Citation Nr: A21020264 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 190802-16429 DATE: December 20, 2021 ISSUES 1. Entitlement to a disability rating in excess of 10 percent for service-connected peripheral neuropathy of the left upper extremity, median nerve. 2. Entitlement to a disability rating in excess of 10 percent for service-connected peripheral neuropathy of the right upper extremity, median nerve. 3. Entitlement to an initial compensable disability rating for service-connected peripheral neuropathy of the left lower extremity. 4. Entitlement to an initial compensable disability rating for service-connected peripheral neuropathy of the right lower extremity. ORDER Entitlement to a disability rating in excess of 10 percent for service-connected peripheral neuropathy of the left upper extremity, median nerve is denied. Entitlement to a separate 10 percent disability rating, but no higher, for service-connected peripheral neuropathy of the left upper extremity, ulnar nerve is granted. Entitlement to a disability rating in excess of 10 percent for service-connected peripheral neuropathy of the right upper extremity, median nerve is denied. Entitlement to a separate 10 percent disability rating, but no higher, for service-connected peripheral neuropathy of the right upper extremity, ulnar nerve is granted. REMANDED Entitlement to an initial compensable disability rating for service-connected peripheral neuropathy of the left lower extremity is remanded. Entitlement to an initial compensable disability rating for service-connected peripheral neuropathy of the right lower extremity is remanded. FINDINGS OF FACT 1. For the entire period on appeal, the Veteran's diabetic peripheral neuropathy of the left upper extremity has been manifested by a disability picture that more nearly approximates no more than mild incomplete paralysis of the median nerve with symptoms of mild paresthesias and/or dysesthesias, and numbness. 2. For the entire period on appeal, the Veteran's diabetic peripheral neuropathy of the left upper extremity has been manifested by a disability picture that more nearly approximates no more than mild incomplete paralysis of the ulnar nerve with symptoms of mild paresthesias and/or dysesthesias, and numbness. 3. For the entire period on appeal, the Veteran's diabetic peripheral neuropathy of the right upper extremity has been manifested by a disability picture that more nearly approximates no more than mild incomplete paralysis of the median nerve with symptoms of mild paresthesias and/or dysesthesias, and numbness. 4. For the entire period on appeal, the Veteran's diabetic peripheral neuropathy of the right upper extremity has been manifested by a disability picture that more nearly approximates no more than mild incomplete paralysis of the ulnar nerve with symptoms of mild paresthesias and/or dysesthesias, and numbness. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for the entire period on appeal for the diabetic peripheral neuropathy of the left upper extremity, median nerve have not been met or approximated. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8515. 2. The criteria for a separate rating of 10 percent, but no higher, for the entire period on appeal for the diabetic peripheral neuropathy of the left upper extremity, ulnar nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.14, 4.124a, Diagnostic Code 8516; Esteban v. Brown, 6 Vet. App. 259 (1994). 3. The criteria for a rating in excess of 10 percent for the entire period on appeal for the diabetic peripheral neuropathy of the right upper extremity, median nerve have not been met or approximated. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8515. 4. The criteria for a separate rating of 10 percent, but no higher, for the entire period on appeal for the diabetic peripheral neuropathy of the right upper extremity, ulnar nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.14, 4.124a, Diagnostic Code 8516; Esteban v. Brown, 6 Vet. App. 259 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1968 to November 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2019 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Pittsburgh, Pennsylvania. On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55, 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). This law creates a new framework for Veterans dissatisfied with VA's decision on their claim to seek review. The AMA automatically applies to all claims for which VA issues notice of an initial decision on or after February 19, 2019, as here. See 38 C.F.R. § 3.2400 (a)(1) (2019) (the modernized review system applies to all claims for which VA issues notice of an initial decision on or after the effective date of the modernized review system). This decision has been written consistent with the new AMA framework. Following the June 2019 rating decision, on August 2, 2019, the Veteran filed a VA Form 10182, Notice of Disagreement in the modernized system, and selected the Direct Review option; 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. As such, the Board notes that the allowable evidence window for the peripheral neuropathy increased rating claims, commences April 16, 2019, the date of the Veteran's claims. The limiting date for evidence submission for all of the claims by the Veteran is June 17, 2019, the day he was notified of the negative decision by the AOJ. This claim was previously before the Board in July 2020, where each of the above identified Issues was denied. The Veteran then appealed that Decision to the United States Court of Appeals for Veterans Claims (Court). In a Joint Motion for Partial Remand (JMPR) from May 2021, in relevant part, the Court vacated the part of the July 2020 Board Decision that denied entitlement to each of the above-identified issues. Remaining portions of the Board's July 2020 Decision were undisturbed. Thus, those increased ratings claims have since returned to the Board for additional adjudication. When a Veteran files a claim for an increased rating, he or she is presumed to be seeking the maximum benefit under any applicable theory, including a total disability evaluation based on individual unemployability (TDIU). See Rice v. Shinseki, 22 Vet. App. 447, 45354 (2009). In light of this principle, entitlement to special monthly compensation (SMC) has been found to be an inferable issue anytime a veteran is requesting increased benefits. Akles v. Derwinski, 1 Vet. App. 118 (1991). As the Veteran has not asserted that his service-connected disabilities prevent him from gaining and maintaining employment, the Board declines to infer a claim for TDIU at this time. There is no further lay or medical evidence the Veteran is housebound in fact, requires aid and attendance, or that his disabilities result in loss of use of a limb, blindness or deafness. 38 U.S.C. §§ 1114 (s), (l), (k); 38 C.F.R. § 3.350 (a), (b), (i). As such, the Board will not infer the issue of entitlement to SMC at this time. 1. Entitlement to disability ratings in excess of 10 percent for service-connected peripheral neuropathy of the bilateral upper extremities. The Veteran has claimed that his service-connected peripheral neuropathy of the bilateral extremities is each worse than currently rated. Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. If two disability evaluations are potentially applicable, the higher evaluation 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. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1 (2013); Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). That said, higher evaluations may be assigned for separate periods based on the facts found during the appeal period. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). This practice is known as staged ratings. Id. The determination of whether an increased disability rating is warranted is to be based on a review of the entire evidence of record and the application of all pertinent regulations. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In every instance where the rating schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent or noncompensable evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. The Board considers not only the criteria of the currently assigned diagnostic codes, but also the criteria of other potentially applicable diagnostic codes. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. However, the evaluation of the same "disability" or the same "manifestations" under various diagnoses is not allowed. See 38 C.F.R. § 4.14. A claimant may not be compensated twice for the same symptomatology as "such a result would overcompensate the claimant for the actual impairment of his earning capacity." See 38 U.S.C. § 1155 (2012); Brady v. Brown, 4 Vet. App. 203, 206 (1993). This would result in pyramiding, contrary to the provisions of 38 C.F.R. § 4.14. However, if a veteran has separate and distinct manifestations attributable to the same injury, they should be compensated under different diagnostic codes. See Esteban v. Brown, 6 Vet. App. 259 (1994); Fanning v. Brown, 4 Vet. App. 225, 230 (1993). If the evidence for and against a claim is in equipoise, the claim will be granted. 38 C.F.R. § 4.3. A claim will be denied only if the preponderance of the evidence is against the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran is seeking increased ratings for his service-connected peripheral neuropathy of the right and left upper extremities involving the median nerve, saying that his condition had worsened since originally rated. The Veteran is also seeking compensable ratings for his service-connected peripheral neuropathy of the right and left lower extremities, also saying that his condition for those had worsened since originally rated. Neurological conditions are rated pursuant to 38 C.F.R. § 4.124a. A rating is assigned based on the particular nerve involved and whether the disability is manifested by neuritis, neuralgia and/or incomplete or complete paralysis of the particular nerve involved. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. 38 C.F.R. § 4.123. The maximum rating which may be assigned for neuritis not characterized by organic changes as noted above will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. Id. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate, incomplete paralysis. 38 C.F.R. § 4.124. For his upper extremities, the Veteran is currently rated under Diseases of the Peripheral Nerves, 38 C.F.R. § 4.124a, Diagnostic Code 8515, with an evaluation of 10 percent disabling for peripheral neuropathy, median nerve, for the right and the left upper extremities, effective from April 11, 2007. The Veteran is right hand dominant. Therefore, for the right upper extremity, Diagnostic Code 8515 provides 10, 30, and 50 percent, respectively, for mild, moderate, and severe incomplete paralysis of the median nerve. A rating of 70 percent is warranted for complete paralysis. For the left upper extremity, the non-dominant extremity, Diagnostic Code 8515 provides 10, 20, and 40 percent, respectively, for mild, moderate, and severe incomplete paralysis of the median nerve. A rating of 60 percent is warranted for complete paralysis. 38 C.F.R. § 4.124a, Diagnostic Code 8515. For his lower extremities, the Veteran is currently rated analogously under Diseases of the Peripheral Nerves, 38 C.F.R. § 4.124a, Diagnostic Code 8523, with a noncompensable evaluation for peripheral diabetic neuropathy, each the right and the left lower extremity, effective from March 12, 2018. This diagnostic code provides the rating criteria for injuries affecting the anterior tibial nerve (deep peroneal). Under this code, a noncompensable evaluation is assigned for mild incomplete paralysis of the nerve; 10 and 20 percent evaluations are warranted for moderate and severe incomplete paralysis, respectively. A 30 percent rating is assigned for complete paralysis of the nerve. 38 C.F.R. § 4.124a, Diagnostic Code 8523. 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. See 38 C.F.R. § 4.124a, Note preceding Diagnostic Code 8510. When the involvement is wholly sensory, the rating should be for the mild, or at most, moderate degree. Id. The words "slight," "mild," "moderate," and "severe" as used in the various diagnostic codes are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence for "equitable and just decisions." 38 C.F.R. § 4.6. All the medical evidence was to be evaluated to determine the appropriate rating that would compensate the Veteran for impairment in earning capacity, functional impairment, etc. Chronologically, the Veteran's bilateral upper extremity peripheral neuropathy was granted service connection in an October 2011 rating decision, with a rating of 10 percent effective from the original date of claim of April 11, 2007. The Veteran filed a claim on April 16, 2019 for increased ratings for both upper and lower extremity peripheral neuropathy, saying his condition had worsened. As the relevant temporal focus for adjudicating an increased-rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim, the Board will consider the Veteran's appeal from April 2018 forward. Hart v. Mansfield, 21 Vet. App. 505, 509 (2007) (discussing 38 U.S.C. § 5110 and 38 C.F.R. § 3.400 (o)). The Veteran received a VA examination for diabetic sensory-motor peripheral neuropathy in May 2018. This examiner diagnosed bilateral lower extremity diabetic peripheral neuropathy and bilateral upper extremity diabetic peripheral neuropathy. The Veteran reported symptoms of leg numbness and tingling intermittently. He denied pain in either the upper or lower extremities. The Veteran presented with an antalgic gait and he used a cane to assist ambulation. He also stated he was unable to walk more than 10 minutes or unable to stand in one place for longer than 5 minutes. Regarding his upper extremities, the Veteran stated he had difficulty with fine motor skills. The examiner found mild paresthesias and/or dysesthesias with mild numbness for both bilateral upper and lower extremities. Vibration sensation and cold sensation each were normal for the upper extremities but absent for the lower extremities. Trophic changes were noted for the bilateral lower extremities. The examiner considered the affected nerves for the upper extremities to be both the median and ulnar nerves, each with mild incomplete paralysis. For the lower extremities, the examiner considered both the sciatic and the femoral nerves to be normal, without any finding for incomplete or complete paralysis. In the final Remarks portion of the exam, the examiner stated that the "identification of [lower extremity] nerves involved would include, but not [be] limited to the bilateral deep peroneal and sural nerves, incomplete paralysis, mild in severity." The Veteran received another VA examination for his diabetic peripheral neuropathy, both upper and lower extremities, in May 2019. This examiner diagnosed both right and left lower extremity peripheral neuropathy and right and left upper extremity peripheral neuropathy. For the lower extremities, the Veteran reported he feels like his socks are always on, states at times his feet feel cold, that he trips a lot and cannot walk reliably well, and that he can lose balance. He also reported constant numbness on the tops and bottoms of his feet. He reported he takes no current medications for his neuropathy and will use a cane if he has to walk long distances. For the upper extremities, the Veteran reported his hands feel like they are going to sleep on him, that when sitting in a chair, it is hard to pick up nearby objects such as a dime or a hearing aid battery. The examiner recorded mild symptoms of paresthesias and/or dysesthesias for the bilateral upper and lower extremities, and mild symptoms of numbness also for the bilateral upper and lower extremities. Constant pain or intermittent pain were not noted. Vibration sensation for the upper extremities was normal, and for the lower extremities, it was absent. Regarding the upper extremity peripheral neuropathy, the May 2019 examiner noted bilateral mild incomplete paralysis for the median nerve, and bilateral mild incomplete paralysis for the ulnar nerve as well. For the lower extremities, the examiner considered both the sciatic and the femoral nerves to be normal, without any finding for incomplete or complete paralysis. In the final Remarks portion of the exam, the examiner stated that the "identification of nerves involved would include, but not [be] limited to the bilateral common peroneal and sural nerves, incomplete paralysis, mild to moderate in severity." When considering all the evidence for the Veteran's bilateral diabetic peripheral neuropathy disabilities of the upper extremities, the median nerves, for the entire period on appeal, the Board finds that a 10 percent rating, but no higher, is warranted. VA medical examiners described intermittent bilateral upper extremity mild pain, paresthesias, dysesthesias, and numbness involving the median and the ulnar nerves, characterizing the neuropathy as "mild" for each the right and the left upper extremities. Pursuant to Diagnostic Code 8515, which describes the median nerve only, mild, incomplete paralysis is to be rated at 10 percent for each the major and the minor extremity. A higher rating of 30 percent for the major extremity or 20 percent for the minor extremity is not warranted unless there is moderate incomplete paralysis shown of the upper extremities. To the extent that the Veteran reports that his bilateral upper extremity diabetic neuropathy is worse than evaluated, the Board has considered his statements. However, far more probative of the degree of the disability are the results of the two VA examinations by different examiners who observed similar symptoms. Therefore, the Board finds that for the period on appeal that the Veteran's symptomatology associated with his service-connected bilateral upper extremity peripheral neuropathy, median nerve, more nearly approximates a 10 percent rating for each upper extremity. Therefore, the Board finds that the preponderance of evidence is against assigning a rating in excess of 10 percent for left or right upper extremity diabetic neuropathy, as it relates to the median nerve. See 38 C.F.R. § 4.124a, Diagnostic Code 8515; see also 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). The Board also recognizes however that both the May 2018 and 2019 examiners noted bilateral mild incomplete paralysis for the median nerve, and bilateral mild incomplete paralysis for the ulnar nerve. Importantly, the Veteran is currently rated under DC 8515 for his mild incomplete paralysis of the median nerve only. According to that DC, the median nerve impacts the area of the index and middle fingers, as well as the thumb. Again, the May 2018 and 2019 examiners also found mild incomplete paralysis of the ulnar nerve, which the Board observes is rated under DC 8516. According to that DC, the ulnar nerve impacts the area of the ring and little fingers, which the Board recognizes as separate and distinct manifestations attributable to the same injury. As such, they may be compensated under different diagnostic codes, as this would not result in impermissible pyramiding. See Esteban v. Brown, 6 Vet. App. 259 (1994); Fanning v. Brown, 4 Vet. App. 225, 230 (1993). Both relevant VA examiners noted the Veteran's ulnar nerve incomplete paralysis to be mild and did not describe the incomplete paralysis to be moderate. As such, the Board assigns separate and distinct 10 percent disability ratings for the Veteran's mild incomplete paralysis of the ulnar nerves, for each upper extremity, and for the entire period on appeal. See 38 C.F.R. § 4.124a, Diagnostic Code 8516. The Board also notes that the assignment of two separate 10 percent disability ratings for the Veteran's incomplete paralysis of the ulnar nerves for his service-connected peripheral neuropathy of the bilateral upper extremities directly address the findings made by the May 2021 Court JMPR. No further findings were made by the JMPR which need to be addressed in this section. All other potentially applicable diagnostic codes have been considered, and there is no basis to assign an alternative evaluation for the Veteran's upper extremity diabetic peripheral neuropathy other than that discussed above. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). Staged ratings were considered but are not warranted beyond those already assigned, as noted in the discussion above. See Hart, 21 Vet. App. at 505. REASONS FOR REMAND The Board incorporates its discussion from the sections above by reference. The Board finds that additional evidentiary development is required before the claims on appeal are adjudicated. Entitlement to initial compensable disability ratings for service-connected peripheral neuropathy of the bilateral lower extremities are each remanded. The Veteran's bilateral lower extremity peripheral neuropathy was granted service connection in a May 2018 rating decision, with a noncompensable rating effective from the date of claim of March 12, 2018. As noted above, the Veteran filed a claim on April 16, 2019 for increased ratings for both upper and lower extremity peripheral neuropathy, saying his conditions had worsened. As the relevant temporal focus for adjudicating an increased-rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim, the Board will consider the Veteran's appeal from April 2018 forward. Hart v. Mansfield, 21 Vet. App. 505, 509 (2007) (discussing 38 U.S.C. § 5110 and 38 C.F.R. § 3.400 (o)). As noted in the preceding section, the Veteran was given VA examinations for his service-connected peripheral neuropathy of the bilateral lower extremities in May 2018 and again in May 2019. The May 2018 examiner noted that both the sciatic and the femoral nerves were normal, however in the Remarks portion of the exam, the examiner stated that the "identification of [lower extremity] nerves involved would include, but not [be] limited to the bilateral deep peroneal and sural nerves, incomplete paralysis, mild in severity." The May 2019 examiner noted that both the sciatic and the femoral nerves were normal, however in the Remarks portion of the exam, the examiner stated that the "identification of [lower extremity] nerves involved would include, but not [be] limited to the bilateral common peroneal and sural nerves, incomplete paralysis, mild to moderate in severity." Importantly, the May 2018 examiner did not indicate that the common peroneal nerve was affected, while the May 2019 examiner did not indicate that the deep peroneal nerve was affected. In relevant part, these nerves are contemplated by different Diagnostic Codes: DC 8521 rates external popliteal nerve (common peroneal), while DC 8523 rates anterior tibial nerve (deep peroneal). These DCs also carry different disability ratings, with the bilateral common peroneal giving a 10 percent disability rating for mild incomplete paralysis, and the deep peroneal giving a noncompensable disability rating for mild incomplete paralysis. Furthermore, the most recent VA examiner described the severity of the bilateral common peroneal nerve as being "mild to moderate in severity." Thus, not only has the affected nerve changed from May 2018 to May 2019, the severity of the disability also does not appropriately fit into the applicable ratings criteria. Considering that the Board cannot insert its own medical opinion to distinguish the common peroneal nerve versus the deep peroneal nerve and considering that the severity of the Veteran's disability (or disabilities if more than one nerve group can be separately identified) is at best, unclear, the Board finds that more information is needed prior to the adjudication of the Veteran's claim. See Colvin v. Derwinski, 1 Vet. App. 171 (1991) (stating that VA adjudicators are not permitted to substitute their own judgment on a medical matter). One of the effects of the AMA is to narrow the set of circumstances in which the Board must remand appeals to the AOJ for further development instead of immediately remanding them directly. Nevertheless, even under the AMA the Board still has the duty to remand issues when necessary to correct a pre-decisional duty to assist error. See Pub L. No. 115-55 section (2)(d); 38 C.F.R. § 20.802 (a). The Board notes that the discrepancy between the VA examinations from May 2018 and May 2019 has created uncertainty in regard to the current severity of the Veteran's service-connected peripheral neuropathy of the bilateral lower extremities. This uncertainty also extends to the identification of which nerve groupings are affected for the bilateral lower extremities. The Board notes that this discrepancy in VA examinations represents a pre-decisional duty to assist error, and thus, a remand is warranted. See 38 C.F.R. § 20.802 (a). The Board finds that the Veteran should be afforded a new VA examination to determine the prior nature and severity of his service-connected peripheral neuropathy of the bilateral lower extremities for the period from April 16, 2018 to June 17, 2019. The VA examiner is asked to clarify which nerve groupings were affected for the bilateral lower extremities, and to specify the severity of each affected group for that period on appeal. Finally, the Board acknowledges the May 2021 Court JMPR, which indicated that the Board's July 2020 Decision incorrectly found that no nerves other than the sciatic and femoral nerves were found to be symptomatic by the May 2019 examiner. The Board notes the May 2021 Court JMPR findings to be correct, and further notes that the discrepancy between identifying nerve groups and their current severity cannot be fully addressed without the additional development identified herein. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA medical examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) with an appropriate physician to assess the severity of his service-connected diabetic peripheral neuropathy of the bilateral lower extremities. The entire claims file, including a copy of this Remand, should be made available to, and be reviewed by, the VA examiner. All appropriate tests, studies, and consultation should be accomplished, and all clinical findings should be reported in detail. The VA examiner is asked to clearly identify which specific lower extremity nerve (or nerves, if more than one is applicable) were affected and/or involved during the period from April 16, 2018 to June 17, 2019, as well as to provide a characterization of the symptoms as to whether they represent complete paralysis or incomplete paralysis. If incomplete paralysis is represented by the manifestations, the VA examiner should characterize these manifestations as having been mild, moderate, or severe. The examiner is reminded that the May 2018 VA examiner identified the nerve to include, but not be limited to the bilateral deep peroneal and sural nerves, incomplete paralysis, mild in severity, but that the May 2019 VA examiner identified the nerve to include but not be limited to the bilateral common peroneal and sural nerves, incomplete paralysis, mild to moderate in severity. 2. After completing the development noted above, readjudicate the issues on appeal. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Mulrain, 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.