Citation Nr: 19139656 Decision Date: 05/21/19 Archive Date: 05/21/19 DOCKET NO. 17-36 093 DATE: May 21, 2019 ORDER Entitlement to an increased rating, in excess of 60 percent disabling, for diabetes mellitus type II with diabetic dermopathy and erectile dysfunction is denied. Entitlement to an initial rating in excess of 50 percent for posttraumatic stress disorder (PTSD) with dissociative symptoms is denied. Entitlement to an increased rating, in excess of 10 percent disabling, for left lower extremity peripheral sciatic neuropathy is denied. Entitlement to an increased rating, in excess of 10 percent disabling, for right lower extremity peripheral sciatic neuropathy is denied. Entitlement to an initial rating, in excess of 10 percent disabling, for left lower extremity peripheral femoral neuropathy is denied. Entitlement to an initial rating, in excess of 10 percent disabling, for right lower extremity peripheral femoral neuropathy is denied. Entitlement to a compensable rating for hypertension is denied. Entitlement to an effective date earlier than December 22, 2014 for the grant of a 10 percent disability rating for left lower extremity peripheral femoral neuropathy is denied. Entitlement to an effective date earlier than December 22, 2014 for the grant of a 10 percent disability rating for right lower extremity peripheral femoral neuropathy is denied. Entitlement to an effective date earlier than December 22, 2014 for the grant of a 60 percent disability rating for Diabetes Mellitus Type II with diabetic dermopathy and erectile dysfunction is denied. Entitlement to an effective date earlier to December 22, 2014 for the award of service connection for PTSD with dissociative symptoms is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to February 29, 2016 is granted. FINDINGS OF FACT 1. Diabetes mellitus has not resulted in 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. 2. Throughout the appeal, the Veteran’s PTSD has been shown to be manifested primarily by depressed mood with crying spells, anxiety, suspiciousness, flattened affect, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, impaired impulse control, guilt, decreased concentration, hopelessness, flashbacks, difficulties in establishing and maintaining social and work relationships, recurrent and intrusive distressing memories, recurrent distressing dreams, avoidance behavior, irritable behavior and hypervigilance; the frequency, severity and duration of these symptoms have been productive of no more than occupational and social impairment with reduced reliability and productivity. 2. The Veteran’s peripheral neuropathy of the right and left lower extremities has been manifested by constant pain and numbness with decreased with normal motor strength and no evidence of muscle atrophy, trophic changes or reflex abnormalities resulting in no more than mild incomplete paralysis of the sciatic nerve, and mild incomplete paralysis of the femoral nerve. 3. For the period on appeal, the Veteran’s hypertension was not productive of diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or a history of diastolic pressure predominantly 100 or more controlled by medication. 4. It is not factually ascertainable that the Veteran’s right and left lower extremity peripheral femoral neuropathy had manifested prior to December 22, 2014. 5. It is not factually ascertainable that the Veteran’s diabetes mellitus type II with diabetic dermopathy and erectile dysfunction increased in severity prior to December 22, 2014. 6. A final February 2010 AOJ rating decision denied a claim of entitlement to service connection for PTSD on the basis that the criteria for a diagnosis of PTSD had not been met; the Veteran next filed an application to reopen the claim on December 22, 2014. 7. Prior to February 29, 2016, the Veteran’s service-connected disabilities prevented him from obtaining and maintaining substantially gainful employment consistent with his educational and vocational experience. CONCLUSIONS OF LAW 1. The criteria for entitlement to an increased rating, in excess of 60 percent disabling, for diabetes mellitus type II with diabetic dermopathy and erectile dysfunction have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.119, Diagnostic Code 7913 (2018). 2. The criteria for entitlement to an initial rating in excess of 50 percent for PTSD with dissociative symptoms have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.119, Diagnostic Code 9411. 3. The criteria for entitlement to an increased rating, in excess of 10 percent disabling, for left lower extremity peripheral sciatic neuropathy, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.119, Diagnostic Code 8520. 4. The criteria for entitlement to an increased rating, in excess of 10 percent disabling, for right lower extremity peripheral sciatic neuropathy, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.119, Diagnostic Code 8520. 5. The criteria for entitlement to an initial rating in excess of 10 percent disabling for left lower extremity peripheral femoral neuropathy, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.119, Diagnostic Code 8526. 6. The criteria for entitlement to an initial rating in excess of 10 percent disabling for right lower extremity peripheral femoral neuropathy, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.119, Diagnostic Code 8526. 7. The criteria for entitlement to a compensable rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.119, Diagnostic Code 7101. 8. The criteria for an earlier effective date, prior to December 22, 2014 for the award of a 10 percent rating for left lower extremity peripheral femoral neuropathy have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 9. The criteria for an earlier effective date, prior to December 22, 2014 for the award of a 10 percent rating for right lower extremity peripheral femoral neuropathy have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 10. The criteria for an earlier effective date, prior to December 22, 2014 for the grant of a 60 percent disability rating for Diabetes Mellitus Type II with diabetic dermopathy and erectile dysfunction have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 11. The criteria for an effective date earlier than December 22, 2014 for the award of service connection for PTSD with dissociative symptoms have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.157, 3.400. 12. For the time period prior to February 29, 2016, the criteria for entitlement to TDIU have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1966 to May 1968. This appeal comes before the Board of Veterans’ Appeals (Board) from several rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO), in San Diego, California (hereinafter Agency of Original Jurisdiction (AOJ)). Increased Ratings Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, where the evidence contains factual findings that show a change in the severity of symptoms during the course of the rating period on appeal, assignment of staged ratings would be permissible. See Fenderson v. West, 12 Vet. App. 119 (1999). For increased rating claims, the relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to an increased rating, in excess of 60 percent disabling, for diabetes mellitus type II with diabetic dermopathy and erectile dysfunction. The Veteran contends that he is entitled to an evaluation in excess of 60 percent for his service-connected diabetes mellitus. A May 2015 rating decision assigned a 60 percent rating for nephropathy associated with diabetes mellitus II and included the dermopathy and erectile dysfunction disabilities due to such in the 60 percent rating assigned for diabetes under Diagnostic Code 7913. The Veteran’s diabetes mellitus type II is rated under the diagnostic code for diabetes mellitus in accordance with the General Rating Formula for the Endocrine system. 38 C.F.R. § 4.119, Diagnostic Code 7913. A 20 percent evaluation is warranted for requiring insulin and restricted diet, or; oral hypoglycemic agent and restricted diet. A 40 percent evaluation is warranted for requiring insulin, restricted diet, and regulation of activities. A 60 percent evaluation is warranted for 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 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 not be compensable if separately evaluated. Id. Relevant to this appeal, the criteria for rating diabetes are “successive.” Camacho v. Nicholson, 21 Vet. App. 360, 366 (2007). “Successive” criteria exist where the evaluation for each higher disability rating includes the criteria of each lower disability rating, such that if a component is not met at any one level, the Veteran can only be rated at the level that does not require the missing component. Tatum v. Shinseki, 23 Vet. App. 152, 156 (2008). “Regulation of activities” has been defined as the situation where a veteran has been prescribed or advised to avoid strenuous occupational and recreational activities. 61 Fed. Reg. 20,440, 20,443 (May 7, 1996) (defining “regulation of activities” as used by VA in 7913). Medical evidence is required to show that occupational and recreational activities have been restricted. Camacho v. Nicholson, 21 Vet. App. 360, 363-64 (2007). The Veteran’s treatment records show that he has had an ongoing diagnosis of diabetes mellitus type II, treated with insulin and oral medication. These records do not show any hypoglycemic reactions requiring a hospitalization nor twice a month visits to a diabetic care provider A VA diabetes examination conducted in February 2015 noted that the Veteran’s diabetes required more than one injection of insulin per day but did not require regulation of activities. It also indicated the Veteran visited his diabetic care provider for episodes of ketoacidosis and hypoglycemia 2 times per month but that he had not had any hospitalizations for ketoacidosis and hypoglycemia in the prior 12 months. The examiner noted that the Veteran had not undergone progressive unintentional weight loss due to diabetes mellitus but did have loss of strength due to diabetes mellitus. The examiner stated that the complications of diabetes mellitus were limited to diabetic peripheral neuropathy and erectile dysfunction. She also indicated that the Veteran’s diabetes mellitus did impact the ability of the Veteran to work, due to weakness, slow reaction time and memory loss. Additionally, the following conditions would be rated as noncompensable if rated by themselves: erectile dysfunction and dermopathy. Erectile dysfunction would warrant a separate 20 percent evaluation if there is loss of erectile power with penile deformity. Diabetic dermopathy would warrant a higher evaluation of 10 percent if there is at least 5 percent, but less than 20 percent, of the entire body affected; or, at least 5 percent, but less than 20 percent, of the exposed areas of the body affected; or, intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. March 2015 VA examinations of these conditions, as well as the clinic records and lay evidence, have not established that separate compensable ratings are warranted for these conditions. The Board has also reviewed the Veteran’s VA treatment records for the period on appeal. There is no evidence of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider contained within the treatment records. The Board finds that a rating in excess of 60 percent for diabetes mellitus, type II, with erectile dysfunction and diabetic dermopathy is not warranted. In addition to more than one daily injection of insulin, restricted diet, and regulation activities, the evidence must show 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 lay and medical evidence of record does not support a finding of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider. The lay and medical evidence of record also fails to show weekly visits to his diabetic care provider or progressive loss of weight, although there is a loss of strength. The record does reflect complications that are not separately evaluated. These include erectile dysfunction and diabetic dermopathy. Although the Veteran does meet some of the requirements necessary for a 100 percent disability rating for his diabetes mellitus, he does not meet them all. As previously mentioned, the criteria for rating diabetes mellitus is successive, meaning that if a component is not met at any one level, the Veteran may only be rated at the level not requiring that component. In the instant case, the Veteran does not meet the requirement regarding episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider. The Veteran is competent to describe his symptoms and their effects. See Layno, 6 Vet. App. at 465. While he is credible to the extent that he sincerely believes he is entitled to a higher rating, he is not competent to identify a specific level of disability according to the appropriate Diagnostic Code, as this is a complex medical determination outside the realm of common knowledge of a lay person. See e.g. Kahana, 24 Vet. App. at 435. The Board acknowledges that the Veteran is sincere in his belief that his condition warrants a higher rating. He would be competent to describe the frequency of hospital and doctor visitations, but he has not described three hospitalizations per year due to ketoacidosis or hypoglycemic reacons, or weekly visitations to a diabetic care provider. The documentary evidence also does not support such findings. Overall, the Board finds that the Veteran’s belief is outweighed by competent and credible medical evidence that evaluates the true extent of the diabetes mellitus based on objective data coupled with the lay complaints. In this regard, the VA examiner has the training and expertise necessary to administer the appropriate tests for a determination on the type and degree of the impairment associated with the Veteran’s complaints. Medical evidence is required to show that episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider have occurred. Here, the February 2015 findings explicitly stated that the Veteran’s condition did not result in episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider which is consistent with the treatment records. Therefore, the Board affords greater evidentiary weight to these findings. With respect to whether a rating may be assigned for diabetes in excess of 60 percent under DC 7913, as the February 2015 VA examination indicated the Veteran's diabetes did not result in episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, nor is such a disability cluster shown by any other evidence, a rating in excess of 60 percent under Diagnostic Code 7913 cannot be assigned. Finally, in making the rating determinations above, the Board has considered the doctrine of reasonable doubt, but as the preponderance of the evidence is against the assignment of a disability ratings in excess of 60 percent for diabetes mellitus II with diabetic dermopathy and erectile dysfunction, an increase in compensation for such disabilities may not be granted. 38 U.S.C. § 5107. 2. Entitlement to an initial rating in excess of 50 percent for PTSD with dissociative symptoms. The Veteran contents that his service-connected PTSD warrants a higher disability rating, under Diagnostic Code 9411. The rating criteria for rating mental disorders under Diagnostic Code 9411 reads as follows: A 100 percent rating requires total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. 38 C.F.R. § 4.130. A 70 percent rating requires occupational and social impairment, with deficiencies in most areas, such as work, school, family relations judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence) spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. Id. A 50 percent rating requires occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing effective work and social relationships. Id. Evaluation under § 4.130 is symptom-driven, meaning that symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating under that regulation. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). The Federal Circuit explained that the frequency, severity, and duration of the symptoms also played an important role in determining the rating. Id. at 117. Significantly, however, the list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). If the evidence shows that the Veteran suffers symptoms listed in the rating criteria or symptoms of similar severity, frequency, and duration, that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the criteria for a particular rating, the appropriate equivalent rating will be assigned. Id. at 443; see also Vazquez-Claudio, 713 F.3d at 117. In a November 2014 correspondence, the Veteran submitted a checklist which purported to report that he had psychiatric symptoms including: anger, anxiety, chronic sleep problems, danger of hurting self or others, delusions, denial, depression, difficulty making decisions, emotional numbing, flashbacks, guilt, hallucinations, heavy use of alcohol, inability to make or keep friends, inappropriate behavior, intrusive thoughts, isolation, lack of emotions, lack of self-esteem, memory loss, neglects family, nervousness, no friends, panic attacks, period of violence, problems with communication, problems at work, problems getting along with people, sense of helplessness, suicidal feelings/thoughts, suspiciousness, and unable to share feelings. In a January 2015 mental health note, the psychiatrist noted presents wearing Vietnam vet hat, well groomed, pleasant and cooperative. Is hard of hearing. He c/o nightmares and feeling ‘jumpy’ since he got out of the service in 1968. He does recall being prescribed prazosin in the past for nightmares, which he stopped years ago. Says it didn't really help. Discusses that he has current stressors which include financial and marital. He is currently retired. Has depressed mood with occasional crying spells. His primary complaint is nightmares twice weekly. His wife has told him that he appears to stop breathing at night. Says he and wife fight frequently. He admits that he has a temper. Pt denies implicitly and explicitly thoughts, plans or intent to cause death or bodily harm to self or others. The psychiatrist noted symptoms of sleep disturbance, guilt, decreased concentration, hopelessness, hypervigilance, anxiety, flashbacks, nightmares, and worry. The Veteran did not have hallucinations, delusions, or paranoia. The Veteran denied suicidal or homicidal thoughts or ideation. In a January 2015 mental health note, the treating psychiatrist noted that the Veteran was not suicidal or homicidal. An examination was conducted by VA in March 2015. The Veteran reported that He avoids fireworks displays due to the anxiety this causes. When he feels anxious like that, he has to investigate what has happened, and says that this happens mostly at night now. He has nightmares about combat events about twice a week, and then he has night sweats. Even without a nightmare, his side of the bed is always wet from night sweats. He gets about five hours of interrupted sleep through the night, jumping out of bed if the cats touch him in the sleep. Most of the time, he tries not to think about combat, and leaves the room if someone reminds him of combat. He does not talk about what happened in Vietnam because it leads to crying. At that time, the diagnosis was PTSD. The examiner summarized the occupational and social impairment resulting from the Veteran’s PTSD as being impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily with normal routine behavior, self-care and conversation. The Veteran endorsed many of the diagnostic criteria for a diagnosis of PTSD, including recurrent and intrusive distressing memories of traumatic events and recurrent distressing dreams, avoidance behavior, an inability to remember an important aspect of the traumatic event, persistent and exaggerated negative beliefs or expectations about oneself or others, persistent negative emotional state and an inability to experience positive emotions, irritable behavior, hypervigilance, and sleep disturbances. Symptoms included depressed mood, anxiety, suspiciousness, flattened affect, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, impaired impulse control, and difficulties in establishing and maintaining social and work relationships. The symptoms did not include: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence) spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. In a June 2015 mental health treatment note, the treating psychiatrist noted that the Veteran had appropriate affect, fair judgment, average intelligence, circumstantial thought, and appropriate cognition. The Veteran did not have hallucinations, delusions, or paranoia. The Veteran reported mild depression, forgetfulness, nightmares, avoidant behavior, and reexperiencing the traumatic event. The Veteran denied suicidal or homicidal thoughts or ideation. In a September 2015 treatment note the Veteran was noted as having normal affect, fair judgment, average intelligence, circumstantial thought, and appropriate cognition. The Veteran did not have hallucinations, delusions, or paranoia. The Veteran reported mild depression, forgetfulness, nightmares, avoidant behavior, and reexperiencing the traumatic event. The Veteran denied suicidal or homicidal thoughts or ideation. In a November 2015 treatment note, the treating psychiatrist noted that the Veteran had appropriate affect, fair judgment, average intelligence, circumstantial thought, and appropriate cognition. The Veteran did not have hallucinations, delusions, or paranoia. The Veteran reported mild depression, forgetfulness, nightmares, avoidant behavior, and reexperiencing the traumatic event. The Veteran denied suicidal or homicidal thoughts or ideation. In a February 2017 treatment note, the Veteran reported mild depression, forgetfulness, nightmares, avoidant behavior, and reexperiencing the traumatic event. The Veteran denied suicidal or homicidal thoughts or ideation. The Board finds that, throughout the appeal, the lay and medical evidence establishes that the Veteran’s PTSD has been shown to be manifested primarily by depressed mood with crying spells, anxiety, suspiciousness, flattened affect, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, impaired impulse control, guilt, decreased concentration, hopelessness, flashbacks, difficulties in establishing and maintaining social and work relationships, recurrent and intrusive distressing memories, recurrent distressing dreams, avoidance behavior, irritable behavior and hypervigilance. The Veteran did endorse additional symptoms such as being a danger of hurting self or others, hallucinations, inappropriate behavior, neglect of family, social isolation, panic attacks, periods of violence, and suicidal thoughts/feelings in a checklist form in 2014. However, the lay and medical evidence – which includes the Veteran’s description of symptoms during clinic therapy sessions and during formal examinations – does not demonstrate persistence of these symptoms or clinic evaluations that such symptoms were affecting his occupational and social impairment to any significant degree. In the clinic setting, the Veteran has primarily reported chronic sleep impairment with nightmares twice weekly, marital fights, mild depression forgetfulness, avoidant behavior and reexperiencing traumatic events. However, he has consistently denied suicidal/homicidal ideation while mental status examinations were negative for hallucinations or delusions. The expert medical opinion from the VA examiner in 2015 found that the frequency, severity and duration of the Veteran’s overall PTSD symptoms resulted in occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily with normal routine behavior, self-care and conversation. This opinion is consistent with mental status examinations consisting reflecting no significant impairment of speech, orientation, affect, or thought process. In the opinion of the Board, when considering the frequency, duration and severity of the reported symptoms and the Veteran’s self-description of functioning, the Board places great probative weight on the opinion of the 2015 VA examiner regarding the overall occupational and social impairment due to PTSD. This evidence reflects that, while the Veteran has endorsed symptoms which are considered examples for higher ratings still such as suicidal ideation, impaired impulse control, delusions, hallucination, and inappropriate behavior, the Veteran’s overall occupational and functional impairment due to PTSD has resulted in no more than social and industrial impairment with reduced reliability and productivity for the entire appeal period. In so finding, the Board has considered all lay symptoms reported by the Veteran and his self-description of occupational and social impairment. However, the Board places significant probative weight on the opinion of the VA examiner who – upon review of the claims folder, the Veteran’s description of symptoms and mental status examination findings – has relied upon his own psychiatric expertise and experience in evaluating the Veteran’s overall occupational and social impairment. Behavioral observations by the examiners in the clinic setting similarly do not support overall impairment to the required level of severity so as to warrant an increased disability rating in excess of 50 percent. Therefore, to the extent that the evidence of record documents some of the symptoms included in the individual rating criteria for an increased 70 percent or 100 percent disability rating, the Board finds that such symptoms have not been of sufficient frequency, severity and duration to have resulted in overall impairment to the required level of severity so as to warrant an increased disability rating. Therefore, the Board finds that the Veteran’s manifested psychiatric symptoms for the period on appeal are most closely approximated by the assigned 50 percent disability rating. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim for a higher initial rating for PTSD, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to an increased rating, in excess of 10 percent disabling, for right lower extremity peripheral sciatic neuropathy. 4. Entitlement to an increased rating, in excess of 10 percent disabling, for left lower extremity peripheral sciatic neuropathy. 5. Entitlement to an increased rating, in excess of 10 percent disabling, for right lower extremity peripheral femoral neuropathy. 6. Entitlement to an increased rating, in excess of 10 percent disabling, for left lower extremity peripheral femoral neuropathy. The Veteran is currently in receipt of separate ratings in regard to peripheral neuropathy of the left and right lower extremities, affecting the sciatic and femoral nerve; both associated with his service connected diabetes mellitus. Under Diagnostic Code 8520, the Veteran is currently in receipt of 10 percent disability for the peripheral neuropathy affecting the sciatic nerve for both left and right lower extremity separately. Also, under Diagnostic Code 8526 the Veteran is currently in receipt of 10 percent disability for the peripheral neuropathy affecting the femoral nerve for both left and right lower extremity separately. For diseases of the peripheral nerves, disability ratings are based on whether there is complete or incomplete paralysis of the particular nerve. The term “incomplete paralysis,” indicates 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. See 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 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. Complete paralysis of the sciatic nerve is evidenced by the foot dangled and dropped, no active movement possible of muscles below the knee, and flexion of knee weakened or (very rarely) lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520. 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. Under Diagnostic Codes 8520, for incomplete paralysis, and 8620, for neuritis, a 10 percent disability rating is assigned for mild incomplete paralysis. If the condition is considered “moderate,” a 20 percent disability rating is provided. If the condition is considered “moderately severe,” a 40 percent disability rating is provided, and a 60 percent rating is warranted for conditions considered “severe, with marked muscular atrophy.” Diagnostic Code 8526 pertains to a disability comparable to paralysis of the anterior crural nerve (femoral). Under Diagnostic Code 8526, a 10 percent rating is warranted for mild incomplete paralysis, a 20 percent rating is warranted for moderate incomplete paralysis, and a 30 percent rating is warranted for severe incomplete paralysis. A 40 percent rating is warranted for complete paralysis of the anterior crural nerve (femoral) resulting in paralysis of the quadriceps extensor muscles. The Board observes that the words “mild,” “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 of the evidence, to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. 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 is for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. See 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” In a February 2015 VA examination, the examiner conducted a review of the Veteran’s medical records and conducted a thorough physical examination. The examination found that muscle strength testing was 5/5 for the bilateral lower extremities. There was no muscle atrophy. Deep tendon reflexes were 2+ for the bilateral lower extremities. Sensory findings were decreased for the bilateral ankle/lower legs and foot/toes, including decreased sensation of vibration and cold. There was constant pain, paresthesias and/or dysesthesias, and numbness of a moderate degree of the bilateral lower extremities. The nerve roots affected were the sciatic and femoral nerves. The examiner found that the Veteran had mild paralysis of the sciatic and nerves of both lower extremities. In a July 2016 VA examination, the examiner conducted a review of the Veteran’s medical records and conducted a thorough physical examination. The examination showed muscle strength testing was 5/5 for the bilateral lower extremities. There was no muscle atrophy. Deep tendon reflexes were 2+ for the bilateral lower extremities. Sensory findings were normal for the bilateral ankle/lower leg and foot/toes. There were no symptoms of constant pain, intermittent pain, paresthesias and/or dysesthesias, or numbness of the bilateral lower extremities. The nerve roots affected were the sciatic and femoral nerves. The examiner found that the Veteran had mild paralysis of the sciatic and nerves of both lower extremities. The available clinic records reflect abnormal monofilament sensory findings, but no specific findings regarding muscle strength, reflexes, etc. The Veteran is currently in receipt of 10 percent disability for the peripheral neuropathy affecting the sciatic nerve for both left and right lower extremity separately as well as separate 10 percent ratings for peripheral neuropathy affecting the femoral nerve. The lay and medical evidence reflects the Veteran’s credible reports of constant pain and numbness with decreased sensation. However, the clinic findings also reflect normal motor strength and no evidence of muscle atrophy, trophic changes or reflex abnormalities. When considering the extent of sensory abnormality in light of otherwise normal findings for motor strength and reflexes with no evidence of muscle atrophy or trophic changes, the Board finds that the Veteran’s peripheral neuropathy affecting the sciatic and femoral nerves is manifested by at most mild incomplete paralysis of the sciatic and femoral nerves in both lower extremities. As such, disability ratings in excess of 10 percent for both the sciatic and femoral nerves in both lower extremities is not warranted. In so finding, the Board has found the Veteran’s description of symptoms such as pain and numbness to be credible and consistent with the evidentiary record. With regard to specific findings such as motor strength, the extent of sensory impairment, reflex abnormalities, muscle atrophy and trophic changes, the Board places greater probative weight on the findings of clinicians trained to evaluate specific clinic findings attributable to a neurologic disabilities. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran's claim for increased rating for bilateral lower extremity peripheral sciatic and femoral neuropathy, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 7. Entitlement to a compensable rating for hypertension. The Veteran seeks a higher evaluation for his service-connected hypertension. Under Diagnostic Code 7101, a 10 percent evaluation is warranted for diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or for a history of diastolic pressure predominantly 100 or more controlled by medication. A 20 percent evaluation is warranted for diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more. A 40 percent evaluation is warranted for diastolic pressure predominantly 120 or more. A maximum 60 percent rating is warranted for diastolic pressure predominantly 130 or more. The Board finds that the evidence weighs against finding that a compensable evaluation is warranted for the Veteran’s hypertension for the period on appeal. Higher ratings are available for hypertension that is productive of diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or a history of diastolic pressure predominantly 100 or more controlled by medication. The evidence weighs against such manifestations. A March 2015 VA examination report noted February 2015 blood pressure readings of 124/72 mm. VA treatment records during the appeal period reflects pertinent blood pressure readings as follows: 139/84 in November 2012, 131/86 in May 2013, 116/63 in November 2013, 139/81 in November 2014, 126/69 mm in November 2014, 118/69 mm in June 2015, 138/73 mm in June 2016, 140/67 mm in February 2017, 134/77 mm in June 2017, and 119/67 mm in August 2017. The private treatment records do not reflect diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or history of being prescribed medication for a history of diastolic pressure predominantly 100 or more. The Veteran has not reported any specific blood pressure readings which could reasonably support a factual finding for these criteria. Based on the foregoing, the evidence does not demonstrate that the Veteran’s hypertension more nearly approximated the criteria for a compensable evaluation at any point during the period on appeal. Accordingly, a compensable evaluation for hypertension is not warranted. 38 C.F.R. §§ 4.3, 4.7, 4.104, Diagnostic Code 7101. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim for increased rating for hypertension and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Effective Dates The statutory guidelines for the determination of an effective date of an award of disability compensation are set forth in 38 U.S.C. §5110. Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after a final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. In cases involving direct service connection, the effective date will be the day following separation from active service or the date entitlement arose if the claim is received within one year after separation from service. Otherwise, the effective date will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. §3.400 (b)(2)(i). The reference above to “the date entitlement arose” is not defined in the current statute or regulation. The CAVC has interpreted it as the date when the claimant met the requirements for the benefits sought; this is determined on a “facts found” basis. See 38 U.S.C. § 5110 (a); see also McGrath v. Gober, 14 Vet. App. 28, 35 (2000). These “facts found” include the date the disability first manifested and the date entitlement to benefits was authorized by law and regulation. See generally 38 C.F.R. § 3.400. However, the date entitlement arose is not the date that VA receives the evidence, but the date to which that evidence refers. McGrath, 14 Vet. App. at 35. “Claim” is defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p); Brannon v. West, 12 Vet. App. 32, 34-35 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). The Board notes that, effective March 24, 2015, VA amended its adjudication regulations to require that all claims governed by VA’s adjudication regulations be filed on standard forms prescribed by the Secretary (i.e., VA Form 21-526). 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). This rulemaking also eliminated the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims for increase and revised 38 C.F.R. § 3.400(o)(2). These amendments, however, are only applicable with respect to claims and appeals filed on or after March 24, 2015, and are not applicable in the present case. See 79 Fed. Reg. 57,660, 57,686 (Sept. 25, 2014). As such, any communication or action in this case, indicating an intent to apply for one or more benefits under laws administered by the VA from a claimant may be considered an informal claim. Such an informal claim must identify the benefits 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. Upon receipt of an informal claim, if a formal claim has not been filed, an application form must be forwarded to the claimant for execution. If the application form is 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. § 3.155(a). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). Also applicable to this claim, the former provisions of 38 C.F.R. §3.157(b) are applicable which stated that once a formal claim for pension or compensation had been allowed or a formal claim for compensation disallowed for the reason that the service-connected disability is not compensable in degree, receipt of (1) a report of examination or hospitalization by VA or uniformed services, (2) evidence from a private physician or layman, or (3) reports and records from State and other institutions will be accepted as an informal claim for increased benefits or an informal claim to reopen. However, the Court has held that this regulation only applies to a particular group of claims. See Pacheco v. Gibson, 27 Vet. App. 21 (2014) (en banc) (construing ambiguity contained in §3.157 as applying to a previous disallowance for a service-connected disability not being compensable in degree); see Sears v. Principi, 16 Vet. App. 244, 249 (2002) (finding that §3.157 applies to a defined group of claims, i.e., as to disability compensation, those claims for which a report of a medical examination or hospitalization is accepted as an informal claim for an increase of a service-connected rating where service connection has already been established). Specifically, VA medical records are not accepted as informal claims for disabilities where service connection has not been established, since the mere presence of medical evidence does not establish intent on the part of the Veteran to seek service connection for a condition. See Brannon v. West, 12 Vet. App. 32, 35 (1998); see also Lalonde v. West, 12 Vet. App. 377, 382 (1999). The effective date for an increased rating is to be the earliest date as of which it is factually ascertainable that an increase in disability occurred if a claim is received within one year from such date; otherwise, the effective date for increased rating is the date of receipt of the claim for increase. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2); Gaston v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010). Determining an appropriate effective date for an increased rating involves an analysis of the evidence to determine (1) when a claim for an increased rating was received and, if possible (2) when the increase in disability actually occurred. 38 C.F.R. §§ 3.155, 3.400(o)(2); see also Hazan v. Gober, 10 Vet. App. 511 (1997). 8. Entitlement to an earlier effective date, prior to December 22, 2014 for the grant of a 10 percent disability rating for left lower extremity peripheral femoral neuropathy. 9. Entitlement to an earlier effective date, prior to December 22, 2014 for the grant of a 10 percent disability rating for right lower extremity peripheral femoral neuropathy. In the present case, the Veteran submitted an increased rating claim for his diabetes mellitus on December 22, 2014. Due to the results of a subsequent VA examination, the AOJ granted service connection for these conditions, and awarded 10 percent disability ratings for each extremity, with an effective date of the December 22, 2014, the date of the Veteran’s report of an increased severity of disability. A prior VA examination report in March 2013 specifically found normal clinic findings for the femoral nerve root for both lower extremities. The clinic records up to December 22, 2014 also do not disclose any assessment of femoral nerve root impairment for either extremity. Additionally, the Veteran has not provided any specific lay description of differing symptoms in either lower extremity prior to December 22, 2014 for which it would be factually ascertainable that femoral nerve root impairment of either extremity manifested at any specific time period prior to December 22, 2014. The AOJ has favorably construed December 2014 report of increased symptoms of diabetes mellitus to be the onset of femoral nerve root impairment. However, for the reasons stated above, the Board finds that the evidence preponderates against a finding of entitlement to an effective date earlier than December 22, 2014 for the award of separate 10 percent ratings for bilateral lower extremity peripheral femoral neuropathy. Consequently, the effective date of December 22, 2014 is the earliest allowable date under the law. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran's claims for earlier effective dates, prior to December 22, 2014 for the grant of a 10 percent disability rating for left and right lower extremity peripheral femoral neuropathy, and the claims must be denied. Because the preponderance of the evidence is against the claims, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 10. Entitlement to an earlier effective date, prior to December 22, 2014 for the grant of a 60 percent disability rating for Diabetes Mellitus Type II with diabetic dermopathy & erectile dysfunction. In the present case, the Veteran’s claimed an increased severity of diabetes mellitus Type on December 22, 2014. See December 2014 Statement in Support of Claim. A May 2015 AOJ rating decision awarded a 60 percent rating under Diagnostic Code 7913 reportedly on the basis of 1) complications that would not be compensable if separately rated; 2) episodes of ketoacidosis requiring twice a month visits to a diabetic care provider; 3) hypoglycemic reactions requiring twice a month visits to a diabetic care provider; and 4) requiring more than one daily injection of insulin. The Veteran’s treatment records prior to December 22, 2014 do not reflect episodes of ketoacidosis requiring twice a month visits to a diabetic care provider or hypoglycemic reactions requiring twice a month visits to a diabetic care provider which is required for a 60 percent rating. To the extent the Veteran reports this type of frequency of visitations, such a history is not consistent with the documentary evidence. The Board places greater probative weight to the documentary evidence which establishes the dates of treatments and the reasons for treatment rather than the Veteran’s recollections. As such, the Board finds that it is not factually ascertainable that an increase in severity of the Veteran’s diabetes mellitus occurred prior to December 22, 2014. Based on the foregoing, the Board finds that the evidence preponderates against a finding of entitlement to an effective date earlier than December 22, 2014 for increased rating for diabetes mellitus Type II with diabetic dermopathy & erectile dysfunction. Consequently, the effective date of December 22, 2014 is the earliest allowable date under the law, and an earlier effective date for the increased ratings for Diabetes Mellitus Type II with diabetic dermopathy & erectile dysfunction is not warranted. 11. Entitlement to an effective date earlier than December 22, 2014 for the award of service connection for PTSD with dissociative symptoms. The Veteran seeks an effective date earlier than December 22, 2014 for the award of service connection for PTSD with dissociative symptoms. Historically, a February 2010 AOJ rating decision denied service connection for PTSD on the merits holding that the criteria for diagnosing PTSD had not been met. The Veteran was notified of this decision, and his appellate rights, by letter dated February 8, 2010. The Veteran did not appeal this decision, or submit new and material evidence, within one year of notice of this decision. The February 2010 decision, therefore, is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. The record next reflects that the Veteran forwarded a written communication on December 22, 2014 seeking to reopen his claim of entitlement to service connection for PTSD; this is the effective date of award assigned by the AOJ. Between February 2010 and December 22, 2014, the Board does not find any written communication from the Veteran or his representative which reflected an intent to reopen the claim of entitlement to service connection for PTSD. The Board acknowledges that the Veteran may have manifested PTSD prior to the effective date of award, but any references in medical records cannot constitute a formal or informal claim for service connection under 38 C.F.R. §3.157(b). Pacheco, 27 Vet. App. 21 (2014); Sears, 16 Vet. App. at 249. Based on the foregoing, the Board finds that the evidence preponderates against a finding of entitlement to an effective date earlier than December 22, 2014 for the award of service connection for PTSD with dissociative symptoms as the date of December 22, 2014 is the earliest allowable date under the law. 12. Entitlement to TDIU The Veteran filed an application for TDIU benefits on December 22, 2014 – which is the same date he claimed a severity for service-connected diabetes mellitus. Effective December 22, 2014 to February 28, 2016, the Veteran holds a combined 90 percent rating due to bilateral hearing loss rated as 40 percent disabling, diabetes mellitus rated as 60 percent disabling, PTSD rated as 50 percent disabling, tinnitus rated as 10 percent disabling, left lower extremity peripheral neuropathy of the sciatic nerve rated as 10 percent disabling, right lower extremity peripheral neuropathy of the sciatic nerve rated as 10 percent disabling, voiding dysfunction rated as 10 percent disabling, left lower extremity peripheral neuropathy of the femoral nerve rated as 10 percent disabling, right lower extremity peripheral neuropathy of the femoral nerve rated as 10 percent disabling and hypertension rated as noncompensable. Effective February 29, 2016, the Veteran has been rated as 100 percent disabled due to bilateral hearing loss with an additional 20 percent rating for peripheral neuropathy of the right upper extremity. On a November 2014 VA Form 21-8940 (Application for Increased Compensation Based on Unemployability), the Veteran stated “none” to the question of “what service-connected disability prevented you from securing or following any substantially gainful employment?” but also noted treatment for diabetes, PTSD, high blood pressure, knees and heart. He also noted that he had retired from his job as a heavy duty automobile mechanic in July 2007. He indicated that he had completed high school and had had no other education or training. On his May 2016 application for TDIU, the Veteran stated that he had been unable to work as a result of his “daily panic attacks” due to his service-connected PTSD. He did not assert that any other disability made him unable to maintain gainful employment. He stated that he had worked as a mechanic from February 1984 to July 2008 but listed no other employment history. He indicated that he had completed high school and had had no other education or training since he became too disabled to work. Total disability ratings for compensation may be assigned where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation because of service-connected disabilities. If there is only one such disability, this disability shall be ratable as 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16. For TDIU purposes, marginal employment is not to be considered substantially gainful employment. 38 C.F.R. § 4.1. Factors to be considered, however, will include the Veteran’s employment history, educational attainment, and vocational experience. 38 C.F.R. § 4.16. The Veteran meets the criteria for a schedular TDIU rating under 38 C.F.R. § 4.16 (a) since December 22, 2014. In Moore v. Derwinski, 1 Vet. App. 356, 359 (1991), the U.S. Court of Veterans Appeals (now the U.S. Court of Appeals for Veterans Claims) (Court) discussed the meaning of “substantially gainful employment.” In this context, it noted the following standard announced by the United States Federal Court of Appeals in Timmerman v. Weinberger, 510 F.2d 439, 442 (8th Cir. 1975): It is clear that the claimant need not be a total ‘basket case’ before the courts find that there is an inability to engage in substantial gainful activity. The question must be looked at in a practical manner, and mere theoretical ability to engage in substantial gainful employment is not a sufficient basis to deny benefits. The test is whether a particular job is realistically within the physical and mental capabilities of the claimant. However, to receive TDIU, the Veteran’s service-connected disabilities, alone, must be sufficiently severe to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). As noted in Moore, the Board must address the TDIU question as a practical manner. Here, the record reflects that the Veteran’s primary area of employment was a heavy duty automobile mechanic. The record reflects that, since December 2014, the Veteran has had significant hearing impairment, diabetes mellitus manifested by loss of strength and daily injections of insulin with episodes of ketoacidosis and hypoglycemic reactions requiring twice a month visits to a diabetic care provider, impairment of the lower extremities as well as PTSD which has been deemed productive of reduced reliability and productivity. For the period prior to February 29, 2016, the Veteran had a combined 90 percent rating which is reflective of very little residual occupational capacity, and his physical impairments likely precluded anything more than sedentary employment. Additionally, the Veteran has a limited education and there is no showing of any sedentary occupation within the Veteran’s occupational and educational experience wherein he could earn substantially gainful employment. See generally Bowling v. Principi, 15 Vet. App. 1, 7 (2001) (substantially gainful employment refers to, at the minimum, the ability to earn a living wage, and is not engaged in substantially gainful employment if annual income below the poverty threshold for one person). (continued on the next page) Given these facts, and affording the Veteran the benefit of the doubt, the Board finds that the Veteran does not practically possess the ability to obtain or maintain substantially gainful employment consistent with his vocational background. The claim, therefore, is granted for the time period prior to February 29, 2016. 38 U.S.C. § 1155 ; 38 C.F.R. §§ 3.340, 3.341, 4.16. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Michael J. O'Connor