Citation Nr: 18146104 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 13-19 873 DATE: October 30, 2018 ORDER Entitlement to an initial rating in excess of 10 percent for bilateral conjunctival injection, to include on an extraschedular basis, is denied. Entitlement to a separate 20 percent rating for bilateral dry eye syndrome is granted. Entitlement to a total disability based on individual unemployability by reason of service-connected disabilities (TDIU), to include on an extraschedular basis, is denied. FINDINGS OF FACT 1. For the entire period of appeal, the bilateral conjunctival injection has been rated as 10 percent disabling under Diagnostic Code 6099-6018, which is the maximum rating for active conjunctivitis under this diagnostic code. The conjunctival injection has not resulted in corrected visual acuity of 20/200 or remaining visual field of 15 degrees or less. 2. For the entire period of appeal, the Veteran has a diagnosis of bilateral dry eye syndrome, and the evidence is in equipoise on whether it is related to service. 3. The Veteran’s symptoms and functional loss associated with his bilateral conjunctival injection and dry eye syndrome are either contemplated by the rating criteria or do not present an exceptional or unusual disability picture so as to render impractical the application of the regular schedular standards. 4. The Veteran has at least two years of college education and worked as a memorial counselor and self-employed performer. 5. The Veteran’s service-connected disabilities consist of bilateral conjunctival injection (10 percent from October 9, 2009) and bilateral dry eye syndrome (granted herein, 20 percent from October 9, 2009). His combined total rating is 30 percent since October 9, 2009. 6. The Veteran’s service-connected disabilities do not preclude him from securing and following substantially gainful employment consistent with his educational and occupational experience. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for bilateral conjunctival injection are not met on either a schedular or extraschedular basis. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321(b)(1), 4.79, Diagnostic Codes 6099-6018, 6066, 6080. 2. The criteria for a separate 20 percent rating for bilateral dry eye syndrome, effective from October 9, 2009, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.79, Diagnostic Code 6025. 3. The criteria for entitlement to a TDIU are not met on either a schedular or extraschedular basis. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Marine Corps from January 1974 to April 1978. The Veteran testified at a videoconference hearing before the undersigned in September 2013, and a transcript of that hearing is of record. In April 2014 and May 2017, the Board remanded the case for further development, including obtaining relevant treatment records and Social Security Administration (SSA) disability records, obtaining a medical opinion on the nature and severity of all eye diagnoses, and referral for consideration of entitlement to an increased rating for the bilateral eye disability and TDIU on an extraschedular basis. VA, non-VA, and SSA records have since been obtained, an advisory opinion on extraschedular consideration for the eye disability and TDIU was obtained in August 2016, and a medical opinion on the nature and severity of the Veteran’s eye conditions was obtained in August 2017. The Board therefore finds there has been substantial compliance with remand directives. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Stegall v. West, 11 Vet. App. 268 (1998). 1. Increased rating for bilateral conjunctival injection. The Veteran was originally granted service connection for chronic bilateral conjunctival injection (claimed as an eye condition and previously claimed as bilateral conjunctivitis), and assigned a 10 percent rating from October 9, 2009, under Diagnostic Code 6099-6018. During the pendency of the appeal for an increased initial rating, the Veteran submitted claims for service connection for dry eyes and photophobia. The RO construed the claim as an increased rating claim and in an October 2012 rating decision continued the 10 percent rating for chronic bilateral conjunctival injection. In a May 2018 rating decision, the RO recharacterized the eye disability to “dry eye syndrome with chronic bilateral conjunctival injection” and continued the 10 percent rating. The RO noted that service connection for bilateral dry eye was in order, but because the conjunctival injection was found to be a direct result of dry eye syndrome, “the newly service-connected bilateral dry eye syndrome is combined with conjunctival injection.” Rating Criteria Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the assigned rating; the additional code is shown after the hyphen. The provisions of 38 C.F.R. § 4.27 provide that unlisted disabilities requiring rating by analogy will be coded with the first two numbers of the schedule provisions for the most closely related body part and 99. Here, the hyphenated diagnostic code indicates that the bilateral conjunctival injection is rated as analogous to a disease of the eye (Diagnostic Code 6099) under the criteria for chronic conjunctivitis (Diagnostic Code 6018). 38 C.F.R. § 4.79. Under the regulations that went into effect on December 10, 2008, chronic conjunctivitis warrants a 10 percent rating when it is active (with objective findings such as red, thick conjunctivae, mucous secretion, etc.). When the conjunctivitis is inactive is to be evaluated based on residuals, such as visual impairment and disfigurement. 38 C.F.R. § 4.79, Diagnostic Code 6018. With respect to field of vision impairment, 38 C.F.R. § 4.76a, Table III, the normal visual field extent at the 8 principal meridians totals 500 degrees. The normal for the 8 principal meridians are as follows: 85 degrees temporally; 85 degrees down temporally; 65 degrees down; 50 degrees down nasally; 60 degrees nasally; 55 degrees up nasally; 45 degrees up; and 55 degrees up temporally. 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. The degrees lost are then added together to determine the total number of degrees lost, which are subtracted from 500. The total remaining degrees of the visual field are then divided by eight to represent the average contraction for rating purposes. 38 C.F.R. § 4.76a. Under Diagnostic Code 6080, visual field defects are evaluated as follows: A 10 percent evaluation for concentric contraction of visual field with remaining field of 46 to 60 degrees bilaterally or unilaterally; with remaining field of 31 to 45 degrees unilaterally; with remaining field of 16 to 30 degrees unilaterally; loss of superior half of visual field bilaterally or unilaterally; loss of interior half of visual field unilaterally; loss of nasal half of visual field bilaterally or unilaterally; and loss of temporal half of visual field unilaterally. A 20 percent evaluation if assigned for concentric contraction of visual field with remaining field of 6 to 15 degrees unilaterally. A 30 percent evaluation is assigned for concentric contraction of visual field with remaining field of 31 to 45 degrees bilaterally; remaining field of 5 degrees unilaterally; loss of inferior half of visual filed bilaterally; loss of temporal half of visual field bilaterally; and homonymous hemianopsia visual filed defects. A 50 percent rating is assigned for concentric contraction of visual field with remaining field of 16 to 30 degrees bilaterally. A 70 percent rating is assigned for concentric contraction of visual field with remaining field of 6 to 15 degrees bilaterally. A 100 percent rating is assigned for concentric contraction of visual field with remaining field of 5 degrees bilaterally. Visual impairment is also rated based on impairment of visual acuity (excluding developmental errors of refraction). 38 C.F.R. § 4.79, Diagnostic Codes 6061-6066. 38 C.F.R. § 4.76(b) dictates that evaluation of visual acuity should be done on the basis of corrected distance vision with central fixation, unless the lens required to correct distance vision in the poorer eye differs by more than three diopters from the lens required to correct distance vision in the better eye. A 10 percent rating is warranted only when there is (1) 20/50 vision in one eye with 20/40 or 20/50 vision in the other eye; (2) 20/70 vision in one eye with 20/40 vision in the other eye; or (3) 20/100 vision in one eye with 20/40 vision in the other eye. A 20 percent rating is warranted when there is (1) 20/70 vision in one eye with 20/50 vision in the other eye; (2) 20/100 vision in one eye with 20/50 vision in the other eye; (3) 20/200 vision in one eye with 20/40 vision in the other eye; or (4) 15/200 vision in one eye with 20/40 vision in the other eye. A 30 percent rating is warranted (1) when vision in both eyes is correctable to 20/70; (2) when vision in one eye is correctable to 20/100 and vision in the other eye is correctable to 20/70; (3) when vision in one eye is correctable to 20/200 and vision in the other eye is correctable to 20/50; (4) when vision in one eye is correctable to 15/200 and vision in the other eye is correctable to 20/50; (5) when vision in one eye is correctable to 10/200 and vision in the other eye is correctable to 20/40; (6) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 20/40; and (7) when vision in one eye is no more than light perception and vision in the other eye is correctable to 20/40. A 40 percent rating is warranted (1) when vision in one eye is correctable to 15/200 and vision in the other eye is correctable to 20/70; (2) when vision in one eye is correctable to 10/200 and vision in the other eye is correctable to 20/50; (3) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 20/50; (4) when vision in one eye is no more than light perception and vision in the other eye is correctable to 20/50 or (5) when there is anatomical loss of one eye and vision in the other eye is correctable to 20/40. A 50 percent disability rating is warranted (1) when vision in one eye is correctable to 20/100 and vision in the other eye is correctable to 20/100; (2) when vision in one eye is correctable to 10/200 and vision in the other eye is correctable to 20/70; (3) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 20/70; (4) when vision in one eye is no more than light perception and vision in the other eye is correctable to 20/70; or (5) when there is anatomical loss of one eye and vision in the other eye is correctable to 20/50. A 60 percent disability rating is warranted (1) when vision in one eye is correctable to 20/200 and vision in the other eye is correctable to 20/100; (2) when vision in one eye is correctable to 15/200 and vision in the other eye is correctable to 20/100; (3) when vision in one eye is correctable to 10/200 and vision in the other eye is correctable to 20/200; (4) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 20/100; (5) when vision in one eye is no more than light perception and vision in the other eye is correctable to 20/100; or (6) when there is anatomical loss of one eye and vision in the other eye is correctable to 20/70 or 20/100. A 70 percent disability rating is warranted (1) when vision in one eye is correctable to 20/200 and vision in the other eye is correctable to 20/200; (2) when vision in one eye is correctable to 15/200 and vision in the other eye is correctable to 20/200; (3) when vision in one eye is correctable to 10/200 and vision in the other eye is correctable to 20/200; (4) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 20/200; (5) when vision in one eye is no more than light perception and vision in the other eye is correctable to 20/200; or (6) when there is anatomical loss of one eye and vision in the other eye is correctable to 20/200. An 80 percent disability rating is warranted (1) when vision in one eye is correctable to 15/200 and vision in the other eye is correctable to 15/200; (2) when vision in one eye is correctable to 10/200 and vision in the other eye is correctable to 15/200; (3) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 15/200; (4) when vision in one eye is no more than light perception and vision in the other eye is correctable to 15/200; or (5) when there is anatomical loss of one eye and vision in the other eye is correctable to 15/200. A 90 percent disability rating is warranted only (1) when vision in one eye is correctable to 10/200 and vision in the other eye is correctable to 10/200; (2) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 10/200; (3) when vision in one eye is no more than light perception and vision in the other eye is correctable to 10/200; or (4) when there is anatomical loss of one eye and vision in the other eye is correctable to 10/200. A 100 percent disability rating is warranted only (1) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 5/200; (2) when vision in one eye is no more than light perception and vision in the other eye is correctable to 5/200; (3) when there is anatomical loss of one eye and vision in the other eye is correctable to 5/200; (4) when there is no more than light perception in both eyes; or (5) when there is anatomical loss of both eyes. To determine the rating for visual impairment when both decreased visual acuity and visual field defect are present in one or both eyes and are service-connected, separately rate the visual acuity and visual field defect, expressed as a level of visual acuity, and combine them under the provisions of § 4.25. 38 C.F.R. § 4.77(c). Schedular Analysis The Board concludes that for the entire period of appeal, a rating in excess of 10 percent for the bilateral conjunctival injection is not warranted under Diagnostic Code 6099-6018. VA treatment records indicate that in October 2009, the Veteran reported having blurry vision all the time since his in-service injury. He also reported having eye pain frequently and wearing sunglasses most of the time due to light sensitivity. He denied having diplopia (double vision), drainage, vision loss, or headaches. In a December 2009 VA eye examination, the Veteran reported symptoms of redness, itching, tearing, headache, and photophobia. The examiner noted that the Veteran was wearing sunglasses and a hat with a brim, which the Veteran stated that he wore all the time. The Veteran was able to sit comfortably for the examination in normal lighting and with his eye illuminated by the slit lamp, but had discomfort after dilation. The examiner also noted that the Veteran was prescribed lubricant eye drops for dry eyes, which he used “very rarely” because he did not like taking medicines. On examination, the Veteran’s corrected visual acuity was 20/20 bilaterally. He was noted to have chronic bilateral conjunctival injection, which was most likely secondary to dry eyes; chronic photophobia, which could be related to dry eye, but was most likely related to reported in-service head trauma; episodic allergic conjunctivitis, which was most likely due to seasonal or environmental factors; deutan color vision deficiency, which was congenital and the Veteran was aware of the condition since he was young; and retinal lattice degeneration, which was first documented in 2009. In January 2013, the Veteran had another VA eye examination. He reported symptoms of constant redness and irritation, as well as always wearing sunglasses for light sensitivity. On examination, his corrected near and distance vision was 20/40 or better bilaterally. His pupils were equal in diameter, round, and reactive to light. There was no afferent pupillary defect, anatomical loss, light perception only, extremely poor vision, blindness, corneal irregularity that resulted in severe irregular astigmatism, or diplopia. Both eyes showed conjunctival injection and lattice degeneration, and were otherwise normal externally and internally. The Veteran did not have a visual field defect or a condition that resulted in a visual field defect. The Veteran also had not had any incapacitating episodes in the last 12 months due to any eye condition. The examiner indicated that there were no residuals of the Veteran’s reported in-service eye injury. The Veteran did have conjunctival injection in both eyes, which was most likely due to dry eyes. In February 2013, the Veteran was noted to have conjunctivitis and dry eye syndrome for 30 years and photophobia for 4 years. In a March 2013 SSA disability examination, the Veteran reported being very sensitive to light, which started five years ago and was constant. He also reported having dizzy spells during which his vision was blurry and he could not focus on anything. His corrected right eye distance vision was 20/25-1 and left eye corrected distance vision was 20/20. The examiner indicated that it was difficult to view his fundus due to photophobia but there was no definite lattice degeneration seen in either eye. Visual field testing showed contraction of field in both eyes, but there was poor test reliability in both eyes. The Veteran had a VA eye appointment in August 2013. He reported that his eyes were getting worse and he thought he was going blind. He was very sensitive to light and had blurriness, “bright lights shooting through his eyes,” and sometimes dizziness and migraines. He had glasses he got in 2009 but did not wear them because they gave him a headache. The examiner indicated that the Veteran’s corrected distance vision was at least 20/40; the Veteran read two letters on the 20/40 line and would not try to read anything on the 20/30 line. The Veteran was noted to have crusting on the upper lashes bilaterally and grade 2 diffuse injection bilaterally. In a September 2013 Board hearing, the Veteran was noted to be wearing a cap and glasses due to photophobia and glare sensitivity. He testified that he had daily pain and episodes that required him to be in bed or at least in a prone position because of the pain and discomfort of his five diagnosed eye conditions. He asserted that he was prescribed medication for dry eyes, which he did not like taking and when he did try to use it, it causes his eyes to become gummy with a sticky film and blurry vision. The Veteran stated that his vision had gotten worse in the last couple of years, and that he could not spend much time outside during the day because it was too bright. In March 2014, VA was informed that the Veteran was living in Ukraine, and was unsure of when he would return to the United States. VA obtained a medical opinion on August 2017. A VA optometrist reviewed the Veteran’s claims file and opined first that the Veteran’s conjunctival injection was more likely than not caused by or a result of the dry eye syndrome. The examiner indicated that dry eye syndrome caused the eye to become chronically irritated. The cornea could become very dry and also result in conjunctival injection. Conjunctival injection does not cause dry eye syndrome. The examiner opined second that dry eye syndrome was less likely than not caused by any in-service injury or environmental factors. He explained that many factors could cause dry eye syndrome, including exposure to chemicals, eye trauma, and eye medication, and as such, it was often difficult to diagnose the exact cause. However, there was no evidence in the Veteran’s treatment records that would predispose him to dry eye syndrome, and the reported in-service injury would not have caused dry eye syndrome. The examiner opined third that the Veteran’s photophobia was less likely than not caused by or a result of the service-connected conjunctival injection. The examiner noted that photophobia could be linked to dry eye syndrome, but it would be more episodic. The photophobia was most likely related to the reported head trauma. Finally, the examiner opined that the retinal lattice degeneration was less likely than not caused by or a result of the service-connected conjunctival injection. The examiner noted that the Veteran’s lattice degeneration was diagnosed in 2010, and it was a very common condition, found in 10 percent of eyes, and could result on retinal detachment, but would not be exacerbated or caused by any in-service activity or injury. In December 2017, the Veteran was seen at a VA emergency department reporting that he was unable to see out of his left eye since October 2017, had worsening vision in the right eye, and had progressively worse pain in both eyes for the past week. Upon examination, his pupils were equal in size, round, and reactive to light. The Veteran was noted to be recently returned from Ukraine and requested an evaluation of both eyes. He was unable to read any line on the eye chart. He was noted to have intact corneas and anterior chambers were clear. He did not have any conjunctival injection. The attending ER physician noted that it was a very difficult evaluation of vision loss that may have a psychiatric component. The Veteran was also seen by VA ophthalmology. In the evaluation, he refused to do a Snellen eye chart and refused dilation. A B-scan (ophthalmic ultrasound) showed total retinal detachment in the left eye. Surgery was not recommended. The Veteran was seen for a follow-up appointment in January 2018. He noted that he had not had any eye care in Ukraine. He was noted to be legally blind in the left eye due to total retinal detachment and undetermined pathology in the right eye. A few weeks later, the Veteran had an eye surgery consultation. The ophthalmologist noted that the Veteran became extremely agitated on discussion of any symptoms or signs, to the point of making accusatory comments about other doctors who had participated in his care, and presented conflicting information regarding the timeline of his retinal detachment. The ophthalmologist also indicated that some of the features in the Veteran’s history and behavior were not entirely congruent with the severity of his vision loss that he claimed. As such, further plans were deferred pending a better understanding of the situation. As noted above, the maximum rating for chronic conjunctivitis (nontrachomatous) that is active is 10 percent. 38 C.F.R. § 4.79, Diagnostic Code 6018. As such, the Veteran has been in receipt of the maximum rating allowed for his bilateral conjunctival injection under this diagnostic code throughout the entire rating period. The Board has considered whether a higher rating or any additional ratings are warranted under an alternative diagnostic code, and finds that, in resolving all reasonable doubt in favor of the Veteran, a separate 20 percent rating for bilateral dry eye syndrome under Diagnostic Code 6025 is warranted from October 9, 2009. Under this diagnostic code, a bilateral disorder of the lacrimal apparatus warrants a 20 percent rating. “Lacrimal” is defined as “pertaining to the tears.” DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 996 (32nd ed. 2012). and the September 2011 VA examiner noted that the Veteran had a bilateral lacrimal gland and lid disorder. Here, the Veteran has consistently been noted to have dry eyes and/or dry eye syndrome throughout the entire period on appeal, including in the December 2009 and January 2013 VA examinations and in the August 2017 VA medical opinion. The Board acknowledges that the August 2017 examiner opined that the dry eye syndrome was less likely than not caused by an in-service injury or environmental factors; however, the Veteran is service-connected for chronic conjunctival injection and all three VA examiners opined that the conjunctival injection was more likely than not secondary to dry eyes. As such, resolving all reasonable doubt in favor of the Veteran, a 20 percent rating is warranted under Diagnostic Code 6025 from October 9, 2009, the effective date of the award of service connection for chronic conjunctival injection. To warrant a higher 20 percent rating based on impaired central visual acuity, the evidence must show that vision in one eye is 20/40 and vision in the other eye is 20/200. 38 C.F.R. § 4.79, Diagnostic Code 6066. Alternatively, to warrant a higher rating based on visual field defect, the evidence must show contraction of the central visual field with a remaining field of six to 15 degrees. 38 C.F.R. § 4.79, Diagnostic Code 6080. Here, prior to December 2017, the Veteran was not found to have an impairment in visual acuity worse than 20/40, impairment in visual field, nor was he been found to have any incapacitating episodes, disfigurement, or scarring to warrant a higher rating or any additional ratings under other diagnostic codes. The Board acknowledges that the Veteran was found to have a total retinal detachment in December 2017, impairing his visual acuity and/or field. However, the August 2017 VA examiner opined that the retinal lattice degeneration, first detected in 2009, was less likely than not caused by or a result of the service-connected conjunctival injection and there is no contradicting medical evidence. As such, a higher 20 percent rating under Diagnostic Code 6018 for impairment in visual acuity or field is not warranted at any point during the period of appeal. Finally, the Board finds that a separate rating for photophobia is not warranted, as the December 2009 and August 2017 VA examiners indicated that it was most likely related to head trauma and there is no contradicting medical evidence. As such, for the entire period of appeal, a schedular rating in excess of 10 percent for the bilateral conjunctival injection under Diagnostic Code 6099-6018 is not warranted, and a separate 20 percent rating for bilateral dry eye syndrome under Diagnostic Code 6025 is warranted. Extraschedular Analysis The issue of entitlement to an extraschedular rating has been raised in this case. To accord justice in the exceptional case where the criteria in VA’s Rating Schedule are found to be inadequate, an extraschedular rating that is commensurate with the average earning capacity impairment caused by the service connected disability is warranted. An extraschedular rating is warranted when the case presents such an unusual disability picture with related factors such as marked interference with employment as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). The Board cannot grant an extraschedular rating in the first instance. Anderson v. Shinseki, 23 Vet. App. 423 (2009). Here, in an August 2016 memorandum, a VA Director of Compensation and Pension Service denied an extraschedular rating for the service-connected bilateral eye disability, noting that VA examiners on record, including the January 2013 VA examiner, found no functional impact to physical or sedentary occupational activity due to the service-connected eye disability. The Director concluded that the evidence was clear and convincing that the Veteran’s eye condition did not pose a unique set of circumstances to render the rating schedule impractical, and as such, an extraschedular rating in excess of 10 percent was not warranted. See Kuppamala v. McDonald, 24 Vet. App. 447 (2016) (noting that an extraschedular rating decision made by the Director must contain a statement of reasons or bases, and is reviewable by the Board on a de novo basis). Following a review of the record, the Board agrees that an extraschedular rating is not warranted because the schedular criteria are adequate in addressing the severity of the Veteran’s bilateral eye disabilities, and because the evidence does not show an exceptional or unusual disability picture. 38 C.F.R. § 3.321(b)(1) (2017); Thun v. Peake, 22 Vet. App. 111 (2008). The Board finds that the rating criteria reasonably describe the Veteran’s disability levels and symptomatology attributable to the service-connected conjunctival injection and dry eye syndrome, to include pain, conjunctivitis, and dryness. The record further shows that despite his eye complaints, the Veteran has retained good corrected visual acuity and field prior to December 2017, without complaints of diplopia or any surgical procedures. As discussed above, the other eye-related complaints of photophobia, retinal degeneration, and December 2017 retinal detachment have been found to result from nonservice-connected eye conditions. Thus, the Board finds that the overall bilateral eye disability picture is contemplated by the rating schedule, and the assigned schedular evaluations are adequate. Id. at 115. 2. Entitlement to a TDIU. Total disability meriting a 100 percent schedular rating exists “when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation.” 38 C.F.R. §§ 3.340(a)(1), 4.15. Where the schedular disability rating is less than 100 percent, a total rating due to individual unemployability may nonetheless be assigned if a veteran is rendered unemployable as a result of service-connected disabilities, provided that certain regulatory requirements are satisfied. See 38 C.F.R. §§ 3.341(a), 4.16(a). Total disability ratings for compensation may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disability of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular- renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16. “Marginal employment,” for example, as a self-employed worker or at odd jobs or while employed at less than half of the usual remuneration, shall not be considered “substantially gainful employment.” 38 C.F.R. § 4.16(a). Here, the Veteran’s service-connected disabilities consist of bilateral conjunctival injection (10 percent from October 9, 2009) and bilateral dry eye syndrome (granted herein, 20 percent from October 9, 2009). His combined total rating is 30 percent since October 9, 2009. Thus, the percentage requirements of § 4.16(a) are not met, and entitlement to a TDIU on a schedular basis is not warranted at any point during the period of appeal. The regulations provide that if the percentage requirements are not met, TDIU may be granted on an extraschedular basis in exceptional cases when the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. 38 C.F.R. §§ 3.321(b), 4.16(b). In Bowling v. Principi, 15 Vet. App. 1, 10 (2001), however, the United States Court of Appeals for Veterans Claims (Court), citing its decision in Floyd v. Brown, 9 Vet. App. 88, 94-97 (1995), held that the Board cannot award TDIU under 38 C.F.R. § 4.16(b) in the first instance, because that regulation requires that the RO first submit the claim to the DCPS for extraschedular consideration. Regarding the Veteran’s education and employment history, the Veteran indicated on March 2010 and August 2014 Applications for Increased Compensation Based on Unemployability that his education consisted of two or three years of college education and no other education or training. He worked as a memorial counselor and self-employed musical performer until October 2009. The Board finds that the Veteran’s service-connected eye disabilities are not shown to preclude him securing and following substantially gainful employment consistent with his educational and work background. A VA treatment record dated in February 2010 indicates that the Veteran reported that heft his job as a cemetery property counselor to pursue his passion for playing music and entertaining. He also indicated that he would begin working at a printing company within the next couple of weeks. In a January 2013 VA eye examination, the Veteran’s corrected near and distance vision was 20/40 or better bilaterally and he did not have a visual field defect or a condition that resulted in a visual field defect. The Veteran also had not had any incapacitating episodes in the last 12 months due to any eye condition. The examiner opined that the Veteran’s eye conditions did not impact his ability to work. In July 2013, the Veteran reported in a VA appointment that he could not work at the current time, but he was working with vocational rehabilitation to return to school and was interested in pursuing a career in pre-law or languages, as he was already fluent in three languages. He indicated that he thought he could pursue jobs in either of these fields even if his eyes worsened, as long as he had accommodations. The Director of Compensation Service submitted an extraschedular advisory opinion in August 2016. She noted the January 2013 VA examiner’s opinion that the Veteran’s eye conditions did not interfere with occupational activity, and noted that although SSA found the Veteran disabled due to visual disturbance and affective/mood disorders, there was no finding that the Veteran’s service-connected eye conditions were individually or collectively the sole reasons for the Veteran’s unemployability (Blackburn v. Brown). As such, entitlement to an extraschedular TDIU was not warranted. The Board recognizes that the Veteran is competent to report on the nature and perceived impact of his symptoms to the extent that they are capable of lay observation. Layno v. Brown, 6 Vet. App. 465 (1994). However, under the facts of this case, the Board finds that the Veteran has limited competence to opine on the occupational impact of such symptoms, as this is beyond his lay competence. Moreover, the Veteran has made contradictory statements about the reason for leaving his employment, noting that he quit as a cemetery counselor to pursue music. Upon review of the evidence of record, the Board finds that the Veteran’s service connected disabilities do not render him and the claim must therefore be denied. The evidence as outlined above reflects the Veteran’s eye disabilities, the only service-connected disabilities, do not render him unable to secure or follow a substantially gainful occupation. The Veteran reported that he had 2-3 years of college education and he described his work as a cemetery counselor and music performer. The examinations of record clearly depict a person who retains some ability to perform work. There is no other medical evidence suggesting that the Veteran is unable to work due to his service-connected disabilities. The Board notes that in December 2017, the Veteran’s visual ability changed due to retinal detachment; however, as discussed above, this was due to a nonservice-connected condition. In reaching this conclusion, the benefit of the doubt has been considered; however, the preponderance of the evidence is against the Veteran’s claim. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Accordingly, the Veteran’s claim for TDIU on a schedular or extraschedular basis is denied. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Nelson, Counsel