Citation Nr: 21007003 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 17-12 546 DATE: February 8, 2021 ORDER Entitlement to an increased rating of 70 percent for posttraumatic stress disorder (PTSD) from August 31, 2011 is granted. Entitlement to a total disability evaluation based upon individual unemployability due to service-connected disability (TDIU) from August 31, 2011, is granted. Entitlement to special monthly compensation (SMC) under 38 C.F.R. § 1114(s)(1) is granted. Entitlement to a rating higher than 20 percent for peripheral neuropathy of the right upper extremity is denied. Entitlement to a rating higher than 20 percent for peripheral neuropathy of the right lower extremity is denied. Entitlement to an initial rating higher than 20 percent for peripheral neuropathy of the left upper extremity is denied. Entitlement to a rating higher than 20 percent for peripheral neuropathy of the left lower extremity from is denied. FINDINGS OF FACT 1. From August 31, 2011, the symptoms and impairment caused by the Veteran’s PTSD more nearly approximately total occupational impairment and social impairment with deficiencies in most areas but did not more nearly approximate total social impairment. 2. The Veteran’s service-connected PTSD prevents him from securing and following substantially gainful employment. 3. The Veteran now has a service-connected disability rated as total and additional service-connected disabilities ratable at 60 percent or more. 4. The Veteran’s peripheral neuropathy of the right upper extremity has not at any time more nearly approximated greater than mild incomplete paralysis of the radial nerve, median nerve, and ulnar nerve. 5. The Veteran’s peripheral neuropathy of the right lower extremity has not at any time more nearly approximated greater than moderate incomplete paralysis of the sciatic nerve. 6. The Veteran’s peripheral neuropathy of the left upper extremity has not at any time more nearly approximated greater than mild incomplete paralysis of the radial nerve, median nerve, and ulnar nerve and an increase was not factually ascertainable prior to May 19, 2014. 7. The Veteran’s peripheral neuropathy of the left lower extremity has not at any time more nearly approximated greater than moderate incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. From August 31, 2011, the criteria for a rating of 70 percent for PTSD have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code 9411. 2. The criteria for establishing entitlement to TDIU from August 31, 2011, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. 3. The criteria for SMC pursuant to 38 U.S.C. § 1114(s)(1) are met. 38 U.S.C. § 1114(s). 4. The criteria for a rating higher than 20 percent for peripheral neuropathy of the right upper extremity are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.123, 4.124, 4.124a, Diagnostic Code 8513. 5. The criteria for a rating higher than 20 percent for peripheral neuropathy of the right lower extremity are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.123, 4.124, 4.124a, Diagnostic Code 8520. 6. The criteria for an initial rating higher than 20 percent for peripheral neuropathy of the left upper extremity, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.123, 4.124, 4.124a, Diagnostic Code 8513. 7. The criteria for a rating higher than 20 percent for peripheral neuropathy of the left lower extremity, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.123, 4.124, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1968 to January 1970. These matters come before the Board of Veterans’ Appeals (Board) on appeal from March 2012 and June 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In the March 2012 rating decision, the RO continued a 30 percent evaluation of the Veteran’s PTSD following a claim for increase received August 31, 2011. The Veteran disagreed with his continued rating on April 30, 2012, July 3, 2012, July 24, 2012, and May 6, 2013. In August 2013, the RO increased the Veteran’s PTSD rating from 30 to 50 percent, effective from the August 31, 2011 date of claim. As the 50 percent increase does not constitute a full grant of benefits presumably sought by the claimant, the issue remanded on appeal. See A.B. v. Brown, 6 Vet. App. 35 (1993). Within a year of the August 2013 rating decision, the Veteran attended a VA examination for his PTSD, and the RO adjudicated the issue again in June 2014, continuing the 50 percent evaluation. In the June 2014 rating decision, the RO denied TDIU, granted service connection for peripheral neuropathy of the left upper extremity evaluated at 20 percent disabling effective May 19, 2014, the date if the VA examination that showed an increase. The RO also increased the Veteran’s ratings for peripheral neuropathies of the right lower extremity and left lower extremity each to 20 percent effective September 17, 2013, the date of claim, and continued a 20 percent rating for peripheral neuropathy of the right upper extremity (previously rated under Diagnostic Code 8512). The Veteran disagreed with the decision the same month and submitted a timely appeal the same month as a February 2017 Statement of the Case. The Veteran testified at a hearing before the undersigned Veterans Law Judge in February 2020. A transcript is of record. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. In deciding this appeal, it has been considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as “staged” ratings. See Fenderson v. West, 12 Vet. App. 119 (1999). In this case, the evidence supports a continuous single rating period for each of the Veteran’s disabilities evaluated on appeal. 1. PTSD rating from August 31, 2011 The Veteran’s PTSD is rated under 38 C.F.R. § 4.130, Diagnostic Code 9411. This disability is rated according to the General Rating Formula for Mental Disorders (General Rating Formula). Under the General Rating Formula, a 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned when symptoms such 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; or memory loss for names of close relatives, own occupation or own name cause total occupational and social impairment. Under the General Rating Formula, the Board must conduct a holistic analysis that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. On the other hand, if the evidence shows that the Veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate equivalent rating will be assigned. Sellers v. Principi, 372 F.3d 1318, 1326 (Fed. Cir. 2004); Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). The criteria for a 70 percent rating are met if there are deficiencies in most of the areas of work, school, family relations, judgment, thinking, and mood. Bowling v. Principi, 15 Vet. App. 1, 11-14 (2001). At the February 2020 Board hearing, the Veteran testified to not being able to hold a job due to his PTSD. He explained that due to his annoyance with people making noise he stays too himself, and in addition feels depressed or paranoid. The Veteran also testified that he has problems with his attention span, feeling anxious, and that he was fired due to drinking which he attributed to his PTSD. The Veteran’s wife also testified that working was not a possibility, stating, “He would get fired.” His wife also testified regarding the Veteran’s uncontrollable temper, his loss of focus, and forgetfulness. Generally, she runs the household and needs to provide him assistance with making appointments and other tasks. Regarding relationships, the Veteran testified that his social contacts were more strained. He did still talk with immediate family, but felt as though the family members did more of the talking while he was in the background. A May 2014 VA examiner assessed the severity of the Veteran’s psychiatric condition. Diagnosing the Veteran with PTSD and a mild neurocognitive disorder due to a traumatic brain injury (TBI), the examiner noted that symptoms more likely associated with PTSD included nightmares, flashbacks, emotional and physiological reactivity to cues, cognitive and behavioral avoidance of cues, hypervigilance, and exaggerated startle response, symptoms common to both PTSD and TBI included concentration difficulties, sleep impairment, anhedonia, anxiety, irritability, verbal aggression when frustrated, feeling distant or cut off from others, and risk-taking behavior, while the symptom more likely associated only with the Veteran’s non-service-connected TBI was tinnitus. At the May 2014 VA examination, the Veteran presented as alert and oriented to person, place, time, and situation, his mood was euthymic with congruent affect, his speech was of normal tone, rate, rhythm, and volume, his thought processes were linear, logical, and goal-directed, his thought content was negative for any active psychotic material, and he denied any current homicidal or suicidal ideation. He was considered to be capable of managing his financial affairs. His PTSD symptoms for “VA rating purposes” were noted to be anxiety and chronic sleep impairment. His other endorsed symptoms included intrusive memories, nightmares, flashbacks, emotional and physiological reactivity to traumatic cues, cognitive and behavioral avoidance of traumatic cues, memory problems, strong negative beliefs about self/world/others, blaming self/others, strong negative emotions, anhedonia, feeling distant from others, trouble experiencing positive feelings, anger/irritability, increased risk-taking behavior, hypervigilance, exaggerated startle response, problems concentrating, and insomnia. Following review of the record and in-person examination of the Veteran, the May 2014 VA examiner opined that the Veteran’s service-connected PTSD resulted in occupational and social impairment with reduced reliability and productivity. VA treatment notes show the Veteran maintains some social relationships, and he is continuing to require treatment for his PTSD with deficiencies in most areas; those symptoms and impairment have been noted throughout the appeal period. Consequently, a 70 percent rating is warranted from August 31, 2011, when the Veteran’s claim for increase was received. The evidence shows some social activity throughout the appeal period, including relationships with immediate family and living with his wife, and therefore the symptoms and impairment have not more nearly approximated the total occupational and social impairment required for a 100 percent rating. As the preponderance of the evidence is against a rating higher than 70 percent, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Moreover, there is no evidence that an increase in disability was factually ascertainable within the year prior to the August 31, 2011 claim. 38 U.S.C. § 5110(b)(3). 2. TDIU VA will grant a TDIU when the evidence shows that a veteran is precluded, by reason of service-connected disabilities, from securing and following “substantially gainful employment” consistent with his or her education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. The central inquiry is, “whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The Board must evaluate whether there are circumstances in the Veteran’s case, apart from any non-service-connected condition and advancing age, which would justify a total rating based on individual unemployability due solely to the service-connected conditions. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The regulations provide that if there is only one such disability, it must be rated at 60 percent or more, and if there are two or more disabilities, at least one disability must be rated at 40 percent or more, and sufficient additional disability must bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). In the present case, the Veteran is service connected for PTSD, increased to 70 percent disabling herein from August 31, 2011. The Veteran also has a number of other service-connected disabilities with a combined evaluation of 90 percent from May 19, 2014. Thus, the Veteran has met the percentage requirements for a TDIU, including TDIU based solely upon his PTSD. 38 C.F.R. § 4.16(a). The remaining question is whether the Veteran’s service-connected disabilities preclude him from securing and following a substantially gainful occupation. See 38 C.F.R. § 4.16(a). In Ray v. Wilkie, 31 Vet. App. 58, 73 (2019), the Court defined the term “unable to secure and follow a substantially gainful occupation” as having two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the following: the Veteran’s history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. Whether a veteran could perform the physical and mental acts required by employment at a given time is an issue about which a lay person may provide competent evidence. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013) (“neither the statute nor the relevant regulations require the combined effect [of disabilities] to be assessed by a medical expert”). Regarding the Veteran’s employability, in his VA 21-8940 formal TDIU application received in September 2013, the Veteran wrote that his service-connected PTSD, diabetes mellitus, and peripheral neuropathy disabilities prevented employment, that he became too disabled to work in November 2003, and last worked full time since then, previously having had worked as an oil field service hand. For school and training, he listed that he had completed three years of college with no other education or training. On the application, the Veteran wrote he was fired because of a drinking problem which he had developed “to be able to put up” with people. He said that he has not continued to look for employment because he does not want to be around people, and he tries to stay home and to himself. The Veteran testified at the February 2020 Board hearing that he was fired due to his drinking problem, and that he is also annoyed by noise and people, and that people make him anxious. Without alcohol, he has to stay to himself, and he testified that the alcohol problem was due to his service-connected PTSD. The Veteran and his wife also testified to the Veteran’s issues with attention span, temper control, and forgetfulness. The Veteran’s wife testified that in a work environment, due to the Veteran’s PTSD, “He would get fired.” Following a May 2014 VA examination, the examiner wrote that the symptoms of the Veteran’s PTSD that he exhibits negative impact the ability to work in sedentary or physical occupations, noting that particularly impactful are persistent negative emotional states such as irritability and anger which seriously impair work relationships and undermine personal productivity. The above evidence reflects that the Veteran has a limited educational background and employment history. With regard to the non-economic factors, the Veteran’s training and educational history is not extensive, nor is his work history varied. The Veteran’s lay statements in conjunction with the May 2014 VA opinion indicate that the Veteran experiences significant impairments from his service-connected PTSD which prevent him from employment. For the foregoing reasons, the Veteran’s service-connected PTSD renders him unable to secure or follow substantially gainful employment, particularly in light of his education and employment history. Therefore, entitlement to a TDIU is warranted. 38 C.F.R. § 4.16(a). Given that the issue of entitlement to a TDIU is part and parcel of the claim for an increased rating for PTSD, the date of the formal TDIU claim is not dispositive and TDIU is warranted from August 31, 2011. Harper v. Wilkie, 30 Vet. App. 356, 361-62 (2018) (confirming that when the issue of entitlement to a TDIU is raised as part and parcel of a rating claim, it should be treated separately from a formal claim for TDIU in all aspects of the appeal). Moreover, it is not factually ascertainable that an increase in disability warranting TDIU occurred within a year prior to the August 31, 2011 claim. 3. Entitlement to SMC under 38 C.F.R. § 1114(s) Pursuant to 38 U.S.C. § 1114(s), when a Veteran has a service-connected disability rated as total and has additional service-connected disability independently ratable at 60 percent or more, he is entitled to SMC. 38 U.S.C. § 1114(s)(1). The Court has held that VA has a “well-established” duty to maximize a claimant’s benefits. Buie v. Shinseki, 24 Vet. App. 242, 250 (2011). This duty to maximize benefits requires VA to assess all of a claimant’s disabilities to determine whether any combination of disabilities establishes entitlement to SMC under 38 U.S.C. § 1114. Perciavalle v. Wilkie, 32 Vet. App. 117, 122 (SMC benefits are to be accorded when a Veteran becomes eligible without need for a separate claim). In the decision above, the Board has granted TDIU based on the Veteran’s service-connected PTSD. In addition, the Veteran is in receipt of service connection for Type II diabetes mellitus rated at 20 percent, peripheral neuropathy right upper extremity rated at 20 percent, peripheral neuropathy left lower extremity rated at 20 percent, peripheral neuropathy right lower extremity rated at 20 percent, peripheral neuropathy left upper extremity rated at 20 percent, tinnitus rated at 10 percent, and scar right calf, scars left leg, and erectile dysfunction each of which are assigned a noncompensable evaluation. When not considering PTSD which resulted in total through grant of TDIU, the remaining ratings combine to 80 percent pursuant to 38 C.F.R. § 4.25. As the Veteran meets the statutory criteria during the appeal period of a service-connected disability rated as total and additional service-connected disability independently ratable as at least 60 percent combined, entitlement to SMC under 38 U.S.C. § 1114(s)(1) is warranted. See Perciavalle v. Wilkie, 32 Vet. App. 117, 122 (“It is true that SMC benefits “are to be accorded when a veteran becomes eligible without need for a separate claim”); see also Bradley v. Peake, 22 Vet. App. 280, 293 (“section 1114(s) does not limit ‘a service-connected disability rated as total’ to only a schedular rating of 100%, and the Secretary’s current regulation permits a TDIU rating based on a single disability to satisfy the statutory requirement of a total rating”). 4. Peripheral neuropathy, right upper extremity, 20 percent rating 5. Peripheral neuropathy, right lower extremity, 20 percent rating 6. Peripheral neuropathy, left upper extremity, initial 20 percent rating 7. Peripheral neuropathy, left lower extremity, 20 percent rating The Veteran’s peripheral neuropathy of the right and left upper extremities are rated under 38 C.F.R. § 4.124a, Diagnostic Code 8513 as paralysis of the radial nerve. The Veteran’s peripheral neuropathy of the right and lower upper extremities are rated under 38 C.F.R. § 4.124a, Diagnostic Code 8520 as paralysis of the sciatic nerve. Under Diagnostic Code 8513, a 20 percent rating is warranted for mild incomplete paralysis, a 40 percent rating is warranted for moderate incomplete paralysis for the major side and 30 percent for moderate incomplete paralysis of the minor side, a 70 percent rating is warranted for severe incomplete paralysis the major side and 60 percent is warranted for severe incomplete paralysis of the minor side, and a 90 percent rating is warranted for complete paralysis of the major side and 80 percent is warranted for complete paralysis of the minor side. 38 C.F.R. § 4.124a, Diagnostic Code 8513. The evidence of record indicates that the Veteran is right hand dominant, and thus his right upper extremity is his major side. Under Diagnostic Code 8520, the following ratings apply: a 10 percent rating is warranted for mild incomplete paralysis; a 20 percent rating is warranted for moderate incomplete paralysis; a 40 percent rating is warranted for moderately severe incomplete paralysis; a 60 percent rating is warranted for severe incomplete paralysis with marked muscular atrophy; and an 80 percent rating is warranted for complete paralysis resulting in the foot dangling and dropping, no possible active movement of muscles below the knee, and weakened or (very rarely) lost flexion of the knee. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The rating schedule provides guidance for rating neurological disabilities. With regard to rating neurological disabilities, cranial or peripheral neuritis, 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 that can be assigned for neuritis not characterized by organic changes will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. Id. Cranial or peripheral neuralgia, usually characterized 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. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type pictured 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 should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Considering the pertinent evidence in light of the applicable rating criteria and considerations delineated above, the Board finds, for the following reasons, that the Veteran’s right and left lower extremity neurological symptoms have not manifested in symptoms of the type and extent, frequency, and/or severity to warrant ratings higher than 20 percent, during the entirety of the periods on appeal. VA treatment records show the Veteran has some tingling and numbness, particularly to his feet. At a May 2014 VA examination, the Veteran reported he experienced intermittent numbness to the fingers of both hands, numbness, tingling, and burning to both of his feet, and that burning pain is aggravated by prolonged standing or walking. He was not on any specific treatment for the neuropathy. The Veteran experienced moderate constant pain that may be excruciating at times in his lower extremities, and none in his upper extremities. He experienced no intermittent pain that was usually dull. Regarding paresthesias and/or dysesthesias as well as numbness, the Veteran experienced these moderately in the lower extremities and mildly in the upper extremities. His strength was 5/5 for all extremity joints tested. As for severity of the upper extremities, the Veteran’s right upper extremity radial nerve was affected by mild incomplete paralysis. The Veteran left radial nerve experienced mild incomplete paralysis. The right and left median nerves and right and left ulnar nerves each experienced mild incomplete paralysis. The Veteran’s lower extremities each experienced moderate incomplete paralysis of the sciatic nerve and the femoral nerve was noted as normal. The Veteran testified at the February 2020 Board hearing that his condition was worse than the previous examination reflected. He also testified that he has a tingling in his toes. He detailed that if he were to get up and not pay much attention, he would have to limp while feeling like he would lose his balance, and he would have stiffness. The Veteran testified that he has not had any falls, but that he has had “quite a few near misses.” Regarding the Veteran’s bilateral upper and bilateral lower extremities peripheral neuropathy disabilities, there is no evidence that any worsening would be of sufficient severity to warrant higher ratings. Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015). The evidence of record shows the Veteran’s peripheral neuropathy of the right upper extremity, left upper extremity, right lower extremity, and left lower extremity are accurately rated at 20 percent disabling each. While an examiner’s characterization of the level of disability is not binding on the Board, here it is consistent with the above evidence of record. That evidence shows pain and numbness in the upper extremities that was intermittent and mild and more frequent and significant and therefore moderate in the lower extremities. Thus, ratings higher than the current 20 percent for bilateral upper and lower extremity peripheral neuropathy is not warranted under Diagnostic Codes 8513 and 8520. As the preponderance of the evidence is against higher ratings, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Moreover, there is no evidence that an increased was factually ascertainable prior to the current effective dates of September 17, 2013 and May 19, 2014. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Kuczynski, 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.