Citation Nr: 20021337 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 18-48 465 DATE: March 25, 2020 ORDER New and material evidence has not been received to reopen the claim for service connection for right foot hammer toes, and the appeal is denied. New and material evidence has not been received to reopen the claim for service connection for left foot hammer toes, and the appeal is denied. New and material evidence has not been received to reopen the claim for service connection for memory loss, and the appeal is denied. New and material evidence has not been received to reopen the claim for service connection for loss of vision, and the appeal is denied. New and material evidence has not been received to reopen the claim for service connection for left knee disability, and the appeal is denied. New and material evidence has not been received to reopen the claim for service connection for bilateral hearing loss, and the appeal is denied. Entitlement to a rating in excess of 30 percent for service-connected dermatophytosis is denied. Entitlement to a rating in excess of 40 percent for service-connected right lower extremity peripheral neuropathy with nerve impingement is denied. Entitlement to a rating in excess of 40 percent for service-connected left lower extremity peripheral neuropathy with nerve impingement is denied. Entitlement to a rating in excess of 20 percent for service-connected right upper extremity peripheral neuropathy with nerve impingement is denied. Entitlement to a rating in excess of 30 percent for service-connected left upper extremity peripheral neuropathy with nerve impingement is denied. Entitlement to a compensable rating for service-connected scars of the upper extremities is denied. Entitlement to a rating in excess of 30 percent for service-connected migraine headaches is denied. Entitlement to an effective date earlier than May 9, 2016 for the award of a 40 percent rating for right lower extremity peripheral neuropathy with nerve impingement is denied. Entitlement to an effective date earlier than May 9, 2016 for the award of a 40 percent rating for left lower extremity peripheral neuropathy with nerve impingement is denied. Entitlement to an effective date earlier than May 9, 2016 for the award of a 30 percent rating for dermatophytosis is denied. Entitlement to special monthly compensation (SMC) based on aid and attendance/housebound status is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. REMANDED Service connection for diabetes is remanded. Entitlement to a rating in excess of 60 percent for multiple lipomas of the arms, abdomen, back, pubic area and lower extremities prior to June 1, 2016 and in excess of 0 percent thereafter, to include the propriety of the reduction in disability rating is remanded. FINDINGS OF FACT 1. In a July 2015 rating decision, the Department of Veterans Affairs (VA) Regional Office (RO) denied service connection for right and left foot hammer toes, memory loss, loss of vision, a left knee disability, and bilateral hearing loss; the Veteran did not appeal the decision and new and material evidence was not received within the one-year appeal period. 2. Evidence associated with the record since the July 2015 decision fails to relate to unestablished facts and does not raise a reasonable possibility of substantiating the claims of entitlement to service connection for right and left foot hammer toes, memory loss, loss of vision, a left knee disability, and bilateral hearing loss. 3. The Veteran’s dermatophytosis is manifest by skin lesions affecting less than 5 percent of the body and topical medication that is not constant. 4. The Veteran’s right and left lower extremity peripheral neuropathy with nerve impingement manifest by no more than moderately severe incomplete paralysis. 5. The Veteran’s right upper extremity peripheral neuropathy with nerve impingement is manifest by no more than mild incomplete paralysis of the minor extremity. 6. The Veteran’s left upper extremity peripheral neuropathy with nerve impingement is manifest by no more than moderate incomplete paralysis of the major extremity. 7. The Veteran’s scars of the upper extremities are neither unstable nor painful. 8. The Veteran’s migraine headaches are not manifest by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 9. The claim resulting in the assignment of 40 percent ratings for right and left lower extremity peripheral neuropathy with nerve impingement was received on May 9, 2016; the conditions are not shown to have worsened in the year prior to the claim. 10. The claim resulting in the assignment of a 30 percent rating for dermatophytosis was received on May 9, 2016; the condition is not shown to have worsened in the year prior to the claim. 11. The Veteran’s service-connected disabilities have not been shown to render him bedridden, confined to his immediate premises, or unable to care for his daily needs without requiring the regular aid and attendance of another person. 12. The Veteran’s service-connected disabilities have not rendered him unable to secure or follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. New and material evidence has not been received and the claim seeking service connection for right foot hammer toes is not reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 2. New and material evidence has not been received and the claim seeking service connection for left foot hammer toes is not reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 3. New and material evidence has not been received and the claim seeking service connection for memory loss is not reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 4. New and material evidence has not been received and the claim seeking service connection for loss of vision is not reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 5. New and material evidence has not been received and the claim seeking service connection for a left knee disability is not reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 6. New and material evidence has not been received and the claim seeking service connection for bilateral hearing loss is not reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 7. The criteria for a rating in excess of 30 percent for service-connected dermatophytosis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.118, Diagnostic Code 7813. 8. The criteria for a disability rating in excess of 40 percent for service-connected right lower extremity peripheral neuropathy with nerve impingement have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 9. The criteria for a disability rating in excess of 40 percent for service-connected left lower extremity peripheral neuropathy with nerve impingement have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 10. The criteria for a disability rating in excess of excess of 20 percent for service-connected right upper extremity peripheral neuropathy with nerve impingement have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Codes 8512, 8516. 11. The criteria for a disability rating in excess of 30 percent for service-connected left upper extremity peripheral neuropathy with nerve impingement not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8615, 8616. 12. The criteria for a compensable disability rating for service-connected scars of the upper extremities have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.118, Diagnostic Code 7804. 13. The criteria for a rating in excess of 30 percent for service-connected migraine headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8100. 14. The criteria for an effective date earlier than May 9, 2016 for the award of a 40 percent rating for right lower extremity peripheral neuropathy with nerve impingement have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 15. The criteria for an effective date earlier than May 9, 2016 for the award of a 40 percent rating for left lower extremity peripheral neuropathy with nerve impingement have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 16. The criteria for an effective date earlier than May 9, 2016 for the award of a 30 percent rating for dermatophytosis have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 17. The criteria for SMC based on the need for aid and attendance or housebound status have not been met. 38 U.S.C. §§ 1114, 5107; 38 C.F.R. §§ 3.350, 3.351, 3.352. 18. The criteria for TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1967 to July 1971. The Board of Veterans’ Appeals (Board) notes that after a September 2019 Statement of the Case, the Veteran filed a November 2019 VA Form 9 (substantive appeal) regarding issues pertaining to sleep apnea and depression/anxiety. This appeal was recently reactivated in VA’s appeals system and is still being worked by the RO. Hence, the issues are not ripe for Board review at this time. In November 2019, the Veteran’s attorney waived review of evidence not considered by the Agency of Original Jurisdiction (AOJ). New and Material Evidence Regardless of the AOJ’s actions, given the previous unappealed denial of the claims on appeal as explained below, the Board has a legal duty under 38 U.S.C. § 5108 to address the question of whether new and material evidence has been received to reopen the claims for service connection. If a claim of entitlement to service connection has been previously denied and that decision became final, the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim. 38 U.S.C. § 5108. New evidence means existing evidence not previously submitted to agency decision-makers. 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). The credibility of the evidence is presumed for purposes of reopening the claim. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for reopening is low. Shade v. Shinseki, 24 Vet. App. 110, 117 (2015). The RO denied the Veteran’s claims of service connection for right and left foot hammer toes, memory loss, loss of vision, a left knee disability, and bilateral hearing loss in a July 2015 rating decision, finding that the evidence did not reflect the Veteran’s disabilities were incurred in or caused by military service. The Veteran was provided notice of this decision and his appellate rights but did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, the decision is final. See 38 C.F.R. §§ 3.156, 20.302, 20.1103 (2015). In May 2016 the Veteran filed a new service connection claim with respect to the issues on appeal. The evidence received since the July 2015 rating decision fails to include evidence that is both new and material to the claim. See 38 C.F.R. § 3.156. For example, at the time of the prior rating decision the evidence of record contained the Veteran’s service treatment records, VA examination reports, VA and private medical records, and lay contentions regarding whether the Veteran’s disabilities were incurred in or caused by military service. Since the previous decision the Veteran has not presented new and material evidence to support the claims for service connection. The Veteran has not undergone additional VA examinations and updated VA treatment records do not address the reason for the previous denials. The Veteran continues to contend that his right and left foot hammer toes, memory loss, loss of vision, a left knee disability, and bilateral hearing loss are related to military service. He reports the current symptomatology associated with the disabilities. See October 2017 Correspondence. However, there is no new and material evidence presented to address the reason for the previous denial; that is, a nexus to service, and raise a reasonable possibility of substantiating the claims. Accordingly, the claims for service connection for right and left foot hammer toes, memory loss, loss of vision, a left knee disability, and bilateral hearing loss are not reopened. Increased Ratings Disability ratings are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. 1. 30 percent rating for dermatophytosis. The Veteran contends his dermatophytosis is more severe than the currently assigned rating. The Veteran’s skin disability is rated under Diagnostic Code 7813. VA amended the criteria for rating skin disabilities effective from August 13, 2018. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after August 13, 2018. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal. Prior to August 13, 2018, Diagnostic Code 7813, instructed to rate as disfigurement of the head, face, or neck (Diagnostic Code 7800) or scars (Diagnostic Codes 7801, 7802, 7803, 7804, or 7805), or dermatitis (Diagnostic Code 7806) depending on the predominant disability. 38 C.F.R. § 4.118, Diagnostic Code 7813. Here, the evidence of record demonstrates that the Veteran’s skin disability is an infectious skin disability affecting the groin and toes; thus rated under diagnostic code 7806. Prior to August 13, 2018, under Diagnostic Code 7806 (Dermatitis or eczema), a noncompensable rating is assigned for less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and; no more than topical therapy required during the past 12 months. A 10 percent rating is assigned for at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas 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. A 30 percent rating is assigned for 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly during the past 12-month period. A 60 percent rating is assigned for more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. Or rate as disfigurement of the head, face, or neck (Diagnostic Code 7800) or scars (Diagnostic Codes 7801, 7802, 7803, 7804, or 7805), depending on the predominant disability. 38 C.F.R. § 4.118, Diagnostic Code 7806. For claims filed prior to August 13, 2018, the United States Court of Appeals for Veterans Claims held that a systematic therapy is one that that affects the entire body in its treatment of the condition at issue, and that the Board must determine (1) whether a topical treatment affects the body as a whole in treating a veteran’s skin condition; and (2) whether the given treatment is “like” a corticosteroid or other immunosuppressive drug.” Burton v. Wilkie, 30 Vet. App. 286 (2018). Only the second question need be addressed if the treatment is clearly systemic. Id. Effective August 31, 2018, VA regulations explicitly state that systemic therapy is treatment that is administered through any route other than the skin, and topical therapy is treatment that is administered through the skin. 38 C.F.R. § 4.118(a). Additionally, effective August 13, 2018, a new General Rating Formula for the Skin applies to Diagnostic Codes 7806, 7809, 7813 to 7816, 7820 to 7822, and 7824. See 38 C.F.R. § 4.118. Under this formula, a noncompensable rating is assigned for no more than topical therapy required over the past 12-month period and at least one of the following: (1) characteristic lesions involving less than 5 percent of the entire body affected; or (2) characteristic lesions involving less than 5 percent of exposed areas affected. A 10 percent rating is assigned for at least one of the following: (1) characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or (2) at least 5 percent, but less than 20 percent, of exposed areas affected; or (3) intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period. A 30 percent rating is assigned at least one of the following: (1) characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or (2) systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is assigned for at least one of the following: (1) characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or (2) constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required over the past 12-month period. Or rate as disfigurement of the head, face, or neck (Diagnostic Code 7800) or scars (Diagnostic Codes 7801, 7802, 7803, 7804, or 7805), depending on the predominant disability. 38 C.F.R. § 4.118, General Rating for the Skin for Diagnostic Codes 7806, 7809, 7813-7816, 7820-7822, and 7824. The Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 30 percent under the pre-August 13, 2018, regulations because the Veteran’s dermatophytosis does not more nearly approximate more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. The Veteran presented for VA examination in August 2016 to assess the current severity of his service-connected dermatophytosis. The examiner reported the Veteran’s skin condition is an infectious skin condition and diagnosed tinea dermatophytosis. He reported the Veteran has a skin eruption on the groin and toes that is unchanged. The examiner explained the Veteran has been treated with topical medication for tinea of six weeks of more, but not constant over the past 12 months. The examiner reported the Veteran has not had any treatments or procedures other than systemic or topical medication in the past 12 months for exfoliative dermatitis or papulosquamous disorders. He reported the Veteran’s skin disability affects less than five percent of the total body area and none of the exposed area of the body. The examiner reported the skin disability has no functional impact on the Veteran’s ability to work. The Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 30 percent under the August 13, 2018 regulations because the Veteran’s dermatophytosis does not more nearly approximate (1) characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or (2) constant or near-constant systemic therapy required over the past 12-month period. The medical and lay evidence of record is absent evidence to support a higher rating for the service-connected dermatophytosis. The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, he does not assert, and medical treatment records do not show, that the Veteran’s disability is manifested by a skin disability involving more than 40 percent of the entire body or constant or near-constant use of systemic therapy. The Board has considered whether any other Diagnostic Codes related to disabilities of the skin would provide for a higher disability evaluation. However, the evidence does not reflect that he would warrant a higher rating under a different diagnostic code. See 38 C.F.R. § 4.118. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim of a rating in excess of 30 percent for dermatophytosis. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. 40 percent ratings for right and left lower extremity peripheral neuropathy with nerve impingement. The Veteran contends that his right and left lower extremity peripheral neuropathy are more severe than the currently assigned ratings. The Veteran’s peripheral neuropathy of the bilateral lower extremities is rated under Diagnostic Code 8520 for each extremity. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8620 and 8720.). Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The Board notes that “Mild,” as relevant to a physical condition, is defined as “not severe” or temperate; with “Temperate” being defined as “keeping or held within limits” and “not extreme or excessive.” MERRIAM-WEBSTER’S DICTIONARY (merriam-webster.com/dictionary, accessed March 18, 2020). “Moderate” is defined as “tending toward the mean or average amount,” “not violent, severe, or intense,” and “limited in scope or effect.” Id. “Severe” is defined as “very painful or harmful” or “of a great degree.” Id. The term “severe” is used throughout the rating schedule, including in Diagnostic Code 8520, to indicate a very great degree of the specific listed disability, in order to differentiate between lesser (or sometimes greater) cases of that same disability within the specific diagnostic code. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term “incomplete paralysis” 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 disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The Veteran underwent VA examination in August 2016 to assess the current severity of his bilateral lower extremity peripheral neuropathy. The examiner reported the Veteran’s lower extremity neuropathy has gotten worse during the past six months, but that the Veteran has also developed diabetes in the past year. He reported there is constant numbness in both hands and feet and that the Veteran experiences “crawly” sensations in the feet and shooting pains down his legs. The Veteran reported mild intermittent pain, mild paresthesias and/or dysthesias and mild numbness in the bilateral lower extremities. The Veteran had no muscle atrophy. The examiner reported decreased reflexes in the ankles. The examiner stated the Veteran has sensory loss in the lower extremities in the lateral soles of the feet, dermatomal pattern. He reported there were no trophic changes and the Veteran’s gait was abnormal due to bilateral sciatica. The examiner reported the Veteran’s service-connected bilateral lower extremity disability affected the sciatic nerve and manifested in moderately severe symptoms. The examiner reported the Veteran’s peripheral nerve condition does not affect the Veteran’s ability to work. VA treatment records are consistent with findings during examination. Based on the above, the Board finds that the disability is primarily manifest by mild pain, decreased reflexes and sensory loss and abnormal gait. The Board also finds that the most probative evidence of record is against a finding that the disability is manifest by severe incomplete paralysis; most notably, muscle atrophy is absent. The Board thus finds that the level of impairment is most analogous to moderately severe incomplete paralysis. The Board acknowledges the lay assertions of numbness in the legs and a burning sensation in the feet. See October 2017 Correspondence. However, the Board finds the Veteran’s lay statements and the medical of evidence of record do not show the Veteran’s disability is more severe than the currently assigned 40 percent ratings for the left and right lower extremity peripheral neuropathy reflects. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 40 percent for service connected right lower extremity and left lower extremity peripheral neuropathy. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. 20 percent rating for right upper extremity peripheral neuropathy with nerve impingement. The Veteran contends that his service connection right upper extremity peripheral neuropathy is more severe than the currently assigned rating. The Veteran’s right upper extremity peripheral neuropathy is rated under Diagnostic Code 8512. Paralysis of the lower radicular group is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8512. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8612 and 8712). Under these criteria, mild incomplete paralysis is rated as 20 percent for both the major and minor extremity. Moderate incomplete paralysis is rated as 40 percent for the major extremity and 30 percent for the minor extremity. Severe incomplete paralysis is rated as 50 percent for the major extremity and 40 percent for the minor extremity. Complete paralysis, with all intrinsic muscles of the hand, and some or all of the flexors of the wrist and fingers, paralyzed (substantial loss of use of the hand) is rated 70 percent for the major extremity and 60 percent for the minor extremity. 38 C.F.R. § 4.124a. The Veteran underwent VA examination in August 2016 to assess the current severity of his service-connected right upper extremity peripheral neuropathy. The Veteran reported his peripheral neuropathy has gotten worse over the past six months and that he has constant numbness in the hands and feet. He reported he has had bilateral carpal tunnel surgery twice in the 1990s. The examiner reported the Veteran is left hand dominant. The Veteran endorsed mild paresthesias and/or dysthesias in the right upper extremity and numbness in the right upper extremity. The examiner reported sensory loss in the upper extremities is only in the small fingers and ulnar aspect of the forearms with positive Wadsworth test bilaterally. Strength and reflex testing were normal. There were no trophic changes. The examiner found the Veteran’s ulnar nerve impairment demonstrated mild incomplete paralysis on the right; the lower radicular group was normal. The examiner reported the Veteran’s peripheral nerve condition would not impact his ability to work. VA treatment records are consistent with findings during examination. Based on the above, the Board finds that the disability is primarily manifest by pain and numbness, and sensory loss in the upper extremities. The Board also finds that the most probative evidence of record is against a finding that the disability is manifest by symptoms severe enough to show moderate incomplete paralysis. The Board thus finds that the level of impairment is most analogous to mild incomplete paralysis. The Board acknowledges the lay assertions of pain and numbness and stiffness, and a lack of strength in the upper extremities. See October 2017 Correspondence. Even considering these complaints, the Board finds the Veteran’s lay statements and the medical of evidence of record do not show the Veteran’s disability is more severe than mild. Currently, the disability is shown to only affect the ulnar nerve and not the lower radicular group. While mild incomplete paralysis of the ulnar nerve warrants only a 10 percent rating, reduction in the Veteran’s rating is not necessary at this time. See 38 C.F.R. § 4.114a, Diagnostic Codes 8512, 8516. The Veteran’s disability should technically be rated more recently using Diagnostic Code 8516. Even if the Board were to consider the Veteran’s reports of diminished strength to represent moderate disability, the subsequent rating would have to be based on Diagnostic Code 8516, which allows for a 20 percent rating for moderate incomplete paralysis of the ulnar nerve in the minor extremity. As a result, the evidence does not show that a rating in excess of 20 percent is warranted for this disability at any point. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 20 percent for right upper extremity peripheral neuropathy. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 4. 30 percent rating for left upper extremity peripheral neuropathy with nerve impingement. The Veteran contends that his service connection left upper extremity peripheral neuropathy is more severe than the currently assigned rating. The Veteran’s left upper extremity peripheral neuropathy is rated under Diagnostic Code 8615. Paralysis of the median nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8515. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8615 and 8715). Under these criteria, mild incomplete paralysis is rated as 10 percent for both the major and minor extremity. Moderate incomplete paralysis is rated as 30 percent for the major extremity and 20 percent for the minor extremity. Severe incomplete paralysis is rated as 50 percent for the major extremity and 40 percent for the minor extremity. Complete paralysis with the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances is rated as 70 percent for the major extremity and 60 percent for the minor extremity. 38 C.F.R. § 4.124a. The Veteran underwent VA examination in August 2016 to assess the current severity of his service-connected left upper extremity peripheral neuropathy. The Veteran reported his peripheral neuropathy has gotten worse over the past six months and that he has constant numbness in the hands and feet. He reported he has had bilateral carpal tunnel surgery twice in the 1990s. The examiner reported the Veteran is left hand dominant. The Veteran endorsed mild paresthesias and/or dysthesias in the left upper extremity and mild numbness in the left upper extremity. The examiner reported sensory loss in the upper extremities is only in the small fingers and ulnar aspect of the forearms with positive Wadsworth test bilaterally. Strength and reflex testing were normal. There were no trophic changes. The examiner reported the Veteran’s ulnar nerve impairment demonstrated mild incomplete paralysis on the left; the lower radicular group was normal. The examiner reported the Veteran’s peripheral nerve condition would not impact his ability to work. VA treatment records are consistent with findings during examination. Based on the above, the Board finds that the disability is primarily manifest by pain and numbness, and sensory loss in the upper extremities. The Board also finds that the most probative evidence of record is against a finding that the disability is manifest by symptoms severe enough to warrant an even higher rating. The Board acknowledges the lay assertions of pain and numbness and stiffness, and a lack of strength in the upper extremities. See October 2017 Correspondence. Even considering these complaints, the Board finds the Veteran’s lay statements and the medical of evidence of record do not show the Veteran’s disability is more severe than mild. Even if the Board were to consider the Veteran’s reports of diminished strength to represent moderate disability, Diagnostic Code 8615 and 8516 only allow for a 30 percent rating for moderate incomplete paralysis of the median or ulnar nerve in the major extremity. As a result, the evidence does not show that a rating in excess of 30 percent is warranted for this disability at any point. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 30 percent for left upper extremity peripheral neuropathy. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 5. Zero percent rating for scars of the upper extremities. Diagnostic Codes 7800 to 7805 pertain to scars. 38 C.F.R. § 4.118. The Schedule of ratings for the skin were amended effective August 13, 2018. See 83 Fed. Reg. 32,592 (July 13, 2018). Prior to August 13, 2018, the Board will consider the old version of the diagnostic codes only (old code); however, for the period beginning August 13, 2018 the Board will consider both the old and amended version (amended code) of the diagnostic codes and rate based on whichever is most favorable to the Veteran. Diagnostic Code 7800 deals with scars and disfigurement of the head, face, or neck and is not applicable to the Veteran’s upper extremity scars. Diagnostic Code 7801 provides for a 10 percent disability evaluation for a scar that is not of the head, face, or neck, that is deep and nonlinear (old code) or associated with underlying soft tissue damage (amended code), and that has an area of at least 6 square inches (39 sq. cm.). Higher ratings are available if larger areas are affected. Under the old code, a “deep scar” is defined as one associated with underlying soft tissue damage. The old and amended codes also differ regarding instructions for totalling the area affected when there is more than one qualifying scar. Diagnostic Code 7802 provides for a 10 percent disability evaluation for a scar not of the head, face, or neck, that is superficial and nonlinear (old code) or not associated with underlying soft tissue damage (amended code) and which covers an area of at least 144 square inches (929 sq. cm.) or more. No higher ratings are available under either version of this code. Under the old code, a “superficial scar” is defined as one not associated with underlying soft tissue damage. The old and amended codes also differ regarding instructions for totalling the area affected when there is more than one qualifying scar. Diagnostic Code 7804 provides for a 10 percent disability evaluation for one or two scars that are unstable or painful. A 20 percent disability evaluation is assigned where there are three or four scars that are unstable or painful. A 30 percent disability evaluation is assigned where there are five or more scars that are unstable or painful. An unstable scar is one where there is frequent loss of skin covering over the scar. If one or more scars are both unstable and painful 10 percent is added to the evaluation. The Veteran contends that his service-connected scars are more severe than the currently assigned rating. The Veteran’s scar disability is rated under Diagnostic Code 7804 for unstable or painful scars. Notably, in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. The Board finds that the preponderance of the evidence is against the assignment of a compensable rating under Diagnostic Code 7804 because the Veteran’s scar disability is not manifest by one or two scars that are unstable or painful. During VA examination in August 2016 and September 2017 the examiner reported the Veteran’s scars are not painful and are not unstable with frequent loss of covering of the skin over the scar. The examiner reported the scars do not impact the Veteran’s ability to work. The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran’s scar disability is not of the head, face, or neck, is not deep and nonlinear, and is not associated with underlying soft tissue damage. Although it is superficial and not associated with underlying soft tissue damage, it does not cover an area or areas of 144 square inches or greater. Therefore, Diagnostic Codes 7800 through 7802, both prior to and from August 13, 2018, are inapplicable. Finally, the evidence of record shows there are no other disabling effects which could be rated under other diagnostic codes. See 38 C.F.R. § 4.118, Diagnostic Code 7805. The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. While the Veteran is competent to report observable symptoms, to include pain or loss of covering of a scar, he has made no such assertions in this case. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a compensable rating for the scar disability. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 6. 30 percent rating for migraine headaches. The Veteran contends his service-connected migraine headaches are more severe than the currently assigned rating. The migraine headaches are rated under Diagnostic Code 8100. Diagnostic Code 8100 provides a zero percent disability rating is warranted for migraines (headaches) with less frequent attacks. A 10 percent disability rating is warranted for migraines (headaches) with characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent disability rating is warranted for migraines (headaches) with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent disability rating, the highest rating available, is warranted for migraines (headaches) with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a. The rating criteria do not define “prostrating.” By way of reference, the Board notes that according to WEBSTER’S NEW WORLD DICTIONARY OF AMERICAN ENGLISH, THIRD COLLEGE EDITION 1080 (1986), “prostration” is defined as “utter physical exhaustion or helplessness.” A very similar definition is found in DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1531 (32nd Ed. 1012), in which “prostration” is defined as “extreme exhaustion or powerlessness.” The Veteran underwent a VA headaches examination in August 2016 to assess the current severity of his service-connected migraine headaches. The examiner stated the Veteran gets headaches two to three times per week that have not changed since the last examination. The Veteran reported the headaches begin with a dizzy sensation and left sided headache, and reported he takes medication and the headache resolves within an hour. The Veteran endorsed pulsating or throbbing headache pain and pain localized to one side of the head. He reported sensitivity to light with typical head pain duration of less than one day and on the left side of the head. The examiner reported the Veteran does not have characteristic prostrating attacks of migraine or non-migraine headache pain. The examiner reported the Veteran’s headaches do not impact his ability to work. The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms, to include symptoms of headache pain. The Veteran reported he gets headaches on a weekly basis; he reported on certain days he becomes unable to do anything until the headache passes. See October 2017 Correspondence. In December 2019 the Veteran’s wife reported the Veteran has had headaches since 2002, with the Veteran experiencing more severe headaches since 2006. She reported the Veteran is very sensitive to light and lays down for two to four hours to relieve headache pain, but that sometimes the headaches last longer. She reported the Veteran becomes lightheaded and dizzy with a headache and the Veteran has fallen a few times due to dizziness. She reported the Veteran on occasion becomes sick to his stomach with nausea due to headaches and he cancels plans and cannot function during those time. He reported the Veteran cannot concentrate and she cannot talk to him during that time. The Board acknowledges the severity of the Veteran’s headache complaints; however, the medical and lay evidence do not show that the Veteran has very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. VA examination reflects the Veteran’s headaches do not impact his ability to work and headaches occur two to three times a week. After interviewing the Veteran, the examiner reported the Veteran does not experience characteristic prostrating attacks of migraine or non-migraine headache pain. The Board finds that the Veteran’s symptoms result in headache pain and as reported, symptoms on occasion become so severe the Veteran cancels plans and cannot function due to headache pain. However, these episodes are not very frequent and do not result in severe economic inadaptability. As such, the Board finds the reported attacks of headache pain shown by the lay and medical evidence of record do not result in headache symptoms to warrant a higher rating. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating higher than 30 percent for the migraine headache disability. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Effective Dates Unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a). Generally, the effective date of an evaluation and award of service-connected compensation is the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. However, in a claim for increased compensation, the effective date may date back as much as one year before the date of the application for increase if it is factually “ascertainable that an increase in disability had occurred” within that one year. 38 U.S.C. § 5110(b)(3); 38 C.F.R. § 3.400(o)(2). 7. 40 percent ratings for right and left lower extremity peripheral neuropathy with nerve impingement. The Veteran contends he is entitled to an earlier effective date for the assigned rating for service-connected right and left lower extremity peripheral neuropathy. In March 2011 service connection for left and right lower extremity peripheral neuropathy was awarded 20 and 10 percent respectively effective August 30, 2010. In April 2013 the Veteran’s left lower extremity peripheral neuropathy was decreased from 20 percent to 10 percent effective March 18, 2013; the evaluation for right lower extremity peripheral neuropathy rated 10 percent disabling was continued. The Veteran did not file a notice of disagreement with these decisions within the requisite period of time, nor did he submit new and material evidence, and the prior decision became final. 38 C.F.R. §§ 20.201, 20.302, 20.1103 (2013). The Veteran did not file a claim for an increased disability rating for service-connected right and left lower extremity peripheral neuropathy until May 9, 2016. As this was the date he filed a claim for increased rating and there is no indication the disability worsened in the year prior to that claim, this is the earliest effective date that can be assigned for a 40 percent disability rating for service-connected right and left lower extremity peripheral neuropathy. The Board received no other communications from the Veteran that could be considered an earlier claim. 38 C.F.R. §§ 3.1(p) (2014). Given the above, entitlement to an effective date earlier than May 9, 2016 for the award of a 40 percent rating for service-connected right and left lower extremity peripheral neuropathy is denied. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 8. 30 percent rating for dermatophytosis. The Veteran contends he is entitled to an earlier effective date for the assigned rating for service-connected dermatophytosis. In September 2013 the RO continued the 10 percent rating for service-connected dermatophytosis effective August 30, 2010; in July 2015 the RO decreased the Veteran’s award for service-connected dermatophytosis effective October 1, 2015. The Veteran did not file a notice of disagreement with these decisions within the requisite period of time, nor did he submit new and material evidence, and the decisions became final. 38 C.F.R. §§ 20.201, 20.302, 20.1103 (2015). The Veteran did not file a claim for an increased disability rating for service-connected dermatophytosis until May 9, 2016. As this was the date he filed a claim for increased rating and there is no indication the disability worsened in the year prior to that claim, this is the earliest effective date that can be assigned for a 30 percent disability rating for service-connected dermatophytosis. The Board received no other communications from the Veteran that could be considered an earlier claim. 38 C.F.R. §§ 3.1(p) (2014). Given the above, entitlement to an effective date earlier than May 9, 2016 for the award of a 40 percent rating for service-connected right and left lower extremity peripheral neuropathy is denied. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. Special Monthly Compensation SMC is payable at the (l) rate if a Veteran, as the result of service-connected disability, is permanently bedridden or so helpless as to be in need of regular aid and attendance. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). The following will be accorded consideration in determining the need for regular aid and attendance: inability of claimant to dress or undress himself, or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of claimant to feed himself through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his daily environment. 38 C.F.R. § 3.352(a). It is not required that all of the disabling conditions enumerated in this paragraph be found to exist before a favorable rating may be made. The particular personal functions which the Veteran is unable to perform should be considered in connection with his condition as a whole. It is only necessary that the evidence establish that the Veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Id. The regulations also provide additional compensation on the basis of being housebound where the veteran (1) has, in addition to a single, permanent service-connected disability rated 100 percent disabling, additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. A veteran will be considered housebound where the evidence shows that, as a direct result of his service-connected disability or disabilities, he is substantially confined to his dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his lifetime. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). The Board finds that the Veteran is not in need of aid and attendance or housebound status due to service-connected disability. The Veteran is currently service-connected for bilateral lower extremity peripheral neuropathy with nerve impingement, rated 40 percent each extremity, left upper extremity peripheral neuropathy with nerve impingement, rated 30 percent, right upper extremity peripheral neuropathy with nerve impingement, rated 20 percent, migraine headaches, rated 30 percent, dermatophytosis, rated 30 percent, and status post excision of chalazion of both eyelids, scars, and multiple lipoma of the arms, abdomen, back, pubic area and lower extremities, all noncompensable; his combined rating has been 100 percent since May 9, 2016 and 90 percent since June 1, 2016. Thus, the Veteran does not have a service-connected disability rated as permanent and total with additional service-connected disabilities independently ratable at 60 percent or more to warrant housebound status based solely on his assigned ratings. As such, SMC based upon schedular ratings is not warranted. The Veteran has also not asserted, and none of the medical evidence of record suggests, that his service-connected disabilities have resulted in loss of use of both feet, one hand and one foot, blindness in both eyes with visual acuity of 5/200 or less, or rendered the Veteran permanently bedridden. With regard to the remaining criteria for a claim for SMC to prevail, the Board finds that the Veteran’s service-connected disabilities do not result in the need for regular aid and attendance of another person or housebound status. The probative medical evidence is against a finding that the Veteran’s service-connected disabilities would cause the Veteran to be unable to dress or undress himself, to keep himself ordinarily clean and presentable, cause frequent need to adjust special prosthetic or orthopedic appliances, or present as an inability to feed himself or attend to wants of nature. Additionally, his service-connected disabilities do not result in incapacity, physical or mental, requiring care or assistance on a regular basis to protect a claimant from the hazards or dangers incident to his daily environment. As noted in more detail above, the Veteran is able to move about and manipulate objects. He is not service connected for a mental health disorder and can cognitively handle these tasks. No medical professional has indicated a level of impairment resulting in the need for aid and attendance or that the Veteran be housebound. For these reasons, the Board finds that the evidence does not support a finding that the Veteran’s service-connected disabilities causes him to require regular aid and attendance within the meaning of the regulation. When considering the Veteran’s service-connected disabilities, alone, the impairment shown does not meet the criteria for SMC. For the reasons set forth above, the preponderance of the evidence is against an award of special monthly compensation pursuant to 38 U.S.C. § 1114(l) and 38 C.F.R. § 3.350(b). TDIU The Veteran asserts that he is unable to secure and follow a substantially gainful occupation as a result of his service-connected disabilities. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows a veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience, by reason of his service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is “whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). In arriving at a conclusion, consideration may be given to the veteran’s level of education, special training, and previous work experience, but not to his age or the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. The United States Court of Appeals for Veterans Claims (Court) has held that the term “unable to secure and follow a substantially gainful occupation” in 38 C.F.R. § 4.16 has two components. First, there is an economic component which essentially contemplates an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Second, there is a non-economic component dealing with the individual veteran’s ability to “follow and secure” employment. For the second component, attention must be given to: (a) the veteran’s history, education, skill and training, (b) the veteran’s physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory and visual, and (c) whether the Veteran has the mental ability to perform the type of activities required by the occupation at issue, with relevant factors such as memory, concentration, and ability to adapt to change, handle work place stress, get along with coworkers and demonstrate reliability and productivity. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). As “sedentary” is defined as “[r]equiring or marked by much sitting ” the Board finds that sedentary employment is a job where the worker primarily sits down. WEBSTER’S II NEW COLLEGE DICTIONARY 999 (1999). If there is only one service-connected disability, it must be rated at least 60 percent disabling to qualify for TDIU benefits; if there are two or more such 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. § 4.16(a). The Veteran meets the threshold schedular disability percentage requirement for TDIU consideration as a result of his service-connected disabilities. 38 C.F.R. § 4.16(a). Military personnel records reflect the Veteran’s military occupation specialty was that of security police. On his February 2012 application for unemployability he reported his multiple lipomas, upper extremity disability and disabilities of the knees prevents him from following a substantially gainful occupation. The Veteran reported completing high school. He reported he last worked full-time in August 1990 as a forklift operator. The Veteran underwent vocational assessment in October 2019. The provider reported the Veteran worked after the military as an equipment mechanic, machinist and builder. The provider noted the findings taken during VA examination and lay statements provided during the period on appeal. She reported that the research indicates that most employers will tolerate variable rates of absence, but most employers allow for no more than eight days per year. She reported the research indicated that depending on the industry these figures for off work time can range from half a day per month to a high of one day per month; she reported the Veteran would be expected to miss more than this based on the reports of his physical symptoms, the results of evaluations and his prior work history and this has been the case since the filing of his claim. The provider elaborated that additional studies showed the acceptable absence rated allowed for no more than slightly over seven days per year, and lower tolerances for unexcused absences existed with employment in areas such as warehousing, retail, trade, production, manufacturing, personal care, food service, leisure and hospitality, and cleaning/grounds maintenance. She reported the Veteran would likely exceed allowed time off due to physical symptoms impacting his concentration and persistence at a work task. She reported the Veteran is unable to perform his prior work as an equipment mechanic, machinist and builder due to the physical limitations from his service-connected impairments, and that these occupations are at least medium in exertional demand and skilled in nature. She determined that based on the totality of the evidence the Veteran is totally occupationally unemployable from all competitive employment due to his service-connected disabilities. VA examinations during the period on appeal reflect the examiners reported the Veteran’s service-connected disabilities to not impact his ability to work. The Veteran’s peripheral neuropathy is manifested by pain, numbness, and sensory loss in the fingers, forearms, and feet. Lay statements reflect that the Veteran is very sensitive to light and lays down for two to four hours to relieve headache pain, but that sometimes the headaches last longer. Statements reflect the Veteran becomes lightheaded and dizzy with a headache and the Veteran has fallen a few times due to dizziness. On occasion he becomes sick to his stomach with nausea due to headaches and he cancels plans and cannot function during those time; the Veteran cannot concentrate and cannot talk to him during that time. Treatment records are not in significant conflict with findings during VA examination. Taken as a whole, the Veteran’s symptoms do not suggest he was unable to obtain and maintain employment. Given the Veteran’s education and work history, symptoms reported by the Veteran, and the level of functional impairment as reported by VA examiners and treatment providers the Board does not consider this level of impairment as one that would preclude employment. The Board considered the Veteran’s lay statements that his symptoms make it difficult to work. The Board acknowledges his physical limitations would make it difficult to work. Such is reflected in the 90 percent disability rating currently assigned. However, after review of the evidence of record the Board finds that the Veteran’s functional limitations would not preclude employment that did not involve walking for extended periods of time, lifting heavy objects, or involve strenuous physical activities. The Board acknowledges the Veteran’s difficulty with concentration and complaints that he is unable to participate in activities during migraine headaches. However, the evidence reflects that the headaches of such severity occur “on occasion” as reported by the Veteran and the evidence does not reflect that the headaches occur with such regularity as to result in an inability to sustain and maintain employment. Notably, the VA examiner identified during examination for the purpose of assessing the current severity of the Veteran’s migraine headaches to include functional impairment, that the Veteran’s headache pain did not impact the Veteran’s ability to work. The Board finds more probative the competent evidence reflecting the Veteran’s ability to function in a work environment than the hypothetical absences projected by the vocational evaluator. Again, the Board is not finding that employment would not be difficult, but that it would not be precluded as a result of the impairment from the Veteran’s service-connected disabilities. Overall, the Veteran is qualified through education and experience for a wide variety of positions, many of which would not require strenuous physical activity or the use of fine motor skills. He is more than qualified for such positions given the Veteran’s training and work history. This type of work would also produce income above the poverty threshold. Based on all the evidence, the Board finds that the evidence is against a finding that the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. Thus, a TDIU is not warranted. REASONS FOR REMAND Diabetes The Veteran contends he developed diabetes mellitus type 2 as a result of military service. Specifically, the Veteran contends he became diabetic when half of his pancreas was removed due to several tumors. See May 2016 VA 21-526 EZ Fully Developed Claim. The Board acknowledges the Veteran underlined the words “Agent Orange,” “Mustard Gas,” and “Ionizing Radiation” on his May 2016 application for compensation benefits. The record reflects the RO undertook development to identify the Veteran’s exposure to herbicide agents during military service. The Veteran has not undergone VA examination to determine the etiology of his diabetes. The Veteran has a current diagnosis of diabetes mellitus. For example, VA treatment records reflect the Veteran was diagnosed with diabetes mellitus type 2. The treatment provider reported the Veteran has had type 2 diabetes since 2013 but the Veteran was never told he had diabetes. The provider reported the Veteran is now status post partial pancreatectomy in June 2015. See September 2016 VA Endocrinology Clinic Note. During the May 1971 separation examination, the examining physician reported the Veteran has had six tumors within the last two years. Accordingly, the Board finds remand is warranted to afford the Veteran VA examination to determine the etiology of his current diabetes. Multiple Lipomas The Veteran filed a claim for an increased rating for his multiple lipomas in February 2014. After examinations and rating decisions proposing a reduction in rating, the RO in March 2016 reduced the rating for the multiple lipomas from 60 percent to 0 percent, effective June 1, 2016. In a February 2017 notice of disagreement, the Veteran disagreed with this decision. A Statement of the Case has yet to be issued. As such, remand is necessary. 38 C.F.R. §§ 19.20, 19.52. This matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s diabetes mellitus type 2 onset during service or is otherwise related to an in-service injury, event, or disease, to include whether the Veteran’s diabetes mellitus onset within one-year of separation from service. In offering the opinion, the examiner is asked to consider the Veteran’s in-service tumors and offer an opinion as to any relationship between tumors and the Veteran’s diabetes mellitus type 2. The examiner should elicit a full history from the Veteran and consider the lay statements of record. The Veteran is competent to attest to factual matters of which he has first-hand knowledge, and if there is a medical basis to support or doubt the history provided by the Veteran the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed is requested as the Board is precluded from making any medical findings 2. Issue a Statement of the Case as to the issue of entitlement to a rating in excess of 60 percent for multiple lipomas of the arms, abdomen, back, pubic area and lower extremities prior to June 1, 2016 and in excess of 0 percent thereafter, to include the propriety of the reduction in disability rating. That matter should only be returned to the Board if the Veteran timely perfects an appeal. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Gonzalez, 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.