Citation Nr: 21002113 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 18-06 049 DATE: January 12, 2021 ORDER A rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied. Reduction in the schedular rating from 40 percent to 30 percent for the right eye optic atrophy was improper; restoration of the 40 percent rating for right eye optic atrophy, effective December 1, 2017, is granted. A rating in excess of 40 percent for right eye optic atrophy is denied. A total disability rating based on individual unemployability due to service-connected disability (TDIU) for the period from March 4, 2014 to September 9, 2015 is granted. FINDINGS OF FACT 1. The service-connected PTSD is shown to most nearly approximate occupational and social impairment with reduced reliability and productivity and difficulty in establishing and maintaining effective work and social relationships. 2. At the time of the November 2017 rating decision which reduced the rating for the Veteran’s right eye optic atrophy, the evidence did not show that improvement in the service-connected disability would be maintained under the ordinary conditions of life. 3. At most there is total loss of visual field in the right eye with corrected vision in the Veteran’s service-connected right eye 5/200 or worse and corrected vision in his left eye 20/20 or better. 4. The Veteran’s service-connected disabilities are shown to preclude the Veteran from securing and following substantially gainful employment consistent with his work and education background from March 4, 2014 to September 9, 2015. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.130, Diagnostic Code 9411. 2. The reduction in the schedular rating for the right eye optic atrophy was improper; the criteria for restoration of the 40 percent rating for the right eye optic atrophy have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.105, 3.344, 4.79, Diagnostic Codes (DC) 6064, 6080. 3. The criteria for a rating in excess of 40 percent for right eye optic atrophy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.79, Diagnostic Codes 6064, 6080. 4. The criteria for entitlement to a TDIU from March 4, 2014 to September 9, 2015 have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.18, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1965 to March 1985. These matters came before the Board of Veterans’ Appeals (Board) on appeal from June 2015, October 2017 and November 2017 rating decisions issued by the RO. The Board remanded these issues on appeal in November 2019 for further development. In pertinent part, the Board instructed the RO to obtain outstanding records of treatment and to schedule the Veteran for examination to evaluate the severity of his service-connected PTSD and right eye optic atrophy. Outstanding records of treatment have been obtained and the Veteran underwent PTSD and eye examinations in July and August 2020. Accordingly, the requested development has been completed and the case is returned to the Board for appellate disposition. The appeal originally included the issues of whether the severance of service connection for multiple myeloma was proper and whether the decision to discontinue entitlement to special monthly compensation (SMC) at the housebound rate was proper. In September 2020, the RO restored service connection for multiple myeloma effective January 1, 2018 and continued entitlement to SMC at the housebound rate. These claims have been resolved and are no longer on appeal. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (where an appealed claim for service connection is granted during the pendency of the appeal, a second NOD must thereafter be timely filed to initiate appellate review of the claim concerning the compensation level assigned for the disability). 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). As to these claims for increased ratings for his PTSD and right eye optic atrophy, the Veteran has not raised any other issues, nor has the record reasonably raised any other issues. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Increased Rating 1. Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) Disability ratings are determined by application of the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). “Staged” ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. The rating for the Veteran’s PTSD has been assigned pursuant to Diagnostic Code 9411 with reference to a General Rating Formula for evaluating psychiatric disabilities other than eating disorders. See 38 C.F.R. § 4.130. Under the formula, a 50 percent rating is assigned when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is assigned for occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closes relatives, own occupation, or own name. The examiner’s assessment of the severity of a condition is not dispositive of the evaluation issue; rather, the examiner’s assessment must be considered in light of the actual symptoms of the Veteran’s disorder, which provide the primary basis for the rating assigned. See 38 C.F.R. § 4.126(a). A June 2014 report of VA PTSD examination documents the psychologist’s assessment that the Veteran’s PTSD was productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks although generally functioning satisfactorily with normal routine behavior, self-care and conversation. The Veteran had been married for 47 years and he and his wife had four daughters. He stated that he had a great/wonderful relationship with his wife and daughters. He did not have any close friends and said that he never cared to make any. He was close to one of his stepbrothers. After his discharge from service, he worked as a jail administrator for a County Sheriff’s Department for 12 years. He also drove a semi-truck for a company for 14 years and retired in 2010 to care for his wife who was battling cancer. He reported a history of heavy alcohol use in the past but had not used alcohol in 25 years. His daughter confirmed the Veteran experienced chronic stress and anxiety and described his history of occasional “unusual” behavior, including the time he took her to the woods for shooting practice so that she would know how to defend him if unknown persons tried to apprehend him. On another occasion, she woke the Veteran up from a nap and in his confused state he struck his daughter in the chest. The Veteran was upset by that episode. The Veteran’s daughter reported that the Veteran was “panicky,” anxious, worried and never slept well. Symptoms of the Veteran’s PTSD included depressed mood, anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, disturbances of motivation and mood and difficulty in adapting to stressful circumstances. On mental status examination, the Veteran was alert and oriented in all spheres. He was neatly attired and well groomed. He made good eye contact and his attitude was cooperative and pleasant. His memory was intact, and his mood/affect was euthymic and tearful at times. His speech tone, volume and prosody were normal. Current thought content appeared linear and directed and there was no history of suicidal or homicidal ideation. He had no history of auditory or visual hallucinations and there was no evidence of paranoia or delusions. He had fair insight and judgment. The psychologist remarked that the Veteran’s PTSD symptoms and functioning were much worse in the immediate years following his discharge from service; however, he was presently functioning satisfactorily. The psychologist remarked that the Veteran had been able to maintain stable employment and a solid, happy marriage. He experienced persistent periods of anxiety and panic attacks when reminded of his traumas; however, he was generally able to maintain functioning. The psychologist opined that while the Veteran’s emotional symptoms could be quite intense at times, the functional impact of his PTSD had been relatively mild. A June 2015 report of VA PTSD examination documents the psychologist’s assessment that the Veteran’s PTSD was productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks although generally functioning satisfactorily with normal routine behavior, self-care and conversation. The Veteran reported that nothing has changed for him except the addition of a puppy to the family. He remained married and had a good relationship with his wife. Documented symptoms of the Veteran’s PTSD included depressed mood, anxiety, suspiciousness, panic attacks more than once a week, near continuous panic or depression affecting the ability to function, chronic sleep impairment, disturbances of motivation and mood and suicidal ideation. On mental status examination, the Veteran was pleasant and courteous though his demeanor was guarded. He made good eye contact. Overall, the Veteran appeared to either over-estimate or over-emphasize his level of current distress. There was no psychomotor agitation or retardation noted. His affect was constricted, and his mood was anxious. He described chronic suicidal ideation but had no current plan or intent. There was no evidence of psychotic thinking. His judgment and insight were fair. The psychologist remarked that the Veteran was not found to be significantly different than the last time he was examined. A November 2015 report of VA PTSD examination documents the psychologist’s assessment that the Veteran’s PTSD was productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks although generally functioning satisfactorily with normal routine behavior, self-care and conversation. The Veteran reported no significant changes since the June 2015 examination. He reported that he had been active in outpatient treatment at the VA. He completed the PTSD symptom management skills group and his counselor reported a reduction his PTSD symptoms and an improvement in his mood. Documented symptoms of the Veteran’s PTSD included depressed mood, anxiety, suspiciousness, panic attacks more than once a week, near continuous panic or depression affecting the ability to function, chronic sleep impairment, disturbances of motivation and mood and suicidal ideation. On mental status examination, the Veteran was alert and oriented to three spheres. He was pleasant and cooperative and made good eye contact. He dressed casually and had good hygiene. He appeared somewhat anxious at the start of the session but relaxed toward the end. He had no thoughts of suicide or homicide. Speech functions were normal. Thought processes were logical and there was no evidence of delusions or hallucinations. Additionally, the Veteran experienced intermittent panic attacks and was diagnosed with panic disorder without agoraphobia attributable to his PTSD. The psychologist remarked that the Veteran’s PTSD symptoms remained chronic but had slightly improved through treatment since the last VA examination. He continued to experience moody irritability, vivid nightmares and sleep difficulties but noted that psychotropic medications lessened their intensity. He also had developed improved cognitive behavioral coping skills through ongoing participation in individual and group therapy. A January 2017 VA individual psychotherapy treatment record reflects the Veteran desired to improve his PTSD symptoms, especially his anxiety. The Veteran agreed to use the PTSD symptom management coping skills he learned to manage distress when exposed to triggers associated with his trauma. He did not leave his house much because he was caring for his sick wife. He was afraid of her dying when he was away. He was also stressed about diagnoses and medical management of various other disabilities. Overall, he felt “okay” using his coping skills. He enjoyed caring for his wife and spending time with her. He reported that his PTSD symptoms were stable, but he had occasional dreams that were not disturbing. On mental status examination, he was alert, attentive, cooperative and reasonable. His speech was of normal rate and rhythm. His mood was euthymic, and he had no perceptual disturbances. Thought processes were normal and coherent and he had no unusual thought content. He had no suicidal or violent ideation. His memory was intact. A September 2017 report of VA PTSD examination reflects that the Veteran PTSD symptoms were stable and improved with therapy and medication; however, his medication dosage had been increased due to an increase in some symptoms. The psychiatrist commented that presently the Veteran’s PTSD was in the moderate to high moderate range. The Veteran kept most of his symptoms and problems to himself. Thus, the psychiatrist concluded that it was possible that the Veteran had minimized symptoms during clinical appointments. As an example, the psychiatrist noted that the Veteran objectively presented as more depressed than what he endorsed based on symptomatology. He “pushed through” his symptoms so that they would not adversely affect others. They psychiatrist concluded that it was more likely than not that the Veteran was having increased difficulty dealing with his symptoms over time and more likely than not had moderate difficulty with occupational functioning and moderate to serious difficulty with interpersonal functioning. The psychiatrist determined that the Veteran’s PTSD was productive of occupational and social impairment with reduced reliability and productivity. He had been married for 50 years and described his marriage as very good. He had four adult children with whom he had some regular contact and an excellent relationship. He kept to himself and did not interact with his neighbors. His parents were deceased, and he had no contact with his siblings. He was previously close to one stepbrother but had withdrawn from that relationship. He had no friends and socialized only with family. He rarely attended family functions, avoided crowds and no longer attended sporting events, movies, fairs or malls. He went to stores and restaurants only when they were not crowded, and he could keep his back to the wall. His time was spent attending to the needs of his wife, even though she had an aide. After service, he worked as a jail administrator for the county sheriff’s department for 12 years. He left the job due to poor stress tolerance and frequent panic attacks. As noted above, he then drove a truck for 14 years before retiring in 2010 to care for his wife who had cancer and because of vision problems. He felt he was able to work as a truck driver because he was able to work alone. He slept in his truck and rarely interacted with other truckers at rest areas. He felt that he interacted well with clients. Although he had problems with anger/irritability, he felt he behaved appropriately. He had few interactions with management or coworkers. All his work duties were computerized, allowing for little human interaction with others. He reported that he would have kept the job if it had not been for his vision problems and wife’s health. While working, he denied difficulty with productivity, reliability or effectiveness. He earned quarterly bonuses and denied difficulty with accepting supervision and/or criticism. He denied missing time from work for mental health reasons. He denied difficulty with flexibility, concentration, mistakes, and/or impulsivity on the job. He continued to have panic attacks while driving but was able to pull off the road until the panic attacks subsided and his shipment deliveries were always timely. Documented symptoms of the Veteran’s PTSD included depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, inability to establish and maintain effective relationships and obsessional rituals which interfere with routine activities. On mental status examination, the Veteran was pleasant, cooperative, alert and oriented in three spheres. His intelligence and fund of knowledge appeared average. He made good eye contact and was neatly dressed and well groomed. Speech was of regular rate and rhythm, relevant and coherent. There were no gross abnormal motor movements and there was no psychomotor retardation or agitation. He displayed hyper-vigilance during the examination. His mood was moderately depressed and anxious, and affect was mood congruent and blunted. There was no evidence of psychosis, mania or obsessive-compulsive symptoms. There was no evidence of any thought disorder or personality disorder. Insight and judgment were good, and the information obtained from the Veteran was reliable. Additionally, the Veteran experienced mistrust, discomfort in crowds, periodic hopelessness/helplessness, social withdrawal, emotional detachment, mild difficulty with concentration/focus/attention/distractibility, survivor guilt, poor frustration tolerance, chronic fatigue, impatience, ruminating thoughts and moodiness attributable to his PTSD. The psychiatrist remarked that the Veteran’s ability to understand and follow instructions; retain instructions and sustain concentration to perform simple tasks; and, accept supervision was considered not impaired. His ability to retain instructions and sustain concentration to perform complex tasks; sustain concentration to task persistence and pace; respond appropriately to coworkers, supervisors or the general public; accept criticism; be flexible in the work setting; exercise impulse control in the work setting; and, reliability and effectiveness in the work setting was considered mildly impaired. His ability to respond appropriately to changes in work setting was mildly to moderately impaired. His ability to deal with the daily stress of a work environment and effectively communicate with others in the work setting was felt to be moderately impaired. His ability to work in groups was considered markedly impaired. An April 2019 VA treatment record reflects that the Veteran received treatment for increased depression and anxiety following the death of his wife. A July 2020 report of VA PTSD examination documents that the Veteran’s PTSD was productive of occupational and social impairment with reduced reliability and productivity. He lived with his second wife, having married in January 2020. He had previously been married for 50 years prior to his wife’s death in 2018. He said that his current marriage was satisfactory and reported that he recently got angry and asked his wife to leave. He was unsure what he was even angry about. He has 4 daughters, 12 grandchildren and 3 great-grandchildren. He reported that he was currently not speaking to 2 of his daughters. He reported that he had not worked since 2010 because he could not pass the Department of Transportation physical due to his vision problems. He was prescribed Cymbalta, Prazosin and Klonopin for his PTSD symptoms. Documented symptoms of the Veteran’s PTSD included depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships and difficulty in adapting to stressful circumstances. On mental status examination, he displayed a flat affect and depressed/irritable mood. He was cooperative during the evaluation. He denied current suicidal ideation. The psychologist remarked that the Veteran continued to have difficulties with self-isolation, suspiciousness of others, irritability, hypervigilance, and poor frustration tolerance. The psychologist noted that test scores were indicative of significant PTSD symptoms. The frequency, severity and duration of his psychiatric symptoms were characterized by manifestations and effects such as depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships and difficulty in adapting to stressful circumstances – adequately contemplated by the 50 percent rating. The Veteran exhibited no worse than moderate to highly moderate symptoms productive of occupational and social impairment with reduced reliability and productivity. Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). The preponderance of the evidence is therefore against the assignment of the already assigned 50 percent rating. As the U.S. Court of Appeals for the Federal Circuit explained, evaluation under § 4.130 is “symptom-driven,” meaning that “symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating” under that regulation. Vazquez–Claudio v. Shinseki, 713 F.3d 112, 116–17 (Fed.Cir.2013). The symptoms listed in the diagnostic code are not exhaustive, but rather “serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating.” In the context of determining whether a higher 70 percent disability evaluation is warranted, the DC requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment with deficiencies in most areas and inability to establish and maintain effective relationships —i.e., “the regulation... requires an ultimate factual conclusion as to the veteran’s level of impairment …” Vazquez-Claudio, 713 F.3d at 117–18; see 38 C.F.R. § 4.130, DC 9411. The preponderance of the evidence is against finding that the Veteran’s PTSD caused occupational and social impairment with deficiencies in most areas and inability to establish and maintain effective relationships, particularly given the fact that the Veteran has not demonstrated severe impairment even though he did exhibit a few symptoms (near continuous panic or depression affecting the ability to function, obsessional rituals which interfere with routine activities, difficulty in adapting to stressful circumstances and suicidal ideation) listed in the exemplar criteria for a 70 percent rating. Here, the VA psychologist’s notation that test scores were indicative of significant PTSD symptoms (July 2020 VA examination report) is not dispositive. See 38 C.F.R. § 4.126(a). Prior to his wife’s death from cancer, the Veteran had been married for over 50 years and described the marriage as very good. He had 4 adult children with whom he had some regular contact and a historically excellent relationship. He remarried in January 2020 and said that his current marriage was satisfactory though he did admit that he recently angered and asked his wife to leave. In the July 2020 VA examination report, he also reported that he was currently not speaking to 2 of his daughters. He worked as a jail administrator and truck driver and had an extensive work record which ended when he retired to care for his wife. Mental status examinations indicate that he was cooperative, had appropriate behavior and demeanor and was fully oriented. His intelligence and fund of knowledge appeared average. He made good eye contact and was neatly dressed and well groomed. Speech was of regular rate and rhythm, relevant and coherent. There were no gross abnormal motor movements and there was no psychomotor retardation or agitation. He displayed hyper-vigilance during an examination. His mood was moderately depressed and anxious, and affect was mood congruent and blunted. There was no evidence of psychosis, mania or obsessive-compulsive symptoms. There was no evidence of any thought disorder or personality disorder. Insight and judgment were good, and he denied current suicidal ideation. There had not been shown current suicidal ideation; speech intermittently illogical, obscure, or irrelevant; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; and inability to establish and maintain effective relationships. The November 2015 and September 2017 reports of VA examination reflect documented symptoms of the Veteran’s PTSD including near continuous panic or depression affecting the ability to function, inability to establish and maintain effective relationships and obsessional rituals which interfere with routine activities. However, the Veteran reported that while working, he had no difficulty with productivity, reliability or effectiveness. He earned quarterly bonuses and denied difficulty with accepting supervision and/or criticism. He did not miss time from work for mental health reasons and denied difficulty with flexibility, concentration, mistakes, and/or impulsivity on the job. Though he continued to have panic attacks while driving, he was able to pull off the road until the panic attacks subsided and his shipment deliveries were always timely. Further, he interacted well with clients and to the extent that he had problems with anger/irritability, he felt he behaved appropriately in those instances. Thus, the Veteran did not demonstrate occupational and social impairment with deficiencies in most areas and inability to establish and maintain effective relationships. In short, the Veteran did not have the constellation of symptoms indicative of the more severe disability. For these reasons, the Board finds that a rating in excess of 50 percent is not warranted. 2. Whether the reduction in the schedular rating for right eye optic atrophy from 40 percent to 30 percent was proper The circumstances under which rating reductions can occur are specifically limited and carefully circumscribed by regulations promulgated by the Secretary. Dofflemyer v. Derwinski, 2 Vet. App. 277, 280 (1992). The provisions of 38 C.F.R. § 3.344 provide criteria and considerations to take into account when determining whether a reduction in a rating is warranted. In this regard, 38 C.F.R. § 3.344 (a) notes that rating agencies will handle cases affected by change of medical findings or diagnosis, so as to produce the greatest degree of stability of disability evaluations consistent with the laws and Department of Veterans Affairs regulations governing disability compensation and pension. It is essential that the entire record of examination and the medical-industrial history be reviewed to ascertain whether the recent examination is full and complete, including all special examinations indicated as a result of general examination and the entire case history. Examinations less full and complete than those in which payments were authorized or continued will not be used as a basis of reduction. Ratings on account of diseases subject to temporary or episodic improvement, e.g., manic depressive or other psychotic reaction, epilepsy, psychoneurotic reaction, arteriosclerotic heart disease, bronchial asthma, gastric or duodenal ulcer, many skin diseases, etc., will not be reduced on any one examination except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. Moreover, though material improvement in the physical or mental condition is clearly reflected, the rating agency will consider whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life. 38 C.F.R. § 3.344 (a). If doubt remains, after according due consideration to all the evidence developed by the several items discussed in paragraph (a) of this section, the rating agency will continue the rating in effect, citing the former diagnosis with the new diagnosis in parentheses, and following the appropriate code there will be added the reference “Rating continued pending reexamination ____ months from this date, § 3.344.” The rating agency will determine of the basis of the facts in each individual case whether 18, 24, or 30 months will be allowed to elapse before the reexamination will be made. 38 C.F.R. § 3.344 (b). The provisions of paragraphs (a) and (b) apply to ratings which have continued for long periods at the same level (5 years or more). They do not apply to disabilities which have not become stabilized and are likely to improve. Re-examination disclosing improvement, physical or mental, in these disabilities will warrant reduction in rating. 38 C.F.R. § 3.344 (c). The 40 percent rating for the Veteran’s right eye optic atrophy was awarded effective March 4, 2014, and was reduced effective December 1, 2017, less than 5 years later. Accordingly, reexaminations showing improvement, physical or mental, in a service-connected disability will warrant a reduction in rating. 38 C.F.R. § 3.344 (c). However, the law also provides that certain regulations “impose a clear requirement that VA rating reductions, as with all VA rating decisions, be based upon a review of the entire history of the Veteran’s disability.” Brown v. Brown, 5 Vet. App. 413, 420 (1993) (referring to 38 C.F.R. §§ 4.1, 4.2, 4.13). A rating reduction requires an inquiry as to “whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations.” Brown at 421. Thus, in any rating-reduction case, not only must it be determined that an improvement in a disability has actually occurred, but also that improvement reflects an improvement under the ordinary conditions of life and work. Here, the Veteran was granted an increased 40 percent rating for his service-connected right eye optic atrophy in a June 2014 rating decision. The 40 percent rating was assigned effective March 4, 2014 (the date his claim for increase was received). The rating for the Veteran’s right eye optic atrophy has been assigned pursuant to Diagnostic Codes 6080-6064. See 38 C.F.R. § 4.79. 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 evaluation assigned. Under Diagnostic Code 6080, a 30 percent rating is assigned for homonymous hemianopsia; bilateral loss of temporal half of visual field; bilateral loss of inferior half of visual field; unilateral concentric contraction of visual field with remaining field of 5 degrees; and, bilateral concentric contraction of visual field with remaining field of 31 to 45 degrees. A 50 percent rating is assigned for bilateral concentric contraction of visual field with remaining field of 16 to 30 degrees. A 70 percent rating is assigned for bilateral concentric contraction of visual field with remaining field of 6 to 15 degrees. A 100 percent rating is assigned for bilateral concentric contraction of visual field with remaining field of 5 degrees. Under Diagnostic Code 6064, a 30 percent rating is assigned for no more than light perception in one eye and vision in the other eye 20/40. A 40 percent rating is assigned for no more than light perception in one eye and vision in the other eye 20/50. A 50 percent rating is assigned for no more than light perception in one eye and vision in the other eye 20/70. A 60 percent rating is assigned for no more than light perception in one eye and vision in the other eye 20/100. A 70 percent rating is assigned for no more than light perception in one eye and vision in the other eye 20/200. An 80 percent rating is assigned for no more than light perception in one eye and vision in the other eye 15/200. A 90 percent rating is assigned for no more than light perception in one eye and vision in the other eye 10/200. A 100 percent rating is assigned for no more than light perception in one eye and vision in the other eye 5/200. The June 2014 report of VA eye conditions examination reflects that the Veteran’s corrected distance vision in his right eye was 10/200; corrected distance vision in his left eye was 20/40 or better. The Veteran’s corrected near vision in his right eye was 10/200; corrected near vision in his left eye was 20/40 or better. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. Visual field testing revealed that he had contraction of a visual field and loss of inferior half of visual field in the right eye. The optometrist indicated that the Veteran had optic atrophy in the right eye and that his decrease in visual acuity or other visual impairment was attributable to his right eye optic atrophy. The optometrist remarked that the Veteran’s right eye optic atrophy was responsible for his decreased acuity and reduced peripheral vision of the right eye. A May 2015 VA optometry treatment record documents that the Veteran had no new complaints and saw well out of his current glasses. The Veteran reported that he could only see out of the upper lefts corner of his right eye. Confrontation of visual fields showed he had full superior nasal vision; all other quadrants were restricted in the right eye. Confrontation of visual field in the left eye was full to finger counting. Corrected vision was 20/60 in the right eye and 20/20 in the left eye. The June 2015 report of VA eye conditions examination reflects that the Veteran’s corrected distance vision in his right eye was 20/200; corrected distance vision in his left eye was 20/40 or better. The Veteran’s corrected near vision in his right eye was 20/200; corrected near vision in his left eye was 20/40 or better. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. Visual field testing revealed that he had contraction of a visual field and loss of inferior half of visual field in the right eye. The optometrist indicated that the Veteran had bilateral eye cataracts and optic atrophy in the right eye and that his decrease in visual acuity or other visual impairment was attributable to his right eye optic atrophy. The optometrist remarked that the Veteran’s right eye optic atrophy was responsible for his decreased vision and visual field defects. The cataracts were not significantly affecting vision. July 2015 private treatment records document the Veteran’s complaint of blurred vision in the right eye at both distance and near vision. Corrected visual acuity was 20/70 in the right eye and 20/30 in the left eye. Anterior segment was essentially normal. There was a 1+ pupillary defect of the right eye; the left eye pupil was normal. Examination of the lenses showed nuclear sclerosis of both eyes. Visual field tested showed advanced field loss of the right eye. The November 2015 report of VA eye conditions examination reflects that the Veteran’s corrected distance vision in his right eye was 20/100; corrected distance vision in his left eye was 20/40 or better. The Veteran’s corrected near vision in his right eye was 15/200; corrected near vision in his left eye was 20/40 or better. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. Visual field testing revealed that he had contraction of a visual field. The optometrist indicated that the Veteran had bilateral eye cataracts and optic atrophy in the right eye and that his decrease in visual acuity or other visual impairment was attributable to his right eye optic atrophy. The optometrist remarked that the Veteran’s right eye optic atrophy was responsible for his decreased acuity and reduced visual field of the right eye. No significant visual deficits were associated with the cataracts. In September and October 2017 rating decisions, the RO proposed to reduce the evaluation of the Veteran’s right eye optic atrophy from 40 percent to 30 percent. The proposed reduction was based on a finding that the service connection was never in effect for any visual impairment of the left eye. The RO explained the higher 40 percent evaluation had been granted based, in part, on impairment to visual fields of the non-service-connected left eye and that the assignment of the 40 percent rating was in error and must be corrected. The RO noted that the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation was to be avoided. The RO explained that the Veteran’s left eye visual impairment was not and had never been rated as service-connected and did not warrant consideration for entitlement to compensation under the rule pertaining to paired organs because the Veteran’s left eye visual impairment was not severe enough for consideration under that rule. The RO concluded that a 30 percent rating was the maximum rating that could be assigned for the Veteran’s visual impairment in one eye and was protected since it had been in effect for a period exceeding 20 years. In the November 2017 rating decision, the RO reduced the evaluation of the Veteran’s right eye optic atrophy from 40 percent to 30 percent, effective December 1, 2017. The RO reiterated the findings of the September and October 2017 proposed rating actions. The June 2014, June 2015 and November 2015 examination reports, May 2015 VA optometry and July 2015 private optometry treatment records documented above (which appear to form the basis for the reduction as proposed in September and October 2017 and finalized in November 2017) indicate that the Veteran’s right eye optic atrophy was not manifested by no more than light perception in the right eye (with 20/50 vision in the other eye) used to justify assignment of the 40 percent rating for the right eye optic atrophy. However, the Board notes that in the November 2017 rating decision that promulgated the reduction, while noting manifestations of a less severe right eye disability, the RO apparently did not consider whether the evidence made it reasonably certain that the improvement will be maintained under the ordinary conditions of life. Such failure constitutes error. Here, the Veteran has decreased vision, visual field defects and reduced peripheral vision of the right eye and the Veteran complained of blurred vision and very limited vision in the right eye. This evidence does not suggest that the improvement was maintained under the ordinary conditions of life. In addition, a November 2017 private ophthalmology record indicates visual field-testing results of the right eye were worse than testing from July 2015. Moreover, the recent August 2020 report of VA eye conditions examination reflects that the Veteran had anatomical loss, light perception only, extremely poor vision or blindness of the right eye. Given the above evidence, it cannot be stated with any certainty that improvement had been maintained under the ordinary conditions of life. Accordingly, the 40 percent rating for the Veteran’s right eye optic atrophy is restored. 3. Entitlement to an increased rating for right eye optic atrophy To reiterate, the rating for the Veteran’s right eye optic atrophy has been assigned pursuant to Diagnostic Codes 6080-6064. See 38 C.F.R. § 4.79. Under Diagnostic Code 6080, a 50 percent rating is assigned for bilateral concentric contraction of visual field with remaining field of 16 to 30 degrees. A 70 percent rating is assigned for bilateral concentric contraction of visual field with remaining field of 6 to 15 degrees. A 100 percent rating is assigned for bilateral concentric contraction of visual field with remaining field of 5 degrees. Under Diagnostic Code 6064, a 40 percent rating is assigned for no more than light perception in one eye and vision in the other eye 20/50. A 50 percent rating is assigned for no more than light perception in one eye and vision in the other eye 20/70. A 60 percent rating is assigned for no more than light perception in one eye and vision in the other eye 20/100. A 70 percent rating is assigned for no more than light perception in one eye and vision in the other eye 20/200. An 80 percent rating is assigned for no more than light perception in one eye and vision in the other eye 15/200. A 90 percent rating is assigned for no more than light perception in one eye and vision in the other eye 10/200. A 100 percent rating is assigned for no more than light perception in one eye and vision in the other eye 5/200. The June 2014 report of VA eye conditions examination reflects that the Veteran’s corrected distance vision in his right eye was 10/200; corrected distance vision in his left eye was 20/40 or better. The Veteran’s corrected near vision in his right eye was 10/200; corrected near vision in his left eye was 20/40 or better. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. Visual field testing revealed that he had contraction of a visual field and loss of inferior half of visual field in the right eye. A May 2015 VA optometry treatment record documents that the Veteran had no new complaints and saw well out of his current glasses. The Veteran reported that he could only see out of the upper lefts corner of his right eye. Confrontation of visual fields showed he had full superior nasal vision; all other quadrants were restricted in the right eye. Confrontation of visual field in the left eye was full to finger counting. Corrected vision was 20/60 in the right eye and 20/20 in the left eye. The June 2015 report of VA eye conditions examination reflects that the Veteran’s corrected distance vision in his right eye was 20/200; corrected distance vision in his left eye was 20/40 or better. The Veteran’s corrected near vision in his right eye was 20/200; corrected near vision in his left eye was 20/40 or better. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. Visual field testing revealed that he had contraction of a visual field and loss of inferior half of visual field in the right eye. July 2015 private treatment records document the Veteran’s complaint of blurred vision in the right eye at both distance and near vision. Corrected visual acuity was 20/70 in the right eye and 20/30 in the left eye. Anterior segment was essentially normal. There was a 1+ pupillary defect of the right eye; the left eye pupil was normal. Examination of the lenses showed nuclear sclerosis of both eyes. Visual field tested showed advanced field loss of the right eye. The November 2015 report of VA eye conditions examination reflects that the Veteran’s corrected distance vision in his right eye was 20/100; corrected distance vision in his left eye was 20/40 or better. The Veteran’s corrected near vision in his right eye was 15/200; corrected near vision in his left eye was 20/40 or better. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. Visual field testing revealed that he had contraction of a visual field. The August 2020 report of VA eye conditions examination documents that the Veteran had no functional vision in the right eye. The Veteran’s corrected distance vision in his right eye was 5/200 or worse; corrected distance vision in his left eye was 20/20 or better. The Veteran’s corrected near vision in his right eye was 5/200 or worse; corrected near vision in his left eye was 20/20 or better. The optometrist indicated that the Veteran had anatomical loss, light perception only, extremely poor vision or blindness of either eye but indicated the Veteran did not have anatomical loss of either eye; did not have vision limited to no more than light perception only in either eye; was able to recognize test letters at 1 foot or closer; was able to perceive objects, hand movements, or count fingers at 3 feet; and, did not have statutory blindness with bilateral visual acuity of 20/200 or less. Visual field testing revealed that he had total loss of visual field in the right eye. The optometrist indicated the right eye optic atrophy caused the vision loss. There is no evidence of anatomical loss or no more than light perception in the right eye. In addition, there is no evidence of bilateral concentric contraction of the visual field. Rather, the evidence at most shows there is total loss of visual field in the right eye with corrected vision in the Veteran’s service-connected right eye 5/200 or worse and corrected vision in his left eye 20/20 or better. (August 2020 report of VA examination). Thus, a rating in excess of 40 percent is not warranted for the right eye optic atrophy. 4. Entitlement to a TDIU for the period from March 4, 2014 to September 9, 2015 Under the applicable criteria, total disability ratings for compensation based upon individual unemployability 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. See 38 C.F.R. §§ 3.340, 3.341, 4.16(a). It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation because of service-connected disabilities shall be rated as totally disabled. Prior to September 9, 2015, service-connection was in effect for PTSD (50 percent disabling), right eye optic atrophy (40 percent disabling) and bilateral hearing loss (10 percent disabling); the combined rating for these service-connected disabilities is 70 percent. The central inquiry is “whether a veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” See Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the Veteran’s education, special training, and previous work experience, but not to his or her age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Van Hoose v. Brown, 4 Vet. App. 361 (1993). The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question, however, is whether a veteran can perform the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose, 4 Vet. App. at 363. The June 2014 report of VA eye conditions examination reflects that the Veteran’s right eye disability impacted his ability to work. The optometrist explained that the decreased acuity and peripheral vision in the right eye would impact the Veteran’s ability to perform functions requiring fine depth perception or detailed acuity. The June 2014 report of VA hearing loss examination reflects that the Veteran’s hearing loss did not impact ordinary conditions of daily life, including the ability to work. The June 2015 report of VA eye conditions examination reflects that the Veteran’s right eye disability impacted his ability to work. The optometrist explained that the Veteran was unable to pass the Department of Transportation Physical as his vision was worse than 20/40 and he had less than 70 degrees of horizontal visual field in the right eye. The June 2015 report of VA PTSD examination reflects the Veteran’s complaint that his disabilities were increasing in severity and documents his report that he lost his job because of his disabilities and had become unemployable. The psychologist remarked that the Veteran’s PTSD was not preventing his employment but explained that the Veteran’s difficulties returning to gainful employment may be due to an exponentially difficult number of physical factors (i.e., right eye optic atrophy impairment), psychiatric functions (reported daily panic attacks) and the impact of possible ageism in the workplace. The psychologist noted that the Veteran’s panic disorder had worsened in the last year. A statement received in July 2015 reflects the examiner’s assessment that the Veteran was indefinitely disqualified from operating a commercial vehicle. The examiner explained that the Veteran had progressively worsening right eye optic atrophy and PTSD with such symptoms as frequent panic attacks and suicidal ideation. The examiner determined that due to the suicidal ideations, panic attacks and need for medication to treat his PTSD symptoms, the Veteran was not mentally or physically safe to be driving a commercial vehicle. The examiner concluded that all the physical, mental and medical treatment directly affects the Veteran’s ability to drive a commercial vehicle safely and recommended that the Veteran be indefinitely disqualified from operating a commercial vehicle due to public safety concerns. The Veteran’s application for a TDIU rating indicated that he last worked full-time in 2013. He reported that his service-connected PTSD and right eye optic atrophy prevented him from securing or following any substantial gainful occupation. He had completed 2 years of college. The evidence shows that the Veteran’s service-connected PTSD and right eye optic atrophy prevented him from realistically obtaining and maintaining any form of gainful employment, consistent with his work and education background for the period from March 4, 2014 to September 9, 2015. He was unable to pass the Department of Transportation Physical as his vision was worse than 20/40 and he had less than 70 degrees of horizontal visual field in the right eye and his difficulties returning to gainful employment were due to an exponentially difficult number of physical factors (i.e., right eye optic atrophy impairment), psychiatric functions (reported daily panic attacks) and the impact of possible ageism in the workplace. Due to his progressively worsening right eye optic atrophy and PTSD with such symptoms as frequent panic attacks and suicidal ideation, the Veteran was not mentally or physically safe to be driving a commercial vehicle. All the physical, mental and medical treatment directly affected the Veteran’s ability to drive a commercial vehicle safely and an examiner recommended that the Veteran be indefinitely disqualified from operating a commercial vehicle due to public safety concerns. (July 2015 examiner assessment). Accordingly, the Board finds that a grant of a TDIU rating is warranted for the period from March 4, 2014 to September 9, 2015. The Board is cognizant of the decision of the Court in Bradley v. Peake, 22 Vet. App. 280 (2008), in which the Court held that there could be a situation where a veteran has a schedular total rating for a particular service-connected disability, and could establish a TDIU rating for another service-connected disability in order to qualify for special monthly compensation (SMC) under 38 U.S.C. § 1114 (s) by having an additional disability of 60 percent or more. Here, the Veteran is in receipt of a 100 percent schedular rating for multiple myeloma and has also been awarded SMC under 38 U.S.C. § 1114 (s) for the period from September 9, 2015. Accordingly, a claim for entitlement to a TDIU from September 9, 2015 is rendered moot. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Jackson The Board’s decision in this case is binding only with respect to this matter. It is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.