Citation Nr: A21020092 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 211101-194520 DATE: December 16, 2021 ORDER Entitlement to a 30 percent rating, and no higher, from June 27, 2019 to December 9, 2020 for right upper extremity diabetic neuropathy is granted. Entitlement to a 30 percent rating, and no higher, from June 27, 2019 to December 9, 2020 for left upper extremity diabetic neuropathy is granted. Entitlement to a rating in excess of 10 percent prior to December 10, 2020 for bilateral pes planus is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) from June 27, 2019 to December 9, 2020 is dismissed as moot. Entitlement to an effective date of June 27, 2019 for the award of Dependents' Educational Assistance (DEA) under chapter 35 is granted. FINDINGS OF FACT 1. From June 27, 2019 to December 9, 2020, the Veteran's right upper extremity diabetic neuropathy manifested by moderate incomplete paralysis of the major extremity. 2. From June 27, 2019 to December 9, 2020, the Veteran's left upper extremity diabetic neuropathy manifested by moderate incomplete paralysis of the minor extremity. 3. Prior to December 10, 2020, the Veteran's bilateral pes planus manifested with pain on use. 4. From June 27, 2019 to December 9, 2020, the Veteran is in receipt of a 100 percent combined schedular rating for his residuals of diabetes. 5. The Veteran became permanently and totally disabled for purposes of DEA benefits on June 27, 2019. CONCLUSIONS OF LAW 1. From June 27, 2019 to December 9, 2020, the criteria for a 30 percent rating, and no higher, for right upper extremity diabetic neuropathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8516. 2. From June 27, 2019 to December 9, 2020, the criteria for a 30 percent rating, and no higher, for left upper extremity diabetic neuropathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8513. 3. The criteria for a rating in excess of 10 percent for bilateral pes planus prior to December 10, 2020 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5276. 4. From June 27, 2019 to December 9, 2020, the claim of entitlement to TDIU is moot. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. 5. The criteria for Chapter 35 DEA benefits have been met from June 27, 2019. 38 U.S.C. §§ 3501, 3510; 38 C.F.R. § 3.807. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1968 to June 1970. The rating decision on appeal was issued in September 2021; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. The September 2021 rating decision noted that following an April 2021 request for higher level review of a March 2021 rating decision, a duty to assist error was identified and the claims were accordingly processed under the supplemental lane. In the November 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. The Board notes that the Veteran filed an intent to file a claim on June 27, 2019, followed by the claim on July 31, 2019. A February 2020 rating decision granted service connection for diabetes mellitus, rated 60 percent disabling, left lower extremity diabetic neuropathy of the femoral nerve, rated 20 percent disabling, left lower extremity diabetic neuropathy of the sciatic nerve, rated 20 percent disabling, left upper extremity diabetic neuropathy, rated 20 percent disabling, right lower extremity diabetic neuropathy of the femoral nerve, rated 20 percent disabling, right lower extremity diabetic neuropathy of the sciatic nerve, rated 20 percent disabling, right upper extremity diabetic neuropathy, rated 10 percent disabling, and bilateral pes planus, rated 10 percent disabling, all effective June 27, 2019, among other things. In a December 2020 supplemental claim, the Veteran sought higher ratings for these disabilities. At the same time, the Veteran sought TDIU as part and parcel of his increased rating claims. A March 2021 rating decision granted a 100 percent rating for the Veteran's diabetes mellitus with complications (including his bilateral upper and lower extremity diabetic neuropathy), a 30 percent rating for bilateral pes planus, and Dependents' Educational Assistance (DEA) based on the 100 percent diabetes rating, all effective December 10, 2020, and denied TDIU as moot. The Veteran filed a request for higher level review of the March 2021 rating decision in April 2021, requesting that the higher ratings and DEA be assigned earlier and appealing the denial of TDIU. A June 2021 rating decision identified a duty to assist error. After development, the September 2021 rating decision now on appeal denied earlier dates for the higher ratings for diabetes (including left and right upper extremity diabetic neuropathy) and pes planus, denied an earlier date for entitlement to DEA, and denied TDIU as moot. While the September 2021 rating decision refers to some of the rating claims as effective date of service connection claims, the analysis in the rating decision makes it clear that the Regional Office was adjudicating whether the higher ratings (awarded effective December 10, 2020) were warranted earlier. As the Veteran has continuously pursued his rating claims since filing his June 27, 2019 intent to file a claim, and the TDIU and DEA were raised or awarded as part of these claims, the period on appeal for the Veteran's claims goes back to June 27, 2019. See 38 C.F.R. § 3.2500(h). The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions 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). 1. Entitlement to a 30 percent rating, and no higher, from June 27, 2019 to December 10, 2020 for right upper extremity diabetic neuropathy is granted. 2. Entitlement to a 30 percent rating, and no higher, from June 27, 2019 to December 10, 2020 for left upper extremity diabetic neuropathy is granted. The Veteran is service connected for right upper extremity diabetic neuropathy which is rated 10 percent disabling and left upper extremity diabetic neuropathy which is rated 20 percent disabling prior to December 10, 2020. From December 10, 2020, the Veteran's upper extremity diabetic neuropathy is rated as part of his 100 percent disabling diabetes mellitus. The Veteran seeks higher ratings for his right and left upper extremity diabetic neuropathy prior to December 10, 2020. The Veteran's right upper extremity diabetic neuropathy is rated 10 percent disabling under Diagnostic Code (DC) 8516, for paralysis of the ulnar nerve. See 38 C.F.R. § 4.124a. Under DC 8516, mild incomplete paralysis is rated as 10 percent disabling for both the major and minor extremity. Moderate incomplete paralysis is rated as 30 percent disabling for the major extremity and 20 percent disabling for the minor extremity. Severe incomplete paralysis is rated as 40 percent disabling for the major extremity and 30 percent disabling for the minor extremity. Complete paralysis is rated as 60 percent for the major extremity and 50 percent for the minor extremity. 38 C.F.R. § 4.124a. The Veteran's left upper extremity diabetic neuropathy is rated 20 percent disabling under DC 8513, for paralysis of all radicular groups. See 38 C.F.R. § 4.124a. Under DC 8513, mild incomplete paralysis is rated as 20 percent disabling for both the major and minor extremity. Moderate incomplete paralysis is rated as 40 percent disabling for the major extremity and 30 percent disabling for the minor extremity. Severe incomplete paralysis is rated as 70 percent disabling for the major extremity and 60 percent disabling for the minor extremity. Complete paralysis is rated as 90 percent for the major extremity and 80 percent for the minor extremity. 38 C.F.R. § 4.124a. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for a higher disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. The Board does note, for reference and illustrative purposes, that accepted definitions for "moderate" include of average or medium quantity, quality, or extent. See Webster's II New College Dictionary at 704 (1995). In addition, accepted definitions for "severe" include extremely intense. Id. at 1012. Regulations provide that ratings for peripheral neurological disorders are to be assigned based on 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. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of 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, the Veteran reported numbness in his fingers and hands in his July 2019 claim. A November 2019 VA contract examiner noted the Veteran's reports that his fourth and fifth fingers on his left hand and his fifth finger on his right hand are numb. The Veteran reported problems with grip and weight-bearing in his arms. The Veteran is right hand dominant. The examiner noted severe constant pain and moderate paresthesias and/or dysesthesias in the bilateral upper extremities, with moderate numbness in the left upper extremity and no numbness in the right upper extremity. Strength testing was normal bilaterally for elbow flexion, elbow extension, wrist flexion, and pinch, with wrist extension and grip normal for the right side but 4 out of 5 (less than normal strength) for the left side. Reflex testing showed decreased reflexes bilaterally. Light touch testing showed normal results for the right side but decreased sensation for the left side. Vibration and cold sensation were decreased bilaterally. There was no muscle atrophy. Trophic changes were noted in that the Veteran has loss of hair on his arms with smooth skin. The examiner noted incomplete paralysis of the radial and ulnar nerves on the left side and incomplete paralysis of the ulnar nerve on the right side and opined that the severity of these conditions was mild. A November 2019 VA hand/finger contract examination also notes the Veteran's diagnosis of diabetic neuropathy. The examiner noted some limitation of flexion in the fingers bilaterally with repeated use based on the Veteran's reports (generally 80 out of 90 degrees) and in the thumb (40 out of 100 degrees) and some abnormal extension on the left side, but the examiner noted the Veteran injured his left-hand fingers in an accident with a saw. In a December 2020 statement, the Veteran reported that his conditions had worsened. A January 2021 VA contract examiner noted the Veteran's reports that his condition had progressed and that he now experienced intermittent weakness, tingling, and numbness in the upper extremities. The examiner noted moderate constant pain, paresthesias and/or dysesthesias, and numbness in the Veteran's bilateral upper extremities. Strength testing was 4 out of 5 (less than normal strength) bilaterally, reflexes were normal, and light touch testing was normal in the shoulder and forearm but decreased in the hand/fingers. Position sense, vibration sensation, and cold sensation were decreased. The examiner noted incomplete paralysis of the ulnar nerve bilaterally and opined that the severity was moderate. Viewing the lay and medical evidence as a whole, from June 27, 2019 to December 9, 2020, the Veteran's right upper extremity diabetic neuropathy is most closely approximate to moderate incomplete paralysis of the ulnar nerve. The November 2019 examiner noted trophic changes, decreased reflexes, and some decreased sensation. The Veteran reported some reduced range of motion in the hand with repeated use. The Veteran's pain was described as severe and his paresthesias and/or dysesthesias as moderate. The Veteran's right upper extremity symptoms show impairment of medium quantity, quality, or extent. It appears based on the evidence that the Veteran's impairment was not wholly sensory. Based on the complete disability picture, a 30 percent rating is warranted from June 27, 2019 to December 9, 2020 for moderate incomplete paralysis of the right ulnar nerve (the major side) under Diagnostic Code 8516. However, a rating in excess of 30 percent is not warranted as the Veteran's right upper extremity diabetic neuropathy is not most closely approximate to severe incomplete paralysis of the ulnar nerve prior to December 10, 2010. The Veteran's disability picture is not appropriately described as "extremely intense" as definitions of severe would indicate. Rather, strength testing for the right upper extremity was normal at the November 2019 examination, the Veteran's light touch sensation was normal, there was no muscle atrophy, and the examiner opined that the Veteran's overall condition was mild. The Board notes that the Veteran reported that his condition had worsened by December 2020, so the January 2021 examination results are less relevant to rating the earlier period. However, even the January 2021 examination, after the Veteran reported worsening, shows only a slight reduction in strength and an overall description of the Veteran's condition as moderate. Viewing the lay and medical evidence as a whole, from June 27, 2019 to December 9, 2020, the Veteran's left upper extremity diabetic neuropathy is most closely approximate to moderate incomplete paralysis of the radicular groups. The November 2019 examiner noted trophic changes, decreased reflexes, decreased sensation, and some reduction in strength. The Veteran reported some reduced range of motion in the hand with repeated use. The Veteran's pain was described as severe and his paresthesias and/or dysesthesias and numbness as moderate. The Veteran's left upper extremity symptoms show impairment of medium quantity, quality, or extent. The Veteran's impairment was not wholly sensory. Based on the complete disability picture, a 30 percent rating is warranted from June 27, 2019 to December 9, 2020 for moderate incomplete paralysis of the left radicular groups (the minor side) under Diagnostic Code 8513. However, a rating in excess of 30 percent is not warranted as the Veteran's left upper extremity diabetic neuropathy is not most closely approximate to severe incomplete paralysis of the ulnar nerve prior to December 10, 2010. The Veteran's disability picture is not appropriately described as "extremely intense" as definitions of severe would indicate. Rather, some strength testing for the left upper extremity was normal and some showed a slight reduction (4 out of 5) at the November 2019 examination, there was no muscle atrophy, and the examiner opined that the Veteran's overall condition was mild. The Board notes that the Veteran reported that his condition had worsened by December 2020, so the January 2021 examination results are less relevant to rating the earlier period. However, even the January 2021 examination, after the Veteran reported worsening, shows only a slight reduction in strength (4 out of 5) and an overall description of the Veteran's condition as moderate. The Board has considered all other potentially applicable Diagnostic Codes for rating the Veteran's right and left upper extremity neuropathy, but there is no basis for a higher or additional rating under another Diagnostic Code. The Board notes that the November 2019 examiner found left-side involvement of both the radial and ulnar nerves. For rating the nerves affecting the upper extremities, combined nerve injuries should be rated by reference to the major involvement, or if sufficient in extent, to consider radicular group ratings. See 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves, Note following Diagnostic Code 8719. The evaluation of the same disability or the same manifestations of disability under multiple diagnoses is to be avoided. 38 C.F.R. § 4.14. In other words, separate ratings may not be assigned when evaluating the Veteran's left-side radial and ulnar nerves but rather only one rating should be assigned based upon the Diagnostic Code providing the highest rating. Therefore, separate ratings under Diagnostic Codes 8514 and 8516 are not warranted for the Veteran's left upper extremity neuropathy. Instead, Diagnostic Code 8513 for "all radicular groups" provides for the highest rating of all potentially applicable Diagnostic Codes for the upper extremities. As such, the Board has evaluated the left-side radial and ulnar nerve incomplete paralysis under DC 8513. See Butts v. Brown, 5 Vet. App. 532, 538 (1993) (choice of diagnostic code should be upheld if it is supported by explanation and evidence). In conclusion, the Board finds that 30 percent ratings, and no higher, are warranted for the Veteran's right and left upper extremity diabetic neuropathy. In making such determinations, the Board finds that the Veteran's upper extremity diabetic neuropathy is fully capable of evaluation under the rating schedule. 3. Entitlement to a rating in excess of 10 percent prior to December 10, 2020 for bilateral pes planus is denied. The Veteran is service connected for bilateral pes planus which is rated 10 percent disabling prior to December 10, 2020. From December 10, 2020, the Veteran's bilateral pes planus is rated 30 percent disabling. The Veteran seeks a higher rating for his bilateral pes planus prior to December 10, 2020. The Veteran's bilateral pes planus is rated under 38 C.F.R. § 4.71a, DC 5276, for acquired flatfoot. Under DC 5276, a noncompensable rating is warranted for mild acquired flatfoot; symptoms relieved by built-up shoe or arch support. A 10 percent rating is warranted for moderate acquired flat foot; weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral. A 20 percent rating is assigned for severe unilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is warranted for severe bilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is also warranted for pronounced unilateral acquired flatfoot; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. A maximum 50 percent rating is warranted for bilateral acquired flatfoot; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, DC 5276. The Board does note, for reference and illustrative purposes, that accepted definitions for "moderate" include of average or medium quantity, quality, or extent. See Webster's II New College Dictionary at 704 (1995). In addition, accepted definitions for "severe" include extremely intense. Id. at 1012. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis, to include in situations where the disability at issue is not evaluated based on range of motion measurements. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011); Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). Turning to the evidence, the Veteran reported pain in both feet in his July 2019 claim. The November 2019 VA examiner diagnosed the Veteran with bilateral pes planus. The examiner noted the Veteran's reports of shooting pain from his leg to his feet and that he sometimes has to stomp his feet to alleviate his symptoms. The Veteran did not report flare-ups. The examiner noted that the Veteran has pain on use of his feet with the pain accentuated on use and that he has decreased longitudinal arch height. The Veteran did not have pain on manipulation of his feet, extreme tenderness of plantar surfaces, objective evidence of marked deformity, marked pronation, swelling on use, characteristic calluses, inward bowing of the achilles tendon, or marked inward displacement and severe spasm of the achilles tendon, and the weight-bearing line did not fall over or medial to the great toe. The Veteran reported that he did not use any arch supports, built up shoes, or orthotics. The examiner noted excess fatigability and lack of endurance and sensory deficit. The examiner noted the Veteran has pain in his feet with prolonged weight bearing such as standing or walking. In a December 2020 statement, the Veteran reported that his conditions had worsened. A January 2021 VA contract examiner noted the Veteran's bilateral pes planus diagnosis. The Veteran reported that his condition had progressed and that he had pain and limited range of motion in both feet due to his worsening flat feet. The Veteran reported using insoles and specialized diabetic shoes. The examiner noted the Veteran was unable to sit, stand, or walk for extended periods of time due to constant pain. The Veteran reported pain and numbness in his feet with daily flare-ups in both feet that he described as moderate. The Veteran reported loss of flexibility, range of motion, mobility, endurance, and strength. Upon examination, the examiner noted the Veteran had pain on use of his feet which was not accentuated on use. The Veteran did not have pain on manipulation of the feet, swelling on use, or characteristic calluses. The Veteran had extreme tenderness of plantar surfaces and decreased longitudinal arch height on both feet but no objective evidence of marked deformity or marked pronation. The weight-bearing line was not over or medial to the great toe for either foot, there was no inward bowing of the achilles tendon, and no marked inward displacement and severe spasm of the achilles tendon on manipulation. The examiner noted that pain causes disturbance of locomotion, interference with sitting, interference with standing, and pain. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for the Veteran's bilateral pes planus prior to December 10, 2020. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to excess fatigability and lack of endurance and sensory deficit. However, even considering the Veteran's lay reports of symptoms and functional loss, the degree of additional limitation reflected by the Veteran's statements would not result in symptoms more nearly approximating severe unilateral or bilateral acquired flatfoot. During the November 2019 examination, the Veteran did not have pain on manipulation of his feet, extreme tenderness of plantar surfaces, objective evidence of marked deformity, marked pronation, swelling on use, characteristic calluses, or marked inward displacement and severe spasm of the achilles tendon. The Veteran's pes planus disability picture is not appropriately described as "extremely intense" as definitions of severe would indicate. The Board notes that the Veteran reported that his diabetic conditions worsened in December 2020 and the January 2021 examination shows a worsened condition, including extreme tenderness of plantar surfaces. Prior to December 10, 2020, however, the Veteran's 10 percent rating accounts for his moderate bilateral pes planus disability picture, including his pain on use of the feet. The Board has also considered the other Diagnostic Codes pertaining to the foot. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017). In Scott v. Wilkie, the Federal Circuit expressly adopted the Court's holding that disabilities specifically listed in the rating schedule may only be rated under Diagnostic Codes which specifically pertain to them. Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Copeland v. McDonald, 27 Vet. App. 333, 336 (2015)). The Federal Circuit also expressly adopted the Court's holding that unlisted conditions may be rated by analogy to Diagnostic Codes that may not describe the unlisted disability but addresses disabilities that may be productive of similar symptoms. Scott, 920 F.3d 1375 (citing Yancy v. McDonald, 27 Vet. App. 484, 493 (2016). Finally, the Federal Circuit concluded that the Board must also consider assigning separate ratings under analogous Diagnostic Codes, when rating an unlisted service-connected foot disability exhibiting distinct manifestations, even when service connection has also been granted for one of the eight conditions listed in the rating schedule. Id. Here, the Veteran's disability is specifically listed under the rating schedule and therefore cannot be rated under a different Diagnostic Code. Additionally, the evidence of record does not reflect that the Veteran has any other service-connected foot disabilities that would warrant a separate rating under a different Diagnostic Code. In conclusion, the Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for bilateral pes planus prior to December 10, 2020. 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. In denying an increased rating prior to December 10, 2020, the Board finds that the Veteran's bilateral pes planus disability is fully capable of evaluation under the rating schedule. 4. Entitlement to a TDIU from June 27, 2019 to December 9, 2020 is dismissed as moot. The Veteran seeks TDIU from June 27, 2019 (the original date of service connection for his disabilities) to December 9, 2020, as he is in receipt of a 100 percent rating for his service-connected diabetes from December 10, 2020. However, after consideration of the above grants of higher ratings for right and left upper extremity diabetic neuropathy, the Veteran is now in receipt of a 100 percent schedular rating for the combined ratings of the residuals of his diabetes from June 27, 2019 to December 9, 2020. The Board notes that a 100 percent schedular rating is a higher benefit than a TDIU. As the Veteran is already in receipt of a 100 percent schedular rating based on his combined service-connected disabilities throughout the appeal period, the issue of TDIU based on his combined service-connected disabilities is moot. See Bradley v. Peake, 22 Vet. App. 280 (2008); Herlehy v. Principi, 15 Vet. App. 33, 35 (2001). The Board notes that a veteran may be entitled to special monthly compensation (SMC) if, in addition to having a single permanent disability rated 100 percent disabling under the VA Schedule for Rating Disabilities, the Veteran has an additional disability or disabilities independently ratable at 60 percent or more, separate and distinct from the permanent disability rated as 100 percent disabling and involving different anatomical segments or bodily systems. See 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). The Board does not need to consider whether TDIU is warranted due to a single disability in this case because the Veteran's service-connected disabilities are all residuals of his diabetes and therefore there is no separate and distinct disability that could warrant SMC. Accordingly, the Veteran's claim for TDIU prior to December 10, 2010 is dismissed as moot. 5. Entitlement to an effective date of June 27, 2019 for the award of DEA under chapter 35 is granted. Regarding the earlier effective date for DEA Chapter 35 benefits, DEA benefits are payable when: (1) the Veteran was discharged from service under conditions other than dishonorable or died in service; and (2) the Veteran has a permanent total service-connected disability; or (3) a permanent total service-connected disability was in existence at the date of the Veteran's death; or (4) the Veteran died as a result of a service-connected disability. 38 U.S.C. § 3510; 38 C.F.R. § 3.807(a). In a March 2021 rating decision, the Veteran was granted basic eligibility to DEA benefits, effective December 10, 2020, the date which he was adjudicated to be eligible for a total (100 percent) disability rating. (Continued on the next page) In light of the above grants of higher ratings for right and left upper extremity diabetic neuropathy, the Veteran is now in receipt of a 100 percent schedular rating for the combined ratings of the residuals of his diabetes from June 27, 2019 to December 9, 2020. As the Veteran has been adjudicated to have permanent and total disability from June 27, 2019, DEA benefits from June 27, 2019 are warranted. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Purcell, 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.