Citation Nr: 25013255 Decision Date: 10/23/25 Archive Date: 10/23/25 DOCKET NO. 18-55 289 DATE: October 23, 2025 ORDER Entitlement to a disability rating in excess of 20 percent for right upper extremity peripheral neuropathy prior to May 18, 2023, and in excess of 40 percent thereafter, is denied. Entitlement to a disability rating in excess of 20 percent for left upper extremity peripheral neuropathy prior to May 18, 2023, and in excess of 30 percent thereafter, is denied. Prior to September 18, 2023, a disability rating in excess of 20 percent for right lower extremity peripheral neuropathy of the sciatic nerve is denied. From September 18, 2023, a disability rating of 40 percent, but no higher, for right lower extremity peripheral neuropathy of the sciatic nerve is granted. Entitlement to a disability rating in excess of 20 percent for right lower extremity peripheral neuropathy of the femoral nerve is denied. Prior to September 18, 2023, a disability rating in excess of 20 percent for left lower extremity peripheral neuropathy of the sciatic nerve is denied. From September 18, 2023, a disability rating of 40 percent, but no higher, for left lower extremity peripheral neuropathy of the sciatic nerve is granted. Entitlement to a disability rating in excess of 20 percent for left lower extremity peripheral neuropathy of the femoral nerve is denied. FINDINGS OF FACT 1. Prior to May 18, 2023, the Veteran's right and left upper extremity peripheral neuropathy was not manifest by moderate incomplete paralysis. 2. From May 18, 2023, the Veteran's right and left upper extremity peripheral neuropathy was not manifest by severe incomplete paralysis. 3. Prior to September 18, 2023, the Veteran's right and left lower extremity peripheral neuropathy of the sciatic nerve was not manifest by moderately severe incomplete paralysis. 4. From September 18, 2023, the Veteran's right and left lower extremity peripheral neuropathy of the sciatic nerve was manifest by moderately severe incomplete paralysis. 5. Throughout the appeal period, the Veteran's right and left lower extremity peripheral neuropathy of the femoral nerve was not manifest by severe incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 20 percent for right upper extremity peripheral neuropathy prior to May 18, 2023, and in excess of 40 percent thereafter, have not been met. 38 U.S.C. § 1101, 1155, 5107; 38 C.F.R. § 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Codes 8599-8515, 8513. 2. The criteria for a disability rating in excess of 20 percent for left upper extremity peripheral neuropathy prior to May 18, 2023, and in excess of 30 percent thereafter, have not been met. 38 U.S.C. § 1101, 1155, 5107; 38 C.F.R. § 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Codes 8599-8515, 8513. 3. Prior to September 18, 2023, the criteria for a disability rating in excess of 20 percent for right lower extremity peripheral neuropathy of the sciatic nerve have not been met. 38 U.S.C. § 1101, 1155, 5107; 38 C.F.R. § 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8520. 4. From September 18, 2023, the criteria for a disability rating of 40 percent, but no higher, for right lower extremity peripheral neuropathy of the sciatic nerve have been met. 38 U.S.C. § 1101, 1155, 5107; 38 C.F.R. § 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8520. 5. Prior to September 18, 2023, the criteria for a disability rating in excess of 20 percent for left lower extremity peripheral neuropathy of the sciatic nerve have not been met. 38 U.S.C. § 1101, 1155, 5107; 38 C.F.R. § 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8520. 6. From September 18, 2023, the criteria for a disability rating of 40 percent, but no higher, for left lower extremity peripheral neuropathy of the sciatic nerve have been met. 38 U.S.C. § 1101, 1155, 5107; 38 C.F.R. § 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8520. 7. The criteria for a disability rating in excess of 20 percent for right lower extremity peripheral neuropathy of the femoral nerve have not been met. 38 U.S.C. § 1101, 1155, 5107; 38 C.F.R. § 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8626. 8. The criteria for a disability rating in excess of 20 percent for left lower extremity peripheral neuropathy of the femoral nerve have not been met. 38 U.S.C. § 1101, 1155, 5107; 38 C.F.R. § 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8626. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1968 to May 1970. These matters come to the Board of Veterans' Appeals (Board) on appeal from a December 2016 rating decision. In January 2022, the Veteran testified before the undersigned Veterans Law Judge at a Board hearing. A copy of the transcript is of record. In an April 2023 decision, the Board denied ratings in excess of 20 percent each for right and left upper extremity peripheral neuropathy and right and left lower extremity peripheral neuropathy of the sciatic and femoral nerves. The Veteran appealed to the U.S. Court of Appeals for Veterans Claims (Court). Pursuant to an April 2024 order, the Court granted the parties' Joint Motion for Partial Remand (Motion), vacated the April 2023 Board decision as to these issues, and remanded the issues for further proceedings consistent with the Motion. In an October 2023 rating decision, VA granted increased 40 and 30 percent disability ratings for right and left upper extremity peripheral neuropathy, respectively, effective May 18, 2023. As such, the Board has recharacterized the issues on appeal accordingly. In August 2024, and February 2025, the Board remanded the matters for further development. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in disability rating is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Within that context, VA must assess the level of disability from the date of initial application and determine whether the level of disability warrants the assignment of different disability ratings at different times over the life of the claim, a practice known as a "staged rating." See Fenderson v. West, 12 Vet. App. 119 (1999). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Generally, the Board has been directed to consider only those factors contained wholly in the rating criteria. See Massey v. Brown, 7 Vet. App. 204, 208 (1994); but see Mauerhan v. Principi, 16 Vet. App. 436 (2002) (finding it appropriate to consider factors outside the specific rating criteria in determining level of occupational and social impairment). The standard of proof to be applied in decisions on claims for veteran's benefits is set forth in 38 U.S.C. § 5107. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to a disability rating in excess of 20 percent for right upper extremity peripheral neuropathy prior to May 18, 2023, and in excess of 40 percent thereafter. 2. Entitlement to a disability rating in excess of 20 percent for left upper extremity peripheral neuropathy prior to May 18, 2023, and in excess of 30 percent thereafter. The Veteran seeks increased ratings for his right and left upper extremity peripheral neuropathy. Prior to May 18, 2023, the Veteran's right and left upper extremity peripheral neuropathy are rated at 20 percent each under 38 C.F.R. § 4.124a, DC 8599-8515. 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 rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. The provisions of 38 C.F.R. § 4.27 provide that unlisted disabilities requiring rating by analogy will be coded with the first two numbers of the schedule provisions for the most closely related body part and 99. Id. Here, the hyphenated diagnostic code indicates that an unlisted nerve disability (DC 8599) is rated under the criteria for paralysis of the median nerve (DC 8515). See 38 C.F.R. § 4.20. From May 18, 2023, the Veteran's right and left upper extremity peripheral neuropathy are rated at 40 percent and 30 percent, respectively, under DC 8513 based on mild, incomplete paralysis of all radicular groups, which includes the radial, medial and ulnar nerves. A note to the schedular criteria for rating peripheral nerve disabilities states that combined nerve injuries should be rated by reference to the major involvement, or if sufficient in extent, consider radicular group ratings. 38 C.F.R. § 4.124a. As pertinent here, that would require that the disability be rated under the code that affords the highest ratings for those three nerves. Paralysis of all radicular groups is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, DC 8513. Under these criteria, mild incomplete paralysis is rated as 20 percent disabling for both the major and minor extremity. Moderate incomplete paralysis is rated as 40 percent disabling for the major extremity and 30 percent for the minor extremity. Severe incomplete paralysis is rated as 70 percent disabling for the major extremity and 60 percent for the minor extremity. Complete paralysis is rated as 90 percent disabling for the major extremity and 80 percent for the minor extremity. 38 C.F.R. § 4.124a. Paralysis of the radial nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, DC 8514. Under these criteria, mild incomplete paralysis is rated as 20 percent disabling for both the major and minor extremity. Moderate incomplete paralysis is rated as 30 percent disabling for the major extremity and 20 percent for the minor extremity. Severe incomplete paralysis is rated as 50 percent disabling for the major extremity and 40 percent for the minor extremity. Complete paralysis is rated as 70 percent disabling for the major extremity and 60 percent for the minor extremity. 38 C.F.R. § 4.124a. Paralysis of the median nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, DC 8515. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling for both the major and minor extremity. Moderate incomplete paralysis is rated as 30 percent disabling for the major extremity and 20 percent for the minor extremity. Severe incomplete paralysis is rated as 50 percent disabling for the major extremity and 40 percent for the minor extremity. Complete paralysis is rated as 70 percent disabling for the major extremity and 60 percent for the minor extremity. 38 C.F.R. § 4.124a. Paralysis of the ulnar nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, DC 8516. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling for both the major and minor extremity. Moderate incomplete paralysis is rated as 30 percent disabling for the major extremity and 20 percent for the minor extremity. Severe incomplete paralysis is rated as 40 percent disabling for the major extremity and 30 percent for the minor extremity. Complete paralysis is rated as 60 percent disabling for the major extremity and 50 percent for the minor extremity. 38 C.F.R. § 4.124a. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. One possible source for such definitions would be the dictionary. Merriam-Webster's Dictionary (merriam-webster.com/dictionary), defines "mild," as relevant to a physical condition, as "not severe" or temperate; with "temperate" being defined as "keeping or held within limits" and "not extreme or excessive." "Moderate" is defined as "tending toward the mean or average amount," "not violent, severe, or intense," and "limited in scope or effect." Id. "Severe" is defined as "very painful or harmful" or "of a great degree." Id. The term "severe" is used throughout the rating schedule to indicate a very great degree of the specific listed disability, in order to differentiate between lesser (or sometimes greater) cases of that same disability within the specific diagnostic code. The use of such terminology by VA examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision that is "equitable and just." 38 C.F.R. §§ 4.2, 4.6. Regulations provide that ratings for peripheral neurological disorders are to be assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The Veteran filed his increased rating claim on June 28, 2016; therefore, the Board will consider the evidence of record from June 28, 2015, or one year prior to the date of his increased rating claim. Turning to the evidence of record, an October 2016 VA examination report reflects that the Veteran, who is right-handed, reported his peripheral neuropathy was treated with gabapentin with partial relief of symptoms. He reported his symptoms were worse in his lower extremities than his upper extremities. On examination, there was mild paresthesias and/or dysesthesias and numbness in the upper extremities bilaterally. Muscle strength, deep tendon reflexes, position sense, and vibration sensation were normal. Light touch/monofilament testing was decreased only in the hand/fingers. Cold sensation was decreased. There was no muscle atrophy. The examiner noted trophic changes, specifically, hair loss. The examiner diagnosed mild, incomplete paralysis in the radial, median, and ulnar nerves bilaterally. A September 2022 VA examination report reflects the Veteran denied worsening of his condition. He reported his symptoms were worse in his lower extremities than his upper extremities. On examination, there was mild intermittent pain, paresthesias and/or dysesthesias and numbness in the upper extremities bilaterally. Muscle strength, deep tendon reflexes, position sense, and vibration sensation were normal. Light touch/monofilament testing was decreased only in the hand/fingers. Cold sensation was decreased. There was no muscle atrophy or trophic changes. The examiner diagnosed mild, incomplete paralysis in the radial, median, and ulnar nerves bilaterally. A September 2023 VA examination report reflects the Veteran reported use of gabapentin to treat his worsening peripheral neuropathy with numbness, tingling, and pain. On examination, there was moderate constant pain, paresthesias and/or dysesthesias, and numbness in the upper extremities. Muscle strength, deep tendon reflexes, position sense, and vibration sensation were normal. Light touch/monofilament testing was decreased only in the hand/fingers. Cold sensation was decreased. There was no muscle atrophy. The examiner noted trophic changes, specifically, loss of hair. The examiner diagnosed moderate, incomplete paralysis in the radial, median, and ulnar nerves bilaterally. A February 2025 VA examination report reflects the Veteran reported worsening numbness and tingling. On examination, there was moderate constant pain and severe intermittent pain, paresthesias and/or dysesthesias, and numbness. Muscle strength was reduced to 4/5 in the wrists, hands, and fingers. Deep tendon reflexes were normal. Light touch/monofilament testing was decreased in the shoulders, inner/outer forearm, and hand/fingers. Position sense, vibration sensation, and cold sensation were decreased. There was no muscle atrophy or trophic changes. The examiner diagnosed moderate, incomplete paralysis in the radial and median nerves bilaterally. The examiner noted that while veteran's reported symptoms were severe, but the objective findings were assessed and recorded as moderate. In an August 2025 addendum opinion, the February 2025 examiner indicated that the examination excluded the ameliorative effects of medication. However, it was not possible to provide an accurate or medically sound retrospective opinion without speculation as to the severity of the Veteran's disability in the absence of the ameliorative effects of medication prior to the February 2025 examination, as there was no way to establish a baseline or foundation for comparison. Upon review of the evidence of record, including that not specifically discussed above, the Board finds that prior to September 18, 2023, disability ratings in excess of 20 percent each are not warranted for the Veteran's right and left upper extremity peripheral neuropathy. The Veteran experienced mild intermittent pain, paresthesias/dysesthesias, and numbness, decreased light touch/monofilament testing in the hands/fingers, decreased cold sensation, and varying hair loss, symptoms contemplated by a level of impairment that is most analogous to mild incomplete paralysis. The Board notes that this finding is consistent with the VA examinations of record also describing the Veteran's right and left upper extremity peripheral neuropathy as mild. The Board acknowledges that any pain the Veteran experienced due to his peripheral neuropathy may have been ameliorated by his use of gabapentin. However, the Veteran's remaining symptoms and overall disability picture are not more nearly approximated by moderate incomplete paralysis. Specifically, there was no reduction in muscle strength or decreased deep tendon reflexes, light touch to his shoulders or arms, position sense, or vibration sensation. The Board has considered whether a higher rating is warranted under the individual DCs for the radial, median, or ulnar nerves. However, the highest rating possible for mild, incomplete paralysis of the radial, median, or ulnar nerves is 20 percent. Therefore, a separate or higher rating under a different diagnostic code is not warranted. From September 18, 2023, the date of the September 2023 VA examination and when a factually ascertainable increase in the Veteran's disability occurred, the Board finds that disability ratings in excess of 40 and 30 percent each, respectively, are not warranted for the Veteran's right and left upper extremity peripheral neuropathy. The Veteran experienced at most, moderate constant pain, severe intermittent pain, severe paresthesias/dysesthesias, severe numbness, decreased muscle strength in the wrists, hands, and fingers, decreased light touch in the shoulders, arms, and hands, decreased position sense, decreased vibration sensation, decreased cold sensation, and varying hair loss, symptoms contemplated by a level of impairment that is most analogous to moderate incomplete paralysis. The Board notes that this finding is consistent with the VA examinations of record also describing the Veteran's right and left upper extremity peripheral neuropathy as moderate. From September 18, 2023, the Veteran's symptoms and overall disability picture are not more nearly approximated by severe incomplete paralysis as there was no absence of muscle strength, deep tendon reflexes, or sensation, muscle atrophy, or more significant trophic changes. Furthermore, there was no loss of, or severe interference with, movement to warrant a rating based on complete paralysis. The Board has considered whether a higher rating is warranted under the individual DCs for the radial, median, or ulnar nerves. However, the highest rating possible for moderate, incomplete paralysis of the radial, median, or ulnar nerves is 40 percent for the major side and 30 percent for the minor side. Therefore, a separate or higher rating under a different diagnostic is not warranted. As to the effective date for the ratings of 30 percent and 20 percent for right and left upper extremity peripheral neuropathy, the Board notes that the VA granted an effective date of May 18, 2023, and the Board will not disturb this favorable finding. In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a disability rating in excess of 20 percent each for right and left upper extremity peripheral neuropathy prior to May 18, 2023, and in excess of 40 and 30 percent each, respectively, from May 18, 2023. As the evidence of record persuasively weighs against the claims, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. The Veteran's claims are denied. 3. Entitlement to a disability rating in excess of 20 percent for right lower extremity peripheral neuropathy of the sciatic nerve. 4. Entitlement to a disability rating in excess of 20 percent for right lower extremity peripheral neuropathy of the femoral nerve. 5. Entitlement to a disability rating in excess of 20 percent for left lower extremity peripheral neuropathy of the sciatic nerve. 6. Entitlement to a disability rating in excess of 20 percent for left lower extremity peripheral neuropathy of the femoral nerve. The Veteran seeks increased ratings for his right and left lower extremity peripheral neuropathy. The Veteran's right and left lower extremity peripheral neuropathy are rated at 20 percent each under 38 C.F.R. § 4.124a, DC 8520, for the sciatic nerve, and at 20 percent each under DC 8626, for the femoral nerve. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, DC 8520. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy, is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. Paralysis of the femoral nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, DC 8626. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Severe incomplete paralysis is rated as 30 percent disabling. Complete paralysis of the quadriceps extensor muscles is rated as 40 percent disabling. 38 C.F.R. § 4.124a. The Veterans Benefits Administration (VBA) has determined that there are 5 separate nerve branches in the lower extremities that may be separately rated. M21-1, V.iii.12.A.2.e (last accessed October 20, 2025). According to VBA, the sciatic nerve, the external popliteal nerve, the musculocutaneous nerve, the anterior tibial nerve, the internal popliteal nerve, and the posterior tibial nerve are all part of the sciatic nerve branch and affect the foot and leg sensory and motor function of the buttock, leg, knee, muscles below knee, lower leg, fibula, foot, muscles of the sole of the feet, plantar flexion, and toes. The anterior crural nerve and internal saphenous nerve are part of the femoral nerve branch and affect the thigh and leg sensory and motor function of the quadriceps much, medial calf, and medial malleolus. The obturator, external cutaneous nerve of the thigh, and ilio-inguinal nerves are each their own nerve branch. Assigning separate ratings from within these nerve branches is not warranted as it would constitute impermissible pyramiding. M21-1, III.iv.4.N.4.f. In Overton v. Wilkie, 30 Vet. App. 257, 264 (2018), the Court of Appeals for Veterans Claims held that the Board is required to discuss any relevant provisions contained in the M21 as part of its duty to provide adequate reasons or bases, but because it is not bound by those provisions, it must make its own determination before it chooses to rely on an M21 provision as a factor to support its decision. The Board notes that there is no binding authority on how to apply separate ratings for the various peripheral nerves in the lower extremities. In other words, there is no instruction on when different nerves can be assigned separate ratings without running afoul of the rule against pyramiding. This rule states that the evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. 38 C.F.R. § 4.14. When determining whether separate ratings are applicable, the critical element is that none of the symptomatology for any condition is duplicative of or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261 (1994). In this regard, the Board finds the M21 particularly insightful and instructive when determining whether separate ratings are warranted and for which nerves. The M21 shows that the lower extremities have five nerve branches, and each nerve branch affects different muscles/joints. Thus, to the extent a veteran experiences peripheral neuropathy within the same nerve branch, the Board must be careful not to grant separate ratings where, although multiple nerves are involved, the same symptoms occur. The Veteran filed his increased rating claim on June 28, 2016; therefore, the Board will consider the evidence of record from June 28, 2015, or one year prior to the date of his increased rating claim. Turning to the evidence of record, an October 2016 VA examination report reflects that the Veteran reported his peripheral neuropathy was treated with gabapentin with partial relief of symptoms. He reported his symptoms were worse in his lower extremities than his upper extremities. On examination, there was moderate paresthesias and/or dysesthesias and numbness in the lower extremities bilaterally. Muscle strength, deep tendon reflexes, and position sense were normal. Light touch/monofilament testing was decreased only in the feet/toes. Vibration and cold sensation were decreased. There was no muscle atrophy. The examiner noted trophic changes, specifically, hair loss. The examiner diagnosed moderate, incomplete paralysis in the sciatic and femoral nerves bilaterally. VA treatment records prior to November 2018 reflect that the Veteran had decreased protective sensation in his feet. Treatment records from November 2018 reflect the Veteran has an absence of sensation in his feet. The Veteran is prescribed diabetic footwear. A September 2022 VA examination report reflects that the Veteran denied worsening of his condition. On examination, bilaterally, there was mild intermittent pain, moderate paresthesias and/or dysesthesias, and mild numbness in the lower extremities. Muscle strength, deep tendon reflexes, and position sense were normal. Light touch/monofilament testing was decreased only in the feet/toes. Vibration and cold sensation were decreased. There was no muscle atrophy or trophic changes. The examiner diagnosed mild, incomplete paralysis in the sciatic and femoral nerves bilaterally. A September 2023 VA examination report reflects the Veteran reported worsening of his peripheral neuropathy with numbness, tingling, and pain. On examination, there was moderate constant pain, paresthesias and/or dysesthesias, and numbness in the lower extremities bilaterally. Muscle strength, deep tendon reflexes, and position sense were normal. Light touch/monofilament testing was decreased only in the ankle/lower leg and feet/toes. Vibration and cold sensation were decreased. There was no muscle atrophy. The examiner noted trophic changes, specifically, loss of hair. The examiner diagnosed moderate, incomplete paralysis in the sciatic and femoral nerves bilaterally. A February 2025 VA examination report reflects the Veteran reported worsening numbness and tingling. On examination, there was moderate constant pain and severe intermittent pain, paresthesias and/or dysesthesias, and numbness. Muscle strength was reduced to 4/5 in knees and ankles. Deep tendon reflexes were normal. Light touch/monofilament testing was decreased in the knees, ankle, and feet. Position sense, vibration sensation, and cold sensation were decreased. There was no muscle atrophy or trophic changes. The examiner diagnosed moderate, incomplete paralysis in the sciatic and femoral nerves bilaterally. The examiner noted that while Veteran's reported symptoms were severe, the objective findings were assessed and recorded as moderate. In an August 2025 addendum opinion, the February 2025 examiner indicated that the examination excluded the ameliorative effects of medication. However, it was not possible to provide an accurate or medically sound retrospective opinion without speculation as to the severity of the Veteran's disability in the absence of the ameliorative effects of medication prior to the February 2025 examination, as there was no way to establish a baseline or foundation for comparison. Upon review of the evidence of record, including that not specifically discussed above, the Board finds that prior to September 18, 2023, disability ratings in excess of 20 percent each are not warranted for the Veteran's right and left lower extremity peripheral neuropathy of the sciatic and femoral nerves. The Veteran experienced mild intermittent pain, moderate paresthesias/dysesthesias and numbness, decreased light touch/monofilament in the feet/toes, decreased vibration and cold sensation, and varying hair loss, symptoms contemplated by a level of impairment that is most analogous to moderate incomplete paralysis. The Board notes that this finding is consistent with the VA examinations of record also describing the Veteran's right and left upper extremity peripheral neuropathy as, at most, moderate. The Board acknowledges that any pain the Veteran experienced due to his peripheral neuropathy may have been ameliorated by his use of gabapentin. However, the Veteran's remaining symptoms and overall disability picture are not more nearly approximated by moderate incomplete paralysis. Specifically, there was no reduction in muscle strength or decreased deep tendon reflexes, light touch to his thighs or knees, or position sense. From September 18, 2023, the date of the September 2023 VA examination and when a factually ascertainable increase in the Veteran's disability occurred, the Board finds that a disability rating of 40 percent, but no higher, is warranted for bilateral lower extremity peripheral neuropathy of the sciatic nerve only. The Veteran experienced, at most, moderate constant pain, severe intermittent pain, severe paresthesias/dysesthesias, severe numbness, reduced muscle strength of 4/5 in the knees and ankles, decreased light touch/monofilament in the knees, ankles, and feet, decreased position sense, decreased vibration sensation, decreased cold sensation, and varying hair loss, symptoms contemplated by a level of impairment that is most analogous to moderately severe incomplete paralysis of the sciatic nerve. From September 18, 2023, the Veteran's symptoms and overall disability picture are not more nearly approximated by severe incomplete paralysis of the sciatic or femoral nerves as there were not more significant reductions in muscle strength, any muscle atrophy, decreased deep tendon reflexes, or more significant trophic changes. Furthermore, there was no loss of, or severe interference with, movement to warrant a rating based on complete paralysis. As such, ratings based on severe incomplete paralysis are not warranted for the sciatic or femoral nerves. In sum, affording the Veteran the benefit of the doubt, the Board finds that disability ratings of 40 percent each for moderately severe right and left lower extremity peripheral neuropathy of the sciatic nerve is warranted from September 18, 2023. To the extent the Veteran argues disability ratings in excess of 20 percent each for moderate right and left lower extremity peripheral neuropathy of the sciatic and femoral nerves prior to September 18, 2023, or in excess of 40 percent each for moderately severe right and left lower extremity peripheral neuropathy of the sciatic nerve, or in excess of 20 percent each for moderate right and left lower extremity peripheral neuropathy of the femoral nerve thereafter is warranted, the evidence of record persuasively weighs against the claims and the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. The Veteran's claims are denied. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Owen, Stephanie 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.