PARALYSIS OF RADIAL NERVE

Summary

The veteran, who served in the U.S. Marine Corps from June 1965 to April 1969, appeals the denial of increased disability ratings for bilateral upper and lower extremity peripheral neuropathies affecting the radial, sciatic, and femoral nerves. The veteran also appeals the denial of special monthly compensation (SMC) based on loss of use of extremities. The Board reviewed the veteran's claims in light of the Appeals Modernization Act, noting that the appeal was filed under the Direct Review docket. The Board considered multiple VA examinations conducted between September 2024 and January 2026, which documented varying degrees of incomplete paralysis, sensory deficits, and trophic changes in the veteran's extremities. The veteran's lay statements and his spouse's statement described balance issues, falls, and the need for assistance with daily activities and ambulation. However, the Board found that the objective medical evidence, particularly the VA examiner's findings, did not support ratings higher than those already assigned for mild to severe incomplete paralysis. The Board concluded that the veteran's functional loss was not so diminished as to be equally served by amputation with prosthesis, thus denying the SMC claim. The Board found the medical evidence more probative than the lay evidence regarding the severity of the veteran's functional loss.

Rationale

Objective evidence consistently showed mild incomplete paralysis prior to Oct 29, 2025.; Objective evidence consistently showed severe incomplete paralysis from Oct 29, 2025.; These levels did not warrant higher ratings.

Full Decision Text

Citation Nr: A26038717
Decision Date: 04/24/26	Archive Date: 04/24/26

DOCKET NO. 260306-635433
DATE: April 24, 2026

ORDER

1. Entitlement to an initial evaluation in excess of 20 percent for right upper extremity peripheral neuropathy of the radial nerve prior to October 29, 2025, and in excess of 50 percent thereafter is denied.

2. Entitlement to an initial evaluation in excess of 20 percent for left upper extremity peripheral neuropathy of the radial nerve prior to October 29, 2025, and in excess of 40 percent thereafter is denied.

3. Entitlement to an evaluation in excess of 20 percent for right lower extremity peripheral neuropathy of the sciatic nerve prior to October 29, 2025, and in excess of 40 percent thereafter is denied.

4. Entitlement to an evaluation in excess of 20 percent for left lower extremity peripheral neuropathy of the sciatic nerve prior to October 29, 2025, and in excess of 40 percent thereafter is denied.

5. Entitlement to an initial evaluation in excess of 10 percent for left lower extremity peripheral neuropathy of the femoral nerve prior to October 29, 2025, and in excess of 30 percent thereafter is denied.

6. Entitlement to an initial evaluation in excess of 10 percent for right lower extremity peripheral neuropathy of the femoral nerve prior to October 29, 2025, and in excess of 30 percent thereafter is denied.

7. Entitlement to special monthly compensation (SMC) based on loss of use of the hands and feet is denied.

FINDINGS OF FACT

1. Prior to October 29, 2025, the Veteran's right upper extremity peripheral neuropathy of the radial nerve is manifested by no more than mild incomplete paralysis of the major extremity.

2. From October 29, 2025, the Veteran's right upper extremity peripheral neuropathy of the radial nerve is manifested by no more than severe incomplete paralysis of the major extremity.

3. Prior to October 29, 2025, the Veteran's left upper extremity peripheral neuropathy of the radial nerve is manifested by no more than mild incomplete paralysis of the minor extremity.

4. From October 29, 2025, the Veteran's left upper extremity peripheral neuropathy of the radial nerve is manifested by no more than severe incomplete paralysis of the minor extremity.

5. Prior to October 29, 2025, the Veteran's right lower extremity peripheral neuropathy of the sciatic nerve is manifested by no more than moderate incomplete paralysis.

6. From October 29, 2025, the Veteran's right lower extremity peripheral neuropathy of the sciatic nerve is manifested by no more than moderately severe incomplete paralysis.

7. Prior to October 29, 2025, the Veteran's left lower extremity peripheral neuropathy of the sciatic nerve is manifested by no more than moderate incomplete paralysis.

8. From October 29, 2025, the Veteran's left lower extremity peripheral neuropathy of the sciatic nerve is manifested by no more than moderately severe incomplete paralysis.

9. Prior to October 29, 2025, the Veteran's left lower extremity peripheral neuropathy of the femoral nerve is manifested by no more than mild incomplete paralysis.

10. From October 29, 2025, the Veteran's left lower extremity peripheral neuropathy of the femoral nerve is manifested by no more than severe incomplete paralysis.

11. Prior to October 29, 2025, the Veteran's right lower extremity peripheral neuropathy of the femoral nerve is manifested by no more than mild incomplete paralysis.

12. From October 29, 2025, the Veteran's right lower extremity peripheral neuropathy of the femoral nerve is manifested by no more than severe incomplete paralysis.

13. The competent and credible evidence of record persuasively establishes a finding that the functioning of upper and lower extremities is not so diminished that amputation with prosthesis would equally serve the Veteran.

CONCLUSIONS OF LAW

1. The criteria for an initial evaluation in excess of 20 percent for right upper extremity peripheral neuropathy of the radial nerve prior to October 29, 2025, and in excess of 50 percent thereafter, have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code (DC) 8514.

2. The criteria for an initial evaluation in excess of 20 percent for left upper extremity peripheral neuropathy of the radial nerve prior to October 29,
 diminished that amputation with prosthesis would equally serve the Veteran.

CONCLUSIONS OF LAW

1. The criteria for an initial evaluation in excess of 20 percent for right upper extremity peripheral neuropathy of the radial nerve prior to October 29, 2025, and in excess of 50 percent thereafter, have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code (DC) 8514.

2. The criteria for an initial evaluation in excess of 20 percent for left upper extremity peripheral neuropathy of the radial nerve prior to October 29, 2025, and in excess of 40 percent thereafter, have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8514.

3. The criteria for an evaluation in excess of 20 percent for right lower extremity peripheral neuropathy of the sciatic nerve prior to October 29, 2025, and in excess of 40 percent thereafter, have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520.

4. The criteria for an evaluation in excess of 20 percent for left lower extremity peripheral neuropathy of the sciatic nerve prior to October 29, 2025, and in excess of 40 percent thereafter, have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520.

5. The criteria for an initial evaluation in excess of 10 percent for left lower extremity peripheral neuropathy of the femoral nerve prior to October 29, 2025, and in excess of 30 percent thereafter have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8526.

6. The criteria for an evaluation in excess of 10 percent for left lower extremity peripheral neuropathy of the femoral nerve prior to October 29, 2025, and in excess of 30 percent thereafter have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8526.

7. The criteria for entitlement to additional, separate SMC at the (k) rate for loss of use of both hands and both feet have not been met. 38 U.S.C. §§ 1114(k), 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.350, 4.14, 4.63.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the U.S. Marine Corps from June 1965 to April 1969.

The rating decision on appeal was issued in February 2026 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In December 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a December 2025 decision.  In a January 2026 rating decision, the agency of original jurisdiction (AOJ) identified a duty to assist error during its Higher-Level Review and returned the claim to the supplemental claim process for further development; namely, to obtain a VA examination.  After completing development, the AOJ issued the February 2026 rating decision on appeal and denied the claim for increased ratings.

In the March 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the February 2026 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could
 the AOJ issued the February 2026 rating decision on appeal and denied the claim for increased ratings.

In the March 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the February 2026 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

As an initial matter, the Board notes that it is cognizant of the recent decision issued by the United States Court of Appeals for Veterans Claims (Court) in the case of Williams v. McDonough, 37 Vet. App. 305 (2024). There, the Court held, in essence, that the Board must refrain from deciding a case until the case proceeds to the point where a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2). In the present case, in a March 2026 submission along with his VA Form 10182, the Veteran, through his representative, waived his right to switch to a different Board docket and requested the Board to issue a decision as soon as possible. As such, the Board may proceed with adjudication of the Veteran's appeal without further delay.

Increased Ratings

Disability evaluations are determined by evaluating the extent to which a veteran's service connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Schedule). 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify various disabilities and the criteria for specific ratings. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. §§ 4.7, 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002).

If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran. 38 C.F.R. § 4.3.

Evidence to be considered in the appeal of an initial assignment of a disability rating is not limited to that reflecting the then-current severity of the disorder. Fenderson v. West, 12 Vet. App. 119 (1999). In cases where an initially assigned disability evaluation has been disagreed with, it is possible for a veteran to receive a staged rating. That is, it is possible to be awarded separate percentage evaluations for separate periods, based on the facts found during the appeal period. Id. at 126-28; see also Hart v. Mansfield, 21 Vet. App. 505 (2007) (in determining the present level of a disability for any increased evaluation claim, the Board must consider staged ratings).

However, the increase in disability must have occurred during the one-year period prior to the date of the Veteran's claim in order to receive the benefit of an earlier effective date. Gaston v. Shinseki, 605 F.3d 979 (Fed. Cir. 2010). The purpose of this provision was to provide a one-year grace period for filing a claim following any increase in severity of a service-connected disability. Id.

1. Entitlement to an initial evaluation in excess of 20 percent for right upper extremity peripheral neuropathy prior to October 29, 2025, and in excess of 50 percent thereafter.

2. Entitlement to an initial evaluation in excess of 20 percent for left upper extremity peripheral neuropathy prior to October 29, 2025, and in excess of 40 percent thereafter.

3. Entitlement
 receive the benefit of an earlier effective date. Gaston v. Shinseki, 605 F.3d 979 (Fed. Cir. 2010). The purpose of this provision was to provide a one-year grace period for filing a claim following any increase in severity of a service-connected disability. Id.

1. Entitlement to an initial evaluation in excess of 20 percent for right upper extremity peripheral neuropathy prior to October 29, 2025, and in excess of 50 percent thereafter.

2. Entitlement to an initial evaluation in excess of 20 percent for left upper extremity peripheral neuropathy prior to October 29, 2025, and in excess of 40 percent thereafter.

3. Entitlement to an evaluation in excess of 20 percent for right lower extremity sciatica prior to October 29, 2025, and in excess of 40 percent thereafter.

4. Entitlement to an evaluation in excess of 20 percent for left lower extremity sciatica prior to October 29, 2025, and in excess of 40 percent thereafter.

5. Entitlement to an initial evaluation in excess of 10 percent for left lower extremity peripheral neuropathy of the femoral nerve prior to October 29, 2025, and in excess of 30 percent thereafter.

6. Entitlement to an initial evaluation in excess of 10 percent for right lower extremity peripheral neuropathy of the femoral nerve prior to October 29, 2025, and in excess of 30 percent thereafter.

The Veteran has been variously rated for bilateral upper and lower extremity peripheral neuropathies of the bilateral radial, sciatic, and femoral nerves, pursuant to 38 C.F.R. §4.124a, Diagnostic Codes 8514, 8520, and 8526.

Historically, a December 2024 rating decision granted separate increased evaluations to 20 percent for bilateral lower extremity sciatic nerve effective August 27, 2024.  In the same decision, the AOJ granted service connection for peripheral neuropathy of the bilateral upper extremity radial nerve and assigned separate 20 percent initial evaluations effective August 27, 2024.  Further, the AOJ granted service connect for peripheral neuropathy of the bilateral lower extremity femoral nerve and assigned separate 10 percent initial evaluations effective August 27, 2024.

In a December 2025 rating decision, the AOJ granted increased evaluations for peripheral neuropathy of the radial nerve of the right upper extremity to 50 percent and of the left upper extremity to 40 percent effective October 29, 2025.  Additionally, the AOJ granted increased separate evaluations for peripheral neuropathy of the sciatic nerve of the bilateral lower extremities to 40 percent.  Also, the AOJ granted increased separate evaluations for peripheral neuropathy of the femoral nerve of the bilateral lower extremities to 30 percent.

In the February 2026 rating decision on appeal, the AOJ confirmed and continued the increased evaluations and effective dates as discussed above.  The Veteran contends that he is entitled to higher evaluations across all nerve groups for the entire period on appeal.

DC 8514 contemplates complete and incomplete paralysis of the radial nerve. A 30 percent evaluation is assigned for moderate incomplete paralysis. A 50 percent evaluation is assigned for severe incomplete paralysis. A 70 percent evaluation is assigned for complete paralysis characterized by drop of hand and fingers, wrist and fingers perpetually flexed, the thumb adducted falling within the line of the outer border of the index finger; cannot extend hand at wrist, extend proximal phalanges of fingers, extend thumb , or make lateral movement of wrist; supination of hand, extension and flexion of elbow weakened, the loss of synergic motion of extensors impairs the hand grip seriously; total paralysis of the triceps occurs only as the greatest rarity. See 38 C.F.R. § 4.124a, DC 8514.

Under DC 8520, a 10 percent rating is warranted for mild incomplete paralysis of the sciatic nerve; a 20 percent rating is assigned for moderate incomplete paralysis of the sciatic nerve; a 40 percent rating is assigned for moderately severe incomplete paralysis; a 60 percent rating is assigned for severe incomplete paralysis, with marked muscular atrophy; and a maximum 80 percent rating is assigned for complete paralysis of the sciatic nerve; the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. See 38 C.F.R. § 4.124a, DC 8520.

Under DC 8526, a 20 percent rating is warranted for moderate incomplete paralysis of this nerve, and a 30 percent rating is warranted for severe incomplete paralysis of the sciatic nerve, and a
 is assigned for moderate incomplete paralysis of the sciatic nerve; a 40 percent rating is assigned for moderately severe incomplete paralysis; a 60 percent rating is assigned for severe incomplete paralysis, with marked muscular atrophy; and a maximum 80 percent rating is assigned for complete paralysis of the sciatic nerve; the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. See 38 C.F.R. § 4.124a, DC 8520.

Under DC 8526, a 20 percent rating is warranted for moderate incomplete paralysis of this nerve, and a 30 percent rating is warranted for severe incomplete paralysis of the sciatic nerve, and a 40 percent rating is warranted for complete paralysis of this nerve, with paralysis of the quadriceps extensor muscles.

The term "incomplete paralysis" indicates a degree of lost or impaired function less than the type picture for complete paralysis given with each nerve. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree.

In rating peripheral nerve disability, neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. The maximum rating to be assigned for neuritis not characterized by organic changes referred to in this section will be for moderate incomplete paralysis. 38 C.F.R. § 4.123.

The code does not define "marked." Merriam-Webster's Collegiate Dictionary, 760 (11th Ed. 2007), "marked" means "having a distinctive or emphasized character." 

The words "mild," "moderate" and "severe" are not defined in the Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Rather, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating.  38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6.

VA's Adjudication Procedures Manual (M21-1) provides benchmarks for mild, moderate, moderately severe, and severe peripheral nerve conditions. Although not bound by the M21-1, the Board must consider and address the standards provided in the M21-1 as part of its duty to provide a reasoned explanation for its decision; the M21-1 standards act as "relevant guidance promulgated" to facilitate "the efficient and proper resolution of claims." Healey v. McDonough, 33 Vet. App. 312, 321 (2021).

Per the M21-1, mild incomplete paralysis is assigned "for a disability limited to sensory deficits that are lower graded, less persistent, or affecting a small area." M21-1, V.iii.12.A.2.c. "A very minimal reflex or motor abnormality potentially could also be consistent with mild incomplete paralysis." Id.

Moderate incomplete paralysis encompasses symptoms that may affect a larger area in the nerve distribution and "will likely be described by the claimants and medically graded as significantly disabling." Id. Other sign or symptom combinations of moderate incomplete paralysis include "significant sensory changes and reflex or motor changes of a lower degree" as well as "motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate." Id.

For moderately severe incomplete paralysis, the M21-1 describes "[m]otor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a high level of limitation or disability." Id. The M21-1 notes that atrophy "may be present" but there is no "marked muscular atrophy." Id.

To be classified as severe incomplete paralysis, the evidence must show "a very high level of limitation or disability" due to "motor and/or reflex impairment (for example, atrophy, weakness, or diminished or hyperactive reflexes)." Id. The M21-1 indicates that "the disability picture for severe incomplete paralysis may contain signs/symptoms resembling some of those expected in cases of complete paralysis of the nerve," although they will be "substantially less than representative findings for complete impairment of the nerve." Id.

The Board acknowledges that the M21-1 guidance generally fails to give specific parameters or definitions, instead describing vague interrelated tiers: "sensory deficits that are lower graded, less persistent, or affecting a small area" (m
 classified as severe incomplete paralysis, the evidence must show "a very high level of limitation or disability" due to "motor and/or reflex impairment (for example, atrophy, weakness, or diminished or hyperactive reflexes)." Id. The M21-1 indicates that "the disability picture for severe incomplete paralysis may contain signs/symptoms resembling some of those expected in cases of complete paralysis of the nerve," although they will be "substantially less than representative findings for complete impairment of the nerve." Id.

The Board acknowledges that the M21-1 guidance generally fails to give specific parameters or definitions, instead describing vague interrelated tiers: "sensory deficits that are lower graded, less persistent, or affecting a small area" (mild); "significant" changes and a potentially larger area of nerve distribution affected (moderate); "a high level of limitation" due to "[m]otor and/or reflex impairment" (moderately severe); and "a very high level of limitation" due to "motor and/or reflex impairment" that remains "substantially less than" the criteria for complete paralysis. As such, the Board has also considered relevant dictionary definitions including as follows: "mild," as relevant to a physical condition, is defined as "not severe" or temperate, with "temperate" being defined as "keeping or held within limits" and "not extreme or excessive." Merriam-Webster's Dictionary (merriam-webster.com/dictionary, accessed January 27, 2026). It is similar to "slight," which is defined as "small of its kind or in amount." Id. "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, differentiating between lesser (or sometimes greater) cases of that same disability within that Code.

The term "incomplete paralysis" indicates a degree of lost or impaired function that is substantially less than the complete paralysis described with each nerve.  38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." This lesser degree of loss or impairment may be "due to varied level of the nerve lesion or to partial regeneration." Id. "When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree." Id. This establishes a maximum disability rating for conditions that are wholly sensory, not a minimum disability rating for conditions that are more than wholly sensory. Miller v. Shulkin, 28 Vet. App. 376, 377 (2017).

Finally, the M21-1 provides a table noting that there are five nerve branches in the lower extremities. Each branch has its separate and distinct functions. The sciatic branch includes the sciatic nerve, external popliteal nerve (common peroneal), musculocutaneous (superficial peroneal), anterior tibial nerve (deep peroneal), internal popliteal (tibial), and posterior tibial nerves. The femoral branch includes the anterior crural (femoral) and the internal saphenous nerves. The obturator, external cutaneous thigh, and ilio-inguinal nerve branches only include one nerve each. M21-1, V.iii.12.A.2.e.

Turning to the record, in September 2024, the Veteran was afforded a VA examination with respect to peripheral nerve conditions, not including diabetic sensory-motor peripheral neuropathy. The examiner noted that the Veteran did not have a diagnosis for a peripheral nerve condition or peripheral neuropathy. Rather, the examiner did not identify any evidence of neuropathy which was not the result of diabetic neuropathy.

In another September 2024 VA examination for diabetic sensory-motor peripheral neuropathy, a diagnosis of bilateral upper and lower extremity peripheral neuropathy was rendered. The Veteran reported that he was diagnosed with neuropathy shortly after being diagnosed with diabetes mellitus. Further, the Veteran reported that his most prominent symptom is numbness followed by tingling, with occasional lower extremity pain. The examiner noted that the Veteran is right hand dominant. The Veteran endorsed symptoms of mild intermittent pain at the bilateral lower extremities; mild paresthesias and/or dysesthesias at the bilateral upper extremities and moderate at the bilateral lower extremities; mild numbness at the bilateral upper extremities and moderate at the bilateral lower extremities. Muscle strength testing and deep tendon reflexes were normal. Light touch testing was decreased at the bilateral hand/fingers, bilateral ankle/lower leg, and the bilateral foot
 rendered. The Veteran reported that he was diagnosed with neuropathy shortly after being diagnosed with diabetes mellitus. Further, the Veteran reported that his most prominent symptom is numbness followed by tingling, with occasional lower extremity pain. The examiner noted that the Veteran is right hand dominant. The Veteran endorsed symptoms of mild intermittent pain at the bilateral lower extremities; mild paresthesias and/or dysesthesias at the bilateral upper extremities and moderate at the bilateral lower extremities; mild numbness at the bilateral upper extremities and moderate at the bilateral lower extremities. Muscle strength testing and deep tendon reflexes were normal. Light touch testing was decreased at the bilateral hand/fingers, bilateral ankle/lower leg, and the bilateral foot/toes. Position sense was normal at the bilateral upper and lower extremities. Vibration sensation was decreased at the bilateral upper and lower extremities. There was no evidence of muscle atrophy. Trophic changes were noted as loss of hair on toes and smooth, shiny skin on toes bilaterally. The examiner determined that the Veteran has mild incomplete paralysis of the bilateral radial nerve. Further, the examiner determined that the Veteran has mild incomplete paralysis of the bilateral sciatic nerve. At the time of the examination, the Veteran had mild incomplete paralysis of the bilateral femoral nerve. Finally, the examiner noted that physical examination was consistent with mild upper extremity peripheral neuropathy with decreased sensation and vibratory sensation involving the hands.

In January 2025, the Veteran submitted a statement in connection with his claim.  He explained that he is unable to get to standing from sitting in a chair. He further described that he has fallen as a result of balance issues. The Veteran described that the neuropathy he experiences has weakened his muscles.

In January 2025, the Veteran submitted a statement from his spouse in support of his claim. In her statement, the Veteran's spouse described that she assists the Veteran with most of his daily activities, including cleaning, cooking, grocery shopping, and driving. She explained that the Veteran's ability to stand up has been worsening.

In October 2025, the Veteran was afforded additional VA examinations for peripheral neuropathy other than diabetic sensory-motor peripheral neuropathy; and diabetic sensory-motor peripheral neuropathy with the same VA examiner. Both examinations found that the Veteran had bilateral lower extremity neuropathy of the sciatic and femoral nerves. The examiner noted that the Veteran is right hand dominant. The Veteran reported that he experiences numbness, pain, tingling, and weakness in his legs and arms. The examiner determined that the Veteran experiences severe intermittent pain, paresthesias and/or dysesthesias, and numbness in the bilateral upper and lower extremities. Muscle strength testing was normal bilaterally across all extremities. Deep tendon reflexes were decreased at the bilateral biceps; normal at the bilateral triceps; decreased at the bilateral brachioradialis and the bilateral knees; and absent at the bilateral ankles. Light touch testing varied slightly in the examinations, however, both examinations showed decreased sensitivity at the bilateral hands/fingers; at the bilateral knee/thigh; and at the ankle/lower leg; and absent at the bilateral foot/toes. Position sense was decreased at the bilateral upper extremities and absent at the bilateral lower extremities. Vibration sensation was decreased at the right upper extremity, and absent at the left upper extremity and at the bilateral lower extremities. Cold sensation was absent at the bilateral upper and lower extremities.  There was no evidence of muscle atrophy. Trophic changes were described as loss of hair over the lower extremities, and smooth, shiny skin texture. The Veteran showed an unsteady gait due to his bilateral lower extremity diabetic neuropathy.  Both examinations showed that the Veteran had bilateral severe incomplete paralysis of the radial nerve. The Veteran's bilateral lower extremity sciatica was determined to show bilateral severe incomplete paralysis at the diabetic motor-sensory examination. At the peripheral nerve examination, the examiner found that the Veterans right sciatica showed severe incomplete paralysis, and the left sciatic showed complete paralysis. Both examinations showed that the Veteran's bilateral lower extremity femoral nerve evidenced severe incomplete paralysis. The Veteran reported constant use of a cane, walker, and/or compression stockings.

Another separate VA examination was conducted with respect to diabetic sensory-motor peripheral neuropathy in January 2026. It was noted that the Veteran was diagnosed with diabetic peripheral neuropathy in 2005. The Veteran endorsed symptoms of intermittent pain, paresthesias and/or dysesthesias, and numbness were noted as severe at both the bilateral upper and lower extremities. Muscle strength testing was reduced to less than normal strength at the bilateral grip, the bilateral ankle plantar flexion, the bilateral ankle dorsiflexion, but noted to be normal across all other extremities. Deep tendon reflexes were normal at
 femoral nerve evidenced severe incomplete paralysis. The Veteran reported constant use of a cane, walker, and/or compression stockings.

Another separate VA examination was conducted with respect to diabetic sensory-motor peripheral neuropathy in January 2026. It was noted that the Veteran was diagnosed with diabetic peripheral neuropathy in 2005. The Veteran endorsed symptoms of intermittent pain, paresthesias and/or dysesthesias, and numbness were noted as severe at both the bilateral upper and lower extremities. Muscle strength testing was reduced to less than normal strength at the bilateral grip, the bilateral ankle plantar flexion, the bilateral ankle dorsiflexion, but noted to be normal across all other extremities. Deep tendon reflexes were normal at the bilateral triceps, but decreased at the bilateral biceps, bilateral brachioradialis, and at the bilateral knee; they were also noted to be absent at the bilateral ankles. Light touch was found to be normal at the bilateral shoulder and inner/outer forearm, decreased at the bilateral hands/fingers and bilateral knee/thigh; and absent at the bilateral ankle/lower leg and at the bilateral foot/toes. Position sense was decreased at the bilateral upper extremities and absent at the bilateral lower extremities. Vibration was decreased at the left upper extremity and absent at the right upper extremity and the bilateral lower extremities. Cold sensation was decreased at the bilateral upper extremities and absent at the bilateral lower extremities. There was evidence of atrophy noted at the left wrist and the right ankle. Trophic changes were described as loss of hair over the lower extremities and smooth, shiny skin texture. The examiner determined that the Veteran had severe incomplete paralysis of the radial nerve in the bilateral upper extremities.  Further, the examiner found that the Veteran had severe incomplete paralysis of the bilateral sciatic and femoral nerves. The Veteran reported the constant use of a cane.

The Board observes that another VA examination for the peripheral nerves not including diabetic sensory-motor peripheral neuropathy was also conducted in January 2026. However, this examination confirmed that the Veteran's peripheral neuropathies is due to his diabetes mellitus and provided identical reports on the severity of the Veteran's nerve disabilities.

Later in January 2026, another VA examination was conducted with respect to diabetic sensory-motor peripheral neuropathy. It was noted that the Veteran was diagnosed with diabetic peripheral neuropathy in 2010. The Veteran endorsed symptoms of constant pain, noted as moderate at the bilateral upper extremities and noted as severe at the bilateral lower extremities. Intermittent pain and paresthesias and/or dysesthesias was noted as severe at both the bilateral upper and lower extremities. Numbness was noted as moderate at the bilateral upper extremities and as severe at the bilateral lower extremities. Muscle strength testing was reduced to less than normal strength across all extremities. Deep tendon reflexes were decreased across all extremities. Light touch was found to be decreased across all extremities. There was no evidence of muscle atrophy.  There were no trophic changes noted. The examiner found that the Veteran had mild incomplete paralysis of the bilateral radial nerve. Additionally, the examiner found that the Veteran had moderate incomplete paralysis of the ulnar nerve. The examiner determined that the Veteran had mild incomplete paralysis of the sciatic nerve. Notably, the examiner did not find that the Veteran had any paralysis of the femoral nerve. The Veteran reported the constant use of a cane.

Upon review of the record, the Board finds that ratings in excess of those currently assigned are not warranted for any period on appeal for the Veteran's bilateral upper and lower extremity peripheral neuropathy of the radial, sciatic, and femoral nerves.

Regarding the Veteran's bilateral upper extremities, the Board finds that prior to October 29, 2025, the Veteran has mild incomplete paralysis of the bilateral radial nerve. In this regard, the objective evidence consistently shows that that the severity during this period is mild; therefore, a higher rating for moderate incomplete paralysis is not warranted. Moreover, although deep tendon reflexes and sensation to light touch were decreased, these symptoms have been shown to be recurrent, but not continuous during this period. These reports and findings are consistent with the M21-1 guidelines and definitions noted above and support a finding of mild incomplete paralysis of the bilateral upper extremity peripheral neuropathy of the radial nerve. Additionally, from October 29, 2025, the Board finds that ratings in excess of 50 percent for the right upper extremity, and in excess of 40 percent for the left upper extremity for peripheral neuropathy of the radial nerve are not warranted. In this regard, the objective medical evidence during this period consistently found that the level of impairment is severe incomplete paralysis of the radial. Accordingly, higher evaluations in excess of those assigned are not warranted.

Regarding the Veteran's bilateral lower extrem
 to be recurrent, but not continuous during this period. These reports and findings are consistent with the M21-1 guidelines and definitions noted above and support a finding of mild incomplete paralysis of the bilateral upper extremity peripheral neuropathy of the radial nerve. Additionally, from October 29, 2025, the Board finds that ratings in excess of 50 percent for the right upper extremity, and in excess of 40 percent for the left upper extremity for peripheral neuropathy of the radial nerve are not warranted. In this regard, the objective medical evidence during this period consistently found that the level of impairment is severe incomplete paralysis of the radial. Accordingly, higher evaluations in excess of those assigned are not warranted.

Regarding the Veteran's bilateral lower extremity peripheral neuropathy of the sciatic nerve, the Board finds that separate evaluations in excess of 20 percent are not warranted prior to October 29, 2025. Specifically, the evidence has shown that at worst the Veteran has had mild incomplete paralysis of the sciatic nerve, however, the evidence has shown continuous decreased sensations and trophic changes, with moderate symptoms reported during this period. From October 29, 2025, the Board finds that evaluations in excess of 40 percent are not warranted.  In this regard, during this period, while some there was some atrophy noted in the later examinations, at no point was marked muscular atrophy noted. Moreover, while the October 2025 VA examination indicated complete paralysis of the left lower extremity sciatic nerve, multiple later examinations assessed the level of severity to be incomplete paralysis.

With respect to the Veteran's bilateral lower extremity peripheral neuropathy of the femoral nerve, the Board finds that initial separate evaluations in excess of 10 percent are not warranted. In this regard, the objective medical evidence of record consistently shows that that the severity during this period is mild; therefore, a higher rating for moderate incomplete paralysis is not warranted.  In particular, deep tendon reflexes and sensation to light touch were shown to be normal, consistent with a mild evaluation. However, from October 29, 2025, the Veteran's bilateral peripheral neuropathy of the femoral is noted to show severe incomplete paralysis. Although the later January 2026 VA examination did not find that the Veteran had any impairment of the bilateral lower extremity femoral nerve, significantly, the earlier January 2026 VA examination determined that the Veteran had severe incomplete paralysis of the femoral nerve. As the record does not show evidence of more severe symptoms, higher evaluations are not applicable.

The Board is cognizant that the Veteran is competent to attest to things he experiences through his senses, such as numbness and tingling in his extremities.  Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The statements from the Veteran are competent evidence to report his increased bilateral upper and lower extremity peripheral neuropathy symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469, 470 (1994). The Veteran is also sincere. However, the more probative evidence of record does not indicate that the assignment of evaluations in excess of those discussed above are warranted. In so finding, the Board notes that it weighed the lay and medical evidence and finds more probative assessments rendered by medical professionals given their expertise in evaluating neurological disorders.

The Board finds that assigning separate ratings under Diagnostic Codes 8521, 8522, 8523, 8525, and 8527, for the external popliteal, musculocutaneous, anterior tibial, internal popliteal, posterior tibial, and internal saphenous nerve respectively, is not warranted. Such would constitute impermissible pyramiding as impairment of these nerves all contributed to the same and overlapping functional impairment of the lower extremities consisting of pain, paresthesias, numbness, and gait changes. VA regulations prohibit evaluation of the same disability or the same or overlapping symptomatology under different diagnostic codes (which is called "pyramiding"). 38 C.F.R. § 4.14; M21-1, V.iii.12.A.2.e.

The Board recognizes the holding in Banschbach v. McDonough, 37 Vet. App. 422 (2024) where the Court found that 38 C.F.R. § 4.124a does not necessarily prohibit the assignment of separate compensable ratings for paralysis, neuritis, and neuralgia. However, in the present appeal, assigning separate ratings for neuritis or neuralgia in addition to the Veteran's current rating for paralysis would also constitute prohibited pyramiding. 38 CFR 4.14. Moreover, the Board notes that in Banschbach, the Board did
ramiding"). 38 C.F.R. § 4.14; M21-1, V.iii.12.A.2.e.

The Board recognizes the holding in Banschbach v. McDonough, 37 Vet. App. 422 (2024) where the Court found that 38 C.F.R. § 4.124a does not necessarily prohibit the assignment of separate compensable ratings for paralysis, neuritis, and neuralgia. However, in the present appeal, assigning separate ratings for neuritis or neuralgia in addition to the Veteran's current rating for paralysis would also constitute prohibited pyramiding. 38 CFR 4.14. Moreover, the Board notes that in Banschbach, the Board did not consider the M21 provisions, as discussed above, with respect to neurological disorders, which discussion can be favorable to the Veteran.  Id.; see also Overton, 30 Vet. App. at 263-64. Nevertheless, the record before the Board does not specifically note findings of neuritis or neuralgia, only references to nerve impairment. Accordingly, no further consideration of separate ratings under DC 8620 or neuralgia under DC 8720 is required.  

The Board finds that the evidence of record persuasively weighs against the Veteran's increased rating claims. The Board has considered the objective findings of the VA examiners, the treatment records, and the Veteran's lay evidence and finds the assigned ratings to be appropriate for the Veteran's symptoms. 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; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

7. Entitlement to special monthly compensation (SMC) based on loss of use of the feet.

The Veteran's representative argues that the Veteran has no effective remaining function of the upper and lower extremities, thereby entitling him to SMC for the loss of use of the upper and lower extremities. See March 2026 Notice of Disagreement.

SMC under 38 U.S.C.§ 1114(k) is payable for each anatomical loss or loss of use of one hand, one foot, both buttocks, one or more creative organs, blindness of one eye having only light perception, deafness of both ears, having absence of air and bone conduction, complete organic aphonia with constant inability to communicate by speech or, in the case of a female Veteran, the anatomical loss of 25 percent or more of tissue from a single breast or both breasts in combination (including loss by mastectomy or partial mastectomy) or following receipt of radiation treatment of breast tissue. 38 C.F.R. § 3.350.

Under 38 C.F.R. § 3.350(a)(2)(i), loss of use of a hand or foot exists when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below the knee with use of a suitable prosthetic appliance. The determination is made on the basis of the actual remaining function, for example, balance or propulsion accomplished equally well by an amputation stump with prosthesis in the case of the foot. The responsibility for determining loss of use lies with the adjudicator and not an examining physician.  38 C.F.R. §§ 3.350(a)(2)(i), 4.63; see also Tucker v. West, 11 Vet. App. 369 (1998). The Court also stated that, in accordance with 38 C.F.R. § 4.40, the Board is required to consider the impact of pain in making its decision and to articulate how pain with use was factored into its decision. Id.

Examples under 38 C.F.R. § 3.350(a)(2) which constitute loss of use of a foot include extremely unfavorable ankylosis of the knee, complete ankylosis of two major joints of an extremity, shortening of the lower extremity of three and a half inches or more, and complete paralysis of the external popliteal (common peroneal) nerve and consequent foot-drop, accompanied by characteristic organic changes including trophic and circulatory disturbances and other concomitants confirmatory of complete paralysis of that nerve. 38 C.F.R. §§ 3.350(a)(2)(i), 4.63.

Turning to the record, in November 2024, the Veteran was afforded VA examinations in connection his service-connected bilateral upper and lower extremity peripheral neuropathy. The examiner determined that the remaining function of the extremities was not so diminished that amputation with prothesis would
 two major joints of an extremity, shortening of the lower extremity of three and a half inches or more, and complete paralysis of the external popliteal (common peroneal) nerve and consequent foot-drop, accompanied by characteristic organic changes including trophic and circulatory disturbances and other concomitants confirmatory of complete paralysis of that nerve. 38 C.F.R. §§ 3.350(a)(2)(i), 4.63.

Turning to the record, in November 2024, the Veteran was afforded VA examinations in connection his service-connected bilateral upper and lower extremity peripheral neuropathy. The examiner determined that the remaining function of the extremities was not so diminished that amputation with prothesis would equally serve the Veteran. Further, the external popliteal nerve was noted to be normal bilaterally. There was no evidence reported that the Veteran experienced foot-drop. Significantly, constant pain was not noted as a symptom attributable to the Veteran's peripheral neuropathies. Rather, the Veteran reported that his most prominent symptom is numbness. The examiner noted that the Veteran presented with a normal gait.

In November 2024, the Veteran was afforded a VA examination for foot condition. A diagnosis of bilateral hammer toes was rendered. The examiner determined that the remaining function of the extremities was not so diminished that amputation with prothesis would equally serve the Veteran. The Veteran denied pain in his feet.

In January 2025, the Veteran submitted a statement in support of his claim. He reported that his balance is impacted by his neuropathies and that he has fallen. His spouse also submitted a statement in which she reported that the Veteran experiences balance issues and that he needs assistance to move around the house.

In October 2025, additional VA examinations were obtained. The examiner determined that the remaining function of the extremities was not so diminished that amputation with prothesis would equally serve the Veteran. There was no evidence of involvement of the external popliteal nerve. The Veteran described his peripheral neuropathy as numbness, tingling, and weakness in his arms and legs. He further reported that he needs help with ordinary activities because he drops things easily. The Veteran did not report any symptoms of constant pain. The examiner noted that the Veteran presented with an unsteady gait.

In January 2026, additional VA examinations were conducted. The examiner determined that the remaining function of the extremities was not so diminished that amputation with prothesis would equally serve the Veteran. There was no involvement of the external popliteal nerve noted. The Veteran reported numbness, pain, tingling, and weakness in his arms and legs. However, there was no report of constant pain during examination. The examiner noted that the Veteran's gait was slow and cautious.

Later in January 2026, another VA examination was performed. The examiner determined that the remaining function of the extremities was not so diminished that amputation with prothesis would equally serve the Veteran. Examination revealed constant moderate pain at the bilateral upper extremities and constant severe pain at the bilateral lower extremities. The Veteran reported gait instability, frequent falls, and the need for a cane for ambulation.

After reviewing the record, the Board finds the criteria for SMC based on the loss of use of the hands and feet have not been met. See 38 U.S.C. § 1114(k); 38 C.F.R. § 3.350(b). The evidence described above does not show that the Veteran's functioning is so diminished as to be equally well served by amputation of the hands or feet with prosthesis. Moreover, the examination findings during the appeal period showed at least some functioning of the bilateral upper and lower extremities that establish that the Veteran has some use and are evidence against a claim of loss of use of the hands and feet.

As discussed above, during the relevant period on appeal, the Veteran's bilateral upper and lower extremity peripheral neuropathy were manifested by, at worst, no more than severe incomplete paralysis of the affected nerves. The Veteran's symptoms at the bilateral upper and lower extremities of constant pain, intermittent pain, numbness, and paresthesias and/or dysesthesias have ranged from mild, to moderate, to severe. While the Veteran has consistently been reported to require the constant use of a cane for ambulation, it has not been shown that the Veteran is unable to walk with both feet. Likewise, it has not been shown that the Veteran is unable to move and use his arms. There is no evidence to suggest that actual remaining function of the bilateral upper and lower extremities, including balance and propulsion, is equal to that of amputation with prosthesis. Rather, the evidence reflects that while the Veteran experienced severe incomplete paralysis of the radial, sciatic, and femoral nerves, he has not experienced total paralysis of these nerves or any other symptoms consistent
aresthesias and/or dysesthesias have ranged from mild, to moderate, to severe. While the Veteran has consistently been reported to require the constant use of a cane for ambulation, it has not been shown that the Veteran is unable to walk with both feet. Likewise, it has not been shown that the Veteran is unable to move and use his arms. There is no evidence to suggest that actual remaining function of the bilateral upper and lower extremities, including balance and propulsion, is equal to that of amputation with prosthesis. Rather, the evidence reflects that while the Veteran experienced severe incomplete paralysis of the radial, sciatic, and femoral nerves, he has not experienced total paralysis of these nerves or any other symptoms consistent with total functional loss. 38 C.F.R. §§ 3.350(a)(2)(i).

The Board acknowledges the Veteran's reports that walking was challenging and that he experienced pain, instability and an increased risk of falls due to being unbalanced or unsteady at times. The Veteran is competent to report on matters observed or within his personal knowledge. See Layno, 6 Vet. App. at 470.  However, the more probative evidence of record does not indicate that the Veteran's bilateral and upper and lower extremity have diminished in function to the extent that the Veteran is better served with amputation. In so finding, the Board notes that it weighed the lay and medical evidence and finds more probative assessments rendered by medical professionals given their expertise in evaluating neurological disorders.

The Board recognizes that the Veteran's bilateral upper and lower extremity peripheral neuropathies result in a significant degree of functional loss as evidence by the ratings as discussed above. However, to the extent he alleges that he has functionally lost the use of his hands and feet, these statements are not competent evidence and are not considered persuasive.

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As the competent medical evidence of record shows, the Veteran's bilateral upper and lower extremity functioning is not so diminished as to be equally served by amputation and prosthesis. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the doubt doctrine. However, because the evidence weighs persuasively against the Veteran's claim, the Board finds that the claim of entitlement to SMC(k) based on the loss of use of the hands and feet must be denied.

 

 

D. C. JOHNSON

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Scanlan, 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.