Citation Nr: 21000180 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 16-26 615 DATE: January 4, 2021 ORDER Entitlement to an initial rating in excess of 30 percent for the service-connected posttraumatic stress disorder (PTSD) is denied. Entitlement to a rating in excess of 20 percent for the service-connected diabetes mellitus, type II, with erectile dysfunction, is denied. FINDINGS OF FACT 1. For the entire appeal period, the Veteran’s service-connected PTSD has not been manifested by symptoms that reflect occupational and social impairment with reduced reliability and productivity. 2. For the entire appeal period, the Veteran’s service-connected diabetes mellitus, type II, with erectile dysfunction is not shown to require a regulation of his activities; and his erectile dysfunction has not manifested to a compensable level. CONCLUSIONS OF LAW 1. For the entire appeal period, the criteria for an initial disability rating in excess of 30 percent for the service-connected PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 2. For the entire appeal period, the criteria for an increased rating in excess of 20 percent for diabetes mellitus type II, with erectile dysfunction are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.119, Diagnostic Code 7913. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 1966 to February 1968. In November 2017, the Board of Veterans’ Appeals (Board) denied his claims for an initial rating in excess of 30 percent for the service-connected PTSD and for a rating in excess of 20 percent for the service-connected diabetes mellitus, type II, with diabetic retinopathy and erectile dysfunction. He appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court). In July 2018, the Court issued an Order that granted a Joint Motion for Remand (Joint Motion) filed by counsel for both parties, vacated the Board’s decision, and remanded the matter to the Board for action in compliance with the Joint Motion. In January 2019, pursuant to directives stipulated in the Joint Motion, the Board remanded this case for further development, which has since been completed. As such, the Board will proceed with adjudication of these matters on appeal. In an August 2020 rating decision, the agency of original jurisdiction (AOJ) granted the Veteran service connection for bilateral cataracts with diabetic retinopathy as secondary to the service-connected diabetes mellitus, type II with erectile dysfunction. The Veteran was awarded a separate evaluation of 10 percent for this disability, which includes his diabetic retinopathy. As such, the Board recharacterized the issue of entitlement to an increased rating for diabetes mellitus, type II, to exclude diabetic retinopathy. Increased Ratings Disability ratings are determined by comparing a Veteran’s present symptoms 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. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. A critical element in permitting the assignment of several ratings under various Diagnostic Codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. Esteban v. Brown, 6 Vet. App. 259, 262 (1994); 38 C.F.R. § 4.14. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a Veteran prevailing in either event; or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. PTSD The Veteran contends that a disability rating higher than the current evaluation of 30 percent would more accurately reflect the severity of his PTSD symptoms. His PTSD has been evaluated as 30 percent disabling under Diagnostic Code 9411. 38 C.F.R. § 4.130. The psychiatric symptoms listed in these criteria are not exclusive but are examples of typical symptoms for the listed percentage ratings. Mauerhan v. Principi, 16 Vet. App. 436 (2002). In particular, the criteria of Diagnostic Code 9411 provide for a 30 percent rating where the evidence shows occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). The criteria provide for a 50 percent rating where the evidence shows occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. The criteria provide for a 70 percent rating where the evidence shows occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence) spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. The criteria provide for a 100 percent rating where the evidence shows total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions of hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. Prior to August 4, 2014, VA’s Rating Schedule that addresses service-connected psychiatric disabilities was based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association (also known as “DSM-IV”). 38 C.F.R. § 4.130. As in this case, diagnoses many times included an Axis V diagnosis, or a Global Assessment of Functioning (GAF) score (explained in more detail below). The DSM has been updated with a 5th Edition (DSM-V), and VA issued an interim final rule amending certain provisions in the regulations to reflect this update, including the Schedule for Rating Disabilities. 70 Fed. Reg. 45093 ((Aug. 4, 2014). This updated medical text recommends that GAF scores be dropped due to their “conceptual lack of clarity.” DSM-V, at 16. As the Veteran’s initial rating claim was in the process of adjudication prior to and during the adoption of the DSM-V, both the DSM-IV and DSM-V criteria will be utilized in the analysis set forth below. With regard to GAF scores, when in effect, it was considered a scale reflecting the psychological, social, and occupational functioning on a hypothetical continuum of mental health illness. Carpenter v. Brown, 8 Vet. App. 240 (1995). GAF scores from 31 through 40 contemplate some impairment in reality testing or communication (e.g., speech at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work). GAF scores from 21 through 30 illustrate behavior considerably influenced by delusions or hallucinations or serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) or inability to function in almost all areas (e.g., stays in bed all day, no job, home or friends). VA and private treatment records dated from 2001 to 2014 show very intermittent treatment for PTSD. Treatment records dated in 2014 reveal that the Veteran’s wife died suddenly and that he was currently residing with his daughter. At a November 2014 VA examination, the Veteran reported having some panic attacks, some irritability, hypervigilance, exaggerated startle response, and problems with concentration. The examiner noted symptoms such as anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, and mild memory loss. The Veteran reported that his symptoms did not cause significant occupational impairment when he was employed, but did cause some social impairment (i.e., irritability and emotional numbing/detachment affect relationships; and he notes he does not like to go out into the dark due to feeling vulnerable). Mental status examination was unremarkable. The Veteran denied current thoughts of suicide. The examiner noted that the Veteran’s PTSD manifests as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal). Further, the examiner indicated that the Veteran is currently receiving Social Security retirement benefits. It was noted that the Veteran last worked for a company from July 2000 to November 2004, and the Veteran reported that the company did not call him back after a winter slowdown. He indicated that he was old enough to retire and that therefore he did. The Veteran felt he was not asked back because of his diabetes as he would have to stop and eat a snack. Otherwise, the Veteran stated that he was a good worker without problems. The examiner found that the Veteran is likely to be mildly impaired in a work environment that requires the ability to sustain concentration and focus as normally found in most jobs. He also noted that the Veteran is likely to be mildly impaired in a work environment that is fast paced, complex, and/or frequently changing. VA treatment records dated in August 2016 show that the Veteran was living alone at a private residence. It was noted that he did not require help or supervision with activities of daily living. It was also indicated that the Veteran did not have a recent change in his level of functioning. Private treatment records, dated in August 2016, from treatment specialist, M.W., note that the Veteran reported having nightmares, anxiety, and poor sleep. The Veteran indicated, in part, that he wanted treatment for PTSD; however, he did not feel that his PTSD had increased in severity. The records show that the Veteran was directly referred to M.W. by another private treatment facility, but there is no indication that the Veteran was treated at that other private facility from which he was referred. At a February 2020 VA examination, the Veteran reported having some anxiety, i.e., future-oriented worry and occasional ongoing unprovoked angst. He also reported some sleeping difficulties. The Veteran stated that he was currently residing with his adult daughter, with whom he has maintained a good relationship. He also stated that he had resided with his adult daughter for approximately 40 years. The Veteran denied any other family relationships, friendships, or social acquaintances. He also reported that he last worked 20 years in heavy equipment construction. The examiner indicated that the Veteran experienced two main symptoms – anxiety and chronic sleep impairment. It was noted that the Veteran presented with dysphoric mood and congruent affect and appeared somewhat guarded. He was well groomed and appropriately dressed. The examiner noted that the Veteran’s PTSD symptoms resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal). On a separate behavioral health questionnaire, the examiner indicated that the Veteran had no job-related difficulties secondary to service-connected mental health issues. The Board finds that a disability rating in excess of 30 percent for the Veteran’s PTSD is not warranted at any time during the appeal period. He has not demonstrated the type and degree of symptoms, such as flattened affect, difficulty in understanding complex commands, impairment of short- and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks), impaired judgment, or impaired abstract thinking, that lead to occupational and social impairment with reduced reliability and productivity. There is also no evidence of panic attacks occurring more than once a week. While the Veteran was assessed with some irritability, occasional unprovoked angst, and depressed mood, these symptoms are not of the specific type and degree to warrant a higher rating as occupational and social impairment was not affected to the degree required for the next-higher rating. Additionally, the Veteran does not appear to have problems with maintaining relationships as he reported living with his daughter, with whom he seems to have a great relationship, for the past 40 years. He also reported to a private treatment specialist that he did not believe his PTSD symptoms had increased in severity. In addition, it appears that, prior to his retirement, the Veteran was consistently and steadily employed in the same field for 20 years. He indicated that his PTSD symptoms did not interfere with his duties when he was employed. Further, the November 2014 examiner indicated that the Veteran’s PTSD symptoms would only be mildly impaired in a work environment that requires the ability to sustain concentration and focus or in a work environment that is fast paced, complex, and/or frequently changing, and the February 2020 examiner stated that the Veteran would not experience job-related difficulties secondary to any service-connected mental health issue. The presence or absence of certain symptoms is not necessarily determinative. Those symptoms must ultimately result in the level of occupational and social impairment in the referenced areas. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). Here, however, the VA examination reports and VA treatment records are not indicative of occupational and social impairment with reduced reliability and productivity that approximate the criteria for 50 percent, the next higher rating. The findings of the VA examiners demonstrate that the Veteran had occupational and social impairment that was specifically described as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal). Thus, the Board finds that this evidence weighs against the claim for an increased rating in excess of 30 percent for PTSD. In reaching this conclusion, the Board finds that the existence and severity of the Veteran’s psychiatric symptoms are adequately contemplated by the relevant rating criteria. His primary PTSD symptoms are specifically listed, and are contemplated, in the General Rating Formula for Mental Disorders. These symptoms are consistent with the currently assigned 30 percent disability rating and do not meet the criteria for the next-higher rating of 50 percent. In addition, neither the Veteran nor his representative has raised any other issues over which the Board has proper jurisdiction, nor have any other issues been reasonably raised by the record. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Accordingly, an initial rating in excess of 30 percent for PTSD is not warranted. As the preponderance of the evidence is against the claim, the claim must be denied. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. 49. Diabetes Mellitus, Type II, With Erectile Dysfunction The Veteran contends that a rating in excess of 20 percent would more accurately reflect the severity of his diabetes mellitus symptoms. Prior to March 13, 2020, the Veteran was assigned a 20 percent rating for his diabetes mellitus, type II with diabetic retinopathy and erectile dysfunction. However, as previously stated, in an August 2020 rating decision, he was granted service-connection for bilateral cataracts with diabetic retinopathy, for which he was assigned a separate 10 percent rating effective March 13, 2020. Thus, for the entire rating period on appeal, diabetes mellitus, type II with erectile dysfunction has been rated at 20 percent under the criteria at 38 C.F.R. § 4.119, Code 7913. Pursuant to the rating criteria for the endocrine system, the Veteran’s service-connected diabetes mellitus is evaluated at a 20 percent disability rating under Diagnostic Code 7913. A 20 percent evaluation is warranted when insulin and a restricted diet, or; an oral hypoglycemic agent and a restricted diet is required. A 40 percent rating is assigned when insulin, a restricted diet, and regulation of activities are required. A 60 percent evaluation is warranted when diabetes mellitus requires insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A 100 percent evaluation is warranted when diabetes mellitus requires more than one daily injection of insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. 38 C.F.R. § 4.119, Diagnostic Code 7913. The criteria for rating diabetes mellitus are conjunctive, meaning that each element of the criteria is needed to meet the requirements for the specified evaluation. Camacho v. Nicholson, 21 Vet. App. 360 (2007). Complications of diabetes mellitus are to be evaluated separately, unless they are part of the criteria used to support a 100 percent evaluation. 38 C.F.R. § 4.119, Note (1). Pursuant to Note (1) to Code 7913, the noncompensable complications of erectile dysfunction are considered part of the diabetic process. In November 2014, the Veteran was afforded a VA examination focused on the severity of his service-connected diabetes mellitus, type II, with erectile dysfunction. The examiner reviewed the claims file, considered the Veteran’s subjective accounts, and conducted an examination. The examiner indicated that the Veteran’s diabetes mellitus was managed by a restricted diet and an insulin pump. The examiner noted that the Veteran does not require a regulation of activities as part of his diabetes mellitus medical management plan. It was indicated that the Veteran visited his diabetic care provider for episodes of ketoacidosis less than two times per month, but that he had not been hospitalized for ketoacidosis or hypoglycemia in the prior 12 months. The Veteran had not undergone progressive unintentional weight loss and loss of strength due to his diabetes mellitus. His complications of diabetes mellitus were limited to diabetic retinopathy and erectile dysfunction (caused by his diabetes mellitus). The examiner noted that, functionally, diabetes did not impact the Veteran’s ability to work, that his blood sugar was well-controlled, and that diabetes did not affect his ability to do anything that he needs to do. During the Veteran’s November 2014 examination for PTSD, he reported that he felt he was not asked back to work, shortly before his retirement, because of his diabetes, as he would have to stop and eat a snack. In his notice of disagreement lay statement, received in February 2015, the Veteran indicated that he does take insulin with a pump. He further stated that he sometimes has problems finishing activities that he starts. VA treatment notes dated in April 2015 show that the Veteran reported increased activity and that low blood sugar levels were very rare. He also reported that he experienced lows when he worked in the yard. This was also documented in an October 2016 VA treatment note, except that he mentioned a general decrease in activity at that time. At a February 2020 VA examination, the examiner reviewed the claims file, considered the Veteran’s subjective accounts, and conducted an examination. The examiner indicated that the Veteran’s diabetes mellitus was managed by more than one insulin injection per day. The examiner noted that the Veteran does not require a regulation of activities as part of his diabetes mellitus medical management plan. It was indicated that the Veteran visited his diabetic care provider for episodes of ketoacidosis or hypoglycemia less than two times per month, but that he had not been hospitalized for ketoacidosis or hypoglycemia in the prior 12 months. The Veteran had not undergone progressive unintentional weight loss and loss of strength due to his diabetes mellitus. The Veteran’s complications of diabetes mellitus were limited to diabetic retinopathy and erectile dysfunction (caused by his diabetes mellitus). Functionally, the examiner noted that diabetes did not impact the Veteran’s ability to work. In further remarks, the examiner emphasized that the Veteran does not require regulation of activities and avoidance of strenuous activities due to diabetes mellitus. After careful consideration of the medical evidence of record, the Board finds that a rating in excess of 20 percent for diabetes mellitus is not warranted. The next higher rating of 40 percent requires insulin, restricted diet, and regulation of activities. 38 C.F.R. § 4.119, Diagnostic Code 7913. Here, the record reflects that the Veteran’s diabetes requires insulin and a restricted diet, but there is no evidence that reflects his diabetes has required any regulation of activities (avoidance of strenuous occupational and recreational activities). In fact, the February 2020 VA examiner stressed that the Veteran does not require regulation of activities and avoidance of strenuous activities due to diabetes mellitus. The Board finds the February 2020 VA examination to be probative because the examiner carefully reviewed and considered the entire record, including the Veteran’s medical history, before rendering an opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board finds that the weight of the evidence is against a finding that management of diabetes mellitus requires a regulation of activities as required for a 40 percent rating under Code 7913. Throughout the rating period on appeal, management of diabetes mellitus required the use of insulin or an oral hypoglycemic agent, and a restricted diet, which is consistent with the 20 percent rating criteria under Code 7913. The evidence does not otherwise indicate that management of diabetes mellitus also required avoidance of strenuous occupational and recreational activities, which is the additional criterion necessary for the next higher 40 percent schedular rating. See Camacho v. Nicholson, 21 Vet. App. 360 (2007) (holding that the criteria for rating diabetes mellitus are conjunctive, and that each element of the criteria is needed to meet the requirements for the specified evaluation). For the increased rating period on appeal, there is simply no evidence to suggest the Veteran was required to avoid strenuous occupational and recreational activities to control his blood sugars and diabetes mellitus, type II. Indeed, several VA treatment records document his report to his providers that he does yard work, and there is no indication that he has been discouraged from doing yard work. The Board acknowledges statements from the Veteran regarding the fact that he took frequent snacks because of his diabetes, that he sometimes experienced a decrease in his activity levels because of his diabetes, and that he sometimes had trouble finishing activities he started because of his diabetes. However, none of these statements suggest that the Veteran required a regulation of his activities due to his diabetes mellitus. These statements and reports were reviewed by the examiners who observed the Veteran and they did not find it necessary to ask the Veteran to avoid any strenuous activity, including yard work. As such, the weight of the evidence is against a finding that a rating in excess of 20 percent under Code 7913 for diabetes mellitus is warranted for any period. 38 C.F.R. §§ 4.3, 4.7. The Board further notes that the Veteran has erectile dysfunction associated with his type II diabetes mellitus. As discussed herein, Note (1) to 38 C.F.R. § 4.119, Code 7913, provides that compensable complications of diabetes are evaluated separately. Moreover, as previously stated, Note (1) also provides that noncompensable complications are considered part of the diabetic process under code 7913. In this regard, the AOJ determined that the Veteran’s erectile dysfunction was noncompensable (zero percent disabling). Erectile dysfunction is rated under 38 C.F.R. § 4.115b, Diagnostic Code 7599-7522 (penis, deformity, with loss of erectile power). Under Diagnostic Code 7522, for the Veteran to receive a compensable rating for erectile dysfunction, physical deformity of the penis with loss of erectile power is required. Such manifestations would warrant a 20 percent rating. 38 C.F.R. § 4.115b. Simply stated, the condition is not compensable in the absence of penile deformity. Upon review of the evidence, the Veteran does not meet the criteria for a 20 percent rating. It is not in dispute that he has loss of erectile power. During the November 2014 VA examination, he reported erectile dysfunction since 2001. He denied having a history of an orchiectomy, renal dysfunction due to condition, or voiding dysfunction. He indicated that he was unable to achieve an erection sufficient for penetration and ejaculation without medication, but also that he has not used medications for treatment of his erectile dysfunction. He also did not have a history of chronic epididymitis, epididymo-orchitis, or prostatitis. The Veteran requested to not have his male reproductive organs examined and reported a normal anatomy with no penile, testicular, or epididymis, deformities or abnormalities. He did not have any related benign or malignant neoplasm or metastases. He did not have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions. In the present case, the evidence of record does not reveal any physical deformity of the Veteran’s penis. He has not alleged, nor does the evidence show, that he has penile deformity. As such, there is no lay or medical support for a compensable disability rating for erectile dysfunction under Diagnostic Code 7522. Moreover, the Board notes that the Veteran is already in receipt of special monthly compensation for loss of use of a creative organ. Although a February 2020 VA examiner noted that there is an increasingly worsening erectile dysfunction over the years and that the Veteran takes daily medication for his erectile dysfunction, there is no evidence of a loss of erectile power with penile deformity to warrant a separate 20 percent evaluation. Also, with regard to the Veteran’s diabetic retinopathy, as previously indicated, he was already assigned a separate rating for this disability, along with bilateral cataracts. Based on the foregoing, the Veteran has not been shown to meet the criteria for an increased evaluation under the rating criteria. Although the Veteran has been shown to require an oral hypoglycemic agent, and at times insulin and a restricted diet, he does not require a regulation of activities, which is a necessary component for the next higher evaluation. Accordingly, the Veteran is not entitled to an evaluation in excess of 20 percent for his diabetes mellitus with erectile dysfunction. A preponderance of the evidence is against the Veteran’s claim, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Other Considerations Entitlement to a total rating based on individual unemployability due to service-connected disabilities (TDIU) is also an element of a claim for a higher disability rating. Rice v. Shinseki, 22 Vet. App. 447 (2009). Here, the Veteran did not appeal his claim for a TDIU, which was denied by the AOJ in January 2015. The evidence does not otherwise suggest that his service-connected disabilities, to include his PTSD and diabetes mellitus with erectile dysfunction, prevent employability such that a derivative TDIU claim would be now raised (again). Consistently, the VA examinations have shown findings that his service-connected disabilities do not prevent employment. See Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001) (holding that a claim for TDIU is raised where a Veteran: (1) submits evidence of a medical disability; (2) makes a claim for the highest rating possible; and (3) submits evidence of unemployability); see also Jackson v. Shinseki, 587 F.3d 1106 (2009) (holding that an inferred claim for a TDIU is raised as part and parcel of an increased-rating claim only when the Roberson requirements are met). Finally, the Veteran has not raised any other issues with respect to the increased rating claims, nor have any other assertions been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Trowers, 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.