Citation Nr: 20005183 Decision Date: 01/22/20 Archive Date: 01/22/20 DOCKET NO. 16-55 201 DATE: January 22, 2020 ORDER Entitlement to service connection for hypertension is dismissed. Entitlement to service connection for a bilateral eye condition (claimed as vision impairment) is dismissed. Entitlement to a disability rating in excess of 20 percent for service-connected diabetes mellitus type II with erectile dysfunction (hereafter referred to as "diabetes") is denied. For the period on appeal prior to May 21, 2018, entitlement to a disability rating in excess of 10 for service-connected right lower extremity peripheral neuropathy is denied. For the period on appeal prior to May 21, 2018, entitlement to a disability rating in excess of 10 for service-connected left lower extremity peripheral neuropathy is denied. Entitlement to a 20 percent disability rating, beginning May 21, 2018, for service-connected right lower extremity peripheral neuropathy is granted. Entitlement to a 20 percent disability rating, beginning May 21, 2018, for service-connected left lower extremity peripheral neuropathy is granted. Entitlement to a disability rating in excess of 20 percent for service-connected right upper extremity peripheral neuropathy is denied. Entitlement to a disability rating in excess of 20 percent for service-connected left upper extremity peripheral neuropathy is denied. Entitlement to total disability based on individual unemployability (TDIU), beginning May 24, 2012, is granted. FINDINGS OF FACT 1. Prior to the promulgation of a decision on the appeal, the Veteran withdrew his appeal of the issue of entitlement to service connection for hypertension. 2. Prior to the promulgation of a decision on the appeal, the Veteran withdrew his appeal of the issue of entitlement to service connection for a bilateral eye condition. 3. The Veteran’s service-connected diabetes requires no more than insulin and restricted diet or oral hypoglycemic agent and restricted diet. 4. Prior to May 21, 2018, the Veteran’s service-connected peripheral neuropathy of the right lower extremity manifests slight, incomplete paralysis. 5. Prior to May 21, 2018, the Veteran’s service-connected peripheral neuropathy of the left lower extremity manifests slight, incomplete paralysis. 6. Beginning May 21, 2018, the Veteran’s service-connected peripheral neuropathy of the right lower extremity manifests moderate, incomplete paralysis. 7. Beginning May 21, 2018, the Veteran’s service-connected peripheral neuropathy of the left lower extremity manifests moderate, incomplete paralysis. 8. The Veteran’s service-connected peripheral neuropathy of the right upper extremity manifests no more than mild, incomplete paralysis. 9. The Veteran’s service-connected peripheral neuropathy of the left upper extremity manifests no more than mild, incomplete paralysis. 10. Beginning May 24, 2012, the Veteran’s service-connected disabilities have rendered him unable to secure or follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal for entitlement to service connection for hypertension have been met. 38 U.S.C. § 7105(d); 38 C.F.R. § 20.205. 2. The criteria for withdrawal of the appeal for entitlement to service connection for a bilateral eye condition have been met. 38 U.S.C. § 7105(d); 38 C.F.R. § 20.205. 3. The criteria for entitlement to a disability rating in excess of 20 percent for service-connected diabetes have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.119, Diagnostic Code (DC) 7913. 4. Prior to May 21, 2018, the criteria for entitlement to a disability rating in excess of 10 percent for service-connected peripheral neuropathy of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.124a, 8520. 5. Prior to May 21, 2018, the criteria for entitlement to a disability rating in excess of 10 percent for service-connected peripheral neuropathy of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.124a, 8520. 6. The criteria for entitlement to a 20 percent disability rating, beginning May 21, 2018, for service-connected peripheral neuropathy of the right lower extremity have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.124a, 8520. 7. The criteria for entitlement to a 20 percent disability rating, beginning May 21, 2018, for service-connected peripheral neuropathy of the left lower extremity have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.124a, DC 8520. 8. The criteria for entitlement to a disability rating in excess of 20 percent for service-connected peripheral neuropathy of the right upper extremity have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.124a, DC 8514. 9. The criteria for entitlement to a disability rating in excess of 20 percent for service-connected peripheral neuropathy of the left upper extremity have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.124a, DC 8514. 10. The criteria for entitlement to TDIU, beginning May 24, 2012, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.16(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1970 to October 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Lincoln, Nebraska. A Board hearing was conducted via videoconference with the RO in Lincoln, Nebraska. A transcript of this hearing is contained within the electronic claims file. See October 15, 2019, Hearing Transcript (Tr.). At the hearing, the undersigned Veterans Law Judge (VLJ) notified the Veteran and his attorney that there was additional evidence added to the claims file since VA issued its October 2016 Statement of the Case (SOC). Counsel indicated that the Veteran would be waiving RO consideration of any evidence added to the claims file since that point. Thus, the Board need not remand for the agency of original jurisdiction (AOJ) to review this evidence in the first instance and will proceed to adjudicate the Veteran’s claims. See 38 C.F.R. §§ 19.37(b), 20.1305(c). Withdrawal The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision by the appellant or by his or her authorized representative. 38 C.F.R. § 20.205(a). The withdrawal must be filed with the Board and include the name of the veteran, the applicable VA file number, and a statement that the appeal is withdrawn. If the appeal involves multiple issues, the withdrawal must specify that the appeal is withdrawn in its entirety or list the issue(s) withdrawn from the appeal. Withdrawals are effective when received by the Board if a decision has not been promulgated. 38 C.F.R. § 20.205(b)(1)–(3). An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. Withdrawal may be made by a veteran or by an authorized representative and must be (1) explicit, (2) unambiguous, and (3) done with a full understanding of the consequences of such action by the appellant. Acree v. O’Rourke, 891 F.3d 1009, 1012 (Fed. Cir. 2018); DeLisio v. Shinseki, 25 Vet. App. 45, 57–58 (2011); 38 C.F.R. § 20.205. On his November 2016 VA Form 9, the Veteran appealed the issues contained herein, as well as the issues of entitlement to service connection for hypertension and a bilateral eye condition. The Veteran’s attorney subsequently wrote to VA withdrawing those issues from appellate consideration. See May 7, 2018, Correspondence. This withdrawal was confirmed at the hearing. See Tr. at 2. As there remains no allegations of errors of fact or law for appellate consideration for these issues, the Board does not have jurisdiction to review them, and the claims of entitlement to service connection for hypertension and a bilateral eye condition (claimed as vision impairment) are dismissed. See 38 U.S.C. § 7105; 38 C.F.R. § 20.205. Increased Rating Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. 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. Fenderson v. West, 12 Vet. App. 119, 126 (1999). While a veteran’s entire history is reviewed when assigning a disability rating, where service connection has already been established and an increase in the rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). In determining the present level of a disability for any increased rating claim, the Board must consider the application of staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509 (2007). In other words, where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings is necessary. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the veteran. 38 C.F.R. § 4.3. The Veteran originally was awarded service connection for diabetes and peripheral neuropathy of his bilateral lower extremities in a June 2010 rating decision. Diabetes was rated as 20 percent disabling and each lower extremity received a 10 percent disability rating. The effective date for all three awards was April 13, 2010. Increased rating claims for those conditions were filed on May 24, 2012. An October 2012 rating decision denied an increase in evaluation for the Veteran’s diabetes but awarded service connection for peripheral neuropathy of the bilateral upper extremities; each upper extremity was assigned a 20 percent disability rating effective May 24, 2012. The October 2012 decision did not address the Veteran’s lower extremities, but an October 2014 rating decision denied an increase. The Veteran filed, in July 2015, increased rating claims for diabetes bilateral upper extremities, and bilateral lower extremities. The September 2015 rating decision denied those increases, and the Veteran timely appealed. The Veteran’s claims for his lower extremities, however, has remained pending since his May 24, 2012, claim. Pursuant to 38 C.F.R. § 3.156(b), new and material evidence received prior to the expiration of the appeal period, or prior to the appellate decision if a timely appeal has been filed, will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. New evidence is evidence not previously part of the actual record before agency adjudicators. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In August 2015—before the expiration of the appellate period for the October 2014 rating decision for the bilateral lower extremities—the Veteran was afforded a VA examination for his peripheral neuropathy of his upper and lower extremities. That examination is new and material evidence. It previously was not considered by VA adjudicators and raises a reasonable possibility of substantiating the Veteran’s increased rating claim. Therefore, with respect to his bilateral lower extremities, the Veteran’s original May 24, 2012, claim has remained pending since that date. 1. Entitlement to a disability rating in excess of 20 percent for service-connected diabetes is denied. Under 38 C.F.R. § 4.119, DC 7913 is assigned to diabetes. A 100 percent rating requires more than one daily injection of insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. A 60 percent disability requires regular 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 40 percent rating requires regular insulin, restricted diet, and regulation of activities. An August 2015 VA examination report noted physical examination of the Veteran and review of the claims file and recited the Veteran’s complaints and medical history. The report indicates that the Veteran is prescribed an oral hypoglycemic agent. The Veteran’s diabetes does not require regulation of activities; the Veteran visits his diabetic care provider less than two times per month for episodes of ketoacidosis and hypoglycemia. There have been no episodes of ketoacidosis or hypoglycemia that required hospitalization in the past twelve months. The examiner noted that there was no progressive, unintended weight loss and loss of strength attributable to diabetes. A May 2018 VA examination report noted physical examination of the Veteran and review of the claims file and recited the Veteran’s complaints and medical history. The report indicates that the Veteran is prescribed an oral hypoglycemic agent. The Veteran’s diabetes does not require regulation of activities; the Veteran visits his diabetic care provider less than two times per month for episodes of ketoacidosis and hypoglycemia. There have been no episodes of ketoacidosis or hypoglycemia that required hospitalization in the past twelve months. The examiner noted that there was no progressive, unintended weight loss and loss of strength attributable to diabetes. The evidence of record does not show that an increase in evaluation for the Veteran’s diabetes is warranted. The medical evidence does not show that the Veteran currently requires insulin or that he has regulation of activities. While the VA medical center (VAMC) records discuss the importance of a regulated diet for control of the Veteran’s diabetes, the rating criteria requires regulation of diet, regulation of activities, and regular insulin. Without all three, the Veteran does not meet the criteria for an increased rating, and his appeal on this issue must be denied. See 38 C.F.R. § 4.119, DC 7913. Peripheral Neuropathy In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. A July 2012 VA examination report noted physical examination of the Veteran’s upper extremities and review of the claims file and recited the Veteran’s complaints and medical history. The report indicates that the Veteran is right hand dominant and experiences mild (1) intermittent pain, (2) paresthesias and/or dysesthesias, and (3) numbness in his upper extremities. Muscle strength and deep tendon reflexes were noted as normal. Light touch/monofilament testing revealed decreased sensation in the hands/fingers. There was no muscle atrophy or trophic changes. Overall the examiner characterized the Veteran’s condition as mild, incomplete paralysis of the bilateral radial nerves. A February 2013 VAMC record notes that an EMG study was performed, which confirmed bilateral carpel tunnel and peripheral neuropathy. The treating physician stated that the Veteran’s symptoms are not typical for carpal tunnel syndrome, but the cause of the electrical findings, carpal tunnel syndrome may be responsible for some of his findings. Options were discussed. I also explained to him that obviously we would not be taking care of the numbness in his feet, which seems to be as bad as the numbness in his hands. This would be a fact that works against the numbness in hands being secondary to carpal tunnel syndrome. We have elected to take a watch-and-wait approach. I will see him in routine followup in three months. An August 2015 VA examination report noted physical examination of the Veteran’s upper and lower extremities and review of the claims file and recited the Veteran’s complaints and medical history. The report indicates that the Veteran is right hand dominant and experiences mild constant pain in the bilateral lower extremities and moderate paresthesias and/or dysesthesias in all extremities. Muscle strength was noted as normal, and there was no muscle atrophy. All reflexes were normal. Light touch sensation examination revealed normal findings except numbness in both soles of the Veteran’s feet. There were no trophic changes. In Sections 11 and 12 of the report, the examiner indicates that the Veteran has normal upper and lower extremity nerves. Section 13, however, indicates that an EMG study was performed, which revealed abnormal findings for all four extremities. The results were “1) Bilateral carpal tunnel syndrome that is severe in the right side and moderate in the left side. 2) Peripheral (axonal) neuropathy which can be associated with his diabetes mellitus type II among other things.” A May 2018 VA examination report noted physical examination of the Veteran’s upper and lower extremities and review of the claims file and recited the Veteran’s complaints and medical history. The report indicates that the Veteran is right hand dominant. The Veteran experiences mild constant pain in the bilateral lower extremities; mild intermittent pain in the bilateral upper extremities and moderate intermittent pain in the bilateral lower extremities; moderate paresthesias and/or dysesthesias of all extremities; and moderate numbness in all extremities. Muscle strength and deep tendon reflexes were noted as normal. Light touch testing revealed decreased sensation at various points in the Veteran’s upper and lower bilateral extremities. There was no muscle atrophy, but there were trophic changes noted as “shiny smooth lower legs.” The Veteran was diagnosed with mild, incomplete paralysis of the median nerve in the bilateral upper extremities and moderate incomplete paralysis of the sciatic nerve in the bilateral lower extremities. At his hearing, the Veteran testified that he has shooting pain in his legs that comes and goes and that the pain also makes it difficult to walk when it reaches his knees. Tr. at 4–5. With respect to his upper extremities, the Veteran testified that his hands tingle with shooting pain causing difficulty with gripping. Id. at 8. VAMC records through July 2019 and Social Security Administration (SSA) records and discuss the continued care and treatment of the Veteran’s conditions including his peripheral neuropathy. 2. Entitlement to a disability rating in excess of 10 percent, prior to May 21, 2018, for service-connected peripheral neuropathy of each the right and lower extremity is denied; and entitlement to a 20 percent disability rating, beginning May 21, 2018, is granted. Under 38 C.F.R. § 4.124a, DC 8520 is assigned for impairment of the sciatic nerve. An 80 percent disability rating is warranted for complete paralysis with the following symptoms: the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. A 60 percent disability rating is warranted for incomplete paralysis with severe symptoms marked by muscular atrophy. A 40 percent disability rating is warranted for incomplete paralysis with moderately severe symptoms. A 20 percent disability rating is warranted for incomplete paralysis with moderate symptoms. A 10 percent disability rating is warranted for incomplete paralysis with mild symptoms. Prior to May 21, 2018, the evidence of record does not show that the Veteran’s peripheral neuropathy of his bilateral lower extremities warrants an increase in evaluation. The evidence (VA examinations, VAMC records, and the Veteran’s testimony) are consistent with his current 10 percent disability rating for mild, incomplete paralysis. Prior to May 21, 2018, there has been no muscle atrophy, and muscle strength and deep tendon reflexes at all times objectively was noted as normal. The only impairments were sensory disturbances, which the VA examiners have characterized as mild, incomplete paralysis. Thus, the Board finds that, for this time frame, the Veteran’s appeal must be denied. See 38 C.F.R. §§ 4.120, 4.124a, DC 8520. At the Veteran’s last VA examination (May 21, 2018), however, the examiner indicated that the Veteran’s bilateral lower extremities manifest moderate, incomplete paralysis of the sciatic nerve. The Veteran’s October 2019 testimony that his shooting pain in his legs comes and goes also comports with that examiner’s findings. Thus, the Board finds that, beginning May 21, 2018, both the right and left lower extremity each are entitled to a 20 percent disability rating. See 38 C.F.R. § 4.124a, DC 8520. Past this date, the record does not show that the Veteran’s lower extremity neuropathy manifests moderately severe, incomplete paralysis. As stated, the Board finds the Veteran’s testimony, which is the most recent evidence of record, aligns with a finding of moderate, incomplete paralysis. 3. Entitlement to a disability rating in excess of 20 percent for service-connected right and left upper extremity peripheral neuropathy is denied. DC 8514 is assigned for the musculospiral nerve (the radial nerve). Evaluations differ depending on whether the major (dominant) or minor (nondominant) extremity is affected. A 70 (major) or 60 (minor) percent rating is warranted for complete paralysis of the musculospiral nerve manifesting drop of hand and fingers, wrist and fingers perpetually flexed, the thumb adducted falling within the line of the outer border of the index finger; inability to extend hand at wrist, extend proximal phalanges of fingers, extend thumb, or make lateral movement of wrist; supination of hand, extension and flexion of elbow weakened, the loss of synergic motion of extensors impairs the hand grip seriously; or total paralysis of the triceps occurs only as the greatest rarity. Severe, incomplete paralysis warrants a 50 (major) or 40 (minor) percent rating. Moderate, incomplete paralysis warrants a 30 (major) or 20 (minor) percent rating. Mild, incomplete paralysis warrants a 20 percent rating for either the major or minor extremity. Throughout the period on appeal, the evidence of record does not show that the Veteran’s upper extremity neuropathy manifests anything more than mild, incomplete paralysis. The VA examinations of record never characterized the Veteran’s upper extremity neuropathy as anything other than mild. The Veteran’s hearing testimony that he experiences tingling and some pain in his hands comports with this finding of mild, incomplete paralysis. There has been no muscle atrophy, and muscle strength and deep tendon reflexes at all times objectively was noted as normal. The only impairments were sensory disturbances, which the VA examiners have characterized as mild, incomplete paralysis. Thus, the Board finds that, with respect to these claims, the Veteran’s appeal must be denied. See 38 C.F.R. §§ 4.120, 4.124a, DC 8514. TDIU A July 2018 rating decision granted the Veteran entitlement to TDIU, beginning May 3, 2018. Throughout the appeal, however, there has been disagreement regarding the effective date for the award for TDIU. VA has maintained that the effective date can be no earlier than May 3, 2018—the Veteran’s most recent application for TDIU. The Veteran, on the other hand, argues that TDIU should be awarded beginning October 29, 2014, the date of a rating decision for his peripheral neuropathy, which, as will be explained, has remained pending. A claim for TDIU is part and parcel of the claim for an increased rating. See Rice v. Shinseki, 22 Vet. App. 447, 454 (2009). As previously noted, VA indicated to develop a TDIU claim for the Veteran when he filed, on May 24, 2012, for his increased rating claim for the bilateral lower extremities. Because the Board previously has discussed how the Veteran’s increased rating claims remained pending since May 24, 2012, the Veteran’s TDIU claim likewise has remained pending since that date. See 38 C.F.R. § 3.156(b). It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. A finding of total disability is appropriate when there is present any impairment of mind or body, which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. §§ 3.340(a)(1), 4.15, 4.16. A claim for a total disability rating based upon individual unemployability presupposes that the rating for the service-connected disability is less than 100 percent, and only asks for TDIU because of subjective factors that the objective rating does not consider. Vettese v. Brown, 7 Vet. App. 31, 34–35 (1994). Where the schedular rating is less than total, a total disability rating for compensation may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, that disability shall be ratable at 60 percent or more. If there are two or more disabilities, then there shall be at least one disability ratable at 40 percent or more and the combined rating must be 70 percent or more. 38 C.F.R. § 4.16(a). The term substantially gainful occupation is not specifically defined for purposes of the regulations governing TDIU. Marginal employment, however, is not considered substantially gainful employment. Marginal employment includes situations in which an individual’s annual income does not exceed the poverty threshold for one person. Employment may be marginal even when the individual’s earned income exceeds the poverty threshold if such individual is employed in a protected environment such as a family business or sheltered workshop. 38 C.F.R. § 4.16(a). In evaluating a veteran’s employability, consideration may be given to his level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. The Board notes that, since May 24, 2012, the Veteran has had a combined disability evaluation of 60 percent, which is comprised of his diabetes and peripheral neuropathy ratings. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. The Board notes that the Veteran’s diabetes and resulting peripheral neuropathy are disabilities resulting from a common etiology. Thus, since May 24, 2012, the Veteran has met the criteria for TDIU on a schedular basis. See 38 C.F.R. § 4.16(a). On a May 2018 application for TDIU, the Veteran reported that he worked, from January 1983 to January 2013, at a hospital performing medical equipment repair. The Veteran included a statement on that application: I lost my job because of my Diabetes because I kept getting tired and falling asleep at work. I am unable to work because I can’t walk a lot or stand a lot. You have to be able to walk or stand to work. I have fallen several times because I can’t feel my legs. I got into an accident recently because I couldn’t feel my brake pedal. [I] have shooting pains in my legs. I have never done any other work besides electronics and machine repair. My diabetes makes it so I can’t sit for a while because I fall asleep all the time and am always tired. The Veteran indicated that he has completed two years of college and has no other education, training, or support since he became unemployed. A September 2012 VA Form 21-4192 (employment verification) from the Veteran’s former employer listed that he was terminated for unsatisfactory performance in April 16, 2009. A January 2013 SSA decision determined that the Veteran had not engaged in substantial gainful activity since April 7, 2010, as a result of diabetes mellitus and depression. The August 2015 VA examination indicated that the Veteran’s neuropathy impacted his ability to work as he is unable to stand for long periods of time and has difficulty gripping objects. At his hearing, the Veteran testified to the various difficulties he had working at the hospital, to include staying awake at work, remaining on his feet for long periods of time, falling down, and difficulty gripping the tools necessary to perform his duties. See Tr. 4–5, 6, 8, 9. There is conflicting evidence regarding the Veteran’s last day of employment. The Board, however, will credit the SSA determination that the Veteran has been unable to secure or follow a substantially gainful occupation since April 7, 2010. A determination as to when the Veteran stopped participating in substantially gainful employment, however, automatically does not determine the earliest possible effective date. As previously discussed, the Veteran’s TDIU claim is tied to his May 24, 2012, increased rating claim. Given that the effective date of an award for increased disability compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability has occurred, if the claim is received within one year from such date; otherwise, it is the date of receipt of the claim, see 38 U.S.C. § 5110(b)(3); 38 C.F.R. § 3.400(o)(2), the earliest possible date for the award of TDIU is May 24, 2012. Based on this evidence, the Board finds that, since April 7, 2010, the Veteran has been unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities. The SSA decision specifically cited the Veteran’s service-connected diabetes as reasons for unemployability. The Veteran offered numerous statements, which the Board finds credible, regarding how his diabetes made him sleepy and how is neuropathy made it both difficult to walk and painful to grip the tools necessary to perform his duties. While the Veteran has completed two years of college, the Board notes that the Veteran only has training in the field of biomedical electronics, which constantly required the use of his hands for tools and to be on his feet. As the evidence shows, this type of occupation no longer is feasible for this particular Veteran. Because the Veteran filed for TDIU on May 24, 2012, however, the Board cannot grant his effective date back to SSA’s April 7, 2010, finding, and will award him an effective date of May 24, 2012. See 38 C.F.R. § 4.16(a). JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Trevor T. Bernard, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.