Citation Nr: 21022131 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 14-10 150 DATE: April 14, 2021 ORDER Service connection for bilateral cataracts (claimed as fluctuating visual acuity), to include as secondary to diabetes mellitus, type II, is denied. An initial rating in excess of 20 percent for diabetes mellitus, type II, with erectile dysfunction and hypertension, is denied. A separate compensable rating for hypertension is denied. An initial rating in excess of 10 percent for right lower extremity peripheral neuropathy is denied. An initial rating in excess of 10 percent for left lower extremity peripheral neuropathy is denied. An initial rating in excess of 10 percent prior to February 4, 2014, and in excess of 20 percent from February 4, 2014, for right upper extremity carpal tunnel syndrome (CTS)/peripheral neuropathy is denied. An initial rating in excess of 10 percent prior to February 4, 2014, and in excess of 20 percent from February 4, 2014, for left upper extremity CTS/peripheral neuropathy is denied. FINDINGS OF FACT 1. The Veteran’s bilateral cataracts did not originate in service, are not otherwise etiologically related to service, and are not shown to be caused or aggravated by service-connected diabetes mellitus, type II. 2. For the entire period of the appeal, the evidence does not establish that the Veteran’s hypertension has been manifested by diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or a history of diastolic pressure predominantly 100 or more with continuous medication required for control. 3. For the entire period of the appeal, the Veteran has not required regulation of activities as part of medical management of diabetes mellitus; also, he has not shown evidence of penile deformity, diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or a history of diastolic pressure predominantly 100 or more with continuous medication required for control. 4. For the entire period of the appeal, the Veteran’s right lower extremity peripheral neuropathy has been productive of no more than mild incomplete paralysis of the sciatic nerve. 5. For the entire period of the appeal, the Veteran’s left lower extremity peripheral neuropathy has been productive of no more than mild incomplete paralysis of the sciatic nerve. 6. For the period prior to February 4, 2014, the Veteran’s service-connected right and left upper extremity CTS/peripheral neuropathy were each manifested by no more than mild incomplete paralysis of the median nerve with no reflex, strength, or motor defects. 7. For the period beginning February 4, 2014, the Veteran’s service-connected right and left upper extremity CTS/peripheral neuropathy each have been manifested by symptoms approximating no more than mild incomplete paralysis of the lower radicular group. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral cataracts have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for a separate compensable rating for hypertension associated with diabetes mellitus, type II, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.31, 4.104, 4.119, Diagnostic Codes (DCs) 7101, 7913, Note (1). 3. The criteria for a rating in excess of 20 percent for diabetes mellitus, type II, with erectile dysfunction and hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.3, 4.7, 4.104, 4.119, DCs 7101, 7522, 7913. 4. The criteria for a rating in excess of 10 percent for right lower extremity peripheral neuropathy have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.2, 4.6, 4.7, 4.124a, DC 8520. 5. The criteria for a rating in excess of 10 percent for left lower extremity peripheral neuropathy have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.2, 4.6, 4.7, 4.124a, DC 8520. 6. The criteria for an initial rating in excess of 10 percent prior to February 4, 2014, and in excess of 20 percent from February 4, 2014, for right upper extremity CTS/peripheral neuropathy have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.2, 4.6, 4.7, 4.123, 4.124a, DCs 8512, 8513, 8515. 7. The criteria for an initial rating in excess of 10 percent prior to February 4, 2014, and in excess of 20 percent from February 4, 2014, for left upper extremity CTS/peripheral neuropathy have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.2, 4.6, 4.7, 4.123, 4.124a, DCs 8512, 8513, 8515. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1965 to November 1967, to include service in the Republic of Vietnam. These issues were before the Board in February 2018 when they were remanded for additional development. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service - the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). When aggravation of a nonservice-connected condition is proximately due to or a result of a service-connected disability a veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. Allen v. Brown, 7 Vet. App. 439, 448 (1995). Finally, in a claim for service connection, the ultimate credibility or weight to be accorded evidence must be determined as a question of fact. The Board determines whether (1) the weight of the evidence supports the claim, or (2) the weight of the “positive” evidence in favor of the claim is in relative balance with the weight of the “negative” evidence against the claim; the appellant prevails in either event. However, if the weight of the evidence is against the appellant’s claim, the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran maintains that his cataracts, claimed as fluctuating visual acuity, are secondary to his service-connected diabetes mellitus. See September 2011 VA examination report. A March 2012 rating decision denied service connection for cataracts and the Veteran appealed. Notably, he did not appeal the March 2012 rating decision’s denial of service connection for refractive error and dry eyes. After reviewing the evidence of record, the Board concludes that the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of cataracts began during service or is otherwise related to an in-service injury, event, or disease, or is secondary to service-connected diabetes mellitus, Type II. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § § 3.303(a), (d), 3.310. In this regard, the medical evidence (see September 2011 and September 2020 VA examination reports) shows current evidence of cataracts. Service treatment records (STRs) are negative for complaints or findings related to cataracts. Further, regarding direct service connection, the medical evidence does not show that the Veteran’s current cataracts, diagnosed in 2010, are related to his active duty service, nor does the Veteran maintain that they are. Rather, the Veteran maintains that he developed cataracts because of his diabetes mellitus. See September 2011 VA Eye Conditions Disability Benefits Questionnaire (DBQ). In September 2020, the Veteran was provided a VA examination. The VA examiner opined that the Veteran’s diagnosed eye disabilities, including nuclear sclerosis (cataracts), were less likely than not due to or aggravated by the Veteran’s service-connected diabetes mellitus. The examiner explained that cataracts are an age-related disability and would have occurred even in the absence of diabetes mellitus. The September 2020 VA examiner’s opinion is probative, because it is based on examination of the Veteran and a review of the claims file, including the Veteran’s contentions, and includes a thorough explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There is no competent opinion to the contrary. Although there is also a February 2011 letter from the Veteran’s private physician of record, it states, “Ocular abnormalities associated with diabetes include fluctuating visual acuity which [the Veteran] presents.” This is a general statement that is not supported by reasons and bases or citations to specific medical evidence in the record. Therefore, it cannot support the Veteran’s claim. See Obert v. Brown, 5 Vet. App. 30, 33 (1993).) To the extent the Veteran believes his cataracts are related to his service-connected diabetes mellitus, he is not competent to provide a nexus opinion regarding this issue. The questions addressed in this case are medical in nature and require knowledge of the interaction between multiple organ systems in the body. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examiner’s opinion. Increased Ratings Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects the Veteran’s ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where a veteran challenges the initial rating of a disability for which the Veteran has been granted service connection, the Board considers all evidence of severity since the effective date for the award of service connection. See Fenderson v. West, 12 Vet. App. 119 (1999). In evaluating a disability, the Board considers the current examination reports in light of the entire record to ensure that the current rating accurately reflects the severity of the condition. 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. Reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Rating for Diabetes with Complications of Hypertension and ED The Veteran is service connected for diabetes mellitus type II, with hypertension and erectile dysfunction. An initial rating of 20 percent has been assigned, effective June 7, 2010. He maintains that he is entitled to a separate compensable rating for hypertension, as well as a higher initial rating for diabetes mellitus (to include diabetic complications). See December 2017 Appellate Brief. Diabetes mellitus, type II is rated under DC 7913. 38 C.F.R. § 4.119. Under DC 7913, a 20 percent rating is warranted where the condition requires one or more daily injection of insulin and restricted diet; or, oral hypoglycemic agent and restricted diet. Id. A 40 percent rating is warranted where the condition requires one or more daily injection of insulin, restricted diet, and regulation of activities. Id. A 60 percent rating is warranted where the condition requires one or more daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. Id. A 100 percent rating, which is the highest rating available, is warranted where the conditions require more than one daily injection of insulin, restricted diet, and regulation 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 provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. Id. Pursuant to Note 1 under DC 7913, separate ratings for any compensable complications of the Veteran’s service-connected diabetes mellitus, type II, are warranted. All noncompensable complications are considered part of the diabetic process. 38 C.F.R. § 4.119; DC 7913, Note (1). 1. Separate Rating for Hypertension The Veteran’s hypertension has been established as a complication of his service-connected diabetes. If a compensable rating is warranted, it will be evaluated separately. 38 C.F.R. § 4.119, DC 7913, Note (1). Hypertension is rated under 38 C.F.R. § 4.101, DC 7101. Under DC 7101, a 10 percent rating is warranted where diastolic pressure is predominantly 100 or more; or, systolic pressure is predominantly 160 or more; or, for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. Note 1 to DC 7101 provides that hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. Id. A 20-percent rating is warranted where diastolic pressure is predominantly 110 or more; or, systolic pressure is predominantly 200 or more. Id. A 40-percent rating is warranted where diastolic pressure is predominantly 120 or more. Id. A 60-percent rating, which is the highest rating available under this schedule, is warranted where diastolic pressure is predominantly 130 or more. Id. The evidence of record shows the following blood pressure readings: 144/84, 140/90, and 142/90 in August 2009; 120/80 and 122/80 in October 2010; 146/83, 148/92, and 143/93 in September 2011; 141/59 in April 2013; 147/81 in November 2013; 135/80 in January 2014; 133/79 in March 2016; 132/73 in December 2018; 136/66 in March 2019; and 139/65, 141/62, and 138/59 in October 2020. After review of all the evidence, the Board finds that a compensable rating is not warranted. The evidence does not reflect that the Veteran’s hypertension has manifested in a systolic pressure predominantly 160 or more, or in a diastolic pressure predominantly 100 or more. The Board also recognizes that the Veteran has prescribed medication to control his hypertension for the entire period of the appeal. Thus, though the evidence does show the Veteran has continuously required medication across the appeal period, without evidence to support a history of diastolic pressure predominantly 100 or more, the 10 percent rating cannot be established. 38 C.F.R. § 4.104, DC 7101. Because a compensable rating for hypertension is not warranted, the service-connected hypertension associated with diabetes will remain noncompensable as part of the diabetic process for the rating under DC 7913. See 38 C.F.R. § 4.119, DC 7913, Note (1). 2. Rating for Diabetes Mellitus, Type II The February 2011 rating decision on appeal granted service connection for diabetes mellitus, type II, and assigned an initial rating of 20 percent effective June 7, 2010. This disability is now characterized as diabetes mellitus, type II, with hypertension and erectile dysfunction. The Veteran seeks a higher initial rating. The Board notes incidentally that the Veteran is also service connected for diabetic peripheral neuropathy of the right and left lower and upper extremities; he is assigned separate ratings for these disabilities. Claims of increased ratings for these disabilities are discussed separately below. Because of the successive nature of the rating criteria for diabetes mellitus (i.e. the evaluation for each higher disability rating includes the criteria of each lower disability rating), each of the three criteria listed in the 40 percent rating must be met in order to warrant such a rating. See Tatum v. Shinseki, 23 Vet. App. 152 (2009). Stated another way, if a component is not met at any one level, a veteran can only be rated at the level that did not require the missing component. Id. Competent medical evidence is required to establish “regulation of activities,” namely, prescribed avoidance of strenuous occupational and recreational activities, for a 40 percent rating under Diagnostic Code 7913. See Camacho v. Nicholson, 21 Vet. App. 360 (2007). Upon review of the evidence of record, the Board finds that an initial rating in excess of 20 percent for the Veteran’s service-connected diabetes mellitus is not warranted. The evidence in this case reflects that throughout the appeal period, the Veteran has required an oral hypoglycemic agent, with insulin added in 2014, and a restricted diet. These findings are noted in the 2010 VA examination report, February 2011 letter from private physician, February 2014 VA examination report, and October 2020 VA examination report. The Veteran is not shown to have required regulation of activities to maintain glycemic control, as noted on VA examinations in August 2009, February 2014 and October 2020. Notably, a January 2012 VA treatment record shows the Veteran was to exercise as tolerated and March 2018 VA treatment record shows the Veteran was directed to exercise his feet daily. Compensable complications of diabetes are to be evaluated separately unless they are part of the criteria used to support a 100 percent disability evaluation, with noncompensable complications to be considered as part of the diabetic process under DC 7913. 38 C.F.R. § 4.119, DC 7913, Note (1). As noted above, a separate compensable rating is not warranted for the Veteran’s hypertension. The Board has also considered whether a separate compensable rating is warranted for the Veteran’s erectile dysfunction. For the reasons discussed below, the Board finds that erectile dysfunction does not warrant a compensable rating. Erectile dysfunction is rated by analogy under 38 C.F.R. § 4.115b, DC 7522, which provides that deformity of the penis with loss of erectile power is rated as 20 percent disabling. A September 2011 VA Male Reproductive System Conditions DBQ showed no findings of erectile dysfunction or penile deformity. A February 2014 VA Male Reproductive System Conditions DBQ showed a history of erectile dysfunction since 2012. He reported taking medication, which did not help sustain an erection. On examination, anatomy was normal without deformity or abnormality. An October 2020 VA Male Reproductive System Conditions DBQ noted findings of loss of erectile power. While the Veteran declined examination, he reported normal anatomy without penile abnormality or deformity. Given the foregoing, the record shows that the Veteran has experienced loss of erectile power, for which he takes medication; however, the record does not show any finding of penile deformity. Thus, a separate compensable rating for erectile dysfunction under DC 7522 is not warranted. Although a separate, compensable rating is not warranted for the Veteran’s erectile dysfunction, the Board does note that he has been separately awarded special monthly compensation based on the loss of use of a creative organ, effective February 4, 2014, to compensate for his inability to achieve an erection sufficient for penetration and ejaculation. See 38 U.S.C. § 1114 (k); 38 C.F.R. § 3.350(a). Peripheral Nerves Neuritis is characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain. 38 C.F.R. § 4.123. Neuralgia is characterized by a dull and intermittent pain. 38 C.F.R. § 4.124. Neurological conditions of the peripheral nerves are rated based on various tables corresponding to the nerves involved. 38 C.F.R. § 4.124a. Radiculopathy of the extremities is rated under 38 C.F.R. § 4.124a, DCs 8510-8540. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id. Descriptive words such as “slight,” “moderate” and “severe” are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The use of descriptive terminology by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision. 38 U.S.C. § 7104(a); 38 C.F.R. §§ 4.2, 4.6. 1. Peripheral Neuropathy of Right and Left Lower Extremities A March 2012 rating decision awarded service connection for peripheral neuropathy of the left and right lower extremities secondary to diabetes mellitus, and assigned a 10 percent evaluation for each disability, effective May 27, 2009. The Veteran has appealed the initial ratings assigned. These disabilities are rated under the diagnostic code for the ratings of the sciatic nerve. 38 C.F.R. § 4.124a, DC 8520. Under this regulation, an 80 percent disability rating is warranted for complete paralysis of the sciatic nerve; characterized by a foot that dangles and drops, the lack of any active movement below the knee, or weakened or lost motion below the knee. A 60 percent disability rating is warranted for incomplete paralysis of the sciatic nerve that is severe and marked by muscular atrophy. A 40 percent disability rating is warranted for moderately severe incomplete paralysis of the sciatic nerve. A 20 percent disability rating is warranted for moderate incomplete paralysis of the sciatic nerve. A 10 percent disability rating is warranted for mild incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a, DC 8520. An August 2009 VA diabetes mellitus examination report notes that the lower extremities were normal temperature and color on examination. No sensory loss or motor loss was seen on examination. Deep tendon reflexes were normal in the lower extremities. A May 2011 VA peripheral neuropathy examination report notes the Veteran’s complaints of pain and cramps in his legs. He denied pain. Examination revealed normal reflexes in the knees and feet, and hypoactive reflexes in the ankles. Strength was normal in both lower extremities, with no muscle atrophy. There was no gait abnormality, imbalance, tremor, or joint function affected by the neuropathy. The sciatic nerve involvement in both lower extremities was characterized as mild by the examiner. An October 2020 VA diabetic sensory-motor peripheral neuropathy DBQ notes the Veteran’s complaints of pain, numbness, and paresthesias/dysesthesias in the lower extremities. On examination, strength was full in the lower extremities; there was no muscle atrophy. Deep tendon reflexes were normal in both lower extremities. Position sense and cold sensation were normal. The examiner noted decreased light touch/monofilament testing only in the feet and toes bilaterally. The sciatic nerve involvement in both lower extremities was characterized as mild by the examiner. Additional medical evidence includes VA and private treatment records dated from 2010 to 2020 which note the Veteran’s ongoing complaints of lower extremity peripheral neuropathy and findings of full muscle strength. The symptoms noted for both the right and left lower extremities for the entire appeal period are best characterized as neuritis and correspond to a mild incomplete paralysis of the sciatic nerves. The evidence does not show that the Veteran’s right and left lower extremity radiculopathy manifested symptoms productive of moderate incomplete paralysis of the affected nerves. The preponderance of the evidence shows that the symptoms related to the Veteran’s service-connected peripheral neuropathy of the right and left lower extremities are for the most part sensory and, at most mild, and are equivalent to mild incomplete paralysis. While the Veteran has experienced severe pain, paresthesias, and numbness in the lower extremities, objective examination shows no atrophy and there have been minimal to no reflex, neurologic, strength, or motor defects. In short, there has been no showing of impairment approximating moderately severe incomplete paralysis. 38 C.F.R. § 4.7. Consequently, the benefit-of-the-doubt rule does not apply, and the claims for initial ratings in excess of 10 percent must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, supra. 2. CTS/Peripheral Neuropathy of Right and Left Upper Extremities A March 2012 rating decision awarded service connection for CTS of the left and right lower extremities secondary to diabetes mellitus, and assigned a 10 percent evaluation for each disability, effective May 27, 2009. The Veteran appealed the initial ratings assigned. Thereafter, a December 2014 rating decision recharacterized the disabilities as CTS/peripheral neuropathy, and assigned increased 20 percent ratings for each disability, effective February 4, 2014. These disabilities were initially rated under the diagnostic code for paralysis of the median nerve. A 10 percent rating is assigned for mild incomplete paralysis of either the major or minor extremity. A 20 percent rating is assigned for moderate incomplete paralysis of the minor extremity and a 30 percent rating is assigned where there is moderate incomplete paralysis of the major extremity. A 40 percent rating is assigned for severe incomplete paralysis of the minor extremity and a 50 percent rating is assigned for severe incomplete paralysis of the major extremity. A 60 percent rating is assigned for complete paralysis of the minor extremity and a 70 percent rating is assigned for complete paralysis of the major extremity. Complete paralysis of the median nerve is characterized by the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand; pronation incomplete and defective, absence of flexion of the index finger and feeble flexion of the middle finger, inability to make a fist, index and middle fingers remaining extended; inability to flex the distal phalanx of the thumb, defective opposition and abduction of the thumb at right angles to the palm; flexion of the wrist weakened; and pain with trophic disturbances. 38 C.F.R. § 4.124a, DC 8515. The Veteran’s disabilities are now rated under the diagnostic code for the ratings of all radicular groups (upper, middle, and lower) of nerves. 38 C.F.R. § 4.124a, DC 8513. Under this regulation, mild incomplete paralysis is rated as 20 percent disabling on the major side and 20 percent on the minor side; moderate incomplete paralysis is rated 40 percent disabling on the major side and 30 percent on the minor side; and severe incomplete paralysis is rated 70 percent disabling on the major side and 60 percent disabling on the minor side. Complete paralysis of all radicular groups is rated as 90 percent disabling on the major side and 80 percent disabling on the minor side. 38 C.F.R. § 4.124a, DC 8513. Additionally, DC 8512 provides ratings for paralysis of the lower radicular group of nerves. DC 8512 provides that mild incomplete paralysis is rated as 20 percent disabling on the major side and 20 percent on the minor side; moderate incomplete paralysis is rated 40 percent disabling on the major side and 30 percent on the minor side; and severe incomplete paralysis is rated 50 percent disabling on the major side and 40 percent on the minor side. Complete paralysis of the lower radicular group with all intrinsic muscles of hand, and some or all of flexors of wrist and fingers, paralyzed (substantial loss of use of hand) is rated 70 percent disabling on the major side and 60 percent on the minor side. 38 C.F.R. § 4.124a, DC 8512. For the period from May 27, 2009, through February 3, 2014, the Veteran is receiving 10 percent ratings (each) for right and left upper extremity CTS/peripheral neuropathy under DC 8515. 38 C.F.R. § 4.124a. These ratings represent mild incomplete paralysis of the median nerve. Id. An August 2009 VA diabetes mellitus examination report notes that the upper extremities were normal in color and temperature. Coordination, motor strength, deep tendon reflexes, and sensory testing were normal. Cranial nerves were intact. An October 2010 VA diabetes mellitus examination report notes the Veteran’s complaints of neuropathy. Examination revealed normal skin color and temperature in the upper extremities. Nerve conduction studies revealed bilateral mild median nerve distal sensory neuropathy. The diagnosis was CTS secondary to diabetes mellitus. October 2010 nerve conduction studies revealed normal findings for bilateral median and ulnar motor nerves. Sensory nerve testing revealed mild slowing and mild increased latency in the bilateral median nerves compatible with mild distal sensory neuropathy. Nerve conduction studies were normal for all other sensory nerves. A May 2011 VA peripheral nerves examination report notes the Veteran’s complaints of cramps in both hands for the past year. Examination of the upper extremities revealed decreased vibration sensation, pain/pinprick sensation, and light touch sensation in the median nerve distribution bilaterally. Position sense was normal and there was no dysesthesias. Motor strength was full, and muscle tone was normal without atrophy. No joint function was affected. An August 2012 VA treatment record shows that strength was full, and reflexes were normal in the upper extremities. Based on these findings, the Veteran’s right and left upper extremity symptoms approximated no more than mild incomplete paralysis of the median nerve for the initial rating period prior to February 4, 2014. While the Veteran did report some symptoms such as cramping during this period, examination revealed only mild sensory involvement with no functional loss. Further, motor function was within normal limits. Therefore, a rating in excess of 10 percent for either upper extremity is not warranted prior to February 4, 2014. 38 C.F.R. § 4.124a, DC 8515. Moreover, as the evidence shows involvement of only the median nerve, no other diagnostic code is for application for this period. For the period beginning February 4, 2014, the Veteran is receiving 20 percent ratings (each) for right and left upper extremity CTS/peripheral neuropathy under DC 8513. 38 C.F.R. § 4.124a. These ratings represent mild incomplete paralysis of all the radicular groups of nerves. Id. The Veteran underwent a VA diabetic sensory-motor peripheral neuropathy examination on February 4, 2014. The examination report notes the Veteran’s complaints of bilateral hand pain, numbness, and muscle cramping. Neurologic examination showed full muscle strength and normal deep tendon reflexes in the upper extremities. Position sense was normal. Light touch testing was decreased in the hand and fingers only. Vibration sensation was decreased in both upper extremities. There was no muscle atrophy. There were no trophic changes. The examiner found mild, incomplete paralysis in the radial, median, and ulnar nerves bilaterally. A September 2019 VA treatment record shows the Veteran attended occupational therapy for bilateral CTS. The Veteran underwent VA examination in October 2020. He reported bilateral hand numbness, pain, and cramping. He characterized these symptoms as moderate to severe. He used carpal tunnel braces regularly at night. On examination, muscle strength was normal in the upper extremities. There was no muscle atrophy. Deep tendon reflexes were normal. Light touch sensation was decreased only in the hands and fingers. Phalen’s sign and Tinel’s sign were positive bilaterally. Right and left radial, musculocutaneous, circumflex, long thoracic, and upper, middle, and lower radicular group nerves were normal. Mild, incomplete paralysis was noted in the median and ulnar nerves bilaterally. The examiner opined that the Veteran was limited in grasping, holding, typing, and writing. The examiner characterized the Veteran’s disability as productive of mild sensory neuropathy. For the evidence beginning February 4, 2014, the Veteran’s service-connected neuropathy of the upper extremities is shown to affect multiple nerves of the lower radicular group. Therefore, this disability is most appropriately rated under DC 5312. Moreover, based on the findings noted above, the Veteran’s right and left upper extremity symptoms approximated no more than mild incomplete paralysis of the lower radicular group for the period beginning February 4, 2014. While the Veteran complained of pain, numbness, and cramping during this period, examination revealed only sensory involvement with no functional loss. While the 2020 VA examiner opined that the Veteran was limited in such activities as grasping and writing, examinations during the period showed no less than full strength, including grip strength, with normal reflexes. Therefore, a rating in excess of 20 percent for either upper extremity is not warranted for the period beginning February 4, 2014. 38 C.F.R. § 4.124a, DC 8512. No other diagnostic code addressing the Veteran’s bilateral upper extremity diabetic neuropathy permits higher schedular ratings for this period. Therefore, higher schedular disability ratings are not warranted under different rating criteria. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Fletcher, Kathleen 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.