Citation Nr: 18156907 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 14-31 315 DATE: December 11, 2018 ORDER Entitlement to an earlier effective date prior to June 6, 2018 for a compensable disability rating for residuals of priapism is denied. Entitlement to an increased rating for residuals of priapism, currently evaluated as 20 percent disabling, is denied. FINDINGS OF FACT 1. The Veteran is in receipt of an award of special monthly compensation for the loss of use of a creative organ. 2. There is no evidence prior to June 6, 2018, the appellant’s priapism was manifested by both a penile deformity and a loss of erectile power. 3. Priapism is not manifested by a removal of half or more of the Veteran’s penis. CONCLUSIONS OF LAW 1. The criteria for an effective date prior to June 6, 2018, for a grant of a compensable rating for priapism have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.105(a), 3.400, 4.115b. 2. The criteria for a rating in excess of 20 percent for residuals of priapism have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 4.115b. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from July 1981 to June 1984. These matters come before the Board of Veterans’ Appeals (Board) on appeal from February 2013 and August 2018 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston- Salem, North Carolina. The Board acknowledges the Veteran’s request for special monthly compensation for priapism. The Veteran has, however, received special monthly compensation since April 9, 2018 pursuant to 38 U.S.C. § 1114(k) and 38 C.F.R. § 3.350(a). Hence, there is no need to further address this argument. Earlier effective date Compensable rating prior to June 6, 2018 for priapism In an August 2018 rating decision VA assigned a 20 percent rating for the priapism effective June 6, 2018. The Veteran claims entitlement to an earlier effective date. Generally, the effective date of an award of increased compensation for service-connected disability shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400 (o)(1). There is an exception in that the effective date may the earliest date as of which it is ascertainable that an increase in disability has occurred, provided that the application therefor is received within one year from such date. 38 U.S.C. § 5110 (b)(2); 38 C.F.R. § 3.400 (o)(2). In light of the date of filing in this case, any communication or action, indicating an intent to apply for one or more benefits under the laws administered by VA, from a claimant, his duly authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui juris may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant 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 receipt of the informal claim. 38 C.F.R. §§ 3.1 (p), 3.155(a); Servello v. Derwinski, 3 Vet. App. 196 (1992). A March 2005 VA outpatient urology consult noted that the appellant had a history of priapism, and that shunts had been implanted in November 2003 at a private facility (Strong Memorial Hospital). In a May 2012 rating decision, the Veteran was granted entitlement to compensation pursuant to 38 U.S.C. § 1151 for residuals of priapism effective April 28, 2004, and a noncompensable rating was assigned. The Veteran was notified of this decision in June 2012, however, a timely appeal to that rating decision was not perfected. As such, it is final. 38 U.S.C. § 7105. The Veteran was seen for a VA examination in January 2013. At that examination the appellant denied any symptoms of priapism. He did report having erectile dysfunction at times, but he was also able to have sex at times. Physical examination did not reveal evidence of erectile dysfunction, and the appellant’s penis was clinically evaluated as normal. The Veteran did report having a shunt implanted in his penis. In February 2014 VA received a statement from his representative that the appellant disagreed with the assignment of a noncompensable rating for priapism. Given that the May 2012 rating decision is final, this is considered to be a claim for an increased rating. On June 6, 2018, the appellant was seen for a VA examination. That examination diagnosed erectile dysfunction and priapism. The claimant reported that in April 2018 he had a new episode of priapism which made his disorder worse. Physical examination revealed erectile dysfunction, and for the first time an abnormal penis. The basis for this abnormality was a finding that the appellant had palpable implants. From the foregoing it is evident that the appellant has had penile shunts since November 2003. Significantly, the first evidence that these shunts were productive of a deformity was the evidence derived from findings at the June 6, 2018 VA examination. At no time prior to June 6, 2018 was the appellant’s penis ever described as abnormal. Given these facts, the Board finds that entitlement to an effective date prior to June 6, 2018 for a 20 percent evaluation for priapism is not in order. While the appellant’s claim was presented prior to that date, the evidence did not show entitlement to the compensable rating prior to that date. The appeal is denied. Increased rating Priapism The Veteran contends that priapism warrants a rating in excess of 20 percent. The Veteran has been in receipt of compensation under 38 U.S.C. § 1151 for priapism since June 6, 2018. Disability evaluations are determined by evaluating the extent to which a Veteran’s compensated disability adversely affects her ability to function under the ordinary conditions of daily life, including employment, by comparing her symptomatology with the criteria set forth in the Schedule for Rating Disabilities Diagnostic Code 7599-7522. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran’s condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505. Here, the evidence of record preponderates against finding entitlement to a higher rating for priapism. In this regard, the appellant is already in receipt of the maximum allowable rating under 38 C.F.R. § 4.115b, Diagnostic Code 7522 for a penile deformity with a loss of erectile power. To secure a higher rating the provisions of 38 C.F.R. § 4.118, Diagnostic Code 7520 provide for a 30 percent rating when half or more of the male organ has been removed. In this case, the VA examination in June 2018 indicates the Veteran has had shunt procedures. The treatment records show the Veteran has been treated for erectile disfunction and has been admitted to the hospital for pain and discomfort. But, the records do not show the Veteran having half or more of his male organ removed. Therefore, a higher evaluation is not warranted for residuals of priapism. The claim is denied. The Board considered the doctrine of reasonable doubt, however, given that the preponderance of the evidence is against the claim the doctrine is inapplicable. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Anthony L. Hines Associate Attorney