Citation Nr: 20049917 Decision Date: 07/27/20 Archive Date: 07/27/20 DOCKET NO. 16-08 330 DATE: July 27, 2020 ORDER Entitlement to service connection for a bilateral eye condition is denied. Entitlement to compensation under 38 U.S.C. § 1151 for a bilateral eye condition is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. A refractive error was noted upon entry to service. Refractive errors of the eye (including myopia, and astigmatism) are not diseases or injuries for VA disability compensation purposes. 2. Other than a refractive error, the Veteran does not have another eye condition that originated in service, within a year of service, or is otherwise etiologically related to the Veteran’s active service. 3. The Veteran’s right eye blindness did not result from carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA, or an event not reasonably foreseeable. 4. The Veteran is service connected for the following disabilities: bilateral hearing loss rated 40 percent disabling prior to January 2019, and 60 percent disabling thereafter; and, tinnitus rated 10 percent disabling as of May 2017. 5. The Veteran’s service-connected disabilities, either individually or through their combined-effect thereof, do not preclude him from securing and following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for service connection for a bilateral eye condition are not met. 38 U.S.C. §§ 1110, 1131, 1153, 5103, 5103A, 5107; 38 C.F.R. § 3.303. 2. The criteria for compensation benefits under the provisions of 38 U.S.C. § 1151 for a bilateral eye condition have not been met. 38 U.S.C. §§ 1151, 5103A, 5107; 38 C.F.R. § 3.361. 3. Throughout the period on appeal, the criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5103, 5103A; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1961 to March 1969. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision by a Department of Veterans Affairs Regional Office (RO). In April 2018, the Veteran testified at a Board videoconference hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file. In July 2018, the Board remanded this case for the Agency of Original Jurisdiction (AOJ) to consider medical evidence submitted after the claim on appeal was last adjudicated in the February 2016 statement of the case (SOC). The Board notes that the AOJ most recently readjudicated the claims on appeal in a May 2020 supplemental SOC which has been associated with the claims file. Accordingly, after reviewing the actions of the AOJ, the Board finds there was substantial compliance with the requested development. Dyment v. West, 13 Vet. App. 141 (1999); Stegall v. West, 11 Vet. App. 268 (1998). Bilateral Eye Condition Factual Background The Veteran seeks entitlement to service connection for a bilateral eye condition. Specifically, the Veteran asserts that he developed a bilateral eye condition due to exposure to harsh environmental conditions during service, including exposure to glaring sun, wind, sand, cold and snow-blindness without eye protection. See September 2019 Letter. The Veteran has additionally asserted that his currently diagnosed eye conditions were present during service, but that he was never provided with an eye examination which would have detected his eye disease. He further asserted that during service he complained about blurry vision and pain in his eyes, but that he was only treated with glasses. See September 2015 Notice of Disagreement (NOD) and September 2019 Letter. Alternatively, the Veteran asserts that due to VA treatment, or lack thereof, his right eye nerve was allowed to die due to improper treatment. See September 2015 NOD, April 2018 Board Hearing Transcript and September 2019 Letter. The evidence of record includes the Veteran’s service treatment records (STRs). A June 1961 enlistment examination noted normal eyes. A distant vision examination noted 20/40 vision for the right eye vision corrected to 20/30, and 20/30 vision for the left eye. A near vision test noted the same. The clinician noted that the Veteran’s bilateral distant vision was not improved with pin hole. The Veteran denied having any eye trouble or having worn glasses. An August 1961 STR noted the Veteran passed out and was unconscious for 5 minutes. The Veteran reported having symptoms of blurred vision and headaches. The clinician noted that the Veteran probably hyperventilated. Another August 1961 STR shows the Veteran underwent an optometric examination and was prescribed eyeglasses. The Veteran reported that he was last prescribed eyeglasses two years prior. No other eye condition was diagnosed. A June 1963 eye examination shows the Veteran reported noticing some difficulty clearly seeing distantly, and he further reported a photophobic reaction when going from indoors to outdoors. No eye condition other than a refractive error was noted. An October 1963 isolated duty examination noted normal eyes. A distant vision examination noted 20/70 vision for the right eye corrected to 20/20, and 20/50 vision for the left eye corrected to 20/20. The Veteran reported having eye trouble and having worn glasses. The clinician noted the Veteran wore glasses for a refractive error. Additionally, a February 1965 reenlistment examination noted normal eyes. A distant vision examination noted 20/200 vision for the both eyes corrected to 20/30 for the right eye, and 20/40 for the left eye. The Veteran reported having eye trouble and having worn glasses. The clinician noted the Veteran wore glasses for a refractive error. A March 1966 visual examination form further shows a refractive error bilaterally. No other eye condition was identified. Lastly, a March 1969 separation examination noted normal eyes. A distant vision examination noted 20/200 vision for the both eyes corrected to 20/25 and the Veteran was noted to have a refraction error. His field of vision was noted as normal. The Veteran reported having eye trouble and having worn glasses. The clinician noted the Veteran wore glasses for defective distant visual acuity. Thereafter, a December 2003 VA medical record shows the Veteran reported a history of glaucoma in his right eye. A January 2004 VA medical record shows the Veteran reported having had right eye glaucoma since 1999, and that he had previous bilateral implants. The Veteran reported having been seen by a Dr. Felch in the past and that he took Cosopt, Pred Forte and Xylan. The Veteran was assessed with glaucoma and referred to ophthalmology. A September 2004 VA medical record noted the Veteran used several eye drops for glaucoma, and that he was blind in his right eye. Additionally, a May 2005 VA medical record shows the Veteran reported a past surgical history for bilateral cataract removal in the 1980’s. In a March 2015 letter, the Veteran asserted that he had undergone several eye operations at his VA medical centers, but that his eye condition continued to worsen. The Veteran further stated that he thereafter sought treatment via a private ophthalmologist who told him that he was blind in his right eye and that if he had any light entering his right eye, his vision could have been saved. The Veteran further stated that his left eye continued to deteriorate during this time and that he underwent a cornea transplant which did not improve his vision. Accordingly, the Veteran asserted that he became legally blind due to an eye condition that was not properly treated when it was initially discovered. The Veteran underwent a VA examination in January 2016. The examiner was specifically asked to opine whether the Veteran had a diagnosis for glaucoma and visual impairment due to not being allowed to wear sunglasses during service. The examiner opined that the Veteran’s claimed eye conditions were “less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event or illness.” In support of this opinion, the examiner stated that there was “absolutely no medical evidence to support such a claim.” In a June 2016 addendum opinion, the VA examiner opined that it was “not at least as likely as not that the claimed disability of glaucoma and visual impairment was caused by or became worse as a result of VA treatment.” The examiner also opined that it was “not at least as likely as not that the Veteran developed an additional eye disability as a result of carelessness, negligence, lack of skill or similar incidence of fault on the part of the attending VA personnel, resulted from an event that could not have reasonably been foreseen by a reasonable healthcare provider, or failure on the part of VA to timely diagnose and/or properly treat the claimed eye conditions. In support of these opinions, the examiner stated there was no medical evidence to support any of the Veteran’s claims. In this regard, the examiner noted that there were no eye medical records from the time the Veteran was discharged from service in 1969 until he was 62 years of age in December 2013 (Later corrected to December 2003. See January 2016 Addendum). During the time period for which there were no medical records, the examiner noted that the Veteran could have and likely did develop glaucoma that was not present and thus not detectable during service, and that there was absolutely no medical evidence that linked a cause and effect relationship between not wearing sunglasses and glaucoma. At an April 2018 Board hearing, the representative asserted that the Veteran’s current bilateral eye condition was etiologically related to service including due to being exposed to harsh conditions such exposure to light reflection off snow while he was stationed in Alaska, and desert condition during his deployment to Pakistan. The Veteran testified that when he enlisted, he was told he needed glasses but that he was not provided glasses for six months. In addition, he testified that when he was provided glasses during service, they caused headaches and blurry vision. He further testified that during service he was not allowed to wear sunglasses while in uniform. During his active duty service, he testified that his vision deteriorated and that he believed his vision problems were not adequately assessed. Finally, the Veteran asserted that his bilateral vision condition resulted from improper VA medical care received post-service. Specifically, the Veteran asserted that VA failed to properly treat his glaucoma resulting in his current vision problems. The Veteran submitted a letter in April 2018 in which he asserted having slowly become blind from an eye condition that began during active duty service, and was exacerbated by improper or incomplete care. Specifically, the Veteran asserted that he was ordered not to wear sunglasses which exposed him to conditions including harsh sunlight, sand, wind, dust and snow, and further asserted that exposure to those conditions caused his current eye diseases and vision loss. Specifically, the Veteran asserted that as a result of exposure to the above conditions, he developed corneal edema, glaucoma, superficial punctate keratitis, meibomianitis/hordeolum, subluxation of lens, acute endophthalmitis and total right eye blindness. Additionally, the Veteran asserted that he complained about blurry vision, pain in his eyes and headaches during service, but that he was not treated for the eye disease he was developing. After separation from service, the Veteran asserted that he did not receive the medical care he needed because he was not informed that he could receive care through VA. The Veteran further asserted that when he began receiving treatment at his VA medical center, his eye condition worsened, and he began losing vision in his right eye and did not get the level of care that would have reversed or slowed down the deterioration of his sight. The Veteran submitted a letter from his private eye physician, Dr. DeBry, in May 2018. Dr. DeBry noted that he had reviewed the Veteran’s medical records, but that records prior to 2005 were not available thereby making it difficult to comment on the cause of the Veteran’s right eye vision loss. It was noted that the Veteran had severe vision loss in the right eye due to advanced glaucoma and that in 2005 his right eye vision had decreased light perception. Common causes for this condition were noted to include failure to make a timely diagnosis, failure to adequately control the eye pressure and surgical complications. Dr. DeBry stated that it was “more than likely” that any or all of those factors played a role in his vision loss from glaucoma. In support of this opinion, Dr. DeBry stated that an examination of the right eye revealed a displaced intraocular lens suggesting surgical complications from past procedures. Dr. DeBry thereafter stated that in order to fully understand the Veteran’s vision loss, and in order to determine if there were any deviations to the standard of care for glaucoma treatment, the entire STRs would need to be reviewed. Despite noting that the STRs were not reviewed, Dr. DeBry further opined that it was “more than likely that the glaucoma was present for many years and was not correctly diagnosed due to the lack of screening examinations during military service.” Lastly, Dr. DeBry noted that the Veteran underwent a corneal transplant operation due to his glaucoma condition and glaucoma surgeries, but that the corneal transplant was complicated by a post-operative eye infection which impacted the Veteran’s best potential visual acuity. A December 2018 VA eye clinic record noted an ocular history positive for primary open angle glaucoma with end stage right eye glaucoma, right eye pseudophakic bullous keratopathy, status post bilateral eye CE with PCIOL and right eye subluxated PCIOL; status post left eye iridectomy and Ahmed tube shunt. Additionally, the eye clinic record noted that the Veteran’s private physician, Dr. DeBry, had performed two corneal surgical transplants in 2013 which were complicated by a subsequent fecal infection. A June 2019 VA optometry record noted the following current eye diagnoses: bilateral refractive error with presbyopia; bilateral monocular diplopia and vitelliform dystrophy most likely due to bilateral posterior capsular opacification (PCO) with the right eye worse than the left; stable bilateral pseudophakia; mild bilateral PCO casing some monocular diplopia; diabetes without retinopathy; and adult vitelliform dystrophy. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Lay evidence presented by a veteran concerning continuity of symptoms after service may not be deemed to lack credibility solely because of a lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (2006). The Board has the authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). After a review of the evidence of record, the Board finds that entitlement to service connection for a bilateral eye condition is not warranted. In this regard, a review of the evidence of record shows that the only diagnosed eye condition noted during service was a refractive error. Service connection is not generally established for refractive error of the eye as it is not a disease or injury within the meaning of applicable legislation providing compensation benefits. 38 C.F.R. §§ 3.303(c), 4.9. Accordingly, actual pathology, other than refractive error, is required to support impairment of visual acuity. Id. Further, VA regulations specifically prohibit service connection for refractive error unless such defect was subjected to a superimposed disease or injury which created additional disability. See VAOPGCPREC 82-90 (service connection may not be granted for defects of congenital, developmental or familial origin, unless the defect was subject to a superimposed disease or injury). Here, there is no evidence that the Veteran’s refractive error was subject to a superimposed disease or injury during his military service. Despite the Veteran’s contentions that his eyes were not evaluated during service, the STRs clearly show that the Veteran underwent several eye examinations. However, the only eye condition found was a refractive error. Therefore, the Veteran’s assertion that he was not treated for the eye condition he was developing during service is not supported by the competent evidence of record. The Board does recognize the Veteran’s lay statements that he developed glaucoma during service for which he was not treated, or alternatively, that his current eye disabilities were caused by exposure to conditions such as bright sunlight, dust, sand and snow. The Veteran is competent to report purported symptoms such as blurry vision or whether he has received a diagnosis from a medical professional. 38 C.F.R. § 3.159(a)(2); Barr v. Nicholson, 21 Vet. App. 303 (2007). However, without evidence showing that he has medical training or expertise, he cannot competently provide a medical nexus opinion between a current diagnosis and the development of an eye condition during service. In other words, he is not competent to assert that his glaucoma began during service, or was caused by events during service. 38 C.F.R. § 3.159(a)(1)-(2); Jandreau v. Nicholson, 492 F.3d 1372 (2007). In any event, to the extent the Veteran may be competent to opine as to medical etiology, the Board finds he has provided conflicting statements with regard to the onset and treatment of his eye diseases. Specifically, the Board notes that at the time the Veteran established care at his local VA medical center in December 2003, he reported a prior history of glaucoma in his right eye. One month later, the Veteran reported that his right eye glaucoma had its onset in 1999, approximately 4 years prior to VA treatment. However, in a March 2015 letter, the Veteran asserted that his right eye glaucoma began after he initiated treatment at VA. With regard to statements the Veteran made at the time he initially began receiving treatment at his VA medical center, the Board notes that statements made to clinicians for the purpose of treatment are considered reliable because one seeking medical treatment is aware of the necessity for being truthful to secure proper care. See Rucker v. Brown, 10 Vet. App. 67 (1997) (ascribing heightened credibility to statements made to clinicians for the purpose of treatment); see also Williams v. Gov. of Virgin Islands, 271 F.Supp.2d 696, 702 (V.I.2003) (noting that statements made for the purpose of diagnosis or treatment “are regarded as inherently reliable because of the recognition that one seeking medical treatment is keenly aware of the necessity for being truthful in order to secure proper care”). The Veteran has further asserted that he reported having eye symptoms of blurry vision, eye pain and headaches during service, but that those symptoms were only treated with prescription glasses. However, a review of the STRs shows that during eye examinations, the Veteran only reported blurry distant vision related to his refractive error. The STRs do not evidence any such reported symptoms of blurry vision and headaches that he related to his eyes that were not addressed. Instead, an August 1961 STR shows that the Veteran reported having blurred vision and headaches which he reported was caused by passing out and being unconscious for 5 minutes which the clinician found due to probable hyperventilation. The Board further notes that a February 1965 STR shows the Veteran underwent psychological counselling in 1961 for habitual lying. Accordingly, with regard to the Veteran’s lay statements as to the onset of his eye symptoms other than a refractive error during service, the Board finds the Veteran to be an inaccurate historian and provides such statements little probative value. The Board further recognizes the November 2018 private opinion letter by Dr. DeBry who opined that it was “more than likely that the glaucoma was present for many years and was not correctly diagnosed due to the lack of screening examinations during military service.” However, Dr. DeBry provided this opinion despite stating that he was unable to review the Veteran’s STRs and that such review was necessary to fully understand the Veteran’s vision loss. In this regard, the STRs clearly show several eye examinations during service. Therefore, the rationale provided by Dr. DeBry is not supported by the record. As such, with regard to direct service connection, the Board finds the November 2018 private opinion letter speculative, unsupported and based solely on the Veteran’s lay statements. As noted above, the Board provides little weight to the Veteran’s lay statements. Therefore, the Board finds the November 2018 private opinion letter of little probative value. The Board further finds probative the January 2016 VA examiner’s opinion that the Veteran’s glaucoma and visual impairment were “less likely than not (less than 50% probability)” due to not being allowed to wear sunglasses during service. This opinion was based on a finding that there was absolutely no medical evidence to support any such etiological association. The examiner further based this opinion on the approximate 34 year gap in time between separation from service and the onset of the Veterans treatment at his VA medical center in December 2003, and that during that gap in time for which there were no medical records, the examiner noted that the Veteran could have and likely did develop glaucoma that was not present and thus not detectable during service. The examiner’s rationale is supported by the VA medical record showing the Veteran reported being treated for right eye glaucoma since 1999 via a private medical provider. The examiner has training, knowledge, and expertise on which she relied to form her opinion, and she provided a persuasive rationale. Importantly, there is no competent medical evidence to the contrary. Therefore, because glaucoma or any other eye condition other than a refractive error has not been shown to be directly related to service, the Board finds that the second and third Shedden requirements have not been met with regard to that claim on appeal. Additionally, because refractive error is excluded from the definition of a disease for which service connection may be granted, service connection for a refractive error is not warranted as a matter of law. 38 U.S.C. § 1151 Turning to the Veteran’s 38 U.S.C. § 1151 claim, under VA laws and regulations, when a veteran suffers additional disability as a result of training, hospital care, medical or surgical treatment, or an examination furnished by the VA, disability compensation shall be awarded in the same manner as if such disability was service connected. 38 U.S.C. § 1151; 38 C.F.R. §§ 3.358, 3.361. The veteran must show some degree of fault, and more specifically, that the proximate cause of his disability was due to carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing medical care or was an event not reasonably foreseeable. 38 U.S.C. § 1151(a)(1); 38 C.F.R. § 3.361. In determining that additional disability exists, VA compares the veteran’s condition immediately before the beginning of the hospital care, medical or surgical treatment, examination, training and rehabilitation services, or compensated work therapy program upon which the claim is based to the veteran’s condition after such care, treatment, examination, services, or program has stopped. 38 C.F.R. § 3.361(b). To establish causation, the evidence must show that the hospital care, medical or surgical treatment, or examination resulted in the Veteran’s additional disability. Merely showing that a veteran received care, treatment, or examination and that that the veteran has an additional disability does not establish cause. 38 C.F.R. § 3.361(c)(1). Hospital care, medical or surgical treatment, or examination cannot cause the continuance or natural progress of a disease or injury for which the care, treatment, or examination was furnished unless VA’s failure to timely diagnosis and properly treat the disease or injury proximately caused the continuance or natural progress. 38 C.F.R. § 3.361(c)(2). Additional disability caused by a veteran’s failure to follow properly given medical instructions is not caused by hospital care, medical or surgical treatment, or examination. 38 C.F.R. § 3.361(c)(3). To establish that carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on VA’s part in furnishing hospital care, medical or surgical treatment, or examination proximately caused a Veteran’s additional disability, it must be shown that VA failed to exercise the degree of care that would be expected of a reasonable health care provider; or, that VA furnished the hospital care, medical or surgical treatment, or examination without the veteran’s informed consent. 38 C.F.R. § 3.361(d)(1). Whether the proximate cause of a veteran’s additional disability was an event not reasonably foreseeable is in each claim to be determined based on what a reasonable health care provider would have foreseen. The event need not be completely unforeseeable or unimaginable but must be one that a reasonable health care provider would not have considered to be an ordinary risk of the treatment provided. 38 C.F.R. § 3.361(d)(2). Initially, the Board notes that the threshold element for 38 U.S.C. § 1151 compensation, the presence of a qualifying additional disability, has been met in this case as the record establishes that the Veteran has been shown to have several bilateral eye diagnoses. As noted above, the Veteran asserts that due to inadequate care, or lack of care, through his treating VA medical centers, that his right eye was allowed to deteriorate resulting in blindness. Specifically, in a March 2015 letter, the Veteran asserted that his blindness was caused by not being properly treated at his VA medical center “once discovered.” After a review of the evidence of record, the Board finds that compensation benefits under the provisions of 38 U.S.C. § 1151 for right eye blindness are not warranted. In this regard, the evidence of record shows that at the time the Veteran established care at VA, he had been treated for right eye glaucoma since 1999. Additionally, and more importantly, a VA medical record dated in September 2004, shortly after he initiated care, clearly showed that the Veteran was already blind in his right eye at that time. Therefore, as the Veteran has been shown to have had glaucoma in his right eye approximately 4 years prior to VA treatment, and that right eye blindness was further noted shortly after he initiated treatment at his VA medical center, the Board finds that the weight of the evidence does not establish that he either developed an additional eye condition, to include right eye blindness, due to treatment received at a VA medical center, and the condition cannot be said to have resulted from VA’s carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault. The Board also notes that the Veteran’s lay statements with regard to when, how and why he became legally blind are directly contradicted by the medical evidence of record. Specifically, in a March 2015 letter, the Veteran asserted that his bilateral eye condition was not treated properly at his VA medical center once it was discovered. He further stated that he was first told he was blind in his right eye by a private ophthalmologist which occurred after he began receiving treatment at VA. However, the medical records clearly show that the condition existed several years prior to VA treatment, and that the first record noting right eye blindness is a VA medical record dated September 2004, shortly after he initiated VA treatment. Accordingly, as the Veteran has provided conflicting statements in this matter, the Board finds such statements of little probative value. The Board further finds probative the January 2016 VA addendum opinion. The examiner opined that it was “not at least as likely as not that the claimed disability of glaucoma and visual impairment was caused by or became worse as a result of VA treatment,” that it was “not at least as likely as not” that the Veteran developed an additional eye disability as a result of carelessness, negligence, lack of skill or similar incidence of fault on the part of the attending VA personnel, resulted from an event that could not have reasonably been foreseen by a reasonable healthcare provider, or failure on the part of VA to timely diagnose and/or properly treat the claimed eye conditions. The examiner based these opinions on a lack of any medical evidence supporting such claims. Importantly, there is no medical evidence to the contrary. In this regard, the above -mentioned November 2018 opinion letter by Dr. DeBry, the Veteran’s treating ophthalmologist, did not address VA care and only stated that the condition was not properly treated during service. As noted above, that statement was solely based on the Veteran’s lay statements which have been shown to be unreliable. In sum, with regard to the Veteran’s direct service connection claim on appeal, as the second and third Shedden requirements have not been met the Board finds that the preponderance of the evidence is against that claim. Additionally, because refractive error is excluded from the definition of a disease for which service connection may be granted, service connection for a refractive error is not warranted as a matter of law. Lastly, absent credible evidence showing the Veteran developed right eye blindness or an additional eye condition as a result of treatment received at a VA facility, or lack thereof, the claim for compensation under the provisions of 38 U.S.C. § 1151 must be denied. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the competent evidence weighs against the claims, that doctrine is not applicable in the instant appeal. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). TDIU It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16. A finding of total disability is appropriate “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. “Substantially gainful employment” is that employment “which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides.” Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). “Marginal employment shall not be considered substantially gainful employment.” 38 C.F.R. § 4.16(a). In determining whether unemployability exists, consideration may be given to the veteran’s level of education, special training, and previous work experience, but not to his age or to any impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. A total disability rating for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more. If there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and the combined rating must be 70 percent or more. 38 C.F.R. § 4.16(a). During the pendency of the appeal, the Veteran has been service connected for the following disabilities: bilateral hearing loss rated 40 percent disabling prior to January 17, 2019, and 60 percent disabling thereafter; and tinnitus rated 10 percent disabling as of May 12, 2017. The Board notes the Veteran has met the schedular rating criteria as of January 17, 2019. The evidence of record includes a June 2017 VA hearing loss and tinnitus examination. The examiner noted that the Veteran’s diagnosed bilateral hearing loss impacted his ability to work due issues such as being able to hear church sermons and understanding speech. With regard to his tinnitus, the Veteran stated that the condition impacted his ability to concentrate. An October 2017 VA medical record shows the Veteran reported being retired. A November 2017 VA medical record shows the Veteran reported that he had previously been provided hearing aids in 2011, but that he only wore them for approximately two weeks because he did not like the sound quality. Thereafter, he stated he lost both hearing aids in 2011. Another November 2017 VA medical record shows the Veteran reported that he was currently employed as a travel agent. The Veteran submitted a letter by a physician’s assistant in November 2017. The physician’s assistant stated that the Veteran had several medical issues that made it difficult to work, including impaired vision, bariatric surgery complications, chronic obstruction in his small bowel and impaired cardiac function. The Veteran underwent another VA hearing loss and tinnitus examination in December 2017. The examiner noted that the Veteran was currently using bilateral VA issued hearing aids for improved communication skills and that his tinnitus impacted his ability to concentrate. In a September 2018 letter, the Veteran’s spouse stated he was unable to maintain gainful employment due being legally blind and having severe hearing loss in addition to other disabilities for which he was not yet service connected. At an April 2018 Board hearing, the representative asserted that the Veteran’s last day of employment was February 2018. Prior to that time, the representative asserted that the Veteran was a travel coordinator for an airline and worked 32 hours from home on a very large computer screen and that he was one of the top employees for the full three years he worked there. The Veteran asserted that due to his vision problems which required him to use a large screen, special glasses and a five-power magnifying glass, he could no longer effectively take care of his clients. The Veteran further stated that the company he worked for wanted him to stay, but that he decided to resign. He denied ever having been disciplined or reprimanded at work and that his resignation was voluntary on the basis that he could not read and see his computer screen sufficiently to do his job. In addition, the Veteran reported that he did a lot of indexing for his church requiring him to transfer printed records to a computer, but that due to his eye conditions he could no longer do that work. When asked by his representative whether he could hear with the assistance of hearing aids, the Veteran stated he could hear fairly well. A May 2018 VA hearing loss and tinnitus examination report shows the examiner found that the Veteran’s bilateral hearing loss impacted his ability to work due to having to use hearing aids on a daily basis for improved communication skills, and that his tinnitus impaired his sleeping habits and caused him not to be able to do anything. The Veteran submitted a letter from his private eye physician, Dr. DeBry, in May 2018. Dr. DeBry opined that the Veteran’s severe vision loss was interfering with his ability to work and daily activities. The Veteran last underwent a VA hearing loss and tinnitus examination in March 2019. The Veteran reported that his employment required him to use a headset, but that he was unable to use his hearing aids with the headset resulting in an inability to hear and understand transmissions. With regard to his tinnitus, the Veteran stated that it impacted his ability to concentrate. In October 2019, the Veteran submitted VA Form 5655, Financial Status Report, and stated that he worked in customer service from July 2014 to February 2018, and that he had been unemployed since February 2018. In a March 2020 letter, the representative asserted that the Veteran’s hearing loss and other health conditions, including loss of sight, precluded him from being gainfully employed. In another March 2020 letter, the same physician’s assistant who wrote the above-mentioned November 2017 letter asserted that the Veteran had severe hearing loss and that even with hearing aids he had difficulty carrying on a conversation especially phone conversations. As a result, the physician’s assistant stated that the bilateral hearing loss handicapped the Veteran in dealing with any proposed employment situation and rendered him unemployable. Other conditions affecting the Veteran’s employability included heart failure and blindness. Lastly, in a March 2020 letter, Dr. Lambert stated that the Veteran had severe balance issues and was incapable of being employed. After a review of the evidence of record, the Board finds that entitlement to a TDIU is not warranted. Initially, the Board notes that it is unclear whether the Veteran is currently employed. In this regard, a March 2019 VA hearing loss examination shows that the Veteran reported that his current employment required him to wear headphones which precluded him from being able to utilize his hearing aids. However, several records, including a more recent October 2019 VA Form 5655, show the Veteran has reported being unemployed since February 2018. Despite the record being unclear as to the Veteran’s current employment status, the Board finds that remanding this matter for the sole purpose of affording the Veteran another opportunity to furnish information about his employment history during the period on appeal would serve no useful purpose. Specifically, the Board finds that regardless of the Veteran’s current employment status, that his service-connected bilateral hearing loss and tinnitus have not been shown to preclude him from securing and following a substantially gainful occupation. For instance, throughout the period on appeal, the evidence of record shows that the Veteran has been able to maintain a high level of productivity at work, despite his service-connected bilateral hearing loss and tinnitus. The evidence further shows that the Veteran’s nonservice-connected disabilities, to include vision loss, have had a greater impact on his ability to work. Specifically, during his April 2018 Board hearing the Veteran stated that he had been one of the top performers at his company and that they did not want him to retire. He further stated that it was his vision problems that precluded him from effectively taking care of his clients, that his retirement was voluntary, and that his retirement was solely due to an inability to read and sufficiently see his computer screen. When questioned by his representative, he further stated that with the assistance of his hearing aids, he could hear fairly well. One month following the Board hearing, during a VA hearing loss examination the Veteran reported that his hearing loss impacted his ability to work due to having to use hearing aids on a daily basis for improved communication skills, and during his most recent March 2019 VA hearing loss examination he reported that the type of work he performed required him to use a headset with which he was unable to use his hearing aids resulting in an inability to hear and understand transmissions. In this regard, the Veteran had previously reported that he had not worn hearing aids between 2011 and 2017. However, during this time period, despite not using hearing aids he reported being one of the top performers at his company. The Board further notes that since June 2017, the Veteran has reported that his tinnitus impacted his ability to concentrate. However, during the same period on appeal the evidence shows that the Veteran had maintained high-performance levels at work despite any such issue. While the Board recognizes the March 2020 physician’s assistant letter which asserts that the Veteran’s hearing loss rendered him unemployable, the only limitation noted was difficulty carrying on a conversation, especially via the telephone. The physician’s assistant did not provide any further analysis as to why such limitation rendered the Veteran unemployable and did not address the above-mentioned evidence which directly contradicts that finding. Moreover, in a previous November 2017 letter, the same physician’s assistant listed several medical conditions that made it difficult for the Veteran to work including impaired vision, bariatric surgery complications, impaired cardiac function and chronic small bowel obstruction; all nonservice-connected conditions. Absent in the November 2017 letter was any mention of hearing loss. Based on such deficiencies, the Board finds the March 2020 physician’s assistant letter of little probative value in this matter. Therefore, the Board finds that the totality of the evidence of record shows that the functional impairments caused by the Veteran’s service-connected bilateral hearing loss and tinnitus have not rendered him unable to secure or follow a substantially gainful occupation. The Board does not doubt that the Veteran’s service-connected conditions have some effect on his employability, as evidenced by the existing ratings assigned such disabilities. Loss of industrial capacity is the principal factor in assigning schedular disability ratings. 38 C.F.R. §§ 3.321(a), 4.1. Indeed, 38 C.F.R. § 4.1 specifically states: “[g]enerally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability.” See also Moyer v. Derwinski, 2 Vet. App. 289, 293 (1992); Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (noting that the disability rating itself is recognition that industrial capabilities are impaired). However, the Board finds that the preponderance of the record shows the Veteran’s non-service-connected conditions, such as vision impairment, have resulted in his inability to be gainfully employed. As the preponderance of the evidence is against this claim, the “benefit-of-the-doubt” rule is not for application, and the Board must deny the claim. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Lamb, 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.