Citation Nr: 18117704 Decision Date: 07/12/18 Archive Date: 07/11/18 DOCKET NO. 17-08 044 DATE: July 12, 2018 ORDER 1. New and material evidence has not been received to reopen the claim for service connection for bilateral hearing loss, and the appeal is denied. 2. Entitlement to service connection for bilateral hand numbness is denied. 3. Entitlement to an initial rating in excess of 10 percent for diabetes mellitus type II is denied. 4. Entitlement to a compensable rating for diabetic peripheral neuropathy of the bilateral lower extremities is denied. FINDINGS OF FACT 1. A final February 2010 rating decision denied the Veteran’s claim for service connection for bilateral hearing loss because the evidence failed to demonstrate that the hearing loss was incurred in service; although notified of the decision, the Veteran did not express an intent to appeal the decision, and new and material evidence was not added within one year of that decision. 2. Additional evidence associated with the claims file since the February 2010 rating decision is cumulative and redundant of the evidence of record at the time of the prior denial, it does not relate to unestablished facts necessary to substantiate his claim for service connection for bilateral hearing loss, and it does not raise a reasonable possibility of substantiating the claim. 3. The Veteran has not been diagnosed with a disability related to bilateral hand numbness during the pendency of his claim. 4. Throughout the appeal period, the Veteran’s diabetes mellitus required following a restricted diet, but did not require oral hypoglycemic agents, insulin, or regulation of activities. 5. Throughout the appeal period, the Veteran has not demonstrated any degree of incomplete paralysis of the bilateral lower extremities. CONCLUSIONS OF LAW 1. The February 2010 rating decision that denied service connection for bilateral hearing loss is final. 38 U.S.C. § 7105 (c) (2012); 38 C.F.R. § 3.104, 20.302, 20.1103 (2017). 2. As evidence received since the February 2010 rating decision is not new and material, the criteria for reopening the Veteran’s claim for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2017). 3. The criteria for service connection for bilateral hand numbness have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). 4. Throughout the appeal period, the criteria for an initial disability rating in excess of 10 percent for diabetes mellitus have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.119, Diagnostic Code (DC) 7913 (2017). 5. Throughout the appeal period, the rating criteria for a compensable rating for diabetic peripheral neuropathy of the bilateral lower extremities have not been met. 38 U.S.C. §§ 1155, 5107, 5110 (2012); 38 C.F.R. §§ 3.102, 3.400, 4.3, 4.7, 4.124a, DCs 8520-8540 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty between November 1965 and October 1967. These matters come before the Board of Veterans’ Appeals (BVA or Board) on appeal from September 2015 and October 2015 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Guaynabo, Puerto Rico. New and Material Evidence 1. New and material evidence has not been received to reopen the claim for service connection for bilateral hearing loss. Rating actions are final and binding based on the evidence on file at the time the claimant is notified of the decision and may not be revised on the same factual basis except by a duly constituted appellate authority. 38 U.S.C. § 5108; 38 C.F.R. § 3.104 (a). The claimant has one year from the notification of an RO decision to initiate an appeal by filing a notice of disagreement with the decision, and the decision becomes final if an appeal is not perfected within the allowed time period. 38 U.S.C. § 7105 (b), (c); 38 C.F.R. § 3.160 (d), 20.200, 20.201, 20.202, 20.302(a) (2017). However, if new and material evidence is presented or secured, VA shall reopen and review the former disposition of the claim. 38 U.S.C. § 5108 (2012). “New and material evidence” is defined as evidence not previously submitted to the agency decision makers which is neither cumulative or redundant, which by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim, and which raises a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The United States Court of Appeals for Veterans Claims (Court) has held that the determination of whether newly submitted evidence raises a reasonable possibility of substantiating the claim should be considered a component of the question of what evidence is new and material, rather than a separate determination to be made after the Board has found that evidence is new and material. See Shade v. Shinseki, 24 Vet. App. 110 (2010). The Court further held that new evidence would raise a reasonable possibility of substantiating the claim if, when considered with the old evidence, it would at least trigger the Secretary’s duty to assist by providing a medical opinion. Id. For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The Veteran’s claim for service connection for bilateral hearing loss was denied in a February 2010 rating decision. At that time, the RO determined that the evidence of record failed to demonstrate that the Veteran’s hearing loss was incurred in or related to his military service. At the time of the February 2010 rating decision, the evidence of record included the Veteran’s service treatment records and post-service VA treatment records. The Veteran was notified of the decision and his appellate rights in February 2010. However, he did not file a notice of disagreement in response to the rating decision. No further communication regarding his claim was received until March 2015, when VA received his petition to reopen. Therefore, the February 2010 rating decision is final. 38 U.S.C. § 7105 (c); 38 C.F.R. § 3.104, 20.302, 20.1103. Evidence added to the record since the February 2010 rating decision includes additional VA treatment records and the October 2015 VA audiological examination report. The October 2015 examiner noted that the Veteran had sensorineural hearing loss in both ears, but opined that the disability was less likely than not incurred in or caused by acoustic trauma during service. She acknowledged that prolonged exposure to noise of high intensity and short duration, such as that which occurs in the military, may result in permanent hearing loss. However, she explained that such a deficit is expected to occur either immediately or gradually after the exposure period. The examiner reasoned that retroactive hearing loss is not expected to occur so many years after the exposure, as in this case. She provided an additional explanation, suggesting that the Veteran’s hearing loss may be associated with the normal aging process, due to the dysfunction of outer hair cells. The additional VA examination report is new, but is not material, as it does not link the current hearing loss with service. See Villalobos v. Principi, 3 Vet. App. 450 (1992) (noting that evidence that is unfavorable to a claimant is not new and material). The new evidence of record does not contain any indication that the Veteran’s hearing loss is related to his military service. In addition, the Veteran’s current claim indicating that his hearing loss is related to in-service acoustic trauma is simply a reiteration of his previously considered claim and assertions, namely that he experienced acoustic trauma during service. The Board acknowledges that there has been medical evidence added to the record in the form of the October 2015 VA examination report. However, as this new evidence does not support a relationship between the Veteran’s hearing loss and his military service, it is not considered material for the purposes of reopening the appeal. Thus, the additional evidence of record does not raise a reasonable possibility of substantiating the claim. In sum, as the evidence submitted since the February 2010 rating decision is not new and material, the claim for service connection for bilateral hearing loss is not reopened and the appeal is denied. Service Connection Under the relevant laws and regulations, service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). In general, service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App 370, 374 (2002). When considering whether lay evidence is competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). However, although the Veteran is competent in certain situations to provide a diagnosis of a simple condition such as a headache, varicose veins, or tinnitus, the Veteran is not competent to provide evidence as to more complex medical questions, such as the etiology of psychiatric, respiratory, or orthopedic disorders. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 1. Entitlement to service connection for bilateral hand numbness is denied. The Veteran contends that he has bilateral hand numbness that is related to his military service. Service treatment records and post-service treatment records are silent regarding any complaints, treatment, or diagnoses related to bilateral hand numbness. Indeed, the only evidence of record related to the claim is the Veteran’s own contention that he experiences numbness in his hands and has difficulty holding objects. See November 2015 Notice of Disagreement. In October 2015, the Veteran was afforded a VA examination for his peripheral neuropathy. The examiner concluded that he did not have peripheral neuropathy of either upper extremity. Although the Veteran may experience bilateral hand numbness, the evidence shows no current diagnosis of peripheral neuropathy of the bilateral upper extremities. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (service connection requires a current disability). A current disability is one shown at some time during the period beginning proximate to the date of claim. Romanowsky v. Shinseki, 26 Vet. App. 303 (2013). In this case, there is no evidence of complaints, treatment or a diagnosis related to bilateral hand numbness either during or after service. Furthermore, the October 2015 VA examiner determined that the Veteran did not have peripheral neuropathy of the bilateral upper extremities. In the absence of proof of a present disability there can be no valid claim. Although the Veteran is competent to report observable complaints such as hand numbness, he is not competent to provide a diagnosis to account for such complaints. Rather this question requires medical expertise due to the complex nature of the neurological system. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, the preponderance of the evidence is against service connection for bilateral hand numbness. Reasonable doubt does not arise, and the benefit-of-the-doubt doctrine does not apply; the Veteran’s claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 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 rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, 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 benefit of the doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). Staged ratings are appropriate for an increased rating claim whenever the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 50 (2007). 1. Entitlement to an initial rating in excess of 10 percent for diabetes mellitus type II is denied. Diabetes mellitus is rated under 38 C.F.R. § 4.119, DC 7913, which provides a 10 percent rating when manageable by restricted diet only. A 20 percent rating is warranted when insulin and a restricted diet, or an oral hypoglycemic agent and a restricted diet are required. A 40 percent rating is warranted when insulin, a restricted diet, and regulation of activities are required. A 60 percent evaluation is warranted for 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 evaluated. A 100 percent evaluation is warranted for 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 evaluated. Compensable complications of diabetes are evaluated separately unless they are part of the criteria used to support a 100 percent evaluation. Noncompensable complications are considered part of the diabetic process under DC 7913. 38 C.F.R. § 4.119, DC 7913, Note 1 (2017). Here, VA treatment records and the October 2015 VA examination report reflect that the Veteran’s diabetes was managed by restricted diet alone. See March 13, 2016 VA Treatment Record; October 2015 VA Examination Report. Indeed, the October 2015 examiner noted that the Veteran did not demonstrate progressive unintentional weight loss, nor had he required hospitalization for ketoacidosis over the previous year. Additionally, the Veteran visited his diabetic care provider less than twice per month for episodes of hypoglycemia and ketoacidosis. Thus, the Board finds that an initial rating in excess of 10 percent for diabetes is not warranted. The evidence does not show that the Veteran has required an oral hypoglycemic agent or insulin to manage the disability at any point during the appeal period. See October 2015 VA Examination Report. Moreover, the evidence does not show that the Veteran is required to regulate his activities. The Court 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 October 2015 examiner opined that the Veteran’s diabetes mellitus did not require regulation of activities as part of medical management of his diabetes mellitus. The Veteran also has a complication of diabetes mellitus, namely peripheral neuropathy of his bilateral lower extremities which will be discussed separately below. As such, the competent medical evidence of record is against a finding that the Veteran required insulin, oral hypoglycemic agents, or regulation of activities to control his diabetes. Accordingly, an initial rating in excess of 10 percent is not warranted. 2. Entitlement to a compensable rating for diabetic peripheral neuropathy of the bilateral lower extremities is denied. The Veteran has also noted a separate condition that is a complication of diabetes for which he has identified as warranting a separate rating. Where a complication of diabetes is noncompensable, it is rated with diabetes as part of the diabetic process. However, when the complication itself is at least 10 percent disabling, it is to be rated separately. 38 C.F.R. § 4.119, DC 7913 note (1). The Veteran’s diabetic peripheral neuropathy of the bilateral lower extremities has not been rated under a separate diagnostic code, as it is currently considered a noncompensable complication. Thus, the Board will evaluate the severity of this disability under all applicable codes. A note in the Rating Schedule pertaining to “Diseases of the Peripheral Nerves” provides that the term “incomplete paralysis” indicates a degree of lost or impaired function which is substantially less than that which results from complete paralysis of these nerve groups, whether the loss is due to the varied level of the nerve lesion or to partial nerve regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a, DCs 8510-8540 (2017). Neuritis of the peripheral nerves, 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 rating equal to severe, incomplete, paralysis. The maximum rating that may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123 (2017). Neuralgia of a peripheral nerve, 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 (2017). In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury and the relative impairment in motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. DC 8520 provides ratings for the sciatic nerve. DC 8520 provides that mild incomplete paralysis is rated 10 percent disabling; moderate incomplete paralysis is rated 20 percent disabling; and moderately severe incomplete paralysis is rated 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy, is rated 60 percent disabling. Complete paralysis of the sciatic nerve, the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost, is rated 80 percent disabling. DC 8620 refers to neuritis of the sciatic nerve, while DC 8720 refers to neuralgia of the sciatic nerve. DC 8521 provides ratings for paralysis of the external popliteal. DC 8521 provides that mild incomplete paralysis is rated as 10 percent disabling; moderate incomplete paralysis is rated 20 percent disabling; and severe incomplete paralysis is rated 30 percent disabling. Complete paralysis of the external popliteal nerve, foot drop and slight droop of first phalanges of all toes, cannot dorsiflex the foot, extension (dorsal flexion) of proximal phalanges of toes lost; abduction of foot lost, adduction weakened; anesthesia covers entire dorsum of foot and toes, is rated 40 percent disabling. DC 8621 refers to neuritis of the external popliteal nerve, while DC 8721 refers to neuralgia of the external popliteal nerve. DC 8522 provides ratings for paralysis of the musculocutaneous (superficial peroneal) nerve. DC 8522 provides that mild incomplete paralysis is rated as noncompensable; moderate incomplete paralysis is rated 10 percent disabling; and severe incomplete paralysis is rated 20 percent disabling. Complete paralysis of the musculocutaneous (superficial peroneal) nerve, eversion of foot weakened, is rated 30 percent disabling. DC 8622 refers to neuritis of the musculocutaneous (superficial peroneal) nerve, while DC 8722 refers to neuralgia of the musculocutaneous (superficial peroneal) nerve. DC 8523 provides ratings for paralysis of the anterior tibial nerve (deep peroneal). DC 8523 provides that mild incomplete paralysis is rated as noncompensable; moderate incomplete paralysis is rated as 10 percent disabling; and severe incomplete paralysis is rated as 20 percent disabling. Complete paralysis, dorsal flexion of foot lost, is rated 30 percent disabling. DC 8623 refers to neuritis of the anterior tibial nerve (deep peroneal), while DC 8723 refers to neuralgia of the anterior tibial nerve (deep peroneal) nerve. DC 8524 provides ratings for paralysis of the internal popliteal nerve (tibial). DC 8524 provides that mild incomplete paralysis is rated as 10 percent disabling; moderate incomplete paralysis is rated as 20 percent disabling; and severe incomplete paralysis is rated as 30 percent disabling. Complete paralysis, plantar flexion lost, frank adduction of foot impossible, flexion and separation of toes abolished; no muscle in sole can move; in lesions of the nerve high in popliteal fossa, plantar flexion is lost; is rated as 40 percent disabling. DC 8624 refers to neuritis of the internal popliteal nerve (tibial), while DC 8724 refers to neuralgia of the internal popliteal nerve (tibial) nerve. DC 8525 provides ratings for paralysis of the posterior tibial nerve. DC 8525 provides that mild and moderate incomplete paralysis is rated as 10 percent disabling, and severe incomplete paralysis is rated as 20 percent disabling. Complete paralysis-complete paralysis of all muscles of sole of foot, frequently with painful paralysis of a causalgic nature; toes cannot be flexed; adduction is weakened; plantar flexion is impaired-is rated as 30 percent disabling. DC 8625 refers to neuritis of the posterior tibial nerve, while DC 8725 refers to neuralgia of the posterior tibial nerve. DC 8526 provides ratings for paralysis of the anterior crural nerve (femoral). DC 8526 provides that mild incomplete paralysis is rated 10 percent disabling; moderate incomplete paralysis is rated 10 percent disabling; and severe incomplete paralysis is rated 20 percent disabling. Complete paralysis of all muscles of sole of foot, frequently with painful paralysis of a causalgic nature; toes cannot be flexed; adduction is weakened; plantar flexion is impaired, is rated 30 percent disabling. DC 8626 refers to neuritis of the musculocutaneous (superficial peroneal) nerve, while DC 8726 refers to neuralgia of the musculocutaneous (superficial peroneal) nerve. DC 8527 provides ratings for paralysis of the internal saphenous nerve. DC 8527 provides that mild to moderate incomplete paralysis is rated as noncompensable. Severe to complete paralysis is rated 10 percent disabling. DC 8627 refers to neuritis of the musculocutaneous (superficial peroneal) nerve, while DC 8727 refers to neuralgia of the musculocutaneous (superficial peroneal) nerve. DC 8528 provides ratings for paralysis of the obturator nerve. DC 8528 provides a noncompensable rating is provided for mild or moderate paralysis. A 10 percent rating is provided for severe to complete paralysis. DC 8628 refers to neuritis of the obturator nerve, while DC 8728 refers to neuralgia of the obturator nerve. DC 8529 provides ratings for the external cutaneous nerve of the thigh. DC 8529 provides a noncompensable rating for mild to moderate incomplete paralysis of the external cutaneous nerve of the thigh. A 10 percent rating is warranted for severe to complete paralysis of the external cutaneous nerve of the thigh. DC 8629 refers to neuritis of the external cutaneous nerve, while DC 8729 refers to neuralgia of the external cutaneous nerve. DC 8530 provides ratings for the ilio-inguinal nerve. DC 8530 provides a noncompensable rating is warranted where there is mild or moderate paralysis of the ilio-inguinal nerve. A 10 percent rating is warranted where there is severe incomplete paralysis to complete paralysis of the nerve. DC 8630 refers to neuritis of the ilio-inguinal nerve, while DC 8729 refers to neuralgia of the ilio-inguinal nerve. Descriptive words such as “slight,” “moderate” and “severe” are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The use of descriptive terminology by medical examiners, 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. 38 U.S.C. § 7104 (a); 38 C.F.R. §§ 4.2, 4.6. However, VA’s Adjudication Manual does provide guidance in evaluating the severity of nerve paralysis. According to the Manual, “mild” incomplete paralysis is demonstrated by subjective symptoms or diminished sensation. M-21, III.iv.4.G.4.b. “Moderate” incomplete paralysis is manifested by the absence of sensation confirmed by objective findings. Id. “Severe” incomplete paralysis is manifested when more than sensory findings are demonstrated, such as atrophy, weakness, and diminished reflexes. Id. Furthermore, the Veterans Benefits Administration (VBA) has determined that there are 5 separate nerve branches in the lower extremities which may be separately rated. M21-1, III.iv.4.G.4.c. According to VBA, the sciatic nerve (DCs 8520, 8620 and 8720), the external popliteal nerve (common peroneal) (DCs 8521, 8621 and 8721), the musculocutaneous nerve (DCs 8522, 8622 and 8722), the anterior tibial nerve (deep peroneal) (DCs 8523, 8623, 8723), the internal popliteal nerve (tibial) (DCs 8524, 8624, and 8724), and the posterior tibial nerve (DCs 8525, 8625, and 8725) affect the foot and leg sensory and motor function of the buttock, leg, knee, muscles below knee, lower leg, fibula, foot, muscles of the sole of the feet, plantar flexion, and toes. Id. M21-1, Part III, Subpart iv, 4.G.4.c. Assigning separate ratings from within these nerve branches is not warranted as it would constitute impermissible pyramiding. M21-1, III.iv.4.G.4.d. The anterior crural nerve (femoral) (DCs 8526, 8626, and 8726) and internal saphenous nerve (DCs 8527, 8627, and 8727) affect the thigh and leg sensory and motor function of the quadriceps muscle, front of thigh; medial calf; and medial malleolus. M21-1, Part III, Subpart iv, 4.G.4.c. These are part of a separate nerve group that may receive a separate evaluation from the sciatic nerve group. M21-1, III.iv.4.G.4.d. In October 2015, the Veteran underwent a VA examination for his diabetic peripheral neuropathy. He reported experiencing mild intermittent pain, numbness, and paresthesias and/or dysesthesias of the right lower extremity, as well as moderate levels of these symptoms in the left lower extremity. Muscle strength testing and reflex testing were normal, aside from decreased reflexes in both ankles. There was also evidence of decreased sensation in both feet, as well as decreased vibration sensation in the left lower extremity. There was no sign of muscle atrophy. The Veteran demonstrated loss of hair and shiny skin on the bilateral lower extremities as a result of the diabetic peripheral neuropathy. The examiner concluded that the Veteran’s sciatic and femoral nerves were normal, with no evidence of incomplete or complete paralysis. Upon review of this evidence, the Board finds that the objective manifestations of the Veteran’s peripheral neuropathy of the bilateral lower extremities show a mild impairment at most. The Board otherwise notes that the Veteran has complained of symptoms such as pain and numbness, and demonstrated decreased reflexes and sensation in the feet and ankles. However, such complaints themselves are insufficient to establish that the Veteran’s symptoms have approximated mild incomplete paralysis or worse at any time, particularly given the findings of the VA examiner that he did not have incomplete or complete paralysis. Thus, in applying the above law to the facts of the case, the Board finds that the Veteran is not entitled to compensable disability ratings for his service-connected peripheral neuropathy of the bilateral lower extremities. Here, there is no evidence of mild incomplete paralysis, or worse, of any nerve of the lower extremities, to warrant compensable disability ratings throughout the appeal period. The Board also concludes that the evidence does not demonstrate that the Veteran’s peripheral neuropathy of the bilateral lower extremities is shown to have been manifested by neuritis or neuralgia of any related nerve, such that an increased rating is warranted under a separate diagnostic code. In addition, there is no indication of soft-tissue sarcoma of either lower extremity. 38 C.F.R. § 4.124(a), DC 8540. Therefore, a separate compensable disability rating for diabetic peripheral neuropathy of the bilateral lower extremities is not warranted. 38 C.F.R. § 4.124(a), DC 8520-8530. The Veteran has not raised any other issues with respect to the higher initial rating claim, nor have any other assertions been reasonably raised by the record. I Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Erin J. Carroll, Associate Counsel