Entitlement to higher initial ratings for service-connected restless leg syndrome associated with left lower extremity diabetic neuropathy is remanded.

Citation Nr: A26069999 Decision Date: 07/30/26 Archive Date: 07/30/26 DOCKET NO. 260331-642934 DATE: July 30, 2026 REMANDED Entitlement to higher initial ratings for service-connected restless leg syndrome associated with left lower extremity diabetic neuropathy is remanded. Entitlement to higher initial ratings for service-connected restless leg syndrome associated with right lower extremity diabetic neuropathy is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from May 1966 to May 1968. These matters are before the Board of Veterans' Appeals (Board) on appeal from a February 2026 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which was appealed by a timely March 2026 VA Form 10182 Notice of Disagreement (NOD) electing the Evidence Submission docket. By law, for claims appealed in this docket, the Board may only consider the evidence of record at the time of the Agency of Jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, then, by law, the Board is not permitted to consider that evidence in this decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. Therefore, the Board will consider the evidence of record as of the February 24, 2026, decision on appeal as well as any submitted within 90 days of the NOD (i.e., between March 31 and June 29, 2026). The Board is aware that the Veteran ordinarily would have until February 2027 to switch dockets under the modernized appeals framework. 38 C.F.R. § 20.202(c)(2); Williams v. McDonough, 37 Vet. App. 305, 311 (2024). However, in this case, the Veteran identified relevant private medical records and, consequently, VA obtained them on his behalf, during the post-NOD evidence submission window pursuant to 38 C.F.R. § 20.303. Therefore, the opportunity to modify his NOD and change the docket on appeal is not available under 38 C.F.R. § 20.202(c)(2). At the outset, the Board notes that this claim originated in a September 20, 2024, Intent to File a Claim and a November 16, 2024, Fully Developed Claim (VA Form 21-526EZ) that appears to seek service connection for restless leg syndrome (RLS) as secondary to his diabetic neuropathy. In March 2025, the AOJ instead issued a decision continuing separate 20 percent ratings for bilateral lower extremity diabetic neuropathy of the sciatic nerve but crucially amended the service-connected disability to include RLS, effectively granting secondary service connection and assigning a noncompensable rating. Previously, his lower extremity diabetic neuropathy had been rated based solely on impairment of the sciatic and femoral nerves without any mention of restless RLS. In September 2025, the Veteran filed a VA Form 20-0996 Request for Higher-Level Review (HLR) contesting the fact that the AOJ granted service connection for RLS in March 2025 without increasing the overall rating for the associated diabetic neuropathies. In essence, the Board finds that his primary point of contention here was with the initial noncompensable rating effectively assigned to his RLS. The AOJ then issued a December 2025 HLR decision finding it had previously erred in developing the original claim. The attached HLR return document shows the AOJ sought to clarify "which nerve the restless leg syndrome affects for the right/left lower extremities," to include specifically determining whether it affected the femoral, sciatic, or both nerves. After obtaining new examination reports, the AOJ then increased the rating for his right and left lower extremity femoral nerve neuropathies to 20 percent each while adding RLS to those service-connected disabilities as well, and the current appeal is from that decision. Under the circumstances, the Board finds the Veteran's appeal here is more accurately described as contesting the initial ratings assigned for the implicit awards of service connection for right and left lower extremity restless leg syndrome, and the issue on appeal has been recharacterized accordingly. 1. Entitlement to higher initial ratings for service-connected restless leg syndrome associated with left lower extremity diabetic neuropathy 2. Entitlement to higher initial ratings for service-connected restless leg syndrome associated with right lower extremity diabetic neuropathy Issues 1-2: Despite the AOJ's prior finding (with which the Board concurs) that it had erred in its development of the original November 2024 claim by failing to properly clarify what portions of the identified femoral and sciatic nerve impairment was attributable to diabetic neuropathy and restless leg syndrome, the Board finds the subsequent January 2026 VA examination reports obtained after the December 2025 HLR decision do little to resolve the medical questions identified. Such constitutes a pre-decisional duty to assist error on the part of the AOJ that requires remand to remedy. Notably, neither a general peripheral nerves disability benefit questionnaire (DBQ) or a more specific diabetic neuropathy DBQ actually clarifies whether the sciatic or femoral nerve impairment described therein is attributable to one disability or the other (or both). Furthermore, the two examination reports, completed by the same examiner, are inconsistent with respect to the overall severities of the neuropathies identified. The general DBQ indicates bilateral lower extremity diabetic neuropathy causes moderate, incomplete paralysis of the right sciatic nerve; severe, incomplete paralysis of the left sciatic nerve; moderate, incomplete paralysis of the external popliteal nerve bilaterally; and moderate, incomplete paralysis of the femoral nerve bilaterally. In contrast, the diabetic neuropathy DBQ shows his lower extremity diabetic neuropathy involved moderate, incomplete paralysis of the sciatic and femoral nerves on the right side and mild, incomplete paralysis of the sciatic and femoral nerves on the left side. Therefore, the Board finds the AOJ erred by relying on these examination reports without explaining the rationale behind how they weighed them against one another to arrive at the ultimate decisions on appeal. Absent that rationale or further development clarifying the inconsistent and incomplete answers to the key medical questions associated with this appeal, the Board cannot evaluate the propriety of the AOJ's conclusions adequately. The matters are REMANDED for the following action: 1. Forward the record to the January 2026 VA peripheral nerves examiner (or another appropriate clinician if needed) for a clarifying opinion on the etiology and current severity of the Veteran's service-connected restless leg syndrome as it pertains to impairment of his left and right lower extremity neurological functioning. Based on a review of the entire record and the prior VA examination reports describing these disabilities, the examiner is asked to respond to the following: (a.) Please reconcile the conflicting severities described in the January 2026 peripheral nerves DBQ and the January 2026 diabetic neuropathy DBQ regarding the severity of the femoral and sciatic nerve involvement noted in both. (b.) Is it possible to distinguish between the portion of the overall impairment, individual symptoms, or any other presentation associated with his left and right lower extremity sciatic or femoral nerve involvement that is attributable to restless leg syndrome from that which is attributable to his diabetic neuropathy? Why or why not? (c.) If it is possible to make such distinctions, please clarify which symptoms and what degree of overall impairment is attributable to his diabetic neuropathies and which are attributable to his restless leg syndrome. All opinions requested must be supported by complete rationale citing to supporting evidence, observations, or medical principles as appropriate. Failure to do so may further delay the claim and require additional clarification. A. Dean Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Yuan, 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.