Citation Nr: 21062969 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 16-03 062 DATE: October 12, 2021 ORDER Entitlement to a rating in excess of 10 percent prior to September 23, 2013, in excess of 20 percent from September 23, 2013 to February 3, 2017, in excess of 30 percent from February 3, 2017 to April 29, 2021, and in excess of 70 percent thereafter for bilateral glaucoma is denied. Entitlement to a total rating based on individual unemployability due to service connected disability (TDIU) is denied. FINDINGS OF FACT 1. For the appeal period prior to September 23, 2013, the Veteran's bilateral glaucoma required continuous medication; the evidence does not indicate the bilateral glaucoma manifested with decreased visual acuity or other visual impairment, or incapacitating episodes. 2. For the appeal period from September 23, 2013 to February 3, 2017, the Veteran's bilateral glaucoma manifested in, at worst, corrected distance visual acuity of, at worst, 20/40 bilaterally and visual field contraction of 47 degrees in the right eye and 35 degrees in the left eye; the evidence does not indicate the bilateral glaucoma manifested with incapacitating episodes. 3. For the appeal period from February 3, 2017 to April 29, 2021, the Veteran's bilateral glaucoma manifested in, at worst, corrected distance visual acuity of, at worst, 20/40 bilaterally and visual contraction of 44 degrees in the right eye and 25 degrees in the left eye; the evidence does not indicate the bilateral glaucoma manifested with incapacitating episodes. 4. For the appeal period beginning on April 29, 2021, the Veteran's bilateral glaucoma manifested in, at worst, corrected distance visual acuity of, at worst, 20/200 in the right eye and 20/70 in the left eye and visual field contraction of 43 degrees in the right eye and 25 degrees in the left eye; the evidence does not indicate the bilateral glaucoma manifested with incapacitating episodes. 5. The preponderance of the evidence does not show that the Veteran's service-connected disabilities rendered him unable to obtain and maintain substantially gainful employment due to service-connected disability at any time during the period on appeal. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent prior to September 23, 2013, in excess of 20 percent from September 23, 2013 to February 3, 2017, in excess of 30 percent from February 3, 2017 to April 29, 2021, and in excess of 70 percent thereafter for bilateral glaucoma have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.14.14, 4.27, 4.79, Diagnostic Codes 6013, 6066. 2. The criteria for entitlement to a TDIU prior are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from June 1972 to July 1975, and from January 1980 to December 1996. These matters come to the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) St. Louis, Missouri. Jurisdiction of this appeal is currently with the RO in Jackson, Mississippi. This case was most recently before the Board in June 2019, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. Specifically, the matters were remanded to provide proper notice regarding the evidence necessary to substantiate a claim for a TDIU, for the Veteran to complete an Application for Increased Compensation Based on Individual Unemployability (VA Form 21-8940), to obtain private treatment records, to obtain updated VA treatment records and to conduct an examination to determine the current severity of the Veteran's glaucoma. A December 2019 letter requested that the Veteran complete an appropriate authorization form to allow VA to obtain private treatment records on his behalf while a January 2020 letter provided the Veteran notice regarding how to substantiate a claim for a TDIU and requested that he complete a VA Form 21-8940. Updated VA treatment records have been associated with the record and a May 2021 eye examination was conducted. Therefore, the Board determines that there has been substantial compliance with its previous remand. The case has now been returned to the Board for appellate action. 1. Increased Rating Glaucoma The Veteran seeks entitlement to increased ratings for his service-connected glaucoma as his symptoms are more severe than contemplated by the current ratings assigned. Specifically, the Veteran contends that his glaucoma has required surgery, drains, possible stint placements, decreased visual acuity, negative impacts on daily activities, and inability to perform his work as a cinematographer. See VA Form 9, December 28, 2015. Disability ratings are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. 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. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. The veteran's entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A claimant may experience multiple distinct degrees of disability that may result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The following analysis is undertaken with consideration of the possibility that different ratings may be warranted for different time periods. The rating of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. That does not preclude the assignment of separate ratings for separate and distinct symptomatology where none of the symptomatology justifying a rating under one diagnostic code is duplicative of or overlapping with the symptomatology justifying a rating under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259 (1994). The Veteran's bilateral glaucoma is assigned a 10 percent rating prior to September 23, 2013, a 20 percent rating from September 23, 2013 to February 3, 2017, a 30 percent rating from February 3, 2017 to April 29, 2021, and a 70 percent rating thereafter under 38 C.F.R. § 4.79, Diagnostic Code 6013-6066 for glaucoma. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. 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. 83 Fed. Reg. 15316 (Apr. 10, 2018). The final rule went into effect on May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim using both the former and revised schedular rating criteria, although an increased rating based on the revised criteria cannot predate the effective date of the amendments. Under Diagnostic Code 6013, both the former and revised criteria indicate that a minimum 10 percent rating was warranted if continuous medication was required. Under the former criteria, Diagnostic Code 6013 instructed to evaluate pursuant to visual impairment due to open-angle glaucoma. Under the revised criteria, Diagnostic Code 6013 instructs to evaluate pursuant to the General Rating Formula for Diseases of the Eye. The Board notes that the General Rating Formula for Diseases of the Eye instructs to evaluate a condition based on visual impairment or its rating criteria for incapacitating episodes. Thus, the primary difference between the former and revised criteria is consideration of incapacitating episodes. With regard to visual impairment, the 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 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 one but less than three 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 three but less than five 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 five but less than seen treatment visits for an eye condition during the past 12 months, a 40 percent rating is warranted. Where there are documented incapacitating episodes requiring seven 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. Note (3) indicates that, for the purposes of evaluating visual impairment due to a particular condition, refer to 38 C.F.R. § 4.75--4.78 and to § 4.79, Diagnostic Codes 6061-6091. 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). Examinations of visual impairment must be conducted by a licensed optometrist or ophthalmologist, and the examiner must identify the disease, injury, or other pathologic process for any visual impairment found. Id. § 4.75(b). Examinations of visual field or muscle function will be conducted only when medically indicated. Id. The table of Ratings for Impairment of Visual Fields encompasses Diagnostic Codes 6080 6081. Homonymous hemianopsia is rated 30 percent. Loss of temporal half of visual field warrants a 30 percent rating is it is bilateral and a 10 percent rating if it is unilateral. Alternatively, this equates to 20/70 vision in each affected eye. Loss of nasal half of visual field warrants a 10 percent rating, whether or not the effect is bilateral or unilateral. Alternatively, this equates to 20/50 vision in each affected eye. Loss of inferior half of visual field warrants a 30 percent rating is it is bilateral and a 10 percent rating if it is unilateral. Alternatively, this equates to 20/70 vision in each affected eye. Loss of superior half of visual field warrants a 10 percent rating, whether or not the effect is bilateral or unilateral. Alternatively, this equates to 20/50 vision in each affected eye. Ratings are also provided for concentric contraction of visual field. Where there is a remaining field of 46 to 60 degrees, a 10 percent rating is warranted for either bilateral or unilateral involvement. Alternatively, this equates to 20/50 vision in each affected eye. Where there is a remaining field of 31 to 45 degrees, a 30 percent rating is warranted for bilateral involvement and a 10 percent rating is warranted for unilateral involvement. Alternatively, this equates to 20/70 vision in each eye. Where there is a remaining field of 16 to 30 degrees, a 50 percent rating is warranted for bilateral involvement and a 10 percent rating is warranted for unilateral involvement. Alternatively, this equates to 20/100 vision in each affected eye. Where there is a remaining field of 6 to 15 degrees, a 70 percent rating is warranted for bilateral involvement and a 20 percent rating is warranted for unilateral involvement. Alternatively, this equates to 20/200 vision in each affected eye. Where there is a remaining field of 5 degrees, a 100 percent rating is warranted for bilateral involvement and a 30 percent rating is warranted for unilateral involvement. Alternatively, this equates to 5/200 vision in each affected eye. 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. The rater will first locate the step that matches the visual acuity of the poorer eye. Within that step, the rater will then locate the subsection that matches the visual acuity of the better eye, which will produce the corresponding rating. 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). When the lens required to correct distance vision in the poorer eye differs by more than three diopters from the lens required to correct distance vision in the better eye (and the difference is not due to congenital or developmental refractive error), and either the poorer eye or both eyes are service connected, the visual acuity of the poorer eye will be evaluated using either its uncorrected or corrected visual acuity, whichever results in better combined visual acuity. 38 C.F.R. § 4.76(b)(1). Provided that the claimant customarily wears contact lenses, evaluate the visual acuity of any individual affected by a corneal disorder that results in severe irregular astigmatism that can be improved more by contact lenses than by eye glasses, as corrected by contact lenses. 38 C.F.R. § 4.76(b)(2). In any case where an examiner reports that there is a difference equal to two or more scheduled steps between near and distance corrected vision, with the near vision being worse, the examination report must include at least two recordings of near and distance corrected vision and an explanation of the reason for the difference. In these cases, evaluation will be based on corrected distance vision adjusted to one step poorer than measured. 38 C.F.R. § 4.76(b)(3). Diagnostic Code 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 one eye (the poorer eye) is 20/50, the following ratings apply. A 10 percent rating is warranted where vision in the other eye is either 20/50 or 20/40. Where the visual acuity in one eye (the poorer eye) is 20/70, the following ratings apply. A 30 percent rating is warranted where vision in the other eye is also 20/70. A 20 percent rating is warranted where vision in the other eye is 20/50. A 10 percent rating is warranted where vision in the other eye is 20/40. Where the visual acuity in one eye (the poorer eye) is 20/100, the following ratings apply. A 50 percent rating is warranted where vision in the other eye is also 20/100. A 30 percent rating is warranted where vision in the other eye is 20/70. A 20 percent rating is warranted where vision in the other eye is 20/50. A 10 percent rating is warranted where vision in the other eye is 20/40. Where visual acuity in one eye (the poorer eye) is 20/200, the following ratings apply. A 70 percent rating is warranted where vision in the other eye is also 20/200. A 60 percent rating is warranted where vision in the other eye is 20/100. A 40 percent rating is warranted where vision in the other eye is 20/70. A 30 percent rating is warranted where vision in the other eye is 20/50. A 20 percent rating is warranted where vision in the other eye is 20/40. Where visual acuity in one eye (the poorer eye) is 15/200, the following ratings apply. An 80 percent rating is warranted where vision in the other eye is also 15/200. A 70 percent rating is warranted where vision in the other eye is 20/200. A 60 percent rating is warranted where vision in the other eye is 20/100. A 40 percent rating is warranted where vision in the other eye is 20/70. A 30 percent rating is warranted where vision in the other eye is 20/50. A 20 percent rating is warranted where vision in the other eye is 20/40. Where visual acuity in one eye (the poorer eye) is 10/200, the following ratings apply. A 90 percent rating is warranted where vision in the other eye is also 10/200. An 80 percent rating is warranted where vision in the other eye is 15/200. A 70 percent rating is warranted where vision in the other eye is 20/200. A 60 percent rating is warranted where vision in the other eye is 20/100. A 50 percent rating is warranted where vision in the other eye is 20/70. A 40 percent rating is warranted where vision in the other eye is 20/50. A 30 percent rating is warranted where vision in the other eye is 20/40. Evaluation of visual field is based on the remaining field of vision in each eye. The examiner must record the remaining visual field of at least 16 meridians 2212 degrees apart for each eye, even though only the visual field at eight principal meridians 45 degrees apart will be used for rating purposes. Id. 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. To calculate average concentric contraction, the rater should add the remaining visual field (in degrees) at each of eight principal meridians 45 degrees apart and divide the sum by eight. 38 C.F.R. § 4.77(b). 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 § 4.25. 38 C.F.R. § 4.77(c). Evaluation of impairment of muscle function is based on the degree of diplopia. The examiner must record test results for the four major quadrants (upward, downward, and right and left lateral) and the central field (20 degrees or less). 38 C.F.R. § 4.78(a). Diplopia in the central field (20 degrees or less) of any of the four major quadrants equates to 5/200 visual acuity. From 21 to 30 degrees, diplopia in the down quadrant equates to 15/200 visual acuity, diplopia in either lateral quadrant equates to 20/100 visual acuity, and diplopia in the up quadrant equates to 20/70 visual acuity. From 31 to 40 degrees, diplopia in the down quadrant equates to 20/200 visual acuity, diplopia in either lateral quadrant equates to 20/70 visual acuity, and diplopia in the up quadrant equates to 20/40 visual acuity. In accordance with 38 C.F.R. § 4.31, diplopia that is occasional or that is correctable with spectacles is evaluated at 0 percent. An evaluation for diplopia will be assigned to only one eye. When a claimant has both diplopia and decreased visual acuity or visual field defect, the rater will assign a level of corrected visual acuity for the poorer eye (or the affected eye, if disability of only one eye is service-connected) that is: one step poorer than it would otherwise warrant if the evaluation for diplopia under Diagnostic Code 6090 is 20/70 or 20/100; two steps poorer if the evaluation under Diagnostic Code 6090 is 20/200 or 15/200; or three steps poorer if the evaluation under Diagnostic Code 6090 is 5/200. This adjusted level of corrected visual acuity cannot exceed a level of 5/200. The rater will apply the adjusted visual acuity for the poorer eye and the corrected visual acuity for the better eye to Diagnostic Codes 6065-66 in the table of Impairment of Central Visual Acuity to determine the rating. 38 C.F.R. § 4.78(b)(1). When diplopia extends beyond more than one quadrant or range of degrees, evaluate diplopia based on the quadrant and degree range that provides the highest evaluation. 38 C.F.R. § 4.78(b)(2). When diplopia exists in two separate areas of the same eye, increase the equivalent visual acuity under Diagnostic Code 6090 to the next poorer level of visual acuity, not to exceed 5/200. 38 C.F.R. § 4.78(b)(3). The Board notes that the medical evidence does not indicate any muscle function impairments. Turning to the evidence, a February 2013 private treatment record that indicates the Veteran had lost 90 percent of his vision in the left eye and 5 to 10 percent of the vision in his right eye due to glaucoma. The Veteran underwent a laser treatment in his left eye at that time, and express shunt was placed to lessen the need for eyedrops to control his glaucoma. The Veteran was afforded a VA examination in May 2014. At that time, the Veteran's visual acuity was as follows: uncorrected distance was 20/40 in the right eye and 20/200 in the left eye; uncorrected near was 20/70 in the right eye and 20/100 and the left eye; and corrected distance and corrected near were to 20/40 bilaterally. The Veteran did not have a difference equal to two or more lines on the Snellen test type chart or its equivalent between distance and near corrected vision, with the near vision being worse. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. The Veteran did not have a corneal irregularity that results in severe irregular astigmatism. He did not have diplopia. Visual field testing was performed; the Goldmann charts were associated with the claims file. He did not have legal blindness, loss of visual field, nor scotoma. The Veteran's decrease in visual acuity or other visual impairment was attributable to his glaucoma. Visual field defect was shown at the May 2014 VA examination, and the Veteran had contraction of a visual field. For the May 2014 VA examination, perimetry as to the Veteran's right and left eyes showed the remaining visual fields were, in degrees: Meridian Normal Degrees Right Eye Left eye Up 45 25 20 Up Temporally 55 25 30 Temporally 85 75 70 Down Temporally 85 75 70 Down 65 55 35 Down Nasally 50 40 20 Nasally 60 45 15 Up Nasally 55 35 20 Total 500 375 280 Adding the remaining visual field for the Veteran's right eye at each principal meridian results in a total remaining visual field of 375 degrees, and the left eye at each principal meridian results in a total remaining visual field of 280 degrees. Dividing 375 by 8 and rounding to the nearest whole number, results in an average concentric contraction 47 of the visual field for the right eye. Dividing 280 by 8 and rounding to the nearest whole number, results in an average concentric contraction 35 of the visual field for the left eye. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. The Veteran did not have any incapacitating episodes attributable to any eye condition. The examiner remarked the Veteran's glaucoma did not impact his ability to work. The Veteran was afforded a VA examination in February 2017. At that time, the Veteran was treated with laser surgery and continuous medication. His visual acuity was as follows: uncorrected distance was 20/70 in the right eye and 5/200 in the left eye; uncorrected near was 20/40 in the right eye and 20/200 in the left eye; and corrected distance and corrected near were to 20/40 bilaterally. The Veteran did not have a difference equal to two or more lines on the Snellen test type chart or its equivalent between distance and near corrected vision, with the near vision being worse. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. The Veteran did not have a corneal irregularity that results in severe irregular astigmatism. He did not have diplopia. Visual field testing was performed; the Goldmann charts were associated with the claims file. He did not have legal blindness, loss of visual field, nor scotoma. The Veteran's decrease in visual acuity or other visual impairment was attributable to his glaucoma and to his bilateral pre-operative cataracts. Visual field defect was shown at the February 2017 VA examination, and the Veteran had contraction of a visual field. For the February 2017 VA examination, perimetry as to the Veteran's right and left eyes showed the remaining visual fields were, in degrees: Meridian Normal Degrees Right Eye Left eye Up 45 25 24 Up Temporally 55 47 32 Temporally 85 74 57 Down Temporally 85 67 42 Down 65 43 5 Down Nasally 50 30 8 Nasally 60 39 12 Up Nasally 55 27 19 Total 500 352 199 Adding the remaining visual field for the Veteran's right eye at each principal meridian results in a total remaining visual field of 352 degrees, and the left eye at each principal meridian results in a total remaining visual field of 199 degrees. Dividing 352 by 8 and rounding to the nearest whole number, results in an average concentric contraction 44 of the visual field for the right eye. Dividing 199 by 8 and rounding to the nearest whole number, results in an average concentric contraction 25 of the visual field for the left eye. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. The Veteran did not have any incapacitating episodes attributable to any eye condition. The examiner remarked the Veteran's glaucoma did not impact his ability to work. An August 2019 private treatment record that shows vision had improved in the left eye, and he had diagnosis of pseudophakia in the left eye and age related nuclear cataract in the right eye. His vision had improved but was likely limited by central vision loss from glaucomatous atrophy; his right eye vision was easily correctable to 20/20. A September 2019 private treatment record that shows the Veteran had severe glaucoma of the left eye with central vision lost; limited residual vision in the left eye. The Veteran was afforded a VA examination in April 2021. At that time, the examiner diagnosed severe primary open bilateral glaucoma, nuclear sclerotic cataract of the right eye, and pseudophakia of his left eye. The Veteran treated with eye drops to lower intraocular pressures, that he underwent a trabeculectomy in the left eye and several laser procedures and that his night vision was very limited. He stated he was a motion picture photographer and he had great difficulty due to poor depth perception and poor focus. He also reported light sensitivity. He stated these problems prevented him from getting jobs as a cinematographer. Upon physical examination in April 2021, the Veteran's visual acuity was as follows: uncorrected distance was 10/200 in the right eye and 20/100 in the left eye; corrected distance was 20/200 in the right eye and 20/70 in the left eye; uncorrected near was 20/100 in the right eye and 20/200 in the left eye; and corrected near was 20/40 in the right eye and 20/200 in the left eye. The Veteran did not have a difference equal to two or more lines on the Snellen test type chart or its equivalent between distance and near corrected vision, with the near vision being worse. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. He did not have diplopia. Visual field testing was performed. Visual field defect was shown at the April 2021 VA examination, and the Veteran had contraction of a visual field and documented visual field defect. For the April 2021 VA examination, perimetry as to the Veteran's right and left eyes showed the remaining visual fields were, in degrees: Meridian Normal Degrees Right Eye Left eye Up 45 20 20 Up Temporally 55 30 35 Temporally 85 68 41 Down Temporally 85 64 40 Down 65 42 20 Down Nasally 50 40 10 Nasally 60 38 15 Up Nasally 55 43 15 Total 500 345 196 Adding the remaining visual field for the Veteran's right eye at each principal meridian results in a total remaining visual field of 345 degrees, and the left eye at each principal meridian results in a total remaining visual field of 196 degrees. Dividing 345 by 8 and rounding to the nearest whole number, results in an average concentric contraction 43 of the visual field for the right eye. Dividing 196 by 8 and rounding to the nearest whole number, results in an average concentric contraction 25 of the visual field for the left eye. The April 2021 VA examiner noted the Veteran had scotoma that affected at least 1/4 of the visual field bilaterally. He was not legally blind. The Veteran's decrease in visual acuity or other visual impairment was attributable to his glaucoma. His decrease in visual acuity or other visual impairment was not attributable to his cataracts. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. The Veteran did not have any incapacitating episodes attributable to any eye condition. The examiner remarked the Veteran's glaucoma impacted his ability to work due to his profession as a motion picture photographer and impaired depth perception, poor focus, and difficulty getting a job. Further review of the record shows that the Veteran received treatment at the VA medical center and from private treatment providers for various disabilities, to include his bilateral glaucoma. However, there is no indication from the treatment notes of record that the Veteran has reported symptoms of glaucoma that are worse than those noted in the various VA examination reports and treatment records of record. Based on the foregoing, the Board finds that a rating higher than 10 percent is not warranted prior to September 23, 2013 for his bilateral glaucoma. In this regard, the medical evidence shows that the Veteran required continuous medication for treatment of his glaucoma to warrant a 10 percent rating. However, the evidence does not show that the Veteran had incapacitating episodes, visual acuity, nor visual field contraction to warrant a higher 20 percent rating. Specifically, the Veteran has not been shown to have visual acuity or visual field contraction equivalent to 20/100 in the poorer eye and 20/50 in the other eye, 20/200 in the poorer eye and 20/40 in the other eye, or 15/200 in the poorer eye and 20/40 in the other eye. Therefore, the Board finds that the evidence does not demonstrate that the service-connected bilateral glaucoma meets or more nearly approximates the criteria for a higher than 10 percent rating under Diagnostic Code 6013, 6066, or any other potentially applicable diagnostic code prior to September 23, 2013. Based on the foregoing, the Board finds that a rating higher than 20 percent is not warranted from September 23, 2013 to February 3, 2017 for the Veteran's bilateral glaucoma. In this regard, the medical evidence shows that the Veteran had corrected distance visual acuity of, at worst, 20/40 bilaterally and visual field contraction of 47 degrees in the right eye and 35 degrees in the left eye to warrant a 20 percent rating. In this regard, the Veteran's visual acuity of 20/40 bilaterally warrants a noncompensable rating. However, his visual field contraction showed average contraction of the right eye to 47 degrees and left eye to 35 degrees. Those visual field contractions are equivalent to 20/70 in the right eye and 20/50 in the left eye to warrant a 20 percent rating. However, the evidence does not show the Veteran had incapacitating episodes, visual acuity, or visual field contraction to warrant a higher 30 percent rating. Specifically, the Veteran has not been shown to have visual acuity or visual field contraction equivalent to 20/70 bilaterally, 20/100 in the poorer eye and 20/70 in the other eye, 20/200 in the poorer eye and 20/50 in the other eye, 15/200 in the poorer eye and 20/50 in the other eye, and 10/200 in the poorer eye and 20/40 in the other eye. Therefore, the Board finds that the evidence does not demonstrate that the service-connected bilateral glaucoma meets or more nearly approximates the criteria for a higher than 20 percent rating under Diagnostic Code 6013, 6066, or any other potentially applicable diagnostic code from September 23, 2013 to February 3, 2017. Based on the foregoing, the Board finds that a rating higher than 30 percent is not warranted from February 3, 2017 to April 29, 2021 for his bilateral glaucoma. In this regard, the medical evidence shows that the Veteran had corrected distance visual acuity of, at worst, 20/40 bilaterally and visual contraction of 44 degrees in the right eye and 25 degrees in the left eye to warrant a 30 percent rating. In this regard, the Veteran's visual acuity of 20/40 bilaterally warrants a noncompensable rating. However, his visual field contraction showed average contraction of the right eye to 44 degrees and 25 degrees in the left eye. Those visual field contractions are equivalent to 20/70 in the right eye and 20/100 in the left eye to warrant a 30 percent rating. However, the evidence does not show the Veteran had incapacitating episodes, visual acuity, or visual field contraction to warrant a higher 40 percent rating. Specifically, the Veteran has not been shown to have visual acuity or visual field contraction equivalent to 20/100 bilaterally, 15/200 in the poorer eye and 20/70 in the other eye, and 10/200 in the poorer eye and 20/50 in the other eye. Therefore, the Board finds that the evidence does not demonstrate that the service-connected bilateral glaucoma meets or more nearly approximates the criteria for a higher than 30 percent rating under Diagnostic Code 6013, 6066, or any other potentially applicable diagnostic code from February 3, 2017 to April 29, 2021. Finally, based on the foregoing, the Board finds that a rating higher than 70 percent is not warranted beginning April 29, 2021 for his bilateral glaucoma. In this regard, the medical evidence shows the Veteran had corrected distance visual acuity of, at worst, 20/200 in the right eye and 20/70 in the left eye and visual field contraction of 43 degrees in the right eye and 25 degrees in the left eye. The Veteran's visual acuity of 20/200 in the poorer eye and 20/70 in the other eye warrants a 60 percent rating. Specifically, the Veteran has not been shown to have visual acuity or visual field contraction equivalent to 15/200 bilaterally or 10/200 in the poorer eye and 15/200 in the other eye. Additionally, his visual field contraction showed average contraction of the right eye to 43 degrees and left eye to 25 degrees. Those visual field contractions are equivalent to 20/70 in the right eye and 20/100 in the left eye to warrant a 30 percent rating. Therefore, the Board finds that the evidence does not demonstrate that the service-connected bilateral glaucoma meets or more nearly approximates the criteria for a higher than 70 percent rating under Diagnostic Code 6013, 6066, or any other potentially applicable diagnostic code from February 3, 2017. The Board has considered whether a higher rating is warranted for the Veteran's bilateral glaucoma under another diagnostic code. Here, the medical evidence of record fails to show a finding of impairment of muscle function, to include diplopia, or any documented incapacitating episodes. Therefore, the Veteran is not entitled to a higher rating at any time during the period on appeal. The Board has considered whether additional staged ratings under Hart, supra, is warranted, however, the Board finds that his symptomatology has been stable throughout each period on appeal. Therefore, assigning additional staged ratings is not warranted. Further, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). The Board acknowledges the Veteran's statements that his glaucoma symptoms are more severe than evaluated as due to symptoms of surgery, drains, possible stint placements, decreased visual acuity, negative impacts on daily activities. The Veteran is competent to report his symptoms and has presented credible statements in this regard. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). The Board finds, however, that neither the Veteran's statements nor medical evidence demonstrate that the criteria for higher ratings have been met. The Board also acknowledges that the Veteran's VA treatment records note complaints of and treatment for his bilateral glaucoma. However, these records do not address the specific rating criteria necessary to determine severity. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. Accordingly, the Board finds that the preponderance of the evidence is against a finding that a rating in excess of 10 percent prior to September 23, 2013, in excess of 20 percent from September 23, 2013 to February 3, 2017, in excess of 30 percent from February 3, 2017 to April 29, 2021, and in excess of 70 percent thereafter for bilateral glaucoma is warranted, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to a TDIU The Veteran asserts he is entitled to a TDIU. Specifically, he contends that he is unemployable as a result of his service-connected bilateral glaucoma due to symptoms such as inability to drive, decreased visual acuity, and poor depth perception and focus. See e.g., VA Form 9, December 28, 2015; see also VA examination report, April 29, 2021. However, the Board finds that entitlement to a TDIU is not warranted. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, such disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Rating boards should submit to the Director of Compensation Service for extraschedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities but who fail to meet the percentage standards set forth in 38 C.F.R. § 4.16(a). See 38 C.F.R. § 4.16(b). Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, "entitlement to a TDIU is based on an individual's particular circumstances." Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). Therefore, when adjudicating a TDIU claim, VA must take into account the individual veteran's education, training, and work history. Hatlestad v. Derwinski, 1 Vet. App. 164 (1991) (level of education is a factor in deciding employability); see Friscia v. Brown, 7 Vet. App. 294 (1994) (considering Veteran's experience as a pilot, his training in business administration and computer programming, and his history of obtaining and losing 19 jobs in the previous 18 years); Beaty v. Brown, 6 Vet. App. 532 (1994) (considering Veteran's 8th grade education and sole occupation as a farmer); Moore v. Derwinski, 1 Vet. App. 356 (1991) (considering Veteran's master's degree in education and his part-time work as a tutor). Age may not be considered as a factor when evaluating unemployability or intercurrent disability, and it may not be used as a basis for a total disability rating. 38 C.F.R. § 4.19. There must be a determination that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age or a non-service-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question, however, is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In the instant case, service connection is currently in effect for glaucoma rated as 20 percent disabling from September 23, 2013 to February 3, 2017, 30 percent disabling from February 3, 2017 to April 29, 2021, and 70 percent disabling beginning April 29, 2021; coronary artery disease rated as 30 percent disabling from October 3, 2019 to December 9, 2019, 100 percent disabling from December 9, 2019 to April 1, 2020, and 30 percent thereafter; traumatic arthritis of the thoracic and lumbar spine, rated as 10 percent disabling from January 1, 1997 to June 29, 2000; traumatic arthritis of the lumbar spine, rated as 10 percent disabling from June 30, 2000; traumatic arthritis of the thoracic spine, rated as noncompensable from June 30, 2000, residual surgical scars associated with coronary artery disease, rated as noncompensable from December 9, 2019, and right shoulder strain, right hip strain, hearing loss, hypertension, hemorrhoids, cord block epididymitis, excision lipomas, headaches, and herpes simplex, each rated as noncompensable from January 1, 1997. Therefore, his combined rating for the relevant period on appeal was 40 percent prior to February 3, 2017, 50 percent from February 3, 2017 to October 3, 2019, 70 percent from October 3, 2019 to December 9, 2019, 100 percent from December 9, 2019 to April 1, 2020, and 90 percent beginning April 29, 2021. Thus, the schedular criteria for a TDIU have not been met prior to October 3, 2019 and have been met thereafter. However, when a Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities, but fails to meet the percentage requirements for a TDIU set forth in 38 C.F.R. § 4.16(a), the case may be referred to appropriate VA officials for consideration of assignment of a TDIU rating. 38 C.F.R. § 4.16(b). Initially, the Board notes that in a June 2019 Board remand, the RO was directed to request the Veteran to complete and submit a VA Form 21-8940 in support of his claim for entitlement to a TDIU. In a January 2020 correspondence, the AOJ requested and attached such form from the Veteran. See Subsequent Development Letter, January 15, 2020. The requested form was not returned by the Veteran, and in a July 2020 rating decision, the AOJ denied entitlement to a TDIU. See Rating Decision, July 17, 2020. To date, the Veteran has not submitted a VA Form 21-8940 in support of his claim. The Board notes that the Veteran's physical limitations and functional impact of his service-connected bilateral glaucoma are discussed in the preceding section and incorporated herein. Turning to the evidence, the Veteran was afforded a VA examination in March 2020 for his heart. At that time, the examiner noted the Veteran's dyspnea and fatigue limited his physical activities, including work. The examiner noted the Veteran was a film maker and photographer and the Veteran reported he did not believe he could be hired due to his current condition. Notably, the Veteran had several complications following surgery and was still participating in rehabilitation. Here, the evidence is against finding that the Veteran is precluded by his service connected disability from obtaining and maintaining any form of gainful employment consistent with his education, experience, and skillset. The record is absent as to the Veteran's highest level of education and current employment status and/or employment history. During service, the Veteran's military occupational specialty (MOS) included photographer and the March 2020 VA examination suggests that he worked as a film maker and photographer following service. The ultimate question is whether he is capable of performing the physical and mental acts required by employment, not whether he can find employment. 38 C.F.R. § 4.16(a); Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Based on the foregoing, the Board finds that the Veteran is not entitled to a TDIU at any time prior during the period on appeal. The Board has carefully considered the Veteran's statements regarding the effects of his bilateral glaucoma, to include decreased depth perception, poor focus, surgical treatment, continuous medication, and decreased visual acuity, on his employability. Although the Veteran experienced limitation as a result of his service-connected bilateral glaucoma, and this disability has been found to cause some impact on his daily functioning and earning capacity, that impact was considered in the schedular ratings currently assigned. Simply stated, if he did not have impairment with his service-connected bilateral glaucoma, there would be no basis for the combined ratings during the period on appeal. Thus, such disability is not shown to render the Veteran unable to secure or follow a substantially gainful occupation. The fact that he was having impairments or difficulties does not provide a basis to grant TDIU. Further, the Veteran himself asserted that he could not find employment in his chosen profession as a cinematographer as a result of a combination of his service-connected glaucoma, but did not discuss whether the Veteran could find employment in an alternate profession. Because the record is unclear as to the Veteran's education level, prior employment history, certifications or trainings obtained, and skillset, the Board cannot determine whether the Veteran is unemployable in only his chosen profession or overall. (Continued on the next page) Therefore, based on the foregoing, the Board finds that, while the service-connected bilateral glaucoma results in some impairment in occupational functioning, which is represented by his currently assigned ratings, such does not render him unable to secure or follow a substantially gainful occupation. Therefore, the Board finds that the Veteran's service-connected disabilities do not render him unable to secure and follow a substantially gainful occupation. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable, and a referral for extraschedular consideration for a TDIU is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mariah N. Sim, 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.