KIDNEY DISEASE OF

JONATHAN HAGER · 2026 · Case ID: A26040366

MIXED

Summary

The veteran, an Air Force veteran who served from March 1969 to March 1995, appeals rating decisions concerning chronic kidney disease, diabetes mellitus type II, and peripheral neuropathies affecting the lower and upper extremities. The veteran sought increased ratings for several conditions, including chronic kidney disease (seeking 60% or higher), diabetes mellitus type II (seeking 40% or higher), and various peripheral neuropathies. The Board reviewed the evidence, including the veteran's service treatment records and prior rating decisions, to determine if the criteria for increased ratings or initial grants were met. The Board found that the veteran met the criteria for an increased rating to 60% for chronic kidney disease and an increased rating to 40% for diabetes mellitus type II. Service connection for bilateral lower extremity peripheral neuropathy of the external popliteal nerve and radial nerve was granted at 20% each, and bilateral upper extremity peripheral neuropathy of the ulnar nerve was granted at 10% each. However, the Board denied increased ratings for bilateral lower extremity peripheral neuropathy of the sciatic nerve and femoral nerve, as well as bilateral upper extremity peripheral neuropathy of the median nerve, finding the veteran's symptoms did not meet the higher diagnostic criteria. The Board also denied an earlier effective date for the chronic kidney disease claim and for BLE peripheral neuropathy of the femoral nerve. The veteran's claim for TDIU was granted, and entitlement to Chapter 35 DEA benefits was also met.

Rationale

Criteria for 60% rating met; Effective July 24, 2024; Chronic kidney disease with GFR 30-44

Service Branch

AIR FORCE

Special Benefit

TDIU; EARLIER EFFECTIVE DATE

Diagnostic Code

7541

Docket No.

260129-628974

Full Decision Text

Citation Nr: A26040366
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 260129-628974
DATE: April 29, 2026

ORDER

Entitlement to an increased rating of 60 percent, but no higher, for service-connected chronic kidney disease is granted from July 24, 2024, subject to controlling regulations governing the payment of monetary awards.

Entitlement to an increased rating of 40 percent, but no higher, for service-connected diabetes mellitus, type II (diabetes) is granted from October 23, 2024, subject to controlling regulations governing the payment of monetary awards.

Entitlement to an increased rating higher than 40 percent for service-connected LLE peripheral neuropathy of the sciatic nerve is denied.

Entitlement to an increased rating higher than 40 percent for service-connected RLE peripheral neuropathy of the sciatic nerve is denied.

Entitlement to an increased rating higher than 30 percent for service-connected LLE peripheral neuropathy of the femoral nerve is denied.

Entitlement to an increased rating higher than 30 percent for service-connected RLE peripheral neuropathy of the femoral nerve is denied.

Entitlement to an increased rating higher than 20 percent for service-connected LUE peripheral neuropathy of the median nerve is denied.

Entitlement to an increased rating higher than 20 percent for service-connected RUE peripheral neuropathy of the median nerve is denied.

Entitlement to an initial separate 20 percent rating, but no higher, for service-connected LLE peripheral neuropathy of the external popliteal nerve is granted from October 23, 2024, subject to controlling regulations governing the payment of monetary awards.

Entitlement to an initial separate 20 percent rating, but no higher, for service-connected RLE peripheral neuropathy of the external popliteal nerve is granted from October 23, 2024, subject to controlling regulations governing the payment of monetary awards.

Entitlement to an initial separate 20 percent rating, but no higher, for service-connected LUE peripheral neuropathy of the radial nerve is granted from October 23, 2024, subject to controlling regulations governing the payment of monetary awards.

Entitlement to an initial separate 20 percent rating, but no higher for service-connected RUE peripheral neuropathy of the radial nerve is granted from October 23, 2024, subject to controlling regulations governing the payment of monetary awards.

Entitlement to an initial separate 10 percent rating, but no higher, for service-connected LUE peripheral neuropathy of the ulnar nerve is granted from October 23, 2024, subject to controlling regulations governing the payment of monetary awards.

Entitlement to an initial separate 10 percent rating, but no higher for service-connected RUE peripheral neuropathy of the ulnar nerve is granted from October 23, 2024, subject to controlling regulations governing the payment of monetary awards.

Entitlement to an earlier effective date prior to July 8, 2022 for the award of service connection for chronic kidney disease is denied.

Entitlement to an earlier effective date prior to October 23, 2024 for the award of service connection for LLE peripheral neuropathy of the femoral nerve is denied.

Entitlement to an earlier effective date prior to October 23, 2024 for the award of service connection for RLE peripheral neuropathy of the femoral nerve is denied.

Entitlement to a total disability rating due to individual unemployability (TDIU), from July 8, 2022, due to the combined effects of the Veteran's service-connected disabilities, is granted, subject to controlling regulations governing the payment of monetary awards.

Basic eligibility for Dependents' Educational Assistance (DEA) under 38 U.S.C. Chapter 35 is granted from July 8, 2022.

FINDINGS OF FACT

1. From July 24, 2024, the Veteran's renal dysfunction more nearly approximated chronic kidney disease with consecutive glomerular filtration rates (GFR) from 30 to 44 for at least three consecutive months during the previous 12 months. However, the Veteran's renal dysfunction did not more nearly approximate chronic kidney disease with GFR from 15 to 29 for at least 3 consecutive months during the past 12 months.

2. From October 23, 2024, the Veteran's diabetes required insulin, restricted diet, and regulation of activities throughout the appeal period, but there have not been episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider.

3. The symptoms of the Veteran's bilateral lower extremity (BLE) peripheral neuropathy of the sciatic nerve have not more nearly approximated severe incomplete paralysis with marked muscular atrophy nor complete paralysis at any point
. However, the Veteran's renal dysfunction did not more nearly approximate chronic kidney disease with GFR from 15 to 29 for at least 3 consecutive months during the past 12 months.

4. The symptoms of the Veteran's BLE peripheral neuropathy of the femoral nerve have not more nearly approximated complete paralysis of the quadriceps extensor muscles at any point in the appeal period.

5. The symptoms of the Veteran's bilateral upper extremity (BUE) peripheral neuropathy of the median nerve have not more nearly approximated severe incomplete paralysis in either extremity at any point in the appeal period.

6. The symptoms of the Veteran's BLE peripheral neuropathy more nearly approximated moderate incomplete paralysis of the external popliteal nerve, but did not more nearly approximate severe incomplete paralysis.

7. The symptoms of the Veteran's BUE peripheral neuropathy more nearly approximated mild incomplete paralysis of the radial nerve, but did not more nearly approximate moderate incomplete paralysis.

8. The symptoms of the Veteran's BUE peripheral neuropathy more nearly approximated mild incomplete paralysis of the ulnar nerve, but did not more nearly approximate moderate incomplete paralysis.

9. VA received the Veteran's Fully Developed Claim, via VA Form 21-526EZ, claiming service connection for chronic kidney disease, on July 8, 2022, and there is no formal or informal claim for compensation for this disability prior to that date.

10. VA received the Veteran's Supplemental Claim, via VA Form 20-0995, on October 23, 2024, and there is no formal or informal claim for compensation for BLE peripheral neuropathy of the femoral nerve prior to that date.

11. From July 8, 2022, the combined symptoms of the Veteran's service-connected disabilities precluded all substantially gainful employment for which his education and occupational experience otherwise qualified him.

12. The Veteran became permanently and totally disabled for purposes of DEA benefits on July 8, 2022.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a 60 percent rating, but no higher, for service-connected chronic kidney disease have been met from July 24, 2024. 38 U.S.C. §§ 1155, 5017; 38 C.F.R. §§ 4.3, 4.7, 4.115a, 4.115b, Diagnostic Code (DC) 7541.

2. The criteria for entitlement to an increased disability rating of 40 percent, but no higher, for service-connected diabetes are met from October 23, 2024. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.3, 4.7, 4.10, 4.119, DC 7913.

3. The criteria for entitlement to a rating higher than 40 percent for BLE peripheral neuropathy of the sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.124a, DC 8520.

4. The criteria for entitlement to a rating higher than 30 percent for BLE peripheral neuropathy of the femoral nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.124a, DC 8526.

5. The criteria for entitlement to a rating higher than 20 percent for BUE peripheral neuropathy of the median nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.124a, DC 8515.

6. The criteria for entitlement to separate initial 20 percent ratings, but no higher, for BLE peripheral neuropathy of the external popliteal nerve have been met from October 23, 2024. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.124a, DC 8521.

7. The criteria for entitlement to separate initial 20
than 20 percent for BUE peripheral neuropathy of the median nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.124a, DC 8515.

7. The criteria for entitlement to separate initial 20 percent ratings, but no higher, for BUE peripheral neuropathy of the radial nerve have been met from October 23, 2024. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.124a, DC 8514.

8. The criteria for entitlement to separate initial 10 percent ratings, but no higher, for BUE peripheral neuropathy of the ulnar nerve have been met from October 23, 2024. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.124a, DC 8516.

9. The criteria for an effective date prior to July 8, 2022, for the award of service connection for chronic kidney disease, have not been met. 38 U.S.C. §5107, 5110; 38 C.F.R. §§ 3.109(b), 3.400, 3.2500(h)(1).

10. The criteria for an effective date prior to October 23, 2024, for the award of service connection for BLE peripheral neuropathy of the femoral nerve, have not been met. 38 U.S.C. §5107, 5110; 38 C.F.R. §§ 3.109(b), 3.400, 3.2500(h)(1).

11. From July 8, 2022, the criteria for a TDIU, due to the combined symptoms of the Veteran's service-connected disabilities, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16.

12. The criteria for Chapter 35 DEA benefits have been met from July 8, 2022. 38 U.S.C. § 3510; 38 C.F.R. § 3.807.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the Air Force from March 1969 to March 1995.

This matter comes before the Board of Veterans' Appeals (Board) from February 2025 and May 2025 rating decisions, as well as a June 2025 Higher-Level Review (HLR). The issues on appeal are explained in detail below.

By way of history, the Veteran filed a service connection claim for BLE peripheral neuropathy and diabetes in January 2010, and a July 2010 rating decision granted service connection for diabetes and assigned an initial 20 percent disability rating, and granted service connection for BLE peripheral neuropathy and granted initial 10 percent disability ratings for each extremity. In July 2011, the Veteran filed a claim for service connection for BUE peripheral neuropathy, and a December 2011 rating decision granted service connection and assigned initial 10 percent ratings for each extremity. In June 2013, the Veteran filed an increased rating claim for his service-connected BLE peripheral neuropathy, and an April 2014 rating decision continued the 10 percent ratings. These three rating decisions became final after the Veteran neither appealed nor submitted new and material evidence within one year of the issuance of the decisions. See 38 U.S.C. § 7105(c); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 20.302(a), 20.1103.

In February 2016, the Veteran filed increased rating claims for diabetes and "peripheral neuropathy," which the agency of original jurisdiction (AOJ) inferred to mean the Veteran was appealing the ratings for both his BLE and BUE peripheral neuropathy. An April 2016 rating decision assigned a higher 20 percent rating for RLE peripheral neuropathy, continued the 10 percent rating for LLE peripheral neuropathy, proposed reducing the BUE peripheral neuropathy rating from 10 percent to noncompensable, and continued the 20 percent rating for diabetes. The Veteran filed a request for reconsideration of the proposed reduction in August 2016, and a November 2016 rating decision continued the 10 percent ratings for BUE peripheral neuropathy. The Veteran filed a notice of disagreement in April 2017, specifically seeking a 40 percent for service-connected diabetes, and he was issued a Statement of the Case (SOC) in April 2018. The Veteran did not perfect his appeal or submit new and material evidence prior to an appellate decision, so the April 2016 and November 2016 rating decisions became final. 38 U.S.C. § 7105(d)(3) (2012); 38 C.F.R. § 3.156(a)-(b), 20.302(b) (2016).

In July 2022, the Veteran filed a service connection claim for chronic kidney disease, now in the AMA modernized appeal system, and a November 2022 rating decision granted service connection and assigned an initial 30 percent rating effective July 8, 2022, the date of receipt of the Veteran's intent to file. The Veteran filed a request for HLR, seeking an increased rating and earlier effective date for his service-connected chronic kidney disease. A January 2024 HLR denied an earlier effective date and continued the initial 30 percent rating for service-connected chronic kidney disease.

In October 2024, the Veteran filed a Supplemental Claim, via VA Form 20-0995, seeking a higher initial rating and earlier effective date for service-connected chronic kidney disease, as well as a TDIU due to chronic kidney disease; he also filed a formal TDIU application, via Veteran Form 21-8940, on the same day, contending he is unemployable due to his service-connected chronic kidney disease, diabetes, and BUE and BLE peripheral neuropathy. A February 2025 rating decision denied a higher initial rating and earlier effective date for chronic kidney disease. This rating decision is on appeal.

A May 2025 rating decision, issued in response to the October 2024 Supplemental Claim, continued the Veteran's 20 percent rating for service-connected diabetes, increased the ratings for BLE peripheral neuropathy to 40 percent effective October 23, 2024, increased the ratings for BUE peripheral neuropathy to 20 percent, effective October 23, 2024, granted separate 30 percent ratings for BLE peripheral neuropathy of the femoral nerve, effective October 23, 2024, granted basic eligibility to DEA effective October 23, 2024, and denied entitlement to a TDIU as moot. This rating decision is on appeal with respect to all claims except TDIU and DEA.

The Veteran filed a June 3, 2025 request for HLR seeking TDIU and an earlier effective date for DEA, and a June 11, 2025 HLR again denied TDIU as moot and denied an earlier effective date for DEA. This HLR is on appeal.

The Veteran filed a timely "Decision Review Request: Board Appeal (Notice of Disagreement)" form (via VA Form 10182) in January 2026, appealing the above claims and requesting the direct review docket. Notably, the Veteran also included on the Notice of Disagreement an appeal of the effective dates for the separate ratings for BLE peripheral neuropathy of the femoral nerve. 38 C.F.R. §§ 20.202 (b)(1); 20.303. Therefore, the Board may only consider the evidence of record at the time of the February 2025 and May 2025 (subsequently subject to June 2025 HLR with regard to Veteran and DEA) AOJ decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decisions on appeal cannot be considered by the Board.
claims and requesting the direct review docket. Notably, the Veteran also included on the Notice of Disagreement an appeal of the effective dates for the separate ratings for BLE peripheral neuropathy of the femoral nerve. 38 C.F.R. §§ 20.202 (b)(1); 20.303. Therefore, the Board may only consider the evidence of record at the time of the February 2025 and May 2025 (subsequently subject to June 2025 HLR with regard to Veteran and DEA) AOJ decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like the 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 claim, 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 a final preliminary matter, the Board generally may not decide an appeal before the deadline for requesting a docket switch under the Appeals Modernization Act (AMA) has elapsed. Williams v. McDonough, 37 Vet. App. 305 (2024). 38 C.F.R. § 20.202 (2) allows claimants to switch AMA dockets by completing and submitting a new NOD within one year from the date the AOJ mails notice of the decision on appeal, or 60 days from when the Board receives an NOD, whichever is later, unless a claimant has already submitted evidence or testimony. In this case, although the deadline for requesting a docket switch has not yet elapsed with regard to the May 2025 rating decision and June 2025 HLR, the Veteran explicitly waived the remaining time to modify the chosen Board appeal lane in the January 2026 Notice of Disagreement. The Board will therefore proceed with adjudication of the claims.

The case has been advanced on the docket pursuant to 38 U.S.C. § 7107 and 38 C.F.R. § 20.900 (c).

Increased Ratings

Disability ratings are determined by comparing a Veteran's symptoms with criteria set forth in VA's Schedule for Rating Disabilities, which are based on 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, the higher of the two evaluations 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. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3.

In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10.

As indicated in the VA examination reports, the Veteran is right-hand dominant.

Chronic Kidney Disease

The Veteran's chronic kidney disease is currently rated at 30 percent disabling from July 8, 2022 under DC 7541 for renal involvement. DC 7541 contemplates renal involvement in diabetes and instructs the adjudicator to rate as renal dysfunction.

Renal dysfunction warrants a noncompensable rating when glomerular filtration rate (GFR) is between 60 to 89 mL/min/1.73 m2 with albumin/creatin
the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10.

As indicated in the VA examination reports, the Veteran is right-hand dominant.

Chronic Kidney Disease

Renal dysfunction warrants a noncompensable rating when glomerular filtration rate (GFR) is between 60 to 89 mL/min/1.73 m2 with albumin/creatinine ratio (ACR) greater than or equal to 30 mg/g for at least 3 consecutive months during the past 12 months. A 30 percent rating is warranted when GFR is either: a) between 45 to 59 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months; or b) between 60 to 89 mL/min/1.73 m2 with either recurrent RBC casts, white blood cell (WBC) casts, or granular casts between 60 to 89 mL/min/1.73 m2; or c) between 60 to 89 mL/min/1.73 m2 with structural kidney abnormalities (cystic, obstructive, or glomerular) for at least 3 consecutive months during the past 12 months. A 60 percent rating is warranted when GFR is between 30 to 44 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. An 80 percent rating is warranted when GFR is between 15 to 29 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. A 100 percent rating is warranted when GFR is less than 15 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months; or requiring regular routine dialysis; or eligible kidney transplant recipient warrants. A note provides that GFR, estimated GFR (eGFR), and creatinine-based approximations of GFR will be accepted for evaluation purposes under this section when determined to be appropriate and calculated by a medical professional.

Regarding the appeal period, the Veteran filed his initial service connection for chronic kidney disease on July 9, 2022, filed a HLR request within one year of the November 2022 rating decision granting service connection and assigning an initial rating, and filed a Supplemental claim within one year of the January 2024 HLR that continued the initial rating and denied and earlier effective date. Therefore, the Veteran has continuously pursued the initial rating claim since the November 2022 rating decision and the appeal period begins July 9, 2022, the original date of claim.

Turning to the record, treatment records and VA exams show the Veteran recorded eGFR (estimated GFR) of 53.5 in October 2021, 55 in August 2022, a GFR of 55 in October 2022, and eGFRs of 55 in January 2023, 56 in July 2023, and 49 in January 2024. However, later in 2024, the Veteran recorded an eGFR of 33 in July 2024, 38 in August 2024, and a GFR of 36 in September 2024, three consecutive months. Based on these readings, starting July 24, 2024, the Veteran had chronic kidney disease with GFR from 30 to 44 for at least three consecutive months during the previous 12 months. Therefore, resolving reasonable doubt in the Veteran's favor, the Board finds that his GFR, during the period on appeal, was at or less than 41 for at least 3 consecutive months during the past 12 months, satisfying the criteria for a 60 percent rating from July 24, 2024. There is no lay or medical evidence of a factually ascertainable increase prior to this date and no argument has been made pointing to such evidence. Estevez v. McDonough, 36 Vet. App. 157, 175 (2023) ("As we have said before, the Board errs when it reflexively assigns the date of a VA examination as the date of an increased evaluation; instead, the Board must analyze the examination report alongside the other lay and medical evidence of record to determine when an increase in disability actually occurred") (citing Swain v. McDonald, 27 Vet. App. 219, 224-25 (2015) (
60 percent rating from July 24, 2024. There is no lay or medical evidence of a factually ascertainable increase prior to this date and no argument has been made pointing to such evidence. Estevez v. McDonough, 36 Vet. App. 157, 175 (2023) ("As we have said before, the Board errs when it reflexively assigns the date of a VA examination as the date of an increased evaluation; instead, the Board must analyze the examination report alongside the other lay and medical evidence of record to determine when an increase in disability actually occurred") (citing Swain v. McDonald, 27 Vet. App. 219, 224-25 (2015) (rejecting the mechanical assignment of an effective date based on the date of examination and explaining that, for staged evaluation purposes, VA must examine all relevant facts to determine when an increase in a veteran's disability manifests); DeLisio v. Shinseki, 25 Vet. App. 45, 58 (2011) ("[A]n effective date should not be assigned mechanically based on the date of a diagnosis. Rather, all of the facts should be examined to determine the date that [a disability] first manifested")).

A rating in excess of 60 percent, however, is not warranted. The evidence of record does not demonstrate that the Veteran's GFR was less than 30 or that the Veteran required regular routine dialysis or was an eligible kidney transplant recipient.

Accordingly, resolving reasonable doubt in favor of the Veteran, an increased disability rating of 60 percent, but no higher, pursuant to DC 7541 for chronic kidney disease, as a complication of service-connected diabetes mellitus type II, is granted from July 24, 2024, the date the increase was first factually ascertainable.

Diabetes

The Veteran's diabetes is currently rated 20 percent disabling under DC 7913. In his April 2017 legacy notice of disagreement, the Veteran indicated he is seeking a 40 percent rating.

Under DC 7913, diabetes mellitus requiring insulin and restricted diet or; oral hypoglycemic agent and restricted diet warrants a 20 percent disability rating. Diabetes mellitus requiring insulin, restricted diet, and regulation of activities is assigned a 40 percent disability rating. The term regulation of activities is defined in DC 7913 as avoidance of strenuous occupational and recreational activities. Medical evidence is required to show that occupational and recreational activities have been restricted. Camacho v. Nicholson, 21 Vet. App. 360 (2007). Diabetes mellitus requiring insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately rated, is assigned a 60 percent disability rating. Diabetes mellitus requiring more than once-daily injection of insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately rated, is assigned a 100 percent rating.

In addition, the regulations stipulate that compensable complications of diabetes are to be evaluated separately, with noncompensable complications to be considered as part of the diabetic process under DC 7913.

Regarding the appeal period, the July 2010 rating decision that granted service connection for diabetes and assigned an initial rating, as well as the April 2016 rating decision that continued the initial rating, became final as described above. Therefore, the appeal period before us begins October 23, 2024, the date of the Supplemental Claim.

Turning to the evidence, a January 2014 Primary Care Addendum showed the Veteran's diabetes to be better controlled with insulin and the Veteran denied specific symptoms. During a March 2016 VA examination, the examiner noted the Veteran requires more than in injection of insulin per day, responded "No" when asked if the Veteran required regulation of activities as part of medical management of his diabetes, reported that the Veteran has had no hospitalizations for ketoacidosis or hypoglycemia, but he has had progressive unintentional weight loss.

In his April 2016 legacy notice of disagreement (received by VA in April 2017), the Veteran reported that his downtown doctor issued him a handicap plate for his car due to the swelling of his feet so he did not have to walk as much. The Veteran argued this should qualify as reduced activity.

During a February 2025 VA examination, the examiner noted the Veteran requires more than
, the examiner noted the Veteran requires more than in injection of insulin per day, responded "No" when asked if the Veteran required regulation of activities as part of medical management of his diabetes, reported that the Veteran has had no hospitalizations for ketoacidosis or hypoglycemia, but he has had progressive unintentional weight loss.

During a February 2025 VA examination, the examiner noted the Veteran requires more than one injections of insulin per day, but had no proscribed restricted diet or regulation of activities, no hospitalizations for ketoacidosis or hypoglycemia over the previous twelve months were reported, and he was ineligible for a kidney transplant.

The symptoms associated with the Veteran's service-connected diabetes required treatment as specifically described in the criteria for a 20 percent disability rating. The higher ratings all require regulation of activities. While both VA examiners explicitly found that the Veteran's diabetes did not require regulation of activities, the Veteran is competent to report that his private doctor issued him a handicap plate to limit his walking due to his swollen feet. Jandreau v. Nicholson, 492 F.3d 1372, 1377, n. 4 (Fed. Cir. 2007) (a layperson is competent to report observations); Falzone v. Brown, 8 Vet. App. 398, 403 (1995) (lay person competent to testify to pain and visible flatness of his feet). This indicates that his doctor is regulating his activities due to his diabetes symptoms. Thus, resolving reasonable doubt in favor of the Veteran, his diabetes symptoms require one or more daily injection of insulin, restricted diet, and regulation of activities.

However, there is no argument or evidence of ketoacidosis or hypoglycemic reactions requiring hospitalizations or visits to a diabetic care provider at least twice a month; rather, the evidence explicitly shows the Veteran had no hospitalizations or visits to diabetic care providers. Therefore, a higher rating of 60 percent is not warranted at any point in the appeal period.

As discussed above, complications of the Veteran's diabetes may be separately compensated. However, the only complications of the Veteran's diabetes shown in the record is peripheral neuropathy, for which the Veteran is already service-connected and discussed at length below. Accordingly, there is no basis for awarding a separate disability rating for complications of the Veteran's diabetes.

For the foregoing reasons, the Veteran's diabetes symptoms have met the criteria for a 40 percent rating, but no higher, from October 23, 2024.

Increased Ratings for Peripheral Neuropathy

The Veteran, through his representative, contended in an April 2025 statement that his BUE and BLE peripheral neuropathy warrant increased and separate ratings for a variety of different nerves based on the rating criteria found in 38 C.F.R. § 4.124a, DCs 8510-8730. Many of the relevant DCs share common terms, the following definitions of which will apply to the below analysis.

The term "incomplete paralysis," with peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to the partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. See 38 C.F.R. § 4.124a, DCs 8510-8730.

Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "mild," "moderate," "moderately severe," and "severe." Spellers v. Wilkie, 30 Vet. App. 211, 219 (2018) ("DC 8520 does not define 'mild,' 'moderate,' 'moderately severe,' or 'severe,' or generally associate those terms with specific symptoms"). Although the Board has at times attempted to define these terms using dictionary definitions, those definitions are problematic because they "do little to explain the Board's understanding of these terms and do not 'disclos[e] that benchmark it employed to reach [its] conclusion.'" Casey v. McDonough, No. 21-7569, slip op. at 3 (Vet. App. Jan. 24, 2023) (mem dec) (Falvey, J.) (quoting Johnson v. Wilkie, 30 Vet. App. 245, 255 (201
define 'mild,' 'moderate,' 'moderately severe,' or 'severe,' or generally associate those terms with specific symptoms"). Although the Board has at times attempted to define these terms using dictionary definitions, those definitions are problematic because they "do little to explain the Board's understanding of these terms and do not 'disclos[e] that benchmark it employed to reach [its] conclusion.'" Casey v. McDonough, No. 21-7569, slip op. at 3 (Vet. App. Jan. 24, 2023) (mem dec) (Falvey, J.) (quoting Johnson v. Wilkie, 30 Vet. App. 245, 255 (2018) (discussing the Board's attempt to define the terms slight, mild, moderate, and severe in DC 8515). See also Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain). Although 38 C.F.R. § 4.120, 4.123, and 4.124 are "helpful in framing the analysis, [they] are not alone sufficient to explain the Board's decision absent an articulated connection to specific evidence." Lemon v. McDonough, No. 21-3949, 2022 U.S. App. Vet. Claims LEXIS 1998, *7 (Dec. 16, 2022) (mem dec) (Toth, J.). As explained in Lemon, these regulations leave gaps in defining the relevant terms that are filled by Veteran's Adjudication Manual, M21-1:

The Board "is required to discuss any relevant provisions contained in the M21-1 as part of its duty to provide adequate reasons or bases," Overton, 30 Vet. App. at 264. Clearly relevant to this case are M21-1 provisions regarding evaluations of paralysis of the sciatic nerve. The M21-1 describes mild incomplete paralysis as a disability "limited to sensory deficits that are lower graded, less persistent, or affecting a smaller area." Part V, sbpt. Iii, ch. 12, sec. A.2.c. And moderate incomplete paralysis, per the M21-1, should be "reserved for the most significant cases of sensory-only impairment," where the sensory involvement covers "a larger area in the nerve distribution." Id. M21-1 examples of a moderate disability include "motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate." Id. And the M21-1 provides that a moderately severe evaluation (that is, a 40% rating) is available when there is "[m]otor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a higher level of limitation or disability." Id. Atrophy may, but need not, be present for a moderately severe rating.

As concluded by the Court in Lemon, given the relevance of these provisions to rating disabilities of the peripheral nerves, "the Board's failure to mention the M21-1's relevant guidance in this area constitutes clear error." Lemon, at *7-*8. See also Bethea, 2 Vet. App. at 254. The Board will therefore mention, and apply, these definitions in the instant case. The above will be relevant for subsequent analyses of peripheral neuropathy in this decision.

Regarding the appeal period, the July 2010 rating decision that granted service connection for BLE peripheral neuropathy and assigned an initial rating, the December 2011 rating decision that granted service connection for BUE peripheral neuropathy and assigned an initial rating, the April 2014 rating decision that continued the initial rating for BLE peripheral neuropathy, as well as the April 2016 and November 2016 rating decisions, became final as described above. Therefore, the appeal period begins October 23, 2024, the date of the Supplemental Claim.

Finally, the characterization of the level of disability by a VA examiner is not dispositive, but for the reasons below the relevant characterizations were consistent with the evidence of record. See 38 C.F.R. § 3.100(a) (delegating the Secretary's authority "to make findings and decisions... as to the entitlement of claimants to benefits" to, inter alia, VA "adjudicative personnel"); 38 C.F.R. § 4.2 ("It is the responsibility of the rating specialist to interpret reports of examination... so that the current rating may accurately reflect the elements of disability present").

BLE Peripheral Neuropathy of
23, 2024, the date of the Supplemental Claim.

BLE Peripheral Neuropathy of the Sciatic Nerve

The Veteran's BLE peripheral neuropathy of the sciatic nerve, associated with diabetes, are currently rated 40 percent disabling from October 23, 2024 for each extremity under DC 8520. The Veteran was previously in receipt of staged ratings of 10 percent from January 13, 2010 for the LLE, and 10 percent from January 13, 2010 and 20 percent from February 22, 2016 for the RLE. The Veteran contends, via his representative in an April 2025 statement, that his BLE peripheral neuropathy of the sciatic nerve warrants 60 percent ratings each for the right and left lower extremities. For the reasons outlined below, the Board agrees.

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

Turning to the evidence, during a February 2025 VA examination, the Veteran reported numbness in the lower extremities and walking difficulties, but denied paresthesias, dysesthesias, or any surgeries or medication. Intermittent pain was described as mild and numbness was described as moderate. Bilateral knee extension was described as less than normal strength. Decreased tendon reflexes were noted in both the bilateral knees and ankles, and decreased light touch was noted in the bilateral knees, thighs, and feet, and absent in the toes. Position sense and vibration sensation was decreased in the BLE, and cold sensation was absent. No muscle atrophy or trophic changes were noted. Lastly, the VA examiner described the Veteran's incomplete paralysis of the sciatic nerve as "severe."

The Disability Benefits Questionnaire (DBQ) that the VA examiner was asked to complete in February 2025 did not differentiate between severe and moderately severe. Rather, the VA examiner marked "severe." The explicit difference between a 40 percent rating for moderately severe incomplete paralysis and the 60 percent rating for severe incomplete paralysis is that the latter also requires marked muscular atrophy. Here, as noted above, the record is absent any evidence that the Veteran suffers from marked muscle atrophy or trophic changes.

Therefore, the above evidence reflects the symptoms of the Veteran's BLE peripheral neuropathy of the sciatic nerve most closely approximate moderately severe incomplete paralysis. There is no evidence within the claims file which indicates that the Veteran's BLE peripheral neuropathy symptomatology more nearly approximated severe incomplete paralysis of the sciatic nerve with marked muscular atrophy to warrant a rating higher than 40 percent at any time in the appeal period. The February 2025 VA examination specifically noted that there were no muscle atrophy or trophic changes. Additionally, there was no indication that the Veteran's feet dangled and dropped, or that there was no active movement possible of muscle below the knee and that flexion of the knee was weakened or lost, or that there was motor and reflex impairment such as atrophy, weakness, or diminished or hyperactive reflexes at a grade reflecting a very high level of limitation or disability.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether a rating higher than 40 percent for BLE peripheral neuropathy of the sciatic nerve is warranted at any point in the appeal period. Rather, the evidence persuasively weighs against any such higher rating. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not otherwise for application in this case. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 202
was motor and reflex impairment such as atrophy, weakness, or diminished or hyperactive reflexes at a grade reflecting a very high level of limitation or disability.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether a rating higher than 40 percent for BLE peripheral neuropathy of the sciatic nerve is warranted at any point in the appeal period. Rather, the evidence persuasively weighs against any such higher rating. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not otherwise for application in this case. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

BLE Peripheral Neuropathy of the Femoral Nerve

The May 2025 rating decision on appeal granted a separate rating for BLE peripheral neuropathy of the femoral nerve and assigned an initial 30 percent disability rating for each extremity under DC 8526, effective October 23, 2024.

Under DC 8526, a 10 percent rating is assigned for mild incomplete paralysis; a 20 percent rating is assigned for moderate incomplete paralysis; a 30 percent rating is assigned for severe incomplete paralysis; and a 40 percent rating is assigned for complete paralysis of quadriceps extensor muscles.

Turning to the evidence, during a February 2025 Veteran examination, the Veteran reported numbness in the lower extremities and walking difficulties, but denied paresthesias, dysesthesias, or any surgeries or medication. Intermittent pain was described as mild and numbness was described as moderate. Bilateral knee extension was described as less than normal strength. Decreased tendon reflexes were noted in both the bilateral knees and ankles, and decreased light touch was noted in the bilateral knees, thighs, and feet, and absent in the toes. Position sense and vibration sensation were decreased in the BLE, and cold sensation was absent. No muscle atrophy or trophic changes were noted. Lastly, the VA examiner described the Veteran's incomplete paralysis of the femoral nerve as "severe."

The above evidence reflects the symptoms of the Veteran's BLE peripheral neuropathy of the femoral nerve most closely approximate severe incomplete paralysis. There is no evidence within the claims file which indicates that the Veteran's BLE peripheral neuropathy symptomatology more nearly approximated complete paralysis of the quadriceps extensor muscles to warrant a rating higher than 30 percent at any time in the appeal period, which is consistent with the April 2025 letter in which the Veteran's representative argued that the Veteran is shown to have severe incomplete paralysis of the femoral nerve entitling him to a 30 percent rating each of the right and left lower extremities under DC 8526, so the Veteran is already in receipt of the requested disability rating.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether a rating higher than 30 percent for BLE peripheral neuropathy of the femoral nerve is warranted at any point in the appeal period. Rather, the evidence persuasively weighs against any such higher rating. As the evidence persuasively weighs against a higher initial rating, the benefit of the doubt doctrine, see 38 U.S.C. § 5107 (b), 38 C.F.R. § 4.3, is therefore not for application as to this portion of the claim. See Lynch, 21 F.4th at 781-82.

BUE Peripheral Neuropathy of the Median Nerve

The Veteran's BUE peripheral neuropathy, associated with diabetes, are currently rated 20 percent disabling from October 23, 2024 for each extremity under DC 8513 for all radicular groups. The Veteran was previously in receipt of 10 percent ratings for BUE peripheral neuropathy from July 19, 2011 under DC 8515 for paralysis of the median nerve. The Veteran contends, through his representative in an April 2025 statement, that the Veteran warrants a 10 percent rating for each the right and left upper extremities.

The Board finds that the appropriate diagnostic code under which to rate the Veteran's BUE peripheral neuropathy of the median nerve is DC 8515 rather than 8513, as evidenced by its previous history being rated under DC 8515 and the Veteran's representative's arguments for separate ratings for the radial and ulnar nerves, discussed below. 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 the Veteran's relevant medical history, his current diagnosis, and demonstrated symptomatology. Any change in diagnostic code by a Veteran adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). The reasoning for this change explained above does not prejudice the Veteran because the Veteran's representative contends he warrants a rating lower than his current rating.

Under DC 8515, paralysis of the median nerve is rated, in relevant part, as follows: moderate incomplete paralysis warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity; severe incomplete paralysis warrants a 40 percent rating for the minor extremity and a 50 percent rating for the major extremity; and complete paralysis, with the hand inclined to the ulnar side, the index and middle fingers more extended than normal, considerable atrophy of the muscles of the thenar eminence, the thumb in the place of the hand (ape hand), pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, inability to make a fist, and the index and middle finger remain extended, inability to flex the distal phalanx of the thumb, defective opposition and abduction of the thumb at the right angle to the palm, weakened flexion of the wrist, and pain with trophic disturbances, warrants a 60 percent rating for the minor extremity and a 70 percent rating for the major extremity.

Turning to the evidence, during a February 2025 Veteran examination, the Veteran reported numbness in the upper extremities trouble with using his hands such as opening up the jar. The Veteran denied paresthesias and dysesthesias. Intermittent pain was described as mild and numbness was described as moderate. Decreased tendon reflexes were noted in both the bilateral biceps, triceps, and brachioradialis, but light touch to shoulders, inner/outer forearms, hands and fingers were normal, as were position sense, vibration sensation, and cold sensation. No muscle atrophy or trophic changes were noted. Lastly, the VA examiner described the Veteran's incomplete paralysis of the median nerve as "mild."

The above evidence reflects the symptoms of the Veteran's BUE peripheral neuropathy of the median nerve most closely approximate mild incomplete paralysis. There is no evidence within the claims file which indicates that the Veteran's BLE peripheral neuropathy symptomatology more nearly approximated moderate or severe incomplete paralysis of the median nerve to warrant a rating higher than 20 percent at any time in the appeal period, which is consistent with the April 2025 letter in which the Veteran's representative argued that the Veteran is shown to have mild incomplete paralysis of the median nerve entitling him to a 10 percent rating each of the right and left lower extremities under DC 8515.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether a rating higher than 20 percent for BUE peripheral neuropathy of the median nerve is warranted at any point in the appeal period. Rather, the evidence persuasively weighs against any such higher rating. As the evidence persuasively weighs against a higher initial rating, the benefit of the doubt doctrine, see 38 U.S.C. § 5107 (b), 38 C.F.R. § 4.3, is therefore not for application as to this portion of the claim. See Lynch, 21 F.4th at 781-82.

Separate Initial Ratings for Radial, Ulnar, and External Popliteal Nerves

In the April 2025 letter submitted by the Veteran's representative, the Veteran argued that in addition to his current ratings, his BLE and BUE peripheral neuropathy warrant separate ratings for the BUE radial nerve, BUE ulnar nerve, and BLE external popliteal nerve based on the results of the February 2025 VA examination.

The Board must
doctrine, see 38 U.S.C. § 5107 (b), 38 C.F.R. § 4.3, is therefore not for application as to this portion of the claim. See Lynch, 21 F.4th at 781-82.

Separate Initial Ratings for Radial, Ulnar, and External Popliteal Nerves

The Board must also consider whether separate ratings are warranted for paralysis of other nerves as well as neuritis or neuralgia. Banschbach v. McDonough, 37 Vet. App. 422, 429 (2024) ("nothing in the rating schedule or related regulations that prohibits consideration of separate ratings for neuritis or neuralgia of a peripheral nerve when a veteran is rated for paralysis of the same nerve under § 4.124a.... assignment of a paralysis rating under § 4.124a does not preclude as a matter of law separate evaluations for neuritis and neuralgia of the same nerve").

Under DC 8515 (for paralysis of the median nerve): a 10 percent rating is warranted for mild, incomplete paralysis (for either the dominant [major] or nondominant [minor] extremity); a 20 percent rating is warranted for moderate, incomplete paralysis of the nondominant (minor) extremity; a 30 percent rating is warranted for moderate, incomplete paralysis of the dominant (major) extremity; a 40 percent rating is warranted for severe, incomplete paralysis of the nondominant (minor) extremity; a 50 percent rating is warranted for severe, incomplete paralysis of the dominant (major) extremity; a 60 percent (maximum schedular for the nondominant [minor] extremity) rating is warranted for complete paralysis (the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand [ape hand]; pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances); and a 70 percent (maximum schedular for the dominant [major] extremity) rating is warranted for complete paralysis (the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand [ape hand]; pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances). Further, 38 C.F.R. § 4.124a states that, when the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree.

Under DC 8516 for the ulnar nerve of the minor extremity, a 10 percent evaluation is warranted for mild incomplete paralysis. A 20 percent evaluation is warranted for moderate incomplete paralysis. A 30 percent evaluation is warranted for severe incomplete paralysis. A 50 percent evaluation is warranted for complete paralysis of the minor extremity with symptoms such as the "griffin claw" deformity, due to flexor contraction of the ring and little fingers, atrophy very marked in dorsal interspace and thenar and hypothenar eminences; loss of extension of ring and little fingers cannot spread the fingers (or reverse), cannot adduct the thumb; flexion of wrist weakened.

Under DC 8521, paralysis of the external popliteal nerve is rated as follows: complete paralysis (foot drop and slight droop of first phalanges of all toes, cannot dorsiflex the foot, extension (dorsal flexion) of proximal phalanges of toes lost; abduction of foot lost, adduction weakened; anesthesia covers entire dorsum of foot and toes) is rated at 40 percent; severe incomplete paralysis is rated at 30 percent; moderate incomplete paralysis is rated at 20 percent; and mild incomplete paralysis is rated at 10 percent.

To that end, looking at the February
fingers cannot spread the fingers (or reverse), cannot adduct the thumb; flexion of wrist weakened.

To that end, looking at the February 2025 VA examination, the examiner noted the Veteran has mild incomplete paralysis of the bilateral radial nerve, mild incomplete paralysis of the bilateral ulnar nerve, and moderate incomplete paralysis of the bilateral external popliteal nerve.

Thus, separate ratings are warranted for these nerves. While an examiner's characterization of the level of disability is not binding on the Board, 38 C.F.R. § 3.100(a) (delegating the Secretary's authority "to make findings and decisions... as to the entitlement of claimants to benefits" to, inter alia, VA "adjudicative personnel"); 38 C.F.R. § 4.2 ("It is the responsibility of the rating specialist to interpret reports of examination... so that the current rating may accurately reflect the elements of disability present"), here the examiner's characterizations are consistent with the other evidence of record. With regard to the popliteal nerve under DC 8521, there was no muscle atrophy or trophic changes, no indication of the foot dangling or dropping, no evidence that active movement was not possible with regard to the muscle below the knee, no indication that flexion of the knee was weakened or lost, and no indication that there was motor and reflex impairment such as atrophy, weakness, or diminished or hyperactive reflexes at a grade reflecting a very high level of limitation or disability. As to the radial and ulnar nerves, the symptoms in the BUE show decreased tendon reflexes in both the bilateral biceps, triceps, and brachioradialis, but light touch to shoulders, inner/outer forearms, hands and fingers were normal, as were position sense, vibration sensation, and cold sensation. No muscle atrophy or trophic changes were noted.

Therefore, separate initial 20 percent ratings, but no higher, are warranted for BLE peripheral neuropathy of the external popliteal nerve under DC 8521; separate initial 10 percent ratings, but no higher, are warranted for BLE peripheral neuropathy of the ulnar nerve under DC 8516; and separate initial 20 percent ratings, but no higher, are warranted for BLE peripheral neuropathy of the radial nerve under DC 8514, each from October 23, 2024.

Finally, because pain is one of the symptoms that is the basis for each of the above ratings, a separate rating for pain caused by neuralgia or neuritis is not warranted, as this would constitute impermissible pyramiding under 38 C.F.R. § 4.14. Banschbach, 37 Vet. App. at 16 (remanding for the Board to consider whether separate ratings were warranted for neuritis or neuralgia without violating the rule against pyramiding).

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether any higher or separate ratings are warranted, other than those that have been granted. Rather, the evidence persuasively weighs against any such higher or separate ratings. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not otherwise for application in this case. See Lynch, 21 F.4th at 781-82.

Earlier Effective Date

On his January 2026 Notice of Disagreement, the Veteran sought an earlier effective date for the award of service connection for chronic kidney disease as well as the award of service connection for BLE peripheral neuropathy of the femoral nerve. The November 2022 rating decision that granted service connection for chronic kidney disease assigned an effective date of July 8, 2022, the original date of claim for service connection for chronic kidney disease, claimed as secondary to service-connected diabetes. The November 2025 rating decision that granted service connection for BLE peripheral neuropathy of the femoral nerve assigned an effective date of October 23, 2024, the date of the Supplemental Claim.

Unless specifically provided otherwise, the effective date of an award of disability compensation is set in accordance with the facts found but cannot be earlier than the date of receipt of the claim for the compensation that was granted.
award of service connection for BLE peripheral neuropathy of the femoral nerve. The November 2022 rating decision that granted service connection for chronic kidney disease assigned an effective date of July 8, 2022, the original date of claim for service connection for chronic kidney disease, claimed as secondary to service-connected diabetes. The November 2025 rating decision that granted service connection for BLE peripheral neuropathy of the femoral nerve assigned an effective date of October 23, 2024, the date of the Supplemental Claim.

Unless specifically provided otherwise, the effective date of an award of disability compensation is set in accordance with the facts found but cannot be earlier than the date of receipt of the claim for the compensation that was granted. 38 U.S.C. § 5110(a). If the claim for compensation was received within one year of separation from service, the effective date is the day following separation from service, otherwise it is the date of claim or the date entitlement arose, whichever is later. See 38 U.S.C. § 5110(b)(1); see also 38 C.F.R. § 3.400(b)(2)(i) (the effective date for a claim for disability compensation is the date of receipt of claim or the date entitlement arose, whichever is later, unless filed within a year of separation).

In determining the date entitlement arose, when an original claim for benefits is pending, the Board must determine when a claimant's disability manifested itself under all the "facts found" and "the date on which the evidence is submitted is irrelevant." McGrath v. Gober, 14 Vet. App. 28, 35 (2000) (a statement regarding prior conditions may support an effective date prior to the date of the statement); see also Lalonde v. West, 12 Vet. App. 377, 382 (1999) ("[T]he effective date of an award of service connection is not based on the date of the earliest medical evidence demonstrating a causal connection, but on the date that the application upon which service connection was eventually awarded was filed with VA"). The Court has elaborated that "the effective date of an award of service connection is not based on the date of the earliest medical evidence demonstrating a causal connection, but on the date that the application upon which service connection was eventually awarded was filed with VA." Stowers v. Shinseki, 26 Vet. App. 550, 553-54 (2014) (quoting Lalonde, 12 Vet. App. 377).

VA amended its adjudication regulations on March 24, 2015, to require that all claims governed by VA's adjudication regulations be filed on standard forms prescribed by the Secretary, regardless of the type of claim or posture in which the claim arises. The amendments, however, are only effective for claims and appeals filed on or after March 24, 2015.

Moreover, the Federal Circuit reversed the Court and held in Sellers v. Wilkie, 965 F.3d 1328 (Fed. Cir. 2020) that a claim must identify the sickness, disease, or injury for which compensation is sought, with at least a high level of generality, before VA's duty to assist in the development of the claim is triggered.

On July 9, 2022, VA received the Veteran's VA Form 21-526Z (Fully Developed Claim (Compensation) seeking service connection for chronic kidney disease (Intent to File was received on July 8). This is the first and only claim of record seeking service connection for chronic kidney disease, and this is the Veteran's current effective date for the award of service connection for chronic kidney disease. The record contains no earlier claim, formal or informal, for service connection for chronic kidney disease, and the Veteran makes no argument otherwise.

In sum, there is no evidence of record of any unadjudicated formal claim of service connection for chronic kidney disease prior to July 8, 2022, nor is there any prior communication in the record that could be considered an informal claim for VA compensation for the same. July 8, 2022, is therefore the earliest possible effective date for the award of service connection for chronic kidney disease.

With regard to the BLE peripheral neuropathy of the femoral nerve, service connection was granted, secondary to service-connected diabetes, in the May 2025 rating decision and assigned an effective date of October 23, 2024, the date of the Supplemental Claim. The record contains no earlier claim, formal or informal, for service connection for BLE peripheral neuropathy of the femoral nerve, and the Veteran makes no argument otherwise.

In sum, there is no evidence of record of any unadjudicated formal claim of service connection for BLE peripheral neuropathy of
for VA compensation for the same. July 8, 2022, is therefore the earliest possible effective date for the award of service connection for chronic kidney disease.

In sum, there is no evidence of record of any unadjudicated formal claim of service connection for BLE peripheral neuropathy of the femoral nerve prior to October 23, 2024, nor is there any prior communication in the record that could be considered an informal claim for VA compensation for the same. October 23, 2024, is therefore the earliest possible effective date for the award of service connection for BLE peripheral neuropathy.

TDIU

The Veteran argues, via his representative, in a January 2026 statement attached to his NOD, that the functional limitations caused by the combined effects of his service-connected disabilities have rendered him unemployable since July 8, 2022. The May 2025 rating decision on appeal dismissed entitlement to a TDIU as moot because the Veteran was in receipt of a combined 100 percent rating effective October 23, 2024. The Veteran argues, via his representative, that TDIU has properly been on appeal as part and parcel of his service connection claim for chronic kidney disease and appeal for a higher initial rating for this disability, and his specific contention is that the Board should find him entitled to a TDIU from the July 8, 2022, effective date of service connection for this disability, pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). For the reasons below, the Board agrees.

A TDIU is provided where the combined schedular evaluation for service-connected disabilities is less than total. 38 C.F.R. § 4.16 (a). VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that the veteran is precluded from obtaining or maintaining any gainful employment by reason of his or her service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16; Witkowski v. Collins, 38 Vet. App. 459 (2025) (en banc). A finding of total disability is appropriate "when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation." See 38 C.F.R. §§ 3.340 (a)(1), 4.15.

In Ray v. Wilkie, 31 Vet. App. 58, 73 (2019), the Court defined the term "unable to secure and follow a substantially gainful occupation" as having two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the following: the Veteran's history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue.

The central inquiry is, "whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The issue is not whether the Veteran can find employment generally, but whether the Veteran can perform the physical and mental acts required by employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Consideration may be given to the Veteran's education, special training, and previous work experience, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19.

As of July 8, 2022, the Veteran was rated 30 percent for chronic kidney disease, 10 percent for LLE peripheral neuropathy, 20 percent for RLE peripheral neuropathy, 10 percent for LUE peripheral neuropathy, 10 percent for RLE peripheral neuropathy, and as of this decision, 40 percent for diabetes. The Veteran's combined disability rating on July 8, 2022
3). Consideration may be given to the Veteran's education, special training, and previous work experience, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19.

Turning to the evidence, based on the Veteran's February 2024 formal application for a TDIU, it is notable that the Veteran was not working at any point during the period on appeal and he was last employed in October 2018. His education history includes two years of college and various licensures such as radio and TV repair, and air conditioning. He began education in home entertainment electronic systems and electronic engineering, a bachelor's degree in electronics, and computer science, none of which were completed. His occupational history included working as a parts manager and golf card mechanic at Kansas Golf and Turf Inc. from October 1995 to October 2008, and for Wichita Golf Cars from 2017 to October 2018. He was also a cross-country truck driver for wheels Unlimited Inc. from May 2010 to January 2011. His responsibilities at his last job included managing the parts as well as providing assistance and education to other mechanics as needed.

During a March 2016 VA examination, the Veteran exhibited reduced strength and sensation in his extremities due to his diabetes and BLE peripheral neuropathy, and his fall risk was assessed as moderate in a March 2020 VA treatment note. During an April 2021 VA treatment note, the Veteran reported experiencing tremors causing him to spill food while carrying a plate.

In an addendum to his February 2024 formal TDIU application, the Veteran described the impact of his diabetes, chronic kidney disease, and peripheral neuropathy:

"Since at least July 2022, I had to go to the bathroom frequent during the day due to my service-connected chronic kidney disease and diabetes. I went to the bathroom around six to seven times during a day. Whenever I was out in public with my family, I made sure to know where the bathroom was at all times. Most nights, I woke up at least once to use the bathroom. It usually took me anywhere from thirty to forty-five minutes to fall back to sleep. I felt fatigued and groggy the next day as a result. This made it hard to function effectively throughout the day. I fell asleep more often during the day. This happened a couple of times a week, usually when I was sitting and watching TV. During these instances, I was asleep for around twenty minutes on and off throughout the day.

"I constantly experienced numbness in all my extremities due to my peripheral neuropathy. The numbness was more present in my legs and feet. If I stepped on something around the house, I usually didn't feel it. I stumbled once or twice a week because of the numbness in my legs. Normally, I caught myself before falling. However, about two weeks ago I fell and hurt my knee because of the severity of the numbness and weakness in my extremities. I walked around with a limp for about two days before I felt better. I have about four steps I needed to use to enter or leave my home, I always hung on to the rail for support and made sure I stepped properly and fully on each step to avoid falling because of the numbness and weakness in my legs.

"Due to my peripheral neuropathy, I was only able to stand for ten to fifteen minutes before my legs started to hurt and the numbness increased. I tried shifting around to alleviate the discomfort, but only found relief when I sat. I was only able to walk for about ten to fifteen minutes at a slower pace before I needed to rest. I had a walking stick to help me walk whenever I was on uneven grounds as I usually stumbled and had trouble feeling my feet. I needed to rest for around ten to fifteen minutes before I could start walking or standing again. When I sat, I needed to shift around to attempt to feel more comfortable.

"I often experienced numbness in my fingertips and tremors in my hands multiple times a day. Due to these tremors, it was hard to grip items. I often dropped or shook items in my hands. I often spilled
around to alleviate the discomfort, but only found relief when I sat. I was only able to walk for about ten to fifteen minutes at a slower pace before I needed to rest. I had a walking stick to help me walk whenever I was on uneven grounds as I usually stumbled and had trouble feeling my feet. I needed to rest for around ten to fifteen minutes before I could start walking or standing again. When I sat, I needed to shift around to attempt to feel more comfortable.

"I often experienced numbness in my fingertips and tremors in my hands multiple times a day. Due to these tremors, it was hard to grip items. I often dropped or shook items in my hands. I often spilled drinks and dropped small items like pens or pills due to my hands shaking. I avoided writing and typing in general because I was unable to keep my hands steady. I've had to scribble my name onto documents due to not being able to write my name properly. I was unable to lift more than fifteen pounds because of the numbness and tremors in my hands. Due to the reasons I highlighted above, I believe that my service-connected conditions have prevented me from working in any capacity since at least October 2018."

Incorporating the symptoms of the Veteran's service-connected disabilities described in the decision above, the evidence reflects that the Veteran has a high school diploma with some incomplete secondary education and occupational experience requiring frequent use of his hands and continuous ambulation. Overall, the Veteran experiences symptoms associated with his service-connected disabilities that result in functional impairments that would significantly interfere with his ability to secure and follow any substantially gainful employment consistent with his education and occupational experience. For instance, the evidence reflect symptoms and impairments associated with his service-connected diabetes, peripheral neuropathy, and chronic kidney disease such as reduced strength and sensation in his extremities, a history of instability, reduced ability to stand or walk, hand tremors and inability to type or write. This has resulted in significant functional imitations that prevent the Veteran from performing any type of substantially gainful employment, physician or non-physical, consistent with his education and occupational experience.

In light of the above discussion of the severity of the combined symptoms of the Veteran's service-connected disabilities and his educational and occupational experience, the evidence is approximately evenly balanced as to whether the Veteran's service-connected disabilities precluded gainful employment for which his education and occupational experience might have otherwise qualified him from July 8, 2022. Therefore, entitlement to a TDIU from July 8, 2022 is warranted.

DEA

Chapter 35 DEA eligibility requires that a Veteran meet certain criteria, one of which is permanent, totally disabling service-connected disability or disabilities. 38 U.S.C. §§ 3500, 3501, 3510; 38 C.F.R. §§ 3.807, 21.3021. In light of the current decision, the Veteran is entitled to a TDIU from July 8, 2022. Therefore, the Veteran has been adjudicated to have permanent and total disability from July 8, 2022, and entitlement to basic eligibility for DEA is therefore warranted effective July 8, 2022. In sum, the Veteran meets the criteria for basic eligibility for DEA from July 8, 2022 to the present.

Jonathan Hager

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board JR Cummings, 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.

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