Citation Nr: 21069234 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 14-03 107 DATE: November 17, 2021 ORDER Entitlement to a 40 percent disability rating, but no higher, for peripheral neuropathy of the right upper extremity for the period prior to November 5, 2018 is granted. Entitlement to a 30 percent disability rating, but no higher, for peripheral neuropathy of the left upper extremity for the period prior to November 5, 2018 is granted. Entitlement to a 70 percent disability rating, but no higher, for peripheral neuropathy of the right upper extremity for the period since November 5, 2018 is granted. Entitlement to a 60 percent disability rating, but no higher, for peripheral neuropathy of the left upper extremity for the period since November 5, 2018 is granted. Entitlement to a 20 percent rating, but no higher, for peripheral neuropathy of the right lower extremity for the period prior to May 14, 2018 is granted. Entitlement to a 20 percent rating, but no higher, for peripheral neuropathy of the left lower extremity for the period prior to May 14, 2018 is granted. Entitlement to a 40 percent rating, but no higher, for peripheral neuropathy of the right lower extremity for the period since May 14, 2018 is granted. Entitlement to a 40 percent rating, but no higher, for peripheral neuropathy of the left lower extremity for the period since May 14, 2018 is granted. Entitlement to an initial rating in excess of 20 percent for peripheral neuropathy of the right lower extremity (femoral nerve) is denied. Entitlement to an initial rating in excess of 20 percent for peripheral neuropathy of the left lower extremity (femoral nerve) is denied. Entitlement to an initial compensable evaluation for peripheral neuropathy of the right lower extremity (external cutaneous nerve) is denied. Entitlement to an initial compensable evaluation for peripheral neuropathy of the left lower extremity (external cutaneous nerve) is denied. Entitlement to an initial compensable evaluation for peripheral neuropathy of the right lower extremity (ilio-inguinal nerve) is denied. Entitlement to an initial compensable evaluation for peripheral neuropathy of the left lower extremity (ilio-inguinal nerve) is denied. Entitlement to an initial compensable evaluation for peripheral neuropathy of the right lower extremity (obturator nerve) is denied. Entitlement to an initial compensable evaluation for peripheral neuropathy of the left lower extremity (obturator nerve) is denied. Entitlement to a total disability evaluation based on individual unemployability (TDIU) is dismissed. FINDINGS OF FACT 1. For the period prior to November 5, 2018, the Veteran exhibited symptoms consistent with moderate incomplete paralysis of the of the right and left upper extremities. 2. For the period since November 5, 2018, the Veteran exhibited symptoms consistent with severe incomplete paralysis of the of the right and left upper extremities. 3. For the period prior to May 14, 2018, the Veteran exhibited peripheral neuropathy consistent with moderate incomplete paralysis in the bilateral lower extremities. 4. For the period since May 14, 2018, the Veteran exhibited peripheral neuropathy consistent with moderately severe incomplete paralysis in the bilateral lower extremities. 5. The Veteran has exhibited symptoms consistent with moderate incomplete paralysis of the femoral nerve in the right and left lower extremities. 6. The impairment of the Veteran's right and left external cutaneous nerve are no more than moderate in degree. 7. The impairment of the Veteran's right and left ilio-inguinal nerve are no more than moderate in degree. 8. The impairment of the Veteran's right and left obturator nerves are no more than moderate in degree. 9. As a 100 percent combined schedular rating has been assigned for the period since May 26, 2010, the matter of entitlement to a TDIU rating is rendered moot. CONCLUSIONS OF LAW 1. The criteria for a 40 percent disability rating, but no higher, for peripheral neuropathy, right upper extremity for the period prior to November 5, 2018 have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, Diagnostic Code 8513 (2020). 2. The criteria for a 40 percent disability rating, but no higher, for peripheral neuropathy, left upper extremity for the period prior to November 5, 2018 have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, Diagnostic Code 8513 (2020). 3. The criteria for a 70 percent disability rating, but no higher, for peripheral neuropathy, right upper extremity for the period since November 5, 2018 have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, Diagnostic Code 8513 (2020). 4. The criteria for a 60 percent disability rating, but no higher, for peripheral neuropathy, left upper extremity for the period since November 5, 2018 have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, Diagnostic Code 8513 (2020). 5. For the period prior to May 14, 2018, the criteria for a 20 percent disability evaluation, but no higher, for peripheral neuropathy of the right lower extremity have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, Diagnostic Code 8520 (2020). 6. For the period prior to May 14, 2018, the criteria for a 20 percent disability evaluation, but no higher, for peripheral neuropathy of the left lower extremity have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, Diagnostic Code 8520 (2020). 7. For the period since May 14, 2018, the criteria for a 40 percent disability evaluation, but no higher, for peripheral neuropathy of the right lower extremity have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, Diagnostic Code 8520 (2020). 8. For the period since May 14, 2018, the criteria for a 40 percent disability evaluation, but no higher, for peripheral neuropathy of the left lower extremity have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, Diagnostic Code 8520 (2020). 9. The criteria for an initial rating in excess of 20 percent for the Veteran's peripheral neuropathy of the right lower extremity (femoral branch) have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, Diagnostic Code 8526 (2020). 10. The criteria for an initial rating in excess of 20 percent for the Veteran's peripheral neuropathy of the left lower extremity (femoral branch) have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, Diagnostic Code 8526 (2020). 11. The criteria for an initial compensable rating for peripheral neuropathy of the right lower extremity (external cutaneous nerve) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.124a, Diagnostic Code 8529 (2020). 12. The criteria for an initial compensable rating for peripheral neuropathy of the left lower extremity (external cutaneous nerve) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.124a, Diagnostic Code 8529 (2020). 13. The criteria for an initial compensable rating for peripheral neuropathy of the right lower extremity (ilio-inguinal nerve) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.124a, Diagnostic Code 8530 (2020). 14. The criteria for an initial compensable rating for peripheral neuropathy of the left lower extremity (ilio-inguinal nerve) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.124a, Diagnostic Code 8530 (2020). 15. The criteria for an initial compensable rating for peripheral neuropathy of the right lower extremity (obturator nerve) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.124a, Diagnostic Code 8528 (2020). 16. The criteria for an initial compensable rating for peripheral neuropathy of the left lower extremity (obturator nerve) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.124a, Diagnostic Code 8528 (2020). 17. The claim for a TDIU rating is moot. 38 C.F.R. § 4.16 (a) (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1966 to August 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a May 2017 videoconference hearing. A copy of the transcript is associated with the record. The Board remanded these issues in March 2020 for additional development. In an August 2021 rating decision, the RO granted an increased 40 percent rating for peripheral neuropathy of the right upper extremity, effective November 5, 2018 and granted an increased 30 percent rating for increased peripheral neuropathy of the left upper extremity, effective November 5, 2018. As the highest possible evaluation for these disabilities have not been assigned, the appeals for entitlement to an evaluation in excess of 40 percent for peripheral neuropathy of the right upper extremity and an evaluation in excess of 30 percent for peripheral neuropathy of the left upper extremity for the period since November 5, 2018 continue. See AB v. Brown, 6 Vet. App. 35 (1993). The Board additionally notes that the RO in the August 2021 rating decision granted service connection for peripheral neuropathy of the right lower extremity (femoral nerve) at an initial 20 percent disability rating, effective November 5, 2018; granted service connection for peripheral neuropathy of the left lower extremity (femoral nerve) at an initial 20 percent disability rating, effective November 5, 2018; granted service connection for peripheral neuropathy of the right lower extremity (external cutaneous nerve) at an initial noncompensable disability rating, effective March 19, 2021; granted service connection for peripheral neuropathy of the left lower extremity (external cutaneous nerve) at an initial noncompensable disability rating, effective March 19, 2021; granted service connection for peripheral neuropathy of the right lower extremity (ilio-inguinal nerve) at an initial noncompensable disability rating, effective March 19, 2021; granted service connection for peripheral neuropathy of the left lower extremity (ilio-inguinal nerve) at an initial noncompensable disability rating, effective March 19, 2021; granted service connection for peripheral neuropathy of the right lower extremity (obturator nerve) at an initial noncompensable disability rating, effective March 19, 2021; and granted service connection for peripheral neuropathy of the left lower extremity (obturator nerve) at an initial noncompensable disability rating, effective March 19, 2021. Accordingly, these issues are part and parcel of the matters already on appeal and are therefore in appellate status. AB v. Brown, 6 Vet. App. 35, 39 (1993). Laws and Regulations The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claims or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claims, in which case, the claims are denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2012). Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2020). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2020). The Veteran's entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1 (2020). 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. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, in Fenderson v. West, 12 Vet. App. 119 (1999), it was held that evidence to be considered in the appeal of an initial assignment of a disability rating was not limited to that reflecting the then current severity of the disorder. The Court also discussed the concept of the "staging" of ratings, finding that, in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. See also Hart v. Mansfield, 21 Vet. App. 505 (2008). 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2020). In this case, the Veteran is competent to testify on factual matters of which he has first-hand knowledge. Washington v. Nicholson, 19 Vet. App. 362 (2005). He is also competent to report symptoms of his upper and lower extremity peripheral neuropathy disabilities. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). The Veteran is competent to describe his symptoms and their effects on employment or daily activities. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40. Functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. 38 C.F.R. § 4.59 (discussing facial expressions such as wincing, muscle spasm, crepitation, etc.). Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Excess fatigability and incoordination should be taken into account in addition to more movement than normal, less movement than normal, and weakened movement. 38 C.F.R. § 4.45. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. See 38 C.F.R. § 4.59. Although the first sentence of 38 C.F.R. § 4.59 refers only to arthritis, the regulation applies to joint conditions other than arthritis. Burton v. Shinseki, 25 Vet. App. 1, 3-5 (2011). In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). Although pain may cause functional loss, pain itself does not constitute functional loss. Rather, pain must affect some aspect of "the normal working movements of the body," such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40). The Veteran filed a claim for an increased rating that was received by VA in May 2010. The Veteran has current 10 percent evaluations for the period prior to November 5, 2018 under Diagnostic Codes 7913-8515 (diabetes mellitus-paralysis of the median nerve) for peripheral neuropathy of the right and left upper extremities. For the period since November 5, 2018, the Veteran has 40 and 30 percent disability evaluations for peripheral neuropathy of the right and left upper extremities under Diagnostic Code 8513. The Veteran has current 10 percent evaluations for the period prior to May 14, 2018 and 20 percent disability evaluations for the period since May 14, 2018 for peripheral neuropathy of the right and left lower extremities under Diagnostic Code 8520. As noted above, an August 2021 rating decision granted service connection for peripheral neuropathy of the right and left lower extremities (femoral nerve) at initial 20 percent disability ratings under Diagnostic Code 8526; granted service connection for peripheral neuropathy of the right and left lower extremities (external cutaneous nerve) at initial noncompensable disability ratings under Diagnostic Code 8529; granted service connection for peripheral neuropathy of the right and left lower extremities (ilio-inguinal nerve) at initial noncompensable disability ratings under Diagnostic Code 8530; and granted service connection for peripheral neuropathy of the right and left lower extremities (obturator nerve) at initial noncompensable disability ratings, under Diagnostic Code 8528. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, Diagnostic Codes 8513, 8520, 8526, 8528, 8529 and 8530 were not changed. Because the Veteran is right-handed, his right side is his major (dominant) side. Under Diagnostic Code 8513 (all radicular groups), a disability rating of 20 percent is assigned for mild incomplete paralysis all radicular groups on the dominant and nondominant sides. A disability rating of 30 percent is assigned for moderate incomplete paralysis of the nondominant upper extremity, and a disability rating of 40 percent is assigned for moderate incomplete paralysis of the dominant upper extremity. A disability rating of 60 percent is also assigned for severe incomplete paralysis of the nondominant upper extremity, and a disability rating of 70 percent is assigned for severe incomplete paralysis of the dominant upper extremity. A disability rating of 80 percent is assigned for complete paralysis of the nondominant upper extremity, and a disability rating of 90 percent is assigned for complete paralysis of the dominant upper extremity. Diagnostic Code 8515 addresses complete and incomplete paralysis of the medial nerve. Under this diagnostic code, moderate incomplete paralysis warrants a 20 percent rating for the minor wrist and a 30 percent rating for the major wrist. Severe incomplete paralysis warrants a 40 percent rating for the minor wrist and a 50 percent rating for the major wrist. Complete paralysis with the hand inclined to the ulnar side, the index and middle fingers more extended than normal, considerable atrophy of the muscles of thenar eminence, the thumb in the plane of the hand; pronation incomplete and effective, absence of flexion of the index finger and feeble flexion of the middle finger, that cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of the thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; and pain with trophic disturbances warrants a 60 percent rating for the minor wrist and a 70 percent disability rating for the major wrist. See 38 C.F.R. § 4.124a, Diagnostic Code 8515. Under Diagnostic Code 8514 (radial nerve), a 30/20 percent evaluation is warranted for moderate incomplete paralysis major/minor arm. A 50/40 percent evaluation is warranted for severe incomplete paralysis of the major/minor arm. A 70/60 percent evaluation is warranted for complete paralysis of the radial nerve with drop of hand and fingers, wrist and fingers perpetually flexed, the thumb adducted falling within the line of the outer border of the index finger; cannot extend hand at wrist, extend proximal phalanges of fingers, extend thumb or make lateral movement of the wrist; supination of hand, extension and flexion of elbow weakened, the loss of synergic motion of extensors impairs the hand grip seriously; total paralysis of the triceps occurs only as the greatest rarity. Under Diagnostic Code 8516 (ulnar nerve), a 30/20 percent evaluation is warranted for moderate incomplete paralysis of the major/minor arm. A 40/30 percent evaluation is warranted for severe incomplete paralysis the major/minor arm. A 60/50 percent evaluation is warranted for complete paralysis of the ulnar nerve with the "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. Under Diagnostic Codes 8520, a 10 percent rating is warranted for mild incomplete paralysis. A 20 percent evaluation is warranted for moderate incomplete paralysis of the sciatic nerve of the lower extremity. A 40 percent evaluation is warranted for moderately severe incomplete paralysis of the sciatic nerve of the lower extremity. A 60 percent evaluation is warranted for severe incomplete paralysis, with marked muscular atrophy, of the sciatic nerve of the lower extremity. An 80 percent evaluation is warranted for complete paralysis of the sciatic nerve of the lower extremity. 38 C.F.R. § 4.124a, Diagnostic Codes 8520. Diagnostic Codes 8526, 8626, and 8726 provide ratings for paralysis, neuritis, and neuralgia of the anterior crural (femoral) nerve. Neuritis and neuralgia are rated as incomplete paralysis. Disability ratings of 10, 20, and 30 percent are warranted, respectively, for mild, moderate, severe incomplete paralysis of the femoral nerve. A 40 percent rating is warranted with complete paralysis of the femoral nerve. 38 C.F.R. § 4.124a, Diagnostic Code 8526 (2020). Diagnostic Codes 8528-8530, 8628-8630, and 8728-8730, provide ratings for paralysis, neuritis, and neuralgia of the obturator, external cutaneous, and ilio-inguinal nerves. Neuritis and neuralgia are rated as incomplete paralysis. For each disability, a maximum 10 percent rating is warranted for severe incomplete paralysis or paralysis of the respective nerve. Mild or moderate impairment of each nerve (obturator, external cutaneous, and ilio-inguinal) warrant noncompensable ratings. 38 C.F.R. § 4.124a, Diagnostic Codes 8528-8530, 8628-8630, and 8728-8730 (2020). The term "incomplete paralysis" indicates a degree of lost or impaired function that is substantially less than that which is described in the criteria for an evaluation for complete paralysis of this nerve, whether the less than total paralysis is due to the varied level of the nerve lesion or to partial nerve regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. The words "mild," "moderate" and "severe" are not defined in the VA Schedule for Ratings Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6 (2020). It should also be noted that use of such terminology by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. § 4.2, 4.6 (2020). Factual Background and Analysis The Veteran underwent a VA examination in September 2009. The Veteran presented with complaints of mild to moderate numbness in his upper and lower extremities. It was noted that he used to work as a locksmith but was currently working at a part-time security job. The examiner noted that the Veteran had mild distal peripheral neuropathy of the upper and lower extremities which was currently stable. The Veteran underwent a VA examination in November 2013. The Veteran presented with complaints of numbness and tingling in the bilateral hands and feet. On examination, he had mild intermittent pain in the right and left upper extremities, mild paresthesia in the right and left upper extremities and moderate numbness in the bilateral upper and lower extremities. Strength testing was normal while reflex testing revealed decreased reflexes in the bilateral triceps and ankles. Light touch testing was decreased bilaterally in the upper and lower extremities as was position sense in the bilateral lower extremities. Vibration sensation and cold sensation were decreased on the bilaterally in the upper and lower extremities. The Veteran did not have trophic changes or muscle atrophy. The examiner found that the Veteran's peripheral neuropathy did not impact his ability to work. The examiner indicated that the Veteran had mild to moderate diabetic peripheral neuropathy of both the upper and lower bilateral extremities. The Veteran underwent a VA examination in March 2015. The Veteran presented with complaints of pain, numbness and tingling in the bilateral hands and feet. On examination, the Veteran had mild constant pain of the bilateral lower extremities. He had mild intermittent pain, paresthesia and numbness in the right and left upper and lower extremities. Strength testing was normal while reflex testing revealed decreased reflexes in the ankles. Light touch testing was decreased bilaterally in the hands and feet. Position sense was normal but vibration sensation was decreased bilaterally in the upper and lower extremities. The Veteran did not have trophic changes or muscle atrophy. For the upper extremity, the Veteran had mild incomplete paralysis of the median nerve while for the lower extremity he had mild incomplete paralysis of the sciatic nerve. The examiner found that the Veteran's peripheral neuropathy did not impact his ability to work. During the May 2017 Board hearing, the Veteran's work supervisor testified that the Veteran's neuropathy has rendered him unemployable. The supervisor noted the Veteran had problems with his hands as well as walking. The Veteran testified that pain medication prescribed for this condition affected his ability to work and made him light headed. The Veteran described pain and weakness related to his neuropathy, which had resulted in more than a dozen falls in the year prior to the May 2017 Board hearing. The Veteran also testified he used a cane due to his neuropathy. The Veteran underwent a VA examination in May 2018. The Veteran presented with complaints of pain, numbness and tingling in the bilateral hands and feet. On examination, the Veteran had mild constant pain of the bilateral upper and lower extremities. He had mild intermittent pain of the upper extremities and moderate intermittent pain of the bilateral lower extremities. He had mild paresthesia and numbness in the right and left upper and lower extremities. Strength testing was normal while reflex testing revealed decreased reflexes in the ankles. Light touch testing was decreased bilaterally in the feet and toes. Position sense was decreased in the right and left lower extremities. The Veteran did not have trophic changes or muscle atrophy. For the upper extremity, the Veteran had mild incomplete paralysis of the median nerve while for the lower extremity he had moderate incomplete paralysis of the sciatic nerve. The examiner found that the Veteran's peripheral neuropathy did not impact his ability to work. A November 2018 Diabetic Sensory-Motor Neuropathy Disability Benefits Questionnaire (DBQ) indicated that the Veteran had severe constant pain and severe intermittent pain of the bilateral upper and lower extremities. The Veteran also had moderate paresthesia and numbness of the bilateral upper and lower extremities. Muscle strength testing revealed less than normal strength (4/5). Deep tendon reflexes and light touch testing were decreased. Position sense and vibration sensation were decreased in the bilateral lower extremities. Cold sensation was decreased in the bilateral upper and lower extremities. There was atrophy and the Veteran had trophic changes. The private physician found that the Veteran had moderate bilateral peripheral neuropathy of the ulnar, radial and median nerves. The Veteran also had moderately severe bilateral peripheral neuropathy of the sciatic and femoral, nerves. The physician found that the Veteran's peripheral neuropathy impacted his ability to work as he was in constant pain. Per the March 2020 Board remand instructions, the Veteran underwent a VA examination in March 2021. The Veteran reported that he had no feeling in his hands and that his feet were numb and weak most of the time which resulted in him being unable to stand for long periods of time. It was noted that his neuropathy was more severe than it was before. The examiner noted that the Veteran was suffering from moderately severe lumbar radiculopathy and peripheral neuropathy which can affect his ability to work. On examination, the Veteran had moderate constant pain, moderate paresthesia and moderate numbness of the bilateral upper and lower extremities. There was no muscle atrophy. Reflexes and strength testing were normal. He had trophic changes as there was loss of hair and smoothness of the hands and legs. The Veteran had moderate incomplete paralysis of the ulnar, radial, median, musculocutaneous, circumflex, long thoracic, upper radicular group, middle radicular group and lower radicular group nerves of the bilateral extremities. He had moderately severe incomplete paralysis of the bilateral sciatic nerve. He had moderate incomplete paralysis of the external popliteal, superficial peroneal, deep peroneal, tibial, posterior tibial, femoral, internal saphenous, obturator, external cutaneous and ilio-inguinal nerves. He did not use any assistive devices. The examiner found that the Veteran's peripheral neuropathy impacted his ability to work as he had difficulty standing for long periods of time and difficulty walking without assistance. He had problems with balance and was an increased risk of falling. The examiner noted that the Veteran was unable to perform sedentary work. In a June 2021 addendum opinion, the March 2021 VA examiner noted that the Veteran had problems with positional awareness and that for the last 18 months the symptoms had worsened. The Veteran used a cane and a walker regularly due to his lower extremity peripheral neuropathy. Bilateral Upper Extremities Period prior to November 5, 2018 For the period prior to November 5, 2018, the Veteran's service-connected peripheral neuropathy of the bilateral upper extremities are rated as 10 percent disabling under Diagnostic Codes 7913-8515. Under the circumstances of this case, and with resolution of all reasonable doubt in the Veteran's favor, the Board concludes that a 40 percent disability rating, but no higher, is warranted for peripheral neuropathy of the upper right extremity and a 30 percent disability rating, but no higher, is warranted for peripheral neuropathy of the upper left extremity for the period prior to November 5, 2018. As noted above, a 40 percent rating is warranted for moderate incomplete paralysis of the dominant upper extremity while a 30 percent rating is warranted for moderate incomplete paralysis of the non-dominant extremity under Diagnostic Code 8515. Notably, the May 2018 VA examiner found that the Veteran had mild incomplete paralysis of the median nerve. However, on VA examination in September 2009 the Veteran reported having mild to moderate numbness of the bilateral upper extremities while the November 2013 VA examination specifically indicated that the Veteran had mild to moderate diabetic peripheral neuropathy of both the upper bilateral extremities. As a result and when affording the Veteran the benefit of the doubt, the Board finds that a 40 percent rating is warranted for moderate incomplete paralysis of the right (dominant) upper extremity and a 30 percent rating is warranted for moderate incomplete paralysis of the left (non-dominant) upper extremity under Diagnostic Code 8515 for the period prior to November 5, 2018. However, evaluations in excess of 40 percent and 30 percent for the peripheral neuropathy of the right and left upper extremities have not been demonstrated by the evidence of record at any point for the period prior to November 5, 2018. As noted above, under Diagnostic Code 8513 a disability rating of 60 percent is requires severe incomplete paralysis of the nondominant upper extremity while a disability rating of 70 percent is assigned for severe incomplete paralysis of the dominant upper extremity. While the Veteran exhibited constant and intermittent pain as well as numbness, the May 2018 VA examiner specifically indicated that the Veteran only had mild incomplete paralysis of the bilateral upper extremities. Additionally, the Board notes that ratings in excess of 30 percent (nondominant) and 40 percent (dominant) are available under Diagnostic Codes 8514 (radial nerve), 8515(medial nerve) and 8516 (ulnar nerve). However, these higher ratings are warranted for nerves which demonstrate severe incomplete paralysis which has not been demonstrated. Notably, the Board has already applied the most advantageous and analogous Diagnostic Code for the Veteran's disability and symptoms which is Diagnostic Code 8513. Diagnostic Code 8513 contemplates all radicular groups of the left and right upper extremities, and thus separate or higher ratings under a different Diagnostic Code is not warranted. As a result, the Board finds that 40 and 30 percent ratings, but no higher, are warranted for the period prior to November 5, 2018 as the Veteran has exhibited symptoms consistent with moderate incomplete paralysis in the right and left upper extremities. Period since November 5, 2018 For the period since November 5, 2018, the Veteran has current 40 and 30 percent ratings for peripheral neuropathy of the right and left upper extremities under Diagnostic Code 8513. Under the circumstances of this case, and with resolution of all reasonable doubt in the Veteran's favor, the Board concludes that a 70 percent disability rating, but no higher, for peripheral neuropathy of the right upper extremity is warranted and a 60 percent disability rating, but no higher, for peripheral neuropathy of the left upper extremity is warranted for the period since November 5, 2018. As noted above, under Diagnostic Code 8513 a disability rating of 60 percent is requires severe incomplete paralysis of the nondominant upper extremity while a disability rating of 70 percent is assigned for severe incomplete paralysis of the dominant upper extremity. Notably the November 2018 DBQ physician found that the Veteran had moderate bilateral peripheral neuropathy of the ulnar, radial and median nerves while the May 2021 VA examiner determined that the Veteran had moderate incomplete paralysis of the upper radicular group. However, the November 2018 DBQ physician also noted that the Veteran had severe constant pain and severe intermittent pain of the bilateral upper extremities while strength, reflexes, light touch, position sense and vibration sensation were all decreased. The March 2021 VA examiner additionally found that the Veteran reported that he had no feeling in his hands. The March 2021 VA examiner also noted that the Veteran's neuropathy was more severe than it was before and that the Veteran was incapable of sedentary work. As a result, and when affording the Veteran the benefit of the doubt, the Board finds that a 70 percent disability evaluation is warranted for the Veteran's service-connected peripheral neuropathy of the right upper extremity (dominant) and a 60 percent disability evaluation is warranted for the Veteran's service-connected peripheral neuropathy of the left upper extremity (minor) for the period since November 5, 2018. However, evaluations in excess of 70 percent and 60 percent for the peripheral neuropathy of the left and right hands for the period since November 5, 2018have not been demonstrated by the evidence of record at any point. As noted above, under Diagnostic Code 8513 a disability rating of 80 percent is assigned for complete paralysis of the nondominant upper extremity, and a disability rating of 90 percent is assigned for complete paralysis of the dominant upper extremity. As noted above, at no point during the period on appeal has complete paralysis of the dominant or nondominant extremity been demonstrated. The March 2021 VA examiner specifically indicated that the Veteran had moderate incomplete paralysis of the upper radicular group. As a result, the Board finds that 70 and 60 percent ratings, but no higher, is warranted for the period since November 5, 2018 as the Veteran has exhibited symptoms consistent with severe incomplete paralysis in the right and left upper extremities. Bilateral Lower Extremities Period prior to May 14, 2018 Currently, the Veteran has 10 percent disability ratings for peripheral neuropathy of the bilateral lower extremities for the period prior to May 14, 2018 under Diagnostic Code 8520. Under the circumstances of this case, and with resolution of all reasonable doubt in the Veteran's favor, the Board concludes that 20 percent disability ratings, but no higher, are warranted for peripheral neuropathy of the bilateral lower extremities for the period prior to May 14, 2018. As noted above, a 20 percent rating is warranted for moderate incomplete paralysis of the sciatic nerve of the lower extremity. Notably, the November 2013 VA examination indicated that the Veteran had moderate numbness in the bilateral lower extremities and decreased reflexes in the ankles. Light touch testing was also decreased in the bilateral lower extremities. Vibration sensation, cold sensation and position sense were also decreased bilaterally in the lower extremities while the examiner specifically indicated that the Veteran had mild to moderate diabetic peripheral neuropathy of both the lower bilateral extremities. As a result, and when affording the Veteran the benefit of the doubt, the Board finds that 20 percent disability ratings, but no higher, are warranted for peripheral neuropathy of the bilateral lower extremities for the period prior to May 14, 2018. However, evaluations in excess of 20 percent for the peripheral neuropathy of the right and left lower extremities have not been demonstrated by the evidence of record at any point for the period prior to May 14, 2018. While the Veteran had numbness and pain there was no evidence of foot drop, paralysis, constant weakness, or muscle atrophy. Additionally, the March 2015 VA examiner also specifically indicated that the Veteran only had mild incomplete paralysis of the sciatic nerve of the bilateral lower extremities. As a result, the Board finds that 20 percent ratings, but no higher, are warranted for the period prior to May 14, 2018 as the Veteran has exhibited symptoms consistent with moderate incomplete paralysis in the right and left lower extremities. Period since May 14, 2018 Currently, the Veteran has 20 percent disability ratings for peripheral neuropathy of the bilateral lower extremities for the period since May 14, 2018 under Diagnostic Code 8520. Under the circumstances of this case, and with resolution of all reasonable doubt in the Veteran's favor, the Board concludes that 40 percent disability ratings, but no higher, are warranted for peripheral neuropathy of the bilateral lower extremities for the period since May 14, 2018. As noted above, under Diagnostic Code 8520 a 40 percent rating is warranted for moderately severe incomplete paralysis of the sciatic nerve of the lower extremity. Notably, the November 2018 private DBQ physician and the March 2021 VA examiner both indicated that the Veteran had moderately severe bilateral peripheral neuropathy of the sciatic nerves. As a result, and when affording the Veteran the benefit of the doubt, the Board finds that 40 percent disability ratings, but no higher, are warranted for peripheral neuropathy of the bilateral lower extremities for the period since May 14, 2018. However, evaluations in excess of 40 percent for the peripheral neuropathy of the right and left lower extremities have not been demonstrated by the evidence of record at any point for the period since May 14, 2018. While the Veteran had numbness and pain there was no evidence of foot drop, paralysis or constant weakness. Additionally, the May 2018 VA examiner found that the Veteran had moderate incomplete paralysis of the sciatic nerve while the March 2021 VA examiner again specifically indicated that the Veteran only had moderately severe incomplete paralysis of the sciatic nerve of the bilateral lower extremities. The Board again notes that a higher 60 percent evaluation under Diagnostic Code 8520 requires severe incomplete paralysis and marked muscular atrophy of the sciatic nerve. As noted above, there is no evidence of muscular atrophy as the May 2018 and March 2021 VA examinations both specifically indicated that there was no atrophy. As a result, the Board finds that 40 percent ratings, but no higher, are warranted for the period since May 14, 2018 as the Veteran has exhibited symptoms consistent with moderately severe incomplete paralysis in the right and left lower extremities. Femoral Nerve As noted above, in an August 2021 rating decision, the RO granted service connection for peripheral neuropathy of the right and left lower extremities (femoral nerve) at initial 20 percent disability ratings, effective November 5, 2018 under Diagnostic Code 8526. Based on the evidence, the Board does not find that the Veteran is entitled to initial evaluations in excess of the current 20 percent disability ratings for his peripheral neuropathy of the femoral nerves of the left and right lower extremities as there is no indication that incomplete paralysis is more than moderate to warrant initial disability ratings in excess of 20 percent. As noted above, under Diagnostic Code 8526, moderate incomplete paralysis is rated 20 percent disabling; severe incomplete paralysis is rated 30 percent disabling; and complete paralysis is rated 40 percent disabling. On VA examination in March 2021, the VA examiner specifically indicated that the Veteran had moderate incomplete paralysis of the femoral nerve of the right and left lower extremities. While the November 2018 DBQ physician indicated that the Veteran had moderately severe bilateral peripheral neuropathy of the femoral nerves, the Board again notes that the Veteran is also compensated for incomplete paralysis of the sciatic nerve as the Veteran has 40 percent and then 70 and 60 percent disability evaluations under Diagnostic Code 8520. As a result, and based on the March 2021 VA examiner specifically describing the Veteran's peripheral neuropathy of the femoral nerve of the bilateral lower extremities as moderate incomplete paralysis, the Board finds that the Veteran is accurately compensated for his bilateral lower extremity peripheral neuropathy symptoms. Accordingly, initial ratings in excess of 20 percent for severe incomplete paralysis of the femoral nerve of the right and left lower extremities are not warranted. Obturator nerve, External Cutaneous Nerve, Ilio-inguinal Nerve As noted above, in an August 2021 rating decision, the RO granted service connection for peripheral neuropathy of the right and left lower extremity (external cutaneous nerve), (ilio-inguinal nerve) and (obturator nerve) at initial noncompensable disability ratings, effective March 19, 2021 under Diagnostic Codes 8528, 8529 and 8530. Diagnostic Codes 8528-8530, 8628-8630, and 8728-8730, provide ratings for paralysis, neuritis, and neuralgia of the obturator, external cutaneous, and ilio-inguinal nerves. Neuritis and neuralgia are rated as incomplete paralysis. For each disability, a maximum 10 percent rating is warranted for severe incomplete paralysis or paralysis of the respective nerve. Mild or moderate impairment of each nerve (obturator, external cutaneous, and ilio-inguinal) warrant noncompensable ratings. 38 C.F.R. § 4.124a, Diagnostic Codes 8528-8530, 8628-8630, and 8728-8730 (2020). Based on the evidence, the Board does not find that the Veteran is entitled to initial compensable evaluations for his peripheral neuropathy of the obturator, external cutaneous, and ilio-inguinal nerves of the left and right lower extremities as there is no indication that the Veteran's nerve impairment of either lower extremity more nearly approximates either "severe" incomplete paralysis or complete paralysis. Notably, the March 2021 VA examiner specifically found that the Veteran had moderate incomplete paralysis of the obturator, external cutaneous and ilio-inguinal nerves. As a result, initial compensable ratings for impairment of the right or left obturator, external cutaneous, or ilio-inguinal nerves are not warranted. See 38 C.F.R. § 4.124a, Diagnostic Code 8520, 8526, 8528, 8529, 8530 (2020). TDIU Laws and Regulations Total disability will be considered to exist where there is present any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340 (2019). Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that the Veteran meets the schedular requirements. If there is only one service-connected disability, this disability should be rated at 60 percent or more; if there are two or more disabilities, at least one should be rated at 40 percent or more with sufficient additional service-connected disability to bring the combination to 70 percent or more. 38 C.F.R. § 4.16(a) (2020). To meet the requirement of "one 60 percent disability" or "one 40 percent disability," the following will be considered as one disability: (1) disability of one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from one common etiology; (3) disabilities affecting a single body system; (4) multiple injuries incurred in action; and (5) multiple disabilities incurred as a prisoner of war. Id. Substantially gainful employment is defined as work which is more than marginal and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). In determining whether unemployability exists, consideration may be given to the Veteran's level of education, special training, and previous work experience, but it may not be given to his or her age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19 (2020). Analysis As noted above, the Veteran filed a claim for an increased rating for his peripheral neuropathy disabilities that was received by VA on May 26, 2010. When a Veteran submits evidence of unemployability in association with a claim for an increased rating, a claim for TDIU benefits is inferred. Rice v. Shinseki, 22 Vet. App. 447 (2009). Here, there is evidence that the Veteran's service-connected peripheral neuropathy disabilities contributed to the Veteran's perceived individual unemployability. As a result, the Board finds that per Rice, the Veteran had an inferred claim for a TDIU based May 26, 2010 date of his increased rating claim for his peripheral neuropathy disabilities. For the period from May 26, 2010, the Veteran's service-connected disabilities consisted of posttraumatic stress disorder (PTSD) (rated at 50 and 70 percent), urethritis (rated at 40 percent), peripheral neuropathy of the right upper extremity (rated as 40 and 70 percent), peripheral neuropathy of the left upper extremity (rated at 30 and 60 percent), diabetes mellitus (rated at 20 percent), peripheral neuropathy of the right lower extremity (rated at 20 and 40 percent), peripheral neuropathy of the left lower extremity (rated at 20 and 40 percent), peripheral neuropathy of the right lower extremity (femoral nerve) (rated at 20 percent), peripheral neuropathy of the left lower extremity(femoral nerve) (rated at 20 percent), tinnitus (rated at 10 percent), left ear hearing loss (rated at 0 percent), peripheral neuropathy of the right lower extremity (external cutaneous nerve) (rated at 0 percent), peripheral neuropathy of the left lower extremity (external cutaneous nerve) (rated at 0 percent), peripheral neuropathy of the right lower extremity (ilio-inguinal nerve) (rated at 0 percent), peripheral neuropathy of the left lower extremity (ilio-inguinal nerve) (rated at 0 percent), peripheral neuropathy of the right lower extremity (obturator nerve) (rated at 0 percent), and peripheral neuropathy of the left lower extremity (obturator nerve) (rated at 0 percent). This results in the combined 100 percent disability rating. However, a grant of a 100 percent disability again does not always render the issue of TDIU moot. VA's duty to maximize a claimant's benefits includes consideration of whether his disabilities establish entitlement to special monthly compensation (SMC) under 38 U.S.C. § 1114. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). This case, however, is distinguished from the case in Bradley, in that grant of a TDIU would not be predicated on a single disability but on multiple service-connected disabilities. Specifically, the grant of entitlement to TDIU would be based on the cumulative symptomatology associated with the Veteran's service-connected disabilities. Therefore, the grant of TDIU would be based on impairment from several service-connected disabilities, and not just a single disability. As the Veteran has no single service-connected disability that is rated at 100 percent, and the Veteran's TDIU would be predicated on multiple service-connected disabilities, the percentage rating criteria for SMC at the housebound rate have not been met at any point during the period under consideration in this appeal. As such, entitlement to a TDIU for the period since May 26, 2010 is considered moot, as the Veteran is already in receipt of a combined schedular evaluation of 100 percent and the findings in Bradley are not applicable in this case. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001). As such, there remain no allegations of error of fact or law for appellate consideration, the Board has no jurisdiction to review this appeal for the issue of entitlement to a TDIU is dismissed. 38 U.S.C. § 7105 (d)(5); 38 C.F.R. § 20.202. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James A. DeFrank, 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.