Citation Nr: 20021464 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 19-34 866 DATE: March 25, 2020 ORDER Entitlement to an effective date earlier than July 1997 for the grant of service connection for coronary artery disease (CAD) is denied. Entitlement to an effective date earlier than January 3, 2005 for the grant of service connection for Parkinson’s disease is denied. Entitlement to an initial “staged” rating in excess of 10 percent prior to April 25, 2005 for the CAD is denied. Entitlement to a rating in excess of 30 percent for the Parkinson’s disease is denied. FINDINGS OF FACT 1. In an unappealed December 2015 decision, the Board granted an effective date of July 1, 1997 for the award of service connection for CAD; there is no allegation of clear and unmistakable error (CUE) in that decision. 2. The Veteran reported the onset of Parkinson’s Disease in January 2005, and there is no competent and credible evidence supporting an effective date earlier than January 3, 2005 for the grant of service connection for this disease. 3. There are not ejection fraction results or probative findings concerning metabolic equivalents of task (METS) supporting a higher initial rating for the CAD. 4. For the entire rating period on appeal, the symptoms owing to the Veteran's service-connected Parkinson's disease are most appropriately evaluated collectively under Diagnostic Code 8004. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than July 1997 for the grant of service connection for CAD have not been met. 38 U.S.C. §§ 5103(a), 5103A, 5107(b), 5110; 38 C.F.R. § 3.400. 2. The criteria for an effective date earlier than January 3, 2005 for the grant of service connection for Parkinson’s disease have not been met. 38 U.S.C. §§ 5103(a), 5103A, 5107(b), 5110; 38 C.F.R. § 3.400. 3. For the period at issue prior to April 25, 2005, the criteria are not met for an initial rating higher than 10 percent for the CAD. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.104, Diagnostic Code 7005. 4. The criteria for a rating in excess of 30 percent for the Parkinson’s disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8004.   REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran died in May 2015; the Appellant is his widow. Initially, the Board will address some of the Appellant’s statements in her VA Form 9 to provide her with more clarity as to prior decisions. With regard to Parkinson’s Disease, the Board, in a December 2015 decision, granted service connection for Parkinson’s Disease but did not set an effective date or a rating; those decisions (the effective date and the rating) were left to the RO (regional office) to adjudicate/determine. In a May 2016 rating decision, the RO effectuated the Board’s grant of service connection for Parkinson’s Disease. The RO then had a duty to assign what it considered to be an appropriate effective date and rating after review of the claims file; it found that an effective date of January 3, 2005 and a rating of 30 percent were appropriate (see September 2019 rating decision). With regard to CAD, at the time of the Board’s December 2015 decision, the Veteran was already in receipt of service connection for CAD with an effective date of April 25, 2005. In the December 2015 decision, the Board granted an earlier effective date of July 1, 1997 for service connection for CAD but did not set a rating; that decision (the rating) was left to the RO to adjudicate/determine. In a May 2016 rating decision, the RO effectuated the Board’s grant of an earlier effective date of July 1, 1997. The RO then had a duty to assign what it considered to be an appropriate rating after review of the claims file; it assigned a 10 percent rating prior to April 25, 2005, a 60 percent rating from April 25, 2005 to March 26, 2012, and a 100 percent rating thereafter. Merely because a Veteran is in receipt of service connection does not mean that his disability is entitled to a 100 percent rating. A disability rating is based on his symptoms and consequent impairment – including in relation to the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. In other words, disabilities may receive no compensation, may receive a 100 percent rating, or may receive a rating somewhere in between, depending on the severity, or lack thereof, of symptoms.   Effective Dates Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA’s adjudication regulations be filed on a standard form. See 79 Fed. Reg. 57,660 (Sept. 25, 2014), codified as amended at 38 C.F.R. §§ 3.151, 3.155, 3.157. The amended regulations, however, apply only to claims filed on or after March 24, 2015. Because the Veteran’s claims were received by VA prior to that date, the former regulations apply where warranted. Except as otherwise provided, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be on 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. If a claim is reviewed at the request of the claimant more than one year after the effective date of a liberalizing law, benefits may be authorized for a period of one year prior to the date of receipt of such request. 38 C.F.R. § 3.114(a)(2). A claim is a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 U.S.C. § 101 (30); 38 C.F.R. § 3.1 (p). The date of receipt shall be the date on which a claim, information or evidence was received by VA. 38 U.S.C. § 101(30); 38 C.F.R. § 3.1(r). Any communication or action, indicating intent to apply for one or more benefits under the laws administered by VA, from a claimant, his or her duly authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui juris may be considered an informal claim. Such informal claims must identify the benefit sought. 38 C.F.R. § 3.155   1. Entitlement to an effective date earlier than July 1997 for the grant of service connection for CAD In a December 2015 decision, the Board found that an effective date of July 1, 1997, and no earlier, was warranted for the grant of service connection for CAD. The Appellant did not appeal the Board’s decision to the higher United States Court of Appeals for Veterans Claims (Court/CAVC), so that decision became final and binding. 38 U.S.C. § 7104; 38 C.F.R. § 20.1100. The Appellant has not alleged that there was CUE in the Board’s decision, and the evidence does not indicate there was. The Veteran’s original claim for service connection for heart disease was received on July 1, 1997, which was after May 3, 1989 (the date set in 38 C.F.R. § 3.816) and before August 31, 2010 (the effective date of the regulation establishing ischemic heart disease (IHD) as an herbicide-presumptive disability). Under 38 C.F.R. § 3.816(c)(2), the effective date should be the latter of dates of July 1, 1997 (the date of his claim) or the date the disability arose. Records in 1995 showed reversible ischemia, and records in 1996 showed mild inferior ischemia. Therefore, the later of the dates is July 1, 1997, the date he filed his claim. (See also discussion of Nehmer Regulations below). Based on the foregoing, an earlier effective date is not warranted because there is no basis for a free-standing earlier effective date claim from matters addressed in a final and binding decision. See Rudd v. Nicholson, 20 Vet. App. 296 (2006). 2. Entitlement to an effective date earlier than January 3, 2005 for the grant of service connection for Parkinson’s disease. When determining when the entitlement arose, an effective date for benefits can be no earlier than the date the disability at issue first manifested. See DeLisio v. Shinseki, 25 Vet. App. 45, 52 (2011). On August 31, 2010, Parkinson’s disease was added to the list of presumptive herbicide-related diseases enumerated in 38 C.F.R. § 3.309 (e). See 75 Fed. Reg. 53,702 (August 31, 2010). Effective dates of awards of presumptive service connection for Parkinson’s disease under 38 C.F.R. § 3.309 (e) are governed by the Nehmer Regulations. See 38 C.F.R. § 3.816 ; see also 75 Fed. Reg. at 53,202 ; Nehmer v. United States Veterans Admin., 712 F. Supp. 1404 (N.D. Cal. 1989) (Nehmer I); Nehmer v. United States Veterans Admin., 32 F. Supp. 2d. 1175 (N.D. Cal. 1999) (Nehmer II); Nehmer v. Veterans Admin. of the Gov’t of the United States, 284 F.3d 1158 (9th Cir. 2002) (Nehmer III). Because the Veteran served in Vietnam and was diagnosed with Parkinson’s disease, a covered herbicide disease, he qualifies as a Nehmer class member under the Nehmer Regulations. See 38 C.F.R. § 3.816(b)(1)(i). Under these Nehmer regulations, a veteran may be entitled to an earlier effective date prior to the date of the liberalizing law, in this case, August 31, 2010, where either (1) VA denied compensation for the same covered herbicide disease in a decision issued between September 25, 1985, and May 3, 1989; or (2) the class member’s claim for disability compensation for the covered herbicide disease either (a) was pending before VA on May 3, 1989; or (b) was received by VA between May 3, 1989, and the effective date of the statute or regulations establishing a presumption of service connection for the covered disease (in this case, August 31, 2010). See 38 C.F.R. § 3.816(c). Where either one of these elements has been established by the evidence of record, the effective date of the award shall be the later of the date such claim was received by VA or the date the disability arose. In correspondence received by VA on July 25, 2005, the Veteran stated “I want to file informal claim for VA Pension. I am unable to work because of Parkinsons.” The earliest clinical evidence of Parkinson’s Disease is in January 2005, at which time it was noted to be a subacute onset (see January 13, 2005 VA clinical record). Moreover, when being treated in 2005 for his symptoms, the Veteran asserted that they began in January 2005 (e.g. April 2005 private records). Based upon the evidence in this case, the earliest that that it can be factually ascertained that he met the criteria for Parkinson’s Disease is after January 3, 2005; thus, an earlier effective date is not possible. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Increased Ratings Disability evaluations are determined by comparing a Veteran’s present symptomatology with criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. Id. § 4.3. Further, a disability rating may require re-evaluation in accordance with changes in a Veteran’s condition. It is thus essential in determining the level of current impairment that the disability is considered in the context of the entire recorded history. Id. § 4.1. Nevertheless, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Board notes that staged ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). In McGrath v. Gober, 14 Vet. App. 28 (2000), the Court held that when evidence is created is irrelevant compared to when the Veteran was actually experiencing the symptoms. Thus, the Board will consider whether the evidence of record suggests that the severity of pertinent symptoms increased sometime prior to the date of the examination reports noting pertinent findings.   3. Entitlement to initial “staged” rating in excess of 10 percent prior to April 25, 2005 for the CAD. It is initially worth pointing out that the Board lacks jurisdiction over the period from April 25, 2005 onwards (i.e., as concerning the higher 60 and 100 percent ratings for the CAD since) because it was not addressed in the May 2016 rating decision that is on appeal. By way of background, a September 2011 rating decision granted service connection for CAD, rated as 60-percent disabling, effective April 25, 2005. The Veteran appealed the effective date for the grant of service connection for CAD in a November 2011 notice of disagreement (NOD). Of note, he did not appeal the rating assigned in the September 2011 rating decision. A June 2013 Statement of the Case (SOC) denied entitlement to an effective date prior to April 25, 2005, and he perfected his appeal of that issue. An October 2013 rating decision granted a 100 percent rating effective March 26, 2012. In December 2015, the Board granted an earlier effective date of July 1, 1997 for the award of service connection for the CAD. A May 2016 RO rating decision implemented the Board’s December 2015 decision by granting service connection for the CAD as of the earlier effective date mentioned – namely, as of July 1, 1997, and assigned an initial 10 percent rating for CAD from July 1, 1997 to April 24, 2005. A June 2017 NOD appealed the rating assigned for the CAD and a September 2019 SOC denied entitlement to an increased rating for that period. The Veteran perfected his appeal of that issue to the Board. In the legacy system, appellate review is initiated by a NOD and completed by a substantive appeal after an SOC is furnished. 38 C.F.R. §§ 19.20, 19.21.   In this case, the May 2016 rating decision on appeal did not adjudicate an increased rating for the CAD from April 25, 2005 onwards. Rather, the rating decision only addressed the rating for the CAD for the newly service-connected period from July 1, 1997, to April 24, 2005. In addition, neither the June 2017 NOD nor the September 2019 SOC addressed the period from April 25, 2005. The Board, accordingly, does not have jurisdiction over the increased rating for the CAD as of April 25, 2005 and beyond; this issue, therefore, cannot be addressed in the decision. The Veteran’s CAD is rated under 38 C.F.R. § 4.104, Diagnostic Code (DC) 7005. Under DC 7005, CAD resulting in workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; when continuous medication is required, is rated 10 percent disabling. CAD resulting in workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray, is rated 30 percent disabling. CAD resulting in more than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent, is rated 60 percent disabling. CAD resulting in chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent, is rated 100 percent disabling. For rating diseases of the heart, one MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for rating, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. 38 C.F.R. § 4.104, Note (2). Prior to April 25, 2005 (currently rated as 10-percent disabling) The Veteran would be entitled to a rating in excess of 10 percent if he had CAD resulting in workload of greater than 5 METs but not greater than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. A January 1997 private record (correspondence by Dr. Ludbrook) reflects that the Veteran had no chest pain or palpitation, and his heart sounds were unremarkable. Dr. Ludbrook stated that the Veteran’s cardiovascular system was quite stable, and his coronary arteries were functionally normally, he was not on any medication, and it was noted that he should be seen again in year. It was also noted that his cardiovascular system was quite stable. 2003 VA records note that the Veteran reported increase shortness of breath with activity, occasional dizziness, and exertional agnina and dyspnea on exertion; it was noted that he had been off medication, but it would be restarted. (A 10 percent rating is warranted when continuous medication is required.) It was noted that the Veteran had chest pains which were relieved with Nitro. It was also noted that he had chest pains after bending over to pick up a 70-pound piece of steel; the pains lasted 30 minutes and abated with rest. The Veteran also reported that he has dyspnea after climbing 16 steps and that such had been present in a lesser degree for two years. There are no clinical records noting that the Veteran had a METs not greater than 7 and causing the above noted symptoms. Moreover, he was not competent to state the level of symptoms due to his CAD as opposed to his other disabilities.   Conclusion A 10 percent rating may adequately compensate a person for dyspnea, fatigue, angina, dizziness, or syncope depending on the level of METs that brings on the symptoms. In the present claim, the Board finds that there are not clinically estimated METs based on the Veteran’s CAD supporting any higher rating for this initial period at issue in this appeal. The Board also finds that the ejection fractions, which are the most probative evidence of record, are against a finding that an increased rating is warranted for this initial period at issue in this appeal. There also is no evidence of more than one episode of acute congestive heart failure (CHF) in one year or chronic CHF. In sum, the Board finds that the preponderance of the evidence is against the award of an initial rating greater than 10 percent prior to April 25, 2005 for the Veteran’s CAD. Therefore, the benefit of the doubt doctrine is inapplicable, and the Appellant-widow’s claim for an increased rating is denied. 4. Entitlement to a rating in excess of 30 percent for Parkinson’s disease. The Veteran’s Parkinson’s disease is rated as 30 percent disabling under DC 8004. The Appellant contends that a 100 percent rating is warranted but has not provided probative evidence of such. Rather, it appears that she erroneously believes that under Nehmer, a Veteran is entitled to a 100 percent rating for a service-connected disability. Nehmer, as noted above, deals with effective dates and not ratings. Ratings for Parkinson’s disease, known in VA regulations as “paralysis agitans,” are assigned pursuant to 38 C.F.R. § 4.124a, DC 8004. Under this DC, a minimum 30 percent rating is for application when there are “ascertainable residuals” of the disability. However, VA is required to also consider whether any of these residuals may be otherwise rated under a separate DC. Potential residuals include, but are not limited to, loss of smell or taste (38 C.F.R. § 4.87a, DCs 6275, 6276), bladder or bowel dysfunction (38 C.F.R. §§ 4.114, DC 7332 & 4.115 DC 7542), disorders to the cranial nerves or nerves in the extremities (38 C.F.R. § 4.124a) or cognitive impairment (38 C.F.R. § 4.130, DC 9326). (See VA Adjudication Procedures Manual M21-1MR, Part III.iv.4.G.25. VA should also analyze individual symptoms under the appropriate diagnostic code for that bodily system. See 38 C.F.R. § 4.124a.) If there are identifiable residuals that can be rated under a separate DC, and the combined disability rating resulting from these residuals exceeds 30 percent, then these separate ratings will be assigned in place of the minimum rating assigned under DC 8004. The Veteran was in receipt of service connection for Parkinson’s Disease effective from January 3, 2005. The Veteran was also in receipt of service connection for peripheral neuropathy of each lower extremity evaluated as 10 percent disabling from August 24, 2006 to March 26, 2012, and as 100 percent disabling thereafter for loss of use of both feet. He was also in receipt of right and left upper extremity peripheral neuropathy evaluated as 10 percent disabling effective from March 26, 2012. He was in receipt of service connection for a stroke evaluated as 100 percent disabling effective from February 28, 2013 to September 1, 2013. He was in receipt of vision disabilities evaluated as 10 percent disabling effective from April 9, 2012. He was also in receipt of special monthly compensation for erectile dysfunction effective from March 26, 2012. Thus, any symptoms of Parkinson’s disease which overlaps with one of these service-connected disabilities may not be considered in the award for Parkinson’s Disease as this would constitute impermissible pyramiding. The Board has summarized some of the clinical findings below. Reference to the Veteran’s disabilities is presented in additional evidence of record beyond the most detailed pertinent evidence discussed by the Board in this decision. The additional evidence of record does not present findings concerning the Veteran’s Parkinson’s Disease that significantly expand upon, revise, or contradict the findings discussed by the Board in this decision. The Veteran had a significant number of complaints/symptoms and had an extensive medical history. However, and importantly, he was diagnosed with a significant number of disabilities (both service-connected and nonservice-connected). Neither he, nor the Appellant, has been shown to be competent to state which symptoms were related to his Parkinson’s Disease. A January 2005 VA clinical record notes subacute onset of Parkinsonian features. He had a head tremor, but did not have an upper extremity tremor, and did not have rigidity when evaluated by neurology although it was apparently noted by others. He had bradykinesias, shuffling gait, and postural instability. It was noted that of the four cardinal symptoms of Parkinson’s, the Veteran only had one. March 2005 VA clinical records note that the Veteran reported feeling numbness which comes and goes in the legs; he also reported leg cramps. He had intermittent high frequency tremors. The assessment was conversion reaction. 2005 private Mercy Medical Center records reflect that the Veteran complained of facial numbness and had high blood pressure; a carotid ultrasound was normal, and a CT of the head was normal. He also complained of weakness of the right side, walking with a shuffle, shaking, and bilateral leg weakness since January 2005. It was noted that the Veteran is a “very poor historian”. Although the Veteran reported that he had been diagnosed with a stroke the week earlier, an April 21, 2005 Mercy record notes that a CT scan showed no acute intracerebral process detected, and an April 22, 2005 MRI showed no evidence of a stroke. He was diagnosed with an essentially normal MRI. June 2005 correspondence from Dr. S. Burns reflects her opinion that the Veteran had end stage Parkinson’s disease with a tremor and shuffled gait, CAD, peripheral vascular disease, peripheral neuropathy, and has had a stroke. She further stated that he requires continuous oxygen, has five-word conversational dyspnea, and can only walk six feet without becoming even more dyspneic; however, she did not provide symptoms specific to Parkinson’s other than a tremor and a shuffled gait. Moreover, her assessment that the Veteran had a stroke appears in contradictory to the 2004 evidence noted above. Her finding of “end-stage Parkinson’s Disease” is also not supported by the record, especially given that he lived another ten years. A June 2005 Bettendorf Health Care record (Dr. Blechle) reflects that the Veteran was admitted to their facility due to an investigation of abuse at his home. Upon neurologic review, his cranial nerves II through XII were grossly intact. His affect was somewhat flat, but he was oriented times three and alert. July 2005 correspondence from Dr. D. Osaro reflects that he has been treating the Veteran for Parkinson’s disease with mixed incontinence, cerebral artery occlusion, and unstable gait. He noted that the Veteran is unable to perform daily ADL’s without assistance such as toileting, bathing, feeding, dressing, ambulation, and hygiene, without assistance. Dr. D. Osaro did not differentiate which of the Veteran’s limitations with his ADLs was due to Parkinson’s Disease as opposed to his other disabilities. A September 2005 record (Dr. Osaro) reflects diagnoses of myalgia, incontinence, asthma, Parkinsonism, Hypertension, arthritis, COPD, depression, CAD, status post CVA, and GERD. VA records note that the Veteran had gait difficulty due to his peripheral vascular disease (PVD) and peripheral neuropathy. A July 2005 record notes that the Veteran has “severe peripheral vascular disease with totally occluded right superficial femoral artery . . . . Patient continues to complain bitterly about the right lower extremity symptoms. We will make an attempt to revascularize the right lower extremity vessel.” An August 2006 record notes that he denied stress incontinence, nocturia, urgency, hesitancy, or urge incontinence. It was noted that he had bilobar prostate enlargement. The record does not support that he had a urinary disability due to his Parkinson’s. An April 2007 VA clinical record reflects that he did not have a loss of taste, as he reported that he does not like the taste of the food in his diabetic diet. A June 2007 record notes that no incontinence was reported. A July 2007 records reflect that the Veteran requested a wheelchair due to left sided weakness from an “old cva”. An August 2007 VA record notes that the Veteran had a history of PVD and diabetes mellitus neuropathy. He was noted to ambulate into the clinic wearing tennis shoes without assistance and in no acute distress.   A December 2007 VA neurology record reflects that the Veteran reported that he had tremors that started in 2005 which affect his hands. There were no changes in gait or slowness of movements. He had mild left facial droop and a decrease left shoulder shrug. He had decreased power and hemiparetic gait. He used a cane to walk. The impression was an essential tremor. The Veteran reported that his medication for Parkinson’s had helped with the tremors, but that his handwriting had changed lately, and he has some problems with eating. The Veteran had normal ocular motility in all quadrants. The examiner found that the symptoms and signs do not fit within Parkinson’s Disease. A May 2008 VA record notes he had laser treatment for his prostate, and reported good urine stream, nocturia times two, and a main problem of dysuria. This record is indicative that urinary problems were related to his prostate and not Parkinson’s Disease. A July 2011 VA examination report reflects that the Veteran reflects that the Veteran did not display any tremor. Motor and sensory examinations were “very limited” because the Veteran reported joint pain, which the examiner felt should be evaluated by a rheumatologist. Although the Veteran had a gait impairment, the examiner stated that it was not typical of Parkinson’s disease. The Veteran reported no bladder or bowel impairment, and his sense of smell and taste were not affected. The examiner did not feel confident in the diagnosis of Parkinson’s disease. An April 2012 VA clinical record notes that the Veteran’s Parkinson’s Disease was stable on Sinemet. He was admitted with complaints of dizziness (which he also had the previous week due to very high blood sugars). The impressions noted dizziness and vision changes suspected cerebrovascular accident, poorly controlled diabetes with neuropathy.   DBQs in 2013 reflect that the Veteran is unable to walk for any distance because of [diabetic] neuropathy in the lower legs and imbalance of gait after his stroke. He was further noted to have IBS likely related to his reflux disease. It was noted that when he takes his blood pressure medication for his hypertension, he does not have dizziness or light-headedness. The Veteran reported that his loss of vision was the result of a stroke. Thus, the evidence is against a finding that his symptoms were related to his Parkinson’s Disease. Conclusion The Board finds that the evidence of record does not support loss of smell or taste, IBS, erectile dysfunction, lightheadedness, dizziness, or urinary symptoms related to Parkinson’s disease, as these symptoms have been found to not exist or are found to be related to diabetes, hypertension, CAD, a stroke, or another disability Moreover, his drooping facial muscle has not been shown to cause functional impairment or be moderate in severity. Thus, they would not be awarded compensation under the Rating Criteria. With regard to his lower extremity symptoms, as discussed above, they have been noted to be due to peripheral neuropathy, PVD, and a stroke. The evidence does not support, that even if some of the symptoms were due, in part, to his Parkinson’s disease, it would amount to more than mild in severity (which would warrant a noncompensable of 10 percent rating). The Veteran is already in receipt of a 10 percent rating for peripheral neuropathy for each lower extremity from August 24, 2006 to March 26, 2012, and a 100 percent rating thereafter for loss of use of both feet. For the period prior to August 24, 2006, the Veteran’s 30 percent for Parkinson’s Disease is a higher evaluation than individual 10 percent ratings and the bilateral factor for the lower extremities. Thereafter, the Veteran cannot be rated for the same symptoms under other separate diagnostic codes while at the same time have a 30 percent rating under DC 8004. With regard to his upper extremities, there is no credible evidence that the Veteran had bilateral upper extremity symptoms, taken together with other Parkinson’s Disease symptoms, which were of such severity that the 30 percent did not adequately compensate him. The Board finds that for the entire appeal period, the symptoms related to the Veteran’s service-connected Parkinson’s disease are most appropriately rated collectively under Diagnostic Code 8004. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102; 4.3. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Wishard 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.