Citation Nr: 21026178 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 16-31 405 DATE: April 30, 2021 ORDER Entitlement to a rating in excess of 20 percent for diabetes mellitus with erectile dysfunction and microalbuminuria is denied. FINDING OF FACT During the entire period on appeal, the Veteran’s diabetes mellitus required only oral hypoglycemic agent and restricted diet. CONCLUSION OF LAW The criteria for a disability rating in excess of 20 percent for diabetes mellitus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.115a, 4.115b, 4.119, Diagnostic Code 7522-7913. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1967 to May 1970. 1. Entitlement to a rating in excess of 20 percent for diabetes mellitus with erectile dysfunction and microalbuminuria Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R., Part 4. The ratings are intended to compensate impairment in earning capacity due to a service-connected disease or injury. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of a veteran. 38 C.F.R. § 4.3. The Board will consider not only the criteria of the currently assigned diagnostic code, but also the criteria of other potentially applicable diagnostic codes. The Veteran is currently rated with a rating of 20 percent for diabetes mellitus under diagnostic code 7522-7913. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. Under diagnostic code 7913, a rating of 10 percent is warranted if diabetes is manageable by restricted diet only. A rating of 20 percent is warranted if diabetes requires sone or more daily injection of insulin and restricted diet, or; oral hypoglycemic agent and restricted diet. A rating of 40 percent is warranted if there is evidence that diabetes requires one or more daily injections of insulin, restricted diet, and regulation of activities. A rating of 60 percent is warranted for diabetes requiring more than one 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. A rating of 100 percent is warranted for diabetes requiring 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. Note 1 to diagnostic code 7913 sets forth that compensable complications of diabetes shall be evaluated separately unless they are part of the criteria used to support a 100 percent evaluation. Noncompensable complications are considered part of diabetic process under DC 7913. Note 2 to diagnostic code 7913 sets for that when diabetes mellitus has been conclusively diagnosed, a glucose tolerance test is not required solely for rating purposes. The Veteran contends that his diabetes should be rated in excess of 20 percent because his diabetes causes erectile dysfunction. He states that the erectile dysfunction has negatively affected his marriage. See Notice of Disagreement, dated October 30, 2014. Notwithstanding the Veteran’s contentions, the preponderance of the probative evidence of record, as discussed below does not show that the Veteran's diabetes requires regulation of activities, or results in episodes of hypoglycemia or ketoacidosis in order to warrant entitlement to a rating in excess of 20 percent for diabetes mellitus. A VA examiner conducted a Compensation and Pension Examination on the Veteran in September 2013. The examiner noted that the Veteran’s medical history of his diabetes included management by a restricted diet and prescribed oral hypoglycemic agents. The examiner remarked that the Veteran had not been hospitalized for ketoacidosis or hypoglycemic reactions within the past twelve months. The examiner noted no progressive unintentional weight loss or loss of strength due to diabetes. In a separate examination, the examiner diagnosed erectile dysfunction, and concluded that it was related to the Veteran’s diabetes. The examiner also noted that the Veteran did have peripheral neuropathy and had to regulate his activities. The Veteran reported severe insomnia due to neuropathy. The Board notes that, after this examination, the Veteran was granted entitlement to service connection for right and left peripheral neuropathy of the lower extremities, each rated at 10 percent. In a subsequent Board decision, this initial rating was increased to 20 percent for each peripheral neuropathy of the lower extremities. The Veteran was afforded a second VA examination in May 2016. The examiner noted that the Veteran’s medical history of his included prescribed oral hypoglycemic agents. The examiner reported that the Veteran had no restricted activities due to his diabetes. The examiner remarked that the Veteran had not been hospitalized for ketoacidosis or hypoglycemic reactions within the past twelve months. The examiner noted no progressive unintentional weight loss or loss of strength due to diabetes. The examiner affirmed that the Veteran’s erectile dysfunction was related to his diabetes, and also found microalbuminuria. The examiner concluded that the Veteran’s microalbuminuria was due to his diabetes. The record contains no additional evidence received prior to the May 2016 rating decision with respect to the Veteran’s diabetes. Ultimately the record does not substantiate entitlement to a rating in excess of 20 percent for the Veteran’s diabetes as the preponderance of the probative evidence of record does not establish evidence of restricted diet or restricted activities, and no evidence of ketoacidosis or hypoglycemia. Note 1 of diagnostic code 7913 requires that any compensable complications of diabetes be rated separately under the appropriate diagnostic code. Here, the Veteran has bilateral neuropathy, microalbuminuria and erectile dysfunction as a result of his diabetes. As discussed above, the Veteran’s bilateral neuropathy is currently service-connected with a compensable rating. The record does establish that the Veteran has erectile dysfunction as a result of his diabetes. Erectile dysfunction is rated under diagnostic code 7255. However, in order to warrant a compensable rating, there must be evidence of a penis deformity with loss of erectile power. Here, neither the Veteran’s September 2013 VA examination nor his May 2016 VA examination note penis deformities. Further, the Veteran does not allege any penile deformities. Based on no evidence of a penile deformity, the Veteran is not entitled to a compensable rating under diagnostic code 7522 or any other applicable diagnostic code. The record also establishes that the Veteran has microalbuminuria as the result of his diabetes. Microalbuminuria is rated under diagnostic code 7101. A noncompensable rating is warranted for albumin and casts with history of acute nephritis; or hypertension compensable under Diagnostic Code 7101. A 30 percent rating is warranted in cases of albumin constant or recurring with hyaline and granular casts or red blood cells; or transient or slight edema or hypertension at least 10 percent disabling under Diagnostic Code 7101. A 60 percent rating is warranted in cases of constant albuminuria with some edema; or definite decrease in kidney function; or hypertension at least 40 percent disabling under Diagnostic Code 7101. An 80 percent rating is warranted if the Veteran has persistent edema and albuminuria with BUN 40 to 80mg%; or creatinine 4 to 8mg%; or generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion. A rating of 100 percent is warranted when the Veteran requires regular dialysis, or is precluded from more than sedentary activity by one of the following: persistent edema and albuminuria; or BUN more than 80mg%; or creatinine more than 8mg%; or markedly decreased function of kidney or other organ systems, especially the cardiovascular. Here, neither the Veteran’s September 2013 VA examination nor his May 2016 VA examination note cases of albumin constant or recurring with hyaline and granular casts or red blood cells; or transient or slight edema or hypertension at least 10 percent disabling under Diagnostic Code 7101. Neither examination showcase all of the criteria consistent with any other compensable rating under Diagnostic Code 7101. Further, the Veteran does not allege an increase in severity of microalbuminuria since his last examination, and has not submitted medical evidence consistent with such an assertion. Based on no evidence of anything further than albumin and casts with history of acute nephritis; or hypertension compensable under Diagnostic Code 7101, the Veteran is not entitled to a noncompensable rating under diagnostic code 7101 or any other applicable diagnostic code. In rendering a decision, the Board has considered all evidence of record including the Veteran's contentions and lay statements. While the Veteran is competent to report his symptoms of diabetes mellitus, even considering the Veteran’s lay statements, his associated erectile dysfunction and microalbuminuria, and all of the evidence of record, the Board does not find that the severity of the Veteran’s diabetes more nearly approximates a rating in excess of 20 percent under diagnostic code 7913 or any other applicable diagnostic code. Entitlement to a rating in excess of 20 percent for diabetes mellitus is denied. N. RIPPEL Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jonah Nelson, 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.