Citation Nr: 21009657 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 16-39 644 DATE: February 23, 2021 ORDER Entitlement to a compensable initial rating for bilateral diabetic retinopathy with bilateral cataracts prior to June 23, 2014 is denied. Entitlement to a rating in excess of 60 percent for bilateral diabetic retinopathy with bilateral cataracts from June 23, 2014 to June 24, 2015 is denied. Entitlement to a rating in excess of 70 percent for bilateral diabetic retinopathy with bilateral cataracts from June 25, 2015 is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due to a single service-connected disability is granted, effective June 23, 2014. From June 23, 2014, entitlement to special monthly compensation (SMC) under 38 U.S.C. § 1114(s) and 38 C.F.R. § 3.350(i)(1) is granted; subject to the rules and regulations governing the payment of monetary awards. Entitlement to SMC based on loss of use or blindness of one eye, having only light perception, is denied. FINDINGS OF FACT 1. Prior to June 23, 2014, the Veteran’s corrected distance vision was, at worst, 20/25 in the right eye and 20/25 in the left eye.  There is no evidence of impairment of muscle function or visual field defect. 2. From June 23, 2014 to June 24, 2015, the average concentric contraction of the Veteran’s visual field was, at worst, 30 degrees in the right eye and 8 degrees in the left eye.  Corrected distance vision was, at worst, 20/40 in the right eye and 20/20 in the left eye. There is no evidence of impairment of muscle function or incapacitating episodes. 3. From June 25, 2015, the average concentric contraction of the Veteran’s visual field was, at worst, 19 degrees in the right eye and 8 degrees in the left eye. Corresponding corrected distance vision was 20/40 in the right eye and 5/200 in the left eye, with documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months. There is no evidence of impairment of muscle function. 4. The Veteran is precluded from securing or following a substantially gainful occupation consistent with her education and work experience because of a single service-connected disability, specifically, bilateral diabetic retinopathy with bilateral cataracts. Her bilateral diabetic retinopathy with bilateral cataracts meets the 60 percent schedular criteria for entitlement to a TDIU on June 23, 2014. 5. The instant Board decision is granting a schedular TDIU rating based on the Veteran’s service-connected bilateral diabetic retinopathy with bilateral cataracts, effective June 23, 2014. In addition, for this same period, her additional service-connected disabilities are independently ratable at 60 percent. 6. The Veteran’s service-connected bilateral eye disability is not shown to have caused blindness in either eye, such that the Veteran has only light perception in one eye. CONCLUSIONS OF LAW 1. Prior to June 23, 2014, the criteria for a compensable initial rating for bilateral diabetic retinopathy with bilateral cataracts are not met.  38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.75-4.79, Diagnostic Code 6006-6066 (2019). 2. From June 23, 2014 to June 24, 2015, the criteria for a rating in excess of 60 percent for bilateral diabetic retinopathy with bilateral cataracts are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.75-4.79, Diagnostic Code 6006-6066 (2019). 3. From June 25, 2015, the criteria for a rating in excess of 70 percent for bilateral diabetic retinopathy with bilateral cataracts are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.75-4.79, Diagnostic Code 6006-6066 (2019). 4. From June 23, 2014, the criteria for entitlement to a TDIU based on a single service-connected disability are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16 (2019). 5. From June 23, 2014, the criteria for an award of SMC are met. 38 U.S.C. § 1114(s) (2012); 38 C.F.R. § 3.350(i)(1) (2019). 6. The criteria for an award of SMC based on loss of use or blindness in one eye, having only light perception, are not met. 38 U.S.C. § 1114(k) (2012); 38 C.F.R. § 3.350(a)(4) (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from September 2001 to May 2005. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a March 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) and were previously remanded by the Board in April 2019. An August 2016 rating decision assigned a 60 percent rating for bilateral diabetic retinopathy with bilateral cataracts from June 23, 2014 to June 24, 2015 and a 70 percent rating from June 25, 2015. As the rating periods regarding the Veteran’s bilateral eye disability prior to June 23, 2014, from June 23, 2014 to June 24, 2015, and from June 25, 2015 are not the maximum allowable, the issues remain on appeal. AB. v. Brown, 6 Vet. App. 35 (1993). On an August 2016 VA Form 21-8940, the Veteran alleged that she was prevented from securing or following any substantially gainful occupation due to her service-connected bilateral eye disability. While a TDIU rating was denied in a January 2017 rating decision, the issue of entitlement to a TDIU is before the Board due to having been raised in the context of the increased rating claim for the Veteran’s bilateral eye disability on appeal. See Rice v. Shinseki, 22 Vet. App. 447 (2009). The Board’s April 2019 remand directed the RO to obtain any outstanding VA and private treatment records from January 2017 to the present and to afford the Veteran a new VA examination to assess the current severity of her service-connected bilateral eye disability. The Board finds that there has been substantial compliance with its April 2019 remand directives, and it will proceed with adjudication of the issues on appeal. Stegall v. West, 11 Vet. App. 268 (1998). Increased Ratings Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity.  Individual disabilities are assigned separate diagnostic codes.  38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2019).  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 (2019).  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 (2019).  However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided.  38 C.F.R. § 4.14 (2019).  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).  1. Entitlement to an initial compensable rating for bilateral diabetic retinopathy with bilateral cataracts prior to June 23, 2014 2. Entitlement to a rating in excess of 60 percent for bilateral diabetic retinopathy with bilateral cataracts from June 23, 2014 to June 24, 2015 3. Entitlement to a rating in excess of 70 percent for bilateral diabetic retinopathy with bilateral cataracts from June 25, 2015 The Veteran seeks higher ratings for her bilateral diabetic retinopathy with bilateral cataracts. Under Diagnostic Code 6006-6066, which is analogous to a disease of the eye (Diagnostic Code 6006, Retinopathy) under the criteria for impairment of visual acuity (Diagnostic Code 6006, Visual acuity in one eye 10/200 or better), the Veteran’s bilateral eye disability is rated as noncompensable prior to June 23, 2014, as 60 percent disabling from June 23, 2014 to June 24, 2015, and as 70 percent disabling from June 25, 2015. 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 in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments.    Both the former and revised criteria provide for consideration of visual impairment, which is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function.  38 C.F.R. § 4.75(a).  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.    Under both the former and revised criteria for Diagnostic Code 6066, visual acuity, a 60 percent rating is warranted when visual acuity in one eye (the poorer eye) is 20/200, and vision in the other eye is 20/100; when visual acuity in one eye (the poorer eye) is 15/200, and vision in other eye is 20/100; or when visual acuity in one eye (the poorer eye) is 10/200, and vision in the other eye is 20/100. 38 C.F.R. § 4.79. Under both the former and revised criteria for Diagnostic Code 6066, visual acuity, a 70 percent rating is warranted when visual acuity in one eye (the poorer eye) is 20/200, and vision in the other eye is 20/200; when visual acuity in one eye (the poorer eye) is 15/200, and vision in other eye is 20/200; or when visual acuity in one eye (the poorer eye) is 10/200, and vision in the other eye is 20/200. 38 C.F.R. § 4.79. Under both the former and revised criteria for Diagnostic Code 6066, visual acuity, a 80 percent rating is warranted when visual acuity in one eye (the poorer eye) is 15/200, and vision in the other eye is 15/200; or when visual acuity in one eye (the poorer eye) is 10/200, and vision in other eye is 15/200. 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 both the former and revised criteria for Diagnostic Code 6080, when the remaining visual field is 46 to 60 degrees bilaterally or unilaterally, a 10 percent disability rating is assigned, or each 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 or bilaterally, 10 percent and 30 percent disability ratings are assigned respectively, or each affected eye may be evaluated as 20/70.  Id.  When the remaining visual field is 16 to 30 degrees unilaterally or bilaterally, 10 percent and 50 percent disability ratings are assigned respectively, or each affected eye may be evaluated as 20/100.  Id.  When the remaining visual field is 6 to 16 degrees unilaterally or bilaterally, 20 percent and 70 percent disability ratings are assigned respectively, or each affected eye may be evaluated as 20/200.  Id.  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 the former criteria, Diagnostic Code 6027 (Cataract) instructed to evaluate preoperative cataracts and postoperative cataracts where a replacement lens is present (pseudophakia) based on visual impairment, while postoperative cataracts without a replacement lens were to be evaluated under Diagnostic Code 6029, aphakia.  Under the revised criteria, Diagnostic Code 6027 instructs to evaluate preoperative cataracts and postoperative cataracts where a replacement lens is present under the General Rating Formula for Diseases of the Eye, while postoperative cataracts without a replacement lens are to be evaluated under Diagnostic Code 6029. The General Rating Formula for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to a particular condition or incapacitating episodes, whichever results in a higher evaluation. Under the amended regulations, 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.  38 C.F.R. § 4.79. Rating period prior to June 23, 2014 Turing first to the period on appeal prior to June 23, 2014, based on a review of the relevant evidence, the Board finds that a compensable initial rating for bilateral diabetic retinopathy with bilateral cataracts is not warranted. There were no VA examinations conducted during this appeal period. Further, post-service VA treatment records for the period on appeal are silent for evidence of visual acuity of at least 20/50 in one eye and 20/50 in the other eye, nor does the evidence reflect a visual field defect or impairment of muscle function, to include diplopia. Here, the medical evidence of records reflects corrected distance vision of, at worst, 20/25 in the Veteran’s right eye and 20/25 in her left eye. Therefore, the currently assigned noncompensable initial rating is appropriate for bilateral diabetic retinopathy with bilateral cataracts prior to June 23, 2014, and the Veteran is not entitled to a higher rating.  The Board has also considered whether a higher rating is warranted under Diagnostic Code 6027 for the Veteran’s bilateral cataracts. As the rating period on appeal prior to June 23, 2014 predates May 13, 2018, when the amended regulations went into effect, only the former criteria under Diagnostic Code 6027 are for consideration. As the Veteran’s right eye and left eye cataracts during the period on appeal were both preoperative, Diagnostic Code 6027 instructs to evaluate the Veteran’s bilateral cataracts based on visual impairment. Here, as the medical evidence of record fails to show visual acuity of at least 20/50 in one eye and 20/50 in the other eye, a visual field defect, or impairment of muscle function, to include diplopia, a higher rating under Diagnostic Code 6027 is not warranted. Thus, the Veteran’s claim for a compensable initial rating for bilateral diabetic retinopathy with bilateral cataracts prior to June 23, 2014 is denied. Rating period from June 23, 2014 to June 24, 2015 Turning next to the period on appeal from June 23, 2014 to June 24, 2015, based on a review of the relevant evidence, the Board finds that a rating in excess of 60 percent for bilateral diabetic retinopathy with bilateral cataracts is not warranted. Specifically, the medical evidence of record, to include the November 2014 VA examination and post-service VA treatment records, reflects corrected distance measuring no more than 20/40 in the right eye and 20/20 in the left eye.  Further, the medical evidence of record is silent for evidence of visual acuity of at least 20/50 in one eye and 20/50 in the other eye.  When applying visual acuity of 20/40 for the right eye and 20/20 for the left eye, under Diagnostic Code 6066, a noncompensable rating is warranted for visual acuity.   Additionally, the November 2014 VA examiner indicated the presence of bilateral visual field defects.  Goldmann perimetry as to the Veteran’s right eye showed the remaining visual fields were, in degrees: 48 temporally, 52 down temporally, 15 down, 32 down nasally, 27 nasally, 25 up nasally, 15 up, and 28 up temporally. Adding the remaining visual field at each principal meridian results in a total remaining visual field of 242. Dividing 242 by 8 and rounding to the nearest whole number, results in an average concentric contraction of 30 degrees of the visual field for the right eye. Goldmann perimetry testing as to the Veteran’s left eye showed the remaining visual fields were in degrees:  18 temporally, 0 down temporally, 8 down, 36 down nasally, 0 nasally, 0 up nasally, 0 up, and 0 up temporally.  Adding the remaining visual field at each principal meridian results in a total remaining visual field of 62 degrees.  Dividing 62 by 8 and rounding to the nearest whole number, results in an average concentric contraction of 8 degrees of the visual field for the left eye.   The Veteran’s visual field defect may be evaluated based on either remaining visual field degrees or based on visual acuity assigned for remaining visual field degrees, whichever results in the higher rating.  As the Veteran’s remaining visual field during the period on appeal was, at worst, 30 degrees, in her right eye and 8 degrees in her left eye, a 10 percent rating is warranted for right eye visual field defect with remaining visual field between 16 and 30 degrees, and a 20 percent rating is warranted for left eye visual field defect with remaining visual field between 6 and 15 degrees. However, remaining visual field criteria also instructs to evaluate the Veteran’s right eye as 20/100, as her average remaining visual field is 30 degrees in her right eye (when remaining visual field is 16 to 30 degrees, each affected eye is evaluated as 20/100), and her left eye as 20/200, as her average remaining visual field is 8 degrees in her left eye (when remaining visual field is 6 to 15 degrees, each affected eye is evaluated as 20/200). When applying visual acuity of 20/100 for the right eye and 20/200 for the left eye to determine visual field defect, a 60 percent rating would be warranted.  Thus, taking the higher of the two evaluations (30 percent based on unilateral ratings for remaining visual field of 30 degrees for the right eye and remaining visual field of 8 degrees for the left eye, or 60 percent based on applying visual acuity of 20/100 for the right eye and 20/200 for the left eye), here, evaluating the Veteran’s visual field defect based on visual acuity of 20/100 for the right eye and 20/200 for the left eye yields a higher and more favorable rating of 60 percent.    To the determine the evaluation for visual impairment when both decreased visual acuity and visual field defect are present, VA separately evaluates the visual acuity and visual field defect (expressed as a level of visual acuity) and combines them under the provisions of 38 C.F.R. § 4.25.  Thus, when combining the Veteran’s noncompensable rating for her visual acuity impairment with her 60 percent rating for her visual field defect, a 60 percent rating is achieved.  Therefore, the currently assigned 60 percent rating for the period on appeal from June 23, 2014 to June 24, 2015 is appropriate, and the Veteran is not entitled to a higher rating.  The Board has also considered whether a higher rating is warranted under Diagnostic Code 6027 for the Veteran’s bilateral cataracts. As the rating period on appeal from June 23, 2014 to June 24, 2015 predates May 13, 2018, when the amended regulations went into effect, only the former criteria under Diagnostic Code 6027 are for consideration. As the Veteran’s right eye and left eye cataracts during the period on appeal were both preoperative, Diagnostic Code 6027 instructs to evaluate the Veteran’s bilateral cataracts based on visual impairment. Here, as a 60 percent rating is already established based on bilateral visual acuity and visual field defect, a higher rating under Diagnostic Code 6027 is not warranted. Thus, the Veteran’s claim for a rating in excess of 60 percent for bilateral diabetic retinopathy with bilateral cataracts from June 23, 2014 to June 24, 2015 is denied. Rating period from June 25, 2015 Lastly, turning to the period on appeal from June 25, 2015, based on a review of the relevant evidence, the Board finds that a rating in excess of 70 percent for bilateral diabetic retinopathy with bilateral cataracts is not warranted. Specifically, the October 2015 VA examination reflects corrected distance measuring 20/40 in the right eye and 5/200 in the left eye. The May 2016 VA examination reflects corrected distance measuring 20/40 in the right eye and 5/200 in the left eye. The January 2020 VA examination reflects corrected distance measuring 20/70 in the right eye and 20/200 in the left eye. Post-service VA treatment records for the period on appeal reflect corrected distance measuring no higher than 20/50 in the right eye and 20/200 in the left eye, with the majority of corrected distance readings measuring 20/40 in the right eye and 20/100 in the left eye. When applying visual acuity of 20/40 for the right eye and 20/100 for the left eye, as reflected in the post-service VA treatment records for the period on appeal, under Diagnostic Code 6066, a 10 percent rating would be warranted for visual acuity. When applying visual acuity of 20/40 for the right eye and 5/200 for the left eye, obtained during the October 2015 VA examination, under Diagnostic Code 6065, a 30 percent rating would be warranted for visual acuity. When applying visual acuity of 20/40 for the right eye and 5/200 for the left eye, obtained during the May 2016 VA examination, under Diagnostic Code 6065, a 30 percent rating would be warranted for visual acuity. When applying visual acuity of 20/70 for the right eye and 20/200 for the left eye, obtained during the January 2020 VA examination, under Diagnostic Code 6066, a 40 percent rating would be warranted for visual acuity. While post-service VA treatment records for the period on appeal are silent for evidence of visual field testing, and the Veteran did not keep her appointment for a visual field test corresponding to her October 2015 VA examination, the May 2016 and January 2020 VA examiners indicated the presence of bilateral visual field defects.  Regarding the May 2016 VA examination, Goldmann perimetry as to the Veteran’s right eye showed the remaining visual fields were, in degrees: 28 temporally, 29 down temporally, 10 down, 17 down nasally, 19 nasally, 14 up nasally, 12 up, and 26 up temporally. Adding the remaining visual field at each principal meridian results in a total remaining visual field of 115. Dividing 115 by 8 and rounding to the nearest whole number, results in an average concentric contraction of 19 degrees of the visual field for the right eye. Goldmann perimetry testing as to the Veteran’s left eye showed the remaining visual fields were in degrees:  75 temporally, 0 down temporally, 0 down, 0 down nasally, 0 nasally, 0 up nasally, 0 up, and 0 up temporally.  Adding the remaining visual field at each principal meridian results in a total remaining visual field of 75 degrees. Dividing 75 by 8 and rounding to the nearest whole number, results in an average concentric contraction of 9 degrees of the visual field for the left eye.   For the January 2020 VA examination, Goldmann perimetry as to the Veteran’s right eye showed the remaining visual fields were, in degrees: 52 temporally, 70 down temporally, 60 down, 50 down nasally, 55 nasally, 42 up nasally, 35 up, and 55 up temporally. Adding the remaining visual field at each principal meridian results in a total remaining visual field of 419. Dividing 419 by 8 and rounding to the nearest whole number, results in an average concentric contraction of 52 degrees of the visual field for the right eye. Goldmann perimetry testing as to the Veteran’s left eye showed the remaining visual fields were in degrees:  72 temporally, 68 down temporally, 60 down, 50 down nasally, 51 nasally, 50 up nasally, 34 up, and 52 up temporally.  Adding the remaining visual field at each principal meridian results in a total remaining visual field of 437 degrees.  Dividing 437 by 8 and rounding to the nearest whole number, results in an average concentric contraction of 55 degrees of the visual field for the left eye. The Veteran’s visual field defect may be evaluated based on either remaining visual field degrees or based on visual acuity assigned for remaining visual field degrees, whichever results in the higher rating.  As the Veteran’s remaining visual field during the period on appeal was, at worst, 19 degrees, in her right eye and 8 degrees in her left eye, a 10 percent rating is warranted for right eye visual field defect with remaining visual field between 16 and 30 degrees, and a 20 percent rating is warranted for left eye visual field defect with remaining visual field between 6 and 15 degrees. However, remaining visual field criteria also instructs to evaluate the Veteran’s right eye as 20/100, as her average remaining visual field is 19 degrees in her right eye (when remaining visual field is 16 to 30 degrees, each affected eye is evaluated as 20/100), and her left eye as 20/200, as her average remaining visual field is 8 degrees in her left eye (when remaining visual field is 6 to 15 degrees, each affected eye is evaluated as 20/200). When applying visual acuity of 20/100 for the right eye and 20/200 for the left eye to determine visual field defect, a 60 percent rating would be warranted.  Thus, taking the higher of the two evaluations (30 percent based on unilateral ratings for remaining visual field of 19 degrees for the right eye and remaining visual field of 8 degrees for the left eye, or 60 percent based on applying visual acuity of 20/100 for the right eye and 20/200 for the left eye), here, evaluating the Veteran’s visual field defect based on visual acuity of 20/100 for the right eye and 20/200 for the left eye yields a higher and more favorable rating of 60 percent.    To the determine the evaluation for visual impairment when both decreased visual acuity and visual field defect are present, VA separately evaluates the visual acuity and visual field defect (expressed as a level of visual acuity) and combines them under the provisions of 38 C.F.R. § 4.25.  Thus, when combining the Veteran’s corresponding visual acuity impairment of 30 percent from her May 2016 VA examination with her 60 percent rating for her visual field defect, a 70 percent rating is achieved.  Therefore, the currently assigned 70 percent rating for the period on appeal from June 23, 2014 to June 24, 2015 is appropriate, and the Veteran is not entitled to a higher rating.  The Board notes that the January 2020 VA examination shows visual acuity of 20/70 for the right eye and 20/200 for the left eye which would warrant a 40 percent rating. However, corresponding visual field defects noted during this examination shows an average concentric contraction of 52 degrees of the visual field for the right eye and 55 degrees of the visual field for the left eye, which would warrant a 10 percent rating for bilateral visual field defect with remaining visual fields between 46 to 60 degrees. Further, while remaining visual field criteria also instructs to evaluate the Veteran’s right eye as 20/50 and her left eye as 20/50, as her average remaining visual fields are 52 degrees in her right eye and 55 degrees in her left eye (when remaining visual field is 46 to 60 degrees, each affected eye is evaluated as 20/50), when applying visual acuity of 20/50 for the right eye and 20/50 for the left eye to determine visual field defect, a 10 percent rating would be warranted. Thus, a 10 percent rating would be warranted for visual field defect in either situation (10 percent based on bilateral rating for remaining visual field of 52 degrees for the right eye and remaining visual field of 55 degrees for the left eye, or 10 percent based on applying visual acuity of 20/50 for the right eye and 20/50 for the left eye). When combining the Veteran’s corresponding visual acuity impairment of 40 percent from her January 2020 VA examination with her 10 percent rating for her visual field defect, a 50 percent rating is achieved. While the medical evidence of record demonstrates significant improvement in the Veteran’s bilateral visual fields during the January 2020 VA examination, the Board will not disturb the 70 percent disability rating currently assigned based upon the visual acuity and visual field defects found during the May 2016 VA examination. The Board has also considered whether a higher rating is warranted under Diagnostic Code 6027 for the Veteran’s bilateral cataracts. As the amended regulations went into effect during the rating period on appeal from June 25, 2015 to the present, both the former and revised criteria under Diagnostic Code 6027 are for consideration. During this period on appeal, the Veteran’s right eye cataract was preoperative, and her left eye cataract were postoperative with a replacement lens present. Here, under the former criteria, a 70 percent rating is already established based on bilateral visual acuity and visual field defect. Therefore, a higher rating under the former criteria for Diagnostic Code 6027 is not warranted. Moreover, under the revised criteria, while there is evidence of incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months, which warrants a 20 percent rating, the General Rating Formula for Diseases of the Eye 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. Here, evaluation on the basis of visual impairment (visual acuity and visual field defect) results in the higher and more favorable rating of 70 percent. Therefore, a higher rating under the revised criteria for Diagnostic Code 6027 is not warranted. As such, the Veteran’s claim for a rating in excess of 70 percent for bilateral diabetic retinopathy with bilateral cataracts from June 25, 2015 is denied.  In sum, as the Board finds that the preponderance of the evidence is against the Veteran’s claims for a compensable initial rating for bilateral diabetic retinopathy with bilateral cataracts prior to June 23, 2014; a rating in excess of 60 percent for bilateral diabetic retinopathy with bilateral cataracts from June 23, 2014 to June 24, 2015; and a rating in excess of 70 percent for bilateral diabetic retinopathy with bilateral cataracts from June 25, 2015, the claims must be denied.  In denying such ratings, the Board finds the benefit of the doubt doctrine is not applicable.  38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7.  TDIU It is the established policy of VA that all Veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated as totally disabled. 38 C.F.R. § 4.16 (2019). Substantially gainful employment is employment that is ordinarily followed by the nondisabled to earn their livelihoods with earnings common to the particular occupation in the community where the veteran resides. Moore v. Derwinski, 1 Vet. App. 356 (1991). Marginal employment will not be considered substantially gainful employment. 38 C.F.R. § 4.16(a) (2019). The Board must evaluate whether there are circumstances in the Veteran’s case, apart from any non-service-connected condition and advancing age, which would justify a total rating based on individual unemployability due solely to the service-connected conditions. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993); see also Blackburn v. Brown, 5 Vet. App. 375 (1993). The regulations provide that if there is only one such disability, it must be rated at 60 percent or more; and if there are two or more disabilities, at least one disability must be rated at 40 percent or more, and sufficient additional disability must bring the combined rating to 70 percent or more. Disabilities resulting from common etiology or a single accident or disabilities affecting a single body system will be considered as one disability for the above purposes of one 60 percent disability or one 40 percent disability. 38 C.F.R. § 4.16(a) (2019). Entitlement to a TDIU due to a single service-connected disability The Veteran contends that her service-connected bilateral diabetic retinopathy with bilateral cataracts precludes her from securing and following a substantially gainful occupation consistent with her education and work experience. At the time the Veteran filed a claim of entitlement to a TDIU, in August 2016, she was in receipt of a 60 percent rating for bilateral diabetic retinopathy with bilateral cataracts, effective June 23, 2014, under Diagnostic Code 6006-6066, and she had a combined schedular rating of 100 percent from February 26, 2014. The United States Court of Appeals for Veterans Claims (CAVC) has recognized that a 100 percent rating under the Schedule for Rating Disabilities means that a Veteran is totally disabled. Holland v. Brown, 6 Vet. App. 443, 446 (1994), citing Swan v. Derwinski, 1 Vet. App. 20, 22 (1990). Thus, if VA has found a veteran to be totally disabled as a result of a particular service-connected disability or combination of disabilities pursuant to the rating schedule, there is no need, and no authority, to otherwise rate that veteran totally disabled on any other basis. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (finding a request for a TDIU moot where 100 percent scheduler rating was awarded for the same period). However, the receipt of a 100 percent schedular rating for a service-connected disability does not necessarily render moot any pending claim for a TDIU. See Bradley v. Peake, 22 Vet. App. 280, 291-92 (2008). Although no additional disability compensation may be paid when a total schedular disability rating is already in effect, Bradley recognizes that a separate award of a TDIU predicated on a single disability may form the basis for an award of special monthly compensation under 38 U.S.C. § 1114(s). Id. A TDIU rating based upon multiple disabilities does not meet the requirement of a single disability requirement of 38 U.S.C. § 1114(s). See Buie v. Shinseki, 24 Vet. App. 242 (2010). Thus, it might benefit the Veteran to retain the TDIU rating, even where a 100 percent schedular rating has also been granted. See also Buie v. Shinseki, 24 Vet. App. 242, 248 (2010). Here, the Veteran meets the criteria for schedular consideration of a TDIU based on her bilateral diabetic retinopathy with bilateral cataracts beginning on June 23, 2014.  38 C.F.R. § 4.16(a). The relevant evidence of record reflects that the Veteran completed three years of college. The majority of her employment from separation from service until 2010 was administrative in nature, to include working on computers. During her November 2014 VA examination, the Veteran’s left eye could not be tested for visual acuity, as the eye had a vitreous haze due to high blood pressure from uncontrolled diabetes. Corrected distance in the right eye was 20/40. Visual field testing revealed bilateral concentric contraction of visual fields with remaining visual fields of 30 degrees in the Veteran’s right eye and 8 degrees in her left eye. The examiner opined that the Veteran’s bilateral eye disability affected her ability to work, noting that nothing could be promised as to whether the blood in her left eye would clear up to allow her vision to improve. The examiner did not offer an opinion as to which types of jobs, if any, the Veteran would be able to perform. During the October 2015 VA examination, the Veteran’s corrected distance in her right eye was 20/40 and her left eye was 5/200. The examiner opined that the Veteran’s bilateral eye disability impacted her ability to work, stating that her right eye was extremely nearsighted, while her left eye had a macular scar and myopia. The examiner did not opine as to which types of jobs, if any, the Veteran would be able to perform. The Veteran’s May 2016 VA examination reflected corrected distance visual acuity of 20/40 in the right eye and 5/200 in the left eye. The examiner opined that the Veteran’s bilateral eye disability impacted her ability to work, indicating that the Veteran stated that she is unable to focus due to loss of vision in her left eye, which limits her ability to seek out work because using only her right eye causes a strain on the eye. The Veteran stated that using only her right eye makes working in customer service and computer work difficult. A November 2016 opinion was obtained by VA to address the impact of the Veteran’s bilateral eye disability on her ability to obtain and maintain substantially gainful employment. The examiner opined that, given Veteran’s poor vision in her left eye, she would have more difficulty with depth perception and may have trouble with employment that requires three-dimension visualization or the need to see well with both eyes. The examiner indicated that a job as a pilot, truck driver, artist, or surgeon would be difficult for the Veteran, but given the Veteran’s employment history working with a computer and telephone for customer service tasks, she would not be precluded from working a desk job, as she could increase the font size on the computer, use good lighting, and take 1-2 minute eye breaks when needed. The January 2020 VA examination reflected corrected distance visual acuity of 20/70 in the right eye and 20/200 in the left eye. Visual field testing performed revealed bilateral concentric contraction of visual fields with remaining visual fields of 52 degrees in the Veteran’s right eye and 55 degrees in her left eye. The examiner opined that the Veteran’s bilateral eye disability impacted her ability to work, stating that she would have difficulty driving and performing visual tasks. The examiner did not offer an opinion as to which types of jobs, if any, the Veteran would be able to perform. Upon review of the relevant evidence of record, the Board finds that entitlement to a TDIU due to a single-service connected disability, the Veteran’s bilateral eye disability, is warranted. Significantly, the Board finds the November 2016 and January 2020 VA medical opinions to be the most probative evidence of record. Upon examination of the Veteran and review of her claims file, along with consideration given to the Veteran’s educational and employment background, both examiners opined that the Veteran’s bilateral eye disability impacts her ability to work. Specifically, the November 2016 VA examiner indicated that the Veteran’s bilateral eye disability would cause difficulty with employment involving depth perception or three-dimension visualization. The January 2020 VA examiner indicated that the Veteran’s bilateral eye disability caused difficulty driving and performing visual tasks. Here, the relevant evidence shows that the Veteran would face great difficulty working in an office setting, as driving with her bilateral eye disability is very difficult since she cannot see well out of her left eye, and that performing visual tasks, such as typing on a computer, would also be difficult since her bilateral eye disability affects her ability to visually focus on objects. Although the 2015, 2016, and 2020 VA examiners did not opine as to whether the Veteran could sustain and maintain gainful employment working from home, the Board is unaware of any jobs that the Veteran would be able to perform from home given the severity of her bilateral eye disability, as well as her employment history in customer service working with computers, which could easily put strain on the Veteran’s right eye, which is very nearsighted, since her left eye is extremely visually impaired. In light of the Veteran’s occupational background and the functional limitations described, the Board finds that the Veteran is unable to obtain and maintain substantially gainful employment in accordance with her background and education level as a result of her service-connected bilateral diabetic retinopathy with bilateral cataracts. As the Veteran’s bilateral eye disability met the schedular requirements for a TDIU effective June 23, 2014, entitlement to a TDIU due to a single service-connected disability, the Veteran’s bilateral diabetic retinopathy with bilateral cataracts, is warranted from June 23, 2014. SMC The Board notes that VA has a duty to maximize benefits and policy, and to consider entitlement to SMC where applicable. See Akles v. Derwinski, 1 Vet. App. 118, 121 (1991); AB v. Brown, 6 Vet. App. 35 at 38; Bradley v. Peake, 22 Vet. App. 280 (2008); see also 38 C.F.R.§ 3.103(a) (noting VA’s obligation to “render a decision which grants every benefit that can be supported in law”). Therefore, in light of the instant Board decision awarding a schedular TDIU rating based on the Veteran’s service-connected bilateral diabetic retinopathy with bilateral cataracts, effective June 23, 2014, the Board will properly take jurisdiction of the derivative issue of entitlement to SMC under 38 U.S.C. § 1114(s) and 38 C.F.R. § 3.350(i)(1) for the period beginning on June 23, 2014. The issue of entitlement to SMC for loss of use or blindness of one eye under 38 U.S.C. § 1114(k) and 38 C.F.R. § 3.350(a)(4) is also for review and consideration, as the Veteran has directly raised this issue during the period on appeal. Loss of use or blindness of one eye - 1114(k) and 38 C.F.R. § 3.350(a)(4) Under 38 U.S.C. § 1114(k) and 38 C.F.R. § 3.350(a)(4), SMC is payable if a Veteran has loss of use or blindness of one eye, having only light perception, which will be held to exist when there is inability to recognize test letters at 1 foot and when further examination of the eye reveals that perception of objects, hand movements, or counting fingers cannot be accomplished at 3 feet. Lesser extents of vision, particularly perception of objects, hand movements, or counting fingers at distances less than 3 feet is considered of negligible utility. Upon review of the relevant evidence of record, the Board finds that SMC based on loss of use or blindness of one eye is not warranted. Specifically, the November 2014, October 2015, May 2016, and January 2020 VA examinations and post-service VA treatment records do not reflect that the Veteran’s vision is limited to no more than light perception only in either eye. Throughout the Veteran’s VA examinations, she was able to recognize test letters at 1 foot, as well as be able to perceive objects, hand movements, or counting fingers at 3 feet. As the medical evidence of record does not reflect loss of use or blindness of one eye, SMC under 38 U.S.C. § 1114(k) and 38 C.F.R. § 3.350(a)(4) is not warranted. Total plus 60 percent - 38 U.S.C. § 1114(s) and 38 C.F.R. § 3.350(i)(1) Under 38 U.S.C. § 1114(s) and 38 C.F.R. § 3.350(i)(1), SMC is payable if the Veteran has a single service-connected disability rated as 100 percent disabling, and she has additional service-connected disability or disabilities independently ratable at 60 percent or more, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems. Upon review of the relevant evidence of record, the Board finds that SMC under 38 U.S.C. § 1114(s) and 38 C.F.R. § 3.350(i)(1) is warranted. Here, the instant Board decision is granting a schedular TDIU rating (i.e., a total rating equivalent to 100 percent for SMC purposes) based on the Veteran’s service-connected bilateral diabetic retinopathy with bilateral cataracts, effective June 23, 2014. Further, for this same period, the Veteran’s additional service-connected disabilities are independently ratable at 60 percent, in accordance with the Combined Ratings Table under 38 C.F.R. § 4.25 based on the following levels of severity: major depressive disorder (rated 70 percent); diabetic nephropathy (rated 30 percent); exercise induced asthma (rated 30 percent); headaches (rated 30 percent); diabetes mellitus type 2 (rated 20 percent); lumbar spine disability (rated 10 percent); right foot disability (rated 10 percent); left foot disability (rated 10 percent); right lower extremity peripheral neuropathy (rated 10 percent); and left lower extremity peripheral neuropathy (rated 10 percent). Therefore, the Board finds that entitlement to SMC under 38 U.S.C. § 1114(s) and 38 C.F.R. § 3.350(i) is warranted from June 23, 2014. 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.