Citation Nr: 22018606 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 16-27 954 DATE: March 29, 2022 ISSUES 1. Entitlement to a compensable disability rating for right ilio-inguinal neuritis, with radiation of pain to groin, pelvis, hips, thighs, neck, shoulder, chest and ribs, for the period prior to March 29, 2016, and in excess of 10 percent thereafter. 2. Entitlement to a compensable disability rating for left ilio-inguinal neuritis, with radiation of pain to groin, pelvis, hips, thighs, neck, shoulder, chest and ribs. ORDER Entitlement to a disability rating of 10 percent for a right ilio-inguinal neuritis disability for the period prior to March 29, 2016 is granted, subject to the laws and regulations governing the payment of monetary benefits. For the period from Mary 29, 2016, a disability rating in excess of 10 percent for a right ilio-inguinal neuritis disability is denied. Entitlement to a disability rating of 10 percent for a left ilio-inguinal neuritis disability is granted, subject to the law and regulations governing the payment of monetary benefits. REMANDED Entitlement to rating in excess of 10 percent for a right ilio-inguinal neuritis disability on an extraschedular basis is remanded. Entitlement to rating in excess of 10 percent for a left ilio-inguinal neuritis disability on an extraschedular basis is remanded. FINDINGS OF FACT 1. For the period prior to March 29, 2016, resolving any reasonable doubt in the Veteran's favor, the Veteran has exhibited symptoms consistent with severe partial paralysis of the right ilio-inguinal nerve. 2. For the period from March 29, 2016, the Veteran is in receipt of the maximum rating allowed under Diagnostic Code 8530 for his for his right ilio-inguinal neuritis disability. 3. Resolving any reasonable doubt in the Veteran's favor, the Veteran has exhibited symptoms consistent with severe partial paralysis of the left ilio-inguinal nerve throughout the period on appeal. CONCLUSIONS OF LAW 1. For the period prior to March 29, 2016, the criteria for a disability rating of 10 percent, but no higher, for a right ilio-inguinal neuritis disability are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8530. 2. For the period from March 29, 2016, the criteria for a disability rating in excess of 10 percent for a right ilio-inguinal neuritis disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8530. 3. For the entire period on appeal, the criteria for a disability rating of 10 percent, but no higher, for a left ilio-inguinal neuritis disability are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8530. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS This matter is before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision of a Department of Veterans Affairs (VA), Regional Office (RO) in Decatur, GA. This October 2014 rating decision continued a noncompensable rating for the Veteran's right and left ilio-inguinal neuritis, with radiation of pain to groin, pelvis, hips, thighs, neck, shoulder, chest and rib. In January 2021, the Veteran testified at a virtual tele-hearing before the undersigned Veteran's Law Judge. A transcript of that Board Hearing has been associated with the claims file. The Board notes, in a May 2016 rating decision, the Veteran's disability rating for his right ilio-inguinal neuritis, with radiation of pain to groin, pelvis, hips, thighs, neck, shoulder, chest and ribs was increased to 10 percent, effective March 29, 2016 (the date of a VA examination). As this increase does not represent a full grant of benefits sought on appeal, the claim for an increased disability rating for the service-connected right ilio-inguinal neuritis, with radiation of pain to groin, pelvis, hips, thighs, neck, shoulder, chest and ribs remains pending before the Board, as reflected on the title page. See A.B. v. Brown, 6 Vet. App., 35, 39 (1993) (the claimant is presumed to be seeking the highest possible rating for a disability unless he or she expressly indicates otherwise). In July 2021, the Board remanded this matter for the purpose of obtaining private treatment records and affording the Veteran an additional examination to evaluate the current severity of his disabilities. The matter has been properly returned to the Board for appellate consideration and the Board is satisfied that there has been substantial compliance with the Board remand. Thus, no further action is required. See Stegall v. West, 11 Vet. App. 268 (1998). The Board notes that there is considerable overlap in the applicable evidence for the Veteran's claims for entitlement to increased ratings for his right and left ilio-inguinal neuritis, with radiation of pain to the groin, pelvis, hips, thighs, neck shoulder, chest and ribs; hence, these two claims will be discussed together Entitlement to a compensable disability rating for right ilio-inguinal neuritis, with radiation of pain to groin, pelvis, hips, thighs, neck, shoulder, chest and ribs, for the period prior to March 29, 2016, and in excess of 10 percent thereafter. Entitlement to a compensable disability rating for left ilio-inguinal neuritis, with radiation of pain to groin, pelvis, hips, thighs, neck, shoulder, chest and ribs. The Veteran contends that a higher rating for his right and left ilio-inguinal neuritis, with radiation of pain to groin, pelvis, hips, thighs, neck, shoulder, chest and ribs is warranted. See October 20, 2014, Notice of Disagreement. The Veteran filed his claim for an increased rating on March 26, 2014; therefore, the appeal period begins on March 16, 2014, plus the one-year look-back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). Disability ratings Disability evaluations are determined by comparing a veteran's present symptoms with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code (also abbreviated "DC"), the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the Veteran. 38 C.F.R. § 4.3. A disability rating may require re-evaluation in accordance with changes in a veteran's condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1. See also Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a claimant is awarded service connection and assigned an initial disability rating, separate disability ratings may be assigned for separate periods of time in accordance with the facts found. Where the veteran is appealing the rating for an already established service-connected condition, her present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). The assignment of a particular DC is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One DC may be more appropriate than another based on such factors as an individual's relevant medical history, the DC, and the demonstrated symptomatology. Any change in a DC by VA must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625 (1992). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to her through her senses. See Layno, 6 Vet. App. at 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 137. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. If the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise), the claimant receives the benefit of the doubt. Lynch v. McDonough, No. 2020-2067, 2021 U.S. App. LEXIS 37307 at *10 (Fed. Cir. Dec. 7, 2021). If the evidence persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-rule does not apply. Id. at *11. Diseases of the Peripheral Nerves Diagnostic Codes 8528-8530, 8628-8630, and 8728-8730, provide ratings for paralysis, neuritis, and neuralgia of the obturator, external cutaneous, and ilio-inguinal nerves. Neuritis and neuralgia are rated as incomplete paralysis. For each disability, a maximum 10 percent rating is warranted for severe incomplete paralysis or paralysis of the respective nerve. Mild or moderate impairment of each nerve (obturator, external cutaneous, and ilio-inguinal) warrant noncompensable ratings. 38 C.F.R. § 4.124a, Diagnostic Codes 8528-8530, 8628-8630, and 8728-8730 (2018). The Veteran's ilioinguinal nerve disability is rated under Code 8530. Under DC 8530, 10 percent is the maximum rating allowable for severe to complete paralysis of the ilio inguinal nerve. The term "incomplete paralysis" indicates a degree of lost or impaired function that is substantially less than that which is described in the criteria for an evaluation for complete paralysis of this nerve, whether the less than total paralysis is due to the varied level of the nerve lesion or to partial nerve regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "mild," "moderate," "moderately severe," and "severe." Sellers v. Wilkie, No. 16-2993 (Vet. App. Aug. 23, 2018) ("DC 8520 does not define 'mild,' 'moderate,' 'moderately severe,' or 'severe,' or generally associate those terms with specific symptoms"). Rather than applying a mechanical formula, the Board must instead evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Discussion The Veteran's July 2014 private treatment records report on history, pain in the left hip, groin. Radiation of pain in the legs, backs, hips. The frequency of pain is described as continuous with intermittent worsening. The effects of pain on daily activities are described as severe. Level of pain, at best is 7 out of 10; at worse, 10 out of 10; average is 4 out of 10. See July 1, 2014 private treatment record. Examinations During the course of this appeal, the Veteran has been afforded VA Peripheral Nerve Condition examinations in August 2014, March 2016 and November 2021. The Veteran also submitted Peripheral Nerve Conditions Disability Benefits Questionnaires from his physician in April 2016 and February 2021. In the August 2014 VA examination, the Veteran was diagnosed with neuritis, ilio-inguinal nerve. On history, the examiner reported the onset of his symptoms in September 2009, resulting from nerve damage during a vasectomy. The examiner reported the Veteran's condition has gotten worse. See August 28, 2014, Peripheral Nerve Condition examination, pg. 1. The examiner reported that the Veteran had the following peripheral nerve symptoms: constant pain, severe for the left lower extremity; intermittent pain, severe for the left lower extremity, paresthesias and/or dysesthesias, severe for the left lower extremity, numbness, severe for the left lower extremity. Id. at pgs. 1-2. Muscle strength testing for was reported as normal for all extremities. Id. at 2. The Veteran did not have muscle atrophy. Id. at 2. Reflex testing was normal for the left and right upper and lower extremities. Id. at 3. Upon sensory examination there was decreased sensation in the foot/toes. Id. at 4. There were no trophic changes, and his gait was normal. Id. The examiner determined the Veteran's ilio-inguinal nerve on the right was normal. Id. at pg. 9. The examiner determined the Veteran's ilio-inguinal nerve on the left was manifest by severe, incomplete paralysis. Id. Addressing functional impact, examiner reported the impact of the Veteran's peripheral neuropathy on the Veteran's ability to works is left inguinal pain with flare ups. Id. at 11. In a March 2016 Peripheral Nerve Conditions VA examination. This examiner reported a diagnosis of ilio-inguinal neuritis, bilateral with radiation to groin, pelvis, hips, neck, thighs, shoulder, chest, and ribs; status post-surgery for persistent pain with residual scarring; chronic pain syndrome-severe. See March 29, 2016 Peripheral Nerve Conditions examination, DBQ, pg. 1 On medical history, the examiner reported the condition has steadily spread throughout the body to include the head, back (worse) inguinal and genital femoral nerve. The examiner reported the Veteran's arms and hands tingle. There is also clenching of the jaw, which resulted in a broken filing. The examiner reported, the Veteran indicates taking 30 mg. of morphine by mouth 4 times daily. The examiner reported the Veteran also has morphine and numbing in pain pump in left hip. Id. at pg. 1. The examiner reported the Veteran had the following peripheral nerve symptoms: constant pain, severe for right and left upper extremity; severe for the right and left lower extremity; paresthesias and/or dysesthesias, moderate for the right and left upper extremity; numbness, moderate for the right and left upper extremity; mild for the right and left lower extremity. Id. at pg. 2. Muscle strength testing 4/5 for elbow flexion, extension, wrist flexion, wrist extension, grip and knee extension. The Veteran did not have muscle atrophy. Id. at pgs. 2-3. Reflex testing revealed 2+ plus (normal) in the biceps, triceps, brachioradiales, and knee; 1+ (hypoactive) right and left ankle. Id. at 3. Upon sensory examination there was decreased sensation in the upper anterior right thigh. Id. at 4. There were no trophic changes. The examiner noted the Veteran's gait was abnormal due to pain. The examiner reported the Veteran is unable to stand still. Id. at 4. The examiner reported Veteran right ilio-inguinal nerve was manifest by severe, incomplete paralysis. The examiner reported Veteran's left ilio-inguinal nerve was normal. Id. at 9. Addressing functional impact, the examiner reported the Veteran has decreased strength, numbness, tingling, which affects sedentary and physical employment. The examiner also remarked the Veteran was in severe pain with diaphoresis and constantly moving, making nerve testing complicated. Id. at 11. In April 2016, the Veteran submitted an April 2016 Peripheral Nerve Conditions Disability Benefits Questionnaire (DBQ) completed by his physician. On medical history, the physician reported the Veteran wakes up with severe left testicle pain. The physician reported the Veteran has had numerous procedures to try and correct his condition over time, without success. See April 1, 2016 Peripheral Nerve Conditions DBQ, pg. 1. (K.S., MD). The physician reported that the Veteran had the following peripheral nerve symptoms: inguinal plus testicular pain that radiates, severe and constant. The physician reported the Veteran's extremities do not have pain. The physician also recorded bilateral inguinal, perineal plus testicular pain that is severe and constant. Id. at pgs. 1-2. Muscle strength testing was normal. The Veteran did not have muscle atrophy. Reflex testing was normal. Id. at 2. Upon sensory examination, the physician reported the Veteran has decreased sensation to touch, but also cutaneous hypersensitivity in the bilateral inguinal and perineal region. Id. at 3. There were no trophic changes. With respect to his gait, the physician reported the Veteran cannot tolerate scrotal movement or touching of scrotum to thighs. Id. The physician reported the Veteran's right and left inguinal nerve was manifest by complete paralysis. The physician reported these nerves have been resected in prior surgeries. Id. at 7. The physician reported walking is extremely painful secondary due to severe testicular pain. Id. at 7. Addressing the remaining effective function of the extremities, the physician reported the Veteran's peripheral neuropathy affects his inguinal region and testicles/scrotum. His limbs function normally. Id. at 7. Addressing other pertinent findings, the physician reported the Veteran has depression and insomnia. Id. at 7. Addressing diagnostic testing, the physician reported he did not think this area can be accurately tested. Addressing any other significant diagnostic testing, the physician reported physical findings, numerous previous surgeries. Id. at 8. Addressing functional impact, the physician reported the Veteran has severe pain, which has severely impaired his ability to function, remain focused. Id. at pg. 8. In a February 2021 Peripheral Nerve Conditions DBQ completed by the Veteran's physician, it was reported that the Veteran had the following peripheral nerve symptoms: constant pain, moderate for the right lower extremity, moderate for the left lower extremity; intermittent pain, mild for the right upper extremity, mild for the left upper extremity; moderate pain for the right and left lower extremity; paresthesias and/or dysesthesias mild for the right upper extremity, mild for the left upper extremity; moderate for the right lower extremity, moderate for the left lower extremity, numbness, mild for the right upper extremity, mild for the left upper extremity, mild for the right lower extremity, mild for the left lower extremity. See February 18, 2021 Peripheral Nerve Conditions DBQ, pg. 1-2. Muscle strength testing for the normal. The physician reported the Veteran has normal motor function, but is significantly deconditioned, which causes weakness. Id. at 2. The physician reported the Veteran did have muscle atrophy, bilateral thigh and calf secondary to chronic wheelchair use. Id. at 2. Reflex testing revealed 1+ plus (hypoactive) in the biceps, triceps, brachioradiales, ankle. Id. at 2. Upon sensory examination, there was decreased sensation in the right and left shoulder forearm (c6/T1), hand/fingers. Id. at 3. There were no trophic changes. The physician reported the Veteran has extremes sensitivity of bilateral inguinal region plus bilateral testicles. The physician reported the Veteran must walk-in bow-legged position and pain of testicles hanging is increased. Id. at 3. With respect to affected nerves, the physician reported there was no paralysis, but there was chronic weakness secondary to decondition state, secondary to chronic pain. Id. at pgs. 5-6. The physician reported that there was complete bilateral paralysis of the right and left side ilio-inguinal nerve. Id. at pg. 7. Addressing functional impact, the physician stated that the Veteran is in constant severe pain, despite numerous interventional procedures, spinal cord stimulator and intrathecal pain pump. Id. at 8. (K.S., MD). Pursuant to the Board's July 2021 remand directives, the Veteran was afforded a November 2021, Peripheral Nerve Conditions examination to assess the severity of his disability. The VA examiner reported on medical history the Veteran's history with nerve blocks and a spinal cord stimulator (which helped, but was removed in 2018). The examiner noted the Veteran had a surgery that helped for a year, and had physical therapy for a limited time. The examiner noted the Veteran's use of a pain pump in 2016 that ultimately did not help. The examiner reported the Veteran is on a morphine pump now. See November 22, 2021, Peripheral Nerve Conditions examination, pg. 1-2. The examiner reported that the Veteran had the following peripheral nerve symptoms: constant pain, mild for the right lower extremity, severe for the right and left lower extremity; paresthesias and/or dysesthesias mild for the right and left lower extremity; numbness, mild for the right and left lower extremity. Id. at pgs. 1-2. Muscle strength testing for the normal for the right lower extremity; muscle strength testing 4/5 knee extension. Id. at 3. The examiner reported the Veteran has muscle atrophy. Id. at 3. Sensory examination was normal. The examiner reported the Veteran's report of sharp shooting pain when he touched the Veteran' left upper lateral thigh. The Veteran reported his bilateral upper extremities feel like they are asleep. The Veteran reported shooting pain in "shorts area." Id. at 4. There were no trophic changes. The examiner reported the Veteran walks on the right ball of his foot, not placing his heel on the floor because of the pain. The Veteran is able to move his right ankle with good range of motion. Id. at 4. The examiner reported the Veteran sciatic nerve was normal, anterior crural (femoral) nerve, normal. Id. at pgs. 6-7. The examiner reported the Veteran's ilio-inguinal nerve on the right side was normal. The examiner reported the Veteran's left side was manifested by incomplete paralysis, moderate. Id. at 8. The examiner reported the Veteran manipulated his own testicles and penis during the exam without showing any signs of discomfort or pain. A chaperone was present during the exam. Id. at 8. Addressing functional impact, the examiner reported the Veteran has multifactorial chronic pain and depression prevent him from working he reports. Id. pgs. 9. The examiner also noted a recommendation for a psychiatric evaluation for a somatic disorder and depression and anxiety. Id. at pg. 10. Addressing the Veteran's reflex examination, the examiner remarked he was unable to test the Veteran's right and left biceps, right and left triceps, right and left brachioradialis, right and left knee, left and right ankle because he the Veteran was unable to relax his muscles. Id. at pg. 10. Lay testimony At his January 2021 Board Hearing, the Veteran testified that as a result of his disability, he has numbness through arms, sharp pain going up to his chest area and more sharp pain going down to his legs and knees. The Veteran testified that his hips are always in excruciating pain. The Veteran testified that because of his disability, it hurts to sit and to use the bathroom. The Veteran testified that he takes oral morphine 4 times a day for his condition and that he cannot participate in any physical therapy. At this Board hearing, the Veteran described his right and left ilio-inguinal neuritis, with radiation of pain to groin, pelvis, hips, thighs, neck, shoulder, chest and ribs as severe. See Board Hearing transcript, at pgs. 3-5. Analysis In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). The Board finds the November 2021 Peripheral Nerve Conditions examination adequate and probative for purposes of adjudication because the examiner reviewed the Veteran's medical history, conducted all appropriate testing, while explaining limitations associated with the Veteran's reflex testing. The examiner also provided sufficient detail about this Veteran's ilio-inguinal neuritis in order for the Board to make an informed decision about the severity of this Veteran's disability. The Board also considers this November 2021 examination along with the probative August 2014 and March 2016 VA Peripheral Nerve Conditions examinations. The Board also finds the April 2016 and February 2021 Peripheral Nerve Condition DBQ's submitted by the Veteran's physician probative as to the severity of this Veteran's ilio-inguinal neuritis during the course of this appeal. The Board notes that in both the April 2016 and February 2021 DBQ's the Veteran's physician (pain specialist) reported the Veteran's left and right ilio-inguinal neuritis disability was manifested by pain with complete paralysis. See April 1, 2016 Peripheral Nerve Conditions DBQ, pg. 7 re: complete paralysis, nerves resected; See also, February 18, 2021 Peripheral Nerve Conditions DBQ, pg. 7 re: bilateral complete paralysis of the right and left side ilio-inguinal nerve. Id. at pg. 7. The Board recognizes that the Veteran's physician did not indicate severity of the paralysis on the DBQ's; however, when the April 2016 and February 2021 DBQ's are read as a whole, the reports provide sufficient information as to the nature and severity of the Veteran's ilio-inguinal nerve disability. With respect to the VA examinations, the Board observes the August 2014 VA examiner determined the Veteran's left ilio-inguinal neuritis disability was manifest by severe, incomplete paralysis. See August 2014, VA Peripheral Nerve Conditions examination, pg. 9. The March 2016 VA examiner reported the Veteran right ilio-inguinal neuritis disability was manifest by severe, incomplete paralysis. See March 2016 VA Peripheral Nerve Conditions examination, pg. 9. The November 2021, Peripheral Nerve Conditions examiner determined the Veteran's ilio-inguinal nerve on the right side was normal. The examiner reported the Veteran's left ilio-inguinal neuritis disability was manifested by moderate, incomplete paralysis. See November 2021, VA Peripheral Nerve Conditions examination, pg. 8. The Board has also considered the Veteran's report of bilateral inguinal pain, perineal and testicular pain that is severe and constant, reflected on medical history in varied forms in the Veteran's DBQ's. See, e.g., April 1, 2016 Peripheral Nerve Conditions Examination, pgs. 1-2. The Board notes the Veteran is competent to describe symptoms associated with his ilio-inguinal nerve pain. See Layno, 6 Vet. App. at 469. Moreover, his statements describing bilateral inguinal pain are credible to the extent of the Veteran's sincere belief that his symptoms are more severe than the current rating for the period on appeal. In this regard, the Board finds probative the Veteran's statements that he experiences continuous pain, with intermittent worsening, describing the severity of his pain as 7/10 at best, 10/10 at worse and 4/10 on average. See July 1, 2014 private treatment record; See also January 2021 Board Hearing transcript pgs. 3-5. Additionally, the Board credits both the Veteran's and his physician's statement that the Veteran has had numerous procedures in an attempt to alleviate his pain over time, without success. See April 1, 2016 Peripheral Nerve Conditions DBQ, pg.1; See also, February 18, 2021 Peripheral Nerve Conditions DBQ, pg. 8 re: spinal cord stimulator and intrathecal pain pump. Resolving reasonable doubt in favor of the Veteran, with particular consideration given to the probative April 2016 and February 2021 Disability Benefit Questionnaires submitted by the Veteran, taken together with VA Peripheral and Nerve Condition examinations, which at varying points, depicted the Veteran's left and right ilioinguinal neuritis disability as manifested by severe, incomplete paralysisthe Board finds that for the entire period on appeal, the Veteran's right and left side ilioinguinal neuritis disability has been manifested by pain that approximates severe partial paralysis of the ilio-inguinal nerve. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the Veteran. 38 C.F.R. § 4.3. As such, the criteria for a 10 percent disability rating, but no higher, under DC 8530 for the entire rating period on appeal is warranted for the Veteran's right and left ilio-inguinal nerve disability with radiation of pain to groin, pelvis, hips, thighs, neck, shoulder, chest and ribs. 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a. The Board notes a 10 percent rating is the maximum rating allowable under DC 8530. As such, the Board finds the evidence is persuasively against the claim for a rating in excess of 10 percent for a right and left ilio-inguinal neuritis disability under the schedular at any point during the appeal period. The benefit of the doubt doctrine, see 38U.S.C. §5107(b), is therefore not for application. Lynch v. McDonough, No. 2020-2067, 2021 U.S. App. LEXIS 37312 (Fed. Cir. Dec. 17, 2021). The Board has considered whether ratings are warranted for higher ratings by analogy through one or more other DCs that consider similar symptoms. To this point, the Board acknowledges the Veteran's contention that his left and right sciatic nerve, left and right radicular nerves have been affected by his vasectomy. See June 15, 2016, VA Form 9. However, the evidence of record is silent as to other signs or symptoms resulting from the Veteran's vasectomy that affect other nerves. 38 C.F.R. § 4.124a, DCs 8511, 8520-8730. Each VA examiner, including the Veteran's own physician identified the right and left side ilio-inguinal nerve as affected by the Veteran's vasectomy. See e.g., April 2016 Peripheral Nerve Conditions DBQ, pgs. 3-7; See also, November 2021, VA Peripheral Nerve Conditions examination, pgs. 6-8. As such, ratings are not warranted under DCs 8511, 8520-8730. REASONS FOR REMAND Entitlement to rating in excess of 10 percent for a right ilio-inguinal neuritis disability on an extraschedular basis is remanded. Entitlement to rating in excess of 10 percent for a left ilio-inguinal neuritis disability is on an extraschedular basis is remanded. As noted in the April 2016 Peripheral Nerve Conditions DBQ, the Veteran manifests symptoms of depression and insomnia associated with his right and left ilio-inguinal neuritis disability. See April 1, 2016, Peripheral Nerve Conditions DBQ, pg. 7 re: depression and insomnia. In the November 2021 VA Peripheral Nerve Conditions examination, the examiner reported that the Veteran's disability manifests symptoms of depression, anxiety and insomnia. The VA examiner indicated the Veteran has multifactorial chronic pain and depression which he reports, prevents him from working. See November 2021 Peripheral Nerve Condition pgs. 9-10 re: recommending psychiatric examination for depression, anxiety, insomnia disorder. Neither sleep impairment, depression or anxiety are specifically contemplated under the Schedular for Diseases of the Peripheral Nerves. On remand, the AOJ should consider whether a higher rating may be in order for such manifestations, either as secondary to the right and left ilio-inguinal neuritis disability or on an extraschedular basis. Accordingly, this matter is REMANDED for the following action: 1. Obtain all outstanding treatment medical records, private and VA, and associate them with the claims file. 2. Thereafter, conduct any further development deemed necessary, to potentially include the provision of an additional VA examinations, to determine whether a higher extraschedular rating and/or additional separate evaluations are warranted for the Veteran's depression, anxiety or insomnia due to his service-connected right side and left side ilio-inguinal neuritis disability. Then refer the service-connected right and left side ilio-inguinal neuritis disability claims to the VA's Director of Compensation Service for extraschedular consideration. 3. If the claims are not granted to the Veteran's satisfaction, the AOJ should issue a Supplemental Statement of the Case and afford the Veteran and his representative an opportunity to respond before returning the appeal to the Board for further appellate review, if in order. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Little, 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.