Citation Nr: 21025011 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 14-16 751 DATE: April 27, 2021 ORDER Entitlement to service connection for a right eye cataract, to include as secondary to diabetes mellitus, II is denied. Entitlement to a rating higher than 20 percent for service connection diabetes mellitus, II is denied. Entitlement to a rating higher than 60 percent for service-connected kidney disease is denied. Entitlement to a rating higher than 10 percent prior to September 30, 2020, and higher than 20 percent thereafter, for peripheral neuropathy for left upper extremity is denied. Entitlement to a rating higher than 10 percent prior to August 3, 2019, and higher than 20 percent thereafter, for peripheral neuropathy of left lower extremity is denied. Entitlement to a compensable rating for erectile dysfunction is denied. Entitlement to an increased rate for special monthly compensation is denied. Entitlement to an earlier effective date for award of service connection for diabetes mellitus II is denied. Entitlement to an earlier effective date for award of service connection for kidney disease is denied. Entitlement to an earlier effective date for award of service connection for peripheral neuropathy of the left upper extremity is denied. Entitlement to an earlier effective date for award of service connection for peripheral neuropathy of the left lower extremity is denied. Entitlement to an effective date of January 24, 2008 for the award of service connection for erectile dysfunction is granted. Entitlement to an effective date of January 24, 2008 for award of special monthly compensation is granted. FINDINGS OF FACT 1. The probative evidence of record does not show the Veteran’s right eye cataract had its onset in or was otherwise due to his service, to include as caused or aggravated by his diabetes mellitus. 2. The Veteran’s diabetes mellitus, type II requires insulin, oral hypoglycemic agents and a restricted diet, but it does not require regulation of activities or result in episodes of ketoacidosis, hypoglycemic reaction requiring hospitalization or visits to a diabetic care provider, unintentional weight loss, or progressive loss of strength. 3. Throughout the pendency of the appeal, the Veteran’s chronic kidney disorder has shown no evidence of persistent edema and albuminuria with BUN 40 to 80 mg percent, or, creatinine 4 to 8 mg percent, or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion. 4. Prior to September 30, 2020, the Veteran’s peripheral neuropathy of the left upper extremity is manifested by no more than mild, incomplete paralysis. 5. From September 30, 2020, the Veteran’s peripheral neuropathy of the left upper extremity is manifested by no more than moderate, incomplete paralysis. 6. Prior to August 3, 2019, the Veteran’s peripheral neuropathy of the left lower extremity was manifested by no more than mild, incomplete paralysis. 7. From August 3, 2019, The Veterans peripheral neuropathy of the left lower extremity is manifested by no more than moderate, incomplete paralysis. 8. The probative evidence of record does not show the Veteran has a penis deformity. 9. The probative evidence of record does not show the Veteran experienced any other disabilities or symptoms that would warrant a higher level of special monthly compensation. 10. The Veteran’s claims of entitlement to service connection for diabetes mellitus, erectile dysfunction, and an eye disability, were denied in April 2009. 11. The Veteran neither appealed the April 2009 rating decision by submitting a notice of disagreement, nor did he submit new and material evidence within one year after notice of the decision. 12. The Veteran filed to reopen the claim of entitlement to diabetes mellitus in May 2012. 13. The RO denied service connection for diabetes mellitus, hypertension, peripheral neuropathy, and kidney disease in September 2013. However, the Veteran continued the appeal for all the claimed disabilities by submitting a notice of disagreement in October 2013 and a substantive appeal in April 2014. 14. In May 2014, the RO readjudicated the Veteran’s claim and granted service connection for diabetes mellitus, assigning an effective date of January 24, 2008 based on the fact that service records were available at the time of the April 2009 decision, but had not been reviewed. 15. There was no claim for diabetes mellitus or erectile dysfunction prior to January 24, 2008. 16. In September 2014, the RO granted service connection for kidney disease, peripheral neuropathy, erectile dysfunction and awarded special monthly compensation, all effective September 16, 2013. 17. A January 2016 rating decision assigned an earlier effective date of May 30, 2012, for the award of service connection for kidney disease, peripheral neuropathy, erectile dysfunction, and special monthly compensation. CONCLUSIONS OF LAW 1. The criteria for service connection for a right eye cataract, to include as secondary to diabetes mellitus, II have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. 2. The criteria for a rating higher than 20 percent for diabetes mellitus, II have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.119, Diagnostic Code 7913. 3. The criteria for a rating higher than 60 percent for kidney disease have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. § 3.159, 3.321, 4.115b, Diagnostic Code 7534. 4. The criteria for a rating higher than 10 percent prior to September 30, 2020, and higher than 20 percent thereafter, for peripheral neuropathy for left upper extremity have not been met. 38 U.S.C. §§ 1155, 107; 38 C.F.R. § 4.124a, Diagnostic Code 8515. 5. The criteria for a rating higher than 10 percent prior to August 3, 2019, and higher than 20 percent thereafter, for peripheral neuropathy of left lower extremity have not been met. 38 U.S.C. §§ 1155, 107; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 6. The criteria for a compensable rating for erectile dysfunction have not been met. 38 U.S.C. § 1155, 5103, 5103A, 5107; 38 C.F.R. § 3.159, 4.115b, Diagnostic Code 7599-7522. 7. The criteria for an increased rate for special monthly compensation have not been met. 38 U.S.C. § 1114, 1115; 38 C.F.R. § 3.350, 3.351. 8. The criteria for an earlier effective date for the award of service connection for diabetes mellitus II have not been met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.157, 3.400. 9. The criteria for an earlier effective date for the award of service connection for kidney disease have not been met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.157, 3.400. 10. The criteria for an earlier effective date for the award of service connection for peripheral neuropathy of the left upper extremity have not been met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.157, 3.400. 11. The criteria for an earlier effective date for the award of service connection for peripheral neuropathy of the left lower extremity have not been met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.157, 3.400. 12. The criteria for an effective date of January 24, 2008 for the award of service connection for erectile dysfunction have been met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.157, 3.400. 13. The criteria for an effective date of January 24, 2008 for the award of special monthly compensation have been met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.157, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the U.S. Navy from July 1964 to November 1966. The Board remanded the appeal in July 2018. While on remand, the RO granted service connection for diabetic dermopathy, facial paralysis and hypertension. The RO also increased ratings for peripheral neuropathy of the left upper extremity radial nerve, left lower extremity sciatic nerve and awarded a separate rating for peripheral neuropathy of the left lower extremity femoral nerve, each at 20 percent effective August 3, 2019. 1. Entitlement to service connection for a right eye cataract, to include as secondary to diabetes mellitus, II. Service connection will be granted if the evidence demonstrates that current disability resulted from a disease or injury incurred in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is also provided for a disability which is proximately due to, the result of, or aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran’s medical records show he has a current diagnosis of right eye cataract. As such, the first element of service connection has been met. Review of the Veteran’s service records does not show a diagnosis of cataracts or any related symptoms. There is an indication of defective visual acuity in the left eye; however, it was corrected and there was no finding that it was caused by or related to a cataract. As such, direct service connection is not warranted as there is no in-service injury, event, or disease. As for whether the Veteran’s cataracts were caused by his service-connected diabetes mellitus, there are several VA opinions. The October 2020 VA examiner opined that the Veteran’s right eye cataract was less likely than not incurred in or due to active duty service because he had normal, age related cataracts, which were surgically removed in 2017 and 2020. The Veteran’s cataracts were not aggravated beyond its natural progression, as the onset was at an average age for cataract development. In August 2019, a VA examiner provided a negative opinion addressing both direct service connection and secondary aggravation of the Veteran’s right eye cataract by his diabetes mellitus. Specifically, the examiner found that the diagnosis of the right eye cataract was not caused by an in-service injury, event, or illness. And it was less likely as not aggravated beyond its natural progression because it was originally diagnosed as congenital and not due to diabetes. The physician who conducted the September 2014 VA eye examination opined that the Veteran’s cataract was more likely than not a congenital factor and has remained unchanged since initial diagnosis in 2000. The Boards notes that the June 2014 VA examination for diabetes mellitus indicated that the Veteran’s eye condition was at least as likely as not due to his diabetes mellitus. However, there was no rationale provided. Rather, it was directed that an eye questionnaire was to be completed, which resulted in the September 2014 examination. As such, the statement in the June 2014 diabetes mellitus examination is not considered probative because it was conclusory and unsupported by a rationale. As noted in the July 2018 Board decision, the September 2014 examiner did not provide a rationale for the negative opinion. As such, it is afforded no probative weight. The Board finds the August 2019 opinion to be inadequate because the examiner based the rationale on the etiology of the Veteran’s cataract as being congenital, rather than addressing whether the condition was aggravated by his diabetes mellitus. As such, it is afforded no probative weight. The Board finds the October 2020 opinion is the most probative. The October 2020 opinion was based upon examination of the Veteran, a review of his medical records and reported history, and is supported by a rationale. The opinion is therefore entitled to significant probative weight. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner “did not explicitly lay out the examiner’s journey from the facts to a conclusion,” did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). The Board acknowledges that the VA examiner did not specifically address whether the Veteran’s cataracts were proximately due to or the result of his service-connected diabetes mellitus. However, the Board finds that the examiner otherwise addressed secondary causation when he concluded that the cataracts are age related and the onset was at an average age for cataract development. To the extent that the Veteran asserts that his right eye cataracts are related to his miliary service and/or his service-connected diabetes mellitus, he is not competent to provide a nexus opinion in this case. The record does not reflect that he has the requisite training or expertise to offer a medical opinion on the nature and etiology of cataracts and as such he is not competent to provide an opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). For the foregoing reasons, the Board finds that a preponderance of the evidence does not confirm the Veteran’s right eye cataract had its onset in service or is proximately due to the Veteran’s service-connected diabetes mellitus. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for bilateral cataracts, secondary to service-connected diabetes mellitus, is granted. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. Increased Rating 2. Entitlement to a rating higher than 20 percent for diabetes mellitus, II. The Veteran contends that he is entitled to a disability rating higher than 20 percent for his service-connected diabetes mellitus. The probative evidence reflects that the Veteran’s diabetes requires insulin and a restricted diet, but no regulation of activities. The Veteran’s diabetes is evaluated under 38 C.F.R. § 4.119, DC 7913. Under this code, a 20 percent rating is warranted for diabetes mellitus that requires insulin and a restricted diet, or an oral hypoglycemic agent and a restricted diet. A 40 percent rating is warranted for diabetes mellitus that requires insulin, a restricted diet, and regulation of activities. A 60 percent rating is warranted for diabetes mellitus that requires insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year, or twice per month visits to a diabetic care provider, plus complications that would be compensable if separately evaluated. A 100 percent rating requires more than one daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year, or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. 38 C.F.R. § 4.119, DC 7913. Compensable complications of diabetes are to be rated separately unless they are part of the criteria used to support a 100 percent rating, but non-compensable complications are considered part of the diabetic process. 38 C.F.R. § 4.119, DC 7913, Note (1). To demonstrate a regulation of activities, medical evidence is required to show that both occupational and recreational activities have been restricted. Camacho v. Nicholson, 21 Vet. App. 360, 364 (2007). The phrase “regulation of activities” means “avoidance of strenuous occupational and recreational activities.” Id. at 362 (quoting 38 C.F.R. § 4.119, DC 7913 (defining the term within the criteria for a 100 rating)). Treatment records were reviewed and reflect that the Veteran required insulin and a restricted diet for his medical management of diabetes. As noted above, a higher rating requires regulation of activities in addition to insulin and a restricted diet. However, the Veteran indicated that a regulation of activities was not part of managing his condition. In fact, he reported the opposite. Specifically, that exercise was strongly recommended and in all of his research and personal experience that a regulation of activities is not part of DMII management. Treatment records show he swam, walked a lot, and went to the gym six days a week, at three hours each time. The August 2019 examination report indicated that the Veteran was prescribed more than one injection of insulin per day, but he did not require regulation of activities as part of medical management for diabetes. The Veteran visited his medical provider less than twice per month for episodes of hypoglycemia and ketoacidosis, and there were zero hospitalizations related to either condition. There was no loss of strength or weight due to his diabetes mellitus. During the September 2014 VA examination, the Veteran’s treatment required one injection of insulin per day, and oral hypoglycemia agents. The examiner reported that the Veteran did not require regulation of activities as part of medical management. The Veteran visited his medical provider less than twice per month for episodes of hypoglycemia and ketoacidosis, and there were zero hospitalizations related to either condition. There was no loss of strength or weight associated with his diabetes mellitus. Upon review of the evidence of record, the Board finds that the Veteran’s diabetes mellitus type II required insulin and a restricted diet, but there was no regulation of activities due solely to his diabetes mellitus. Throughout the period of appeal, the Veteran used insulin, oral hypoglycemic agents, and a restricted diet to help manage his diabetes. There is no indication that the Veteran’s activities were regulated at the direction of a physician. Rather, the opposite has been found. The Veteran was told by a physician to increase his physical activity via aerobic exercise. At no time during the period of appeal did the VA examiners or the Veteran indicate that the he had episodes of ketoacidosis or hypoglycemic reactions that required 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 (other than already service-connected hypertension, peripheral neuropathy, cardiomyopathy, dermopathy, erectile dysfunction and kidney disease); no unintentional weight loss attributable to diabetes; and no progressive loss of strength. Therefore, a higher disability rating under DC 7913 is not warranted. See Tatum v. Shinseki, 23 Vet. App. 152, 156 (2009). For the foregoing reasons, a rating higher than 20 percent for diabetes mellitus, type II, is not warranted. As the preponderance of the evidence is against any higher rating, the benefit of the doubt doctrine is not for application 3. Entitlement to a rating higher than 60 percent for kidney disease. The Veteran’s kidney disease is currently rated at 60 percent pursuant to Code 7534 which instructs that renal involvement in artery disease is to be rated under the criteria for renal dysfunction. 38 C.F.R. § 4.115b. Under the criteria for rating renal dysfunction, a 60 percent rating is warranted where there is constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under Code 7101. An 80 percent rating requires persistent edema and albuminuria with BUN 40 to 80 mg percent, or, creatinine 4 to 8 mg percent, or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion. Finally, a 100 percent evaluation is assigned for renal dysfunction requiring regular dialysis or precluding more than sedentary activity from one of the following: persistent edema and albuminuria, or, BUN more than 80 mg percent, or, creatinine more than 8 mg percent, or, markedly decreased function of kidney or other organ systems, especially cardiovascular. In this case, the evidence does not demonstrate the symptoms necessary to obtain a higher rating. Indeed, the pertinent laboratory results obtained during the appeal period, including the August 2019 examination do not demonstrate persistent edema and albuminuria with BUN 40 to 80 mg percent or creatinine 4 to 8mg percent. Treatment records show BUN measurements between 14 and 21 percent during the appeal period. His creatinine levels were between 1.3 and 1.81. The Veteran’s BUN result was 15 in the August 2019 examination report. Further, the VA examination does not show that that he experiences generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion. The evidence also shows the Veteran has never been on dialysis, is not precluded from sedentary activities, or has marked decrease functions of the kidney or other organ systems. The VA examination and post-service treatment records during the appeal period do not demonstrate the findings necessary for the higher 80 or 100 percent ratings. Instead, the current 60 percent rating is based upon the Veteran’s definite decrease in kidney function, which is reflected in the VA and treatment records, and the subsequent August 2019 VA examination report. The Board has considered the applicability of a staged rating, but finds it is not applicable. As a rating higher than 60 percent for the service-connected chronic kidney disease is not warranted, benefit of the doubt is not for application. The appeal is denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 4. Entitlement to a rating higher than 10 percent prior to September 30, 2020, and higher than 20 percent thereafter, for peripheral neuropathy for left upper extremity. 5. Entitlement to a rating higher than 10 percent prior to August 3, 2019, and higher than 20 percent thereafter, for peripheral neuropathy of left lower extremity sciatic nerve. Under Diagnostic Code 8515 a 10 percent disability rating is assigned for mild incomplete paralysis. A 30 percent disability rating is assigned for moderate incomplete paralysis. A 50 percent disability rating is assigned for severe incomplete paralysis. 38 C.F.R. § 4.124a, Diagnostic Code 8515. Under Diagnostic Code 8520, incomplete mild paralysis of the sciatic nerve warrants a 10 percent rating. A 20 percent rating requires moderate incomplete paralysis of the sciatic nerve. A 40 percent rating requires moderately severe paralysis of the sciatic nerve. A 60 percent rating requires severe incomplete paralysis of the sciatic nerve, with marked muscular atrophy. An 80 percent rating requires complete paralysis of the sciatic nerve, which is characterized by foot dangle and drop, no active movement possible of muscle below the knee, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a, DC 8520. The term “incomplete paralysis” with peripheral nerve injuries indicates a degree of loss or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to the varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. See note at “Diseases of the Peripheral Nerves” in 38 C.F.R. § 4.124(a). Treatment records show the Veteran complained of numbness in the fourth digit on the left hand in January 2019. There was decreased sensation in both feet, greater on the left, reported in January 2017. He also described pain and burning in his left extremity. An EMG was obtained in April 2018, but no specific findings were reported other than neuropathy was related to the Veteran’s diabetes mellitus. The June 2014 diabetes mellitus examination indicated neurological examination of the upper and lower extremities was abnormal, with decreased sensation in the left hand and left foot. During the June 2014 examination, the Veteran’s symptoms included mild intermittent pain in the left lower extremity, moderate paresthesias and/or dysesthesias and moderate numbness in the left upper extremity. There were no occurrences of constant pain. Muscle strength testing was normal. Deep tendon reflexes were absent in the left upper extremity and normal in the left ankle and knee. There was a decrease in sensation for light touch/monofilament in the left foot/toes and left hand/fingers. There was also decreased vibration and cold sensation in the left lower extremity. There was mild, incomplete paralysis in the left median nerve and sciatic nerve. The Veteran underwent an examination in September 2019. As for numbness and paresthesias and/or dysesthesias, he had mild symptoms of the left upper and left lower extremities. There were no occurrences of intermittent or constant pain. Muscle strength testing was normal. Deep tendon reflexes were decreased testing at all extremities. Light touch/monofilament testing was normal. Position sense, vibration sensation and cold sensation were not tested. He did not have muscle atrophy or trophic changes. His left upper extremity median nerves had mild incomplete paralysis. His bilateral lower extremity femoral nerves had mild incomplete paralysis. During the September 2020 VA examination, the Veteran described burning in his left foot that caused him to start hopping on the right and then stop walking. He also reported pain to his leg, tingling and numbness to his hand. As for numbness and paresthesias and/or dysesthesias, he had mild symptoms of the left upper and left lower extremities. There were no occurrences of intermittent or constant pain. Muscle strength testing was normal. Deep tendon reflexes were decreased testing at all extremities. Light touch/monofilament testing was normal. Position sense, vibration sensation and cold sensation were not tested. He did not have muscle atrophy or trophic changes. His left upper extremity median nerves had mild incomplete paralysis. His bilateral lower extremity femoral nerves had mild incomplete paralysis. The Veteran has been diagnosed and is service connected for bilateral upper and bilateral lower extremity neuropathy. As stated above, on appeal is only the left upper and left lower extremities. Left Upper – Prior to September 30, 2020 Left Lower – Prior August 3, 2019 During the appeal period, the most probative evidence of record does not show that his left upper and left lower extremity peripheral neuropathy is more than mild in nature. Absent more severe symptomatology, a disability rating in excess of 10 percent is not warranted. In reaching this conclusion, the Board has considered the lay evidence of record, but finds that the 2014 VA examination report outweighs any lay evidence of worsening symptoms. The severity of the left upper and lower extremity neuropathies as demonstrated in the 2014 exam is the most probative evidence of record as it was provided following review of the claims file, interview and examination of the Veteran, considered the Veteran’s lay statements regarding the severity of his symptoms, and is consistent with the other medical evidence of record. The 2014 examiner noted the exact nerves involved with the level of severity of the paralysis. Although there were slightly decreased sensations but there was no loss of strength, muscle atrophy or shiny skin noted. The Veteran complained of intermittent pain in the left lower extremity. Looking at the total disability picture, the Board finds that the Veteran experienced mild, incomplete paralysis of the nerves involved. Left Upper – After September 30, 2020 Left Lower – After August 3, 2019 During the appeal period, the most probative evidence of record does not show that his left upper extremity peripheral neuropathy is more than moderate in nature. Absent more severe symptomatology, a disability rating in excess of 20 percent for either upper or lower extremity is not warranted. In reaching this conclusion, the Board has considered the lay evidence of record, but finds that the 2019 and 2020 VA examination reports outweigh any lay evidence of worsening symptoms. The severity of the bilateral upper and bilateral lower extremity neuropathies as demonstrated in the exams conducted during this appeal period is the most probative evidence of record. Both examiners noted the exact nerves involved with the level of severity of the paralysis. Although there were decreased sensations but there was no muscle atrophy or trophic changes of the skin noted. There was some slight decrease in reflexes and complaints of mild numbness and paresthesias in the upper and lower extremities. Although the examiners concluded the Veteran’s experienced mild severity, the Board will not disturb the findings that the Veteran experienced moderate, incomplete paralysis of the nerves involved, warranting a 20 percent rating, and no higher. Based on the foregoing, higher ratings for peripheral neuropathy of the left upper extremity and left lower extremity is not warranted at any point during the appeal period. The Veteran is competent to report his symptoms but lacks the appropriate medical background to determine whether those symptoms meet the criteria for higher ratings. 6. Entitlement to a compensable rating for erectile dysfunction. The Board notes that there is no specific Diagnostic Code for erectile dysfunction. See generally 38 C.F.R. § 4.115b, Ratings of the Genitourinary System, Diagnostic Codes 7500-42. When a Veteran is diagnosed with an unlisted disease, the condition must be rated under an analogous diagnostic code. 38 C.F.R. §§ 4.20, 4.27. Here, the RO rated the Veteran’s erectile dysfunction under Diagnostic Code “7599-7522,” which represents an unlisted genitourinary disability evaluated by analogy to penis deformity with loss of erectile power. See 38 C.F.R. § 4.115b, DC 7522. See generally 38 C.F.R. §§ 4.20, 4.27 (providing that unlisted disabilities requiring rating by analogy will be coded as the first two numbers of the most closely related body part and “99”). Pursuant to Diagnostic Code 7522, a 20 percent rating is warranted for deformity of the penis with the loss of erectile power. This is the only schedular rating provided under this diagnostic code. The Board notes that, in every instance where the schedule does not provide a zero percent rating for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. The Board further notes that no other schedular criteria are applicable to erectile dysfunction and no other criteria has been claimed. Based on the evidence of record during the relevant appeal period, the Board finds that the Veteran’s erectile dysfunction does not warrant a compensable rating at any time pertinent to the appeal period. The December 2016 private examination report indicates the Veteran has difficulty getting and maintaining an erection and the cause is most likely his related to the stenosis of his lumbar spine. During the examination the Veteran reported experiencing numbness in his scrotum and in the shaft of his penis. The September 2019 VA examination indicates the Veteran had erectile dysfunction that did not improve with treatment. He experienced voiding dysfunction, but its etiology was unrelated to his erectile dysfunction. Both examinations are silent for deformities of the penis. The remaining VA and private medical treatment records show treatment for the dysfunction via medication. The records are silent for any additional evidence of treatment for or complaints of erectile dysfunction or a penile deformity. Thus, for the Veteran to receive a compensable disability rating, he must show both physical deformity of the penis and loss of erectile power. Here, there is simply no contention or indication in the medical evidence that the Veteran has ever had a physical deformity of his penis. Absent penis deformity, his loss of erectile power does not warrant a compensable schedular rating. 38 C.F.R. § 4.115(b), Diagnostic Code 7522. VA regulations do not provide for a specific disability rating for erectile dysfunction, as such a rating would require “penile deformity;” which is not shown or alleged here. Instead, compensation for the Veteran’s erectile dysfunction is provided by the compensation paid for special monthly compensation based on the loss of a creative organ. Other rating criteria under 38 C.F.R. § 4.115b are not applicable, as the Veteran does not contend and the evidence does not indicate he has had removal of half or more of the penis (Diagnostic Code 7520); removal of the glans of the penis (Diagnostic Code 7521); testicular atrophy (Diagnostic Code 7523); or testicular removal (Diagnostic Code 7524). Here, the weight of the evidence fails to demonstrate that the Veteran’s disability manifests in a penis deformity. The Board acknowledges the Veteran’s statements that he does have of a deformity of the penis. However, he lacks the medical training to make this medical determination and the probative medical evidence disproves his contention. Therefore, entitlement to a compensable disability rating for erectile dysfunction is denied. 7. Entitlement to an increased rate for special monthly compensation. SMC is available when, as the result of service-connected disability, a veteran suffers additional hardships above and beyond those contemplated by VA’s schedule for rating disabilities. 38 U.S.C. § 1114; 38 C.F.R. §§ 3.350 and 3.352. The rate of SMC varies according to the nature of the veteran’s service-connected disabilities. Basic levels of SMC are listed at 38 U.S.C. § 1114(k). In the present case, the Veteran is in receipt of SMC at the (k) rate for loss of use of a creative organ due to erectile dysfunction. SMC under 38 U.S.C. § 1114(k) is payable if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of one or more creative organs, or one foot, or one hand, or both buttocks, or blindness of one eye, having only light perception, has suffered complete organic aphonia with constant inability to communicate by speech, or deafness of both ears, having absence of air and bone conduction, or, in the case of a woman veteran, has suffered the anatomical loss of 25 percent or more of tissue from a single breast or both breasts in combination (including loss by mastectomy or partial mastectomy) or has received radiation treatment of breast tissue, the rate of compensation therefor shall be $96 per month for each such loss or loss of use independent of any other compensation provided in subsections (a) through (j) or subsection (s) of this section but in no event to exceed $3,327 per month; and in the event the veteran has suffered one or more of the disabilities heretofore specified in this subsection, in addition to the requirement for any of the rates specified in subsections (l) through (n) of this section, the rate of compensation shall be increased by $96 per month for each such loss or loss of use, but in no event to exceed $4,667 per month. The probative evidence of record does not show the Veteran required aid and attendance, is considered housebound, has suffered paralysis or the anatomical loss of any his feet, hands or experienced blindness that would warrant entitlement to a higher level of special monthly compensation. As such, a claim for an increased rate of special monthly compensation is denied. Earlier Effective Date Generally, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim for increase, or a claim reopened after final disallowance, will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. Unless otherwise provided, the effective date of compensation will not be earlier than the date of receipt of the claimant’s application. 38 U.S.C. § 5110(a). Under VA regulations, a claim includes a formal or informal communication, in writing, requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p); Brannon v. West, 12 Vet. App. 32, 34-5 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). Any communication or action, indicating intent to apply for one or more benefits under laws administered by the VA from a claimant may be considered an informal claim. 8. Entitlement to an earlier effective date for award of service connection for diabetes mellitus II. 9. Entitlement to an earlier effective date for award of service connection for kidney disease. 10. Entitlement to an earlier effective date for award of service connection for peripheral neuropathy of the left upper extremity. 11. Entitlement to an earlier effective date for award of service connection for peripheral neuropathy of the left lower extremity. 12. Entitlement to an earlier effective date for the award of service connection for erectile dysfunction. 13. Entitlement to an earlier effective date for award of special monthly compensation. The Veteran’s claims of entitlement to service connection for diabetes mellitus, erectile dysfunction, and an eye disability, were denied in April 2009. The Veteran neither appealed the April 2009 rating decision by submitting a notice of disagreement, nor did he submit new and material evidence within one year after notice of the decision. The Veteran filed to reopen the claim of entitlement to diabetes mellitus in May 2012. The RO denied service connection for diabetes mellitus, hypertension, peripheral neuropathy, and kidney disease in September 2013. However, the Veteran continued the appeal for all the claimed disabilities by submitting a notice of disagreement in October 2013 and a substantive appeal in April 2014. In May 2014, the RO readjudicated the Veteran’s claim and granted service connection for diabetes mellitus, assigning an effective date of January 24, 2008 based on the fact that service records were available at the time of the April 2009 decision, but had not been reviewed. In September 2014, the RO granted service connection for kidney disease, peripheral neuropathy, erectile dysfunction and awarded special monthly compensation, all effective September 16, 2013. A January 2016 rating decision assigned an earlier effective date of May 30, 2012, for the award of service connection for kidney disease, peripheral neuropathy, erectile dysfunction, and special monthly compensation. There was no claim for diabetes mellitus or erectile dysfunction prior to January 24, 2008. As such, an earlier effective date for the grant of service connection for diabetes mellitus is not warranted. However, the Board finds that an effective date of January 24, 2008 for the award of service connection for erectile dysfunction and special month compensation is warranted. The Veteran initially filed for service connection for erectile dysfunction at the same time he filed for diabetes mellitus. Treatment records show the onset of erectile dysfunction in 2006. As such, entitlement to an effective date of January 24, 2008 is established for both erectile dysfunction and special monthly compensation under 38 U.S.C. § 1114(k). (Continued on the next page)   As for the Veteran’s peripheral neuropathy and kidney disease, an earlier effective date is not warranted. The Veteran did not file an initial claim specific to either disability. Rather, he submitted a notice of disagreement in October 2013 and was awarded service connection after the medical evidence confirmed both diagnoses. The evidence shows the onset of symptoms related to his kidney disease in August 2013 and neuropathy in 2011. As such, effective date prior to May 30, 2012 is not warranted. D. SMART Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Price, 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.