Citation Nr: 20021880 Decision Date: 03/27/20 Archive Date: 03/27/20 DOCKET NO. 18-24 077 DATE: March 27, 2020 ORDER An increased rating in excess of 20 percent from December 14, 2016 through April 14, 2017 for radiculopathy, right lower sciatic nerve is denied. An increased rating in excess of 10 percent from April 15, 2017 through February 13, 2020 for radiculopathy, right lower sciatic nerve is denied. An increased rating in excess of 20 percent since February 14, 2020 for radiculopathy, right lower sciatic nerve is denied. An increased rating in excess of 20 percent from December 14, 2016 through April 14, 2017 for radiculopathy, left lower sciatic nerve is denied. An increased rating in excess of 10 percent since April 15, 2017 for radiculopathy, right lower sciatic nerve is denied. An increased rating of 20 percent, but no higher, effective December 14, 2016 for degenerative arthritis of the spine is granted. Service connection for a right eye condition is denied. Service connection for a left eye condition is denied. Entitlement to a total disability individual unemployability (TDIU) rating since May 1, 2013 is granted. FINDINGS OF FACT 1. From December 14, 2016 through April 14, 2017, the Veteran’s radiculopathy, right lower sciatic nerve manifested with moderate incomplete paralysis. 2. From April 15, 2017 through February 13, 2020, the Veteran’s radiculopathy, right lower sciatic nerve manifested with mild incomplete paralysis. 3. Since February 14, 2020, the Veteran’s radiculopathy, right lower sciatic nerve manifested with moderate incomplete paralysis. 4. From December 14, 2016 through April 14, 2017, the Veteran’s radiculopathy, left lower sciatic nerve manifested with moderate incomplete paralysis. 5. Since April 15, 2017, the Veteran’s radiculopathy, left lower sciatic nerve manifested with mild incomplete paralysis. 6. During the period on appeal, the Veteran’s degenerative arthritis of the spine manifested with forward flexion limited to 40 degrees. 7. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a right eye condition. 8. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a left eye condition. 9. Myopia is a refractive error, which does not constitute a "disease" or "injury" for VA compensation purposes. 10. With resolution of the doubt in his favor, the Veteran’s service-connected disorders render him unemployable since May 1, 2013. CONCLUSIONS OF LAW 1. The criteria for an increased rating in excess of 20 percent from December 14, 2016 through April 14, 2017 for radiculopathy, right lower sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.124a, Diagnostic Code (DC) 8520. 2. The criteria for an increased rating in excess of 10 percent from April 15, 2017 through February 13, 2020 for radiculopathy, right lower sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.124a, DC 8520. 3. The criteria for an increased rating in excess of 20 percent since February 14, 2020 for radiculopathy, right lower sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.124a, DC 8520. 4. The criteria for an increased rating in excess of 20 percent from December 14, 2016 through April 14, 2017 for radiculopathy, left lower sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.124a, DC 8520. 5. The criteria for an increased rating in excess of 10 percent since April 15, 2017 for radiculopathy, right lower sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.124a, DC 8520. 6. The criteria for an increased rating of 20 percent, but no higher, effective December 14, 2016 for degenerative arthritis of the spine have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5242. 7. The criteria to establish service connection for a left eye condition have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for entitlement to a TDIU rating since May 1, 2013 have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Air Force from October 1988 through April 2013. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In February 2020, the Veteran was afforded a video conference hearing before the undersigned Veterans Law Judge (VLJ). During the hearing, the VLJ engaged in a colloquy with the Veteran toward substantiation of the claims. Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). A hearing transcript is in the record. The claim for a TDIU has been added to the appeal pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Increased Rating Disability ratings are determined by applying 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 (“Code”). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations should 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. In disability rating cases, VA assesses the level of disability from the initial grant of service connection or a year prior to the date of application for an increased rating and determines whether the level of disability warrants the assignment of different disability ratings at different times over the course of the claim, a practice known as “staged ratings.” See Fenderson v. West, 12 Vet. App. 119, 126 (1999); see also Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007) (holding that staged ratings may be warranted in increased rating claims). Additionally, the evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided. Separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). In assigning a higher disability rating, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. An increased rating in excess of 20 percent from December 14, 2016 through April 14, 2017; in excess of 10 percent from April 15, 2017 through February 13, 2020; and in excess of 20 percent since February 14, 2020 for radiculopathy, right lower sciatic nerve; and 2. An increased rating in excess of 20 percent from December 14, 2016 through April 14, 2017 and in excess of 10 percent since April 15, 2017 for radiculopathy, left lower sciatic nerve. The Veteran was in receipt of a 20 percent rating for radiculopathy, right lower sciatic nerve from December 14, 2016 through April 14, 2017 and a 10 percent rating from April 15, 2017 through February 13, 2020. He has been in receipt of a 20 percent rating for radiculopathy, right lower sciatic nerve since February 14, 2020. See 38 C.F.R. § 4.71a, DCs 8520, 8620. The Veteran was in receipt of a 20 percent rating for radiculopathy, left lower sciatic nerve from December 14, 2016 through April 14, 2017 and has been in receipt of a 10 percent rating since April 15, 2017. See 38 C.F.R. § 4.71a, DCs 8520, 8620. DC 8520 provides ratings for paralysis of the sciatic nerve. Mild incomplete paralysis warrants a 10 percent rating. Moderate incomplete paralysis warrants a 20 percent rating. Moderately severe incomplete paralysis warrants a 40 percent rating. Severe incomplete paralysis with marked muscular atrophy warrants a 60 percent rating. Complete paralysis warrants an 80 percent rating. 38 C.F.R. § 4.124a, DC 8520. The term "incomplete paralysis," indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor. Id. Words such as "moderate" and "severe" are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. In an April 2017 back examination, a VA examiner reported that sensory exam for the Veteran’s bilateral lower leg/ankle (L4/L5/S1) and foot/toes (L5) was decreased. Muscle strength testing of the lower extremities was normal. The examiner reported that straight leg testing was positive bilaterally. The examiner further reported that the Veteran had radicular symptoms of moderate intermittent pain in his bilateral lower extremities; moderate paresthesias and/or dysesthesias, and numbness in his right lower extremity; and mild paresthesias and/or dysesthesias, and numbness in his left lower extremity; all with involvement of L4/L5/S1/S2/S3 nerve roots bilaterally. The examiner indicated radiculopathy symptoms of mild severity bilaterally. In a March 2020 back examination, the examiner reported that sensory exam for the Veteran’s bilateral thigh/knee (L3/L4); lower leg/ankle (L4/L5/S1); and foot/toes (L5) was normal. Muscle strength testing of the left lower extremity was normal and showed active movement against some resistance in the right lower extremity. The examiner further reported that the Veteran’s bilateral lower extremities had radicular symptoms of moderate intermittent pain; paresthesias and/or dysesthesias, and numbness; all with involvement of L4/L5/S1/S2/S3 nerve roots bilaterally. The examiner indicated radiculopathy symptoms of moderate severity in the right lower extremity and mild severity in the left lower extremity. Further, in a March 2020 VA peripheral nerves examination, a VA examiner indicated that the Veteran’s sciatic nerve showed incomplete paralysis with moderate severity in the right lower extremity and mild severity in the left lower extremity. VA and private treatment records and statements from the Veteran indicate symptoms of tingling, numbness, and pain radiating down the legs, all of which he is competent to describe. Given these facts, the Board finds that a 20 percent rating for the Veteran’s radiculopathy, right lower sciatic nerve from December 14, 2016 through April 14, 2017 most closely approximates the Veteran’s radicular symptoms during this period. A higher 30 percent rating is not warranted because the record does not show “severe” incomplete paralysis. There is no relevant medical evidence during this period. As such, the Board finds that a rating in excess of 20 percent for the Veteran’s radiculopathy, right lower sciatic nerve is not warranted from December 14, 2016 through April 14, 2017. A 10 percent rating for the Veteran’s radiculopathy, right lower sciatic nerve from April 15, 2017 through February 13, 2020 most closely approximates the Veteran’s radicular symptoms during this period. A higher 20 percent rating is not warranted because the record does not show “moderate” incomplete paralysis. The April 2017 back examination indicated radiculopathy symptoms of mild severity bilaterally. As such, the Board finds that a rating in excess of 10 percent for the Veteran’s radiculopathy, right lower sciatic nerve is not warranted from April 15, 2017 through February 13, 2020. A 20 percent rating for the Veteran’s radiculopathy, right lower sciatic nerve since February 14, 2020 most closely approximates the Veteran’s radicular symptoms during this period. A higher 30 percent rating is not warranted because the record does not show “severe” incomplete paralysis. The March 2020 VA examiner indicated radicular symptoms of “moderate” severity in the right lower extremity. As such, the Board finds that a rating in excess of 20 percent for the Veteran’s radiculopathy, right lower sciatic nerve is not warranted since February 14, 2020. Regarding radiculopathy, left lower sciatic nerve, the Board finds that a 20 percent rating from December 14, 2016 through April 14, 2017 most closely approximates the Veteran’s radicular symptoms during this period. A higher 30 percent rating is not warranted because the record does not show “severe” incomplete paralysis. There is no relevant medical evidence during this period. As such, the Board finds that a rating in excess of 20 percent for the Veteran’s radiculopathy, left lower sciatic nerve is not warranted from December 14, 2016 through April 14, 2017. A 10 percent rating for the Veteran’s radiculopathy, left lower sciatic nerve since April 15, 2017 most closely approximates the Veteran’s radicular symptoms during this period. A higher 20 percent rating is not warranted because the record does not show “moderate” incomplete paralysis. The April 2017 and May 2020 VA examiners indicated radicular symptoms of mild severity in the left lower extremity. As such, the Board finds that a rating in excess of 10 percent for the Veteran’s radiculopathy, left lower sciatic nerve is not warranted since April 15, 2017. In making these determinations, the Board has considered, along with the schedular criteria, the Veteran’s functional loss due to pain. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202, 206-207 (1995). 3. An increased rating in excess of 10 percent for degenerative arthritis of the spine. The Veteran's service-connected degenerative arthritis of the spine has been rated as 10 percent disabling under DC 5242 since May 1, 2013. The appellate period is from December 14, 2016, the date of receipt of the Veteran’s increased rating claim. DC 5242 provides ratings for lumbar spine disorders. A 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; the combined range of motion of the thoracolumbar 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. 38 C.F.R. § 4.71a; DC 5242. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; 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. Id. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine 30 degrees or less or for favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. Id. There are also several relevant note provisions associated with DC 5242. Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. 38 C.F.R. § 4.71a; DC 5242. In April 2017, the Veteran was afforded a VA examination. He reported flare-ups when he could only walk a few steps at a time due to severe lower back pain, associated with right leg weakness. The Veteran further reported having functional loss or functional impairment such that it was hard to bend forward, look up, do heavy lifting, or use the stairs. On examination, the examiner noted a range of flexion limited to 15 degrees; extension limited to 10 degrees; left and right lateral flexion limited to 10 degrees; and left and right lateral rotation limited to 10 degrees. The examiner indicated that the range of motion did not contribute to functional loss and no pain noted on examination. There was objective evidence of hypoactive ankles reflexes; decreased sensation in bilateral lower leg, ankles, feet, and toes; positive straight leg lift; moderate intermittent pain in bilateral lower extremity; moderate paresthesias and/or dysesthesias, and numbness in right lower extremity; mild paresthesias and/or dysesthesias, and numbness in left lower extremity; and regular use of a brace. There was no objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine; pain with weight bearing; additional limitation in range of motion after three repetitions; guarding or muscle spasm; reduced muscle strength; muscle atrophy; abnormal knee reflexes; abnormal sensory exam in bilateral upper anterior thigh, thigh, and knee; constant pain in bilateral lower extremity; ankylosis; other neurologic abnormalities; Intervertebral Disc Syndrome (IVDS); functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis; or scars. The examiner indicated that the Veteran’s lumbar spine disorder impacted his ability to work leading to poor tolerance for general physical work, especially heavy physical work involving lifting or twisting motions; and poor tolerance for extended walking or driving limitations. The examiner indicated that he was unable to say without mere speculation whether pain, weakness, fatigability, or incoordination significantly limited functional ability with flare-ups or repeated use over a period of time. The examiner explained that there was extremely poor range of motion displayed on focused exam, and near-normal range of motion without pain noted with transitions and in the waiting room, indicating probable intentional manipulation of exam results. Therefore, the examination could not be used to objectively quantify functional loss at baseline or with repetitive use of with flare-ups. In March 2020, the Veteran was afforded another VA examination. He reported symptoms of pain, numbness, tingling, weakness, and pain in his legs bilaterally. The Veteran further reported flare-ups such as a burning sensation in the lower back, difficulty bending, which was alleviated by a cold compress and laying down. He reported functional loss or functional impairment of difficulty bending; lifting items over 10-15 pounds; and an inability to sit, walk, or stand for longer than 10 to 15 minutes. On examination, the examiner noted a range of flexion limited to 45 degrees; extension limited to 5 degrees; left and right lateral flexion limited to 25 degrees; and left and right lateral rotation limited to 30 degrees; with pain on motion. The examiner indicated that the range of motion contributed to functional loss such as bending, lifting, and extending back. The examiner indicated that pain significantly limited functional ability with repeated use over time with additional limitation in range of motion for flexion limited to 40 degrees; extension limited to 0 degrees; left and right lateral flexion limited to 20 degrees; and left and right lateral rotation limited to 25 degrees. The examiner further indicated that pain and weakness significantly limited functional ability with flare-ups with additional limitation in range of motion for flexion limited to 40 degrees; extension limited to 5 degrees; left and right lateral flexion limited to 20 degrees; and left and right lateral rotation limited to 25 degrees. There was objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine; pain with weight bearing; guarding and muscle spasm, not resulting in abnormal gait or abnormal spinal contour; interference with sitting and standing; active movement against some resistance on the right side; decreased sensation in bilateral thigh, knee, lower leg, ankles, feet, and toes; positive straight leg lift; moderate intermittent pain, paresthesias and/or dysesthesias, and numbness in bilateral lower extremity; There was no objective evidence of additional limitation in range of motion after three repetitions; reduced muscle strength on the left side; muscle atrophy; abnormal reflex exam; abnormal sensory exam in bilateral upper anterior thigh; constant pain in bilateral lower extremity; ankylosis; other neurologic abnormalities; IVDS; assistive devices; functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis; or scars. The examiner indicated that the Veteran’s lumbar spine disorder impacted his ability to work such that he could not lift heavy items, stand, sit, or walk for long periods at a time, nor perform bending movements. VA and private treatment records indicate symptoms of constant back pain radiating to his legs, tenderness, use of a back brace, sleep disturbance, stiffness, muscle spasm, all of which the Veteran is competent to describe. However, he is not competent to provide an accurate measurement of the point at which pain affects his range of lumbar spine motion. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). The competent evidence with respect to the range of motion of the Veteran’s lumbar spine consists of the VA and private medical records, none of which indicate that forward flexion has been limited to 30 degrees or less during the pendency of the appeal, even considering pain and other factors. Given these facts, the Board finds that a 20 percent rating for the Veteran’s lumbar spine disorder most closely approximates the Veteran’s limitation of motion and functional impairment during the period on appeal. A 40 percent rating is not warranted for the Veteran’s lumbar spine disorder because he did not have forward flexion 30 degrees or less or for favorable ankylosis of the entire thoracolumbar spine. The March 2020 VA examination showed flexion limited to 40 degrees. Although the April 2017 VA examination showed flexion limited to 15 degrees, the examiner indicated that the examination could not be used to objectively quantify functional loss. In making these determinations, the Board has considered, along with the schedular criteria, the Veteran’s functional loss due to pain. 38 C.F.R. §§ 4.40, 4.45; supra DeLuca. The preponderance of the evidence is against the Veteran’s claim for an initial rating in excess of 20 percent for thoracic lumbar strain. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). For these reasons, the claim is denied. Additionally, staged ratings are not warranted, as the Veteran has had a relatively stable level of symptomatology throughout the appeal. Any other increases in severity were not sufficient for a higher rating. See Fenderson, 12 Vet. App. at 126–27. 4. Service connection for a bilateral eye condition. The Veteran contends that he a bilateral eye condition due to his active service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. VA regulations provide that refractive error does not constitute a "disease" or "injury" within the meaning of applicable legislation for VA compensation purposes. See 38 C.F.R. § §§ 3.303(c), 4.9; Terry v. Principi, 340 F.3d 1378 (Fed. Cir. 2003). Therefore, service connection may not be allowed for refractive error of the eyes. See VAOPGCPREC 82-90 (July 18, 1990). Service connection could be granted for superimposed disease or injury. The April 2017 VA examiner evaluated the Veteran and determined that, while he experienced subjective symptoms of difficulty seeing up close and focusing, the Veteran did not have a diagnosis of an eye condition other than congenital or developmental errors of refraction. The examiner explained that he was unable to diagnose the claimed condition due to a present lack of objective evidence. The examiner further noted that the Veteran was myopic, which is a refractive error and does not constitute a disease or injury for VA compensation purposes, and that his optic nerves were normal. The examiner explained that the Veteran’s optic nerve cupping is a benign condition associated with being myopic and was not glaucomatous. The Veteran’s service treatment records contain diagnoses of refractive error – myopia, astigmatism, and optic nerve. However, the VA examiner noted the conditions were refractive. While the Veteran believes he has a current bilateral eye condition, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. The Veteran does not have a current diagnosis of a bilateral eye condition and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Refractive error does not constitute a "disease" or "injury" for VA compensation purposes, and the Veteran's refractive error is not shown to have been subject to superimposed disease or injury in service. As the Veteran does not have a current disability, service connection is not warranted. Accordingly, the Veteran’s claim of service connection for a bilateral eye condition. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; supra Gilbert v. Derwinski. 5. Entitlement to a TDIU rating. VA regulations allow for the assignment of TDIU when a Veteran is unable to secure or follow a substantially gainful occupation due to service-connected disabilities, and the Veteran has certain combinations of ratings for service-connected disabilities. If there is only one such disability, that disability must be ratable at 60 percent or more. If there are two or more disabilities, there must be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Disabilities of one or both upper or extremities or one or both lower extremities (to include the bilateral factor), disabilities resulting from a common etiology or a single accident, and disabilities affecting a single body system (such as orthopedic disabilities) are considered as one disability for TDIU purposes. Id. The central inquiry is “whether a Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the Veteran’s education, special training, and previous experience, but not to his or her age or to the impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Van Hoose v. Brown, 4 Vet. App. 361 (1993). The Veteran’s service-connected disorders are 50 percent for obstructive sleep apnea; 30 percent for bilateral feet plantar fasciitis; 20 percent for radiculopathy, right lower sciatic nerve; 20 percent for degenerative arthritis of the spine; 10 percent for left knee shin splints; 10 percent for tinnitus; 10 percent for dermatitis; 10 percent for radiculopathy, left lower sciatic nerve; and noncompensable ratings for right wrist strain, right achilles tendonitis with shin splints, left foot plantar fascitis, and hypertension. The Veteran has had at least a combined 80 percent evaluation since May 1, 2013. The Veteran contends that he is unable to maintain substantially gainful employment due to his service-connected disorders. The Veteran indicated that he has been unemployed since April 30, 2013. In August 2013 disability benefits questionnaires (DBQs), a VA examiner indicated that the Veteran’s tinnitus, knee, lower leg, ankle, and foot conditions did not impact ordinary conditions of daily life, including ability to work. In a September 2014 skin diseases DBQ, a VA examiner indicated that the Veteran’s skin conditions did not impact his ability to work. In a September 2014 foot conditions DBQ, a VA examiner indicated that the Veteran’s foot conditions impacted his ability to work such that he was unable to perform physical activities, including extended walking and standing. In a September 2014 back (thoracolumbar spine) conditions DBQ, a VA examiner indicated that the Veteran’s back condition impacted his ability to work such that he was unable to perform physical activities, including heavy lifting and overhead activities. The April 2017 VA examiner noted that the Veteran’s lumbar spine disorder impacted his ability to work leading to poor tolerance for general physical work, especially heavy physical work involving lifting or twisting motions; and poor tolerance for extended walking or driving limitations. In an April 2017 skin diseases DBQ, a VA examiner indicated that the Veteran’s skin conditions did not impact his ability to work. In an April 2017 foot conditions DBQ, a VA examiner indicated that the Veteran’s foot condition impacted his ability to work such that his bilateral foot pain worsened with time and heavy use, which limited his ability to handle long days on his feet. In the March 2020 back (thoracolumbar spine) conditions DBQ, a VA examiner indicated noted that the Veteran’s lumbar spine disorder impacted his ability to work such that he could not lift heavy items, stand, sit, or walk for long periods at a time, nor perform bending movements. In the March 2020 peripheral nerves conditions DBQ, a VA examiner indicated that the Veteran’s peripheral nerve and/or peripheral neuropathy conditions impacted his ability to work such that it impacted his ability to climb stairs, stand, sit, or walk for longe periods of time. In a March 2020 individual unemployability statement, a nurse practitioner opined that it is at least as likely as not that the Veteran was able to perform sedentary work exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, and pull. The nurse practitioner indicated that sedentary work involved sitting most of the time, but may include walking or standing for brief periods of time and jobs are considered sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. The Board will grant a total rating based on the benefit-of-the-doubt doctrine since May 1, 2013. Therefore, a TDIU is warranted and the claim is granted. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. McLendon, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.