Citation Nr: 21066685 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 09-46 800 DATE: November 1, 2021 ORDER Service connection for numbness in the face (mask area), to include as secondary to diabetes mellitus is denied. REMANDED A total disability rating for compensation based on individual unemployability (TDIU). FINDING OF FACT The evidence of record does not establish that the Veteran has numbness/tingling in the face (mask area), to include as secondary to diabetes mellitus. CONCLUSION OF LAW The criteria for service connection for numbness in the face (mask area), to include as secondary to diabetes mellitus have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1964 to February 1967. The case is on appeal from a February 2010 rating decision. In April 2015, the Veteran testified at a Board hearing. The claim was last before the Board in May 2021. At that time, the Board remanded the claims of service connection for residuals of a right ankle/foot injury; genitourinary dysfunction, to include as secondary to diabetes mellitus; numbness in the face (mask area), to include as secondary to diabetes mellitus; and, TDIU for further development. While the claim was in appellate status, the RO issued an August 2021 rating decision granting service connection for benign prostate hypertrophy with an evaluation of 20 percent, effective December 1, 2009, and service connection for right ankle degenerative arthritis with an evaluation of 0 percent, effective May 27, 2008. Thus, the issues that remain on appeal are service connection for numbness in the face and TDIU. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service connection for numbness in the face (mask area), to include as secondary to diabetes mellitus. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(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." Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. See 38 C.F.R. § 3.310. Analysis The Veteran contends he currently has numbness/tingling in his face, which he asserts is secondary to his service-connected diabetes mellitus. Review of the record does not show that the Veteran currently has numbness or tingling of the face or that his past experiences are related to his service-connected diabetes mellitus. Service treatment records (STRs), including his entrance and separation examinations, are silent for any complaints, treatment, or diagnosis of this disorder. Medical records provided from November 2009 note the Veteran did not experience numbness in the mask type region of the face. In February 2010, he reported having numbness in his face. An August 2010 neurology consult provided the Veteran experienced intermittent numbness in the mask distribution of his face, where he would feel his nose and lips get numb. In November 2016, the Veteran reported that he was diagnosed with severe neuropathy in September 2009 in his hands, feet, and in the mask distribution of his face. He also denied any numbness of the race, rather endorsing an intermittent tingling under his eyes for the past 3 years. The Veteran was afforded a VA examination in July 2016 for neuropathy. The examiner noted that, in September 2009, he was diagnosed with severe neuropathy in the hands, feet, and mask distribution. Additionally, in August 2010, he noted that the initial symptoms of tingling/numbness were constant, including his nose and lips. While the examiner noted the Veteran reported intermittent tingling of the face, it was provided that this tingling is not consistent with diabetic neuropathy, as it does not affect the face and does not follow a typical diabetic pattern. Therefore, the etiology is unknown. Pursuant to the Board's May 2021 remand, the Veteran was afforded a VA examination regarding facial numbness/tingling in August 2021. The examiner opined the Veteran's condition was less like than not incurred in or caused by active-duty service. As rationale, the examiner provided the Veteran did not develop symptoms of facial numbness until 2012, which is post-service. Further, the claimed condition is less likely than not proximately due to or the result of the Veteran's service-connected conditions, including diabetic neuropathy of the upper and lower extremities and diabetes mellitus type II. As rationale, the examiner provided medical evidence fails to show this disability has been clinically diagnosed. While the Veteran has subjective complaints of tingling in the upper face, there are no objective findings to make a diagnosis. Further, numbness is a symptom, and service connection cannot be granted in the absence of a current, chronic condition that is incurred in or aggravated by service that numbness is attributed to. His STRs and PMEs were silent for complaints of, or treatment for, facial numbness or a diagnosis of a condition that facial numbness is a symptom of. Lacking a current diagnosis for facial numbness/tingling, the Veteran does not meet the cornerstone element of service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). This includes the potential of symptoms without a diagnosis as functional impairment has not been shown. See Saunders, 886 F.3d at 1361. As such, an assessment of the remaining elements is not necessary, and service connection for facial numbness/tingling is not warranted. The Board has considered, with sympathy, the Veteran's reports that he has experienced facial tingling and numbness. However, as the presence/diagnosis and cause of facial numbness/tingling is not something that can be determined based on observable symptoms alone, the Board does not afford probative weight to his assertions with respect to the etiology and diagnosis of his symptoms. Rather, the Board finds the examiner's findings and the other medical evidence of record to be the most probative evidence on these questions. As such, the preponderance of the evidence is against the claim and the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Therefore, service connection for numbness in the face (mask area) is not warranted. REASONS FOR REMAND A TDIU. Pursuant to the Board's remand, the RO sent the Veteran a TDIU application (VA Form 21-8940) in May 2021 and previously in February 2018 and June 2015. He has not yet submitted a completed application with his employment history information. On remand, the RO should again send the Veteran a TDIU application and request that he complete and return it. Failure to return the form may be abandonment of the TDIU claim. See Jernigan v. Shinseki, 25 Vet. App. 220, 229-30 (2012). The matters are REMANDED for the following action: Allow the Veteran an opportunity to provide his employment history and submit a VA Form 21-8940 (Application for Increased Compensation Based on Unemployability) in addition to any additional evidence that is relevant with regard to his claim for a TDIU. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Becton, 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.