Citation Nr: 21025105 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 09-37 010A DATE: April 27, 2021 ORDER Entitlement to service connection for hypothyroidism is granted. Entitlement to service connection for hepatitis B is granted. An effective date earlier than July 31, 2014, is not warranted for a rating of 60 percent for diabetes mellitus, type II, with erectile dysfunction. Entitlement to a rating in excess of 60 percent, for diabetes mellitus, type II, with erectile dysfunction from July 31, 2014, is denied. REMANDED Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s hypothyroidism was at least as likely as not related to exposure to herbicide agents at Udorn Royal Thai Air Force Base (RTAFB), Thailand. 2. The Veteran’s hepatitis B is related to his active duty service. 3. It is not factually ascertainable that the Veteran’s diabetes mellitus, type II, increased in severity within the year prior to his claim for increase in August 2014 any earlier than July 31, 2014 such that it required insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year. 4. From July 31, 2014, the Veteran’s diabetes mellitus, type II, did not manifest in 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; and his erectile dysfunction has not manifested to a compensable level. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for hypothyroidism have been met. 38 U.S.C. §§ 1110, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for hepatitis B are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for an effective date earlier than July 31, 2014 for a rating of 60 percent for diabetes mellitus, type II, with erectile dysfunction have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.119, Diagnostic Code 7913. 4. Effective from July 31, 2014, the criteria for a rating in excess of 60 percent for diabetes mellitus, type II, with erectile dysfunction, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.119, Diagnostic Code 7913. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1961 to May 1969. These matters come before the Board of Veterans’ Appeals (Board) on appeal of March 2008 (hepatitis B), August 2011 (hypothyroidism), October 2014 (diabetes mellitus) and August 2015 (TDIU) rating decisions issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). This case was previously before the Board. In May 2013, the Board, in part, remanded entitlement to service connection for hepatitis B for further evidentiary development. In September 2016, the Board, in part, remanded service connection for hepatitis B as well as service connection for hypothyroidism to afford the Veteran his requested Board hearing. In October 2017, the Board, in part, again remanded service connection for hepatitis B and hypothyroidism as well as an increased rating for diabetes mellitus type II, an effective date earlier than July 31, 2014 for the award of a 60 percent rating for diabetes mellitus, type II, and entitlement to a TDIU. These issues now return for appellate review. Additionally, following the October 2017 Board remand, in October 2018, the Veteran provided a VA Form 21-4142, Authorization and Consent to Release Information to the Department of Veterans Affairs, and identified private medical records, from Kaiser Permanente, dated from January 1970 to June 1973. In November 2018, Kaiser Permanente responded that the records could not be provided without certain additional personal identifiers of the Veteran. The record does not reflect the Veteran was specifically notified of VA’s inability to obtain these records. Nonetheless, as these identified records were dated from January 1970 to June 1973, they are only relevant to the service connection claims for hepatitis B and hypothyroidism, which are granted in full in the decision below. Thus, the grant of these claims renders moot lack of compliance, if any exists, with VA’s duty to assist in obtaining these records. In correspondence received by VA on January 8, 2021, the Veteran noted the December 2020 supplemental statement of the case was received 14 days after it was dated, and thus, requested an extension of 30 days from the date VA received his request. As the Veteran has not requested an additional extension of time, and as the requested extension has elapsed, the Board may proceed with appellate review. As a final initial matter, in a January 2014, substantive appeal, VA Form 9, Appeal to Board of Veterans’ Appeals which perfected the Veteran’s appeal as to his claim for hypothyroidism, he requested a Travel Board hearing before the Board. In a May 2016 correspondence, and in a May 2016, substantive appeal, VA Form 9, Appeal to Board of Veterans’ Appeals, which perfected appeals as to the issues of an increased rating for diabetes mellitus, type II, an earlier effective date for the award of a 60 percent rating for diabetes mellitus, type II and a TDIU, the Veteran’s then representative requested a videoconference hearing before the Board. The record reflects a Board hearing was scheduled for December 14, 2016. However, in November 2016, the Veteran’s then representative withdrew the hearing request. The record reflects a Board hearing was again scheduled for April 4, 2017. However, in March 2017 correspondence, the Veteran’s current representative withdrew the hearing request. Thus, the Veteran’s hearing requests are deemed withdrawn and the Board may proceed with appellate review. 38 C.F.R. § 20.704 (e). SERVICE CONNECTION 1. Entitlement to service connection for hypothyroidism The Veteran contends that service connection for hypothyroidism is warranted, to include as due to in-service herbicide exposure. Specifically, in an August 2010 statement, the Veteran reported that the drinking the water in Thailand exposed him to many things. In October 2015 argument, the Veteran’s then representative stated, in part, that the Veteran contended his hypothyroidism was as a result of in-service exposure to Agent Orange. Similarly, in a statement received by VA in September 2020, the Veteran linked his hypothyroidism to in-service Agent Orange exposure. Most recently, in a January 2021 statement, the Veteran, in part, reported that he was diagnosed with hypothyroidism in 1971, and that while stationed in Thailand, he was exposed to Agent Orange. Generally, if a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases are presumed to be service connected if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, even though there is no record of the disease during service, provided that the rebuttable presumption provisions of 38 C.F.R. § 3.307 (d) are also satisfied. 38 U.S.C. § 1116 (a); 38 C.F.R. § 3.309 (e). The term “herbicide agent” (colloquially known as Agent Orange) means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, specifically: 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram. 38 C.F.R. § 3.307 (a)(6)(i). However, VA regulations do not presume herbicidal agent exposure for veterans who served in Thailand. Vietnam era veterans who served in Thailand are entitled to demonstrate actual exposure to herbicides. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994) (unavailability of a presumption does not foreclose service connection on a direct basis). The United States Court of Appeals for Veterans Claims has noted that “[t]he VA Compensation Service has acknowledged that there was some evidence that the herbicides used on the Thailand base perimeters may have been either tactical, procured from Vietnam, or a commercial variant of much greater strength and with characteristics of tactical herbicides.” Parseeya-Picchione v. McDonald, 28 Vet. App. 171, 177 (2016). A declassified Vietnam era Department of Defense document titled Project CHECO Southwest Asia Report: Base Defense in Thailand, indicated herbicides were used for weed control in Thailand. See Overton v. Wilkie, 30 Vet. App. 257 (2018). VA has conceded that the Veteran had in-service herbicide exposure as he was a military policeman stationed in Udorn, Thailand during part of the Vietnam Era. See August 2011 rating decision. The Veteran’s service at the Udorn RTAFB, beginning in April 1966, is verified by his service personnel records. Additionally, the Veteran’s DD 214, which encompasses the time period of April 1966, documented that his military occupational specialty was a security policeman. In this regard, service connection may be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents even though there is no record of such disease during service, if they manifest to a compensable degree any time after service. 38 C.F.R. § 3.307 (a)(6); 38 C.F.R. § 3.309. Effective January 1, 2021, the National Defense Authorization Act authorized the addition of three diseases to the list of those presumed to be related to in-service exposure to herbicide agents, including hypothyroidism. The Veteran’s medical records, including a VA treatment record most recently dated in September 2020, reflect a diagnosis of hypothyroidism. Also, a February 2018 VA examiner provided an opinion based on a diagnosis of hyperthyroidism. The record shows that the Veteran’s hypothyroidism has manifested at least to a compensable degree under the relevant rating criteria found in 38 C.F.R. § 4.119, Diagnostic Code 7903, for hypothyroidism. The criteria for Diagnostic Code 7903 were amended effective December 10, 2017. 82 Fed. Reg. 50802 (November 2, 2017). Under the prior version of Diagnostic Code 7903, a 10 percent rating was warranted for hypothyroidism manifested by fatigability, or where continuous medication was required for control of the condition. In this regard, the Veteran’s medical records reflect he has been treated with medication for his hypothyroidism. Specifically, a March 2020 VA treatment record documented, in part, as the Veteran’s hypothyroidism, he was to continue and refill levothyroxine. Therefore, the Board concludes that service connection for hypothyroidism is warranted on a presumptive basis. See 38 U.S.C. § 5107 (b); 38 C.F.R. § § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for hepatitis B The Veteran contends that entitlement to service connection for hepatitis B is warranted. In his March 2007 informal claim for service connection, the Veteran reported his doctor specified that his hepatitis B was due to his service in Thailand, that he had had a hepatitis agent in his blood since the 1970s, and that he was told for many years that he could not give blood because of this fact. In an October 2009 statement, received in lieu of a VA Form 9, the Veteran reported, in 1973 he attempted to give blood to the blood bank at the Air National Guard and was he was told he could not donate because he had a hepatitis agent his blood. He also described that years later, a VA doctor mentioned that he could have been exposed to hepatitis while he was stationed in Thailand. The Veteran also related that, in Thailand, the water was bad, many times filthy and dirty and that he was exposed to people with hepatitis. In a July 2010 statement, he again referenced he was stationed in Thailand, and through the water there, was exposed to many things. Most recently, in a January 2021 statement, the Veteran, in part, linked his hepatitis B to in-service Agent Orange exposure. The Board concludes that the Veteran has a current disability of hepatitis B that is related to his active duty service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). In this regard, a July 2013 VA examiner endorsed a diagnosis of hepatitis B in 2007 but also noted the Veteran was asymptomatic for liver disease or any other manifestation of hepatitis. Of record are the Veteran’s March 2007 VA treatment records, which documented he was positive for a hepatitis B surface antigen and that he was considered a hepatitis B virus (HBV) carrier with low viral load but had normal liver function tests. As discussed above, this claim stems from a March 2007 informal claim, thus the diagnosis of hepatitis B in 2007 is sufficient to establish the element of current disability. Further, the Veteran’s medical records, including VA treatment records, subsequently continued a diagnosis of hepatitis as part of an active problem list. In a March 2007 VA treatment record, the Veteran also gave risk factors of sex with sex workers and sexually transmitted disease in Thailand in the 1970s. Consistent with the Veteran’s recollection, a June 1967 service treatment record documented, in part, a diagnosis of gonorrhea. While the Board also notes the Veteran was not on active duty during the 1970s, as discussed above, service records confirm he was stationed at Udorn Air Force Base in Thailand, beginning in April 1966. Thus, the question becomes whether his hepatitis B is related to service. On this question there is probative evidence in favor of and against the claim. The evidence against the claim includes a July 2013 VA examiner’s opinion, which found the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. However, in November 2017, the Board found this opinion inadequate and remanded for another opinion, the thus July 2013 VA examiner’s opinion will not be discussed further. Pursuant to the November 2017 Board remand, a February 2018 VA examiner reviewed the record and found there was no additional evidence which objectively showed when the Veteran contracted hepatitis B and no such test was available per reviewed literature on the subject. The February 2018 VA examiner explained hepatitis B was transmitted through direct transmission of blood products, and the predominant mode of the HBV transmission varied in different geographical areas. Specifically, the February 2018 VA examiner explained mother-to-child transmission was the predominant mode of transmission in high-prevalence areas. However, the February 2018 VA examiner explained, in comparison, horizontal transmission, particularly in early childhood, accounted for most cases of chronic HBV infection in intermediate-prevalence areas, while unprotected sexual intercourse and injection drug use in adults were the major routes of spread in low-prevalence areas. The February 2018 VA examiner noted the Veteran apparently contracted gonorrhea in the military in 1967 as noted in original examination report and it was possible that he contracted hepatitis B at that same sexual encounter since that was one of the two most common modes of transmission. However, the February 2018 VA examiner found it was clearly less likely than possible that hepatitis B was contracted then because it was not detected by clinical examination or testing at that same time period or the time between 1967 and 2007 when he was eventually confirmed as being in a chronic carrier state for hepatitis B. The February 2018 VA examiner explained the Veteran’s current diagnosis of hepatitis B, which was 40 years later, was adequate time for having contracted hepatitis B from any possible source after military separation. The February 2018 VA examiner explained the difference was one of probability (i.e. likelier than not) verus possibility (yes, he could have obtained hepatitis B at the time he got gonorrhea) but by statistical likelihood, it remained less likely than not that the hazardous sexual behavior in 1967, causing infection with gonorrhea, was also the cause of his current hepatitis B. The February 2018 VA examiner also addressed the Veteran’s contentions regarding drinking water in Thailand. The evidence in favor of the claim includes VA treatment records dated in 1971 and 1972 which documented findings consistent with hepatitis B. Specifically, a December 1971 VA treatment record documented, in part, that the Veteran gave blood to the Red Cross and was subsequently informed that there was evidence of hepatitis in his blood. Another December 1971 VA treatment record documented the Veteran was told he might be a hepatitis carrier and endorsed a diagnosis of leukopenia. A February 1972 VA treatment record documented the Veteran had leukopenia of undetermined etiology. A March 1972 VA treatment record documented the Veteran was referred because of leukopenia, that a few months ago, he went to give blood at the Red Cross and was found to have a hepatitis virus, but he was checked at the emergency room at this hospital and was told he did not have a hepatitis antigen. A subsequent March 1972 VA treatment record documented that an absolute diagnosis could not be made. An April 1972 VA treatment record documented the Veteran’s only positive tests were still persistent Australia antigen, polyclonal gammopathy, and leucopenia, and provided an impression that polyclonal gammopathy and leucopenia were related to persistent Australia antigen, and that chronic hepatitis had to be ruled out, which was why he was referred to another clinic. An subsequent April 1972 VA treatment record documented, in part, that chronic hepatitis was being considered. Another April 1972 VA treatment of the same date noted, in December 1971 the Veteran went to donate blood at the Red Cross and was found to have Australian antigen positivity. This April 1972 VA treatment record provided a final impression that the Veteran’s leukopenia and polyclonal gammopathy was related to the persistence of Australian antigen associated hepatitis. A May 1972 VA treatment record noted a diagnosis of Australian antigen without evidence to suggest chronic liver disease. A November 1972 VA treatment record noted, in part, all tests were negative except for positive antibodies antigen (hepatitis). Thereafter, a May 2002 VA treatment noted the Veteran was rejected as blood donor, and as to hepatitis there was no clear documentation on type, and a check hepatitis B and C serology was indicated. July 2002 VA treatment records documented the Veteran was hepatitis B surface antigen positive, which was again documented in March 2007. A hepatitis B surface antigen (as defined as Australia antigen, HBsAg, Hepatitis B antigen Virology) is defined as the protein coat of HBV; it is produced in excess during acute HBV infection, and correlates epidemiologically with an increased risk of liver CA and infectivity. McGraw-Hill Concise Dictionary of Modern Medicine. S.v. “hepatitis B surface antigen.” Retrieved April 7 2021 from https://medical-dictionary.thefreedictionary.com/hepatitis+B+surface+antigen. Thus, as discussed, the record reflects the Veteran had laboratory findings indicative of hepatitis B in 1971 and 1972, less than three years after separation from service. This directly contradicts the February 2018 VA examiner’s finding that the time between 1967 and 2007 when the Veteran was eventually confirmed as being in a chronic carrier state for hepatitis B, 40 years, was adequate time for having contracted hepatitis B from any possible source after military separation. Notably, as discussed, the February 2018 VA examiner also explained it was possible the Veteran’s that hazardous sexual behavior in 1967, causing infection with gonorrhea, was also the cause of his current hepatitis B. Given the evidence outlined above, and with resolution of doubt in the Veteran’s favor, the Board finds the February 2018 VA examiner’s finding that it was possible the Veteran’s that hazardous sexual behavior in 1967, causing infection with gonorrhea, was also the cause of his current hepatitis, when combined with evidence of hepatitis B in 1971 and 1972, only a few years after separation from service, is of sufficient evidentiary weight to substantiate the claim. Thus, upon review of the record, the Board finds the evidence is at least in equipoise as to whether the Veteran’s current hepatitis B arose in service. Accordingly, resolving any remaining doubt in the Veteran’s favor, the Board finds that service connection for hepatitis B is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 54-56. Increased Ratings 3. Entitlement to an effective date earlier than July 31, 2014 for the award of a 60 percent rating for diabetes mellitus, type II with erectile dysfunction 4. Entitlement to a rating in excess of 60 percent for diabetes mellitus, type II, with erectile dysfunction, from July 31, 2014 The Veteran contends that he is entitled to a higher rating for diabetes mellitus, type, and an earlier effective date for the award of a 60 percent disability rating. Specifically, in an August 2014 statement, the Veteran noted the attached letters, from his doctor and diabetic educator, showed that they assigned him regulation of activities to make sure that he avoided strenuous occupational and recreational activities, due to the fact that this would, or could, raise his stress levels to adversely affected his blood sugar or increase the frequency of hypoglycemic episodes. He also noted he had had a hypoglycemic episode in July 2014. In an August 2015 statement, the Veteran reported he now took five to six shots a day and his pancreas did not produce any insulin. In a January 2021 statement, the Veteran argued, in part, that he had been taking three to four injections of insulin daily since his diagnosis in 1992. An August 2011 rating decision, in part, granted service connection for diabetes mellitus type II with erectile dysfunction effective May 8, 2001. The Veteran appealed the initial evaluation assigned, but in July 2013 correspondence, he withdrew this appeal. Accordingly, the August 2011 rating decision is final. The Veteran had not asserted the August 2011 rating decision is not final, nor has he alleged that the decision contained clear and unmistakable error. Lang v. Wilkie, 971 F.3d 1348 (Fed. Cir. 2020). Thus, to the extent the Veteran raises entitlement to an earlier effective date for grant of service connection itself, such is not on appeal and is an impermissible freestanding claim. See Rudd v. Nicholson, 20 Vet. App. 296 (2006). Under 38 U.S.C. § 5110 (a), the effective date of an increase in a veteran’s disability compensation shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. However, an increased rating may be awarded up to one year prior to receipt of the claim if the evidence shows an increase in disability was factually ascertainable during that period. The Board has closely reviewed the evidence following the August 2011 rating decision and the August 19, 2014 claim and does not find that any formal or informal claim for increase was filed during that time. Therefore, August 19, 2014, was the date of the receipt of the claim for increase. Here, the Agency of Original Jurisdiction (AOJ) has granted a 60 percent evaluation for the Veteran’s diabetes mellitus type II, effective July 31, 2014, based on a private medical letter from Dr. C. Anozie, dated July 13, 2014. Thus, Board has considered the period from August 19, 2013 to July 30, 2014 to determine whether an increase in disability was factually ascertainable during that period. However, the preponderance of the evidence is against such a finding. Throughout the appeal period the Veteran’s diabetes mellitus, type II, is rated under Diagnostic Code 7913, for diabetes mellitus. Copeland v McDonald, 27 Vet. App. 333 (2015). Diagnostic Code 7913 provides a structured scheme of specific, successive, cumulative criteria. Each higher rating includes the same criteria as the lower rating plus distinct new criteria. Middleton v. Shinseki, 727 F.3d 1172, 1178 (Fed. Cir. 2013). The criteria for Diagnostic Code 7913 were amended effective December 10, 2017 primarily to require "one or more daily injection" of insulin for a 20-, 40- or 60-percent rating. See 82 Fed. Reg. 50802 (November 2, 2017). Prior to those amendments, the insulin-related criteria was simply “requiring insulin.” These new regulations apply to all applications for benefits received by VA or that are pending before the AOJ on or after December 10, 2017. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal. Under the criteria prior to December 10, 2017, as relevant in this case, 60 percent rating is warranted when diabetes mellitus requires insulin, a restricted diet, and regulation of activities, with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A 100 percent rating is warranted when diabetes mellitus requires more than one daily injection of insulin, a 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 care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. Under the criteria from December 10, 2017, as relevant in this case, a 100 percent rating is warranted when diabetes 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. Thus, the 100 percent criteria is essential unchanged as the revision merely removed the phrase “(avoidance of strenuous occupational and recreational activities)”. Compensable complications of diabetes are evaluated separately unless they are part of the criteria used to support a 100-percent evaluation. Noncompensable complications of diabetes are considered part of the diabetic process. 38 C.F.R. § 4.119, Diagnostic Code 7913 (Note 1). Because Diagnostic Code 7913 contains successive criteria, the criteria for the lower rating must be met before a higher disability rating may be awarded. A higher rating cannot be granted based on a finding that the Veteran’s disability picture more nearly approximates the criteria for the next higher rating. However, reasonable doubt regarding the presence of a criterion may be resolved in the Veteran’ favor. Johnson v. Wilkie, 30 Vet. App. 245 (2018). In weighing the evidence, the Board determines that the preponderance of the evidence is against a finding that it is “factually ascertainable” that the criteria for a 60 percent evaluation for the Veteran’s service-connected diabetes mellitus, type II, were first met from August 19, 2013 to July 30, 2014 under the pre-December 10, 2017, criteria for Diagnostic Code 7913. This is because the evidence documents that the Veteran’s diabetes mellitus increased in severity prior to that time. For example, an August 2011 private treatment record documents the Veteran had an acute hypoglycemic reaction and was taken to the emergency room. Thus, he had a hypoglycemic episode requiring hospitalization prior to August 19, 2013. As such, the effective date can be no earlier than July 30, 2014. See Harper v. Brown, 10 Vet. App. 125, 126 (1997). Thus, the Board finds that that the evidence demonstrates that it is not “factually ascertainable” that the criteria for a 60 percent evaluation for the Veteran’s service-connected diabetes, mellitus, type II, were first met between August 19, 2013 and July 30, 2014, but were in fact met earlier. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 54-56. Thus, for these reasons, the Board finds an earlier effective date for the 60 percent evaluation for the Veteran’s service-connected diabetes, mellitus, type II, is not warranted. The Board concludes that the Veteran’s symptoms did not cause the level of impairment required for a disability rating of 100 percent at any point during the appeal period at issue, to include under the pre- or post- December 10, 2017 criteria for Diagnostic Code 7913. Specifically, the Veteran did not experience 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. In this regard, a July 31, 2014 private medical letter, from Dr. C. Anozie, noted the Veteran’s diabetes mellitus, type II, required insulin, twice a day, a restricted diet and regulation of activities, and that he was advised to avoid strenuous occupation and recreational activities that would raise his stress level, affect blood sugars, or increase his frequency of hypoglycemic episodes. Also of record is a January 2018 private medical record, from C. Coleman, a certified diabetes educator, who reported that the Veteran was currently on two type of insulin and that he had worked hard on lifestyle changes and learning how to utilize his medications for his diabetes, which was in very good control. Also, October 2014, July 2015 and November 2020 VA examiners found the Veteran visited his diabetic care provider for episodes of ketoacidosis or hypoglycemia less than two times per month. The October 2014 VA examiner also found the Veteran had no episodes of hypoglycemic reactions which required hospitalization over the past 12 months, and one episodes of ketoacidosis which required hospitalization over the past 12 months. The July 2015 VA examiner did not address any episodes of ketoacidosis requiring hospitalization over the past 12 months, but found the Veteran had one episode of hypoglycemia requiring hospitalization over the past 12 months. In a January 2016 addendum opinion, the July 2015 VA examiner clarified the Veteran had no episodes of ketoacidosis or hypoglycemia requiring hospitalization over the past 12 months. The November 2020 VA examiner found the Veteran had no episodes of ketoacidosis or hypoglycemic reactions which required hospitalization over the past 12 months. The October 2014 and November 2020 VA examiners also found the Veteran had not had progressive unintentional weight loss and loss of strength attributable to diabetes mellitus. The July 2015 VA examiner found the Veteran had not had progressive unintentional weight loss attributable to diabetes mellitus. Thus, these findings do not reflect 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, as required for a higher rating. The Veteran’s medical records also reflect findings generally consistent with the above discussed examination reports and private medical letters. For example, September 2014 VA treatment record documented, in part, the Veteran was having hypoglycemia during the day when he went for long periods of time without eating. A September 2014 private medical record documented the Veteran was continue medications, diet, check blood sugar, and to exercise as desired. A February 2015 VA treatment record documented that the Veteran reported since doing a food log, he was having less hyperglycemia and hypoglycemia. A January 2016 VA treatment record documented the Veteran had hypoglycemia once a week and that he would call if started having this twice weekly. A May 2016 VA treatment record documented the Veteran reported much fewer episodes of hypoglycemia. A June 2016 private medical record noted the Veteran had diabetes, type II, without retinopathy, uncontrolled but improving glycemic control, and that he was to continue medications. A September 2016 VA treatment record noted the Veteran was positive for hypoglycemic episodes; once when he took too much aspart with lunch and another time when he delayed lunch due to being out of the house for an appointment. An October 2016 VA treatment record noted the Veteran reported hypoglycemia in the late afternoon, which was likely due to too much glargine. A December 2016 VA treatment record noted the Veteran was positive for hypoglycemic episodes, which only happened when he took full dose of aspart for a meal and then did not finish the meal. A January 2017 VA treatment record noted the Veteran was negative for hypoglycemic episodes in the past couple weeks. An August 2017 VA treatment record noted the Veteran reported no current problems with hypoglycemia after his basal insulin regimen was re-adjusted by his primary care and pharmacist team. A November 2017 VA treatment record noted the Veteran had mild hypoglycemia as he reported he overdid it with his short acting insulin or took it too early before his meal. Also, October 2016 and November 2016 and September 2019 VA treatment records noted the Veteran was negative for hypoglycemic episodes. Most recently, a May 2020 VA treatment record documented the Veteran had infrequent hypoglycemia, specifically when he took much insulin for breakfast. An October 2020 VA treatment record also noted he had hypoglycemic episode last Thursday, because he did not check his blood glucose earlier in the day. In a January 2018 private medical record, C. Coleman, a certified diabetes educator, also reported that the Veteran’s codes for billing purposes included diabetes mellitus type I and type II. The November 2020 VA examiner also endorsed diagnoses of diabetes mellitus type I and type II. Additionally, the Veteran’s other medical records, including VA treatment records dated in June 2018 indicated a diagnosis of diabetes mellitus, type I. However, as the Veteran’s service-connected diabetes mellitus, whether type I or type II, is specifically contemplated by the Rating Schedule under Diagnostic Code 7913, this is the appropriate diagnostic code. Copeland, 27 Vet. App. 333 (2015). In November 2016 (and in again in February 2017), the Veteran submitted articles regarding diabetes mellitus. These submissions discussed the symptoms of diabetes mellitus with hyperglycemia, discussed the medications of Humalog, Lantus, and Metformin, and also discussed state driver license law in New Mexico and Department of Transportation medical guidelines for diabetes. However, these submissions provided medical information that was general in nature, and did not address the specifics of the Veteran’s case. Furthermore, the Board recognizes the Veteran’s assertions that his diabetes mellitus, type II, warrants a higher evaluation and these endorsements are admissible and have been taken into consideration. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). However, the Veteran has not been shown to have the requisite knowledge or training to be deemed competent to identify a specific level of disability of his diabetes mellitus, type II according to the rating criteria. Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Such competent evidence concerning the nature and extent of the Veteran’s diabetes mellitus, type II, has been provided by clinical records, including October 2014, July 2015 and November 2020 VA examination reports, associated with the claims file and these medical findings directly address the criteria under which the Veteran’s diabetes mellitus, type II, is evaluated. The Board finds these clinical records to be competent, objective, and probative evidence of record, and are therefore accorded greater weight than the Veteran’s subjective complaints of symptomatology for his diabetes mellitus, type II. Moreover, the Veteran does not assert, and/or medical treatment records do not show, that his diabetes mellitus required at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength. The Board further notes that the Veteran has complications associated with his diabetes mellitus, type II. Specifically, October 2014 and July 2015 VA examiners documented the Veteran had erectile dysfunction which was at least as likely as not due to diabetes mellitus. However, in a January 2016 addendum opinion, the July 2015 VA examiner did not identify any recognized complications of diabetes mellitus. A February 2016 VA examiner also found the Veteran did not have a condition suggestive of bilateral neuropathy of the upper and lower extremities and current examination was unremarkable for diabetic peripheral neuropathy. A November 2020 VA examiner documented the Veteran had recognized complications of diabetes mellitus consisting of diabetic peripheral neuropathy of the lower extremities and erectile dysfunction. As discussed herein, Note (1) to 38 C.F.R. § 4.119, Code 7913, provides that compensable complications of diabetes are evaluated separately. Moreover, as previously stated, Note (1) also provides that noncompensable complications are considered part of the diabetic process under code 7913. In this regard, the AOJ determined that the Veteran’s erectile dysfunction was noncompensable (zero percent disabling). Erectile dysfunction is rated under 38 C.F.R. § 4.115b, Diagnostic Code 7599-7522 (penis, deformity, with loss of erectile power). Under Diagnostic Code 7522, for the Veteran to receive a compensable rating for erectile dysfunction, physical deformity of the penis with loss of erectile power is required. Such manifestations would warrant a 20 percent rating. 38 C.F.R. § 4.115b. Simply stated, the condition is not compensable in the absence of penile deformity. Upon review of the evidence, the Veteran does not meet the criteria for a 20 percent rating for erectile dysfunction. It is not in dispute that he has loss of erectile power. An October 2014 VA examiner found it was unknown if the Veteran could achieve an erection sufficient to penetrate the vagina with medication as he had not given medication a try yet. However, upon physical examination, the October 2014 VA examiner found the Veteran’s penis, testes and epididymis were normal. During a November 2020 examination, the Veteran reported he had difficulty creating and maintaining an erection and that he took Viagra for his condition. However, during the November 2020 examination, the Veteran requested to not have his male reproductive organs examined and reported a normal anatomy with no penile, testicular, or epididymis, deformities or abnormalities. In the present case, the evidence of record does not reveal any physical deformity of the Veteran’s penis. He has not alleged, nor does the evidence show, that he has penile deformity. As such, there is no lay or medical support for a compensable disability rating for erectile dysfunction under Diagnostic Code 7522. Moreover, the Board notes that the Veteran is already in receipt of special monthly compensation for loss of use of a creative organ throughout the period on appeal. Also, with regard to the Veteran’s diabetic peripheral neuropathy, he was assigned separate ratings diabetic sensory peripheral neuropathy of each lower extremity. Additionally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to this claim. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). REASONS FOR REMAND 1. Entitlement to TDIU is remanded. Given the Board’s favorable grant of service connection for hypothyroidism and hepatitis B, as discussed above, it will defer considering the TDIU issue until the AOJ effectuates the Board’s decision. See Bagwell v. Brown, 9 Vet. App. 337 (1996). Specifically, entitlement to TDIU was raised during the pendency, and as part of, the claim for an increased rating for the Veteran’s service-connected diabetes mellitus, type II, received by VA on August 19, 2014. Rice v. Shinseki, 22 Vet. App. 447 (2009). Thus, the rating period for consideration on appeal is from one year prior to the August 19, 2014 date of receipt of the claim for increase, if it is factually ascertainable that an increase warranting a TDIU occurred during that period. The initial ratings assigned for hypothyroidism and hepatitis B disabilities such could affect whether the Veteran meets the schedular criteria for a TDIU for the entire appeal, as he currently does not satisfy the schedular criteria for the entire appeal period.   The matters are REMANDED for the following action: Effectuate the Board’s grants herein, of entitlement to service connection for hypothyroidism and hepatitis B, after undertaking any other development deemed appropriate, readjudicate entitlement to a TDIU. If the benefit sought is not granted, furnish the Veteran and his representative with a supplemental statement of the case and afford them an opportunity to respond before the record is returned to the Board for further review. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Espinoza, 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.