Citation Nr: 21062829 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 15-42 204 DATE: October 12, 2021 ORDER Entitlement to a disability rating in excess of 20 percent prior to October 11, 2019 and in excess of 40 percent thereafter for diabetes mellitus is denied. Entitlement to a disability rating in excess of 10 percent for diabetic retinopathy status post bilateral cataract surgery with intraocular lens implantation with macular pucker associated with diabetes mellitus is denied. FINDINGS OF FACT 1. The evidence shows that prior to October 11, 2019, the Veteran's diabetes mellitus required restricted diet, an oral glycemic agent, and one insulin injection per day; it did not require regulation of activities. 2. The evidence shows that from October 11, 2019, the Veteran did not experience episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, and he did not have complications that would not be compensable if separately evaluated. 3. The Veteran's diabetic retinopathy status post bilateral cataract surgery with intraocular lens implantation with macular pucker has not caused incapacitating episodes, and corrected distance vision has been no worse than 20/80 in the right eye and 20/40 in the left eye. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 20 percent prior to October 11, 2019 and in excess of 40 percent thereafter for diabetes mellitus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.119, Diagnostic Code 7913. 2. The criteria for a disability rating in excess of 10 percent for diabetic retinopathy status post bilateral cataract surgery with intraocular lens implantation with macular pucker have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1-4.16, 4.31, 4.75-4.79, Diagnostic Codes 6006, 6066. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably on active duty with the United States Air Force from August 1960 to July 1964, and from July 1965 to July 1981. He is a recipient of the Air Force Commendation Medal and the Vietnam Service Medal, among other decorations and awards. This case was most recently before the Board in July 2020, at which time the issues on appeal were remanded for additional development. The case has since returned to the Board for appellate consideration. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. Part IV. If two evaluations are potentially applicable, 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. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. 1. Entitlement to a disability rating in excess of 20 percent prior to October 11, 2019 and in excess of 40 percent thereafter for diabetes mellitus The Veteran seeks higher ratings for his service-connected diabetes mellitus, type II, for which he is currently in receipt of a 20 percent disability rating prior to October 11, 2019 and a 40 percent rating thereafter under 38 C.F.R. § 4.119, Diagnostic Code 7913. Diagnostic Code 7913 provides a structured scheme of specific, successive, cumulative criteria. Each higher rating includes the same criteria as the lower rating plus distinct new criteria. Middleton v. Shinseki, 727 F.3d 1172, 1178 (Fed. Cir. 2013). A 20 percent rating is warranted when diabetes requires one or more daily injection of insulin and restricted diet, or an oral hypoglycemic agent and restricted diet. A 40 percent rating is warranted when it requires one or more daily injections of insulin, restricted diet, and regulation of activities. Regulation of activities is defined as avoidance of strenuous occupational and recreational activities. A 60 percent rating is warranted when diabetes requires one or more daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A 100 percent rating is warranted when diabetes requires more than one daily injection of insulin, restricted diet, and regulation of activities, with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. Compensable complications of diabetes are evaluated separately unless they are part of the criteria used to support a 100-percent evaluation. Noncompensable complications of diabetes are considered part of the diabetic process. 38 C.F.R. § 4.119, Diagnostic Code 7913 (Note 1). Because Diagnostic Code 7913 contains successive criteria, the criteria for the lower rating must be met before a higher disability rating may be awarded. A higher rating cannot be granted based on a finding that the Veteran's disability picture more nearly approximates the criteria for the next higher rating. However, reasonable doubt regarding the presence of a criterion may be resolved in the Veteran' favor. Johnson v. Wilkie, 30 Vet. App. 245 (2018). For the period prior to October 11, 2019, the question is whether the Veteran's diabetes mellitus required one or more daily injections of insulin, restricted diet, and regulation of activities. As previously mentioned, regulation of activities is defined as avoidance of strenuous occupational and recreational activities. This criterion requires medical evidence. Camacho v. Nicholson, 21 Vet. App. 360, 364-65 (2007). For the period starting October 11, 2019, the question is whether the Veteran's diabetes mellitus has required one or more daily injections of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. Turning to the evidence, the Board notes that in a statement in support of his July 2010 claim for an increased rating, the Veteran wrote that despite his compliance with diet and medication, his glucose levels continued to fluctuate, which affected his vision and overall physical condition. The Veteran underwent a VA general medical examination in September 2010. Regarding type II diabetes mellitus, the examiner wrote that the Veteran had not had episodes of ketoacidosis nor had he had hypoglycemic reactions; however his blood sugar would get low and cause him to feel shaky. The examiner noted that the Veteran was on insulin for a period of time and then got back on oral medications, which he was currently taking. He was on a diabetic diet, and his weight was stable. His diabetes did not require restriction of activities, and he did not need to avoid strenuous activities to prevent hypoglycemic reactions. He saw his diabetic care provider every three to six months. The examiner found that the Veteran's diabetes impacted his ability to work in that he was only able to work for about 30 minutes before developing extreme fatigue, which would impact his productivity. In a September 2010 statement in support of his claim, the Veteran wrote that for the past year, his glucose level continued to fluctuate regardless of diet and medication, and that he had lost about 30 pounds and at times felt very weak. In statements submitted in September 2010, the Veteran's wife and a co-worker described how the Veteran experienced weakness, fluctuating glucose levels, and decreased energy levels which impacted his ability to work. In a March 2012 statement in support of his claim, the Veteran wrote that he experienced weakness and dizziness related to his diabetes that negatively impacted work activities and day-to-day functioning. In his September 2013 notice of disagreement (NOD), the Veteran wrote that he had to regulate his activities as a result of diabetes. He wrote that he was unable to work as an electrician due to eyesight, diabetes, hypertensive vascular disease, and nerve conditions. The Veteran underwent a VA diabetes mellitus VA examination in September 2015. The examiner indicated that the Veteran's diabetes treatment included restricted diet, and prescription of oral hypoglycemic agent(s) and one injection of insulin per day. The Veteran did not require regulation of activities. He visited his diabetic care provider for episodes of ketoacidosis or hypoglycemic reactions less than twice per month, and he had had no episodes of ketoacidosis or hypoglycemia requiring hospitalization over the past 12 months. The examiner noted that the Veteran had progressive unintentional weight loss of 15 percent of his baseline weight, and loss of strength attributable to diabetes. The examiner further noted that the Veteran's diabetes had been poorly controlled. On his November 2015 VA Form 9, the Veteran wrote that he took both pills and insulin shots to keep his diabetes under control. The Veteran underwent another VA diabetes examination in November 2017. The examiner noted that the Veteran's diabetes was managed with a restricted diet and prescribed oral hypoglycemic agents, and that it required insulin. The Veteran reported no recent weight changes, and no changes with his oral medication and insulin use. He reported going to the VA endocrine clinic about twice per year, in addition to seeing his primary care provider. There were no hospitalization or emergency room visits for diabetes during the past year. He did not require regulation of activities as part of medical management of his diabetes. He visited his diabetic care provider for episodes of ketoacidosis or hypoglycemic reactions less than twice per month, and he had had no episodes of ketoacidosis or hypoglycemia requiring hospitalization over the past 12 months. There was no progressive unintentional weight loss and loss of strength attributable to diabetes mellitus. The examiner found that diabetes impacted the Veteran's ability to work in that he required frequent breaks and a private place with facilities for handwashing and the disposal of glucose testing strips. The examiner also wrote that limitations may be placed on continuous physical exertion, working in extreme temperatures, working at unprotected heights, and working in isolated areas alone, with further progression of the disease possibly requiring limitation on work requiring visual acuity, fine dexterity, prolonged walking, or heavy labor. The examiner noted that diabetes did not affect the Veteran's activities of daily living (ADLs). The Veteran was most recently afforded a VA diabetes examination in October 2019. The examiner indicated that the Veteran's diabetes treatment included restricted diet, and prescription of oral hypoglycemic agent(s) and one injection of insulin per day. The examiner also indicated that the Veteran required regulation of activities to manage his diabetes. He visited his diabetic care provider for episodes of ketoacidosis or hypoglycemic reactions less than twice per month, and he had had no episodes of ketoacidosis or hypoglycemia requiring hospitalization over the past 12 months. The Veteran had not had progressive unintentional weight loss and loss of strength attributable to diabetes mellitus. The examiner determined that the Veteran's diabetes impacted his ability to work in that he was required to avoid strenuous occupational and recreational activities, and needed frequent breaks. He would also need immediate access to food at all times to avoid hypoglycemia, during which he would become dizzy and shaky. The examiner noted that the Veteran had complications of diabetes including diabetic peripheral neuropathy, diabetic retinopathy, and erectile dysfunction. VA treatment records show the Veteran has been treated for diabetes and complications of diabetes throughout the period on appeal, and that his diabetes has been well controlled with medication and restricted diet throughout the period. In September 2010, the Veteran appeared "thin and fragile" and subsequent treatment notes showed a general trend of weight loss associated with concerns about overeating and causing elevated glucose levels. Nevertheless, the Veteran's diabetes was routinely found to be well controlled; indeed, the Veteran was frequently congratulated on his excellent diabetes control, most recently in February 2020. VA treatment records do not show that the Veteran was directed to regulate his activities, and he was noted to be physically active, particularly with yardwork, throughout the period. The Veteran was also periodically counseled on the benefits of regular exercise. Records do not show episodes of ketoacidosis or hypoglycemic reactions requiring hospitalization, nor do they show that he visited a diabetic care provider twice a month. Overall, after careful review of the evidence of record, the Board finds that the evidence does not support awarding a disability rating in excess of 20 percent for diabetes for the period prior to October 11, 2019. The Board finds that the Veteran's diabetes mellitus required only restricted diet and one daily injection of insulin and prescription of oral glycemic agents during that period. He did not require regulation of activities to treat diabetes, and there were no episodes of ketoacidosis or hypoglycemic reactions requiring hospitalization over the past 12 months or twice monthly visits to a diabetic care provider for episodes of ketoacidosis or hypoglycemia. The Board acknowledges the Veteran's reports that he had to regulate his activities to manage his diabetes, including that his diabetes and residual disabilities prevented him from working as an electrician. The Veteran is competent to describe the ways his diabetes has impacted his activities, and his reports are credible in this regard. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, as previously mentioned, regulation of activities is defined as avoidance of strenuous occupational and recreational activitiesa criterion that requires medical evidence. Camacho, 21 Vet. App. at 364-65. Here, the medical evidence of record is against a finding that regulation of activities was required during the period prior to October 11, 2019. Indeed, throughout the period he was noted to be physically active, particularly with yardwork, and he was also periodically counseled on the benefits of regular exercise. Therefore, a disability rating in excess of 20 percent during that period is not warranted. The Board likewise finds that a disability rating in excess of 40 percent is not warranted for the period from October 11, 2019, as the evidence from that date does not show that the Veteran has had episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice monthly visits to a diabetic care provider. The evidence, including VA examination reports, shows that the Veteran's diabetes has resulted in complications including peripheral neuropathy, diabetic retinopathy, erectile dysfunction, and peripheral vascular disease. The only complication that has not already been assigned a separate disability rating is peripheral vascular disease. However, the Board finds that a separate compensable rating is not warranted for peripheral vascular disease at any point during the period on appeal. Diagnostic Code 7114 provides that a 20 percent rating is warranted for claudication on walking more than 100 yards, and; diminished peripheral pulses or an ankle/brachial index (ABI) of 0.9 or less. 38 C.F.R. § 4.114, Diagnostic Code 7114. A 40 percent rating is warranted for claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes (thin skin, absence of hair, dystrophic nails) or ABI of 0.7 or less. A 60 percent rating is warranted for claudication on walking less than 25 yards on a level grade at 2 miles per hour, and; either persistent coldness of the extremity or ABI of 0.5 or less. A 100 percent rating is warranted for ischemic limb pain at rest, and; either deep ischemic ulcers or ABI of 0.4 or less. The ABI is the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure. The normal index is 1.0 or greater. Id. at Note (1). The evaluations are for involvement of a single extremity. If more than extremity is affected, each extremity is to be evaluated separately. Id. at Note (3). The criteria listed in Diagnostic Code 7114 are conjunctive, as evidenced by the use of the word "and." See Melson v. Derwinski, 1 Vet. App. 334, 337 (1991); Camacho v. Nicholson, 21 Vet. App. 360, 366 (2007). Therefore, to satisfy the criteria for a 20 percent rating, the Veteran must demonstrate claudication on walking more than 100 yards and either: (1) diminished peripheral pulses, or (2) an ankle/brachial index (ABI) of 0.9 or less. In cases where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation is assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. The record shows the Veteran was afforded a VA artery and vein conditions examination in November 2017, during which he reported that his lower legs go numb with walking, but he could walk about a half mile before developing such symptoms. The examiner diagnosed mild peripheral artery disease of the bilateral lower extremities secondary to diabetes mellitus and hypertension. The examiner noted that the condition manifested with intermittent bilateral lower extremity coldness, but there was no significant pain at rest or ulceration of the bilateral lower extremities. The Veteran denied surgery or interventional procedures. The examiner determined that there was claudication of the bilateral lower extremities on walking more than half a mile. ABI testing was performed and showed an ABI of 0.93 in the right lower extremity, but the examiner could not occlude the artery to obtain an ABI for the left lower extremity. The examiner wrote that repeating the test would not produce different results, and that mild peripheral artery disease was equivalent to an ABI of about 0.9 or greater. As there was no evidence of claudication on walking more than 100 yards, the Board finds that the criteria for a compensable rating for peripheral vascular disease have not been met. See 38 C.F.R. § 4.114, Diagnostic Code 7114. Accordingly, a separate compensable rating for peripheral vascular disease is not warranted. 2. Entitlement to a disability rating in excess of 10 percent for diabetic retinopathy status post bilateral cataract surgery with intraocular lens implantation with macular pucker The Veteran seeks a higher rating for his service-connected diabetic retinopathy status post bilateral cataract surgery with intraocular lens implantation with macular pucker, for which he has been in receipt of a 10 percent disability rating under 38 C.F.R. § 4.79, Diagnostic Code 6066 for the entire period on appeal. During the pendency of the appeal, the Department of Veterans Affairs (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. Diagnostic Code 6006 provides the criteria for rating retinopathy or maculopathy. Under the former criteria, Diagnostic Code 6006 instructed to evaluate pursuant to the General Rating Formula for Diagnostic Codes 6000 through 6009. 38 C.F.R. § 4.79 (2018). The General Rating Formula for Diagnostic Codes 6000 through 6009 instructed to evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where incapacitating episodes have a total duration of at least 1 week, but less than 2 weeks, during the past 12 months, a 10 percent rating is warranted. Where incapacitating episodes have a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months, a 20 percent rating is warranted. Where incapacitating episodes have a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months, a 40 percent rating is warranted. Where incapacitating episodes have a total duration of at least 6 weeks during the past 12 months, a 60 percent rating is warranted. A Note following the General Rating Formula indicates that, for VA purposes, an incapacitating episode is a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider. 38 C.F.R. § 4.79. Under the revised criteria, Diagnostic Code 6006 instructs to evaluate pursuant to the General Rating Formula for Diseases of the Eye. 38 C.F.R. § 4.79. The General Rating Formula 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. Note (1) indicates that, for the purposes of evaluations under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Note (2) indicates that examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. 38 C.F.R. § 4.79. In this case, the Board has carefully reviewed the evidence of record, including VA treatment records, examination reports, and lay statements, but finds no evidence that the Veteran has been prescribed at least one week of bed rest due to his diabetic retinopathy, or that he has required at least one treatment visit for his disability during a 12-month period as of May 13, 2018. Therefore, the Board finds that an increased rating based on incapacitating episodes is not warranted under either the former or revised criteria. The evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. under both the former and revised criteria. 38 C.F.R. § 4.75 (a). The amendments made no substantive changes to how visual acuity is rated. Regarding visual field and muscle function examinations, the Board notes that use of a Goldmann chart is no longer required. There are otherwise no substantive changes to how those types of visual impairment are rated. 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). Evaluation of visual field is based on the remaining field of vision in each eye. 38 C.F.R. § 4.77. The table of Ratings for Impairment of Visual Fields provides ratings for visual field loss. The first half of the table provides ratings based on loss of an entire half of field of vision in an eye. The second half of the table provides ratings based on the average concentric contraction of the visual field of each eye. Evaluation of visual field is based on the remaining field of vision in each eye. 38 C.F.R. § 4.79. 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, separately evaluate the visual acuity and visual field defect (expressed as a level of visual acuity) and combine them under the provisions of 38 C.F.R. § 4.25. 38 C.F.R. § 4.77(c). Evaluations of visual impairment of muscle function is based on the degree of diplopia. 38 C.F.R. § 4.78. Turning to the evidence, the Board notes that in his July 2010 claim for an increased rating, the Veteran wrote that his vision was affected by fluctuations in his glucose level due to diabetes. In a September 2010 statement, the Veteran wrote that he experienced blurred vision as a result of fluctuating glucose levels. The Veteran underwent a VA eye examination in connection with his claim in September 2010. The Veteran denied eye pain, and the examiner noted that the Veteran had not been hospitalized or had surgery for any eye condition. Uncorrected distance visual acuity was 20/150 in the right eye and 20/80 in the left eye; uncorrected near visual acuity was 20/70 in the right eye and 20/200 in the left eye; corrected distance visual acuity was 20/80 in the right eye and 20/40 in the left eye; and corrected near visual acuity was 20/70 in the right eye and 20/50 in the left eye. Visual fields were normal to confrontation. The examiner indicated that the Veteran had no incapacitating episodes of an eye disease during the last 12 months. In a September 2011 addendum opinion, the September 2010 VA examiner wrote that the Veteran's level of vision did not render him unable to secure and maintain gainful employment. The examiner explained that the Veteran may not see well enough to perform jobs that demand very high levels of vision discrimination, but he could see well enough to get a driver's license and from a vision point of view, perform the majority of job occupations. In a March 2012 statement, the Veteran wrote that he had surgery on his left eye in February, and that he had previously had surgery on his right eye. He wrote that his vision was affected by diabetes, even though he had a driver's license, and that he was unable to drive in a lot of traffic or for any distance due to the fluctuation of his glucose level. He further wrote that his vision was often blurry. In an April 2012 statement, the Veteran wrote that he could not see well enough to draw his insulin and had to be put on a type of insulin that was pre-measured as a result of his impaired vision. Private medical treatment records show the Veteran had epiretinal membrane surgery on the left eye in February 2012 due to severe painless decreased vision in the left eye due to a dense epiretinal membrane. The Veteran underwent another VA eye examination in July 2012. The examiner diagnosed diabetic retinopathy, pseudophakia, and macular pucker. Uncorrected distance and near visual acuity was 20/40 or better in both eyes and corrected distance and near visual acuity was 20/40 or better in both eyes. Internal eye examination revealed background retinopathy of the macula, vessels, and peripheries in both eyes. There was no visual field defect. The examiner indicated that the Veteran had postoperative cataracts with replacement lenses in both eyes; there was no aphakia. The Veteran's visual impairment was not attributable to cataracts; rather, his visual impairment was attributable to his bilateral retinopathy and maculopathy. There was no scarring or disfigurement attributable to an eye condition, and the Veteran had not had any incapacitating episodes attributable to any eye condition during the past 12 months. The examiner determined that the Veteran's eye conditions did not impact his ability to work. The Veteran underwent another VA eye examination in February 2015. The examiner noted diagnoses of diabetic retinopathy, pseudophakia, and macular pucker. Uncorrected distance visual acuity was 20/100 in both eyes; uncorrected near visual acuity was 20/70 in both eyes; corrected distance visual acuity was 20/40 in both eyes; and corrected near visual acuity was 20/40 in both eyes. There was no visual field defect. Visual impairment was attributable to diabetic retinopathy and macular pucker. There was no scarring or disfigurement attributable to an eye condition, and the Veteran had not had any incapacitating episodes attributable to any eye condition during the past 12 months. The examiner determined that the Veteran's eye conditions did not impact his ability to work. The Veteran underwent another VA eye examination in November 2017. Uncorrected distance visual acuity was 20/70 in both eyes; uncorrected near visual acuity was 20/100 in both eyes; corrected distance visual acuity was 20/40 in both eyes; and corrected near visual acuity was 20/40 in both eyes. There was no visual field defect, and the examiner determined that there was no decrease in visual acuity or other visual impairment. There was no scarring or disfigurement attributable to an eye condition, and the Veteran had not had any incapacitating episodes attributable to any eye condition during the past 12 months. The examiner determined that the Veteran's eye conditions did not impact his ability to work and did not impair his ability to perform activities of daily living such as operating a motor vehicle on public streets. The Veteran was afforded another VA eye examination in October 2019. The examiner diagnosed dry eye syndrome, pseudophakia, and macular scars and noted symptoms of blurry vision, especially at night and in rooms with poor lighting. Uncorrected distance visual acuity was 20/70 in both eyes; uncorrected near visual acuity was 20/100 in both eyes; corrected distance visual acuity was 20/50 in the right eye and 20/40 in the left eye; and corrected near visual acuity was 20/50 in both eyes. There was no visual field defect. The examiner determined that visual impairment was due to dry eyes and macular scarring. The examiner found that the Veteran had localized retinal scars, atrophy, or irregularities that were centrally located and resulted in an irregular, duplicated, enlarged, or diminished image in both eyes. There was no scarring or disfigurement attributable to an eye condition, and the Veteran had not had any incapacitating episodes attributable to any eye condition during the past 12 months. The examiner determined that the Veteran's eye conditions did not impact his ability to work. However, the examiner advised against driving public transportation or operating heavy machinery due to macular scarring and a visual field superior on confrontational visual field; however, the Veteran should be able to do computer work and drive with the proper glasses prescription. The Veteran most recently underwent a VA eye examination in August 2021. The examiner diagnosed macular pucker, severe diabetic non-proliferative diabetic retinopathy in the left eye, and glaucoma in the right eye. Uncorrected distance visual acuity was 20/70 in the right eye and 20/100 in the left eye; uncorrected near visual acuity was 20/40 in both eyes; corrected distance visual acuity was 20/40 in the right eye and 20/20 or better in the left eye; and corrected near visual acuity was 20/20 or better in both eyes. There was no visual field defect. The examiner determined that the Veteran's visual impairment was attributable to his diabetic retinal changes and maculopathy. There was no scarring or disfigurement attributable to an eye condition, and the Veteran had not had any incapacitating episodes attributable to any eye condition during the past 12 months. (Continued on the next page) Overall, after careful review of the record, the Board finds that the evidence does not support awarding a disability rating in excess of 10 percent for retinopathy at any point during the period on appeal. The objective medical evidence from the period, including VA and private treatment records and multiple VA examination reports, show that the Veteran's diabetic retinopathy status post bilateral cataract surgery with intraocular lens implantation with macular pucker has not caused incapacitating episodes, and that corrected distance vision has been no worse than 20/80 in the right eye and 20/40 in the left eyefindings commensurate with a 10 percent disability rating for loss of visual acuity under Diagnostic Code 6066. A higher rating would require more severe visual impairment than what has been shown during the period on appeal. Accordingly, the Veteran's claim for an increased rating for his service-connected eye disability must be denied. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. T. Raftery, 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.