Citation Nr: 21004799 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 17-18 639 DATE: January 28, 2021 ORDER Entitlement to a rating higher than 10 percent for chronic blepharitis is denied. FINDING OF FACT During the appeal period, the Veteran’s chronic blepharitis has manifested by periodic eye irritation, including pain, eye watering, and foreign body sensation; the preponderance of the evidence is against a finding that the eye disability caused visual impairment or disfigurement. CONCLUSION OF LAW The criteria for a rating higher than 10 percent for chronic blepharitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.79, Diagnostic Code (DC)6018. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1960 to February 1966. This matter is before the Board on appeal from a February 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned at a June 2018 hearing. A transcript of that hearing is of record. Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and the residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. The determination of whether an increased rating is warranted is based on review of the entire evidence of record and the application of all pertinent regulations. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999). The Veteran contends that a higher rating is warranted for bilateral chronic blepharitis with recurrent chalazion (herein after “eye disability”). The Veteran’s eye disability has been assigned a 10 percent rating under DC 6018 for chronic conjunctivitis. During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. Both the former and revised criteria distinguish active and inactive disease processes. Under the former criteria, an active disease process (with objective findings, such as red, thick conjunctivitae, mucous secretion, etc.) is assigned a 10 percent rating. Under the revised criteria, an active disease process is rated pursuant to the General Rating Formula for Diseases of the Eye, with a minimum rating of 10 percent. For an inactive disease process, both the former and revised criteria instruct to evaluate based on residuals, such as visual impairment and disfigurement (DC 7800). The General Rating Formal for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where there are documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months, a 10 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months, a 20 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition during the past 12 months, a 40 percent rating is warranted. Where there are documented incapacitating episodes requiring 7 or more treatment visits for an eye condition during the past 12 months, a 60 percent rating is warranted. With regard to visual impairment, the May 2018 amendments made no substantive changes to how visual acuity is rated. With regard to visual field and muscle function examinations, the use of a Goldmann chart is no longer required. There are otherwise no substantive changes to how those types of visual impairment are rated. The evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75(a). To determine the evaluation for visual impairment when both decreased visual acuity and visual field defect are present in one or both eyes and are service connected, visual acuity and visual field defects are evaluated separately, and then combined under the provisions of § 4.25. Evaluation of visual acuity is based on corrected distance vision with central fixation. 38 C.F.R. § 4.76(b)(1). The measurements for each eye are applied to the table for Impairment of Central Visual Acuity. Generally, the table is divided into steps corresponding to different levels of visual acuity for one eye, and each step is further divided into subsections of visual acuity for the other eye, with corresponding ratings. Where a reported visual acuity is between two sequentially listed visual acuities, the visual acuity which permits the higher evaluation will be used. 38 C.F.R. § 4.76(c). DC 6066 provides ratings where vision in one eye (the poorer eye) is 10/200 or better. Where the visual acuity in both eyes is 20/40, a 0 percent rating is warranted. Where the visual acuity in the poorer eye is 20/50, a10 percent rating is warranted where vision in the other eye is either 20/50 or 20/40. At a January 2016 VA examination, the examiner noted a history of blepharitis and conjunctivitis status post chalazion removal. The Veteran reported that the condition had remained the same, although he experienced less frequent episodes. He stated he had chalazions within the last year which caused pain and watering. On examination, corrected distance vision was 20/40 bilaterally. There were dry patches on the cornea bilaterally. The examiner found no evidence of a visual field defect. The examiner found that there were no symptoms present on examination related to recurrent chalazion or chronic blepharitis. There was no evidence of scarring, disfigurement, or incapacitating episodes. Further, the examiner found no functional impact on the Veteran’s ability to work due to the eye disability. At an April 2019 VA examination, the examiner noted a history of chronic blepharitis causing symptoms of painful swelling in the eyelids and foreign body sensation bilaterally. The Veteran’s treatment had consisted of antibacterial ointment, draining infected glands, use of hot compresses and oral antibiotics. The Veteran reported he currently took an oral antibiotic and used hot compresses. He also stated he must periodically close his eyes when they burned too much. On examination, corrected distance vision was 20/40 in the right eye and 20/20 in the left eye. External examination found demodex and congestion of the meibomian glands, bilaterally. There was no evidence of a visual field defect. The examiner found that the demodex and meibomian gland dysfunction were part of the reason the Veteran experienced chronic blepharitis. In a September 2020 VA addendum opinion, a VA examiner opined that the Veteran’s chronic blepharitis had been manifested by active conjunctivitis with painful swelling of the eyelids and foreign body sensation. VA and private medical records are consistent with VA examination reports, showing a history of chronic blepharitis with chalazion causing irritation and discomfort. The records indicate the Veteran had chalazions excised, and treated with hot compresses, antibiotics and ointment. The Veteran’s corrected distance vision remained normal, bilaterally. After review of the record, the Board finds that the preponderance of the evidence is against a finding that the Veteran’s eye disability warrants a rating higher than 10 percent at any time during the appeal period. The evidence indicates that the eye disability has manifested by recurrent eye irritation, including some pain, burning, eyelid swelling, and foreign body sensation. These symptoms fall within both the former and revised rating criteria for active conjunctivitis, for which the Veteran has already been rated the minimum 10 percent rating. Considering the General Rating Formula for Diseases of the Eye s of May 13, 2018, the symptoms of the disability would still provide for no higher than a 10 percent rating, as there is no evidence that the Veteran’s eye disability caused decreased visual acuity, impairment of visual fields or incapacitating episodes. Further, there is no evidence that the eye disability has caused scarring or disfigurement that would allow for a separate rating under DC 7800. The Board notes that the Veteran’s representative requested an updated VA examination in the case that the Board denied the claim for increase. However, the Board finds that in the absence of evidence of worsening, an updated examination is not necessary to adequately adjudicate the Veteran’s claims. Palczewski v. Nicholson, 21 Vet. App. 174 (2007). The Board notes that this appeal has been remanded twice previously to obtain updated VA examinations. The passage of 20 months alone is not a basis for remanding again to obtain another VA examination. Neither the Veteran nor his representative has submitted any argument or evidence indicating a worsening of symptoms or why a higher rating is warranted in this case. Accordingly, the Board finds that the preponderance of the evidence is against a finding that a rating higher than 10 percent is warranted for the Veteran’s bilateral eye disability. Therefore, the claim for increased rating must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102 ; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Nathaniel Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Ahmad, 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.