ARTERIOSCLEROTIC HEART DISEASE (CORONARY ARTERY DISEASE)

Summary

The Veteran, who served in the United States Air Force from June 1959 to June 1979, appeals multiple rating decisions concerning various service-connected conditions. The Veteran sought an increased rating for prostate cancer, bilateral lower extremity neuropathy (femoral and sciatic nerves), pubis and bilateral lower extremity scars, diabetes mellitus type II, peripheral artery disease, and arteriosclerotic heart disease. The Veteran also appealed the denial of service connection for erectile dysfunction and pubis/scrotum scars, and sought a higher rating for these conditions. Additionally, the Veteran appealed the denial of TDIU and sought special monthly compensation (SMC) for housebound status. The Board reviewed evidence of record as of the dates of the appealed rating decisions. For arteriosclerotic heart disease, the Board granted a 100 percent rating, finding the criteria for this level of disability were met. Similarly, the Board granted 60 percent for prostate cancer residuals, 40 percent for bilateral sciatic nerve radiculopathy, 40 percent for peripheral artery disease, 30 percent for left femoral nerve radiculopathy, and 30 percent for right femoral nerve radiculopathy. However, the Board denied increased ratings for diabetes mellitus type II and erectile dysfunction, as well as initial ratings for pubis/scrotum scars and left/right lower extremity scars, finding the criteria were not met. The Board also denied TDIU, concluding the Veteran's combined rating did not render him unemployable. Finally, the Board granted SMC for housebound status prior to October 25, 2024.

Rationale

Criteria for 100% rating met; Demonstrated symptoms between 1-3 METS; Breathlessness and fatigue noted

Full Decision Text

Citation Nr: A26040774
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 260305-636548
DATE: April 30, 2026

ORDER

An initial rating of 100 percent for arteriosclerotic heart disease is granted.

An initial rating of 60 percent, but no higher, for prostate cancer is granted.

An initial rating of 40 percent, but no higher, for left lower extremity peripheral neuropathy (sciatic nerve) is granted.

An initial rating of 40 percent, but no higher, for right lower extremity peripheral neuropathy (sciatic nerve) is granted.

An initial rating of 30 percent, but no higher, for left lower extremity peripheral neuropathy (femoral nerve) is granted.

An initial rating of 30 percent but no higher, for right lower extremity peripheral neuropathy (femoral nerve) is granted.

An initial rating in excess of 20 percent for diabetes mellitus, type II, is denied.

An initial compensable rating for erectile dysfunction is denied.

An initial rating of 40 percent, but no higher, for peripheral artery disease is granted.

An initial compensable rating for pubis and scrotum scars is denied.

An initial compensable rating for left lower extremity scars is denied.

An initial compensable rating for right lower extremity scars is denied.

A total disability rating based on individual unemployability (TDIU) as a result of service-connected disabilities based on a single disability is denied.

Special monthly compensation (SMC) based housebound status prior to October 25, 2024, is granted.

FINDINGS OF FACT

1. For the rating period on appeal, the competent and probative evidence of record tends to show the Veteran's arteriosclerotic heart disease demonstrated between 

1-3 METS resulting in breathlessness and fatigue.

2. For the rating period on appeal, the Veteran's service-connected prostate cancer has not had local reoccurrence or metastasis, and his prostate cancer residuals have approximated urine leakage requiring absorbent materials which must be changed 4 or more times per day and the use of appliance; no renal dysfunction associated with his prostate cancer has been demonstrated.

3. For the rating period on appeal, the competent and probative evidence shows moderately severe incomplete paralysis of the left lower extremity (sciatic nerve).

4. For the rating period on appeal, the competent and probative evidence shows moderately severe incomplete paralysis of the right lower extremity (sciatic nerve).

5. The competent and probative evidence shows severe incomplete paralysis of the left lower extremity (femoral nerve).

6. The competent and probative evidence shows severe incomplete paralysis of the right lower extremity (femoral nerve).

7. For the rating period on appeal, the Veteran's diabetes mellitus required oral hypoglycemic agents, and insulin injections, without regulation of activities as part of the medical management of the diabetes.

8. The evidence persuasively weighs against finding the Veteran's service-connected erectile dysfunction is manifested by penile deformity.

9. Resolving doubt in the Veteran's favor, his peripheral artery disease has resulted ankle-brachial index (ABI) between 0.54-0.66.

10. The Veteran's pubis and scrotum scars are not painful or unstable and are less than 144 inches squared.

11. The Veteran's left lower extremity scars are not painful or unstable and are less than 39 centimeters squared.

12. The Veteran's right lower extremity scars are not painful or unstable and are less than 39 centimeters squared.

13. For the entire rating period on appeal, the Veteran has had a combined 100 percent schedular rating for his various service-connected disabilities, and no single service-connected disability has rendered the Veteran unable to obtain and maintain gainful employment.

14. Prior to October 25, 2024, the Veteran is in receipt of a 100 percent rating for a heart disorder and has a separate combined 60 percent rating for his other, independent service-connected disabilities.

CONCLUSIONS OF LAW

1. The criteria for an initial rating of 100 percent for arteriosclerotic heart disease are met throughout the period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.100, 4.104, Diagnostic Codes (DCs) 7018-7005.

2. The criteria for entitlement to an initial rating of 60 percent, but no higher, for residuals of prostate cancer are met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 
CONCLUSIONS OF LAW

1. The criteria for an initial rating of 100 percent for arteriosclerotic heart disease are met throughout the period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.100, 4.104, Diagnostic Codes (DCs) 7018-7005.

2. The criteria for entitlement to an initial rating of 60 percent, but no higher, for residuals of prostate cancer are met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.115a, 4.115b, DC 7528.

3. The criteria for an initial rating of 40 percent, but no higher, for radiculopathy of the left lower extremity (sciatic nerve) are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.124a, DC 8520.

4. The criteria for an initial rating of 40 percent, but no higher, for radiculopathy of the right lower extremity (sciatic nerve) are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.124a, DC 8520.

5. The criteria for an initial rating of 30 percent, but no higher, for radiculopathy of the left lower extremity (femoral nerve) are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.124a, DC 8526.

6. The criteria for an initial rating of 30 percent, but no higher, for radiculopathy of the right lower extremity (femoral nerve) are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.124a, DC 8526.

7. The criteria for an initial rating in excess of 20 percent for diabetes mellitus are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.119, DC 7913.

8. The criteria for an initial compensable rating for the Veteran's erectile dysfunction are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.7, DC 7522.

9. The criteria for entitlement to an initial rating of 40 percent, but no higher, for peripheral artery disease are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.20, 4.114, DC 7114.

10. The criteria for an initial compensable rating for pubis and scrotum scars are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.118, DCs 7800-7805.

11. The criteria for an initial compensable rating for left lower extremity scars are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.118, DCs 7800-7805.

12. The criteria for an initial compensable rating for right lower extremity scars are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.118, DCs 7800-7805.

13. The criteria for entitlement to TDIU based on a single disability are not met for any period of time on appeal. 38 U.S.C.
 for an initial compensable rating for left lower extremity scars are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.118, DCs 7800-7805.

12. The criteria for an initial compensable rating for right lower extremity scars are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.118, DCs 7800-7805.

13. The criteria for entitlement to TDIU based on a single disability are not met for any period of time on appeal. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.341, 4.16, 4.18, 4.25.

14. Prior to October 25, 2024, the criteria for SMC at the housebound rate are met. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service in the United States Air Force from June 1959 to June 1979.

To help clarify the periods on appeal, the Board will briefly discuss the rating decisions that are on appeal in this matter. The March 5, 2025 rating decision continued the ratings for prostate cancer, bilateral lower extremities (femoral and sciatic nerves), erectile dysfunction, pubis and bilateral lower extremity scars, diabetes mellitus, type II, peripheral artery disease, and arteriosclerotic heart disease). 

The May 23, 2025 rating decision increased the ratings for prostate cancer and lower extremity neuropathy involving the femoral and sciatic nerves and continued the ratings for pubis and bilateral lower extremity scars and diabetes mellitus, type II, and granted a 100 percent rating for arteriosclerotic heart disease effective October 25, 2024. The Veteran requested higher-level review in June 2025 regarding the May 2025 rating decision. A July 2025 higher-level review decision continued the ratings for arteriosclerotic heart disease, prostate cancer, and bilateral lower extremity neuropathy involving the femoral and sciatic nerves. 

An October 9, 2025 rating decision continued the ratings for diabetes mellitus, type II, and peripheral artery disease. 

The Veteran timely appealed the March, May, and October 2025 rating decisions to the Board and requested the Board's Direct Review docket in a March 5, 2026, VA Form 10182 and did not appeal the rating for bilateral hearing loss or his chest scars.  

Based upon the selection of the Direct Review option, the Board may only consider the evidence of record as of March 5, 2025 (erectile dysfunction) and October 9, 2025 (diabetes mellitus, type II and peripheral artery disease) -the date of the rating decisions on appeal. See 38 C.F.R. § 20.301. Additionally, the Board may only consider the evidence of record as of May 23, 2025 (prostate cancer, lower extremity neuropathy involving the femoral and sciatic nerves, pubis and bilateral lower extremity scars, and arteriosclerotic heart disease) -the date of the rating decision which prompted the higher-level review requested. 38 C.F.R. § 20.301 If the Veteran submitted evidence that was added to the record after March 5, 2025, May 23, 2025, and October 9, 2025, the Board did not consider it. If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying such evidence. See 38 C.F.R. § 3.2501.

The Board recognizes the Veteran also appealed the effective date for dependency benefits from the October 10, 2025, notification letter. However, that issue will be addressed in a separate Board decision. 

Also, the Board acknowledges a December 2025 rating decision addressed TDIU. See 12/11/2025, Rating Decision - Narrative. The Veteran has not yet appealed that rating decision. However, the Board finds the TDIU matter is raised as part of the increased ratings claim during the period on appeal. See Rice v. Shinseki, 22 Vet. App. 447, 454-55 (2009).

Lastly, the Veteran, through his authorized attorney-representative, submitted a written waiver of the remaining time to change appeal lanes in March 2026, and waived notice of the right to a pre-decisional hearing. See 3
 issue will be addressed in a separate Board decision. 

Also, the Board acknowledges a December 2025 rating decision addressed TDIU. See 12/11/2025, Rating Decision - Narrative. The Veteran has not yet appealed that rating decision. However, the Board finds the TDIU matter is raised as part of the increased ratings claim during the period on appeal. See Rice v. Shinseki, 22 Vet. App. 447, 454-55 (2009).

Lastly, the Veteran, through his authorized attorney-representative, submitted a written waiver of the remaining time to change appeal lanes in March 2026, and waived notice of the right to a pre-decisional hearing. See 3/5/2026, VA Form 10182; 38 C.F.R. § 20.202(c). As such, the Board will proceed to adjudicate this appeal. Additionally, the Veteran, through his authorized attorney-representative, waived any additional VA notice, assistance, or any errors that were of record at the time of the rating decision on appeal. Specifically, the attorney representative waived any errors and/or Board development in the submitted brief. See id.; see Janssen v. Principi, 15 Vet. App. 370, 373 (2001) (stating that represented appellants may waive a procedural right where they have knowledge of the right and an intent to voluntarily and freely surrender it); see also Robinson v. Peake, 21 Vet. App. 545, 554 (2008) (explaining that the Board may assume that "an experienced attorney in veteran's law... says what he means and means what he says"). The Board accepts this written waiver provided by the Veteran's accredited attorney representative. 

Increased Rating

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentages are based on the average impairment of earning capacity as a result of service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. 

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). 

The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other. Esteban v. Brown, 6 Vet. App. 259, 262 (1994); 38 C.F.R. § 4.14. 

The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a).

1. Entitlement to an increased initial rating for arteriosclerotic heart disease

Prior to October 25, 2024, the Veteran received an initial rating of 30 percent under diagnostic code 7005. From October 25, 2024, onward, the Veteran receives a 100 percent rating under DC 7018-7005. 

Effective November 14, 2021, VA amended the rating criteria for arteriosclerotic heart disease under 38 C.F.R. § 4.104, Diagnostic Code 7005. 86 Fed. Reg. 54089 (Sep. 30, 2021). This amended regulation applies to all applications for benefits received by VA or that are pending before the RO on or after November 14, 2021. Claims pending prior to the effective date will be considered under both the pre- and post-amendment rating criteria, and whichever is more favorable to the Veteran will be applied. However, the Board may not apply the post-amendment rating criteria to a period prior to its effective date, unless the regulation explicitly provides otherwise.
14, 2021, VA amended the rating criteria for arteriosclerotic heart disease under 38 C.F.R. § 4.104, Diagnostic Code 7005. 86 Fed. Reg. 54089 (Sep. 30, 2021). This amended regulation applies to all applications for benefits received by VA or that are pending before the RO on or after November 14, 2021. Claims pending prior to the effective date will be considered under both the pre- and post-amendment rating criteria, and whichever is more favorable to the Veteran will be applied. However, the Board may not apply the post-amendment rating criteria to a period prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003).

However, the Veteran's claim period dates from June 30, 2023, onward. Therefore, only the new rating criteria that is effective from November 14, 2021, is applicable in this case.

Under 38 C.F.R. § 4.104, Diagnostic Code 7005, arteriosclerotic heart disease (coronary artery disease) is rated in accordance with the General Rating Formula for Diseases of the Heart, which provides, in pertinent part, that a 60 percent rating is warranted where a workload of 3.1-5.0 METs results in heart failure symptoms. 38 C.F.R. § 4.104, Diagnostic Code 7005, General Rating Formula for Diseases of the Heart. A 100 percent rating is warranted where a workload of 3.0 METs or less results in heart failure symptoms. Id.

One MET is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. 38 C.F.R. § 4.104, Note (2). When the level of METs at which breathlessness, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in those symptoms may be used. Id.

For purposes of the General Rating Formula for Diseases of the Heart, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope. 38 C.F.R. § 4.104, Note (3).

The Veteran underwent an examination for his heart disorder in June 2023 (associated with the claims file in September 2023). See 9/8/2023, C&P Exam. The Veteran acknowledged his symptoms had improved. The Veteran reported that he had shortness of breath with physical exertion. His prior surgical history was noted. The Veteran required aspirin for blood clot prevention and Atorvastatin to lower lipids. Atrial fibrillation was reported. An interview-based METs was performed. The examiner indicated that exercise testing was not performed as it had significant risk. The examiner found that between 5-7 METS resulted in breathlessness. The Veteran had shortness of breath with physical exertion. 

In February 2025, the Veteran participated in an additional examination. See 5/20/2025, C&P Exam. The Veteran's symptoms had progressed and he had dyspnea. He required continuous medications to include Valsartan, Hydralazine, and Xarelto. The Veteran's now had a history of a myocardial infarction from September 2023. Atrial fibrillation was noted. An interview-based METs was performed. The examiner indicated that exercise testing was not performed as it had significant risk and was contraindicated. The examiner found that between 1-3 METS resulted in breathlessness and fatigue. 

After review of the competent and probative evidence, the Board finds that an initial rating of 100 percent is warranted. Initially, the Board acknowledges the Veteran's METs interview showed lesser symptoms in the 2023 examination. However, the Board finds this to be a temporary improvement in the Veteran's symptoms. For example, shortly after the June 2023 examination, the Veteran experienced a myocardial infarction in September 2023. The Board finds this evidence to persuasively show the June 2023 examination findings to be a transient improvement in his symptoms. Therefore, the Board finds the 2025 examination findings to be applicable for the entire period on appeal. The findings from the 2025 examination showed that between 1-3 METS resulted in breathlessness and
 evidence, the Board finds that an initial rating of 100 percent is warranted. Initially, the Board acknowledges the Veteran's METs interview showed lesser symptoms in the 2023 examination. However, the Board finds this to be a temporary improvement in the Veteran's symptoms. For example, shortly after the June 2023 examination, the Veteran experienced a myocardial infarction in September 2023. The Board finds this evidence to persuasively show the June 2023 examination findings to be a transient improvement in his symptoms. Therefore, the Board finds the 2025 examination findings to be applicable for the entire period on appeal. The findings from the 2025 examination showed that between 1-3 METS resulted in breathlessness and fatigue. As such, when resolving reasonable doubt in favor of the Veteran, the Board finds that an initial rating of 100 percent is warranted for the Veteran's disorder under DC 7005 as between 1-3 METS resulted in breathlessness and fatigue.

2. Entitlement to an increased initial rating for prostate cancer

Prior to October 25, 2024, the Veteran received an initial 40 percent rating for his prostate cancer residuals effective May 15, 2007. From October 25, 2024, the Veteran receives a 60 percent rating. He is rated under DC 7528. 

Under DC 7528, a 100 percent rating is warranted following the cessation of surgical, X-ray, antineoplastic chemotherapy, or other therapeutic procedures with a mandatory VA examination at the expiration of six months. If there has been no local recurrence or metastasis, it will be rated on the residuals as voiding dysfunction or renal dysfunction, whichever is predominant. Id.

The rating criteria applicable to the genitourinary system were amended effective November 14, 2021. See 86 Fed. Reg. 54081 (Sep. 30, 2021). However, the criteria applicable here, specifically Diagnostic Code 7528 and the criteria pertaining to voiding dysfunction, were unchanged. See 38 C.F.R. §§ 4.115A, 4.115B, Diagnostic Code 7528 (2020); 38 C.F.R. §§ 4.115A, 4.115B, Diagnostic Code 7528 (2022). These amendments did not significantly revise the rating criteria under Diagnostic Code 7525 except to replace "Epididymo-orchitis" with "Prostatitis, urethritis, epididymitis, orchitis (unilateral or bilateral)." As such, a determination as to whether the prior or revised criteria is more beneficial to the Veteran is not necessary here.

For voiding dysfunction, a 20 percent rating is warranted when wearing of absorbent materials which must be changed less than 2 times per day is required. A 40 percent rating is warranted for when absorbent materials must be changed 2 to 4 times per day. A 60 percent rating is warranted when use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day is required.

For urinary frequency, a 10 percent rating is warranted for daytime voiding interval between two and three hours or awakening to void two times per night. A 20 percent rating is warranted for daytime voiding interval between one and two hours or awakening three to four times per night. A 40 percent rating is warranted for daytime voiding intervals less than one hour or awakening to void five or more times per night.

For obstructed voiding, a 0 percent rating is warranted for obstructive symptomatology with or without stricture disease requiring dilatation 1 to 2 times per year. A 10 percent rating is warranted for marked obstructive symptomatology such as hesitancy, slow or weak stream, or decreased force of stream (with one or a combination of: post-void residuals greater than 150 cc; markedly reduced peak flow rate on uroflowmetry; recurrent urinary tract infection secondary to obstruction; or stricture requiring periodic dilatation. A 30 percent rating is warranted for urinary retention requiring intermittent or continuous catheterization.).

The Veteran had an examination in October 2022. See 10/20/2022, C&P Exam. The Veteran's prostate cancer was stable with no objective symptoms. He did not take continuous medication. No renal dysfunction was noted. A voiding dysfunction was noted. The examiner indicated it caused urine leakage that required absorbent material which needed to be changed two to four times per day. It did not require the use of an appliance. He had daytime voiding interval between two and three hours and nighttime awakening to void two times. He did not have signs or symptoms of obstructive voiding. He did not have a history of chronic prostatitis, urethritis, epididymitis, orchitis, or urinary
eterization.).

The Veteran had an examination in October 2022. See 10/20/2022, C&P Exam. The Veteran's prostate cancer was stable with no objective symptoms. He did not take continuous medication. No renal dysfunction was noted. A voiding dysfunction was noted. The examiner indicated it caused urine leakage that required absorbent material which needed to be changed two to four times per day. It did not require the use of an appliance. He had daytime voiding interval between two and three hours and nighttime awakening to void two times. He did not have signs or symptoms of obstructive voiding. He did not have a history of chronic prostatitis, urethritis, epididymitis, orchitis, or urinary tract infections. The Veteran's malignant neoplasm was in remission. His history of a radical prostatectomy was noted from 2009. 

The Board recognizes a radical prostatectomy was reported in 2009. However, this appears to be a typographical error was it was reported to be from 2003 in his medical records and subsequent VA examinations. See generally, 9/10/2007, Medical Treatment Record - Government Facility, at p. 28; 10/25/2007, Medical Treatment Record - Government Facility, at p. 2.

In June 2023, an additional examination was performed. See 9/8/2023, C&P Exam. The Veteran reported urinary issues since his radical prostatectomy to include incontinence and frequency. A voiding dysfunction required absorbent material which must be changed less than two times per day. He had daytime voiding interval of less than one hour and nighttime awakening to void two times. He did not have signs or symptoms of obstructed voiding. He did not have a history of chronic prostatitis, urethritis, epididymitis, orchitis, or urinary tract infections. The Veteran's malignant neoplasm was in remission.

The most recent examination is from February 2025. See 5/20/2025, C&P Exam. The Veteran reported urinary issues since his radical prostatectomy to include incontinence and frequency. A voiding dysfunction required absorbent material which must be changed more than four times per day. He had daytime voiding interval of less than one hour and nighttime awakening to void three to four times. He did not have signs or symptoms of obstructed voiding. He did not have a history of chronic prostatitis, urethritis, epididymitis, orchitis, or urinary tract infections. The Veteran's malignant neoplasm was in remission.

The Veteran's medical records show that he underwent an artificial urethral sphincter in July 2011 as he never regained urinary continence following his radical prostatectomy. See 6/5/2023, Medical Treatment Record - Non-Government Facility, at p. 14. His records also show a history of using five pads per day. See 9/10/2007, Medical Treatment Record - Government Facility. At times, he would require less. 

After review of the competent and probative evidence, the Board finds that an initial rating of 60 percent for prostate cancer residuals manifested as voiding dysfunction is warranted. Based on the evidence of record that includes VA treatment records, private medical evidence, VA examination reports, and the Veteran's statements regarding symptomatology, the predominant residual dysfunction of the Veteran's prostate cancer is voiding dysfunction. The competent evidence of record does not support that the Veteran has renal dysfunction. Accordingly, the Board finds the predominant residual dysfunction of the Veteran's prostate cancer is voiding dysfunction.

Here, when resolving reasonable doubt in favor of the Veteran, the Board finds the Veteran's symptoms were more nearly approximated as a voiding dysfunction resulting in urine leakage that required the use of absorbent material that must be changed more than 4 times per day and/or the use of an appliance. The Veteran had an appliance implanted in 2011. Additionally, prior to this time, he had acknowledged a history of using five pads per day. The Board recognizes at times he used less than four absorbent materials per day. However, this also appears to be transient improvement as the Veteran subsequently required an appliance in 2011. 

In this case, the Veteran now receives maximum 60 percent evaluation for the entire period on appeal, therefore, a higher rating is not available under Diagnostic Code 7528. 38 C.F.R. § 4.115a. The Board finds that the Veteran's continued need for pads due to incontinence and use of an appliance is contemplated by the rating criteria for voiding dysfunction. Accordingly, the criteria for a disability rating higher than 60 percent are not met.

38 C.F.R. § 4.115a provides evaluations in excess of 60 percent for renal dysfunction. While
 four absorbent materials per day. However, this also appears to be transient improvement as the Veteran subsequently required an appliance in 2011. 

In this case, the Veteran now receives maximum 60 percent evaluation for the entire period on appeal, therefore, a higher rating is not available under Diagnostic Code 7528. 38 C.F.R. § 4.115a. The Board finds that the Veteran's continued need for pads due to incontinence and use of an appliance is contemplated by the rating criteria for voiding dysfunction. Accordingly, the criteria for a disability rating higher than 60 percent are not met.

38 C.F.R. § 4.115a provides evaluations in excess of 60 percent for renal dysfunction. While a disability rating greater than 60 percent is available for prostate cancer residuals when renal dysfunction predominates, the Veteran's service-connected residuals of prostate cancer have not been manifested by renal dysfunction. The medical treatment records indicate that the Veteran's symptoms do not support a higher rating under renal dysfunction. There are no reports of persistent edema and albuminuria with BUN 40 to 80 mg%, or creatinine 4 to 8 mg% or generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of extension.

3. Entitlement to an increased initial rating for left lower extremity peripheral neuropathy (sciatic nerve)

4. Entitlement to an increased initial rating for right lower extremity peripheral neuropathy (sciatic nerve)

5. Entitlement to an increased initial rating for left lower extremity peripheral neuropathy (femoral nerve)

6. Entitlement to an increased initial rating for right lower extremity peripheral neuropathy (femoral nerve)

The Veteran receives initial ratings of 10 percent for his bilateral lower extremity involving the sciatic nerve (8520) and femoral nerve (DC 8526) prior to October 25, 2024. From October 25, 2024, onward, the Veteran receives 40 percent ratings for his sciatic nerves and 20 percent ratings for his femoral nerves.

Per Diagnostic Code 8526, a 10 percent rating is for application for incomplete paralysis of any extremity when "mild." "Moderate" incomplete paralysis of the femoral nerve warrants a 20 percent rating; and "severe" incomplete paralysis warrants a 30 percent rating. Complete paralysis of quadriceps extensor muscles warrants a 40 percent rating. 38 C.F.R. § 4.124a, Diagnostic Code 8526.

Complete paralysis of the sciatic nerve exists when 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. This is evaluated as 80 percent disabling. Severe incomplete paralysis with marked muscular atrophy is evaluated as 60 percent disabling. Moderately severe paralysis is evaluated as 40 percent disabling. Moderate paralysis is evaluated as 20 percent disabling, and mild paralysis is 10 percent disabling. 38 C.F.R. § 4.124a, Code 8520. The term "incomplete paralysis" indicates a degree of impaired function substantially less than the type of picture for "complete paralysis" given for each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating for incomplete paralysis should be for the mild, or, at most, the moderate degree. 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves, Note [to the prior rating schedule].

The words "mild," "moderate," and "severe" as used in the various diagnostic codes are not defined in the VA Rating 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. In the absence of an express definition, words are given their ordinary meaning. Prokarym v. McDonald, 27 Vet. App. 307, 310 (2015) (citations omitted). Absent an express definition, it is presumed that VA regulations employ words using their ordinary dictionary meanings at the time the regulations were promulgated. See Nielson v. Shinseki, 607 F.3d 802, 805-06 (Fed. Cir. 2010) (stating that when terms are not defined, it is a basic principle of statutory interpretation that they are deemed to have their ordinary meaning).

Turning towards a dictionary for the relevant words, "mild" means "not violent, severe, or extreme; slight or gentle." Mild, Cambridge Dictionary Online, https://dictionary.cambridge.org/us/dictionary/english/mild (last visited Jan. 6, 2022).
citations omitted). Absent an express definition, it is presumed that VA regulations employ words using their ordinary dictionary meanings at the time the regulations were promulgated. See Nielson v. Shinseki, 607 F.3d 802, 805-06 (Fed. Cir. 2010) (stating that when terms are not defined, it is a basic principle of statutory interpretation that they are deemed to have their ordinary meaning).

Turning towards a dictionary for the relevant words, "mild" means "not violent, severe, or extreme; slight or gentle." Mild, Cambridge Dictionary Online, https://dictionary.cambridge.org/us/dictionary/english/mild (last visited Jan. 6, 2022). The definitions for "moderate" include of average or medium quantity, quality, or extent. WEBSTER'S II NEW COLLEGE DICTIONARY 704 (1995). Additionally, moderate is generally defined as "tending toward the mean or average amount." MERRIAM-WEBSTER'S COLLEGIATE DICTIONARY 787 (11th ed. 2003). Finally, severe is generally defined as "of a great degree" or "serious." Id. at 1140. Based on the foregoing, moderately severe, therefore, could be construed as falling beyond or outside of the mean or average amount while falling short of being a great degree or serious. "Marked," is defined as "having a distinctive or emphasized character." Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/marked (definition 2).

Additionally, the United States Court of Appeals for the Federal Circuit has held that the VA's Adjudication Procedures Manual (M21-1) does not "carry the force of law." DAV v. Sec'y of Veterans Affairs, 859 F.3d 1072, 1077 (2017). It is "an internal manual used to convey guidance to VA adjudicators. It is not intended to establish substantive rules beyond those contained in statute and regulation." Id. (quoting 72 Fed. Reg. 66,218, 66,219 (Nov. 27, 2007)).

The M-21 provisions do not go through the regular rulemaking procedures and is little more than evidence as to how VBA applies law and regulation in practices; it is not binding on the Board as it is not a regulation, instruction of the Secretary, or OGC opinion. Id.; see also 38 U.S.C. § 7104(c). The regulations further clarify that the Board "is not bound by Department manuals, circulars, or similar administrative issues." 38 C.F.R. § 20.105.

In Overton v. Wilkie, 30 Vet. App. 257, 264 (2018), however, the CAVC held that the Board is required to discuss "any relevant provisions contained in the [M-21] as part of its duty to provide adequate reasons or bases, but because it is not bound by those provisions, it must make its own determination before it chooses to rely on an [M-21] provision as a factor to support its decision." The CAVC has stated, on at least two prior occasions, that, where the rating applicable rating criteria contains terms that are undefined, the Board must define those terms as it applies them to the veteran at hand in order to satisfy its obligation to provide adequate reasons or bases. Johnson v. Wilkie, 30 Vet. App. 245, 254-55 (2018); Spellers v. Wilkie, 30 Vet. App. 211, 219-20 (2018).

VA's M21-1 provides benchmarks for evaluating the severity of peripheral nerve conditions. See M21-1, V.iii.12.A.2.c. The Manual indicates with regard to "mild" as follows: As this is the lowest level of evaluation for each nerve this is the default assigned based on the symptoms, however slight, as long as they were sufficient to support a diagnosis of the peripheral nerve impairment for service connection purposes. In general, look for a disability limited to sensory deficits that are lower graded, less persistent, or affecting a small area. A very minimal reflex or motor abnormality potentially could also be consistent with mild incomplete paralysis.

The Manual indicates with regard to "moderate:" Symptoms will likely be described by the claimants and medically graded as significantly disabling. In such cases a larger area in the nerve distribution may be affected by sensory symptoms. Other sign/symptom combinations that may fall into the moderate category include combinations of significant sensory changes and reflex or motor changes of a lower degree, or motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate.

For moderately
 for service connection purposes. In general, look for a disability limited to sensory deficits that are lower graded, less persistent, or affecting a small area. A very minimal reflex or motor abnormality potentially could also be consistent with mild incomplete paralysis.

The Manual indicates with regard to "moderate:" Symptoms will likely be described by the claimants and medically graded as significantly disabling. In such cases a larger area in the nerve distribution may be affected by sensory symptoms. Other sign/symptom combinations that may fall into the moderate category include combinations of significant sensory changes and reflex or motor changes of a lower degree, or motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate.

For moderately severe incomplete paralysis, it is described as follows: the?moderately severe evaluation level is only applicable for involvement of the sciatic nerve. This is the maximum rating for sciatic nerve neuritis not characterized by the organic changes specified in?38 CFR 4.123. Motor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at?a grade reflecting a high level of limitation or disability is expected. Atrophy may be present. However, for marked muscular atrophy see the criteria for a severe evaluation under?38 C.F.R. § 4.124a, DC 8520. 

Finally, the Manual indicates with regard to "severe:" In general, expect motor and/or reflex impairment (for example, atrophy, weakness, or diminished or hyperactive reflexes) at a grade reflecting a very high level of limitation or disability. Trophic changes may be seen in severe longstanding neuropathy cases. Even though severe incomplete paralysis cases should show findings substantially less than representative findings for complete impairment of the nerve, the disability picture for severe incomplete paralysis may contain signs/symptoms resembling some of those expected in cases of complete paralysis of the nerve. Neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain should be rated as high as severe incomplete paralysis of the nerve.

Although the Board is not bound by the M21-1, those standards are "'relevant guidance promulgated for the purpose of facilitating the efficient and proper resolution of claims,' which the Board must consider and address as part of its duty to provide a reasoned explanation for its decision." Chavis, 34 Vet. App.at 18 (quoting Healey v. McDonough, 33 Vet. App. 312, 321 (2021)).

VA has recognized that moderate incomplete paralysis will likely be described by the Veteran and medically graded as significantly disabling and may be demonstrated by combinations of significant sensory changes and reflex or motor changes of a lower degree, or motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate. In Miller v. Shulkin, the United States Court of Appeals for Veterans Claims (Court) held that "[a]lthough the note preceding § 4.124a directs the claims adjudicator to award no more than a 20% disability rating for incomplete paralysis of a peripheral nerve where the condition is productive of wholly sensory manifestations, it does not logically follow that any claimant who also exhibits non-sensory manifestations must necessarily be rated at a higher level." 28 Vet. App. 376, 380 (2017).

The U.S. Court of Appeals for Veterans Affairs has also held that the assignment of ratings based on paralysis does not preclude separate ratings for neuritis or neuralgia of the same nerve. Banschbach v. McDonough, 37 Vet. App. 422, 429 (2024). The Court explained that each nerve has a diagnostic code and rating scale for paralysis, as well as additional diagnostic codes (but no ratings) for "neuritis" and "neuralgia." Id. at 426. The Court acknowledged that adjudicators must avoid pyramiding, i.e., evaluation of the same disability under various diagnoses. However, the Court noted that the rating schedule provides that separate conditions or manifestations of the same condition are to be rated separately, unless otherwise provided by the rating schedule. Id. at 428; see 38 C.F.R. § 4.25(b). Moreover, the Court concluded that the Board must exhaust all schedular alternative for rating a disability. See Morgan v. Wilkie, 31 Vet. App. 162, 168 (2019). The Court further noted that paralysis, neuritis, and neuralgia are uniquely defined, indicating that each may present separately ratable manifestations. Id.

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
 unless otherwise provided by the rating schedule. Id. at 428; see 38 C.F.R. § 4.25(b). Moreover, the Court concluded that the Board must exhaust all schedular alternative for rating a disability. See Morgan v. Wilkie, 31 Vet. App. 162, 168 (2019). The Court further noted that paralysis, neuritis, and neuralgia are uniquely defined, indicating that each may present separately ratable manifestations. Id.

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 which may be assigned for neuritis not characterized by such organic changes will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123.

Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. Tic douloureux may be rated up to complete paralysis of the affected nerve. 38 C.F.R. § 4.124.

The Veteran participated in an examination in October 2022. See 10/20/2022, C&P Exam. He reported his symptoms were unbearable. Numbness and weakness were reported. Mild intermittent pain, paresthesias and/or dysesthesias, and numbness were noted bilaterally. Muscle strength testing was normal. Deep tendon reflexes were normal (2+). He had decreased sensation testing for ankle/lower leg and foot/toes bilaterally. Position sense, vibration sensation, and cold sensation were decreased for each lower extremity. He did not have muscle atrophy. Trophic changes were noted as the Veteran had loss of hair, and smooth shiny skin. The examiner indicated mild incomplete paralysis of the sciatic nerve for each lower extremity. No EMG studies were available or performed at the time of the examination. 

In June 2023, an additional examination was performed. See 9/8/2023, C&P Exam. The Veteran reported pain, numbness, and tingling. He currently used Gabapentin and had used Lyrica in past. Severe constant pain was reported for the left lower extremity, mild intermittent pain for the right lower extremity, mild paresthesias and/or dysesthesia for the right lower extremity and severe for the left lower extremity, and mild numbness for the right lower extremity and severe for the left lower extremity. Muscle strength testing was normal (5/5). He had decreased (1+) deep tendon reflexes for the bilateral knee and absent (0) for each ankle. Decreased light touch/monofilament testing was reported for each ankle/lower leg and for the left foot/toes. Absent light touch/monofilament testing was documented for the left foot/toes. Absent vibration and cold sensation were noted for each lower extremity. He did not have muscle atrophy. Trophic changes were noted as the Veteran had loss of hair, and smooth shiny skin. The examiner indicated mild incomplete paralysis of the sciatic and femoral nerves for the right lower extremity and moderate incomplete paralysis for the left sciatic and femoral nerves. Prior EMG studies were reported from 2004 where he had bilateral lower extremity absent sural sensory potentials. A functional impact was reported where he would have difficulty walking for prolonged periods of time.  

The most recent examination is from February 2025. See 5/20/2025, C&P Exam. The Veteran reported difficulty with walking and severe pain. He took Lyrica. Moderate intermittent pain, severe paresthesias and/or dysesthesias, and moderate numbness were reported. He had reduced muscle strength testing (4/5 less than normal strength) for knee extension and flexion, and ankle plantar flexion and dorsiflexion. Deep tendon reflexes were normal (2+). He had decreased light touch/monofilament testing for ankle/lower leg and foot/toes bilaterally. He had absent vibration testing for each lower extremity. He did not have muscle atrophy. Trophic changes (smooth shiny skin) were reported. The examiner reported moderately severe incomplete paralysis for the sciatic nerve and moderate incomplete paralysis for the femoral nerve. A functional impact was noted where the Veteran would not be able to work due to pain and difficulty ambulating. 

The Veteran's medical records show he had numbness in his feet. See 10/25/2007, Medical Treatment Record - Non-Government Facility, at p
ion and dorsiflexion. Deep tendon reflexes were normal (2+). He had decreased light touch/monofilament testing for ankle/lower leg and foot/toes bilaterally. He had absent vibration testing for each lower extremity. He did not have muscle atrophy. Trophic changes (smooth shiny skin) were reported. The examiner reported moderately severe incomplete paralysis for the sciatic nerve and moderate incomplete paralysis for the femoral nerve. A functional impact was noted where the Veteran would not be able to work due to pain and difficulty ambulating. 

The Veteran's medical records show he had numbness in his feet. See 10/25/2007, Medical Treatment Record - Non-Government Facility, at p. 62. He also had a history of numbness and tingling in his legs, as well as painful burning sensations. See 10/25/2007, Medical Treatment Record - Non-Government Facility, at p. 2. VA treatment records report persistent aching and burning in his feet that prevented sleep. See 5/10/2014, CAPRI, at p. 10.  

For the above medical evidence, the Board finds that it tends to show that the Veteran has had periods where his symptoms would wax and wane. For example, at the February 2025 examination, he had more severe symptoms for paresthesias and/or dysesthesias, but his deep tendon reflexes were normal. Comparatively, the Veteran had reduced deep tendon reflexes at the June 2023 examination and also had severe constant pain for the left lower extremity. In light of the Veteran's symptoms being intermittently lesser and/or more severe, when resolving reasonable doubt in favor of the Veteran, the Board determines that his more severe symptoms are applicable for the period on appeal. 

After review of the competent and probative evidence, the Board finds that initial ratings of 40 percent are warranted for the sciatic nerves. The Board acknowledges the Veteran's symptoms have waxed and waned from mild to severe. However, as described above, the Board finds the overall evidence tends to show that the improvements to be transient. Additionally, the Veteran has described his symptoms as severe and unbearable. He has had decreased sensation testing and trophic changes. Intermittent reduced deep tendon reflexes have been noted. Additionally, he had severe symptoms at the 2025 examination. Here, the Board finds his symptoms to be more nearly approximated as moderately severe as he had motor and/or reflex impairment at a grade reflecting a high level of limitation or disability. Additionally, the Board has considered any ameliorative effects of medication in assigning the 40 percent rating for the period on appeal. The evidence of record, to include the Veteran's lay statements, does not show that without Veteran's medication and treatment his symptoms would be more nearly approximately by severe incomplete paralysis as he does not have muscle atrophy. See generally Ingram, 38 Vet. App. at 135. For the foregoing reasons, an initial rating of 40 percent is warranted. 

The Board finds the VA examinations of record to be competent and probative as the evidence was gathered by medical professionals who physically examined the Veteran. 

Ratings in excess of 40 percent are not warranted as the competent and credible evidence, to include the Veteran's lay statements, does not show muscle atrophy to include marked muscle atrophy or having a distinctive or emphasized character. Indeed, no examination reports of record document muscle atrophy. For example, the Board finds the examinations of record to be competent and probative as the evidence was gathered by medical professionals who physically examined the Veteran, and the findings are more consistent with the Veteran's VA treatment records during the period on appeal. 

Femoral Nerves 

After review of the competent and probative evidence, the Board finds that initial ratings of 30 percent for each lower extremity involving the femoral nerves are warranted based on a combination of the competent medical evidence and competent lay statements/testimony by the Veteran. In this regard, the Veteran has reported severe symptoms at times. He has had reduced muscle strength as well as decreased deep tendon reflexes. Here, the Board finds his femoral nerve symptoms were more nearly approximated as severe during the period on appeal. The Veteran has described his symptoms as severe and has had significant sensory changes and decreased reflexes. The Veteran has had reduced muscle strength at times and has had trophic changes throughout the period on appeal. The Board recognizes the examiners have not found the Veteran's incomplete paralysis was severe. However, based on the above examinations, as well as the Veteran's statements and private treatment records, that ratings of 30 percent for severe incomplete paralysis are more nearly approximated. The Board finds the Veteran's symptoms tend to be severe and show motor and/or reflex impairment (for example, atrophy, weakness, or diminished or
 reflexes. Here, the Board finds his femoral nerve symptoms were more nearly approximated as severe during the period on appeal. The Veteran has described his symptoms as severe and has had significant sensory changes and decreased reflexes. The Veteran has had reduced muscle strength at times and has had trophic changes throughout the period on appeal. The Board recognizes the examiners have not found the Veteran's incomplete paralysis was severe. However, based on the above examinations, as well as the Veteran's statements and private treatment records, that ratings of 30 percent for severe incomplete paralysis are more nearly approximated. The Board finds the Veteran's symptoms tend to be severe and show motor and/or reflex impairment (for example, atrophy, weakness, or diminished or hyperactive reflexes) at a grade reflecting a very high level of limitation or disability.

Ratings in excess of 30 percent are not warranted as the examination and DBQ reports do not show complete paralysis of the quadriceps extensor muscles. The Veteran does not contend that his symptoms are more nearly approximated by complete paralysis of the quadriceps extensor muscles. 

The Board finds that separate ratings for neuritis or?neuralgia?are not warranted here. The evidence of record does not show neuritis and?neuralgia for the sciatic or femoral nerve. Thus, the Board finds that separate ratings are not warranted. For the foregoing reasons, ratings in excess of 30 percent for the femoral nerves and 40 percent for the sciatic nerves are not more nearly approximated or warranted throughout the period on appeal. 38?C.F.R. §§ 4.3, 4.7.

Lastly, the Board has considered any ameliorative effects of medication in assigning the above ratings for the period on appeal. The evidence of record, to include the Veteran's lay statements, does not tend to show that without Veteran's medication and treatment his symptoms would be more nearly approximately by higher ratings. See generally Ingram, 38 Vet. App. at 135. The Board finds the VA examinations of record to be competent and probative as the evidence was gathered by medical professionals who physically examined the Veteran. 

7. Entitlement to an initial rating excess of 20 percent for diabetes mellitus, type II

The Veteran receives an initial rating of 20 percent for his diabetes mellitus, type II. 

Diabetes mellitus is rated under 38 C.F.R. § 4.119, Diagnostic Code (DC) 7913. Under DC 7913, a 20 percent rating is warranted for diabetes requiring insulin and a restricted diet, or oral hypoglycemic agents and a restricted diet.

A 40 percent rating is warranted when diabetes requires insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities).

A 60 percent rating is warranted for diabetes 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 evaluated.

A 100 percent rating is warranted when diabetes requires more than one daily injection of insulin, restricted diet, and regulation of activities, with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. 38 C.F.R. § 4.119, DC 7913.

Note 1 to Diagnostic Code 7913 provides that compensable complications from diabetes mellitus are to be evaluated separately unless they are part of the criteria used to support a 100 percent evaluation; however, noncompensable complications are considered part of the diabetic process under Diagnostic Code 7913.

The rating criteria in DC 7913 for diabetes are conjunctive. See Melson v. Derwinski, 1 Vet. App. 334 (1991) (noting the use of the conjunctive "and" in a statutory provision meant that all of the conditions listed in the provision must be met). As such, the Board notes that 38 C.F.R. § 4.7 is not applicable, but § 4.3 is for application. See Tatum v. Shinseki, 23 Vet. App. 152 (2009) (holding that 38 C.F.R. § 4.7 is not applicable when the ratings criteria are successive and not variable); see also Johnson v. Wilkie, 30 Vet. App. 245, 254 (2018) ("Unlike §§ 4.7 and 4.21, § 4.3 presents nothing that is incompatible with the nature of successive rating criteria.").

The Veteran underwent an examination for his diabetes
 in the provision must be met). As such, the Board notes that 38 C.F.R. § 4.7 is not applicable, but § 4.3 is for application. See Tatum v. Shinseki, 23 Vet. App. 152 (2009) (holding that 38 C.F.R. § 4.7 is not applicable when the ratings criteria are successive and not variable); see also Johnson v. Wilkie, 30 Vet. App. 245, 254 (2018) ("Unlike §§ 4.7 and 4.21, § 4.3 presents nothing that is incompatible with the nature of successive rating criteria.").

The Veteran underwent an examination for his diabetes mellitus, type II, in October 2022. See 10/20/2022, C&P Exam. He had a prescribed oral hypoglycemic agent, one insulin injection per day was required, and he used Trulicity once a week. Regulation of activities was not required. He visited his diabetic care provider for episodes of ketoacidosis and hypoglycemia less than two times per month. He had zero episodes of ketoacidosis/hypoglycemic reactions that required hospitalization over the past 12 months. He did not have progressive unintentional weight loss and loss of strength attributed to diabetes mellitus. 

In June 2023, the Veteran had an additional examination. See 9/8/2023, C&P Exam. He had one insulin injection per day, and he used Trulicity and Jardiance. Regulation of activities was not required. He visited his diabetic care provider for episodes of ketoacidosis and hypoglycemia less than two times per month. He had zero episodes of ketoacidosis/hypoglycemic reactions that required hospitalization over the past 12 months. He did not have progressive unintentional weight loss and loss of strength attributed to diabetes mellitus.

The most recent examination is from February 2025. See 5/20/2025, C&P Exam. He had a prescribed oral hypoglycemic agent, and one insulin injection per day was required. Regulation of activities was not required. He visited his diabetic care provider for episodes of ketoacidosis and hypoglycemia less than two times per month. He had zero episodes of ketoacidosis/hypoglycemic reactions that required hospitalization over the past 12 months. He did not have progressive unintentional weight loss and loss of strength attributed to diabetes mellitus.

The Veteran's treatment records show compliance with treatment and that he used oral hypoglycemic and insulin. See 1/9/2017, Medical Treatment Record - Non-Government Facility, at p. 9.

After review of the competent and probative evidence, the Board finds that an initial rating in excess of 20 percent is not warranted. The competent and probative evidence weighs against showing that Veteran has had regulation of activities as contemplated by the rating criteria. In this regard, the Court has explained that the term "regulation of activities" means that a claimant must have a medical need to avoid not only strenuous occupational activity, but also strenuous recreational activity. Camacho v. Nicholson, 21 Vet. App. 360, 363 (2007). Medical evidence is required to show that occupational and recreational activities have been restricted. Id. at 364. The Veteran was not competent to provide such medical evidence in this matter. As such, the Board finds that the relevant evidence is persuasively against a finding that the Veteran required regulation of his activities due to his diabetes mellitus for the period on appeal.

As most of the evidence weighs against the claim (that is to say, is neither in approximate balance nor nearly equal), the benefit-of-the-doubt rule is inapplicable, and the claim for increased compensation for diabetes mellitus, type II, is denied.  Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021).

8. Entitlement to an increased initial rating for erectile dysfunction

The Veteran contends a compensable rating for his erectile dysfunction is warranted. 

The Veteran receives a noncompensable rating under DC 7522 effective May 15, 2007. Additionally, he receives special monthly compensation based on loss of use of a creative organ from May 15, 2007.

During the pendency of the appeal, 38 C.F.R. § 4.115b, Diagnostic Code 7522 was amended effective from November 14, 2021. See Schedule for Rating Disabilities: The Genitourinary Diseases and Conditions, 86 Fed. Reg. 54081 -54089, (September 30, 2021) (revising 38 C.F.R. §


The Veteran contends a compensable rating for his erectile dysfunction is warranted. 

The Veteran receives a noncompensable rating under DC 7522 effective May 15, 2007. Additionally, he receives special monthly compensation based on loss of use of a creative organ from May 15, 2007.

During the pendency of the appeal, 38 C.F.R. § 4.115b, Diagnostic Code 7522 was amended effective from November 14, 2021. See Schedule for Rating Disabilities: The Genitourinary Diseases and Conditions, 86 Fed. Reg. 54081 -54089, (September 30, 2021) (revising 38 C.F.R. § 4.115b). If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110 (g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110 (g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. As there is no indication that the amendments were intended to be applied retroactively, the Board will consider the Veteran's claim under both the old and new rating criteria, and the criteria that is more favorable to the Veteran will be applied. If the new criteria are more favorable, they will only be applied from November 14, 2021, when the regulations became effective.

Under the version of Diagnostic Code 7522 in effect prior to November 14, 2021, a 20 percent rating is warranted for deformity of the penis with loss of erectile power. 38 C.F.R. § 4.115b. No other evaluation is provided for under this diagnostic code. As such, two requirements must be met before a 20 percent evaluation can be assigned under the prior version of Diagnostic Code 7522: (1) the deformity must be evident; and (2) the deformity must be accompanied by loss of erectile power. Simply stated, the condition is not compensable in the absence of penile deformity.

Under the version of Diagnostic Code 7522 in effect on and after November 14, 2021, erectile dysfunction is evaluated with a noncompensable evaluation without regard to whether penile deformity is present. A note to the amended Diagnostic Code 7522 states that for the purpose of VA disability evaluation, a disease or traumatic injury of the penis resulting in scarring or deformity shall be rated under diagnostic code 7522.

A footnote to Diagnostic Code 7522 also indicates the disability is to be reviewed for entitlement to special monthly compensation (SMC) for loss of use of a creative organ under 38 C.F.R. § 3.350 (a), however; in the instant case the Veteran has already received SMC under this provision since May 15, 2007.

In this matter, the pre-November 14, 2021, regulations are most favorable to the Veteran. The test of Diagnostic Code 7522 makes clear that a compensable rating is warranted when there is both loss of erectile function and deformity of the penis. See 38 C.F.R. § 4.115b, Diagnostic Code 7522; see also Williams v. Wilkie, 30 Vet. App. 134, 138 (2018) (noting that Diagnostic Code 7522 requires a deformity for a compensable rating). In the absence of a definition from VA, the Court held "that deformity under DC 7522 means a distortion of the penis, either internal or external." Id. DORLAND'S ILLUSTRATED MEDICAL DICTIONARY defines "distortion" as "the state of being twisted out of a natural or normal shape or position." See DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 556 (32d ed. 2012).

The Veteran an examination in October 2022. See 10/20/2022, C&P Exam. The Veteran had erectile dysfunction and did not have retrograde ejaculation. A physical examination was not performed. 

In June 2023, an additional examination was performed. See 9/8/2023, C&P Exam. The Veteran had erectile dysfunction and did not have retrograde ejaculation. His penis, testes, and epididymis were normal. 

The most recent examination is from February 2025. See 5/20/2025, C
 natural or normal shape or position." See DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 556 (32d ed. 2012).

The Veteran an examination in October 2022. See 10/20/2022, C&P Exam. The Veteran had erectile dysfunction and did not have retrograde ejaculation. A physical examination was not performed. 

In June 2023, an additional examination was performed. See 9/8/2023, C&P Exam. The Veteran had erectile dysfunction and did not have retrograde ejaculation. His penis, testes, and epididymis were normal. 

The most recent examination is from February 2025. See 5/20/2025, C&P Exam. The Veteran had erectile dysfunction and did not have retrograde ejaculation. A physical examination was not performed. His penis, testes, and epididymis were normal per the Veteran. 

After review of the competent and probative evidence, the Board finds that an initial compensable rating for erectile dysfunction is not warranted. The evidence of record indicates an ongoing diagnosis of erectile dysfunction, without evidence of deformity of the penis, and that the Veteran was in receipt of special monthly compensation for the loss of use of a creative organ pursuant to 38 U.S.C. § 1114 (k). The Board acknowledges any potential belief that he has a deformity. However, the relevant probative evidence does not show any deformity. In this regard, the Board the above examinations and Veteran statements show no deformity. Additionally, the above examinations noted the Veteran had erectile dysfunction, but that he did not have any pertinent physical findings, complications, conditions, signs, or symptoms related to his erectile dysfunction. 

The regulations clearly indicate that a penile deformity, in addition to loss of erectile power, must be present to warrant a compensable rating for erectile dysfunction under Diagnostic Code 7522. Here, a penile deformity within the meaning of the regulations and applicable caselaw, is not shown. Further, there is no loss or removal of part of the penis (or glans penis) or deformity such as Peyronie's disease.

There is no basis for a higher or separate schedular evaluation under any other potentially available provision. As removal of the glans, complete atrophy or removal of the testis, or removal of half or more of the penis is not shown, a compensable rating under an alternative provision is not warranted. 38 C.F.R. § 4.115b, Diagnostic Codes 7521, 7523, 7524.

As such, a compensable disability rating for erectile dysfunction is not warranted. As most of the evidence weighs against the claim (that is to say, is neither in approximate balance nor nearly equal), the benefit-of-the-doubt rule is inapplicable, and the claim for initial compensable rating for erectile dysfunction is denied.  Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021).

9. Entitlement to an initial compensable rating for peripheral artery disease

The Veteran's peripheral artery disease is rated under DC 7114. 38 C.F.R. § 4.104 DC 7114. The Veteran receives a non-compensable rating from June 30, 2023. 

The regulations pertaining to rating disabilities of the cardiovascular system were revised, effective November 14, 2021.

Since November 14, 2021, compensation for service-connected peripheral arterial disease is evaluated under DC 7114. Under the current DC 7114, a 20 percent evaluation is warranted for at least one of the following: ABI of 0.67-0.79; ankle pressure of 84-99 mm Hg; toe pressure of 50-59 mm Hg; or transcutaneous oxygen tension of 50-59 mm Hg. 38 C.F.R. § 4.104, DC 7114 (2022). A 40 percent evaluation is warranted for at least one of the following: ABI of 0.54-0.66; ankle pressure of 66-83 mm Hg; toe pressure of 40-49 mm Hg; or transcutaneous oxygen tension of 40-49 mm Hg. Id. A 60 percent evaluation is warranted for at least one of the following: ABI of 0.40-0.53; ankle pressure of 50-65 mm Hg; toe pressure of 30-39 mm Hg; or transcutaneous oxygen tension of 30-39 mm Hg. Id. A total disability rating is warranted for at least one of the following: ABI less than or equal to 0.39; ankle pressure less than 50 mm Hg; toe pressure less than 30 mm Hg
66; ankle pressure of 66-83 mm Hg; toe pressure of 40-49 mm Hg; or transcutaneous oxygen tension of 40-49 mm Hg. Id. A 60 percent evaluation is warranted for at least one of the following: ABI of 0.40-0.53; ankle pressure of 50-65 mm Hg; toe pressure of 30-39 mm Hg; or transcutaneous oxygen tension of 30-39 mm Hg. Id. A total disability rating is warranted for at least one of the following: ABI less than or equal to 0.39; ankle pressure less than 50 mm Hg; toe pressure less than 30 mm Hg; or transcutaneous oxygen tension less than 30 mm Hg. Id.

Note (1) of DC 7114 states the ABI is the ratio of the systolic blood pressure at the ankle divided by the simultaneous brachial artery systolic blood pressure. For the purposes of this diagnostic code, normal ABI will be greater than or equal to 0.80. The ankle pressure is the systolic blood pressure measured at the ankle. Normal ankle pressure is greater than or equal to 100 mm Hg. The toe pressure is the systolic blood pressure measured at the great toe. Normal toe pressure is greater than or equal to 60 mm Hg. Transcutaneous oxygen tension is measured at the first intercostal space on the foot. Normal transcutaneous oxygen is greater than or equal to 60 mm Hg. All measurements must be determined by objective testing.

Note (2) of DC 7114 states: if ankle pressure, toe pressure, and transcutaneous oxygen testing are not of record, evaluate based on ABI unless the examiner states that an ankle pressure, toe pressure, or transcutaneous oxygen test is needed in a particular case because ABI does not sufficiently reflect the severity of the veteran's peripheral arterial disease. In all other cases, evaluate based on the test that provides the highest impairment value.

Turning to the evidence, the Veteran underwent an examination in June 2023. See 9/8/2023, C&P Exam. The Veteran reported leg pain, cramping, and swelling. He took Cilostazol. Peripheral arterial disease was diagnosed, but he had not undergone surgery or any procedure. Tophic changes were reported. He did not use an assistive device as a normal mode of locomotion. There was no functional impairment of an extremity such that no effective function remains other than that which would be equally well served by amputation with prosthesis. Right ankle/brachial index (ABI) was 0.63 and left ankle/brachial index was 0.65. ABI testing sufficiently reflected the severity of the Veteran's disorder. He had difficulty with walking for prolonged periods of time. 

In February 2025, the Veteran participated in his most recent examination. See 5/20/2025, C&P Exam. The Veteran reported lower extremity fatigue where he could not walk further than five feet without rest. He took Pravastatin. Peripheral arterial disease was diagnosed, but he had not undergone surgery or any procedure. Tophic changes were reported. He used a cane as an assistive device as a normal mode of locomotion due to fatigue. There was no functional impairment of an extremity such that no effective function remains other than that which would be equally well served by amputation with prosthesis. The examiner indicated that the Veteran had recently had lower extremity arterial doppler showing 50-75 percent occlusion bilaterally. He the Veteran would be unable to work in a position that required ambulation.

After review of the competent and probative evidence, the Board finds that an initial rating of 40 percent, but no higher, for peripheral artery disease is warranted. In this regard, the probative medical evidence from the 2023 VA examination reported the Veteran's ABI for the right was 0.63 and left ankle/brachial index was 0.65. 

A rating in excess of 40 percent is not warranted as the Veteran does not have ABI of 0.40-0.53; ankle pressure of 50-65 mm Hg; toe pressure of 30-39 mm Hg; or transcutaneous oxygen tension of 30-39 mm Hg. As such, an initial rating of 40 percent, but no higher, is warranted.

10. Entitlement to an initial compensable rating for pubis and scrotum scars 

11. Entitlement to an initial compensable rating for left lower extremity scars

12. Entitlement to an initial compensable rating for right lower extremity scars. 

The Veteran asserts entitlement to initial compensable ratings for each group of his scars. The Veteran receives a noncomp
 not warranted as the Veteran does not have ABI of 0.40-0.53; ankle pressure of 50-65 mm Hg; toe pressure of 30-39 mm Hg; or transcutaneous oxygen tension of 30-39 mm Hg. As such, an initial rating of 40 percent, but no higher, is warranted.

10. Entitlement to an initial compensable rating for pubis and scrotum scars 

11. Entitlement to an initial compensable rating for left lower extremity scars

12. Entitlement to an initial compensable rating for right lower extremity scars. 

The Veteran asserts entitlement to initial compensable ratings for each group of his scars. The Veteran receives a noncompensable rating under DC 7805 for his pubis and scrotum scars effective October 23, 2008; and noncompensable ratings for his right and left lower extremity scars effective June 30, 2023, under DC 7802. 

During the pendency of his appeal, the rating criteria changed.

October 23, 2008, to August 13, 2018

Diagnostic Code 7800 provides for burn scars of the head, face or neck, scars of the head, face or neck due to other causes, or other disfigurement of the head, face, or neck. The particular criteria set out under Diagnostic Code 7800 provide for a 10 percent rating with one characteristic of disfigurement. 38 C.F.R. § 4.118, Diagnostic Code 7800.

Note (4): Disabling effects other than disfigurement that are associated with individual scar(s) of the head, face, or neck, such as pain, instability, and residuals of associated muscle or nerve injury, should be separately evaluated under the appropriate diagnostic code(s) and § 4.25 should be applied to combine the evaluation(s) with the evaluation assigned under this diagnostic code.

Note (5): The characteristic(s) of disfigurement may be caused by one scar or by multiple scars and the characteristic(s) required to assign a particular evaluation need not be caused by a single scar in order to assign that evaluation.

Under the DC 7801, burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear are evaluated as: area or areas of 144 square inches (929 sq. cm) or greater (40 percent); area or areas of at least 72 square inches (465 sq. cm) but less than 144 square inches (929 sq. cm) (30 percent); area or areas of at least 12 square inches (77 sq. cm) but less than 72 square inches (465 sq. cm) (20 percent); and area or areas of at least 6 square inches (39 sq. cm) but less than 12 square inches (77 sq. cm) (10 percent).

Under the DC 7802, scars not of the head, face or neck, which are superficial and nonlinear are granted a 10 percent rating if they cover an area of 144 square inches or greater (929 sq. cm). 38 C.F.R. § 4.118, Diagnostic Code 7802 (2017).

Under Diagnostic Code 7804, one or two scars that are unstable or painful warrant a 10 percent rating. A 20 percent rating requires three or four scars that are unstable or painful. A 30 percent rating requires five or more scars that are unstable or painful. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. If one or more scars are both unstable and painful, 10 percent is to be added to the evaluation that is based on the total number of unstable or painful scars. Scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an additional rating under Diagnostic Code 7804, when applicable. 38 C.F.R. § 4.118, Diagnostic Code 7804 (2017).

Under the Diagnostic Code 7805, any disabling effects of other scars (including linear scars), and other effects of scars rated under Diagnostic Codes 7800, 7801, 7802, and 7804 not considered in a rating provided under Diagnostic Codes7800-7804 are to be rated under an appropriate Diagnostic Code. 38 C.F.R. § 4.118, Diagnostic Code 7805 (2017).

August 13, 2018, onward

Effective August 13, 2018, VA amended its regulations governing skin disabilities.

VA's intent is that claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be
Under the Diagnostic Code 7805, any disabling effects of other scars (including linear scars), and other effects of scars rated under Diagnostic Codes 7800, 7801, 7802, and 7804 not considered in a rating provided under Diagnostic Codes7800-7804 are to be rated under an appropriate Diagnostic Code. 38 C.F.R. § 4.118, Diagnostic Code 7805 (2017).

August 13, 2018, onward

Effective August 13, 2018, VA amended its regulations governing skin disabilities.

VA's intent is that claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. 83 Fed. Reg. 32592 (July 13, 2018).

DC 7800 remained the same. DC 7801 was amended to remove "deep and nonlinear scars" which was replaced with "underlying soft tissue damage." Diagnostic Code 7802 was amended to remove "superficial and nonlinear" and was replaced with "not associated with underlying soft tissue damage." Note (1) now provides that for purposes of DCs 7801 and 7802, the six (6) zones of the body are defined as each extremity, anterior trunk, and posterior trunk. The midaxillary line divides the anterior trunk from the posterior trunk.

Note (2) changed to state that a separate evaluation may be assigned for each affected zone of the body. Combine the separate evaluations under § 4.25. Alternatively, if a higher evaluation would result from adding the areas affected from multiple zones of the body, a single evaluation may also be assigned under this diagnostic code. Diagnostic Codes 7804 and 7805 were unaffected by the 2018 revisions.

The Veteran underwent an examination for his scars in September 2023. See 9/8/2023, C&P Exam. No scars were painful or unstable with frequent loss of covering of skin over the scar. No scars were due to burns. The Veteran's right lower extremity scars were 1 x 0.1 cm and 2 x 0.3 cm. The total approximate area was 0.7 cm squared. The Veteran's left lower extremity scars were 2.5 x 0.2 cm and 1 x 0.1 cm. The total approximate area was 0.6 cm squared. The Veteran's anterior trunk scars were 9 x 0.3 cm, 3 x 0.2 cm, 19 x 0.5 cm, 1 x 0.5 cm, 1 x 0.7 cm, and 1 x 0.7 cm. The total approximate area was 14.7 cm squared. No scars were tender to palpation, unstable upon inspection, or had underlying soft tissue damage. No limitation of function was noted for any scar. 

In February 2025, the Veteran participated in an additional examination. See 5/20/2025, C&P Exam. No scars were painful or unstable with frequent loss of covering of skin over the scar. No scars were due to burns. The Veteran's right lower extremity scars were 1 x 1 cm and 1 x 1 cm. The total approximate area was 2 cm squared. The Veteran's left lower extremity scars were 1 x 1 cm and 1 x 1 cm. The total approximate area was 2 cm squared. The Veteran's anterior trunk scars were 19 x 2 cm, 2 x 2 cm, 2 x 2 cm, 2 x 2 cm, and 9 x 1 cm. The total approximate area was 59 cm squared. No scars were tender to palpation, unstable upon inspection, or had underlying soft tissue damage. No limitation of function was noted for any scar.

The Veteran's most recent examination for his scars is from April 2025. See 4/29/2025, C&P Exam. The Veteran's pubis scars were noted. No scars were painful or unstable with frequent loss of covering of skin over the scar. The Veteran's anterior trunk scar (midline below belly button to pubis bone) was 11 x 1 cm. Underlying soft tissue damage was noted, and the total approximate area was 11 cm squared. To the extent a functional impact was noted, his urinary incontinence is rated as a residual for his prostate cancer. 

After review of the competent and probative evidence, initial compensable ratings are not warranted. For the Veteran's scars, the relevant competent evidence, to include the above examinations, shows that the Veteran's scars are not painful or unstable. The evidence does not show
&P Exam. The Veteran's pubis scars were noted. No scars were painful or unstable with frequent loss of covering of skin over the scar. The Veteran's anterior trunk scar (midline below belly button to pubis bone) was 11 x 1 cm. Underlying soft tissue damage was noted, and the total approximate area was 11 cm squared. To the extent a functional impact was noted, his urinary incontinence is rated as a residual for his prostate cancer. 

After review of the competent and probative evidence, initial compensable ratings are not warranted. For the Veteran's scars, the relevant competent evidence, to include the above examinations, shows that the Veteran's scars are not painful or unstable. The evidence does not show the Veteran has reported his scars as painful or unstable. As such, a rating under DC 7804 is not warranted. 

The Board recognizes the April 2025 examiner found the Veteran's pubis scar was a scar with underlying tissue damage. However, it was 11 sq. centimeters and was less than 39 sq. cm and a compensable rating under DC 7801 is not warranted. 

Regarding other possible ratings during the period on appeal, a compensable rating under DC 7802 is not warranted as the Veteran does not have scars of at least 144 square inches. Lastly, to the extent that the Veteran has urinary incontinence, he receives a 60 percent rating under DC 7528 for prostate cancer residuals to include urinary incontinence. An additional rating would be impermissible pyramiding. 38 C.F.R. § 4.14. Accordingly, an additional compensable rating for residuals of the Veteran's scars is not warranted under DC 7805. A rating under 7800 is not warranted as he does not have disfigurement of the head, face, or neck, as his scars are on the right upper extremity and left upper-mid back.

As such, the competent and probative evidence persuasively weighs against initial compensable ratings for the Veteran's scars.

13. Entitlement to a TDIU prior to October 25, 2024

The Veteran, through his attorney representative, asserts entitlement to TDIU prior to October 25, 2024.

A total disability rating may be granted where the schedular rating is less than 100 percent and the veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. Generally, to be eligible for a TDIU, a percentage threshold must be met. 38 C.F.R. §§ 3.340, 3.341, 4.16(a).

In determining unemployability for VA purposes, consideration may be given to the veteran's level of education, special training, and previous work experience, but not to age or any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; Hersey v. Derwinski, 2 Vet. App. 91, 94 (1992); Faust v. West, 13 Vet. App. 342 (2000). The sole fact that a veteran is unemployed or has difficulty securing employment is not enough, as a high rating in itself is a recognition that the impairment makes it difficult to obtain and keep employment. The question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (citing 38 C.F.R. §§ 4.1, 4.15, 4.16(a)). Entitlement to TDIU is based on an individual's particular circumstances. Rice v. Shinseki, 22 Vet. App. 447, 452 (2009).

The United States Court of Appeals for Veterans Claims (Court) has held that the term unable to secure and follow a substantially gainful occupation in 38 C.F.R. § 4.16 has two components. First, there is an economic component which essentially contemplates 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. Second, there is a non-economic component dealing with the individual veteran's ability to follow and secure employment. For the second component, attention must be given to: (a) the veteran's history, education, skill and training, (b) the veteran's physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, gras
 economic component which essentially contemplates 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. Second, there is a non-economic component dealing with the individual veteran's ability to follow and secure employment. For the second component, attention must be given to: (a) the veteran's history, education, skill and training, (b) the veteran's physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory and visual, and (c) whether the Veteran has the mental ability to perform the type of activities required by the occupation at issue, with relevant factors such as memory, concentration, and ability to adapt to change, handle work place stress, get along with coworkers and demonstrate reliability and productivity. Ray v. Wilkie, 31 Vet. App. 58, 72-73 (2019).

The Court has stated that "a veteran can establish marginal employment either by demonstrating an income less than the poverty threshold established by the U.S. Census Bureau or by the facts of his particular case." Ortiz-Valles v. McDonald, 28 Vet. App. 65, 71 (2016) (emphasis in original). Regardless of the method, "if the evidence or facts reflect that a veteran is capable only of marginal employment, he [or she] is incapable of securing or following a substantially gainful occupation and is therefore entitled to [TDIU] if his service-connected disabilities are the cause of that incapability." Id. 

In making a determination, the Board must consider all the evidence of record and make appropriate determinations of competence, credibility, and weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). When there is an approximate balance of positive and negative evidence regarding any material issue, all reasonable doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 

Also, the Court explained TDIU can be raised at various stages of the claims process and arises when VA rates a disability. Because TDIU can arise any time VA is rating a disability, VA may need to address TDIU as part of separate claim streams when rating different disabilities. TDIU, when part of a claim for increase, is not a separate claim for benefits that VA can grant or deny unmoored from the underlying service connection or increased rating claim. Rather, TDIU is part of that underlying claim, as an option for a potential rating, and the eventual effective date depends on the specific claim VA is then adjudicating. Phillips v. McDonough, 37 Vet. App. 394, 400 (2024). 

Here, the Board finds the period on appeal is the entire period on appeal as evidence has shown an effect on his ability to maintain employment due to his service-connected disabilities as detailed in the above increased rating claims. See generally Rice, 22 Vet. App. at 454 (explaining that the vehicle through which TDIU is raised "is important for purposes of assigning an effective date for an award of compensation" because "[d]ifferent statutory and regulatory provisions apply depending on whether the claim is an original claim or one for increased compensation"); see also Chisholm v. Collins, 38 Vet. App. 140 (2025) (stating that because the TDIU application was a request for higher ratings, it included what was simply a renewed (or continued) quest for higher compensation, including for his tinea pedis and radiculopathy). 

Additionally, the Board recognizes the Veteran now receives a 100 percent rating. However, a grant of a 100 percent disability does not always render the issue of TDIU moot. VA's duty to maximize a claimant's benefits includes consideration of whether his disabilities establish entitlement to SMC pursuant to 38 U.S.C. § 1114(s).  See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). Specifically, SMC may be warranted if a veteran has a service-connected disability rated as total and (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, or (2) by reason of such veteran's service-connected disability or disabilities, is permanently housebound. 38 U.S.C. § 1114(s); see Bradley, 22 Vet
 benefits includes consideration of whether his disabilities establish entitlement to SMC pursuant to 38 U.S.C. § 1114(s).  See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). Specifically, SMC may be warranted if a veteran has a service-connected disability rated as total and (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, or (2) by reason of such veteran's service-connected disability or disabilities, is permanently housebound. 38 U.S.C. § 1114(s); see Bradley, 22 Vet. App. 280 (analyzing 38 U.S.C. § 1114(s)). Importantly, the Court has determined entitlement to TDIU for a single disability constitutes a 100 percent rating for a single service-connected disability under 38 U.S.C. § 1114(s). See Bradley, 22 Vet. App. at 292.

The Veteran's VA Form 21-8940 shows he last worked fulltime in December 2012 and became too disabled to work in February 2013. See 10/25/2024, VA Form 21-8940. The Veteran previously worked as a technical officer from 2004 to 2013. The Veteran has significant college experience, to include an associate degree. He also has a pilot's license.  

Concerning the Veteran's service-connected disabilities, the Board has detailed their functional impact above. Here, the evidence shows the Veteran's service-connected disabilities combined would cause unemployability rather than a single disability. In particular, the Veteran's bilateral lower extremity radiculopathy would impair any physically intensive position. The Veteran is service connected for four lower extremity disorders (right and left lower extremity neuropathy involving the sciatic and peripheral nerves). Although it is one group of disorders, it is not a single disability for which TDIU may be granted to allow for SMC benefits. One disability for purposes of meeting the schedular threshold percentage requirements for consideration of a schedular TDIU is not a single disability for purposes of determining entitlement to SMC at the statutory housebound rate. See Youngblood v. Wilkie, 31 Vet. App. 412, 416 (2019); see also, MacKey v. Collins, No. 2024-1854, 2026 U.S. App. LEXIS 9081 (Fed. Cir. Mar. 30, 2026).. Additionally, although his service-connected bilateral lower extremity neuropathy would prevent employment in a physical position, the Veteran would likely be able to maintain employment in a seated position as the evidence indicates the Veteran has a pilot's license.

However, while the Veteran's lower extremity disorders would not prevent employment in a seated position, the Veteran's prostate cancer residuals would prevent such employment. The evidence above indicates that the Veteran has had periods of where he would need to change absorbent material approximately five times per day. This would likely impair the Veteran's ability to maintain concentration in a seated position as well as focusing on his current work assignments. 

Here, the evidence persuasively shows that a TDIU, if awarded, would be based on unemployability due to a combination of his service-connected disabilities, rather than the impairment from a single service-connected disability.

Given the above, while the Veteran's impairments from his service-connected disabilities indeed interfere with his ability to work, particularly as to his ability to perform manual labor, however, there is no single service-connected disability by itself may support assignment of both TDIU and SMC. As such, granting a TDIU would not support entitlement to SMC at the statutory housebound rate under 38 U.S.C. § 1114(s). The evidence is not in approximate balance but is persuasively against the claim. Therefore, there is not reasonable doubt to be resolved in favor of the Veteran. The issue of entitlement to a TDIU for the period on appeal present is denied.

14. Entitlement to SMC based housebound status prior to October 25, 2024.

The Veteran receives SMC based on housebound status effective October 25, 2024. By virtue of the above increased rating grants, the Veteran receives a combined 100 percent rating for the period on appeal. Additionally, he now has a separate 100 percent rating for his heart disease effective June 30, 2023. 

SMC is available when, 'as the result of service-connected disability,' a veteran suffers additional hardships above and beyond those contemplated by VA's schedule for rating disabilities." Breniser v. Shinseki, 25 Vet. App. 64, 68 (2011) (
 present is denied.

14. Entitlement to SMC based housebound status prior to October 25, 2024.

The Veteran receives SMC based on housebound status effective October 25, 2024. By virtue of the above increased rating grants, the Veteran receives a combined 100 percent rating for the period on appeal. Additionally, he now has a separate 100 percent rating for his heart disease effective June 30, 2023. 

SMC is available when, 'as the result of service-connected disability,' a veteran suffers additional hardships above and beyond those contemplated by VA's schedule for rating disabilities." Breniser v. Shinseki, 25 Vet. App. 64, 68 (2011) (citing 38 U.S.C. §§ 1114 (k)-(s)). Section 1114(l) provides five distinct ways for a veteran, "as the result of service-connected disability," to qualify for this rate of SMC: (1) anatomical loss or loss of use of both feet; (2) anatomical loss or loss of use of one hand and one foot; (3) blindness in both eyes with 5/200 visual acuity or less; (4) being permanently bedridden; or (5) having "such significant disabilities as to be in need of regular aid and attendance." 38 U.S.C. § 1114(l).

Under 38 U.S.C. § 1114(s), SMC is payable at the housebound rate if the Veteran has a single service-connected disability rated as 100 percent and either of the following are met: (1) there is additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems; or (2) he or she is permanently housebound by reason of service-connected disability or disabilities. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i).

The requirement of "permanently housebound" will be considered to have been met when the veteran is substantially confined to his or her house (ward or clinical areas, if institutionalized) or immediate premises due to a service-connected disability or disabilities which it is reasonably certain will remain throughout his or her lifetime.

In this case, the Veteran has been granted a 100 percent rating for his heart disorder effective June 30, 2023. He also has other service-connected disabilities that combine to 60 percent or greater for the period on appeal. 38 C.F.R. § 4.25.

The Veteran has a single disability (heart disorder) rated at 100 percent disabling. Additionally, he has other, independent service-connected disabilities that are rated at least 60 percent. As such, he meets the criteria for entitlement to SMC(s). 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). Consequently, entitlement to SMC(s) is granted. The effective date of this award also will be assigned by the AOJ upon implementation of this decision to preserve the Veteran's due process rights. 38 U.S.C. §  7104(a). 

 

 

Paul Sorisio

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	G.M., 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.