Citation Nr: 1305872 Decision Date: 02/20/13 Archive Date: 02/27/13 DOCKET NO. 07-02 711 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUES 1. Entitlement to a disability rating in excess of 20 percent prior to July 18, 2012, in excess of 40 percent thereafter, for ankylosing spondylitis, previously evaluated as chronic low back strain with history of myofascitis and sacroiliitis (back disability). 2. Entitlement to an initial disability rating in excess of 10 percent from March 10, 2005 to May 13, 2005; a compensable rating from May 13, 2005, to July 7, 2008; in excess of 10 percent from July 7, 2008, to August 11, 2008; a compensable rating between August 11, 2008, and April 2, 2011; and in excess of 20 percent thereafter for iritis of the left eye associated with ankylosing spondylitis (left eye disability). 3. Entitlement to a total disability evaluation based upon individual unemployability due to service-connected disabilities (TDIU). REPRESENTATION Veteran represented by: The American Legion ATTORNEY FOR THE BOARD Helena M. Walker, Counsel INTRODUCTION The Veteran had active service from September 1974 to September 1978, and from April 1982 to August 1984. This matter comes before the Board of Veterans' Appeals (Board) on appeal from December 2005 and January 2007 rating determinations of the Department of Veterans Affairs Regional Office (RO) located in Winston-Salem, North Carolina. In the December 2005 rating determination, the RO awarded a 20 percent rating for the Veteran's back disability and denied service connection for left eye iritis. The Veteran appealed these decisions. In a January 2007 rating determination, the RO subsequently granted service connection for iritis of the left eye. Multiple staged ratings were assigned as described on the cover page of this decision. Thereafter, the Veteran perfected his appeal with regard to the assigned disability ratings for his iritis. In a September 2012 decision, the Veteran's left eye disability rating was increased to 20 percent disabling, effective April 2, 2011, and his back disability rating was increased to 40 percent disabling, effective July 18, 2012. Although these were partial grants of the benefits sought, the Board notes that the Veteran has indicated continued disagreement with the ratings assigned and the Veteran has not been granted the maximum benefit allowed; thus, the claim is still active. See AB v. Brown, 6 Vet. App. 35, 38 (1993). As noted in the August 2010 remand, the evidence reasonably raises the claim for a TDIU. As such, the Board has listed the issue on the title page of this decision. Since the September 2012 Supplemental Statement of the case, the Board has received additional evidence, for which the Veteran submitted a waiver of RO review in January 2013. 38 C.F.R. § 20.1304(c) (2012). In addition to the paper claims file, the Veteran also has an electronic claims file contained in Virtual VA. The Board has reviewed this electronic file as well as the paper file prior to reaching this decision. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. Prior to July 18, 2012, the Veteran's back disability has been manifested by painful motion and limitation of flexion to, at its worst, 40 degrees; and the back disability has not resulted in ankylosis or any incapacitating episodes necessitating bed rest prescribed by a physician. 2. Beginning July 18, 2012, the Veteran's back disability has been manifested by forward flexion no worse than 15 degrees, without ankylosis of the entire thoracolumbar spine or incapacitating episodes necessitating bed rest prescribed by a physician having a total duration of at least six weeks during any relevant 12-month period. 3. Prior to April 2, 2011, the Veteran's left eye iritis was manifested by episodic eye irritation with complaints of pain, redness, and decreased/blurred vision, but without impairment of central visual acuity of at least 20/70 in the worse eye and 20/50 in the better eye, or significant impairment of field vision. 4. Beginning April 2, 2011, the Veteran's left eye iritis has been manifested by episodic eye irritation with complaints of pain, redness, and decreased/blurred vision, but without impairment of central visual acuity of at least 20/70 in the worse eye and 20/50 in the better eye, or significant impairment of field vision. 5. The Veteran's service-connected back and left eye disabilities are rated as 50 percent in combination, and are not sufficient by themselves to preclude him from securing or following any form of substantially gainful employment consistent with his education and occupational background. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 20 percent, prior to July 18, 2012, and in excess of 40 percent thereafter, for the Veteran's low back disability have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5243 (2012). 2. The criteria for a disability rating in excess of 10 percent for service-connected iritis of the left eye for the period from March 10, 2005 until May 13, 2005 have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.383, 4.3, 4.7 (2012); 38 C.F.R. §§ 4.75, 4.84a, Diagnostic Code 6003 (2008). 3. The criteria for a 10 percent rating for service-connected iritis of the left eye for the period from May 13, 2005 until July 7, 2008 have been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.383, 4.3, 4.7 (2012); 38 C.F.R. §§ 4.75, 4.84a, Diagnostic Code 6003 (2008). 4. The criteria for a disability rating in excess of 10 percent for service-connected iritis of the left eye from July 7, 2008 until August 11, 2008 have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.383, 4.3, 4.7 (2012); 38 C.F.R. §§ 4.75, 4.84a, Diagnostic Code 6003 (2008). 5. The criteria for a 10 percent rating for service-connected iritis of the left eye for the period from August 11, 2008 until April 2, 2011 have been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.383, 4.3, 4.7 (2012); 38 C.F.R. §§ 4.75, 4.84a, Diagnostic Code 6003 (2008). 6. The criteria for a disability rating in excess of 20 percent beginning April 2, 2011, for service-connected iritis of the left eye have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.383, 4.3, 4.7 (2012); 38 C.F.R. §§ 4.75, 4.84a, Diagnostic Code 6003 (2008). 7. The criteria for TDIU have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.159, 4.1, 4.16, 4.19, 4.25 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). In accordance with 38 C.F.R. § 3.159(b)(1), proper notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. Such notice should also address VA's practices in assigning disability evaluations and effective dates for those evaluations. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Although the required notice should be furnished prior to the issuance of the appealed rating decision, any initial errors of notice will not be prejudicial if: 1) corrective actions (e.g., issuance of a post-adjudication notice letter containing the required information) are taken, and 2) the appeal is readjudicated (e.g., in a Supplemental Statement of the Case). See Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007). In this case, the Veteran received 38 C.F.R. § 3.159(b) notice in May 2005 and September 2005 letters, issued prior to the appealed December 2005 rating decision. This letter pre-dated the Dingess/Hartman decision and did not address disability evaluation and effective date considerations, but this omission did not prejudice the Veteran. The Veteran was provided corrective notice compliant with Dingess/Hartman in March 2006, followed by additional notices in May 2008 and August 2010. The most recent readjudication of the claims was in a September 2012 Supplemental Statement of the Case. Accordingly, there are no notice deficiencies requiring corrective action in this case. See Mayfield v. Nicholson, supra. VA also has a duty to assist the Veteran with the development of facts pertinent to the appeal. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). This duty includes the obtaining of "relevant" records in the custody of a Federal department or agency under 38 C.F.R. § 3.159(c)(2), as well as records not in Federal custody (e.g., private medical records) under 38 C.F.R. § 3.159(c)(1). VA will also provide a medical examination if such examination is determined to be "necessary" to decide the claim. 38 C.F.R. § 3.159(c)(4). In this case, VA and private medical records concerning the Veteran's back and left eye disabilities have been obtained, and there is no indication of additional relevant treatment records concerning these disabilities. The Veteran was also most recently afforded fully comprehensive VA examinations in July 2012. There is no indication from the Veteran's own statements or from the recently obtained medical evidence that the disability has significantly worsened since July 2012, and a further remand for a VA examination on this claim is not "necessary." 38 C.F.R. § 3.159(c)(4); VAOPGCPREC 11-95 (April 7, 1995). Overall, there is no evidence of any VA error in notifying or assisting the Veteran that reasonably affects the fairness of this adjudication. Legal Criteria Increased Ratings: Generally Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Where entitlement to compensation has already been established, and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55 (1994); 38 C.F.R. § 4.2. Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. See generally Hart v. Mansfield, 21 Vet. App. 505 (2007). Increased Rating: Back Disability The general rating formula for disease and injures of the spine, specifically, with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, provides as follows: A 10 percent evaluation is warranted where there is forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height; A 20 percent rating for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, or the combined range of motion of the thoracolumbar spine not greater than 120 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; A 40 percent rating for forward flexion of the thoracolumbar spine 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine; A 50 percent rating for unfavorable ankylosis of the entire thoracolumbar spine; A 100 percent rating for unfavorable ankylosis of the entire spine. Normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees and left and right lateral rotation are 0 to 30 degrees. The normal combined range of motion for the thoracolumbar spine is 240 degrees. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243 (2012). Intervertebral disc syndrome (IVDS) is evaluated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25. The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes warrants a maximum 60 percent rating when rating based on incapacitating episodes, and such is assigned when there are incapacitating episodes having a total duration of at least six weeks during the past 12 months. A 40 percent rating is assigned for incapacitating episodes having a total duration of at least four weeks, but less than six weeks during the past 12 months. Note 1 provides that for the purposes of evaluations under Diagnostic Code 5293, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. "Chronic orthopedic and neurological manifestations" means orthopedic and neurologic signs and symptoms resulting from intervertebral disc syndrome that are present constantly, or nearly so. 38 C.F.R. § 4.71a, Diagnostic Code 5243. Diagnostic Code 8520 provides the rating criteria for paralysis of the sciatic nerve. Mild incomplete paralysis of the sciatic nerve warrants a 10 percent rating. A 20 percent rating requires moderate incomplete paralysis of the sciatic nerve. A 40 percent rating requires moderately severe incomplete paralysis of the sciatic nerve. A 60 percent rating requires severe incomplete paralysis with marked muscular atrophy. An 80 percent rating requires complete paralysis. When there is complete paralysis, the foot dangles and drops, no active movement of the muscles below the knee is possible, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a. The term "incomplete paralysis" with peripheral nerve injuries indicates a degree of loss or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to the varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. See note at "Diseases of the Peripheral Nerves" in 38 C.F.R. § 4.124(a). Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated at a maximum equal to severe, incomplete, paralysis. 38 C.F.R. § 4.123 (2012). The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. Id. Increased Rating: Left Eye disability The Veteran's left eye disability has been evaluated under Diagnostic Code 6003 for iritis. Under that diagnostic code, the disability of the eye is to be rated from 10 percent to 100 percent for impairment of visual acuity or field loss, pain, rest-requirements, or episodic incapacity, combining an additional rating of 10 percent during continuance of active pathology. The minimum rating during active pathology is 10 percent. 38 C.F.R. § 4.84a (Diagnostic Code 6003) (2008). Iritis and other similar diseases of the eye are evaluated in this manner. See 38 C.F.R. § 4.84a (Diagnostic Codes 6000-6009). While the appeal was pending, the rating schedule for evaluating disabilities of the eyes was revised and amended. See 73 Fed. Reg. 66543-54 (Nov. 10, 2008). The effective date of the revisions is December 10, 2008, and the revised criteria apply to all applications for benefits received by VA on or after that date. Although the Veteran's claim was received prior to December 10, 2008, and the old criteria are for application, the RO awarded a higher rating based upon the new criteria in a September 2012 decision. The Board must evaluate the Veteran's rating based upon the old criteria, but will not disturb the determination made by the RO in September 2012. TDIU Under VA laws and regulations, a total disability rating based on individual unemployability may be assigned upon a showing that a veteran is unable to secure or follow a substantially gainful occupation due solely to impairment resulting from his or her service-connected disabilities. See 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. Consideration may be given to a veteran's level of education, special training, and previous work experience, but age and the impairment caused by nonservice-connected disabilities are not for consideration in determining whether such a total disability rating is warranted. See 38 C.F.R. §§ 3.341, 4.16, 4.19. Marginal employment, defined as an amount of earned annual income that does not exceed the poverty threshold determined by the United States Department of Commerce, Bureau of the Census, shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). Furthermore, a total disability rating may be assigned where the combined rating for the veteran's service-connected disabilities is less than total if the disabled veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. Specifically, if there is only one such disability, this disability shall be ratable at 60 percent or more; if there are two or more disabilities, there shall be at least one ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In exceptional cases, an extra-schedular rating may be assigned on the basis of a showing of unemployability alone. See 38 C.F.R. § 4.16(b). Analysis Increased Rating: Back Disability By way of background, the Veteran was originally awarded service connection for his back disability in a June 1979 rating decision. His low back disability was assigned a 10 percent rating at the time he filed his current request for an increase in April 2005. In its December 2005 rating decision, the RO awarded a 20 percent rating for his back disability, effective April 22, 2005. In a September 2012 decision, this rating was increased to 40 percent, effective July 18, 2012. In an August 2005 VA treatment record, the Veteran was diagnosed as having undifferentiated spondyloarthropathy, as there was only limited facet arthropathy of the lumbar spine with mild to moderate arthropathy of both sacroiliac joints shown on x-ray. There were no changes to confirm a diagnosis of ankylosing spondylitis in the lumbar spine. Following his request for increase, the Veteran was afforded a fee-basis VA examination of the spine in October 2005, during which he was diagnosed as having lumbosacral strain with a history of myofascitis of the lumbar spine and sacroliitis. The Veteran reported continued pain for the last 23 years in the back, and it had recently prevented him from working. He related that he is sometimes able to function with medications, but at times needs complete bed rest. He reported to the examiner that he has been on recommended incapacitation several times a month lasting two to three days. The Veteran stated that this has occurred 10-12 times for a total of 20-30 days and has been recommended by a number of VA physicians. He advised that his functional impairment including being unable to stand or walk for extending periods of time. Physical examination revealed forward flexion to 40 degrees, extension to 20 degrees, lateral flexion to 25 degrees in both directions, and bilateral rotation to 20 degrees. The Veteran endorsed increased pain upon attempts to exceed the ranges of motion listed. After repetitive use or during a flare-up, the Veteran is additionally limited by pain, fatigue, weakness, and lack of endurance, but without evidence of incoordination. The major functional impact was noted as pain. The examiner was unable to determine the additional limitation in degrees without resorting to speculation. He found, however, that the Veteran does not have any IVDS with chronic and permanent nerve root involvement. The Veteran's motor and sensory testing was within normal limits. The lumbosacral x-ray was negative. In September 2006 the Veteran underwent another VA examination for his lumbosacral strain. The Veteran reported current symptoms of stiffness, weakness, and constant pain. He characterized his pain as 8 out of 10, with 10 being the most severe, and it is aching and sharp in nature. Physical examination revealed normal position of the head, symmetrical spinal appearance, and normal curvatures of the spine. The examiner found no evidence of IVDS with nerve root involvement. There was evidence of pain from the thoracic spine to the lower lumbosacral regions, and positive paraspinal lower lumbar spasms. There was no tenderness appreciated. Straight leg raise testing was negative bilaterally, and there was no ankylosis of the spine. Range of motion testing revealed forward flexion of the lumbar spine to 40 degrees (pain began at 40 degrees). After repetitive use, the examiner found that the Veteran was additionally limited by pain, weakness, and lack of endurance, but without incoordination or fatigue. The examiner opined that there was no additional limitation in degrees following repetitive use. A neurological examination revealed normal motor and sensory function. X-rays of the lumbar spine were negative, but the bilateral sacroiliac joints showed early ankylosing spondylitis. The examiner opined that the Veteran's initial lumbosacral strain with myofascitis and sacroiliitis had now progressed to include ankylosing spondylitis. In a February 2007 x-ray report, the Veteran was found to have degenerative changes of the lumbar spine and symmetric inflammatory changes of both sacroiliac joints. Beginning in 2008, the Veteran was noted to have degenerative disc disease of the lumbar spine, with mild-moderate narrowing at L4-5 and L5-S1, and mild, facet arthritis. In December 2010, the Veteran underwent another VA examination of the spine, during which he reported continued back pain and described flare-ups every two to three weeks, lasting three to seven days. He identified his back pain as being severe, and during a flare-up, he was able to perform his activities of daily living, but cannot perform chores, shopping, exercise, sports, or traveling. The Veteran endorsed paresthesias and leg or foot weakness. The examiner indicated that his leg and foot weakness was secondary to his (nonservice-connected) knee osteoarthritis and foot drop. The Veteran also described an intermittent history of numbness and paresthesias to both lower legs and fasciculations to the anterior thigh and forearms. The Veteran described additional symptoms including fatigue, decreased motion, stiffness, weakness, spasms, and spinal pain in the lumbar spine and sacroiliac joints. He described the radiating pain from his back into his bilateral thighs that is tingling, burning, pulsating, and a dull aching. The Veteran endorsed incapacitating episodes due to his lumbar spine disability, and indicated that in the last 12-month period he has had four instances of incapacitation lasting three to five days. Inspection of the lumbar spine was normal, except for evidence of lumbar lordosis. The examiner indicated that the Veteran had ankylosis of the entire thoracolumbar spine. She also noted the Veteran had neurologic symptoms due to nerve root stretching. There was painful motion the entire thoracolumbar spine, with spasms and guarding on the left side. The examiner opined, however, that the spasm and guarding were not severe enough to be responsible for abnormal gait or spinal contour. Range of motion testing revealed forward flexion of the thoracolumbar spine to 60 degrees, extension to 13 degrees, bilateral flexion to 15 degrees, left lateral rotation to 15 degrees, and right lateral rotation to 22 degrees. The examiner appreciated objective evidence of pain on active range of motion and following repetitive motion, but there were no additional limitations after three repetitions. Sensory, reflex, and motor testing were all within normal limits. The examiner diagnosed the Veteran as having ankylosing spondylitis of the sacroiliac joints, lumbar spine degenerative joint disease, and intermittent lumbar sciatica and foot drop. The examiner indicated that the Veteran's meralgia/paresthetica is likely due to his obesity. She further found that the bilateral, intermittent sciatica symptoms were consistent with the radiographic findings, and his symptoms could increase or become evident as the day progressed (VA examination was performed during the early morning). The examiner could not determine whether the Veteran's IVDS or ankylosing spondylitis was the cause of his incapacitating episodes. The Veteran's most recent VA examination of the spine was performed in July 2012. At that time, the Veteran reported similar symptoms as in previous VA examinations. Range of motion testing showed forward flexion of the lumbar spine to 30 degrees, with painful motion beginning at 15 degrees; extension to 10 degrees, with painful motion beginning at 5 degrees; bilateral flexion to 10 degrees, with painful motion at 5 degrees; and bilateral rotation to 10 degrees, with pain at 5 degrees. The Veteran was able to perform repetitive motion, and following repetitions, his forward flexion ends at 20 degrees; extension ends at 5 degrees; and flexion and rotation ends at 10 degrees (in both directions). The examiner opined that the Veteran had additional limitation of motion and functional loss following repetitive testing. This limitation was due to less movement than normal and pain on movement. The examiner found evidence of guarding and/or muscle spasm present, but they did not result in abnormal gait or spinal contour. Muscle strength testing was all within normal limits except right great toe extension. Reflex examination revealed normal findings in the knee, but reflexes were absent in the ankles. Sensory examination was all normal, as was straight leg testing. The examiner found no objective evidence of radiculopathy or other neurological abnormalities. The examiner opined that the Veteran did not experience IVDS. X-ray of the thoracic spine revealed mild, upper-thoracic scoliosis, osteophytes between the thoracic vertebrae, minimal degenerative disc formation present throughout the thoracic spine. X-ray of the lumbar spine revealed minimal degenerative disc at L4-5 and hypertrophic changes and facets of L5-S1. The examiner opined that the Veteran's back disability caused difficulties with employment inasmuch as he had limitations regarding bending, lifting, twisting, pushing, pulling, or running. A review of the record shows that the Veteran continues to receive treatment at the VA Medical Center for his low back disability. Most recently, VA treating professionals have questioned whether he has spondylitis, and have found that it is likely that the Veteran is experiencing low back pain without radiculopathy. Upon careful review of the evidence of record, the Board finds that the Veteran is not entitled to a rating in excess of 20 percent prior to July 18, 2012, or in excess of 40 percent thereafter for his service-connected low back disability. Prior to July 18, 2012, the Veteran's documented symptoms were not severe enough to warrant a rating in excess of 20 percent. During that timeframe, the pertinent medical evidence did not show that forward flexion of the lumbar spine was limited to 30 degrees or less, favorable ankylosis of the thoracolumbar spine, or incapacitating episodes of at least 4 weeks in any 12-month period. In fact, the Veteran's forward flexion of the thoracolumbar spine had been no worse than 40 degrees with pain. As such, his symptoms did not meet the rating criteria for a higher rating during that timeframe. Although the December 2010 VA examiner found that the Veteran had neutral, ankylosis of the entire thoracolumbar spine, the Board finds that this notation is inconsistent with the vast amounts of clinical evidence of record. At no other time during the periods on appeal has the Veteran been diagnosed as having ankylosis of the entire thoracolumbar spine. In fact, the most recent VA treatment records and examination make no finding of ankylosis of the thoracolumbar spine. Additionally, December 2010 VA examiner indicated that the Veteran's forward flexion of the thoracolumbar spine was to 60 degrees. In this instance, the Board finds that the conclusion by the December 2010 VA examination regarding ankylosis is contrary to all other clinical findings in the claims file. The Veteran also does not meet the rating criteria for a rating in excess of 40 percent beginning July 18, 2012. During that timeframe, the pertinent medical evidence does not show unfavorable ankylosis of the entire thoracolumbar spine or unfavorable ankylosis of the entire spine. There is also some question as to whether the Veteran experiences IVDS. The Board has also considered whether a higher evaluation is warranted pursuant to the criteria for rating intervertebral disc syndrome. However, there is no evidence showing that bed rest has been prescribed by a physician during either period on appeal. As such, a higher rating pursuant to the criteria for evaluating intervertebral disc syndrome is not for application. The Board has also considered whether separate ratings for neurological manifestations of the Veteran's back disability are warranted. The Board, however, does not find that any neurological symptoms, to the extent present, are attributable to the back disability. While the Board is aware that the December 2010 VA examination indicates bilateral sciatica symptoms, the examiner also found that the Veteran's meralgia/paresthetica was likely due to his obesity. Moreover, sensory, reflex, and motor testing were all within normal limits. Significantly, the July 2012 VA examination report specifically indicates that there was no objective evidence of radiculopathy or other neurological abnormalities. Overall, the Board finds that the evidence does not reflect neurological symptomatology to the degree that would warrant compensable ratings under Diagnostic Code 8520 or any other code section. The clinical records, however, are devoid of any neurological complaints or findings that have been associated with the Veteran's back disability. Although the Veteran has claimed paresthesias and sciatic radiation of pain, the VA examinations of record show that neurological examinations of the Veteran were generally normal, and he was not found to have any objectively identified neurological disabilities related to his low back disabilities. VA must consider all favorable lay evidence of record. 38 U.S.C.A. § 5107(b); Caluza v. Brown, 7 Vet. App. 498 (1995). Accordingly, in addition to the medical evidence above the Board has carefully considered the lay evidence offered by the Veteran in the form of his correspondence to VA and the arguments submitted by his representative. The Veteran, as a layperson, is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). However, even affording both the Veteran full credibility, nothing in the lay evidence provided shows the lumbar disability has met the criteria for higher evaluations during the timeframes on appeal. At no point prior to July 18, 2012, have the criteria for a rating in excess of 20 percent for the Veteran's service-connected low back disability, and at no point since then have the criteria for a rating in excess of 40 percent been met. The Board has considered whether additional compensation is warranted under the DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995) factors. However, functional loss due to pain or weakness must be supported by adequate pathology and evidenced by the visible behavior of the claimant. 38 C.F.R. § 4.40. In this case, either the VA examiners specifically found no additional limitation of function due to pain, weakness, fatigability or incoordination even after repetitive motion, or when they did, they assessed and listed the decreased ranges of motion following repetitive motion. The Board concludes that higher ratings based on those factors are not warranted. Increased Rating: Left Eye Disability Historically, service connection for the Veteran's iritis was awarded in a January 2007 rating decision. The RO assigned a 10 percent rating, effective March 10, 2005, until May 13, 2005, and a noncompensable rating thereafter. Later, a 10 percent rating was assigned beginning July 7, 2008, to August 11, 2008; a noncompensable rating beginning August 11, 2008, to April 2, 2011; and finally, a 20 percent rating, beginning April 2, 2011. The Veteran appealed the ratings assigned. In a March 2005 VA treatment record, the treating physician indicated that the Veteran continued to have active eye problems, and was prescribed steroidal treatment via eye drops. According to a May 2005 VA treatment note, the Veteran's iritis appeared to have resolved. Manifest refraction was 20/20- in both eyes. However, another VA record dated that same month indicated that the Veteran currently had active uveitis, and was using topical steroids for treatment. The Veteran sought VA treatment in December 2005 for continued eye problems, including blurry vision, photophobia, and pain. He was noted to have inflammatory eye disease secondary to systemic disease (spondyloarthropathy) and iritis, currently active. He told the treating professional that he has experienced multiple episodes of iritis, and feels the early stages of it coming on. Visual acuity was 25/20 to 20/20. He was again told to use steroid eye drops for treatment. VA treatment between March 2006 and August 2006 showed no active eye disease and no complaints of eye problems. A history of iritis in the left eye was noted. The Veteran was afforded a VA examination in September 2006, during which his visual acuity revealed corrected vision of 20/20 in both eyes. The Veteran reported that he experienced iritis episodes once or twice a year since the original episode in 1999. The Veteran described blurry distance vision in the left eye without glasses. Visual field examination was within normal limits. The examiner diagnosed the Veteran as having iritis secondary to his back disability, but it was currently asymptomatic. He indicated the eyes are white and "quiet" without any posterior synechiae seen. The examiner indicated that recurrences of iritis are likely to develop over a period of many years. In November 2007, the Veteran underwent VA treatment related to his eye disability. He indicated that he experienced four episodes of iritis since his last visit in 2005. He contended that these symptoms lasted two weeks at a time, and they included photophobia and pain. The Veteran felt that his vision was slowly getting worse with each episode. Visual acuity was assessed at 20/20 and 20/60 (the VA professional did not indicate for which eye each reading was for). Physical examination revealed a quiet eye, and there was no finding of active pathology. In a February 2008 VA treatment note, the Veteran reported no eye problems, but he had iritis episodes from time to time. In a July 2008 ophthalmology treatment note, the Veteran sought treatment complaining of an iritis flare that had started at least five days prior. Visual acuity was 20/20 bilaterally. When the Veteran went back a few days later for follow-up, his iritis had improved, and visual acuity was 20/20- in the right and 20/40- in the left. In August 2008, he underwent an ophthalmology consult, at which time his history of recurrent iritis was noted. Visual acuity examination revealed vision of 20/20-1 in the right eye, and 20/20 in the left. The treating professional just indicated that the visit was for a follow-up for recurring iritis in the left eye, and he told the Veteran to continue his steroid drops indefinitely to reduce the risk of recurrence. No active pathology was indicated. In April 2011, the Veteran was afforded another VA eye examination, during which he reported experiencing recurrent left eye redness, pain, and photophobia due to iritis. He indicated that he had two to three flares of iritis a year and they lasted two to three weeks each time. During a flare, he endorsed pain, redness, tearing, and photophobia. He indicated that his last episode was six months ago, and his symptoms have improved with steroid drops. He was also noted to have a choroidal nevus in the right eye with its onset as being in 2010. Best corrected distance was 20/20 in the right and 20/40+2 in the left. The examiner diagnosed the Veteran as having intermittent episodes of acute iritis, quiet today, but prior episodes had been documented. In July 2012, the Veteran had another VA examination of the eyes, and at that time best corrected distance was 20/40 or better in the left eye. The Veteran had no visual field loss. The examiner indicated that over the past 12-months, the Veteran's iritis has caused at least two weeks, but less than four weeks of incapacitating episodes. Upon careful review of the evidence of record, the Board finds that the Veteran is entitled to a 10 percent rating for his left eye iritis throughout the entire March 10, 2005, and April 2, 2011, timeframe. The Veteran has competently and consistently complained of recurrent active eye pathology related to his service-connected iritis. There is documented evidence of continued and regularly occurring episodes of iritis. Although the evidence shows that there have been some instances during the rating period when the Veteran's iritis has resolved, there have been consistent and regular flare-ups of symptomatology. Particularly, the Veteran has experienced pain, swelling, redness, and photophobia on account of the left eye disability. The Board notes at this juncture that VA will handle cases affected by change in medical findings or diagnosis so as to produce the greatest degree of stability of disability evaluations consistent with the laws and regulations governing disability compensation and pension. See 38 C.F.R. § 3.344(a). As such, the Board finds that the 10 percent rating for active iritis pursuant to Diagnostic Code 6003 is warranted between March 10, 2005, and April 2, 2011. To that extent only, as there have been two periods where a noncompensable evaluation was assigned, the claim is granted. The Veteran is not, however, entitled to a rating in excess of 10 percent between March 10, 2005, and April 2, 2011. A higher rating for impaired vision acuity is not warranted because the Veteran's corrected vision in the left eye has generally been better than 20/40 throughout the entire rating period. Although the Veteran's uncorrected vision has been shown to be impaired, the best corrected distance vision forms the basis for evaluating visual acuity. See 38 C.F.R. § 4.75 (2008). The Veteran is not service connected for a disability of the right eye. Thus, it would be necessary for his corrected visual acuity in the left eye to be 20/50 or worse for a compensable rating to be warranted for impaired visual acuity. See 38 C.F.R. § 4.84a (Diagnostic Code 6079) (2008). Even if the Veteran's right eye were service connected, he has generally exhibited normal corrected visual acuity in the right eye. Additionally, there was no compensable level of visual field loss shown during the entire timeframe on appeal. Also, the applicable rating criteria do not reflect that the Veteran would be entitled to a rating in excess of 20 percent after April 2, 2011. Under the former rating criteria, the Veteran would require central visual acuity impairment far in excess of what the Veteran has in his left eye or visual field loss in order to be assigned a rating in excess of the 20 percent currently assigned for that timeframe. Beginning April 2, 2011, the Veteran's left eye visual acuity (best corrected distance) was 20/40+2, and without any visual field loss. As such, he does not meet the rating criteria for a 30 percent rating under Diagnostic Codes related to impairment of central visual acuity. The Board has considered the Veteran's lay testimony in conjunction with this increased rating claim, and finds that a 10 percent rating is warranted for the entire timeframe between March 10, 2005, and April 2, 2011, but his symptoms do not support a rating in excess of 10 percent during that timeframe or in excess of 20 percent beginning April 2, 2011. Extra-schedular Considerations The Board also has considered whether the Veteran is entitled to a greater level of compensation on an extra-schedular basis. Ordinarily, the VA Schedule will apply unless there are exceptional or unusual factors which would render application of the schedule impractical. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). According to the regulation, an extra-schedular disability rating is warranted based upon a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards. See 38 C.F.R. § 3.321(b)(1) (2012). An exceptional case is said to include such factors as marked interference with employment or frequent periods of hospitalization as to render impracticable the application of the regular schedular standards. See Fanning v. Brown, 4 Vet. App. 225, 229 (1993). Under Thun v. Peake, 22 Vet App 111 (2008), there is a three-step inquiry for determining whether a veteran is entitled to an extra-schedular rating. First, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Second, if the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology and is found inadequate, the Board must determine whether the Veteran's disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extra-schedular rating. With respect to the first prong of Thun, the evidence in this case does not show such an exceptional disability picture that the available schedular evaluations for the service-connected back and eye disabilities is inadequate. A comparison between the level of severity and symptomatology of the Veteran's back and eye disabilities with the established criteria shows that the rating criteria reasonably describe the Veteran's disability levels and symptomatology. Thus, the Veteran's current schedular ratings under the general rating criteria for disabilities of the spine and under the rating criteria for eye disabilities are adequate to fully compensate him for his disabilities on appeal. In short, the rating criteria reasonably describe the Veteran's disability levels and symptomatology. The Board, therefore, has determined that referral of this case for extra-schedular consideration pursuant to 38 C.F.R. 3.321(b)(1) is not warranted. TDIU The Veteran is currently in receipt of service connection for low back disability (40 percent) and left eye iritis (20 percent). His combined rating is 50 percent. The Veteran, accordingly, does not meet the threshold schedular criteria for TDIU under 38 C.F.R. § 4.16(a). However, 38 C.F.R. § 4.16(b) provides that when a veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities, but fails to meet the percentage requirements for a TDIU set forth in 38 C.F.R. § 4.16(a), such case may be considered for extra-schedular consideration. It is the Veteran's contention that he is unable to work due to symptoms related to his service-connected disabilities. A review of the Veteran's Social Security Administration (SSA) records shows that he is in receipt of SSA disability benefits for his back and eye disabilities. However, the Board is not bound by SSA's findings. See Collier v. Derwinski, 1 Vet. App. 413, 417 (1991) (VA is not bound by the findings of disability and/or unemployability made by other agencies, including SSA); see also Martin v. Brown, 4 Vet. App. 136, 140 (1993) (while a SSA decision is not controlling for purposes of VA adjudication, it is "pertinent" to a veteran's claim). Further, during the Veteran's most recent July 2012 VA examination of the spine, the examiner essentially found that the Veteran's back disability made it difficult to perform certain activities, but he did not find that the Veteran's back disability rendered the Veteran unemployable. In addition, the July 2012 VA eye examiner specifically found that the Veteran's eye disability did not render him unemployable. The Board is aware that the Veteran asserts he is unemployable because of his back and eye disabilities, but he is not competent to so report. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In addition, the most recent VA treatment records have assessed the Veteran as having arthritis of the lumbar spine and mechanical low back pain that was previously thought to be ankylosing spondylitis. In summary, the record does not suggest that the Veteran is unemployable on account of his service-connected disabilities. Consequently, referral for extra-schedular consideration of the TDIU claim is not warranted. The preponderance of the evidence is against this claim. Accordingly, it must be denied. ORDER A disability rating in excess of 20 percent prior to July 18, 2012, and in excess of 40 percent thereafter, for ankylosing spondylitis, previously evaluated as chronic low back strain with history of myofascitis and sacroliitis, is denied. A disability rating in excess of 10 percent for service-connected iritis of the left eye for the period from March 10, 2005 until May 13, 2005 is denied. A 10 percent rating for service-connected iritis of the left eye for the period from May 13, 2005 until July 7, 2008 is granted, subject to the laws and regulations governing the payment of monetary benefits. A disability rating in excess of 10 percent for service-connected iritis of the left eye from July 7, 2008 until August 11, 2008 is denied. A 10 percent rating for service-connected iritis of the left eye for the period from August 11, 2008 until April 2, 2011 is granted, subject to the laws and regulations governing the payment of monetary benefits. A disability rating in excess 20 percent for iritis of the left eye for the period beginning on April 2, 2011 is denied. TDIU is denied. ______________________________________________ A. C. MACKENZIE Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs