Citation Nr: 21006659 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 18-34 941 DATE: February 4, 2021 ORDER An effective date of March 3, 2015, for a 60 percent rating for coronary artery disease, status post myocardial infarction, status post stent placement (hereinafter CAD) is granted. A 100 percent rating as of June 14, 2017, but no earlier, for CAD, for accrued benefits, is granted. An effective date of June 14, 2017, but no earlier for the grant of special monthly compensation (SMC) at the housebound rate is granted. A rating higher than 70 percent for PTSD for accrued benefits is denied. A rating higher than 20 percent for diabetes mellitus, type II (DMII), with erectile dysfunction, for accrued benefits, is denied. A 30 percent rating for peripheral neuropathy of the femoral nerve of the right lower extremity for accrued benefits is granted. A 30 percent rating for peripheral neuropathy of the femoral nerve of the left lower extremity for accrued benefits is granted. A 40 percent rating for peripheral neuropathy of the sciatic nerve of the right lower extremity for accrued benefits is granted. A 40 percent rating for peripheral neuropathy of the femoral nerve of the left lower extremity for accrued benefits is granted. A rating higher than 30 percent prior to August 9, 2019, and higher than 60 percent thereafter for diabetic nephropathy with hypertension is denied. FINDINGS OF FACT 1. Resolving all reasonable doubt in favor of the Veteran/appellant, the Veteran’s left ejection fraction was 30-50 percent as of March 3, 2015. 2. As of June 14, 2017, the Veteran’s CAD caused METs of less than 3 with dyspnea and fatigue. 3. As of June 14, 2017, the Veteran’s CAD was granted a 100 percent rating and he has additional disabilities rated at 60 percent or more disabling. 4. The Veteran’s PTSD caused occupational and social impairment with deficiencies in most areas; total occupational and social impairment was not shown. 5. The Veteran’s DMII did not require regulation of activities; his erectile dysfunction did not cause deformity. 6. The Veteran’s bilateral lower extremity femoral nerve peripheral neuropathy was severe. 7. The Veteran’s bilateral lower extremity sciatic nerve peripheral neuropathy was moderately severe. 8. Prior to August 9, 2019, the Veteran’s diabetic nephropathy with hypertension caused to albumin constant or recurring; as of August 9, 2019, there was a definite decrease in kidney function. CONCLUSIONS OF LAW 1. The criteria for an effective date of March 3, 2015, for a 60 percent rating for CAD for accrued benefits are met. 38 U.S.C. § 7105; 38 C.F.R. § 3.400; Harper v. Brown, 10 Vet. App. 125 (1997). 2. The criteria for a 100 percent rating for CAD as of June 14, 2017, but no earlier, for accrued benefits are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.104, DC 7017-7006. 3. As of June 14, 2017, but no earlier, the criteria for SMC at the housebound rate are met. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350. 4. The criteria for a rating higher than 70 percent for PTSD for accrued benefits are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.130, DC 9411. 5. The criteria for a rating higher than 20 percent for DMII for accrued benefits are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.119, DC 7913. 6. The criteria for a 30 percent rating for peripheral neuropathy of the femoral nerve of the right lower extremity for accrued benefits are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 8526. 7. The criteria for a 30 percent rating for peripheral neuropathy of the femoral nerve of the left lower extremity for accrued benefits are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 8526. 8. The criteria for a 40 percent rating for peripheral neuropathy of the sciatic nerve of the right lower extremity for accrued benefits are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 8526. 9. The criteria for a 40 percent rating for peripheral neuropathy of the sciatic nerve of the left lower extremity for accrued benefits are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 8526. 10. The criteria for a rating higher than 30 percent prior to August 9, 2019, and higher than 60 percent thereafter for diabetic nephropathy with hypertension for accrued benefits are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.115a, 4.115b, DC 7541. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1968 to December 1969. The Veteran died in August 2020. The appellant is his surviving spouse and was substituted in August 2020. Earlier Effective Date The method of determining the effective date of an increased evaluation is set forth in 38 U.S.C. § 5110(a) and (b)(2), and 38 C.F.R. § 3.400(o). The general rule with respect to the effective date of an award of increased compensation is that the effective date of such award "shall not be earlier than the date of receipt of application thereof." 38 U.S.C. § 5110(a). This statutory provision is implemented by regulation which provides that the effective date for an award of increased compensation will be the date of receipt of claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(o)(1). An exception to the rule applies, however, under circumstances where evidence demonstrates that a factually ascertainable increase in disability occurred within the one-year period preceding the date of receipt of a claim for increased compensation. In that regard, the law provides that the effective date of the award "shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year from such date, otherwise the date of receipt of the claim." 38 U.S.C. § 5110(b)(2). See 38 C.F.R. § 3.400(o)(2). The phrase "otherwise, date of receipt of claim" applies only if a factually ascertainable increase in disability occurred within one year prior to filing the claim for an increased rating. Harper v. Brown, 10 Vet. App. 125 (1997). Moreover, the term "increase" as used in 38 U.S.C. § 5110 and 38 C.F.R. § 3.400 means an increase to the next disability level. See Hazan v. Gober, 10 Vet. App. 511 (1997). The record shows that the Veteran sought an increased rating for his CAD in March 2016. See March 3, 2016, Notification Letter, acknowledging receipt of Veteran’s Intent to File (ITF) on March 3, 2016. On March 22, 2016, the Veteran subsequently filed for an increased rating for his CAD. Based on that request, VA obtained the Veteran’s treatment records, which showed the Veteran had a myocardial infarction (MI) on February 13, 2016. As such, VA increased the Veteran’s rating to 100 percent from the date of the Veteran’s MI to June 1, 2016, at which time, pursuant to the rating criteria, his CAD was assigned a 60 percent rating. The Board notes that the period for which the Veteran was assigned a 100 percent rating is not on appeal, as that this maximum rating allowed. Additionally, the Veteran’s CAD rating as of June 1, 2016, is discussed below. The Veteran/appellant have sought an earlier effective date for the Veteran’s increased ratings. Thus, pursuant to 38 U.S.C. § 5110(b)(2), 38 C.F.R. § 3.400(o)(2), the earliest possible date upon which a higher rating could be granted is March 3, 2015 – one year prior to VA’s receipt of the ITF – until the 100 percent rating effective February 12, 2016. During that time, the Veteran’s CAD was assigned a 30 percent rating pursuant to DC 7006. Under DC 7006, a 30 percent evaluation is warranted for a workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilation on electrocardiogram, echocardiogram or X-ray. 38 C.F.R. § 4.104. A 60 percent evaluation is warranted for more than one episode of acute CHF in the past year, or workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent rating, which is warranted when there is chronic congestive heart failure (CHF), or; a workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction (LEF) of less than 30 percent. A 100 percent evaluation is also warranted for 3 months following hospital admission for coronary bypass surgery. For rating diseases of the heart, one MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for rating, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. 38 C.F.R. § 4.104, Note 2. A February 2015 VA medical record showed the Veteran’s LEF of 43 percent. A March 18, 2015, VA medical record showed the Veteran was noted to have an LEF of 50s. Thus, the Board finds that, resolving any reasonable doubt in favor of the Veteran/appellant, a 60 percent rating for the Veteran’s CAD as of March 3, 2015, is supported by the record. The Veteran’s LEF percentage was documented to be in the range of 30-50 percent within the time period of the year prior to his request for an increase. There are no records which indicate that the Veteran’s CAD warranted a rating higher than 60 percent prior to his documented February 2016 MI. As such, a 60 percent rating as of March 3, 2015, until the Veteran’s 100 percent rating of February 13, 2016, is granted. Increased Rating Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Heart The Veteran’s heart condition was rated pursuant to DCs 7017-7006. 38 C.F.R. § 4.104. The Veteran’s heart condition was rated at 100 percent for the periods from February 13, 2016 to June 1, 2016, and as of July 11, 2018. As that is the maximum benefit allowed, those periods are not on appeal. Thus, the period on appeal to the Board is from June 1, 2016, to July 11, 2018. Under DCs 7017-7006, the only rating available higher than 60 percent is a 100 percent rating, which is warranted when there is chronic congestive heart failure (CHF), or; a workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction (LEF) of less than 30 percent. A 100 percent evaluation is also warranted for 3 months following hospital admission for coronary bypass surgery. For rating diseases of the heart, one MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for rating, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. 38 C.F.R. § 4.104, Note 2. After review of the records which documented the Veteran’s CAD treatment for the period from June 1, 2016, to July 11, 2018, the Board finds that prior to June 14, 2017, there are no records which show the Veteran meets the criteria for a 100 percent rating during that time. A February 2016 private medical record showed the Veteran’s LEF was 60%. A June 7, 2016, VA examination showed the Veteran’s CAD caused acute CHF, but not chronic CHF. His LEF was noted to 53% (from a 2014 test) and his METs were rated at 3-5 with dyspnea and fatigue. A June 14, 2017, private medical record, however, showed the Veteran had a stress test which resulted in a METs of 1.0. The June 2016 VA examination had established the Veteran suffered dyspnea and fatigue with his METs rating. Thus, as of the June 2017 date, the Veteran met the criteria for a 100 percent rating pursuant to DCs. 7017-7006. The record does not show, however, that the criteria for a 100 percent rating was met prior to the June 14, 2017, stress test record. SMC VA has a duty to infer a claim for SMC when the evidence of record indicates potential entitlement. See Akles v. Derwinski, 1 Vet. App. 118 (1991). SMC at the housebound rate is payable by law when a veteran has a single service-connected disability rated at 100 percent and additional service-connected disabilities independently ratable at 60 percent. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). The Veteran was awarded SMC at the housebound rate as of his prior 100 percent CAD effective date, July 11, 2018. The Veteran has numerous other service- connected disabilities which combine to a total above 60 percent. Based on the above grant of a 100 percent rating for the Veteran’s CAD as of June 14, 2017, the Veteran met the criteria for SMC at the housebound rate as of June 14, 2017. Accordingly, SMC at the statutory housebound rate as of June 14, 2017, is warranted. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). PTSD The Veteran sought an increased rating for his PTSD September 1, 2017. His PTSD was assigned a 70 percent rating as of his request for an increase, pursuant to DC 9411. 38 C.F.R. § 4.130. DC 9411 provides that a 70 percent evaluation is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. A 100 percent evaluation is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126. After review of the record, the Board does not find that any evidence supported a rating higher rating for the Veteran’s PTSD. A November 2018 VA examination found that the Veteran’s PTSD caused occupational and social impairment with deficiencies in most areas. His symptoms included depressed mood, anxiety, suspiciousness, near continuous panic, chronic sleep impairment, mild memory loss, flattened affect, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, inability to establish and maintain effective relationships, suicidal ideation, and impaired impulse control. These symptoms and the impairment level approximated by the symptoms directly align with a 70 percent rating. Importantly, the Veteran did not endorse symptoms of gross impairment of thought process or communication, grossly inappropriate behavior, persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. None of the symptoms or level of impairment associated with a 100 percent rating were endorsed by the Veteran in his 2018 VA examination or noted by the examiner. Specifically, the examiner noted that the Veteran’s thought content did not show hallucinations, delusions, or derealization/depersonalization. There are no records of evidence which indicated that the Veteran endorsed any of the symptoms more closely approximated to that of a 100 percent rating and the Board notes that the Veteran, his representative, and the appellant did not identify any evidence of record, or introduce any evidence into the record, which would support a 100 percent rating for the Veteran’s PTSD. The Board has considered the lay statements of evidence. While the Veteran and the appellant were competent to report his symptoms, whether a disability meets the schedular criteria for the assignment of an evaluation is a factual determination by the Board based on the Veteran’s complaints coupled with the medical evidence. Here, the medical findings show that the Veteran did not meet the schedular requirements for a higher rating, as explained and discussed above. The Board has concluded that the medical evidence, prepared by skilled professionals, is more probative regarding the Veteran’s degree of disability. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not for application, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). DMII The Veteran’s DM was assigned a 20 percent rating as of his grant of service connection pursuant to DC 7913. 38 C.F.R. § 4.119. In September 2017 the Veteran sought a higher rating for his DMII. Under DC 7913, a 20 percent rating is warranted where insulin and restricted diet, or; use of oral hypoglycemic agent and restricted diet is required. A 40 percent rating is warranted where insulin, restricted diet, and regulation of activities is required. A 60 percent rating is warranted for diabetes mellitus requiring 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 for diabetes mellitus requiring more than one daily injection of insulin, restricted diet, and regulations of activities (avoidance of strenuous occupational and recreational 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. 38 C.F.R. § 4.119. Note (1) to DC 7913 provides that compensable complications of diabetes are to be rated separately unless they are part of the criteria used to support a 100 percent rating (under DC 7913). Non-compensable complications are considered part of the diabetic process under DC 7913. Thus, in order for the Veteran’s DMII to warrant a rating higher than 20 percent, he must have been given a regulation of activity. The Veteran’s November 2018 VA examination noted the Veteran’s DMII was treated with restricted diet, 1 insulin injection per day, and an oral hypoglycemic agent. He was not found to require regulation of activity and had no episodes of hypoglycemia or hospitalizations in the year prior. A review of the VA medical records and private medical records of evidence also do not show that the Veteran’s activities were regulated due to his DMII. The Board notes that the Veteran, his representative, and the appellant did not identify any evidence of record, or introduce any evidence into the record, which would support a finding that the Veteran had regulation of his activities due to his DMII. Additionally, the Veteran’s ED was not found to include penile deformity, so a compensable rating for that condition is not warranted. See November 2018 Erectile Dysfunction VA examination. The Veteran’s other complications of DMII – neuropathy and nephropathy are assigned compensable ratings and discussed below. The Board has again considered the lay statements of evidence and has concluded that the medical evidence, prepared by skilled professionals, is more probative regarding the Veteran’s degree of disability. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not for application, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Bilateral Lower Extremity Femoral Nerve Neuropathy The Veteran bilateral lower extremity femoral nerve neuropathy was assigned a 20 percent rating for each extremity as of September 1, 2017, pursuant to DC 8526. The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. 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 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). Under DC 8526, a 40 percent rating is warranted for complete paralysis of the anterior crural nerve (femoral) resulting in paralysis of the quadriceps extensor muscles. Further, incomplete paralysis of the anterior crural nerve (femoral) warrants a 30 percent rating if it is severe a 20 percent rating if it is moderate, or a 10 percent rating if it is mild. 38 C.F.R. § 4.124a, DC 8526. The Veteran’s November 2018 VA examination of his femoral nerve showed his neuropathy caused severe incomplete paralysis. Thus, based on the rating criteria, the Veteran’s bilateral lower extremity femoral nerve neuropathy warrants a 30 percent rating as of his September 1, 2017, request for an increased rating. As there is no evidence that the Veteran’s neuropathy caused complete paralysis, a rating higher than 30 percent for each extremity is not warranted. Bilateral Lower Extremity Sciatic Nerve Neuropathy The Veteran’s sciatic nerve neuropathy was assigned a 20 percent rating for each lower extremity pursuant to DC 8520 as of his September 2017 request for a higher rating. Under DC 8520, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The Veteran’s November 2018 VA examination showed the Veteran had moderately severe incomplete paralysis of the sciatic nerve. Thus, his bilateral lower extremity sciatic nerve neuropathy rating warrants a 40 percent rating as of his September 1, 2017, request for an increased rating. As there is no evidence that the Veteran’s neuropathy caused muscle atrophy or complete paralysis, a rating higher than 40 percent for each extremity is not warranted. Diabetic Nephropathy with Hypertension The Veteran’s diabetic nephropathy with hypertension was assigned a 30 percent rating as of his grant of service connection and a 60 percent rating as of August 9, 2019, pursuant to DC 7541. 38 C.F.R. §§ 4.115b. The Veteran sought an increased rating as of August 2017. DC 7541 directs that the Veteran’s nephropathy with hypertension is rated as renal dysfunction. Renal dysfunction is rated pursuant to 38 C.F.R. §§ 4.115a. A 30 percent rating is warranted due to albumin constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema or hypertension at least 10 percent disabling under DC 7101. A 60 percent rating for constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under Diagnostic Code 7101. An 80 percent rating is warranted for persistent edema and albuminuria with BUN 40 to 80mg; or, creatinine 4 to 8mg; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion. A 100 percent rating is warranted where regular dialysis is required, or more than sedentary activity is precluded from one of the following: persistent edema and albuminuria; or, BUN more than 80mg; or, creatinine more than 8mg; or, markedly decreased function of kidney or other organ systems, especially cardiovascular. DC 7101 states that a 10 percent disability evaluation is warranted where diastolic pressure is predominantly 100 or more, systolic pressure is predominantly 160 or more, or the individual has a history of diastolic pressure of 100 or more and requires continuous medication for control. For the next higher 20 percent disability evaluation, diastolic pressure must be predominantly 110 or more or systolic pressure must be 200 or more. A 40 percent disability evaluation requires diastolic pressure predominantly 120 or more, and a 60 percent disability evaluation requires diastolic blood pressure to be predominantly 130 or more. An April 2018 VA medical record showed the Veteran had minimal to no edema and his creatinine was 1.1. A May 2018 VA medical record showed mid lower extremity edema. A November 2018 VA examination noted that the Veteran had diabetic nephropathy. His symptoms were found to include persistent proteinuria, hematuria, or GFR <60 cc/min/1.73m2. He did not require dialysis. His BUN and creatinine were noted to be normal as of November 26, 2018. An August 9, 2019, VA medical record showed the Veteran’s pro-BNP was elevated. April, July, and December 2019 VA medical records showed the Veteran’s creatinine was 1.3. A November 2018 VA examination of the Veteran’s hypertension showed that his hypertension included taking medication. His pressure reading, at worst, was 128/78. A November 2019 VA medical record showed the Veteran’ had a history of blood pressure readings which, at worst, were 158/85. After review of the record, the Board did not find any evidence which supports a rating higher than 30 percent prior to August 9, 2019, or higher than 60 percent thereafter for the Veteran’s nephropathy with hypertension. The record does not contain laboratory findings which support higher ratings and the Veteran, his representative, and the appellant did not identify any evidence of record, or introduce any evidence into the record, which would support ratings higher than those assigned. The Board has again considered the lay statements of evidence and has concluded that the medical evidence, prepared by skilled professionals, is more probative regarding the Veteran’s degree of disability. (Continued on the next page)   As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not for application, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Parrish, 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.