Citation Nr: 1323786 Decision Date: 07/25/13 Archive Date: 08/06/13 DOCKET NO. 09-33 653 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUES 1. Whether the reduction of the rating for left eye vasculitis, with macular involvement, from 30 percent to 10 percent, effective February 1, 2009, was proper. 2. Entitlement to an increased rating for left eye vasculitis, with macular involvement, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Oklahoma Department of Veterans Affairs ATTORNEY FOR THE BOARD D. Whitehead, Counsel INTRODUCTION The Veteran had active service from December 1966 to December 1969. This matter comes properly before the Board of Veterans' Appeals (Board) on appeal from a November 2008 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in Muskogee, Oklahoma (RO). FINDINGS OF FACT 1. In a January 2008 rating decision, the RO proposed to reduce the disability evaluation for the Veteran's service-connected left eye disorder from 30 percent to 10 percent; the RO promulgated that proposed reduction in a November 2008 rating decision, effective February 1, 2009. 2. The RO's decision to reduce the evaluation for the Veteran's service-connected left eye disorder from 30 percent to 10 percent was supported by the evidence contained in the record at the time of the reduction, and was made in compliance with applicable due process laws and regulations. 3. Throughout the period on appeal, the Veteran's service-connected left eye vasculitis has not been manifested by homonymous hemianopsia, loss of the temporal half, or a concentric contraction of the visual field to at least 15 degrees but not to 5 degrees, or corrected visual acuity worse than 20/100. CONCLUSIONS OF LAW 1. The RO's decision to reduce the evaluation for the service-connected left eye disorder from 30 percent disabling to 10 percent disabling, effective February 1, 2009, was proper. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.105(e), 3.344, 4.84a, Diagnostic Code 6080 (2008). 2. The criteria for a disability rating in excess of 10 percent for a left eye disability are not met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.84a, Diagnostic Code 6080 (2008). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VA's Duty to Notify and Assist VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100 , 5102, 5103, 5103A, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The duty to notify under these statutory and regulatory provisions is triggered by the receipt of a claim. In the case of a reduction, there has been no claim, and the duty under these provisions is therefore not applicable to the instant case of whether the reduction of the rating for left eye vasculitis with macular involvement from 30 percent to 10 percent, effective February 1, 2009, was proper. Moreover, the regulation governing reduction contains its own notice provisions and procedures. 38 C.F.R. § 3.105(e). In the present case, the notice requirements with respect to the rating reduction at issue have been met. First there must be a rating action proposing the reduction, and giving the veteran 60 days to submit additional evidence and request a predetermination hearing. If a hearing is not requested, and reduction is considered to be still warranted, a rating action will be taken to effectuate the reduction. 38 C.F.R. § 3.105(e), (i)(2). The effective date of the reduction will be the last day of the month in which a 60-day period from the date of notice to the Veteran of the final action expires. 38 C.F.R. § 3.105(e), (i)(2)(i). Here, the Veteran was notified of the RO's intent to reduce the 30 percent evaluation for service-connected left eye disability by a letter dated in January 2008. This letter specifically stated that he had at least 60 days in which to present additional evidence, as well as the fact that he had an opportunity for a hearing and time to respond. Thereafter, the proposed reduction was effectuated by the November 2008 rating decision, effective from February 1, 2009. Given the chronology of the process described above, the Board finds that the RO complied with the procedures for reducing the Veteran's disability rating by notifying him of his rights and giving him an opportunity for a hearing and time to respond. 38 C.F.R. § 3.105(e). With respect to the Veteran's claim of entitlement to a rating in excess of 10 percent for his service-connected left eye disorder, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326. The Veteran was notified via letters dated in June 2007 and September 2008 of the information required to substantiate his claim and of his and VA's respective duties for obtaining evidence. The June 2007 letter informed the Veteran of how VA determined disability ratings and effective dates. See Dingess v. Hartman, 19 Vet. App. 473, 490-91 (2006) aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). He was also provided with information regarding the rating criteria for the diagnostic codes relevant to his disability in the September 2008 letter. Nothing more is required. VA also has a duty to assist a Veteran in the development of his claims. This duty includes assisting him in the procurement of service treatment records and other pertinent records, and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The RO has obtained available service treatment records and identified VA and private treatment records. The case was most recently remanded in January 2013 so that outstanding VA records could be obtained. Records dated through 2013 have been obtained and associated with the record. Thus, the RO has substantially complied with the January 2013 remand directives. See D'Aires v. Peake, 22 Vet. App. 97, 105 (2008); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). The Veteran has also been afforded VA examinations with respect to his left eye disability. The Board finds the July 2007, September 2008, June 2012, and April 2013 VA examination reports to be thorough and adequate upon which to base a decision with regard to the Veteran's claims. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (defining adequacy with respect to medical examinations and opinions as those providing sufficient detail so that the Board can perform a fully informed evaluation). Additionally, there is also no objective evidence indicating that there has been a material change in the severity of the Veteran's left eye disability since the most recent April 2013 VA examination. Hence, no further notice or assistance is required to fulfill VA's duty to assist in the development of the claims. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd, 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Legal Criteria By way of history, the RO granted service connection for the left eye disability in a November 1973 rating decision and assigned an initial noncompensable disability rating. The record reflects that the rating for the Veteran's service-connected left eye disorder was increased to 10 percent, effective from September 2001. In a June 2006 rating decision, the RO assigned a 30 percent rating for the service-connected left eye disorder. Thereafter, the Veteran filed a claim for an increased rating in May 2007. In a January 2008 rating decision, the RO proposed to reduce the disability rating for the left eye disability from 30 percent to 10 percent disabling. The RO promulgated this reduction in the November 2008 rating decision, effective February 1, 2009. Thereafter, the Veteran perfected an appeal as to the 10 percent rating assigned for his left eye disability and the propriety of the reduction of the disability rating from 30 to 10 percent. During the pendency of the appeal, the criteria for the evaluation of disabilities of the eyes were amended effective December 10, 2008, but these amended criteria govern cases only when the claim is filed on or after that date. 73 Fed. Reg. 66543 (November 10, 2008). Here, the Veteran's claim was received in May 2007. Prior to December 10, 2008, separate evaluations for loss of visual acuity and visual field defect were not permissible. See 38 C.F.R. § 4.84a, Diagnostic Codes 6080-6081 (2008) ("Note: Rate on loss of central visual acuity or impairment of field vision. Do not combine with any other rating for visual impairment."). In contrast, under the amended criteria which are not applicable in this case, separate evaluations for loss of visual acuity and visual field defect are now permissible effective December 10, 2008. See 38 C.F.R. § 4.77(c) ("separately evaluate the visual acuity and visual field defect (expressed as a level of visual acuity), and combine them under the provisions of § 4.25.") The Veteran's service-connected left eye disorder is rated under 38 C.F.R. § 4.84a, Diagnostic Code 6080, which pertains to impairment of the field of vision. Under this diagnostic code, a 30 percent is warranted for homonymous hemianopsia. A 30 percent evaluation is also warranted for bilateral loss of temporal half of the visual field warrants a 30 percent rating, a 10 percent rating if unilateral loss of temporal half of the visual field is shown, or evaluate as loss of vision at 20/70. Loss of the nasal half of the visual field, bilaterally, results in a 20 percent rating; unilateral loss of the nasal half of the visual field results in a 10 percent evaluation; or is evaluated as loss of vision at 20/50. Concentric contraction of the visual field to 5 degrees, results in a 100 percent evaluation, if bilateral; a 30 percent rating if unilateral; or is evaluates as loss of vision at 5/200. Bilateral concentric contraction of the visual field to 15 degrees but not to 5 degrees results in a 70 percent evaluation, a 20 percent is warranted if unilateral; or is rated as loss of vision at 20/200. Bilateral concentric contraction of the visual field to 30 degrees but not to 15 degrees, results in a 50 percent evaluation; unilateral concentric contraction of the visual field to 30 degrees but not to 15 degrees, results in a 10 percent rating; or is rated as loss of vision at 20/100. Concentric contraction of the visual field to 45 degrees but not to 30 degrees, bilaterally, results in a 30 percent rating; unilateral concentric contraction of the visual field to 45 degrees but not to 30 degrees, results in a 10 percent evaluation; or is rated as loss of vision at 20/70. A bilateral concentric contraction of the visual field to 60 degrees but not to 45 degrees results in an evaluation of 20 percent; a unilateral evaluation of 10 percent is warranted for concentric contraction of the visual field to 60 degrees but not to 45 degrees, or is rate as loss of vision at 20/50. The VA Schedule for Rating Disabilities (Rating Schedule) provides that the extent of visual field contraction in each eye is determined by recording the extent of the remaining visual fields in each of the eight 45 degree principal meridians. 38 C.F.R. Part 4 (2008). The number of degrees lost is determined at each meridian by subtracting the remaining degrees from the normal visual fields given in Table III. 38 C.F.R. § 4.76 (2008). The degrees lost are then added together to determine total degrees lost. This is subtracted from 500. The difference represents the total remaining degrees of visual field. The difference divided by eight represents the average contraction for rating purposes. 38 C.F.R. § 4.76a. The normal visual field extent at the 8 principal meridians, in degrees, is: temporally, 85; down temporally, 85; down, 65; down nasally, 50; nasally, 60; up nasally, 55; up, 45; up temporally, 55. The total is 500 degrees. 38 C.F.R. § 4.76a, Table III. The severity of visual acuity loss is determined by applying the criteria set forth at 38 C.F.R. § 4.84a. Under these criteria, impairment of central visual acuity is evaluated from noncompensable to 100 percent based on the degree of the resulting impairment of visual acuity. 38 C.F.R. § 4.84a, Diagnostic Codes 6061 to 6079 (2008). A disability rating for visual impairment is based on the best distant vision obtainable after the best correction by glasses. 38 C.F.R. § 4.75 (2008). The percentage evaluation will be found from Table V by intersecting the horizontal row appropriate for the Snellen index for one eye and the vertical column appropriate to the Snellen index of the other eye. 38 C.F.R. § 4.83a (2008). Service connection is not in effect for a right eye disorder. f visual impairment of only one eye is service connected, the visual acuity of the other eye will be considered to be 20/40 for purposes of evaluating the service-connected visual impairment. 38 C.F.R. § 4.75(c); see also 38 C.F.R. § 3.383(a). The Veteran's claim for increase was filed prior to the December 2008 amendments to the rating schedule for diseases of the eyes. Nonetheless, the amendments merely codified the longstanding VA practice that the nonservice-connected eye would be considered normal, subject to the paired extremity rule. See 73 Fed. Reg. 66544 (Nov. 10, 2008). Rating Reduction Where the reduction in evaluation of a service-connected disability is considered warranted, and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. As noted above, all applicable notice procedures have been satisfied in this instance. See 38 U.S.C.A. § 5112(b)(6) (West 2002); 38 C.F.R. § 3.105(e). When a rating has continued for an extended period at the same level, five years or more, any rating reduction is valid only if, after a review of the entire record of examinations and the medical-industrial history, it is based upon an examination that is at least as complete as the examination that formed the basis for the original rating. See 38 C.F.R. § 3.344(a); see also Kitchens v. Brown, 7 Vet. App. 320, 324 (1995); Brown v. Brown, 5 Vet. App. 413 (1993). Here, the 30 percent rating for the Veteran's service-connected left eye disorder was in effect from February 15, 2005, to January 31, 2009, and therefore, a reexamination disclosing improvement is sufficient to warrant a reduction in rating. See 38 C.F.R. § 3.344 (c). In considering the propriety of a reduction, the Board must focus on the evidence available to the RO at the time the reduction was effectuated, although post-reduction medical evidence may be considered in the context of evaluating whether the condition had demonstrated actual improvement. Cf. Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-82 (1992). A February 2007 VA treatment record reflects the Veteran's report of decreased vision in his left eye, and flashes of light and floaters bilaterally. The examination revealed corrected visual acuity for distance as 20/25 for the right eye and 20/80 -1 for the left eye. Applying the ratings applicable to impairment of visual acuity, a 10 percent rating is warranted. See 38 C.F.R. § 4.84a, Table V. In July 2007, the Veteran underwent a VA examination, during which he reported having difficulty with vision, particularly in his left eye. He reported having difficulty driving at night and that he had a film over his eye, for which he occasionally used eye drops. The clinical examination revealed best corrected visual acuity of 20/30 for the right eye and 20/60 for the left eye. The Veteran's best corrected near vision was 20/50 for the right eye and 20/125 for the left eye. He was noted to have 2+NS, 1+ cortical cataracts, greater on the left than right. These findings correspond to a 10 percent rating under the applicable rating criteria for impairment of visual acuity. See 38 C.F.R. § 4.84a, Table V. The July 2007 examiner also administered visual field testing, the results of which were documented in graph form. The results in numerical form were, in degrees, as follows: vision temporally, 60; down temporally, 55; vision down, 40; down nasally, 35; vision nasally, 40; up nasally, 28; vision up, 22; and up temporally, 35. Combining the difference between these figures and the normal visual field, the Veteran's total visual field contraction was 185 degrees. Under the version of Diagnostic Code 6080 prior to December 10, 2008, a 10 percent rating is assignable based on these findings. A VA September 2007 ophthalmology examination revealed that the corrected vision for distance was 20/20 for the right eye and 20/40 for the left eye, which corresponds to a noncompensable rating under the applicable rating criteria. See 38 C.F.R. § 4.84a, Table V. During an April 2008 ophthalmology consultation, the Veteran reported having increased throbbing pain in his left eye with increased tearing. He also reported having a "film" over his left eye for a couple of weeks. The examination revealed that his corrected visual acuity for the right eye was 20/25- and 20/100 for the left eye. These findings correspond to a 10 percent rating under the applicable rating criteria for impairment of visual acuity. Id. The Veteran underwent an additional evaluation in April 2008, at which time he reported having blurred vision. His right eye corrected visual acuity for distance was 20/30 and his left eye corrected visual acuity for distance was reported as 20/60. These findings correspond to a 10 percent rating when applying the rating criteria for impairment of visual acuity. See Id. A July 2008 VA eye clinic note shows that the Veteran's corrected right eye visual acuity for distance was 20/30, and his left eye acuity for distance was 20/70. These findings correspond to a 10 percent rating under the applicable rating criteria for impairment of visual acuity. See 38 C.F.R. § 4.84a, Table V. A September 2008 VA examination report documents the Veteran's report of pain in his left eye several times a week. He stated that he used prescription medications and eye drops for his symptoms. On examination, the left eye showed signs of an old vasculitis. The Veteran's unaided visual acuity was reported as 20/30 for the right eye and of 20/70 in the left eye. With refraction, his vision was improved to 20/30 for the right eye and 20/40 for the left eye for distance; a noncompensable rating would be assignable under the rating criteria for impairment of visual acuity based on these findings. Id. The September 2008 examiner also performed visual field testing. The results in numerical form, in degrees, were as follows: vision temporally, 60; down temporally, 55; vision down, 40; down nasally, 35; vision nasally, 40; up nasally, 30; vision up, 22; and up temporally, 40. Combining the difference between these figures and the normal visual field, the Veteran's total visual field contraction was 178 degrees. Under the version of Diagnostic Code 6080 prior to December 10, 2008, a 10 percent rating is assignable based on these findings. The September 2008 examination report shows a relevant diagnosis of retinal vasculitis in the left eye. The September 2008 examiner determined that this disability was stable, with the use of medications. There was no evidence of keratoconus, pterygium, glaucoma, diplopia, enueleation, or nystagmus. In regard to the reduction of the disability rating, the RO followed the proper procedure in reducing the 30 percent rating to 10 percent for the Veteran's left eye disability. The Veteran was notified of the RO's intent to reduce the 30 percent evaluation for service-connected left eye disability by a letter dated in January 2008. This letter specifically stated that he had at least 60 days in which to present additional evidence, as well as the fact that he had an opportunity for a hearing and time to respond. Thereafter, the proposed reduction was effectuated by the November 2008 rating decision, effective from February 1, 2009. Given the chronology of the process described above, the Board finds that the RO complied with the procedures for reducing the Veteran's disability rating by notifying him of his rights and giving him an opportunity for a hearing and time to respond. 38 C.F.R. § 3.105(e). As for the reduced rating itself, the evidence of record at the time of the November 2008 rating decision that effectuated the reduction supports the assignment of a 10 percent disability rating. At the time of this decision, the evidence included the Veteran's VA treatment records and the July 2007 and September 2008 examination report, which all showed that a 10 percent rating, but no higher, was appropriate for the Veteran's service-connected left eye disorder. The evidence of record dated prior to and since the November 2008 rating decision does not support the assignment of a disability rating higher than 10 percent. Consequently, the RO's reduction of the assigned rating to 10 percent is in accord with the competent medical evidence of record. The RO's decision to reduce the evaluation for the Veteran's service-connected left eye disorder from 30 percent to 10 percent was supported by the evidence contained in the record at the time of the reduction, and was made in compliance with applicable due process laws and regulations. In reaching the above determinations, the Board has also considered the Veteran's statements that the reduction of the 30 percent evaluation to a 10 percent evaluation was not warranted for his service-connected left eye disorder. In this case, the Veteran's statements are competent evidence as to his symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Indeed, these statements have been considered by both the Board and the VA examiners. His statements, however, are not competent evidence to identify a specific level of disability relating to an eye disorder to the appropriate diagnostic codes. On the other hand, competent evidence concerning the nature and extent of the Veteran's service-connected left eye disorder has been provided by the medical personnel who have examined his left eye and have rendered pertinent opinions in conjunction with the evaluations. The medical findings, as provided in the examination reports, directly address the criteria under which the Veteran's service-connected left eye disorder is evaluated. Increased Rating Disability ratings are determined by applying the criteria set forth in the Rating Schedule. The Rating Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (2012). The Veteran contends that his left eye disability is more severe than what is reflected by the currently assigned 10 percent disability rating. A December 2009 VA eye clinic note shows the Veteran's report of seeing "blood clots" in his left eye, if he laid on his left side. He reported having continued left eye pain. The Veteran stated that the prescription medication did not help to relieve his pain. His prior history was significant for longstanding left eye pain that was intermittent, with old branch retinal vein occlusion. The examination revealed right eye corrected visual acuity for distance of approximately 20/30 and left eye corrected visual acuity for distance of approximately 20/80. A 10 percent rating is assignable based on the findings in accordance with the applicable rating criteria. See 38 C.F.R. § 4.84a, Table V. The Veteran reiterated his report of left eye pain during a September 2011 VA eye clinic consultation. On examination, the Veteran's right eye corrected visual acuity for distance was approximately 20/40, and his left eye corrected visual acuity for distance was approximately 20/100. This corresponds to a 10 percent rating under the applicable rating criteria for visual acuity. Id. A March 2012 VA treatment record shows that the Veteran's corrected visual acuity for distance was 20/30 for the right eye and 20/80 for the left eye, which warrants a 10 percent rating under the applicable rating criteria. Id. A June 2012 VA examination report shows the Veteran's report of experiencing a sudden loss of vision in his left eye during military service, which never returned. The examiner noted that the Veteran underwent multiple surgeries to treat bilateral retinal degeneration, with retinal holes. The physical examination revealed an uncorrected visual acuity for distance was 20/70 for the right eye and 20/200 for the left eye. His corrected visual acuity for distance was 20/40 or better in the right eye and 20/70 for the left eye; these findings correspond to a 10 percent rating under the relevant rating criteria for visual acuity impairment. See 38 C.F.R. § 4.84a, Table V. The June 2012 examiner determined that the Veteran did not have a difference equal to two or more lines on the Snellen test chart or its equivalent, between distance and near corrected vision. The Veteran did not have an anatomical loss of an eye, and his vision was not limited to no more than light perception only in either eye. The examination was negative for evidence of an astigmatism or diplopia. Bilateral insipissated meibomian glands and acquired melanosis was noted. The examination was also significant for mild retinal pigment epithelium mottling, bilaterally; sclerosed vessels and ghost vessels in the left eye; lattice degeneration, bilaterally; and retinopathy of the left eye. The June 2012 examiner found contraction of the visual field for both eyes and presented the findings of the visual field testing in graph form. Based on these findings, the examiner determined that the Veteran's remaining central visual field for the left eye was 16 to 30 degrees. Applying these findings to the rating criteria set forth under Diagnostic Code 6080, a 10 percent rating is assignable. 38 C.F.R. § 4.84a. The examiner attributed this loss of visual field to the Veteran's service-connected vasculitis. The June 2012 examination revealed that the current appearance of the Veteran's left eye retina was consistent with an old vasculitis. The June 2012 examiner also noted that the Veteran underwent surgery in 1985 to repair lattice degeneration, with retinal holes, in both eyes. According to the examiner, this surgery left retinal scarring, leading to visual field loss, inferiorly, in both eyes. The Veteran's additional diagnoses included meibomian gland dysfunction, dry eyes, and cataracts in both eyes, which the examiner determined were not linked to the Veteran's service-connected vasculitis of the left eye. A January 2013 VA treatment record shows that the Veteran's visual acuity for distance was 20/40 +2 for the right eye and 20/80 for the left eye. A 10 percent rating is assignable under the rating criteria for visual acuity impairment based on these findings. See 38 C.F.R. § 4.84a, Table V. The Veteran underwent an additional VA examination in April 2013. The Veteran reported experiencing increased pain in his left eye since the last VA examination. On the physical examination, uncorrected visual acuity for distance was 20/50 for the right eye and 15/200 for the left eye, and corrected visual acuity for distance was 20/40 or better for the right eye and 20/100 for the left eye. A 10 percent rating is warranted for visual acuity impairment based on these findings. See 38 C.F.R. § 4.84a, Table V. The April 2013 examiner determined that the Veteran did not have a difference equal to two or more lines on the Snellen test type chart or its equivalent, between distance and near corrected vision. There was no anatomical loss of an eye, and the examination was negative for an astigmatism or diplopia. Additional findings included bilateral insipissated meibomian glands, bilateral acquired melanosis, bilateral nuclear sclerosis, bilateral retinal pigment epithelium mottling, and left sclerosed vessels. Retinopathy in the left eye was also shown, which was responsible for branch retinal vein occlusion. The Veteran also underwent visual field testing during the April 2013 examination. The examiner reported that the Veteran's remaining central visual field for the left eye was 16 degrees, vertically, and 25 degrees, horizontally; this loss was attributed to the service-connected vasculitis disability. These findings correspond to a 10 percent rating under Diagnostic Code 6080. 38 C.F.R. § 4.84a. The April 2013 examiner also determined that there was no clear evidence linking the Veteran's additional diagnoses of meibomian gland dysfunction, dry eyes, and cataracts in both eyes to his service-connected left eye disability. The April 2013 examiner further commented that the Veteran's eye disorder impacted his ability to work because he did not have normal depth and he had poor peripheral vision in the left eye. The examiner opined that tasks requiring good depth perception and peripheral vision should be voided, such as operating heavy machinery and firearms. The Veteran's visual acuity was recorded on a number of occasions during his claim. However, the objective evidence does not show that a rating higher than 10 percent is warranted. Thus, a increased rating is not warranted based on impairment of visual acuity. See 38 C.F.R. § 4.84a, Table V. Similarly, a rating in excess of 10 percent is not warranted for the Veteran's disability under Diagnostic Code 6080 based on visual field testing. The objective medical evidence shows contraction of the Veteran's left visual field. However, the findings from the July 2007, September 2008, June 2012, and April 2013 VA examinations do not show that the Veteran's left visual field contraction is of such a severity as to warrant a rating higher than the currently assigned 10 percent evaluation. Based on the foregoing, the Board finds that a rating in excess of 10 percent is not warranted at any time during the appeal period. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran's service-connected left eye disorder is rated based on visual impairment or visual field testing. Moreover, the Board has also considered, but does not find that a higher rating is warranted for the left eye disability under any other diagnostic code relevant to disabilities of the eye. Generally, evaluating a disability using either the corresponding or analogous diagnostic codes contained in the Rating Schedule is sufficient. See 38 C.F.R. §§ 4.20, 4.27. However, because the ratings are averages, it follows that an assigned rating may not completely account for each individual veteran's circumstance, but nevertheless would still be adequate to address the average impairment in earning capacity caused by disability. However, in exceptional cases where the rating is inadequate, it may be appropriate to assign an extraschedular rating. 38 C.F.R. § 3.321(b). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate, a task performed either by the RO or the Board. Id.; see Thun v. Peake, 22 Vet. App. 111, 115 (2008), aff'd, 572 F.3d 1366 (2009); see also Fisher v. Principi, 4 Vet. App. 57, 60 (1993) ("[R]ating [S]chedule will apply unless there are 'exceptional or unusual' factors which render application of the schedule impractical."). Therefore, initially, there must be a comparison between the level of severity and symptomatology of the Veteran's service-connected disability with the established criteria found in the Rating Schedule for that disability. Thun, 22 Vet. App. at 115. If the criteria reasonably describe the Veteran's disability level and symptomatology, then the Veteran's disability picture is contemplated by the Rating Schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. The Board finds that the Veteran's disability picture is not so unusual or exceptional in nature as to render the already assigned rating inadequate. The rating criteria relevant to the Veteran's service-connected left eye disability contemplate the level of visual impairment caused by his disability. Id. When comparing this disability picture with the symptoms contemplated by the Rating Schedule, the Board finds that the manifestations of the Veteran's disability warrant a 10 percent disability rating. Although higher disability ratings are permissible under the relevant rating criteria, the medical evidence demonstrates that the criteria for a higher rating are not present in this case. Consequently, the Board concludes that a schedular evaluation is adequate and that referral of the Veteran's case for extraschedular consideration is not required. In reaching this decision, the Board considered the doctrine of reasonable doubt. However, as the preponderance of the evidence is against the Veteran's claim of entitlement to a rating in excess of 10 percent for his service-connected left eye disorder, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER The rating reduction from 30 percent to 10 percent disabling, effective February 1, 2009, for left eye vasculitis, with macular involvement, was proper, and therefore, the appeal for restoration is denied. A disability rating in excess of 10 percent for left eye vasculitis, with macular involvement, is denied. ____________________________________________ JOY A. MCDONALD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs