Citation Nr: A21020488 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 211025-194132 DATE: December 23, 2021 ORDER Entitlement to an initial disability rating in excess of 10 percent for left eye scotoma is denied. FINDING OF FACT For the entire appeal period, the Veteran's centrally located left eye scotoma resulted in no worse than 20/40 corrected distance vision, without evidence of left eye visual field impairment or impairment of muscle function. CONCLUSION OF LAW The criteria for entitlement to an initial disability rating in excess of 10 percent for left eye scotoma are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.76-4.78, 4.79, Diagnostic Code 6006-6081. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from October 1965 to October 1969. The rating decision on appeal was issued in August 2021 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In his October 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), the Veteran elected the Direct Review option; therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Evidence was added to the claims file during a period of time when new evidence was not allowed. Therefore, the Board may not consider this evidence. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Higher Initial Rating Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings 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 determination of whether an increased rating is warranted is based on review of the entire evidence of record and the application of all pertinent regulations. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. While the Veteran's entire history is reviewed when making a disability determination, where service connection has already been established and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). However, staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Entitlement to an initial disability rating in excess of 10 percent for left eye scotoma The Veteran seeks a higher initial disability rating for his service-connected left eye scotoma, which is currently rated as 10 percent disabling under Diagnostic Code 6066-6081, which is analogous to Diseases of the Eye (Diagnostic Code 6066, Visual acuity in one eye 10/200 or better) under the criteria for Ratings for Impairment of Visual Fields (Diagnostic Code 6081, Scotoma, unilateral). When both decreased visual acuity and visual field defect are present in one or both eyes and are service connected, the visual acuity and visual field defect are separately evaluated and combined under the provisions of 38 C.F.R. § 4.25. 38 C.F.R. § 4.77(c). Under Diagnostic Code 6081, a 10 percent disability rating is warranted for evidence of scotoma affecting at least one-quarter of the visual field (quadrantanopsia) or with centrally located scotoma of any size. 38 C.F.R. § 4.79. Alternatively, Diagnostic Code 6081 also instructs to evaluate scotoma based on visual impairment if that would result in a higher evaluation. Id. 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. 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). Under Diagnostic Code 6066, a 10 percent rating is warranted when visual acuity in one eye (the poorer eye) is 20/50, and vision in the other eye is 20/40; when visual acuity in one eye (the poorer eye) is 20/70, and vision in the other eye is 20/40; or when visual acuity in one eye (the poorer eye) is 20/100, and vision in the other eye is 20/40. 38 C.F.R. § 4.79. Regarding impairment of the field of vision, 38 C.F.R. § 4.76a, Table III, provides that the normal visual field extant at the 8 principal meridians totals 500 degrees. The normal values for the 8 principal meridians are as follows: 85 degrees temporally; 85 degrees down temporally; 65 degrees down; 50 degrees down nasally; 60 degrees nasally; 55 degrees up nasally; 45 degrees up; and 55 degrees up temporally. The extent of visual field contraction in each eye is determined by recording the extent of the remaining visual fields in each of the eight principal meridians. Under Diagnostic Code 6080, when the remaining visual field is 46 to 60 degrees unilaterally, a 10 percent disability rating is assigned, or the affected eye may be evaluated as 20 /50. 38 C.F.R. § 4.79. When the remaining visual field is 31 to 45 degrees unilaterally, a 10 percent disability rating is assigned, or the affected eye may be evaluated as 20 /70. Id. When the remaining visual field is 16 to 30 degrees unilaterally, a 10 percent disability rating is assigned, or the affected eye may be evaluated as 20 /100. Id. When the remaining visual field is 6 to 16 degrees unilaterally, a 20 percent disability rating is assigned, or the affected eye may be evaluated as 20 /200. Id. Based on a review of the relevant evidence, the Board finds that an initial disability rating in excess of 10 percent for left eye scotoma is not warranted. Specifically, the June 2021 VA examination reflects a diagnosis of left eye centrally located scotoma, which, under Diagnostic Code 6081, warrants a 10 percent rating. 38 C.F.R. § 4.79. However, Diagnostic Code 6081 also instructs to evaluate scotoma based on visual impairment if this would result in a higher rating. However, the medical evidence of record, to include the June 2021 VA examination and post-service VA treatment records, reflects corrected distance measuring no more than 20/40 in the left eye. As the Veteran is only service-connected for his left eye, the visual acuity of his non-service-connected right eye is considered to be 20/40 for purposes of evaluating left eye visual impairment. 38 C.F.R. § 4.75(c). When applying visual acuity of 20/40 for the left eye and 20/40 for the non-service-connected right eye, under Diagnostic Code 6066, a noncompensable (zero percent) rating is warranted for visual acuity. Additionally, the June 2021 VA examination does not demonstrate evidence of impairment of left eye visual field. For the 2021 VA examination, Goldmann perimetry as to the Veteran's left eye showed the remaining visual fields were, in degrees: Meridian Normal degrees Left Eye Temporally 85 85 Down temporally 85 75 Down 65 65 Down nasally 50 50 Nasally 60 60 Up nasally 55 55 Up 45 45 Up temporally 55 55 Total 500 490 Adding the remaining visual field at each principal meridian results in a total remaining visual field of 490 degrees. Dividing 490 by 8 and rounding to the nearest whole number, results in an average concentric contraction of 61 degrees of the visual field for the left eye, which reflects a normal visual field in the Veteran's left eye. Here, evaluation under Diagnostic Code 6081 affords the Veteran the higher disability rating of 10 percent for his centrally located left eye scotoma, as evaluation for visual impairment under Diagnostic Code 6066 would only warrant a noncompensable (zero percent) rating for corrected distance vision in the left eye of 20/40. As such, the currently assigned10 percent initial disability rating for left eye scotoma under Diagnostic Code 6066-6081 is appropriate, and a higher rating is not warranted. The Board acknowledges the Veteran's contention made in his November 2021 Appellate Brief that his service-connected left eye scotoma warrants extraschedular consideration. The Board has considered whether the Veteran's current schedular evaluation for his left eye scotoma is inadequate, thus requiring referral of the case to the Under Secretary for Benefits or Director of Compensation and Pension Service for consideration of an extraschedular evaluation to commensurate with the average earning capacity impairment due exclusively to the service-connected disability. 38 C.F.R. § 3.321(b)(1). An extraschedular evaluation is for consideration where a service-connected disability presents an exceptional or unusual disability picture. An exceptional or unusual disability picture occurs where the diagnostic criteria do not reasonably describe or contemplate the severity and symptomatology of the disability. Thun v. Peake, 22 Vet. App. 111 (2008). If there is an exceptional or unusual disability picture, then the Board must consider whether the disability picture exhibits other factors such as marked interference with employment or frequent periods of hospitalization. Id. When either of those elements has been satisfied, the appeal must be referred for consideration of the assignment of an extraschedular rating. Otherwise, the schedular rating is adequate, and referral is not required. Id. 38 C.F.R. § 3.321(b)(1). Here, the schedular evaluation of the Veteran's left eye scotoma is adequate. Although the Veteran's left eye scotoma is assigned the maximum rating under the schedular criteria for Diagnostic Code 6081, higher ratings are available for left eye scotoma under Diagnostic Code 6066 when the evidence demonstrates visual impairment, to include visual acuity, visual field defect, and muscle function. Here, the medical evidence of record does not presently demonstrate any left eye visual impairment. While the Board acknowledges the Veteran's reports that his left eye vision is impaired, the June 2021 VA examination demonstrates no worse than 20/40 corrected distance vision in the left eye, a normal left eye visual field, and no evidence of impaired muscle function, to include diplopia. Here, the currently assigned 10 percent rating under Diagnostic Code 6081 contemplates the Veteran's left eye centrally located scotoma. As the rating schedule is adequate to evaluate the disability, referral for extraschedular consideration is not in order. In conclusion, as the Board finds that the preponderance of the evidence is against the Veteran's claim for an initial disability rating in excess of 10 percent for left eye scotoma, the claim must be denied. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38C.F.R. §§ 4.3, 4.7. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Houle, 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.