Citation Nr: 18156610
Decision Date: 12/10/18	Archive Date: 12/10/18

DOCKET NO. 17-03 754
DATE:	December 10, 2018
ORDER
Entitlement to a rating in excess of 20 percent disabling for non-insulin diabetes mellitus (DM) with erectile dysfunction (ED) is denied.
FINDING OF FACT
For the entire appeal period, the Veteran’s diabetes mellitus required a restricted diet and insulin, but has not required the regulation of activities.
CONCLUSION OF LAW
The criteria for an initial disability evaluation in excess of 20 percent for DM with ED are not met. 38 U.S.C. §§ 1155, 5107(b) (West 2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.21, 4.119, Diagnostic Code (DC) 7913 (2018).


REASONS AND BASES FOR FINDING AND CONCLUSION
Increased Rating
Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule).  38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10.
The Veteran’s diabetes mellitus, type II is currently evaluated as 20 percent disabling under DC 7913.  38 C.F.R. § 4.119, DC 7913 (2015).  Diabetes mellitus requiring insulin, restricted diet, and regulation of activities is rated 40 percent disabling.  Diabetes mellitus requiring 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 rated, is rated 60 percent disabling.  Diabetes mellitus requiring 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 rated, is rated 100 percent disabling.  
“Regulation of activities” has been defined as the situation where the Veteran has been prescribed or advised to avoid strenuous occupational and recreational activities.  61 Fed. Reg. 20,440, 20,446 (May 7, 1996) (defining “regulation of activities,” as used by VA in DC 7913).  Medical evidence is required to show that occupational and recreational activities have been restricted.  Camacho v. Nicholson, 21 Vet. App. 360 (2007).
Entitlement to a rating in excess of 20 percent disabling for non-insulin DM with ED
In September 2015, the Veteran attended a DM VA examination. The examiner diagnosed DM, type II and noted that the Veteran does not require regulation of activities as part of medical management of DM. Further, the examiner did not diagnose any diabetic complications.
In a February 2016 Diabetic Sensory-Motor Peripheral Neuropathy examination, bilateral lower extremity peripheral neuropathy was diagnosed, however, the examiner did not indicate any regulation of activities as part of medical management of DM. (The Veteran is separately service connected and evaluated for peripheral neuropathy which is not the subject of this appeal.)  
Multiple subsequent VA treatment records detail the Veteran’s prescription and use of insulin to control his diabetes along with a prescribed diabetic diet. 
Based on the foregoing evidence of record, the Board finds that a higher rating is not warranted for the entire appeal period. Indeed, as explained in detail above, the Veteran’s diabetes is consistently shown to be managed by a restricted diet and the use of oral medications.  At no time, however, has there been there been need for regulation of activities.  Moreover, there is no indication of the need for hospitalization for any diabetic symptom.  Accordingly, there is no basis upon which to assign a rating in excess of 20 percent for DM.  




The preponderance of the evidence supports no more than a rating of 20 percent for the entire appeal period.  See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102; see also Gilbert, 1 Vet. App. at 49.
 
MICHAEL E. KILCOYNE
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	R.A. Elliott II, Associate Counsel