Citation Nr: 21002912 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 08-30 233 DATE: January 19, 2021 ORDER Entitlement to service connection, to include on a secondary basis, for hypertension is denied. Entitlement to an initial compensable rating erectile dysfunction is denied. Entitlement to a rating in excess of 10 percent for adjustment disorder with depressed mood and organic mood is denied. Entitlement to an initial rating in excess of 10 percent for right hand peripheral neuropathy (ulnar nerve) is denied. Entitlement to an initial rating in excess of 10 percent for left hand peripheral neuropathy (ulnar nerve) is denied. Entitlement to an initial rating in excess of 10 percent for right lower extremity peripheral neuropathy (sciatic nerve) is denied. Entitlement to an initial rating in excess of 10 percent for left lower extremity peripheral neuropathy (sciatic nerve) is denied. Entitlement to a separate 10 percent rating for right hand peripheral neuropathy (median nerve), under Diagnostic Code 8515, is granted, effective October 15, 2018. Entitlement to a separate 10 percent rating for left hand peripheral neuropathy (median nerve), under Diagnostic Code 8515, is granted, effective October 15, 2018. Entitlement to a separate 10 percent rating for right lower extremity peripheral neuropathy (femoral nerve), under Diagnostic Code 8526, is granted, effective October 15, 2018. Entitlement to a separate 10 percent rating for left lower extremity peripheral neuropathy (femoral nerve), under Diagnostic Code 8526, is granted, effective October 15, 2018. REMANDED Entitlement to an initial compensable rating for nonproliferative diabetic retinopathy is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s hypertension did not originate in service, was not manifest within one year of service, and is not otherwise etiologically related to the Veteran’s active service or a service-connected disability. 2. Throughout the period on appeal, the Veteran’s erectile dysfunction has been manifested by loss of erectile power, but not by penis deformity. 3. Throughout the period on appeal, the severity, frequency, and duration of the Veteran’s adjustment disorder with depressed mood and organic mood did not more closely approximate occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 4. Throughout the period on appeal, the Veteran’s right hand peripheral neuropathy is manifested, at most, by mild incomplete paralysis of the ulnar nerve. 5. Throughout the period on appeal, the Veteran’s left hand peripheral neuropathy is manifested, at most, by mild incomplete paralysis of the ulnar nerve. 6. Throughout the period on appeal, the Veteran’s right lower extremity peripheral neuropathy is manifested, at most, by mild incomplete paralysis of the sciatic nerve. 7. Throughout the period on appeal, the Veteran’s left lower extremity peripheral neuropathy is manifested, at most, by mild incomplete paralysis of the sciatic nerve. 8. From October 15, 2018, the Veteran’s right hand peripheral neuropathy is manifested, at most, by mild incomplete paralysis of the median nerve, which is found to be directly due to or related to his service-connected diabetes. 9. From October 15, 2018, the Veteran’s left hand peripheral neuropathy is manifested, at most, by mild incomplete paralysis of the median nerve, which is found to be directly due to or related to his service-connected diabetes. 10. From October 15, 2018, the Veteran’s right lower extremity peripheral neuropathy is manifested, at most, by mild incomplete paralysis of the femoral nerve, which is found to be directly due to or related to his service-connected diabetes. 11. From October 15, 2018, the Veteran’s left lower extremity peripheral neuropathy is manifested, at most, by mild incomplete paralysis of the femoral nerve, which is found to be directly due to or related to his service-connected diabetes. CONCLUSIONS OF LAW 1. The criteria for service connection, to include on a secondary basis, for hypertension are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310 (2019). 2. The criteria for a compensable initial rating for erectile dysfunction are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.115b, Diagnostic Code 7599-7522 (2019). 3. The criteria for a rating in excess of 10 percent for adjustment disorder with depressed mood and organic mood are not met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411 (2019). 4. The criteria for an initial rating in excess of 10 percent for right hand peripheral neuropathy (ulnar nerve) are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.124a, Diagnostic Code 8516 (2019). 5. The criteria for an initial rating in excess of 10 percent for left hand peripheral neuropathy (ulnar nerve) are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.124a, Diagnostic Code 8516 (2019). 6. The criteria for an initial rating in excess of 10 percent for right lower extremity peripheral neuropathy (sciatic nerve) are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.124a, Diagnostic Code 8520 (2019). 7. The criteria for an initial rating in excess of 10 percent for left lower extremity peripheral neuropathy (sciatic nerve) are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.124a, Diagnostic Code 8520 (2019). 8. From October 15, 2018, the criteria for an initial rating of 10 percent for right hand peripheral neuropathy (median nerve) are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.124a, Diagnostic Code 8515 (2019). 9. From October 15, 2018, the criteria for an initial rating of 10 percent for left hand peripheral neuropathy (median nerve) are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.124a, Diagnostic Code 8515 (2019). 10. From October 15, 2018, the criteria for an initial rating of 10 percent for right lower extremity peripheral neuropathy (femoral nerve) are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.124a, Diagnostic Code 8526 (2019). 11. From October 15, 2018, the criteria for an initial rating of 10 percent for left lower extremity peripheral neuropathy (femoral nerve) are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.124a, Diagnostic Code 8526 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from October 1984 to November 1984. As confirmed by the Veteran in August 2013 and verified by VA in June 2017, the Veteran has not had any other periods of verified military service. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a May 2006 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) and were previously remanded by the Board in March 2012, January 2015, April 2017, April 2018, and September 2019. The Board’s September 2019 remand directed the RO to obtain any outstanding VA and private treatment records. The Board finds that there has been substantial compliance with its September 2019 remand directives, and it will proceed with adjudication of the issues on appeal. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Additionally, service connection may be granted for a disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310 (2018). Service connection is permitted not only for a disability caused by a service-connected disability, but also for the degree of disability resulting from aggravation to a nonservice-connected disability by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). Entitlement to service connection, to include on a secondary basis, for hypertension The Veteran contends that his claimed hypertension is related to his active service, or, alternatively, proximately due to or aggravated by his service-connected diabetes. There is no dispute that the Veteran has a current disability, as evidenced by a diagnosis of hypertension in his post-service treatment records and 2005, 2017, and 2018 VA examinations. The dispositive issue is whether this disability began during service or within one year thereafter or is otherwise related to service or a service-connected disability. After consideration of the entire record and relevant law, the Board finds that service connection for hypertension is not warranted. The Board has reviewed all of the evidence of record, to include in-service and post-service treatment records, which does not support the finding that hypertension was demonstrated during the Veteran’s military service, that this claimed disability was compensably disabling within one year of separation from active duty, or that there is a nexus between the claimed disability and service or a service-connected disability. Here, the Veteran’s service treatment records are silent for complaints of, symptoms related to, or a diagnosis of and treatment for hypertension. Additionally, the evidence does not show a manifestation of hypertension within one year of the Veteran’s active service, as post-service treatment records during this timeframe are silent for a diagnosis of and treatment for hypertension. The Board notes that a gap of approximately 13 years exists in the Veteran’s treatment records from the time of separation from service up until the Veteran’s reports of and treatment for hypertension in 1997. This period without treatment for hypertension is evidence that there has not been a continuity of symptoms. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991). Thus, the Board finds that the Veteran’s hypertension did not have its onset in active service or within one year thereafter. Further, there is no medical or other competent evidence of a nexus between the Veteran’s hypertension and service or a service-connected disability. As to direct service connection, both the September 2017 and October 2018 VA examiners opined that it is less likely than not that the Veteran’s hypertension was caused by or a result of military service. Specifically, the examiners indicated that the Veteran’s service treatment records are silent for evidence of symptoms of or a diagnosis of hypertension and that the Veteran’s hypertension did not manifest itself until many years after service. Both examiners found that the Veteran’s hypertension is classified as essential, or primary, hypertension, which they opined is more likely due to multiple causes, to include vasculopathy from tobacco use, hyperlipidemia, and obesity. As to the Veteran’s contention that his service-connected diabetes caused or aggravated his hypertension, the 2005, 2017, and 2018 VA examiners all opined that the Veteran’s diabetes did not cause or aggravate his hypertension, as hypertension that is caused or aggravated by diabetes would manifest after the development of significant diabetic renal disease, which the Veteran does not have. The examiners stated that the Veteran has primary hypertension with a direct cause that is not diabetic-related, but instead, caused primarily by the Veteran’s age and obesity. Further, the examiners indicated that the Veteran’s hypertension is shown to be stable due to his medications and there is no aggravation present for which diabetes could be a contributing factor, as the Veteran’s hypertension is categorized as primary or essential, rather than secondary hypertension, which would be caused by another medical disorder. Thus, the Board finds that the Veteran’s hypertension is not related to active service or a service-connected disability. The Board finds the 2005, 2017, and 2018 VA medical opinions to be probative, as they include the most thorough and factually supported opinions of record, given they are consistent with other evidence of record and included review of the Veteran’s claims file. The VA examiners determined that there was no nexus between the Veteran’s hypertension and his military service or a service-connected disability. The VA examiners have training, knowledge, and expertise on which they relied on to form their opinions, and they provided persuasive rationales for them. The Board acknowledges the Veteran’s contention that his current hypertension is related to service or his service-connected diabetes. The Veteran is considered competent to report the observable manifestations of his claimed disability. See Charles v. Principi, 16 Vet. App. 370, 374-75 (2002); Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). While the Veteran is competent to report observable symptoms, the Board finds that determining the etiology of hypertension requires more than a layperson can be expected to competently address. In this case, the etiology of hypertension is a complex medical question that is not within the competence of a lay person and requires medical expertise. As there is no indication that the Veteran has any medical training, education or expertise, the Board finds he is not competent to etiologically link any such symptoms to a current diagnosis. Therefore, the Board finds that the Veteran’s statements as to the etiology of his hypertension are not sufficient to satisfy the requisite nexus requirement. Taking into account all the relevant evidence of record, the Board finds that the weight of the evidence is against the Veteran’s claim of service connection for hypertension. Absent medical or other competent evidence of a nexus between the Veteran’s hypertension and service or a service-connected disability, the Veteran’s claim for service connection must be denied. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Increased Ratings Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2019). The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10 (2019). The determination of whether an increased rating is warranted is based on review of the entire evidence of record and the application of all pertinent regulations. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2019). However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14 (2019). While the Veteran’s entire history is reviewed when making a disability determination, where service connection has already been established and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). However, staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to a compensable initial rating for erectile dysfunction The Veteran seeks a higher initial rating for his erectile dysfunction, which is currently rated as noncompensable under Diagnostic Code 7599-7522. See 38 C.F.R. § 4.27 (hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen). Here, the RO determined that the most closely analogous Diagnostic Code is 7522, Penis deformity, with loss of erectile power. 38 C.F.R. § 4.115b, Ratings of the genitourinary system. As Diagnostic Code 7522 does not provide rating criteria for a noncompensable rating, a noncompensable rating will be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. Under Diagnostic Code 7522, a 20 percent rating is assigned for evidence of penis deformity with loss of erectile power. 38 C.F.R. § 4.115b.  Based on a review of the relevant evidence, the Board finds that a compensable initial rating for erectile dysfunction is not warranted.  Specifically, the March 2005, September 2017, and October 2018 VA examiners found that the Veteran’s erectile dysfunction causes loss of erectile power. However, the examiners did not find evidence of penis deformity. Moreover, post-service VA and private treatment records for the period on appeal are silent for evidence of penis deformity. Here, the 2005, 2017, and 2018 VA examinations and post-service treatment records reflect loss of erectile power, which is consistent with the current noncompensable initial rating assigned under Diagnostic Code 7599-7522.  The probative evidence of record does not demonstrate that the Veteran’s erectile dysfunction causes penis deformity. Accordingly, a compensable initial rating is not warranted.  In conclusion, as the Board finds that the preponderance of the evidence is against the Veteran’s claim for a compensable initial rating for erectile dysfunction, the claim must be denied.  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. Entitlement to a rating in excess of 10 percent for adjustment disorder with depressed mood and organic mood The Veteran asserts that his service-connected adjustment disorder with depressed mood and organic mood (hereinafter “psychiatric disability”) warrants a higher rating. The issue in this appeal is whether the Veteran’s associated symptoms caused the level of impairment required for a disability rating of 30 percent or higher. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria.  Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130 (2019).  The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages.  Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating.  Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).  The Veteran’s psychiatric disability is currently rated as 10 percent disabling under Diagnostic Code 9411. 38 C.F.R. § 4.130 (2019). Under the General Formula, a 30 percent rating is warranted for 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). Id. A 50 percent rating is warranted for 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 per 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. 38 C.F.R. § 4.130. A 70 percent rating is warranted for 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. 38 C.F.R. § 4.130. A 100 percent rating is warranted for total occupational and social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130. Based on a review of the relevant evidence of record, the Board concludes that the Veteran’s psychiatric symptoms for the period on appeal did not cause the level of impairment required for a disability rating of 30 percent or higher.  The Veteran’s symptoms more closely approximated the symptoms associated with a 10 percent rating and resulted in a level of impairment that most closely approximated the level of impairment associated with a 10 percent rating. Post-service VA and private records, the September 2017 and October 2018 VA examinations, and the Veteran’s lay statements show that the Veteran’s psychiatric disability was manifested by symptoms associated with a 10 percent rating (mild symptoms of anxiety and depression).  The Board also finds the level of impairment caused by the Veteran’s psychiatric symptoms more closely approximates the level associated with a 10 percent rating.  The Veteran experienced occupational and social impairment due to mild or transient symptoms which decrease work efficiency and the ability to perform occupational tasks only during periods of significant stress.  Mental status examinations in the Veteran’s post-service VA treatment records indicate that his insight and judgment were good, his thought process and speech were normal, he was oriented to person, place, and time, his memory was intact, and he was found to be capable of managing his financial affairs. During the September 2017 VA examination, the Veteran indicated that he had good relationships, engaged in activities with his cousin, and attended church on Sundays. He did not report current symptoms of depression during the examination and indicated that he is not currently involved in mental health treatment. The examiner opined that it is most likely that the Veteran’s depression had resolved. During the October 2018 VA examination, the Veteran indicated that he recently bought a house that he was fixing up, that he got along with his neighbors, and that he had friends in Panama. Both examiners found that the Veteran’s psychiatric disability produced occupational and social impairment due to mild or transient symptoms. While post-service VA treatment records indicate that the Veteran did experience symptoms contemplated by a 30 percent rating (depressed mood and anxiety), the evidence overall does not demonstrate the level of impairment associated with a 30 percent rating. Here, the severity, frequency, and duration of the Veteran’s depressed mood and anxiety has not risen to the level contemplated by either a 30 percent or higher disability rating.  Throughout the period on appeal, the medical evidence does not reflect that the Veteran’s depressed mood and anxiety produced intermittent periods of inability to perform occupational tasks. During the 2017 VA examination, the Veteran indicated that he stopped working due to his diabetes, not his psychiatric disability. During the 2018 VA examination, the Veteran indicated that he quit his job to help care for his mother when she was diagnosed with cancer. Although post-service VA treatment records indicate that the Veteran stopped working, the Veteran consistently indicated that this was due to his diabetes, rather than his psychiatric disability. Moreover, throughout the period on appeal, the Veteran’s memory was found to be intact, and he did not report symptoms of weekly panic attacks or chronic sleep impairment. Further, the medical evidence of record reflects that his psychiatric symptoms of depression and anxiety even improved over the years. As the Veteran’s VA examinations and post-service VA and private treatment records reflect that, overall, his psychiatric symptoms of depressed mood and anxiety are mild in nature and did not produce intermittent periods of inability perform occupational tasks, the Board finds that a higher 30 percent rating for the Veteran’s psychiatric disability for the period on appeal is not warranted. In conclusion, for the period on appeal, the Veteran’s psychiatric disability symptoms consistently reflect mild symptoms of depressed mood and anxiety, which are contemplated by his current 10 percent rating for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. Therefore, as the Board concludes that the current 10 percent rating for the Veteran’s psychiatric disability is appropriate, the Veteran’s claim for a rating in excess of 10 percent for adjustment disorder with depressed mood and organic mood is denied. 3. Entitlement to an initial rating in excess of 10 percent for right hand peripheral neuropathy (ulnar nerve) 4. Entitlement to an initial rating in excess of 10 percent for left hand peripheral neuropathy (ulnar nerve) The Veteran asserts that his service-connected right hand peripheral neuropathy (ulnar nerve) and left hand peripheral neuropathy (ulnar nerve) warrant higher ratings. The Veteran’s right hand peripheral neuropathy of the ulnar nerve is currently rated as 10 percent disabling, and his left hand peripheral neuropathy of the ulnar nerve is currently rated as 10 percent disabling, both under Diagnostic Code 8516, Incomplete paralysis of the ulnar nerve. 38 C.F.R. § 4.124a. As the Veteran's left hand is his dominant hand, it is considered his "major" side, while his right hand is considered his "minor" side. Under Diagnostic Code 8516, a 30 percent rating is assigned for evidence of moderate incomplete paralysis of the ulnar nerve of the major side, while a 20 percent rating is assigned for evidence of moderate incomplete paralysis of the ulnar nerve of the minor side. 38 C.F.R. § 4.124a. A 40 percent rating is assigned for evidence of severe incomplete paralysis of the ulnar nerve of the major side, while a 30 percent rating is assigned for evidence of severe incomplete paralysis of the ulnar nerve of the minor side. Id. A 60 percent rating, the highest schedular rating allowed, is assigned for evidence of complete paralysis of the ulnar nerve of the major side, while a 50 percent rating, the highest schedular rating allowed, is assigned for evidence of complete paralysis of the ulnar nerve of the minor side, to include symptoms of “griffin claw” deformity, due to flexor contraction of ring and little fingers, atrophy very marked in dorsal interspace and thenar and hypothenar eminences; loss of extension of ring and little fingers cannot spread the fingers (or reverse), cannot adduct the thumb; flexion of wrist weakened. Id. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. 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. Rather than applying a mechanical formula to determine when symptomatology is "mild" or "moderate" etc., the Board must evaluate all of the evidence to ensure an "equitable and just" decision. 38 C.F.R. § 4.6. 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). Turning to the evidence of record, the March 2005 VA examiner found that the Veteran’s peripheral neuropathy of the hands produced numbness and pain that was moderate in nature, but did not result in motor weakness, muscle atrophy, or wasting. Further, the Veteran’s peripheral neuropathy of the hands was not found to cause any functional or occupational impairment. The examiner opined that it was not severe enough to require the use of medication. During the Veteran’s September 2017 VA examination as to his upper extremity peripheral nerves, the Veteran's right and left upper extremity symptoms were found to be moderate as to constant pain and severe as to paresthesias and numbness. Sensation testing for light touch showed normal sensation in the right and left upper extremities. No muscle atrophy or trophic changes were found as to the right and left upper extremities. The examiner diagnosed the Veteran with mild incomplete paralysis of the right and left ulnar nerves. During the Veteran’s October 2018 VA examination as to his upper extremity peripheral nerves, the Veteran’s right and left upper extremity symptoms were found to be moderate as to constant pain, intermittent pain, paresthesias, and numbness. Sensation testing for light touch showed decreased sensation in the hands and fingers. No muscle atrophy or trophic changes were found as to the right and left upper extremities. The examiner diagnosed the Veteran with mild incomplete paralysis of the right and left ulnar nerves, as well as mild incomplete paralysis of the right and left median nerves, which were found to be related to his service-connected diabetes. Post-service VA and private treatment records for the period on appeal reflect the Veteran's reported pain associated with his peripheral neuropathy of the bilateral upper extremities. Based on the above, the Board finds that ratings in excess of 10 percent for right hand peripheral neuropathy (ulnar nerve) and in excess of 10 percent for left hand extremity peripheral neuropathy (ulnar nerve) are not warranted. Here, the medical evidence of record, to include post-service VA and private treatment records and the 2005, 2017, and 2018 VA examinations, reflects that the Veteran's right hand and left hand peripheral neuropathy is primarily manifested by moderate intermittent to constant pain, moderate paresthesias, moderate numbness, some decreased sensation in the right and left upper extremities, and mild incomplete paralysis of the right and left ulnar nerves. The Board also finds that the most probative evidence of record is against a finding that the Veteran's right and left upper extremity peripheral neuropathy is manifested by light touch sensation that is moderate in nature, any trophic changes, any muscle atrophy, or moderate incomplete paralysis of the right and left ulnar nerves. Therefore, the Board finds that the level of impairment associated with the Veteran's right hand and left hand peripheral neuropathy is most analogous to mild incomplete paralysis of the right ulnar nerve and mild incomplete paralysis of the left ulnar nerve. As the Veteran's left side is his dominant side, the Board finds that the currently assigned 10 percent rating for left hand peripheral neuropathy (ulnar nerve) is appropriate, and the currently assigned 10 percent rating for right hand peripheral neuropathy (ulnar nerve) is appropriate. The Board acknowledges the Veteran's assertions that his right hand peripheral neuropathy (ulnar nerve) and left hand peripheral neuropathy (ulnar nerve) are more severe than the assigned disability ratings reflect. The Veteran is competent to report observable symptoms. Layno v. Brown, 6 Vet. App. 465 (1994). However, in this case, the competent medical evidence offering specific specialized determinations relevant to the rating criteria are the most probative evidence with regard to evaluating the pertinent symptoms of the Veteran's right hand peripheral neuropathy (ulnar nerve) and left hand peripheral neuropathy (ulnar nerve). The Board has considered all other potentially applicable Diagnostic Codes and finds that a separate 10 percent rating for right hand peripheral neuropathy (median nerve) and a separate 10 percent rating for left hand peripheral neuropathy (median nerve) are warranted under Diagnostic Code 8515, Incomplete paralysis of the median nerve. During the 2018 VA examination, the examiner found evidence of mild incomplete paralysis of the right and left median nerves associated with diabetic peripheral neuropathy resulting from the Veteran’s service-connected diabetes. Thus, the Board finds sufficient basis to award a separate 10 percent rating for right hand peripheral neuropathy (median nerve) and a separate 10 percent rating for left hand peripheral neuropathy (median nerve) under Diagnostic Code 8515, effective October 15, 2018, the date of the Veteran’s VA examination where mild incomplete paralysis of the right and left median nerves was first diagnosed in connection with the Veteran’s service-connected diabetes. As there is no evidence showing the Veteran has neurological impairment associated with any other upper extremity peripheral nerves that have not already been service-connected, further separate or higher ratings under a different Diagnostic Code are not warranted. In sum, a rating in excess of 10 percent for right hand peripheral neuropathy (ulnar nerve), under Diagnostic Code 8516, is denied; a rating in excess of 10 percent for left hand peripheral neuropathy (ulnar nerve), under Diagnostic Code 8516, is denied; a separate 10 percent rating for right hand peripheral neuropathy (median nerve), under Diagnostic Code 8515, is granted, effective October 15, 2018; and a separate 10 percent rating for left hand peripheral neuropathy (median nerve), under Diagnostic Code 8515, is granted, effective October 15, 2018. 5. Entitlement to an initial rating in excess of 10 percent for right lower extremity peripheral neuropathy (sciatic nerve) 6. Entitlement to an initial rating in excess of 10 percent for left lower extremity peripheral neuropathy (sciatic nerve) The Veteran asserts that his service-connected right lower extremity peripheral neuropathy (sciatic nerve) and left lower extremity peripheral neuropathy (sciatic nerve) warrant higher ratings. The Veteran’s right lower extremity peripheral neuropathy of the sciatic nerve is currently rated as 10 percent disabling, and his left lower extremity peripheral neuropathy of the sciatic nerve is currently rated as 10 percent disabling, both under Diagnostic Code 8520, Incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a. Under Diagnostic Code 8520, 20 percent rating is assigned for evidence of moderate incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a. A 40 percent rating is assigned for evidence of moderately severe incomplete paralysis of the sciatic nerve. Id. A 60 percent rating is assigned for evidence of severe incomplete paralysis, with marked muscle atrophy, of the sciatic nerve. Id. An 80 percent rating, the highest schedular rating allowed, is assigned for evidence of complete paralysis of the sciatic nerve, to include symptoms of foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. Id. Turning to the evidence of record, the March 2005 VA examiner found that the Veteran’s peripheral neuropathy of the lower extremities produced pain and tingling in the feet that was moderate in nature, but did not result in motor weakness, muscle atrophy, or wasting. Further, the Veteran’s peripheral neuropathy of the lower extremities was not found to cause any functional or occupational impairment. The examiner opined that it was not severe enough to require the use of medication. During the Veteran’s September 2017 VA examination as to his lower extremity peripheral nerves, the Veteran's right and left lower extremity symptoms were found to be severe as to constant pain, paresthesias, and numbness. Sensation testing for light touch showed decreased sensation in the feet and toes, with normal sensation in the knees, thighs, ankles, and lower legs. No muscle atrophy or trophic changes were found as to the right and left lower extremities. The examiner diagnosed the Veteran with mild incomplete paralysis of the right and left sciatic nerves. During the Veteran’s October 2018 VA examination as to his lower extremity peripheral nerves, the Veteran’s right and left lower extremity symptoms were found to be moderate as to constant pain, intermittent pain, paresthesias, and numbness. Sensation testing for light touch showed decreased sensation in the feet, toes, ankles, and lower legs, with normal sensation in the knees and thighs. No muscle atrophy was found. Trophic changes in terms of loss of hair and smooth shiny skin was found from the ankles down in both lower extremities. The examiner diagnosed the Veteran with mild incomplete paralysis of the right and left sciatic nerves, as well as mild incomplete paralysis of the right and left femoral nerves, which were found to be related to his service-connected diabetes. Post-service VA and private treatment records for the period on appeal reflect the Veteran's reported pain associated with his peripheral neuropathy of the bilateral lower extremities. Based on the above, the Board finds that ratings in excess of 10 percent for right lower extremity peripheral neuropathy (sciatic nerve) and in excess of 10 percent for left lower extremity peripheral neuropathy (sciatic nerve) are not warranted. Here, the medical evidence of record, to include post-service VA and private treatment records and the 2005, 2017, and 2018 VA examinations, reflects that the Veteran's right and left lower extremity peripheral neuropathy is primarily manifested by moderate intermittent to constant pain, moderate paresthesias, moderate numbness, some decreased sensation in parts of the lower extremities, but not all, some trophic changes below the ankles, and mild incomplete paralysis of the right and left sciatic nerves. The Board also finds that the most probative evidence of record is against a finding that the Veteran's right and left lower extremity peripheral neuropathy is manifested by light touch sensation that is moderate in nature, trophic changes that are moderate in nature, any muscle atrophy, or moderate incomplete paralysis of the right and left ulnar nerves. Therefore, the Board finds that the level of impairment associated with the Veteran's right and left lower extremity peripheral neuropathy is most analogous to mild incomplete paralysis of the right sciatic nerve and mild incomplete paralysis of the left sciatic nerve. The Board finds that the currently assigned 10 percent rating for right lower extremity peripheral neuropathy (sciatic nerve) is appropriate, and the currently assigned 10 percent rating for left lower extremity peripheral neuropathy (sciatic nerve) is appropriate. The Board acknowledges the Veteran's assertions that his right lower extremity peripheral neuropathy (sciatic nerve) and left lower extremity peripheral neuropathy (sciatic nerve) are more severe than the assigned disability ratings reflect. The Veteran is competent to report observable symptoms. Layno v. Brown, 6 Vet. App. 465 (1994). However, in this case, the competent medical evidence offering specific specialized determinations relevant to the rating criteria are the most probative evidence with regard to evaluating the pertinent symptoms of the Veteran's right lower extremity peripheral neuropathy (sciatic nerve) and left lower extremity peripheral neuropathy (sciatic nerve). The Board has considered all other potentially applicable Diagnostic Codes and finds that a separate 10 percent rating for right lower extremity peripheral neuropathy (femoral nerve) and a separate 10 percent rating for left lower extremity peripheral neuropathy (femoral nerve) are warranted under Diagnostic Code 8526, Incomplete paralysis of the anterior crural nerve (femoral). During the 2018 VA examination, the examiner found evidence of mild incomplete paralysis of the right and left femoral nerves associated with diabetic peripheral neuropathy resulting from the Veteran’s service-connected diabetes. Thus, the Board finds sufficient basis to award a separate 10 percent rating for right lower extremity peripheral neuropathy (femoral nerve) and a separate 10 percent rating for left lower extremity peripheral neuropathy (femoral nerve) under Diagnostic Code 8526, effective October 15, 2018, the date of the Veteran’s VA examination where mild incomplete paralysis of the right and left femoral nerves was first diagnosed in connection with the Veteran’s service-connected diabetes. As there is no evidence showing the Veteran has neurological impairment associated with any other lower extremity peripheral nerves that have not already been service-connected, further separate or higher ratings under a different Diagnostic Code are not warranted. In sum, a rating in excess of 10 percent for right lower extremity peripheral neuropathy (sciatic nerve), under Diagnostic Code 8520, is denied; a rating in excess of 10 percent for left lower extremity peripheral neuropathy (sciatic nerve), under Diagnostic Code 8520, is denied; a separate 10 percent rating for right lower extremity peripheral neuropathy (femoral nerve), under Diagnostic Code 8526, is granted, effective October 15, 2018; and a separate 10 percent rating for left lower extremity peripheral neuropathy (femoral nerve), under Diagnostic Code 8526, is granted, effective October 15, 2018. REASONS FOR REMAND Entitlement to a compensable initial rating for nonproliferative diabetic retinopathy is remanded. Post-service VA treatment records from the Salem Health VA Clinic indicate that the Veteran underwent an eye consultation on November 15, 2019. However, the claims file is silent for the corresponding examination report. This medical record appears relevant to the Veteran’s claim as it may include further information pertaining to the history of symptoms and current severity of the Veteran’s service-connected bilateral eye disability. VA has a duty to seek this record.  38 U.S.C. § 5103A(b)(1) (2012). Entitlement to a TDIU is remanded. The Veteran asserts that his service-connected disabilities preclude him from obtaining and maintaining substantially gainful employment. Pursuant to the Board’s April 2018 remand directives, the Veteran was asked to substantiate his claim by completing a VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability. However, the Veteran’s VA Form 21-8940 is incomplete as to his employment statement section. Specifically, dates of employment and gross earnings information is missing, as is the date that the Veteran claims that he became too disabled to work. As the Board does not have sufficient information regarding the Veteran’s earned income and dates of employment to fully adjudicate his claim, the matter must be remanded again to obtain the Veteran’s employment documentation. The Veteran is reminded that VA’s duty to assist is not always a one-way street. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Rather, the Veteran must cooperate in obtaining the evidence necessary to adjudicate the Veteran’s claim. The matters are REMANDED for the following action: 1. With any necessary identification of sources and authorization by the Veteran, request all VA treatment records for the Veteran not already associated with the file from November 2019 to the present, to specifically include VA treatment records from the Salem Health VA Clinic (November 15, 2019 eye examination results). Copies of any outstanding VA treatment records should be added to the Veteran’s electronic claims file. 2. The Agency of Original Jurisdiction (AOJ) should contact the Veteran and request that he provide information verifying his income, to include submitting a complete VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability and/or VA Employment Questionnaire. The Veteran should be informed that he may also submit copies of W-2 forms or his tax returns, or statements from his previous employers verifying his income earned. 3. After completing all indicated development, the AOJ should readjudicate the Veteran’s claims. If the benefits sought on appeal remain denied, the Veteran should be furnished with a supplemental statement of the case, given the opportunity to respond, and the case should thereafter be returned to the Board for further appellate review, if warranted. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Houle, 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.