinseki, 23 Vet. App. 152 (2009). In reviewing the evidence, the Board has considered whether separate ratings for different periods of time are warranted based on the facts, which is a practice of assigning ratings that is referred to as “staging the ratings.” See Hart v. Mansfield, 21 Vet. App. 505 (2007). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of her current symptomatology that is observable to the senses. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). Additionally, the Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998). By way of background, the RO granted service connection for type II diabetes mellitus (diabetes) and assigned a 20 percent rating, effective from August 22, 2002, in rating decisions dated in October 2003 and December 2008. These decisions are final. See 38 U.S.C. § 7105 (2012); 38 C.F.R. §§ 3.156 (b), 20.201 (2017). In August 2011, the Veteran filed a claim for an increased rating that led to the present appeal. At present, the Veteran has service connection for the following disabilities secondary to his service-connected diabetes: right lower extremity sciatic nerve peripheral neuropathy (10 percent from November 18, 2008, 20 percent from June 20, 2017, and 40 percent from July 26, 2018); left lower extremity sciatic nerve peripheral neuropathy (10 percent from November 18, 2008, 20 percent from June 20, 2017, and 40 percent from July 26, 2018); right upper extremity peripheral neuropathy (20 percent from August 17, 2011, and 30 percent from June 20, 2017); left upper extremity peripheral neuropathy (20 percent from August 17, 2011); and diabetic nephrology (60 percent from June 21, 2017). As explained in further detail below, the Board finds that a rating in excess of 20 percent for diabetes is not warranted. Additionally, increased ratings are not warranted for peripheral neuropathy of the bilateral upper extremities or for diabetic nephrology, and separate ratings are not warranted for an eye condition or erectile dysfunction. The Board does find, however, that a disability rating of 20 percent is warranted for peripheral neuropathy of each lower extremity for the period on appeal prior to July 26, 2018. Diabetes The Veteran was assigned a rating of 20 percent for diabetes under 38 C.F.R. § 4.119, Diagnostic Code 7913. This diagnostic code sets forth the following rating criteria: A 20 percent rating is warranted where the Veteran requires insulin and restricted diet, or an oral hypoglycemic agent and restricted diet. A 40 percent rating is warranted where insulin, restricted diet, and regulation of activities are required. A 60 percent rating is warranted where the condition requires insulin, 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 100 percent rating is warranted where the condition requires more than one daily injection of insulin, 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. The criteria also direct the Board to evaluate compensable complications of diabetes separately unless they are part of the criteria used to support a 100 percent evaluation. 38 C.F.R. § 4.119, Diagnostic Code 7913 (Note 1). Under the criteria, separate evaluations for complications of diabetes are not warranted unless those complications warrant compensable evaluations. See id. The Board finds that symptoms of this disability approximate a rating of 20 percent for the period on appeal because the Veteran’s diabetes has required insulin, oral hypoglycemic agents, and restricted diet, but no more. In finding that a higher rating is not warranted, the Board acknowledges that the Veteran has contended that his condition requires him to regulate his activities. See, e.g., July 2013 Notice of Disagreement; February 2017 representative statement. However, during examinations that were provided in May 2013, December 2015, and July 2018, it was reported that the medical management of the Veteran’s diabetes does not require regulation of his activities. The Board finds the examiners’ reports more probative than the Veteran’s lay report, as the Veteran is not competent to provide an opinion as to whether the medical management of his diabetes requires activity regulation. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (a claimant is competent to report on that of which he or she has personal knowledge). Diabetic Peripheral Neuropathy As acknowledged above, the Veteran has four separate ratings for peripheral neuropathy of the bilateral lower and upper extremities secondary to his service-connected diabetes. More specifically, he has separate ratings for right lower extremity sciatic nerve peripheral neuropathy (10 percent from November 18, 2008, 20 percent from June 20, 2017, and 40 percent from July 26, 2018), left lower extremity sciatic nerve peripheral neuropathy (10 percent from November 18, 2008, 20 percent from June 20, 2017, and 40 percent from July 26, 2018), right upper extremity peripheral neuropathy (20 percent from August 17, 2011, and 30 percent from June 20, 2017), and left upper extremity peripheral neuropathy (20 percent from August 17, 2011). The Veteran’s lower extremities are currently rated under 38 C.F.R. § 4.124a, Diagnostic Code 8520, which sets forth the criteria for evaluating disorders of the sciatic nerve and provides the following: a 10 percent rating is warranted for mild incomplete paralysis of the sciatic nerve in either lower extremity; a 20 percent rating is warranted for moderate incomplete paralysis of the sciatic nerve; a 40 percent rating is warranted for moderately severe incomplete paralysis of the sciatic nerve; a 60 percent rating is warranted for severe incomplete paralysis of the sciatic nerve with marked muscular atrophy; and a maximum 80 percent rating is warranted for complete paralysis of the sciatic nerve that is characterized by a foot that dangles and drops, no active movement possible of muscles below the knee, and flexion of the knee that is weakened or lost. The Veteran’s upper extremities, which were previously rated for a radial nerve disorder under Diagnostic Code 8514, are currently rated under Diagnostic Code 8515, which sets forth the criteria for evaluating disorders of the median nerve. Under Diagnostic Code 8515, mild incomplete paralysis warrants a 10 percent evaluation for both the major and minor side. Moderate incomplete paralysis warrants a 20 percent evaluation on the minor side and a 30 percent evaluation on the major side. Severe incomplete paralysis of the minor side warrants a 40 percent rating, and a 50 percent rating on the major side. Complete paralysis of the median nerve, with the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand, pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, inability to make a fist, index and middle fingers remain extended, cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb at right angles to palm, flexion of wrist weakened, and pain with trophic disturbances, warrants a 60 percent evaluation on the minor side and a 70 percent evaluation on the major side. 38 C.F.R. § 4.124a defines the term “incomplete paralysis” as indicating a degree of lost or impaired function substantially less than the type pictured 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. The words “slight,” “moderate” and “severe” as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all the evidence, to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. It should also be noted that use of terminology such as “severe” by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Here, during a May 2013 diabetic sensory-motor peripheral neuropathy examination, an examiner reported that the Veteran’s condition was diagnosed in 2011, at which time he had sharp pains in his feet at night and he experienced sharp, stabbing pain that would last 10-20 seconds. He also reported having numbness in his toes, non-radiating pain that comes and goes, and a pins-and-needles sensation in his feet when sitting down. Physical examination showed moderate constant pain, intermittent pain, paresthesias and/or dysesthesias, and numbness in the lower extremities, and moderate intermittent pain and numbness in the right upper extremity. A neurologic examination showed normal strength on elbow flexion and extension, wrist flexion and extension, grip, and pinch. There was no muscle atrophy. Regarding the lower extremities, the Veteran demonstrated moderate incomplete paralysis of the sciatic nerve, bilaterally. Regarding the upper extremities, the Veteran demonstrated mild incomplete paralysis of the radial nerve on the right. During a December 2015 VA diabetes examination, the Veteran declined a peripheral nerves examination and reported that his neuropathy had not changed since his previous examination. Upon examination in July 2017, the Veteran demonstrated moderate intermittent pain, paresthesias and/or dysesthesias, and numbness in the bilateral upper extremities; and severe intermittent pain, mild paresthesias and/or dysesthesias, moderate numbness in bilateral lower extremities. There was no muscle atrophy and the examiner concluded that the Veteran had moderate incomplete paralysis of median nerve in the bilateral upper extremities and moderate incomplete paralysis in the sciatic nerve of bilateral lower extremities. Similarly, in July 2018, the Veteran had severe constant pain in the bilateral lower extremities and severe numbness in right lower extremity. In his upper extremities, he had moderate intermittent pain, bilaterally; moderate paresthesias and/or dysesthesias, bilaterally; and severe numbness in right upper extremity. Again, there was no muscle atrophy. Overall, he demonstrated moderate incomplete paralysis of the median nerve in the upper extremities and moderately severe incomplete paralysis of the sciatic nerve in the lower extremities. Regarding the lower extremities, the Board finds that 20 percent ratings are warranted for right lower extremity sciatic nerve peripheral neuropathy and left lower extremity sciatic nerve peripheral neuropathy for the period on appeal from August 17, 2011 (the date of claim) through July 25, 2018. See 38 C.F.R. § 4.124a, Diagnostic Code 8520. The Board comes to this conclusion in light of the May 2013 examiner’s report that the Veteran’s condition was diagnosed in 2011, the Veteran’s report of his ongoing symptoms during the May 2013 examination, and the May 2013 examination finding of moderate disability in the lower extremities. Additionally, the Board finds that a rating in excess of 20 percent is not warranted for the period on appeal prior to July 26, 2018, because neither moderately severe incomplete paralysis, muscular atrophy, nor complete paralysis were shown. The Board also finds that a rating in excess of 40 percent is not warranted for the period from July 26, 2018, because neither muscular atrophy nor complete paralysis are shown. Regarding the upper extremities, the Board finds that higher ratings are not warranted. First, a rating in excess of 20 percent is not warranted for the left upper extremity (minor) because the Veteran has not demonstrated a median nerve disability under Diagnostic Code 8515 or a radial nerve disability under Diagnostic Code 8514 that is more than moderate in severity. Second, a rating in excess of 20 percent is not warranted for the right upper extremity (major) for the period on appeal prior to June 20, 2017, because he did not demonstrate more than mild incomplete paralysis of the radial nerve under Diagnostic Code 8514 and a medial nerve disability was not shown at that time. Lastly, a rating in excess of 30 percent is not warranted for the right upper extremity for the period on appeal from June 20, 2017, because the competent evidence of record shows only moderate incomplete paralysis of the median nerve under Diagnostic Code 8515 during that period. Diabetic Nephrology The Veteran currently has a rating of 60 percent for diabetic nephrology under 38 C.F.R. § 4.115b, Diagnostic Code 7541. This diagnostic code indicates that renal involvement in diabetes should be rated as renal dysfunction under 38 C.F.R. § 4.115a, which sets forth the following relevant rating criteria: A 60 percent rating is warranted where there is constant albuminuria with some edema, or definite decrease in kidney function, or hypertension at least 40 percent disabling under Diagnostic Code 7101. An 80 percent rating is warranted where there is persistent edema and albuminuria with BUN 40 to 80mg%, or creatinine 4 to 8mg%, or generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion. A 100 percent rating is warranted where the condition requires regular dialysis, or if it precludes more than sedentary activity from one of the following: persistent edema and albuminuria, or BUN more than 80mg%, creatinine more than 8mg%, or markedly decreased function of kidney or other organ systems, especially cardiovascular. Here, in July 2018, VA provided an examination during which it was noted that the Veteran was diagnosed with diabetic nephropathy on June 21, 2017. According to the examiner, the Veteran’s treatment plan does not include taking continuous medication for the diagnosed condition, his treatment plan does not require regular dialysis, he does not have any signs or symptoms due to renal dysfunction, he does not have hypertension and/or heart disease due to renal dysfunction, his renal tubular disorder is not symptomatic, he does not have frequent attacks of colic with infection, and he has never had kidney, uretal, or bladder calculi (urolithiasis). Additionally, he does not have a history of recurrent symptomatic urinary tract or kidney infection, has not had a kidney transplant or removal, and has not had a related tumor or neoplasm. Upon examination, he had a BUN of 34mg% and creatinine of 1.9mg%. Considering the foregoing, the Board finds that a rating in excess of 60 percent is not warranted from June 21, 2017, because a BUN of at least 40mg% or creatinine of at least 4mg% has not been shown. Further, the evidence does not show that the Veteran’s kidney condition has been productive of generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion; requires dialysis; or precludes more than sedentary activity. Further, as the condition was diagnosed on June 21, 2017, the Board also finds that a rating for nephrology is not warranted during the period that precedes his diagnosis. Eye Conditions The Veteran does not currently have a separate rating for an eye disability due to service-connected diabetes, but multiple treatment records have indicated that the Veteran might have diabetic retinopathy. See, e.g., December 2015 Disability Benefits Questionnaire (documenting diabetic retinopathy as a complication of service-connected diabetes). However, after careful review of the record, the Board finds that a separate rating is not warranted for an eye disability. First, an October 2011 VA Diabetic Teleretinal Imaging Consult Note that documents an assessment of moderate nonproliferative diabetic retinopathy of the right eye also indicates that there were no examination results available for this teleretinal imaging and the reporting optometrist noted that “[d]igital retinal imaging has been shown to be an effective method of screening for diabetic retinopathy, but cannot substitute for a comprehensive eye exam.” Additionally, a June 2018 VA Optometry Outpatient Note indicates that the Veteran has diabetes without retinopathy or macular edema and a contemporaneous June 2018 VA Nephrology Outpatient Note indicates that the Veteran has had diabetes for twenty-five years without retinopathy. Further, the Veteran’s most recent VA eye examination, which was conducted in August 2018, documents diagnoses of bilateral cataracts, bilateral dry eye, and bilateral glaucoma that are not related to his diabetes and retinopathy was not reported as a current disability. The Board finds it highly probative that retinopathy was not diagnosed during the August 2018 examination, as the Disability Benefits Questionnaire indicates that retinopathy is a condition that was considered for assessment. See August 2018 Disability Benefits Questionnaire, pp. 7, 10. Additionally, the October 2011 report that digital retinal imaging cannot substitute for a comprehensive eye examination, such as the examination that was provided in August 2018, is highly probative in determining whether the Veteran has a current retinopathy diagnosis. Thus, the Board concludes that the comprehensive and competent evidence of record fails to show that the Veteran has diabetic retinopathy, or another eye condition associated with diabetes, that warrants a separate rating at this time. Erectile Dysfunction The Veteran does not currently have a separate rating for erectile dysfunction due to service-connected diabetes. In May 2017 and June 2017, VA physician Dr. S.N. reported that the Veteran suffers from erectile dysfunction due to poorly controlled diabetes. However, after a comprehensive evaluation in July 2018, a VA examiner endorsed that the Veteran does not have erectile dysfunction due to diabetes. As this opinion was provided in light of the examiner’s review of the Veteran’s relevant medical history and based upon a comprehensive evaluation, the Board finds that it is more probative than Dr. S.N.’s report, and thus, a separate evaluation for erectile dysfunction is not warranted. 2. Entitlement to a TDIU. A total disability rating may be assigned, where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as the result of service-connected disabilities. See 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16 (2017). Consideration may be given to a Veteran’s level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. To qualify for a total rating for compensation purposes, the evidence must show: (1) a single disability rated as 100 percent disabling; or (2) that the veteran is unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities and there is one disability ratable at 60 percent or more, or, if more than one disability, at least one disability ratable at 40 percent or more and a combined disability rating of 70 percent. 38 C.F.R. § 4.16(a). For the purpose of establishing one 60 percent disability, or one 40 percent disability in combination, disabilities affecting a single body system are considered as one disability. Id. Disabilities that are not service connected cannot serve as a basis for a total disability rating. 38 C.F.R. §§ 3.341, 4.19. Where these percentage requirements are not met, entitlement to benefits on an extraschedular basis may be considered when a veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disability or disabilities, and consideration is given to the veteran’s background including employment and educational history. 38 C.F.R. § 4.16(b). Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, “entitlement to a TDIU is based on an individual’s particular circumstances.” Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). Therefore, in adjudicating a TDIU claim, VA must consider the individual Veteran’s education, training, and work history. Hatlestad v. Derwinski, 1 Vet. App. 164 (1991) (level of education is a factor in deciding employability); see Friscia v. Brown, 7 Vet. App. 294 (1994) (considering Veteran’s experience as a pilot, his training in business administration and computer programming, and his history of obtaining and losing 19 jobs in the previous 18 years); Beaty v. Brown, 6 Vet. App. 532 (1994) (considering Veteran’s 8th grade education and sole occupation as a farmer); Moore v. Derwinski, 1 Vet. App. 356 (1991) (considering Veteran’s master’s degree in education and his part-time work as a tutor). The Board notes that the United States Court of Appeals for the Federal Circuit held that determination of whether a Veteran is unable to secure or follow a substantially gainful occupation due to service-connected disabilities is a factual rather than a medical question and that it is an adjudicative determination properly made by the Board or the RO. See Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013). As a preliminary matter, the Board finds that the Veteran meets the threshold schedular requirement for an award of TDIU benefits under 38 C.F.R. § 4.16(a) throughout the appeal period, or since August 17, 2011. In June 2017, he reported that he stopped working at Wade Park VA Medical Center (VAMC) in March 1999, which was when his disability affected his full-time employment and he became too disabled to work. See June 2017 Application for Increased Compensation Based on Unemployability (VA Form 21-8940). He reported that his service-connected PTSD and neuropathy of the extremities prevent him from securing or following any substantially gainful occupation and indicated that he completed two years of college, did not have any other education and training before he was too disabled to work, and did not have any education and training since he became too disabled to work. Multiple records indicate that the Veteran was employed by VA as a painter prior to his retirement. See July 2018 VA Diabetes Disability Benefits Questionnaire. A July 2009 Comprehensive Intake Assessment from The Center for Interpersonal Development (CID) documents the Veteran’s report that he believes he missed multiple work days due to his depression, explosive anger outbursts, anxiety, and alcoholism. Although this report was documented prior to the appeal period, the Veteran’s comments are relevant and highly probative. Additionally, an August 2010 letter from a CID social worker indicates that the Veteran’s psychiatric conditions are chronic, severe, and permanent, and an August 2011 CID Outcome Questionnaire documents an endorsement that the Veteran frequently tires quickly, feels stressed at work/school, and has trouble concentrating. Further, VA physician Dr. S.N. reported in May 2017 that the Veteran’s poorly-controlled diabetes has led to neuropathy and subsequent pain and limitations in ambulation and mobility, and examinations that were conducted in July 2017 and July 2018 indicate that the Veteran’s neuropathy impacts his ability to walk, he cannot walk 150 feet, he cannot stand for 20 minutes, he ambulates with a cane, he has difficulty climbing ladders, and he has numbness in his fingers that makes it difficult to hold paint brushes. The Board finds that it is reasonable to assume that such limitations would have a significant impact on the Veteran’s ability to secure and follow his previous occupation. The Board also notes, however, that clinicians who examined the Veteran in May 2013, December 2015, and July 2017 indicated that the Veteran’s diabetes and related neuropathy do not affect his ability to work and his psychiatric disorder would be productive of occasional social discomfort, but would not be debilitating. Resolving any doubt in the Veteran’s favor, the Board finds that his service-connected diabetic neuropathy and psychiatric disorder have prevented him from securing or following substantially gainful employment during the appeal period, or since August 17, 2011. Thus, the appeal is granted. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. C. Wilson, Counsel