Citation Nr: 21014028 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 10-24 549 DATE: March 11, 2021 ORDER Entitlement to revision of a June 14, 2010, rating decision that severed service connection for type 2 diabetes mellitus, on the basis of clear and unmistakable error (CUE) pursuant to 38 C.F.R. § 3.105, is granted, and service connection for type 2 diabetes from September 1, 2010, is restored. Entitlement to an increased 70 percent evaluation, but no higher, for posttraumatic stress disorder (PTSD) is granted. REMANDED Entitlement to service connection for peripheral neuropathy is remanded. Entitlement to a finding of total disability based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The June 14, 2010, rating decision that severed service connection for type 2 diabetes mellitus, became final because the Veteran did not appeal.    2. The December 19, 2008, rating decision establishing service connection for type 2 diabetes mellitus was not clearly and unmistakably erroneous. 3. The Veteran’s PTSD was manifested by occupational and social impairment with reduced reliability and productivity with symptoms such as depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, suicidal ideation, and difficulty in establishing and maintaining effective work and social relationships; total occupational and social impairment was not shown. CONCLUSIONS OF LAW 1. Severance of service connection for type 2 diabetes mellitus, effective September 1, 2010, was not proper. 38 U.S.C. § 5109A; 38 C.F.R. §§ 3.104, 3.105. 2. The criteria for a rating of 70 percent for PTSD are met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from July 1966 to May 1969. He died on April [REDACTED], 2017. The appellant is his surviving spouse, and was recognized as a substituted claimant in a November 2018 administrative decision. These matters come to the Board of Veterans’ Appeals (Board) on appeal from February 2009, March 2010, February 2014, and October 2016 rating decisions by a Regional Office (RO) of the United States Department of Veterans Affairs (VA). The Board, in a July 2014 decision, denied service connection for peripheral neuropathy. The Veteran appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court). In a July 2015 Order, the Court granted a Joint Motion for Remand (JMR) and remanded the matter to the Board for action consistent with the motion. In November 2015, the Board remanded the matter of entitlement to service connection for peripheral neuropathy for further evidentiary development. As such, the issue is again before the Board. Severance of Service Connection The appellant asserts CUE in a June 2010 rating decision that severed connection for the Veteran’s type 2 diabetes mellitus. The appellant’s representative contends that the RO relied upon an inadequate premise when it severed service connection. The appellant’s representative directs attention to diagnoses of diabetes in February 2004, October 2008, and March 2009, which were of record at the time of the June 2010 rating decision. A previous RO determination that is final and binding will be accepted as correct in the absence of CUE. Where evidence establishes such error, the prior decision will be reversed or amended. 38 C.F.R. § 3.105(a). Service connection for type 2 diabetes mellitus was severed in a June 2010 rating decision. The Veteran did not file a timely Notice of Disagreement challenging this determination within one year of the decision. Thus, the June 2010 rating decision became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 3.160(d), 3.156(b), 20.302, 20.1103. Once a decision becomes final, it may only be revised by a showing of CUE. 38 C.F.R. §§ 3.104, 3.105. CUE is a very specific and rare kind of error. It is the kind of error, of fact or of law, that when called to the attention of later reviewers compels the conclusion, to which reasonable minds could not differ, that the result would have been manifestly different but for the error. Simply to claim CUE on the basis that previous adjudications had improperly weighed and evaluated the evidence can never rise to the stringent definition of CUE. Similarly, neither can broad-brush allegations of “failure to follow the regulations” or “failure to give due process,” or any other general, nonspecific claim of error. Fugo v. Brown, 6 Vet. App. 40, 43-44 (1993). In addition, failure to address a specific regulatory provision involves harmless error unless the outcome would have been manifestly different. Id. at 44. Where evidence establishes CUE, the prior decision will be reversed or amended. 38 C.F.R. § 3.105(a). For the purpose of authorizing benefits, the rating or other adjudicatory decision which constitutes a reversal of a prior decision on the grounds of CUE has the same effect as if the corrected decision had been made on the date of the reversed decision. Id. CUE is established when the following conditions are met: (1) either (a) the correct facts in the record were not before the adjudicator, or (b) the statutory or regulatory provisions in existence at the time were incorrectly applied; (2) the alleged error must be “undebatable,” not merely “a disagreement as to how the facts were weighed or evaluated”; and (3) the commission of the alleged error must have “manifestly changed the outcome” of the decision being attacked on the basis of CUE at the time that decision was rendered. Evans v. McDonald, 27 Vet. App. 180, 185 (2014), aff’d, 642 F. App’x 982 (Fed. Cir. 2016); Damrel v. Brown, 6 Vet. App. 242, 245 (1994); Russell v. Principi, 3 Vet. App. 310, 313-14 (1992). The error must be of a type that is outcome-determinative, and subsequently developed evidence may not be considered in determining whether an error existed in the prior decision. See Porter v. Brown, 5 Vet. App. 233, 235-36 (1993); Glover v. West, 185 F.3d 1328 (Fed. Cir. 1999). A manifest change in the outcome of an adjudication means that, absent the alleged CUE, the benefit sought would have been granted at the outset. King v. Shinseki, 26 Vet. App. 433, 441 (2014). The standard is not whether it is reasonable to conclude that the outcome would have been different. Id. at 442. A determination that there was CUE must be based upon the record and the law that existed at the time of the prior adjudication in question. See Pierce v. Principi, 240 F.3d 1348 (Fed. Cir. 2001). Simply to allege CUE on the basis that previous adjudications improperly weighed and evaluated the evidence, or failed to apply the benefit-of-the-doubt doctrine, or failed to give reasons and bases, can never rise to the stringent definition of CUE. Disagreements as to how facts are weighed do not constitute CUE. Russell v. Principi, 3 Vet. App. 310, 313-14 (1992). Once service connection is granted, it can be severed only upon VA’s showing that the rating decision granting service connection is clearly and unmistakably erroneous, and only after certain procedural safeguards have been met. 38 C.F.R. § 3.105(d); see also Daniels v. Gober, 10 Vet. App. 474, 478 (1997); Graves v. Brown, 6 Vet. App. 166 (1994). When severance of service connection is considered warranted, a rating proposing severance will be prepared setting forth all material facts and reasons. The claimant will be notified of the contemplated action at his or her latest address of record, will be furnished detailed reasons for the contemplated action, and will be given 60 days for the presentation of additional evidence to show that service connection should be maintained. If additional evidence is not received within that period, final rating action will be taken and the award will be reduced or discontinued, if in order, effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires. 38 C.F.R. § 3.105(d). Additionally, 38 C.F.R. § 3.105(i) provides that written notice of a proposed severance action should also inform the beneficiary of his or her right to a pre-determination hearing, provided that a request for such a hearing is received within 30 days from the date of the notice. A change in diagnosis may be accepted as a basis for severance action if the examining physician or physicians or other proper medical authority certifies that, in the light of all accumulated evidence, the diagnosis on which service connection was predicated is clearly erroneous. This certification must be accompanied by a summary of the facts, findings, and reasons supporting the conclusion. 38 C.F.R. § 3.105(d). In most respects, the CUE standard for severing service connection under 38 C.F.R. § 3.105(d) is equivalent to the CUE standard for reversing or revising a prior final decision under 38 C.F.R. § 3.105(a). See Baughman v. Derwinski, 1 Vet. App. 563, 566 (1991). Section 3.105(d) places at least as high a burden of proof on the VA when it seeks to sever service connection as 38 C.F.R. § 3.105(a) places upon an appellant seeking to have an unfavorable previous determination overturned. See id. However, the determination is not limited to the law and the record that existed at the time of the original decision. VA may consider medical evidence and diagnoses that postdate the original award of service connection to demonstrate that the diagnosis on which service connection was predicated is clearly erroneous. Stallworth, 20 Vet. App. at 488. The Secretary’s burden is not to prove CUE in the original decision in the same manner a claimant would show CUE under sections 5109A or 7111. Id. To establish that a grant of service connection was the product of clear and unmistakable error (CUE), VA must show that (1) either the correct facts as they were known at the time were not before the adjudicator, the adjudicator made an erroneous factual finding, or the statutory or regulatory provisions were incorrectly applied; (2) the alleged error was undebatable, not merely a disagreement as to how the facts were weighed or evaluated; and (3) the error manifestly changed the outcome of the prior decision. See Allen v. Nicholson, 21 Vet. App. 54, 58-59 (2007); Stallworth v. Nicholson, 20 Vet. App. 482, 487-88 (2006); cf. Bustos v. West, 179 F.3d 1378, 1380-81 (Fed. Cir. 1999); Damrel v. Brown, 6 Vet. App. 242, 245 (1994); Russell v. Principi, 3 Vet. App. 310, 313-14, 319 (1992) (en banc). A clear and unmistakable error is one about which reasonable minds could not differ. See, e.g., 38 C.F.R. § 20.1403(a). A decision that is reversed or amended on the basis of CUE is revised to conform to the true state of the facts or the law that existed at the time of the original adjudication. Allen, 21 Vet. App. at 62. The evidence of record reflects that the Veteran submitted an informal claim of service connection for type 2 diabetes that was received by the RO on October 28, 2008. The Board notes that the record documented diagnoses of type 2 diabetes mellitus. At a February 2004 VA digestive system examination, the VA examiner noted that the Veteran had type 2 diabetes mellitus and had a mild degree of hypoglycemia at the time of the examination. VA outpatient treatment records dated October 2008 indicated that the Veteran was now classified as a diabetic. Thereafter, VA records dated December 2008 documented an active diagnosis of type 2 diabetes mellitus. In March 2009, the Veteran was prescribed glucose test strips. The RO, in a December 2008 rating decision, awarded service connection for type 2 diabetes mellitus associated with herbicide exposure. The rating decision noted that VA outpatient treatment records from the Pensacola, Florida VA Medical Center showed a diagnosis of type 2 diabetes mellitus and that the Veteran followed a restricted diet. During this period, the Veteran also had an outstanding claim of service connection for peripheral neuropathy. The Veteran asserted that his claimed peripheral neuropathy was due to his service-connected type 2 diabetes mellitus. Due to the Veteran’s claim of service connection for peripheral neuropathy on a secondary basis, he was afforded a VA examination in March 2010. The Veteran stated that he did not take any medications for his diabetes. The VA examiner determined that there was no objective evidence that the Veteran met the diagnostic criteria for diabetes mellitus. While noting the Veteran’s lay report of a diagnosis in 2008, the VA examiner reported that an October 2008 treatment note indicated that the Veteran was “now classified as diabetic but medications not indicated.” The VA examiner also stated that the record did not show that the Veteran was prescribed medications for diabetes or that he had a hemoglobin A1c level greater than 5.6, which was reportedly at its highest in February 2010. Based upon the VA examiner’s determination, the RO proposed to sever service connection for type 2 diabetes mellitus in a March 2010 rating decision. Puzzlingly, the Board notes that the RO determined that the medical evidence at the time service connection was granted indicated that type 2 diabetes mellitus was diagnosed, and that “no clear and unmistakable error was made.” In response to the proposal to sever, the Veteran submitted correspondence in June 2010 reiterating his Republic of Vietnam service and his diagnosis of diabetes by his primary physician. He also submitted a snippet listing potential diabetic symptoms and noting that diabetes often goes undiagnosed as many of its symptoms “seem so harmless.” In a June 14, 2010, rating decision, the RO severed service connection for type 2 diabetes mellitus, effective September 1, 2010, the first day of the month following 60 days after notification of the decision. The Veteran did not submit a Notice of Disagreement or submit new and material evidence within one year of the rating decision, and the June 2010 rating decision became final. The Board finds that the grant of service connection for type 2 diabetes mellitus was not clearly and unmistakably erroneous, and that the severance of service connection for type 2 diabetes mellitus was not proper. The June 2010 rating decision is based on incorrect facts and application of the laws and regulations governing the severance of service connection. As discussed above, the Veteran appealed the July 2014 Board’s denial of service connection for peripheral neuropathy to the Court in July 2015. Although the propriety of the severance of service connection for type 2 diabetes mellitus was not before the Court at that time, the JMR discussed the March 2010 VA examination. The parties to the joint motion determined that it was unclear how the March 2010 VA examiner found that the Veteran did not meet the criteria for a diagnosis of type 2 diabetes mellitus, when he was previously diagnosed with the disability and “classified as diabetic” and where that disability is considered to be a chronic disease that typically does not resolve. The joint motion also noted that it was unclear as to what effect, if any, the March 2010 VA examination that found no objective evidence of diabetes mellitus had on the prior diagnoses of record. Indeed, the VA examiner did not provide a rationale as to why the prior diagnoses on which service connection for diabetes was predicated were clearly erroneous. The VA examiner’s opinion was predicated solely upon an October 2008 reference to diabetes. To the extent that a subsequent VA medical opinion was obtained in September 2016, the VA examiner also did not adequately address the prior diagnoses of diabetes mellitus of record, aside from the October 2008 diagnosis, and most importantly, did not discuss why those diagnoses were invalid. The absence of any passing reference to other diagnoses of type 2 diabetes mellitus of record by either VA examiner renders their respective summary of the facts, findings, and reasons supporting the conclusion pursuant to 38 C.F.R. § 3.105(d) inadequate and the RO’s determination that the grant of service connection was the product of CUE to be improper. Accordingly, the severance of service connection for type 2 diabetes mellitus was improper, and service connection is restored effective September 1, 2010. Increased Rating 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.    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 upon all the evidence of record that bears on occupational and social impairment, rather than solely upon 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. In evaluating the severity of a particular disability, it is essential to consider its history.  38 C.F.R. § 4.1; 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).    Separate evaluations may be assigned for separate periods of time based on the facts found.  In other words, the evaluations may be staged.  Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).  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 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 evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of the symptomatology of the other condition.  38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994).    VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a).  Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).    Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336–37 (Fed. Cir. 2006).  However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran’s lay statements.  Id.  Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period.  Maxson v. West, 12 Vet. App. 453, 459 (1999), aff’d sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000).    The Veteran’s PTSD was rated under Diagnostic Code 9411 and evaluated under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.30. The General Rating Formula for Mental Disorders provides that a 50 percent rating is warranted where there is occupational and social impairment with reduced reliability and productivity due to such symptoms 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; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted where there is 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 work like setting); and inability to establish and maintain effective relationships. Id. The Federal Circuit has found that § 4.130 requires an ultimate factual conclusion as to the veteran’s level of impairment in “most areas” for a 70 percent rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). A 100 percent rating 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; or memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, 4.30. Ratings are assigned according to the manifestation of particular symptoms. However, the use of the term “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the evidence considered in determining the level of impairment under § 4.130 is not restricted to the symptoms provided in the diagnostic code. Instead, VA must consider all symptoms of a Veteran’s condition of similar type and degree that affect the level of occupational and social impairment. Id. The Appellant contends that a rating in excess of 50 percent is warranted; the Veteran was rated as 50 percent disabling, effective August 22, 1997. The Veteran filed an Application for Increased Compensation Based on Unemployability (VA 21-8940), which was received by the RO on February 21, 2013. The RO interpreted the application as increased rating claims for the Veteran’s service-connected disabilities, to include PTSD. The Board, in consideration of 38 C.F.R. § 3.400(o)(2) and Gaston v. Shinseki, 605 F.3d 979 (Fed. Cir. 2010), has considered the evidence in the one year prior to the date of receipt of the increased rating claim, but finds that it does not support a finding that the Veteran’s disability increased in severity, such as to warrant a higher rating, during that one year period. VA outpatient treatment records dated April 2012 indicated that the Veteran was alert and oriented, and exhibited fairly calm, euthymic, and reactive affect, goal-directed sentences, fair to good insight and judgment. The Veteran denied complaints of auditory or visual hallucinations, or homicidal or suicidal ideations. Subsequent VA records from June 2012 to February 2016 reflect that the Veteran displayed a constricted affect in the sad range, normal speech, structured and goal-directed thoughts, and good insight and judgment. It was noted that the Veteran denied any suicidal or homicidal ideation or auditory or visual hallucinations. During this period, it was reported that the Veteran denied any suicidal thoughts, plan, or intent, or made any suicidal threats or gestures within the last 30 days. In September 2012, the Veteran endorsed a reported variety of avoidance-based behaviors, such as staying at home, not socializing, and not being very involved in family or social activities. Thereafter, in November 2012, the Veteran reported nightmares almost every night and sleeping with a gun nearby. In a subsequent June 2016 mental status examination, the Veteran appeared alert and oriented in all spheres, and was able to establish rapport. He further displayed euthymic mood, congruent affect, fluent and normal speech, logical and goal-directed thought processes, grossly intact cognition, good insight, and adequate judgment and impulse control. The Veteran reportedly did not express delusional content, and denied perceptual disturbances or suicidal or homicidal ideations or self-injurious behavior. The evidence of record reflects that the Veteran was afforded a VA PTSD examination in February 2014. The examination report referenced the Veteran’s diagnoses of PTSD, major depressive disorder, and alcohol use disorder. The Veteran reported that in his past employment as a letter carrier, he forgot streets and addresses due to intrusive thoughts related to his PTSD. He also noted that as he lived in a military area, he would have reexperiences of his service in the Republic of Vietnam every time a helicopter flew over his house. The VA examiner indicated that the Veteran had symptoms of anxiety, mild memory loss, such as forgetting names, directions, or recent events, and chronic sleep impairment. Upon mental status examination, the Veteran appeared alert and oriented, and displayed normal speech in rate, tone, and syntax, unremarkable thought content and process, euthymic mood with full and reactive affect, no observable responsiveness to internal stimuli, and no observable impairment in attention, concentration, or memory. The VA examiner noted that the Veteran denied hallucinations or delusions, or suicidal and homicidal ideation, intent, or planning. The VA examiner opined that the Veteran had an occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran reported in correspondence dated April 2014 that he experienced difficulties with sleep, including night sweats, nightmares, and difficulties with concentrating, particularly with projects. In May 2014, the appellant submitted a letter on behalf of the Veteran. The appellant stated that the Veteran experienced night sweats, difficulty with breathing and sleep, depression, memory loss, inability to finish projects, loss of sex drive, and was moody. The Board notes that in his October 2014 Notice of Disagreement, the Veteran disagreed with how the February 2014 VA examination was conducted. He stated that the VA examiner only said a few words to him and only provided him with a multiple-choice questionnaire. The Veteran noted that the VA examiner did not spend time with him or watch him in a state of depression. The Veteran stated that the VA examiner “can’t crawl into [his] brain and look around.” With regards to suicide, the Veteran reported that he thought about it more times than he could remember. He further endorsed difficulties with memory, night sweats, nightmares, and mood swings. Based on the Veteran’s overall symptomatology and the resulting impairment stemming therefrom, the Board finds that the evidence shows that his disability picture more nearly approximated the level of severity contemplated by a 70 percent rating for PTSD. 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411. The Veteran exhibited social and occupational impairment in most areas with symptoms such as depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, suicidal ideation, and difficulty in establishing and maintaining effective work and social relationships. While the severity of the Veteran’s PTSD rose to the level envisioned by the 70 percent rating threshold, the Veteran did not display a manifestation of symptoms with the severity, frequency, and duration comparable of a 100 percent disability rating during this period. The February 2014 VA examiner did not note that the Veteran’s symptoms caused total occupational and social impairment. Treatment records and statements made by the Veteran and the appellant also collectively did not note 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. Therefore, an increased rating of 70 percent, but no higher, for PTSD is warranted. REASONS FOR REMAND Regarding the claimed peripheral neuropathy, the Board notes that the Veteran was afforded several VA examinations with regards to diabetes mellitus and peripheral nerves. Nevertheless, the March 2006 and February 2014 VA peripheral nerves examinations were predicated solely upon the Veteran’s service-connected right perennial neuropathy with partial foot drop. Although the March 2010 and September 2016 VA examination reports referenced the Veteran’s diagnoses of generalized sensory and motor neuropathy of the upper and lower extremities, no medical nexus opinions were rendered as to whether service connection for peripheral neuropathy was warranted on a direct basis. See generally Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F. 3d 1039 (Fed. Cir. 1994). The March 2010 VA examiner noted that there were “numerous causes for polyneuropathies,” while the September 2016 VA examiner provided a conclusory opinion that neuropathy was secondary to non-diabetic causes. Therefore, a remand is warranted to obtain an addendum VA medical opinion to obtain the etiology of the claimed peripheral neuropathy. The Board defers a decision on the TDIU claim as inextricably intertwined with the pending service connection claim and restoration of service connection for type 2 diabetes mellitus as granted herein. Consequently, the Veteran’s claim for TDIU requires re-adjudication. The matters are REMANDED for the following action: 1. Obtain a VA medical opinion by an appropriate clinician to determine the nature and etiology of the claimed peripheral neuropathy; the claims folder must be reviewed in conjunction with such. The examiner must opine as to whether it is at least as likely as not that the claimed disability was caused or aggravated by service. As service connection for type 2 diabetes mellitus is restored, effective September 1, 2010, herein, the VA examiner must also opine as to whether peripheral neuropathy was at least as likely as not caused or aggravated by a service-connected type 2 diabetes mellitus. A full and complete rationale is required for all opinions expressed. 2. Readjudicate the claims on appeal. If any benefits sought on appeal remain denied, issue a supplemental statement of the case and allow an appropriate period of time for response before returning the matter to the Board. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G.A. Ong, 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.