Citation Nr: A21020334 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 211123-199765 DATE: December 21, 2021 ORDER An effective date of August 8, 2012, but no earlier, for the award of service connection for diabetes mellitus, type II (DMII), is granted. Entitlement to an effective date prior to March 9, 2018 for the award of service connection for right lower extremity peripheral neuropathy of the sciatic nerve is denied. Entitlement to an effective date prior to March 9, 2018 for the award of service connection for left lower extremity peripheral neuropathy of the sciatic nerve is denied. Entitlement to an effective date prior to March 9, 2018 for the award of service connection for right lower extremity peripheral neuropathy of the femoral nerve is denied. Entitlement to an effective date prior to March 9, 2018 for the award of service connection for left lower extremity peripheral neuropathy of the femoral nerve is denied. Entitlement to a rating in excess of 20 percent for DMII from March 9, 2018 to June 14, 2021 is denied. REMANDED Entitlement to a rating in excess of 10 percent for right lower extremity peripheral neuropathy of the sciatic nerve is remanded. Entitlement to a rating in excess of 10 percent for left lower extremity peripheral neuropathy of the sciatic nerve is remanded. Entitlement to a rating in excess of 10 percent for right lower extremity peripheral neuropathy of the femoral nerve is remanded. Entitlement to a rating in excess of 10 percent for left lower extremity peripheral neuropathy of the femoral nerve is remanded. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. A Statement of the Case (SOC) was issued in October 2011 denying entitlement to service connection for DMII. The SOC was returned to sender, and the document was resent to both known addresses for the Veteran on March 28, 2012. 2. No substantive appeal was received for the March 2012 SOC within 60 days. The August 2012 Form 9 was untimely. 3. An August 8, 2012 Statement in Support of Claim is reasonably read as an informal claim for benefits and was not adjudicated or acknowledged by the Agency of Original Jurisdiction. 4. The earliest claim (or Intent to File a Claim for Compensation) seeking to establish entitlement to service connection for peripheral neuropathy of the bilateral lower extremities was received by VA no earlier than March 9, 2018, with no prior claim or denial concerning this benefit. 5. The Veteran continuously pursued entitlement to service connection for DMII and peripheral neuropathy of the bilateral lower extremities until service connection was granted in a June 2021 rating decision. 6. The Veteran's DMII required only restricted diet and an oral glycemic agent since March 9, 2018. CONCLUSIONS OF LAW 1. The criteria for an effective date of August 8, 2012, for the grant of service connection for DMII have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.151, 3.155, 3.400. 2. The criteria for an effective date prior to March 9, 2018, for the grant of service connection for right lower extremity peripheral neuropathy of the sciatic nerve have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.151, 3.400, 3.2400, 3.2500. 3. The criteria for an effective date prior to March 9, 2018, for the grant of service connection for left lower extremity peripheral neuropathy of the sciatic nerve have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.151, 3.400, 3.2400, 3.2500. 4. The criteria for an effective date prior to March 9, 2018, for the grant of service connection for right lower extremity peripheral neuropathy of the femoral nerve have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.151, 3.400, 3.2400, 3.2500. 5. The criteria for an effective date prior to March 9, 2018, for the grant of service connection for left lower extremity peripheral neuropathy of the femoral nerve have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.151, 3.400, 3.2400, 3.2500. 6. The criteria for a disability rating in excess of 20 percent for DMII have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.119, Diagnostic Code 7913. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from September 1963 to October 1989, at which time he retired based on time in service. The Board thanks the Veteran and his family for his service. In August 2021, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a June 2021 decision. In September 2021, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior June 2021 decision. 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 June 2021 decision. 38 C.F.R. § 20.301. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.800(c). Additional reference to the Veteran's disabilities is presented in the evidence of record beyond the most detailed pertinent evidence discussed by the Board in this decision. The additional evidence of record does not present findings concerning the matters at issue that significantly expand upon, revise, or contradict the findings in the most detailed evidence discussed by the Board in this decision. Earlier Effective Dates Except as otherwise provided, the effective date of an evaluation and award of compensation will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. The effective date of an award of disability compensation shall be the day following separation from service or the date entitlement arose if the claim is received within one year of separation. 38 U.S.C. § 5110(b); 38 C.F.R. § 3.400(b)(2). Where a claim is subject to modernized review system under the Appeals Modernization Act (AMA) based on date of initial claim or by election of the veteran, provisions exist that permit an effective date based on date of claim to be "preserved" following issuance of a decision. See 38 C.F.R. §§ 3.2400, 3.2500. In particular, a veteran "may continuously pursue a claim or an issue by timely and properly filing [an enumerated] administrative review [option]" following issuance of a decision by a RO, the Board, or the Court of Appeals for Veterans Claims. See § 3.2500(c), (h). An effective date will be preserved if a veteran files for administrative review within one year of any decision. § 3.2500(h). However, while the date of claim is preserved when a claim is continuously pursued, the proper effective date is still subject to a finding regarding when entitlement to the benefit sought arose. The reference above to "the date entitlement arose" is not defined in the current statute or regulation. The U.S. Court of Appeals for Veterans Claims (Court) has interpreted it as the date when the claimant met the requirements for the benefits sought; this is determined on a "facts found" basis. See 38 U.S.C. § 5110(a); see also McGrath v. Gober, 14 Vet. App. 28, 35 (2000). A specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid or furnished to any individual under the laws administered by VA. 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). The term "claim" or "application" means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p); Brannon v. West, 12 Vet. App. 32, 34-35 (1998). The Board notes that, effective March 24, 2015, VA amended its adjudication regulations to require that all claims governed by VA's adjudication regulations be filed on standard forms prescribed by the Secretary (i.e., VA Form 21-526). 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). This rulemaking also eliminated the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims for increase and revised 38 C.F.R. § 3.400(o)(2). These amendments, however, are only applicable with respect to claims and appeals filed on or after March 24, 2015, and are not applicable if a claim is found to have been received but unadjudicated prior to that date. See 79 Fed. Reg. 57,660, 57,686 (Sept. 25, 2014). As such, any communication or action of record before March 24, 2015, indicating an intent to apply for one or more benefits under laws administered by the VA from a claimant may be considered an informal claim. Such an informal claim must identify the benefits sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. Upon receipt of an informal claim, if a formal claim has not been filed, an application form must be forwarded to the claimant for execution. If the application form is received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155(a). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). 1. An effective date of August 8, 2012, but no earlier, for the award of service connection for DMII The Veteran seeks an effective date prior to March 9, 2018 for the grant of service connection for DMII. Neither the Veteran nor his representative have submitted any specific contentions as to why an earlier effective date is warranted. The AOJ has granted an effective date of March 9, 2018 based on continuous pursuit of the claim under AMA regulations. The specific factual basis for the March 9, 2018 date is discussed in more detail related to issues two through five below. As the Board finds the Veteran is entitled to an earlier effective date for the grant of service connection for DMII, it will proceed directly with discussion of the relevant procedural history prior to March 2018. The Veteran's claim for service connection for DMII has an extensive procedural history. The most recent prior denial was an October 2011 SOC, which was mailed to the Veteran's last known address in Panama. See Statement in Support of Claim received October 2007. A March 28, 2012 letter from the AOJ states that the October 2011 SOC was returned, and that the AOJ was therefore mailing a copy to the Veteran's known addresses in Panama and Texas. Of note, the record shows that the Veteran regularly moved between the same addresses in Texas and Panama at this time, and Statement in Support of Claim dated June 2012 indicated that he had returned to his address in Texas. The Board finds that the AOJ fulfilled its duty to notify the Veteran because, when the October 2011 SOC was returned as undeliverable, the AOJ resent the SOC to both known addresses of record. Further, as referenced below, the Veteran acknowledged actual receipt of the SOC when he eventually submitted a Form 9 in August 2012. The regulations pertaining to filing deadlines for legacy cases applied to all claims at the time of the March 2012 SOC. Under the provisions of 38 U.S.C. § 7105(a), an appeal to the Board must be initiated by a notice of disagreement and completed by a substantive appeal after an SOC is furnished to the claimant. 38 C.F.R. § 19.20. A substantive appeal must be filed within 60 days of the date of the mailing of an SOC, or within the remainder of the one-year period from the date of mailing of the notification of the determination being appealed, whichever period ends later. 38 U.S.C. § 7105; 38 C.F.R. § 19.52. The date of the mailing of the SOC will be presumed to be the same as the date of the SOC, and the date of mailing the letter of notification of the determination will be presumed to be the same as the date of that letter for purposes of determining whether an appeal has been timely filed. 38 U.S.C. § 7105; 38 C.F.R. § 19.52(b). To continue his appeal, the Veteran was required to submit a substantive appeal to the Board within 60 days of issuance of the SOC. Using March 28, 2012 as the date of mailing, the Veteran was required to submit a substantive appeal by May 27, 2012. The rating decision on appeal had been mailed on May 24, 2006, and thus the one-year period following issuance of the rating decision had ended in May 2007. A July 19, 2012 internal VA note indicates that there was no pending mail for the Veteran, no substantive appeal had been received, and the pending claim for service connection was closed. On August 8, 2012, VA received a Form 9 from the Veteran explaining that he had not received the SOC until June 20, 2012 because he was traveling between the time he left Panama and when he returned to Texas. The law does not contain any provision for delaying the date on which a substantive appeal must be received based on travel or other circumstances related to the Veteran's conduct or whereabouts. Based on the above, the Board finds in this case that the evidence demonstrates that the August 2012 Form 9 was not received within 60 days of issuance of the March 2012 SOC or within one year of the May 2006 rating decision. Thus, the March 2012 SOC denying entitlement to service connection for DMII was final. Because the March 2012 SOC was final, the effective date for service connection for DMII is the later of the date entitlement occurred or the date the next claim for service connection was received. Because the medical evidence of record shows that the Veteran has had a diagnosis for DMII since approximately 2002 (see Diabetes VA Examination dated May 2019), which is before March 2012, the relevant issue before the Board is whether any unadjudicated claims for service connection for DMII were received prior to March 9, 2018. The Board finds that there was. On August 8, 2012, VA also received from the Veteran a Statement in Support of Claim and another Correspondence document. The Veteran's Statement in Support of Claim stated "[t]his letter is to support my claim for Agent Orange Exposure. My diabetes is progressively getting worse" and provided a description of his activities in Thailand and flight layovers in Vietnam between January 1969 and January 1970 that he believed exposed him to herbicide agents. His Correspondence stated "The following is provided to support my claim for diabetes mellitus" and provided a similar description of why he believed he was exposed to herbicide agents in service. Because these statements were received before March 24, 2015 and clearly indicate the benefit sought (i.e. service connection for DMII), they may serve as an informal claim for service connection. An internal VA memo dated September 10, 2012 states "Pull for VFR Review, Form 9 untimely." Despite apparently reviewing the Form 9 and accompanying statements, the AOJ never sent the Veteran a letter either rejecting them as an untimely substantive appeal, seeking clarification, or asking for a formal claim to be submitted. Entitlement to service connection was not adjudicated by the AOJ again until after receipt of the March 9, 2018 intent to file and October 30, 2018 VA 21-526EZ. Finally, the May 2021 Board decision that granted service connection for DMII did so based on a factual finding that the Veteran was exposed to herbicide agents during his service in Thailand based on the Veteran's descriptions of his duties. There were no newly acquired service records, the grant was not based on service in Vietnam, and the Veteran first filed for service connection for DMII in 2002. As such, 38 C.F.R. §§ 3.156(c) and 3.816 do not apply. Based on the above, the Board finds that the Veteran is entitled to an effective date of August 8, 2012, but no earlier, for the grant of service connection for DMII. 2. Entitlement to an effective date prior to March 9, 2018 for the award of service connection for right lower extremity peripheral neuropathy of the sciatic nerve 3. Entitlement to an effective date prior to March 9, 2018 for the award of service connection for left lower extremity peripheral neuropathy of the sciatic nerve 4. Entitlement to an effective date prior to March 9, 2018 for the award of service connection for right lower extremity peripheral neuropathy of the femoral nerve 5. Entitlement to an effective date prior to March 9, 2018 for the award of service connection for left lower extremity peripheral neuropathy of the femoral nerve As noted above, neither the Veteran nor his representative made any arguments as to why he is entitled to an earlier effective date. The Board is relying on the same set of facts in making its decision as to entitlement to an earlier effective date for service connection for right lower extremity peripheral neuropathy of the sciatic nerve, left lower extremity peripheral neuropathy of the sciatic nerve, right lower extremity peripheral neuropathy of the femoral nerve, and left lower extremity peripheral neuropathy of the femoral nerve. Thus, the Board will address all four issues together in order to simplify the decision for the Veteran. Service connection for the Veteran's peripheral neuropathy of the right and left lower extremities has been assigned an effective date of March 9, 2018 based on the receipt date of an Intent to File and a subsequent formal claim received within one year. See Notification Letter dated March 2018; VA 21-526EZ received October 30, 2018. The AOJ adjudicated the Veteran's claim for service connection in rating decision that was mailed to the Veteran on July 1, 2019. As such, AMA regulations regarding effective date apply to the Veteran's claim, to include the right to preserve his effective date based on continuous pursuit of his claim. 38 C.F.R. §§ 3.2400, 3.2500. The relevant procedural history is as follows: June 2019 rating decision denying service connection; October 2019 VA Form 20-0995 Supplemental Claim; December 2019 rating decision denying service connection; April 2020 VA Form 20-0996 Request for Higher-Level Review; August 2020 HLR rating decision confirming denial of service connection; January 2021 VA Form 10182 Notice of Disagreement; May 2021 Board Decision granting service connection; June 2021 rating decision implementing grant of service connection. As shown above, the continuously pursued his claim for entitlement to service connection for peripheral neuropathy of the right and left lower extremities by filing an enumerated administrative review option within one year of the issuance of a notice of decision until service connection was granted by the Board in May 2021. 38 C.F.R. § 3.2500(a), (c). Thus, the AOJ appropriately determined that the Veteran had preserved his original date of claim. On review of the record, there was no formal or informal claim for service connection for peripheral neuropathy of the right or left lower extremity at any time prior to the October 2018 VA 21-526EZ. The AOJ correctly assigned an effective date of March 9, 2018 based on the receipt date of an Intent to File that was received within one year prior to receipt of the Veteran's formal claim. Based on the above information, the Board finds that the preponderance of the evidence is against assigned an effective date prior to March 9, 2018 for the grant of service connection for peripheral neuropathy of the right and left lower extremities. Increased Ratings Disability ratings are assigned in accordance with VA's Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from a disability. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. When a question arises as to which of two ratings shall be applied under a particular diagnostic code, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Where, as here, the rating appealed is the initial rating assigned with a grant of service connection, the entire appeal period is for consideration, and separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings." Moreover, adjudication of a claim for a higher initial disability rating should include specific consideration of whether staged ratings are appropriate. See Fenderson v. West, 12 Vet. App. 119 (1999). In McGrath v. Gober, 14 Vet. App. 28 (2000), the Court held that when the Veteran was actually experiencing symptoms is what is relevant for assigning rating effective dates, not when evidence was created. Thus, the Board will consider whether the evidence of record suggests that the severity of pertinent symptoms increased sometime prior to the date of the examination reports noting pertinent findings. The Board has also considered the history of the Veteran's disability prior to the rating period on appeal to see if it supports a higher rating during the rating period on appeal. The Board has reviewed all of the evidence in the Veteran's record. Although the Board is required to provide reasons and bases supporting its decision, there is no need to discuss each item of evidence in the record. The Board will summarize the pertinent evidence as deemed appropriate, and the Board's analysis will focus specifically on what the evidence of record shows, or does not show, with respect to the claim. See Gonzalez v. West, 218 F.3d 1278, 1380-81 (Fed. Cir. 2000). 6. Entitlement to an increased rating for DMII The Veteran asserts that he is entitled to a higher initial rating for his service-connected DM, but has submitted no specific contentions as to that disability's rating criteria. However, in the cover letter for the Veteran's August 2021 VA Form 20-0996 Request for Higher-Level Review, the Veteran's representative argued that the AOJ had erred in failing to consider the Veteran for "a combination of 100 percent [rating] based on Individual Unemployability." As an initial matter, the Board notes that the AOJ has never issued a rating decision addressing the proper evaluation for the Veteran's service-connected DMII between August 8, 2012 and March 8, 2018. Veterans are entitled to an initial review by the AOJ for any issue prior to consideration by the Board. As such, the Board does not make any findings in this decision as to the proper evaluation for the Veteran's DMII prior to March 9, 2018. The Veteran's service-connected DMII is rated under 38 C.F.R. § 4.119, Diagnostic Code 7913. Diagnostic Code 7913 provides a structured scheme of specific, successive, cumulative criteria. Each higher rating includes the same criteria as the lower rating plus distinct new criteria. Middleton v. Shinseki, 727 F.3d 1172, 1178 (Fed. Cir. 2013). A 10 percent rating is warranted when diabetes is manageable by restricted diet only. A 20 percent rating is warranted when diabetes requires one or more daily injections of insulin and restricted diet, or an oral hypoglycemic agent and restricted diet. A 40 percent rating is warranted when diabetes requires one or more daily injections of insulin, restricted diet, and regulation of activities. Regulation of activities is defined as avoidance of strenuous occupational and recreational activities. A 60 percent rating is warranted when diabetes requires one or more daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A 100 percent rating is warranted when diabetes requires more than one daily injection of insulin, restricted diet, and regulation of activities, with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. Compensable complications of diabetes are evaluated separately unless they are part of the criteria used to support a 100-percent evaluation. Noncompensable complications of diabetes are considered part of the diabetic process. 38 C.F.R. § 4.119, Diagnostic Code 7913 (Note 1). Because Diagnostic Code 7913 contains successive criteria, the criteria for the lower rating must be met before a higher disability rating may be awarded. A higher rating cannot be granted based on a finding that the Veteran's disability picture more nearly approximates the criteria for the next higher rating. However, reasonable doubt regarding the presence of a criterion may be resolved in the Veteran' favor. Johnson v. Wilkie, 30 Vet. App. 245 (2018). The question in this appeal is whether the Veteran's DMII required one or more daily injections of insulin, restricted diet, and regulation of activities. Regulation of activities is defined as avoidance of strenuous occupational and recreational activities. This criterion requires medical evidence. Camacho v. Nicholson, 21 Vet. App. 360, 364-65 (2007). The Board finds that the Veteran's diabetes mellitus required only restricted diet and an oral glycemic agent during the period on appeal. The Veteran's May 2019 VA examination confirms that the Veteran's DMII treatment was limited to restricted diet and oral hypoglycemic agents. It specifically found that there was no regulation of activity required, nor were any of the additional criteria from the 60 percent or 100 percent ratings met. The VA examiner's findings are supported by the medical treatment records in the claims file, which indicate the Veteran's DMII was stable on oral hypoglycemic medications and encouraged increased activity. See, e.g., VA Treatment Records dated August 2018, February 2019, November 2019, April 2021; Medical Treatment Record received January 2021. The Veteran has not reported any additional symptoms or treatment. In addition, the Veteran does not assert, nor does the record show, that he has any complications of diabetes mellitus, aside from his already service-connected diabetic peripheral neuropathy that is separately addressed below. See 38 C.F.R. § 4.119, Diagnostic Code 7913 (Note 1). See VA treatment records dated June 2018, July 2018, April 2021; VA Examination dated May 2019. Accordingly, the Board finds that the preponderance of the evidence is against assigning a rating in excess of 20 percent for service-connected DMII between March 9, 2018 and June 14, 2021. REASONS FOR REMAND 1. Entitlement to a rating in excess of 10 percent for right lower extremity peripheral neuropathy of the sciatic nerve is remanded. 2. Entitlement to a rating in excess of 10 percent for left lower extremity peripheral neuropathy of the sciatic nerve is remanded. 3. Entitlement to a rating in excess of 10 percent for right lower extremity peripheral neuropathy of the femoral nerve is remanded. 4. Entitlement to a rating in excess of 10 percent for left lower extremity peripheral neuropathy of the femoral nerve is remanded. 5. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU) The issues of entitlement to a rating in excess of 10 percent for right lower extremity peripheral neuropathy of the sciatic nerve, left lower extremity peripheral neuropathy of the sciatic nerve, right lower extremity peripheral neuropathy of the femoral nerve, and left lower extremity peripheral neuropathy of the femoral nerve are remanded to correct a duty to assist error that occurred prior to the June 2021 rating decision. The AOJ obtained a May 2021 examination report which did not address whether the Veteran has separate and distinct symptomatology attributable to peripheral neuropathy of the sciatic nerve as compared to the femoral nerve. Based on the evidence of record, the Board is unable to apply the diagnostic criteria in light of the prohibition against pyramiding without obtaining clarification. As such, remand for an addendum opinion is warranted. The Board acknowledges that the Veteran's claims for increased ratings include a claim for TDIU when it is expressly raised by the Veteran or reasonably raised by the record. After a review of the record, the Board finds that the claim for TDIU has been raised by the record. Specifically, the record reflects that the Veteran's representative has raised this issue with the Board. Accordingly, the Board finds that the issue of entitlement to TDIU has been raised by the record and is part and parcel to the Veteran's increased rating claims. See Rice v. Shinseki, 22 Vet. App. 447. Thus, this issue must be remanded for further development and then adjudication by the RO. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's service-connected bilateral lower extremity peripheral neuropathy of the sciatic and femoral nerves. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. The claims file and a copy of this Remand must be made available to the reviewing clinician, and the clinician shall indicate in the addendum report that the claims file was reviewed. The clinician is asked to address the following: (a.) Whether the symptomatology of the Veteran's peripheral neuropathy of the sciatic is separate and distinct from symptomatology of the Veteran's peripheral neuropathy of the femoral nerve? (b.) If the answer to (a) is Yes, describe which symptoms are properly associated with each diagnosis. For any symptoms which may be attributable to both diagnoses, attempt to determine which diagnosis is primarily responsible. (c.) If the answer to (a) is No, attempt to determine which diagnosis is the primary cause of the Veteran's symptomatology. A supporting rationale for all opinions expressed must be provided. If the examiner is unable to provide any opinion as requested, the examiner should fully explain the reason why such opinion could not be rendered. 2. Take all steps necessary to properly develop the Veteran's claim for TDIU. Michael L. Rescan Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Beeler, C. 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.