Citation Nr: 21073143 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 16-42 732 DATE: December 7, 2021 ORDER Entitlement to an initial 10 percent disability rating, but no higher, from January 20, 2014, for right eye retinal detachment, status post laser treatment is granted. Entitlement to an initial compensable disability rating for inguinal hernia, status post herniorrhaphy (surgical hernia repair) is denied. Entitlement to a 10 percent disability rating, but no higher, for diarrhea after surgical hernia repair is granted. FINDINGS OF FACT 1. The preponderance of the evidence demonstrates that from January 20, 2014, the average concentric contraction of the Veteran's visual field was, at worst, 55 degrees in the right eye, corrected right-eye distance vision was, at worst, 20/40, with no incapacitating episodes. 2. The preponderance of the evidence demonstrates that the Veteran's service-connected inguinal hernia disability is not manifested by postoperative recurrence of an inguinal hernia. 3. The preponderance of the evidence demonstrates that the Veteran's diarrhea associated with his postoperative inguinal hernia repair manifests as frequent episodes of bowel disturbance with abdominal distress. CONCLUSIONS OF LAW 1. The criteria for a 10 percent disability rating, and no higher, from January 20, 2014, for right eye retinal detachment, status post laser treatment have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.75-4.78, 4.79, Diagnostic Code 6008-6080. 2. The criteria for an initial compensable disability rating for inguinal hernia, status post herniorrhaphy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.114, Diagnostic Code 7338. 3. The criteria for a 10 percent disability rating, and no higher, for diarrhea status post operation associated with inguinal hernia, status post herniorrhaphy have been met. 38 U.S.C. §§ 1155, 5107, 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.114, Diagnostic Code 7399-7319. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 2004 to June 2012. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2013 rating decision. The Veteran's claims for increased disability ratings were remanded by the Board for further development in July 2019. Following the Board's remand, an August 2019 rating decision granted service connection for diarrhea status post diarrhea status post operation associated with inguinal hernia, status post herniorrhaphy, and assigned a noncompensable disability rating, effective February 11, 2014. Increased Disability Ratings VA has adopted a Schedule for Rating Disabilities to evaluate service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 3.321; see generally, 38 C.F.R. Part IV. The basis of disability evaluations 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 percentage ratings in the Schedule for Rating Disabilities represent, as far as practicably can be determined, the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. All reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3; see also 38 C.F.R. § 3.102. Separate ratings for distinct disabilities resulting from the same injury or disease can be assigned so long as the symptomatology for one condition is not "duplicative or overlapping with the symptomatology" of the other condition. See Amberman v. Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009); Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). However, the evaluation of the same disability or its manifestations under various diagnoses, which is known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. Because the level of disability may have varied over the course of the claim, the rating may be "staged" higher or lower for segments of time during the period under review in accordance with such variations, to the extent the evidence shows distinct time periods where the service-connected disability has exhibited signs or symptoms that would warrant different ratings under the rating criteria. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). In initial-rating cases, where the appeal stems from a granted claim of service connection with respect to the initial evaluation assigned, VA assesses the level of disability from the effective date of service connection. See Fenderson, 12 Vet. App. at 126. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (providing, in pertinent part, that reasonable doubt will be resolved in favor of the claimant). When the evidence supports the claim, or is in relative equipoise, the claim will be granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); see also Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). If the preponderance of the evidence weighs against the claim, it must be denied. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 1. Entitlement to an initial 10 percent disability rating, but no higher, from January 20, 2014, for right eye retinal detachment, status post laser treatment is granted. The Veteran maintains that his right eye retinal detachment, status post laser treatment warrants a higher disability rating. For the reasons discussed below, the Board finds that a 10 percent disability rating is warranted from January 20, 2014, forward, but a higher disability rating is not warranted. The Veteran's right eye retinal detachment, status post laser treatment has been rated under Diagnostic Code 6008-6080. Hyphenated Diagnostic Codes are used when a rating under one code requires 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. Here, the hyphenated diagnostic code indicates that the Veteran's detachment of retina (Diagnostic Code 6008) is rated under the criteria for visual field defects (Diagnostic Code 6080). During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim considering 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. Under the former criteria, Diagnostic Code 6008 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 6008 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. Regarding 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. 38 C.F.R. §§ 4.75(a), (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). 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. 38 C.F.R. §§ 4.75(c), (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 Diagnostic Code 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. 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). The table of Ratings for Impairment of Visual Fields encompasses Diagnostic Codes 6080 6081. Homonymous hernianopsia is rated at 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 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 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. The Veteran was afforded several examinations to evaluate the severity of his right eye retinal detachment, status post laser treatment. A June 2013 VA Eye Conditions examination provides that the Veteran has diagnoses of retinal detachment, status post laser treatment and exophoria. The Veteran's medical history provides that he had right-eye retinal detachment that was treated with a laser twice in September 2005. Concerning visual acuity, the Veteran had 20/40 vision or better bilaterally on corrected distance vision. 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's right and left pupil diameter were 3 millimeters and were round and reactive to light. There was no afferent pupillary defect present. The June 2013 VA examination report states that the Veteran did not have anatomical loss, light perception only, extremely poor vision, or blindness of either eye. He does not have a corneal irregularity that results in severe irregular astigmatism. He does not have diplopia. He had right and left eye pressure of 16. His slit lamp and external eye examinations were normal. His internal eye examination was abnormal as he had superonasal laser scars on the right eye with no retinal detachment. He did not have a visual field defect. He was not shown to have legal blindness, visual field diameter of 20 degrees or less in the better eye, even if the corrected visual acuity is 20/20 based upon visual field loss. He does not have scarring or disfigurement attributable to any eye disability. He has not had any incapacitating episodes attributable to any eye disabilities during the past 12 months and his eye disabilities do not impact his ability to work. The Veteran was also provided with a June 2016 Eye Conditions examination. The examination report states that the Veteran has a diagnosis of chorioretinal scars status post laser treatment and that his current symptoms include seeing flashing light especially during night or in darkness. The Veteran had 20/40 vision or better bilaterally on corrected distance. 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's right and left pupil diameter were 6 millimeters and were round and reactive to light. There was no afferent pupillary defect present. The June 2016 examination report states that the Veteran did not have anatomical loss, light perception only, extremely poor vision, or blindness of either eye. He does not have a corneal irregularity that results in severe irregular astigmatism. He does not have diplopia. He had right eye pressure of 17 and left eye pressure of 16. His slit lamp and external eye examinations were normal. His internal eye examination showed right eye peripheral chorioretinal laser scars of retinal tear. The June 2016 examination report states that the Veteran has a visual field defect or a condition that may result in a visual field defect. He does not have contraction of a visual field and does not have legal blindness based upon visual field loss. He has a retinal disability that is described as right eye detached retina that does not cause a decrease in visual acuity or other visual impairment. He does not have scarring or disfigurement. He has not had any incapacitating episodes attributable to any eye disability during the past 12 months. His eye disability impacts his ability to work as he has difficulty driving at night due to seeing flashes in the dark. Lastly, the Veteran was afforded a March 2020 VA Eye Conditions examination. The examination report provides that the Veteran has a diagnosis of chorioretinal scars, right eye. On corrected distance vision, the Veteran had 20/20 vision 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's right and left pupil diameter were 5 millimeters and were round and reactive to light. There was no afferent pupillary defect present. The March 2020 VA examination report states that the Veteran did not have anatomical loss, light perception only, extremely poor vision, or blindness of either eye. He does not have a corneal irregularity that results in severe irregular astigmatism. He does not have diplopia. He had right eye pressure of 16 and left eye pressure of 15. His slit lamp and external eye examinations were normal. His internal eye examination showed multiple healed laser spots/chorioretinal scarring. The March 2020 VA examination report indicates that he has a documented visual field defect and contraction of a visual field. Using Goldman's equivalent III/4e target showed that the visual field in the right eye was as follows: 80 degrees temporally; 72 degrees down temporally; 56 degrees down; 38 degrees down nasally; 50 degrees nasally; 48 degrees up nasally; 40 degrees up; and 55 degrees up temporally. The total right eye visual field was 439 degrees. The study also showed that the visual field in the left eye was as follows: 84 degrees temporally; 80 degrees down temporally; 65 degrees down; 48 degrees down nasally; 54 degrees nasally; 46 degrees up nasally; 45 degrees up; and 55 degrees up temporally. The total left eye visual field was 477 degrees. Regarding decreased visual field, as detailed above, the total right eye visual field was 439 degrees. Therefore, the average contraction for the right eye was 55 degrees (439 divided by 8). The total left eye visual field was 477 degrees. The average contraction for the right eye is 60 (477 divided by 8). However, he does not have loss of a visual field and does not have a scotoma. He does not have legal blindness based upon visual field loss. The March 2020 VA examination report states that the Veteran has a retinal, macula, or vitreous condition noted as laser scarring after treatment for retinal detachment. His decrease in visual acuity or other visual impairment is attributable to his laser treatment resulting in visual field restriction. He has not had any incapacitating episodes attributable to his eye disability during the past 12 months. His eye disability does not impact his ability to work. Related, a March 2020 VA medical opinion states that it least as likely as not that the Veteran's loss of field of vision is due to his service-connected eye disability. In support, the medical opinion provides that the area of visual field loss corresponds with the area of laser treatment for the retinal detachment of the right eye. When the retina is treated with laser, the underlying tissue is damaged and often leads to a loss of vision in the corresponding area. The Veteran's private treatment records also describe the severity of his service-connected eye disability. A January 2014 treatment record from Access Eye Centers provides that the Veteran has vision loss and right eye flashes of light. The Veteran has a present visual field defect that may be related to his laser repair. The impression is noted as retinal tear without detachment, pinguecula, and lattice degeneration. A January 2014 private treatment record from Ladysmith Medical Center provides that the Veteran has had two previous surgeries for retinal detachment and continues to have symptoms 10 times per day. On physical examination, the Veteran had no swelling, erythema, or discharge. Conjunctiva findings were normal in both eyes and his eye lids were normal bilaterally. An April 2014 private treatment record from Ladysmith Medical Center states that the Veteran has no swelling, erythema, or discharge. Conjunctiva findings were normal in both eyes and his eye lids were normal bilaterally. The Veteran also submitted written statements describing his right eye retinal detachment, status post laser treatment symptoms. In a June 2013 VA Form 21-4138, Statement in Support of Claim, the Veteran stated that he experiences flashing lights and also has blurred vision when reading for longs periods of time. In the January 2014 notice of disagreement, the Veteran stated that he has loss of vision in his right eye, flashing lights that have occurred 3 to 10 times per day that has happened every day since the detachment. In June 2014, the Veteran advised that he has flashing lights continuously in the right lower quadrant of his eye that is more active when reading or writing. In the Veteran's July 2018 VA Form 9, Appeal to the Board of Veterans' Appeals, he stated that when not rested properly, he experiences uncontrollable flashing lights, loss of field of vision, and incapacitating episodes. The Veteran has described his right eye symptoms as provided above. Because the Veteran is not shown to have a medical background or expertise, he is considered a layperson in the field of medicine. Lay testimony is competent as to matters capable of lay observation or within a person's first-hand experience and may be competent evidence with respect to both the diagnosis of a medical condition and its etiology or cause. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). However, lay testimony is not competent with respect to determinations that cannot be made based on lay observation alone due to their medical or scientific complexity. Davidson, 581 F.3d at 1316; Jandreau, 492 F.3d at 1376-77; Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994) (holding that lay testimony is not competent to prove that which would require specialized knowledge, training, or medical expertise). The Board must determine on a case-by-case basis whether lay testimony is competent on the matter at issue, or whether medical evidence is required. See Davidson, 581 F.3d at 1316 (holding that it was error to reject categorically lay statements on the issue of medical nexus, or to make a categorical finding that a medical opinion was required); Kahana v. Shinseki, 24 Vet. App. 428, 434 (2011) (holding that the Board erred in categorically rejecting lay evidence without assessing its competence). The Board finds that the Veteran is competent to report his right eye symptomatology as it is capable of lay observation within a person's first-hand experience. Additionally, the Veteran is credible in his reports of his right eye symptomatology. See Caluza v. Brown, 7 Vet. App. at 711, aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table) (holding that, in determining whether statements submitted by or on behalf of a claimant are credible, the Board may consider their internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant). The Board finds that a 10 percent disability rating is warranted for the Veteran's right eye retinal detachment, status post laser treatment, effective January 20, 2014. However, a higher disability rating is not warranted. The evidence does not demonstrate that the Veteran has had impaired visual acuity or incapacitating episodes during the period of appeal to warrant a compensable disability rating under the versions of Diagnostic Code 6011 that have been in force during the period of appeal. While the Veteran advised of experiencing incapacitating episodes in July 2018, there is no evidence that indicates that he sought treatment, such as systemic immunosuppressants or biologic agents, intravitreal or periocular injections, laser treatments, or other surgical interventions during the relevant period for his right eye retinal detachment, status post laser repair. The March 2020 VA examination report shows that average contraction for the right eye was 55 degrees. The table of Ratings for Impairment of Visual Fields encompasses Diagnostic Codes provides that when there is a remaining field of 46 to 60 degrees, a 10 percent rating is warranted for either bilateral or unilateral involvement. The January 20, 2014 treatment record from Access Eye Centers provides that the Veteran has a present visual field defect that may be related to his laser repair. There is no evidence that the Veteran had a remaining field of 31 to 45 degrees thus warranting a 30 percent disability rating. As such, a 10 percent disability rating, but not higher, is warranted for the Veteran's right eye retinal detachment, status post laser repair from January 20, 2014, the first date that a visual field defect was noted. The preponderance of the evidence weighs in favor of a 10 percent disability rating, but not higher and as such, the benefit of the doubt doctrine is not for application and the claim. See 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. The Board has considered whether a higher disability rating or any additional disability ratings are warranted under an alternative diagnostic code, but as discussed above, finds that there is no indication that the Veteran had any symptoms or diagnoses to warrant any higher or additional disability ratings. Alternatively, the record contains argument that the Veteran's right eye retinal detachment, status post laser treatment symptoms result in an exceptional or unusual disability picture, to include marked interference with employment, that renders the application of the rating schedule inadequate. In exceptional situations where the rating is inadequate, it may be appropriate to refer the case for extraschedular consideration. 38 C.F.R. § 3.321(b); Thun v. Peake, 22 Vet. App. 111, 114 (2008); aff'd, Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). The governing norm in these exceptional cases is a finding that the disability at issue presents such an exceptional or unusual disability picture with related factors such as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). These criteria have been broken up into two elements: (1) The schedular criteria must be inadequate to describe the claimant's disability level and symptomatology; and (2) There must be related factors such as marked interference with employment or frequent periods of hospitalization. Thun, 22 Vet. App. at 114; Anderson v. Shinseki, 22 Vet. App. 423, 427 (2009). If both elements are met, the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for a determination of whether the claimant's disability picture requires the assignment of an extraschedular rating. 38 C.F.R. § 3.321(b); Thun, 22 Vet. App. at 116. If either element is not satisfied, then referral is not warranted. Yancy v. McDonald, 27 Vet. App. 484, 494-95 (2016). The Board has compared the level of severity and symptomatology of the Veteran's right eye retinal detachment, status post laser treatment with the established criteria found in the rating schedule. Particularly, the rating schedule's description of the symptoms as impairment of visual acuity and visual field accurately reflects the Veteran's symptoms. Thus, the Board finds that the schedular criteria adequately contemplate all the symptoms attributable to his right eye retinal detachment, status post laser treatment and extraschedular consideration is not warranted in this case. 38 C.F.R. § 3.321(b)(1); Thun, supra. In all, a 10 percent disability rating, but no higher, is warranted for the Veteran's right eye retinal detachment, status post laser repair from January 20, 2014. The appeal is granted. 2. Entitlement to an initial compensable disability rating for inguinal hernia, status post herniorrhaphy is denied. The Veteran maintains that his service-connected inguinal hernia, status post herniorrhaphy warrants a higher disability rating. In particular, the Veteran states that he experiences diarrhea, fecal incontinence, abdominal pain, loose stools, and physical limitations as a result of this disability. For the reasons discussed below, the Board finds that a 10 percent disability rating, but not higher, is warranted. The Veteran's inguinal hernia, status post herniorrhaphy has been rated as noncompensable under 38 C.F.R. § 4.114, Diagnostic Code 7338. Under Diagnostic Code 7338, a noncompensable (zero percent) disability rating is assigned if the hernia is not operated, but remediable, or when the hernia is small, reducible, or without true hernia protrusion. A 10 percent disability rating is assigned for a hernia that is postoperative recurrent, readily reducible, and well supported by truss or belt. A 30 percent disability rating is assigned when the hernia is small, postoperative recurrent, or unoperated irremediable, not well supported by truss, or not readily reducible. A 60 percent disability rating is assigned where the hernia is large, postoperative, recurrent, not well supported under ordinary conditions and not readily reducible, when considered inoperable. A note in Diagnostic Code 7338 indicates that 10 percent should be added for bilateral involvement, provided the second hernia is compensable. This means that the more severely disabling hernia is to be evaluated, and 10 percent, only, added for the second hernia, if the latter is of compensable degree. To evaluate the Veteran's inguinal hernia, status post herniorrhaphy, he was afforded a June 2013 VA Hernias (Including Abdominal, Inguinal, and Femoral Hernias) Examination. The Veteran was diagnosed with an inguinal hernia and has a history of incarcerated inguinal hernia status post open herniorrhaphy with residual scar. The medical history section of the examination report states that the Veteran had surgery for an incarcerated right lower quadrant abdominal hernia in which a "foot or two of intestines" were removed. Records indicate that the surgery was an uncomplicated open right inguinal hernia repair for incarcerated inguinal hernia. The open right inguinal herniorrhaphy occurred in 2004. On examination, no hernia was detected on the right or left. There was no indication for a supporting belt. The examination report indicates that his hernia disability does not impact his ability to work. The Veteran was also provided a June 2016 Hernias (Including Abdominal, Inguinal and Femoral Hernias) examination. The examination report states that his diagnosis is inguinal hernia status post herniorrhaphy and that he currently has a pinching sensation and pain during intercourse. He had right inguinal hernia surgery during his service. On examination, there was no hernia detected and no indication for a supporting belt. He does not have any other pertinent physical findings, complications, conditions, signs, or symptoms related to his hernia disability. He has one right groin scar that is six centimeters in length by 0.2 centimeters in width at his right groin, this scar is not painful or unstable and does not have a total area equal to or greater than 39 square centimeters (6 square inches), and is not located on the head, face, or neck. Concerning functional impairment, the Veteran's hernia disability causes pain while performing sit-ups and other physical activities. Lastly, the Veteran was afforded an August 2020 Hernias (Including Abdominal, Inguinal and Femoral Hernias) examination. The examination report provides that the Veteran has a diagnosis of status post inguinal/femoral herniorrhaphy with post-operative scar. The Veteran's current symptoms are noted as diarrhea and fecal incontinence. He had a right inguinal herniorrhaphy in 2004. No hernia was detected. There was no indication for support demonstrated on the examination report. The Veteran's hernia disability does not impact his ability to work. The Veteran's private treatment records also describe the severity of his inguinal hernia, status post herniorrhaphy. A January 2014 private treatment record from Ladysmith Medical Center provides that he had colon resection for incarcerated hernia and is now having bowel changes. He had a partial bowel resection secondary to incarceration and he has occasional sharp, burning pains in the area of repair and has bowel movements 20 minutes following a meal. A February 2014 private treatment record from Gastroenterology Associates of Fredericksburg, P.C., states that the Veteran reported symptoms of dysphagia and diarrhea. The Veteran also submitted written statements describing the severity of his inguinal hernia, status post herniorrhaphy. In a June 2013 VA Form 21-4138, Statement in Support of Claim, the Veteran advised that his hernia disability prevents him from performing abdominal exercises. He also experiences a pinching sensation in his lower right abdominal region while sitting. The Veteran stated that he is forced to clean himself twice after a bowel movement and has a bowel movement soon after eating. He also has limitations with sexual activity due to the pinching sensation that he experiences in his right lower abdominal region. In the January 2014 notice of disagreement, the Veteran stated that he has loss of sensation, pain during intercourse, uncontrollable bowels, and that his hernia is supported by a belt that he wears daily. In June 2014, the Veteran advised that he has pain during intercourse, lack of bowel control, and is receiving treatment at a gastroenterologist. In the Veteran's July 2018 VA Form 9, he stated that he has pain in the lower abdominal area caused by mesh, and he experiences a pinching sensation and pain when moving from sitting position to standing. He has pain and discomfort and is supported with a Truss belt. In an October 2020 written statement, the Veteran provided that the issues relating to his hernia repair include soft or loose stools, leaking rectum, diarrhea, rashes, lesions, papules on groin. The frequent washing and leaking that results causes rashes to occur, and he has been prescribed several medications to treat his skin issues. The Veteran has described his hernia disability symptoms as provided above. Again, because the Veteran is not shown to have a medical background or expertise, he is considered a layperson in the field of medicine. The Board finds that the Veteran is competent to report his hernia disability pain symptomatology as it is capable of lay observation within a person's first-hand experience. Additionally, the Veteran is credible in his reports of his hernia pain symptomatology. However, because the record does not indicate the Veteran is qualified to opine concerning complex principles in the field of medicine issues that require knowledge of the interaction between multiple organ systems in his body, his unsupported opinions that his hernia disability causes digestive system symptomatology, rashes, lesions, and papules on his groin are not competent evidence, and thus lacks probative value. See Layno, 6 Vet. App. at 470-71. Based on review of the medical and lay evidence of record, the Board finds that entitlement to a compensable disability rating for inguinal hernia, status post herniorrhaphy is not warranted under Diagnostic Code 7338 at any time during the period on appeal. As noted above, assignment of a compensable rating under Diagnostic Code 7338 is if a hernia is postoperative recurrent, readily reducible, and well supported by truss or belt. While the Veteran has advised that he utilizes a belt, there is no indication that his hernia is recurrent or readily reducible. Further, the above examination reports provide that there is no indication for use of a supporting belt. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, therefore, the claim is denied. See 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. The Board has also considered whether any other applicable rating criteria may enable a compensable rating. However, after review, the Board finds that no other diagnostic code provides for a higher rating. Further, an August 2019 rating decision granted service connection for diarrhea status post diarrhea status post operation associated with inguinal hernia, status post herniorrhaphy. As such, the Veteran is compensated for his digestive system symptoms under this service-connected disability. Thus, the assignment of an increased disability rating under Diagnostic Code 7338 for the Veteran's digestive system symptoms would violate the rule against pyramiding, or the evaluation of the same disability or its manifestations under various diagnoses. See 38 C.F.R. § 4.14. Related, the Veteran's associated service-connected surgical scar, status post right inguinal hernia repair and bowel resection currently warrants a 10 percent disability rating under Diagnostic Code 7804. A higher disability rating is not warranted under Diagnostic Codes 7801 through 7804, as the associated surgical scar is not shown to be located on his head, face, or neck, be three or four scars that are painful or unstable, associated with underlying soft tissue damage, nor is the total area of that scar is shown to be at least 39 square centimeters (6 square inches). See 38 C.F.R. § 4.118, Diagnostic Codes 7801-7804 The Board notes that the Veteran's claims folder contains argument that the Veteran's inguinal hernia, status post herniorrhaphy result in an exceptional or unusual disability picture, to include marked interference with employment, that renders the application of the rating schedule inadequate. In particular, the September 2021 Informal Hearing Presentation states that the Veteran's hernia disability warrants an extraschedular disability rating as his symptoms impact his ability to function in a work environment without constant access and non-retaliatory excusal to use the bathroom frequently. However, as these symptoms are now rated under the Veteran's service-connected diarrhea status post diarrhea status post operation associated with inguinal hernia, status post herniorrhaphy, this argument will be addressed below. 3. Entitlement to a separate 10 percent disability rating, but not higher, for diarrhea status post operation associated with inguinal hernia, status post herniorrhaphy is granted. As noted above, an August 2019 rating decision granted service connection for diarrhea status post diarrhea status post operation associated with inguinal hernia, status post herniorrhaphy, and assigned a noncompensable disability rating, effective February 11, 2014. The Veteran's service-connected diarrhea status post operation associated with inguinal hernia, status post herniorrhaphy is currently evaluated as noncompensable under the provisions of 38 C.F.R. § 4.114, Diagnostic Code 7399-7319. Unlisted disabilities requiring rating by analogy are coded with the first two numbers of the schedule provisions most closely related body part and 99. Here, the hyphenated diagnostic code indicates that the Veteran's diarrhea status post operation associated with inguinal hernia, status post herniorrhaphy as analogous to the digestive system (Diagnostic Code 7399) under the criteria for irritable colon syndrome (Diagnostic Code 7319). 38 C.F.R. § 4.114, Diagnostic Code 7319. Under Diagnostic Code 7319, a noncompensable rating is warranted for mild irritable bowel syndrome, with disturbances of bowel function with occasional episodes of abdominal distress. A 10 percent disability rating is warranted for moderate irritable bowel syndrome with frequent episodes of bowel disturbance and abdominal distress. A maximum schedular 30 percent disability rating is warranted for severe irritable bowel syndrome with diarrhea or alternating diarrhea and constipation with more or less constant abdominal distress. 38 C.F.R. § 4.114, Diagnostic Code 7319. Descriptive words such as "slight," "moderate" and "severe" as used in the various Diagnostic Codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all the evidence for "equitable and just decisions." 38 C.F.R. § 4.6. The Veteran was provided with an August 2020 Rectum and Anus Conditions (Including Hemorrhoids) examination that indicates he has a diagnosis of status post partial small intestine resection for gangrenous bowel status post incarcerated right inguinal/femoral hernia with post-operative scarring. The Veteran's current symptoms are noted as bowel incontinence due to diarrhea. Continuous medication for the diagnosed condition is listed as fiber supplement. He does not have external hemorrhoids, anal fissures, or other abnormalities. The Veteran was also afforded an August 2020 Intestinal Surgery (Bowel Resection, Colostomy, Ileostomy) examination. The examination report states that the Veteran had an intestinal surgery of resection of the small intestine due to an incarcerated right inguinal/femoral hernia with gangrene. His current symptoms are noted as chronic diarrhea with intermittent recurrent bowel incontinence. He has chronic diarrhea attributable to his intestinal surgery. He does not have weight loss or an inability to gain weight due to his intestinal surgery. He does not have any interference with absorption and nutrition attributable to resection of his small intestine. He does not require the use of an ileostomy or colostomy. He does not have and has never had a persistent intestinal fistula attributable to a surgical intestinal condition. Lastly, the Veteran was provided with an August 2020 Intestinal Conditions (Other than Surgical or Infectious) (Including Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis, and Diverticulitis) examination. The examination report states that the Veteran has a diagnosis of chronic diarrhea and he has current symptoms of diarrhea with intermittent fecal incontinence. Continuous medication for the diagnosed condition is listed as fiber supplement. He has diarrhea as a symptom attributable to his non-surgical non-infectious intestinal condition. He does not have episodes of bowel disturbance with abdominal distress, or exacerbations or attacks of the intestinal condition. He does not have weight loss attributable to an intestinal condition. He does not have malnutrition, serious complications, or other general health effects attributable to the intestinal condition. He does not have a benign or malignant neoplasm or metastases related to any diagnosis. Related, an August 2020 medical opinion provides that as operations to the small intestine potentiate the onset of post-operative diarrhea complications including urgency, diarrhea, and incontinence, it is at least as likely that the Veteran's diarrhea, urgency, and incontinence are related to his hernia operation. The Veteran has described his digestive system symptoms as provided above. Again, because the Veteran is not shown to have a medical background or expertise, he is considered a layperson in the field of medicine. The Board finds that the Veteran is competent to report his digestive system symptomatology as it is capable of lay observation within a person's first-hand experience. Additionally, the Veteran is credible in his reports of his digestive system symptomatology. The Board finds that the preponderance of the evidence demonstrates that the Veteran's service-connected diarrhea status post operation associated with inguinal hernia, status post herniorrhaphy warrants a 10 percent disability rating, but not higher, under 38 C.F.R. § 4.114, Code 7399-7319. The evidence demonstrates that the Veteran experiences intermittent or frequent diarrhea, bowel incontinence, abdominal pain, and loose stools. However, the evidence does not show that he had episodes of diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, the preponderance of the evidence is against a disability rating greater than 10 percent. See 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. The Board has considered whether the Veteran is entitled to an increased or separate rating under other relevant diagnostic codes. However, there is no evidence that the Veteran's diarrhea status post operation associated with inguinal hernia, status post herniorrhaphy is due to impairment of sphincter control, stricture of the rectum and anus, or prolapse of the rectum. Thus, an increased or separate rating under an alternative diagnostic code, to include Diagnostic Codes 7332, 7333, and 7334, is not warranted. As noted above, the record contains argument that his digestive system symptoms, which are now rated as part of his service-connected diarrhea status post operation associated with inguinal hernia, status post herniorrhaphy, result in an exceptional or unusual disability picture, to include marked interference with employment, that renders the application of the rating schedule inadequate. The Board has compared the level of severity and symptomatology of the Veteran's diarrhea status post operation associated with inguinal hernia, status post herniorrhaphy with the established criteria found in the rating schedule. Particularly, the rating schedule's description of the symptoms as diarrhea, abdominal stress, and bowel disturbance accurately reflects the Veteran's symptoms. Thus, the Board finds that the schedular criteria adequately contemplate all the symptoms attributable to his diarrhea status post operation associated with inguinal hernia, status post herniorrhaphy and extraschedular consideration is not warranted in this case. 38 C.F.R. § 3.321(b)(1); Thun, supra. In all, the Veteran's service-connected diarrhea status post operation associated with inguinal hernia warrants a 10 percent disability rating, but no higher. The appeal is granted. K.B. McDonald Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mussey, Sean 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.