Citation Nr: 21066544 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 19-23 458 DATE: November 1, 2021 ORDER Entitlement to a compensable rating for peripheral retinal degeneration, lattice-type, of the left eye, with dry eye syndrome is denied. REMANDED Entitlement to service connection for a heart disorder is remanded. Entitlement to an earlier effective date for a lumbar spine strain is remanded. Entitlement to an earlier effective date for costochondritis is remanded. Entitlement to an earlier effective date for peripheral retinal degeneration, lattice-type, of the left eye, with dry eye syndrome, is remanded. FINDING OF FACT Throughout the period on appeal, the Veteran's peripheral retinal degeneration, lattice-type, of the left eye, with dry eye syndrome did not manifest with decreased visual acuity or other visual impairment nor incapacitating episodes. CONCLUSION OF LAW The criteria for a compensable rating for a left eye disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.14.14, 4.27, 4.79, Diagnostic Code 6006. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from May 2003 to January 2007. These matters come to the Board of Veterans' Appeals (Board) on appeal from a September 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Jurisdiction of this appeal is currently with the RO in Montgomery, Alabama. This case was most recently before the Board in June 2020, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. Specifically, the matters were remanded to obtain updated VA treatment records and to conduct a VA examination to determine the current nature and severity of her peripheral retinal degeneration. Updated VA treatment records have been associated with the record and a VA eye examination was conducted in March 2021. The Board therefore determines that there has been substantial compliance with is previous remand with regards to the claim for an increased rating for peripheral retinal degeneration. The case has now been returned to the Board for appellate action. An August 2021 rating decision granted the Veteran's claim for service connection for residuals of a right fifth toe injury and gastroesophageal reflux disease (GERD) and assigned an initial rating for each condition. As this decision represents a full grant of the benefits sought with respect to these claims for service connection, such issues are no longer before the Board for consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). Increased Rating Peripheral Retinal Degeneration The Veteran seeks entitlement to increased ratings for her service-connected peripheral retinal degeneration as her symptoms are more severe than contemplated by the current ratings assigned. Specific argument in support of this appeal has not been provided. 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 peripheral retinal degeneration is assigned a noncompensable rating under 38 C.F.R. § 4.79, Diagnostic Code 6099-6006 for retinopathy or maculopathy not otherwise specified. 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 the former criteria, Diagnostic Code 6006 instructed to evaluate pursuant to the General Rating Formula for Diagnostic Codes 6000 through 6009. The General Rating Formula for Diagnostic Codes 6000 through 6009 instructs 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. Under the revised criteria, Diagnostic Code 6009 instructs to evaluate pursuant to the General Rating Formula for Diseases of the Eye. 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. 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. Both the former and revised criteria provide for consideration of 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 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. 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). Subject to the provisions of § 3.383(a), if visual impairment of only one eye is service connected, the visual acuity of the other eye will be considered to be 20/40 for purposes of evaluating the service-connected visual impairment. 38 C.F.R. § 4.75(c). The evaluation for visual impairment of one eye must not exceed 30 percent unless there is anatomical loss of the eye. Id. § 4.75(d). The evaluation for visual impairment of one eye should be combined with other disabilities of the same eye that are not based on visual impairment (e.g., disfigurement under DC 7800). 38 C.F.R. § 4.75(d). Under § 3.383(a), compensation is payable for the combination of service-connected and nonservice-connected disabilities, provided the nonservice-connected disability is not the result of the veteran's own willful misconduct. As pertinent to eye disabilities, this is allowed where (i) the impairment of vision in each eye is rated at a visual acuity of 20/200 or less; or (ii) the peripheral field of vision for each eye is 20 degrees or less. 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. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. It is permissible to switch diagnostic codes to reflect more accurately a claimant's current symptoms. See Read v. Shinseki, 651 F.3d 1296, 1302 (Fed. Cir. 2011). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran's service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The Veteran is competent to report symptoms and experiences observable by her senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claims. Turning to the evidence, the Veteran was afforded a VA examination in August 2016. At that time, the Veteran was diagnosed with lattice degeneration, dry eye syndrome, and cotton wool spot of the left eye. The Veteran reported thin spots in one eye, but was not sure which eye, that he was given greasy eye drops in the past after an episode of vision loss, that he used drops for dryness since about 2005 and that he did not use eye drops on the day of the examination and that he had glasses. Upon physical examination in August 2016, visual acuity testing results showed corrected distance of 20/40 or better 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 in either eye. The Veteran did not have astigmatism nor diplopia. Slit lamp and external eye examination showed abnormal cornea bilaterally and internal eye examination showed abnormal lattice periphery of the left eye. The Veteran did not have a visual field defect; visual field testing was not performed. The Veteran was not shown to have legal blindness based upon visual field loss. At the August 2016 VA examination, the Veteran had bilateral dry eye syndrome, and did not have lacrimal or lid condition that caused scarring or disfigurement. Other pertinent findings showed cotton wool spot on the left eye. There was no scarring or disfigurement attributable to any eye condition. The Veteran did not have any incapacitating episodes in the past 12 months that were attributable to any eye condition. The examiner noted that the Veteran's eye condition(s) did not impact her ability to work, and the examiner remarked the Veteran recently started hypertension medication that may have manifested in cotton wool spot due to hypertensive retinopathy. The Veteran was afforded a VA examination in February 2021. At that time, the Veteran reported worsening feeling of dry and grittiness with somewhat improvement with the use of artificial tears and warm compresses. Current symptoms included gritty burning sensation in the eyes. Upon physical examination in February 2021, visual acuity testing results showed corrected distance of 20/20 or better 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 astigmatism nor diplopia. Slit lamp and external eye examination showed abnormal cornea bilaterally; internal eye examination showed abnormal lattice periphery of the left eye. The Veteran did not have a visual field defect; visual field testing was not performed. The examiner noted there was no decrease in visual acuity or other visual impairment. The examiner also noted there was no decrease in visual acuity or other visual impairment due to lattice degeneration. Additionally, the examiner noted the Veteran's dry eye required artificial tears, but the lattice degeneration did not require any treatment. 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 her left eye disorder. However, there is no indication from the treatment notes of record that the Veteran has reported symptoms of a left eye disorder that are worse than those noted in the various VA examination reports. Based on the foregoing, the Board finds that a compensable rating for the Veteran's service connected peripheral retinal degeneration is not warranted at any time during the period on appeal. In this regard, the medical evidence shows that the Veteran had visual acuity of 20/40 or better bilaterally at her August 2016 VA examination, did not have any incapacitating episodes and did not have a visual field defect to warrant a compensable rating. Specifically, the Veteran has been shown to consistently have normal visual acuity and did not have a visual defect at any time during the period on appeal. Rather, her visual acuity and visual field have been normal throughout the period on appeal. Therefore, the Board finds that the evidence does not demonstrate that her service-connected peripheral retinal degeneration meets or more nearly approximately the criteria for a higher compensable rating under Diagnostic Code 6006, or any other potentially applicable diagnostic code at any time during the period on appeal. The Board has considered whether a higher rating is warranted for the Veteran's peripheral retinal degeneration 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 under another Diagnostic Code during the period on appeal. The Board has considered whether additional staged ratings under Hart, supra, is warranted, however, the Board finds that her symptomatology has been stable throughout the period on appeal. Therefore, assigning a staged rating is not warranted. Further, neither the Veteran nor her 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 her left eye symptoms are more severe than evaluated. The Veteran is competent to report her 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 her left eye disorder. 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 compensable rating for a peripheral retinal degeneration 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). REASONS FOR REMAND Service Connection Heart Disorder The Board notes that the Veteran has consistently asserted that she has a heart disorder, to include a heart murmur that is etiologically related to her active service. Indeed, the Veteran's service treatment records show that the Veteran complained of, and was treated for, reports of chest pain during active service. The Veteran's post-service treatment records seem to indicate that she currently takes medication to treat a heart condition, and experiences heart symptoms. In light of the Veteran's statements and the medical evidence associated with the claims file, the Board concludes that the Veteran should be afforded a VA examination to determine the nature and etiology of any current heart disorder. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Earlier Effective Date Lumbar Spine Strain, Costochondritis, Peripheral Retinal Degeneration As noted in the Board's prior June 2020 remand, the agency of original jurisdiction (AOJ) increased the rating assigned for the Veteran's lumbar spine strain and continued the ratings assigned for costochondritis and peripheral retinal degeneration, lattice-type, of the left eye, with dry eye syndrome in the September 2016 rating decision. In her July 2017 notice of disagreement (NOD), the Veteran specifically indicated disagreement with both the rating assigned and effective date of award for each issue. Unfortunately, while the July 2019 statement of the case (SOC) addressed the increased rating claims, it did not address the earlier effective date claims. The Veteran continued to seek earlier effective dates in her August 2019 VA Form 9. To date, the AOJ has not issued an SOC addressing the claims for earlier effective dates. When an NOD has been filed, but an SOC has not been issued, the appropriate Board action is to remand the issue to the AOJ for issuance of an SOC. See Manlincon v. West, 12 Vet. App. 238, 240 (1999). Therefore, the claims are remanded for issuance of an SOC. Although the Board remanded these issues for the issuance of an SOC in its June 2020 remand, the AOJ failed to issue such SOC. See Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. Issue the Veteran a Statement of the Case responding to the claims for earlier effective date for the lumbar spine strain, costochondritis and peripheral retinal degeneration. Advise the Veteran of the time period in which to perfect her appeal. If the Veteran perfects her appeal of these issues in a timely fashion, then return the case to the Board for its review, as appropriate. 2. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and her representative and afford her an opportunity to submit any copies in her possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 3. Following the receipt of outstanding records, schedule the Veteran for a VA examination with an appropriate clinician to determine the etiology of the claimed heart disorder. The record, to include a copy of this Remand, should be made available to the examiner, and all indicated tests should be conducted. Further physical examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following question: Is at least as likely as not (50 percent or greater probability) that any currently diagnosed heart disorder had its onset during any period of service, or is otherwise related to such period of service? The examiner must address the Veteran's complaints of and treatment for chest pain that occurred during active service. The examiner must reconcile any conflicting medical evidence of record. A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance. If the examiner opines that any of the above questions cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. A rationale should be provided for any opinion offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 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.