Citation Nr: 21011738 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 16-35 245A DATE: March 2, 2021 ORDER Entitlement to 10 percent rating, but no higher, for service-connected traumatic brain injury (TBI) is granted from July 24, 2008. Entitlement to a rating in excess of 10 percent for service-connected TBI from March 19, 2012 to September 20, 2016 is denied. Entitlement to a 40 percent rating, but no higher, for service-connected TBI is granted from September 21, 2016 to November 25, 2019. A rating in excess of 10 percent for service-connected TBI from November 25, 2019 is denied. Entitlement to an initial compensable rating for service-connected paresthesia of the left face is denied. Entitlement to a rating in excess of 10 percent for service-connected paresthesia of the left face from September 21, 2016 is denied. Entitlement to an initial compensable rating for bilateral vision loss is denied. Entitlement to a rating in excess of 70 percent for service-connected bilateral, severe visual field constriction from December 10, 2019 is denied. REMANDED Entitlement to a rating in excess of 10 percent for service-connected residuals, right ankle fracture is remanded. Entitlement to a rating in excess of 10 percent for service-connected residuals, left ankle sprain is remanded. Entitlement to an increased rating for service-connected residuals, nasal bone fracture is remanded. FINDINGS OF FACT 1. Prior to October 23, 2008, the evidence reflects that the Veteran’s post-concussive syndrome was manifested by subjective reports of tension headaches; the evidence did not show he experienced characteristic prostrating attacks once a month for several months; nor was there evidence of multi-infarct dementia associated with the Veteran’s post-concussive syndrome. 2. From March 19, 2012, the Veteran’s TBI was manifest by subjective complaints of memory loss without objective evidence of any level of memory impairment on testing. 3. From September 21, 2016 to November 25, 2019, the Veteran’s TBI was manifest by objective evidence on testing of mild memory loss, attention, concentration and executive functions with a mild functional impairment; there were also subjective complaints of sensitivity to light and sound that mildly interfered his with work, instrumental activities of daily living, or family or close relationships. 4. From November 25, 2019, the Veteran’s TBI was manifest by subjective complaints of memory loss without objective evidence of any level of memory impairment on testing and a mild impairment in visual spatial orientation; there were also three or more subjective symptoms that mildly interfered with work, instrumental activities of daily living, or family or close relationships; and one or more neurobehavioral effects that occasionally interfered with workplace interaction, social interaction or both but did not preclude them. 5. Prior to September 21, 2016, the Veteran’s paresthesia of the left face was manifest by no more than a mild, occasional sensory impairment in the left mid face. 6. From September 21, 2016, the Veteran’s paresthesia of the left face was manifest by no more than a moderate sensory impairment in the left mid and upper face and subjective reports of mild motor impairment of the muscles impacted by cranial nerve five. 7. Prior to December 10, 2019, the Veteran’s bilateral visual impairment was manifest by visual acuity with best corrected vision no worse than 20/30-1 in the right eye and 20/40 in the left eye without evidence of incapacitating episodes due to the eye impairment or visual field defect. 8. From December 10, 2019, the Veteran’s bilateral visual impairment was manifest by severe visual field constriction with remaining field of 10.625 degrees in the left eye and 11.875 in the right eye; his visual acuity with best corrected distance vision was 20/20 bilaterally and there was no evidence of incapacitating episodes. CONCLUSIONS OF LAW 1. The criteria for a 10 percent rating, but no higher, for service-connected TBI/post-concussive syndrome have been met, effective July 24, 2008. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Codes (DC) 8045, 9304 (2008). 2. The criteria for a rating in excess of 10 percent for service-connected TBI have not been met from March 19, 2012 to September 20, 2016. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, DC 8045, 9304 (2008); DC 8045 (2020). 3. The criteria for a 40 percent rating, but no higher, for service-connected TBI have been met, effective September 21, 2016 to November 25, 2019. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, DC 8045. 4. The criteria for a rating in excess of 10 percent for service-connected TBI have not been met from November 25, 2019. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, DC 8045 (2020). 5. The criteria for a compensable rating for service-connected paresthesia of the left face have not been met prior to September 21, 2016. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, DC 8205 (2020). 6. The criteria for a rating in excess of 10 percent for service-connected paresthesia of the left face have not been met from September 21, 2016. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, DC 8520 (2020). 7. The criteria for an initial compensable rating for service-connected bilateral vision loss have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.79, DC 6066. 8. The criteria for a rating in excess of 70 percent for service-connected bilateral, severe visual field constriction have not been met from December 10, 2019. 38 U.S.C. § 1155; 38 C.F.R. § 4.79, DCs 6066, 6080. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1983 to November 1992. He testified before the undersigned Veterans Law Judge via video conference in February 2019. A transcript of the hearing is associated with the claims file. In August 2020, the Board remanded the claims on appeal for further evidentiary development. The appeal has returned to the Board for consideration. Increased Rating 1. Entitlement to an increased rating for service-connected traumatic brain injury (TBI) This appeal arises from an August 2013 rating decision that awarded an increased, 10 percent rating for TBI/post-concussive syndrome with visual impairment under DC 8045, effective March 19, 2012, the date of receipt of the Veteran’s increased rating claim for that disability. The Board notes, however, that, in July 2008, the Veteran filed a claim seeking an increased rating for several disabilities, including post-concussive syndrome which, at that time, was rated noncompensable (zero percent) under DC 8045. See March 1993 rating decision. In a January 2009 rating decision, a Department of Veterans Affairs (VA) Regional Office (RO) continued the noncompensable rating assigned for service-connected post-concussive syndrome. The Veteran subsequently submitted a written statement titled “notice of disagreement” wherein he stated that he was appealing the decision made with respect to the zero percent rating assigned for post-concussive syndrome. Notably, the statement is date-stamped as received by the RO in Waco, Texas on January 22, 2009 See Janaury 2009 Veteran statement. Because the Veteran’s statement expressed disagreement with the RO’s determination as to the rating assigned for post-concussive syndrome, was in writing, received within one year of the previous rating decision, and expressed a desire to “appeal” the decision, the Board finds the January 2009 constitutes a notice of disagreement (NOD) with respect to the rating assigned for post-concussive syndrome in the January 2009 rating decision. See 38 C.F.R. § 20.201. However, the record reveals that the RO did not provide the Veteran with a Statement of the Case (SOC) addressing the post-concussive syndrome claim and no further action was taken on that claim. Instead, in March 2012, the Veteran submitted a claim seeking an increased rating for residuals of post-concussive syndrome, from which the current appeal stems. Because an appeal regarding the rating assigned for post-concussive syndrome was initiated following the January 2009 rating decision, the Board finds the Veteran’s July 2008 increased rating claim for post-concussive syndrome has remained pending since that time. As such, the Board will consider whether an increased rating is warranted for post-concussive syndrome, now characterized as TBI, since July 24, 2008. As noted, in the August 2013 rating decision, the RO re-characterized the Veteran’s disability as TBI/post-concussive syndrome with visual impairment and assigned an increased 10 percent rating, effective March 19, 2012. The Veteran subsequently perfected an appeal as to the increased rating claim and, during the pendency of the appeal, the RO separated the residual visual impairment from the TBI disability and assigned separate ratings for each. An increased 40 percent rating was assigned for TBI from November 25, 2019, and a 70 percent rating was assigned for severe visual field constriction (which was noted to be previously rated noncompensable as bilateral vision loss). See August 2020 rating decision. Therefore, the Board will consider whether service-connected TBI warrants a compensable rating is from July 24, 2008 to March 19, 2012; a rating in excess of 10 percent from March 19, 2012 to November 25, 2019; a rating in excess of 40 percent from November 25, 2019 to the present. The proper rating for the Veteran’s bilateral visual impairment will also be discussed in this decision. The regulations for traumatic brain injuries (TBI) were revised, effective October 23, 2008. See 73 Fed. Reg. 54,693 (Sept. 23, 2008). Prior to October 2008, DC 8045 directed that TBI disorders were to be rated under DC 9304, as Brain Disease Due to Trauma. See 38 C.F.R. § 4.124a, DC 8045 (2008). Under 9304, purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, were rated 10 percent and no more under DC 9304. This 10 percent rating was not to be combined with any other rating for a disability due to brain trauma. Ratings in excess of 10 percent for brain disease due to trauma under DC 9304 were not assignable in the absence of a diagnosis of multi-infarct dementia associated with brain trauma. 38 C.F.R. § 4.124a. Effective October 23, 2008, DC 8045 states that there are three main areas of dysfunction that may result from TBIs and have profound effects on functioning: cognitive (which is common in varying degrees after a TBI), emotional/behavioral, and physical, including neurological. Each of these areas of dysfunction are defined and described in detail in the Rating Schedule and may require evaluation. 38 C.F.R. § 4.124a, DC 8045. The table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” contains 10 important facets of a TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, and labeled “total.” However, not every facet has every level of severity. Disability ratings are assigned based on the level of impairment for each facet. That is, based on the levels assigned, the Board determines which facet allows for the highest disability rating under DC 8045, which states that impairment 0 warrants a 0 (noncompensable) rating, impairment 1 warrants a 10 percent rating, impairment 2 warrants a 40 percent rating, and impairment 3 (which is the highest level of evaluation for any facet) warrants a 70 percent rating. Distinct, comorbid diagnoses, including any conditions service-connected secondary to the TBI, are evaluated under the appropriate diagnostic codes. If the symptoms associated with the distinct comorbid diagnoses do not overlap with those used to assign the highest disability rating under DC 8045, a separate rating will be assigned under the applicable diagnostic code. If, however, the symptoms associated with the distinct comorbid diagnoses do overlap with those used to assign the highest disability rating under DC 8045, the Board must determine which diagnostic code allows for the highest rating for the overall level of impaired functioning due to both conditions. See 38 C.F.R. § 4.124a, DC 8045, Note (1). Turning to the merits of this claim, the Board again notes that the claim has been pending since July 24, 2008. The record reflects that the Veteran was afforded a VA brain examination in November 2008 wherein he reported having headaches has a symptom of his post-concussive syndrome. The Veteran endorsed having flare-ups of his headaches that occurred two times a week that were manifested by moderate pain and were made better by taking Tylenol 3. The Veteran denied having any other symptoms or impairment related to his post-concussive syndrome at that time, including seizures, dizziness, psychiatric manifestations, joint involvement, or impairments of the motor, sensory, peripheral, or autonomic systems. The examiner also noted that fundoscopic examination of his eyes was normal at that time. The examiner rendered a diagnosis of tension headaches, status post-concussion and opined that the Veteran’s headaches had a moderate effect on his usual occupation and daily activities. See November 2008 VA examination. At this juncture, the Board notes that, while the foregoing evidence was generated after the criteria for evaluating TBI were amended in October 2008, the revisions apply only to applications for benefits received by VA on or after October 23, 2008. Therefore, while the increased rating claim remained pending since July 2008, the Board is unable to apply the amended criteria to this evidence because the pending claim was filed prior to October 2008. The Board notes that a Veteran whose residuals of TBI were rated by VA under a prior version of DC 8045 was permitted to request review under the amended criteria. Therefore, the Board finds that the increased rating claim received in March 2012 was liberally construed as a request to review the Veteran’s service-connected TBI/post-concussive syndrome under the amended criteria. In fact, the RO considered the Veteran’s disability under the amended criteria in the August 2013 rating decision. Therefore, the Board will consider the Veteran’s TBI/post-concussive syndrome disability under the amended criteria from March 19, 2012 and no earlier, as that is the date of receipt of his request to review the disability under the amended criteria. In applying the findings of the November 2008 VA examination to the pre-2008 criteria of DC 8045, the Board finds that a 10 percent rating is warranted based on the Veteran’s subjective reports of tension headaches, which were deemed a residual of his in-service concussion. As noted, prior to October 2008, DC 8045/9304 provided for a 10 percent rating for purely subjective complaints, such as headache, that were recognized as symptomatic of brain trauma. Therefore, a 10 percent rating is warranted from July 24, 2008, the date of receipt of the Veteran’s increased rating claim. However, a rating in excess of 10 percent is not warranted from July 2008 under the criteria of DC 8045 or any other potentially applicable diagnostic code. As noted, under the pre-2008 criteria of DC 8045, ratings in excess of 10 percent for brain disease due to trauma were not assignable in the absence of a diagnosis of multi-infarct dementia associated with brain trauma. There is no evidence multi-infarct dementia associated with the Veteran’s TBI/post-concussive syndrome at any time during the appeal period, including as early as July 2008 or during the one-year look back period prior to the July 2008 claim. Therefore, a rating in excess of 10 percent is not warranted under the pre-2008 criteria of DC 8045. Accordingly, the Board finds that a 10 percent rating, but no higher, for TBI/post-concussive syndrome is warranted from July 24, 2008 under 38 C.F.R. § 4.124a, DC 8045 (2008). The evidence of record does not show symptoms of the Veteran’s post-concussive syndrome during the one-year look back period prior to the July 2008 increased rating claim and, thus, the 10 percent rating is warranted no earlier than July 24, 2008. Rating in excess of 10 percent from March 19, 2012 to November 25, 2019 As noted, from March 19, 2012 to November 25, 2019, the Veteran’s disability was characterized as TBI/post-concussive syndrome with visual impairment and assigned a 10 percent rating under the amended criteria of DC 8045. Therefore, the Board will consider entitlement to a rating in excess of 10 percent under the amended criteria from March 19, 2012 to November 25, 2019 (when the disability was awarded a higher, 40 percent rating). The Veteran was afforded a VA TBI examination in July 2013 during which he endorsed having facial tingling, blurred vision, migraine headaches, dizziness, and tinnitus since the in-service concussion. The examiner noted the Veteran reported having problems with his short-term memory, although he could not give any useful details or examples of such and there was no objective evidence on testing. As for subjective symptoms, the examiner noted the Veteran’s complaints of facial tingling, blurred vision, migraine headaches, dizziness, and tinnitus and noted that none of these conditions interfered with work, instrumental activities of daily living, or family or close relationships. Otherwise, the examiner noted the Veteran’s judgement, motor activity, visual spatial orientation, and consciousness were normal. The examiner noted the Veteran was always oriented to person, time, place, and situation, and stated that the Veteran’s social interaction was routinely appropriate. The examiner further noted the Veteran was able to communicate in spoken and written language and did not have any neurobehavioral effects. The July 2013 VA examiner noted that the Veteran’s residuals included hearing loss/tinnitus, a visual impairment, gait/coordination/balance difficulties, cranial nerve dysfunction, and headaches, but that his residuals did not impact his ability to work. See July 2013 VA TBI examination. The Veteran was afforded another VA TBI examination in September 2016 during which the Veteran endorsed having left side facial tingling and numbness, blurred vision, migraine headaches, dizziness, and tinnitus since the in-service concussion. The examiner noted there was objective evidence of mild memory loss on testing, as he noted below normal results on various tests during the exam. For example, the examiner noted the Veteran scored 24 out of 30 on the MOCA test, whereas a normal score was 26 or more and that he scored 24 out of 30 on the cognitive assessment. As for subjective symptoms, the examiner noted the Veteran reported three or more subjective symptoms that mildly interfered with work, instrumental activities of daily living, or family or close relationships. In this regard, the examiner noted the Veteran’s report of headaches, photosensitivity, phono-sensitivity, and intermittent dizziness. Otherwise, the September 2016 VA examiner noted the Veteran’s judgement, motor activity, visual spatial orientation, and consciousness were normal. The examiner also noted the Veteran was always oriented to person, time, place, and situation, and that his social interaction was routinely appropriate. The examiner further noted the Veteran was able to communicate in spoken and written language and that there were no neurobehavioral effects. The September 2016 VA examiner stated that the Veteran’s residuals included hearing loss/tinnitus, cranial nerve dysfunction, dizziness/vertigo, memory loss, and bilateral vision loss and noted the effect each condition had on the Veteran’s ability to work. With respect to memory loss, the examiner noted the Veteran forgets to do paperwork and forgets why he goes to a room to get something, but that he tries to compensate by writing things down or looking at notes he makes in his phone. See September 2016 VA TBI examination. The Veteran was afforded an addition VA TBI examination in November 2019 during which he reported having headaches which he described as pounding with light sensitivity and, to a lesser degree, noise sensitivity. He also endorsed tinnitus, blurred vision, and facial numbness and tingling on the left side of his face, including in the left cheek and toward the nose and lower mandible. The VA examiner noted the Veteran’s complaint of mild memory loss but stated there was no objective evidence of such on testing. In this regard, the examiner noted the Veteran scored 27 out of 30 on the min-mental state examination (MMSE). With respect to subjective symptoms, the examiner noted the Veteran reported three or more subjective symptoms that mildly interfered with work, instrumental activities of daily living, or family or close relationships. In this regard, the examiner noted the Veteran’s report of intermittent dizziness, daily mild to moderate headaches, intermittent tinnitus, frequent insomnia, and hypersensitivity to sound and light. The examiner also noted the Veteran endorsed one or more neurobehavioral effects that occasionally interfere with workplace interaction, social interaction, or both but do not preclude them. In this regard, the examiner noted the Veteran was irritable and moody with headaches and was inflexible. Otherwise, the November 2019 VA examiner noted the Veteran’s judgement, motor activity, visual spatial orientation, and consciousness were normal. The examiner noted the Veteran is always oriented to person, time, place, and situation, and that his social interaction is routinely appropriate. The examiner also noted the Veteran is able to communicate in spoken and written language. As for residuals, the November 2019 VA examiner noted the Veteran’s hearing loss/tinnitus, cranial nerve dysfunction, and headaches, but stated that the Veteran’s TBI did not impact the Veteran’s ability to work. See November 2019 VA TBI examination. The claims file contains a report of a TBI Cognitive Screening that was conducted in December 2019 which also contains an assessment of the 10 facets. The examining clinician noted the Veteran’s complaint of mild memory loss, such as forgetting tasks he is supposed to complete and often misplacing things, but noted there was no objective evidence on testing. In this regard, the Veteran’s November 2019 MMSE report was included with the December 2019 report. The December 2019 examiner further noted that the Veteran’s judgement, social interaction, orientation, motor activity, communication, and consciousness were normal. As for visual spatial orientation, the examiner noted a mild impairment, as the Veteran reported occasionally getting lost in unfamiliar surroundings and having to use GPS. For subjective symptoms, the examiner noted blurred vision, tinnitus, hearing loss, headaches, frequent insomnia, dizziness, and hypersensitivity to light and sound, all of which were noted to mildly interfere with work, instrumental activities of daily living, or family or close relationships. The December 2019 examiner also noted the Veteran’s neurobehavioral effects included irritability and lack of motivation, which the examiner stated did not interfere with workplace or social interaction. Finally, when asked to identify any mental health suspected as a residual of TBI, the examiner noted that she suspected anxiety, although it had not been formally diagnosed. See December 2019 Cognitive Screening Form. The Board notes that the claims file also contains VA treatment records dated from 2012 to 2019, which consistently show the Veteran was described as alert and oriented to person, time, place, and situation. See e.g., VA treatment records dated March 2012 and April 2019. The treatment records do not contain any additional information or evidence that is relevant to evaluate the severity of the Veteran’s TBI residuals in this decision unless otherwise discussed. Based on the foregoing, the Board finds a 40 percent rating, but no higher, is warranted from September 21, 2016 to November 25, 2019 under the amended criteria of DC 8045. With respect to the first facet - memory, attention, concentration, and executive functions – the July 2013 VA examination documented the Veteran’s complaint of short-term memory loss but there was no objective evidence of memory loss on testing at that time, which warrants a level of impairment of 1. However, during the September 2016 VA examination, the objective testing of the Veteran’s memory revealed a mild impairment, which warrants a level of impairment of 2. During the February 2019 Board hearing, the Veteran testified having lots of short-term memory loss. Similarly, during the November 2019 VA examination, the examiner noted his complaint of mild memory loss, but there was no objective evidence of such on testing conducted at that time, which warrants a level of impairment of 1. Therefore, the Board finds that a level of impairment of 2 is appropriate for the facet of memory, attention, concentration, and executive functions from the date of the September 2016 VA examination, as shown by objective evidence on testing of mild memory loss, attention, concentration and executive functions with a mild functional impairment. However, prior to September 21, 2016 and from November 25, 2019, a level of impairment of 1 is appropriate for this facet, as evidenced by the Veteran’s subjective complaint of memory loss without objective evidence of any level of memory impairment on testing, as shown during the VA examinations conducted in July 2013 and November 2019 and the other relevant evidence of record. Notably, the VA treatment records do not contain any objective testing of the Veteran’s memory, attention, concentration, or executive functions. Regarding the second facet - judgment - the Board finds that a level of impairment higher than 0 is not evident during the relevant period, as the Veteran’s judgment has been consistently described as normal in the evidence of record. There is no indication to the contrary in the treatment records; nor has the Veteran described any impairment in judgement during his hearing testimony or other statements. With regard to the third facet - social interaction - the Board finds that a level of impairment greater than a 0 is not demonstrated by the evidence of record. Again, the relevant evidence shows that the Veteran’s social interaction is routinely appropriate. There is no lay or medical evidence of record to the contrary. Similarly, concerning the fourth facet orientation – orientation - the Board finds that a level of impairment greater than 0 is not shown during the relevant period, as the medical evidence reflects that the Veteran is consistently described as oriented to person, time, place, and situation, and he has not otherwise described being disoriented in any of the four aspects. For the fifth facet - motor activity (with intact motor and sensory system) - the preponderance of the evidence reflects that the Veteran’s motor activity has remained normal throughout the appeal period. Therefore, a level of impairment higher than 0 is not evident during the relevant period. Likewise, with respect to the sixth facet - visual spatial orientation - the Board notes that the medical evidence reflects that the Veteran’s visual spatial orientation was described as normal throughout the appeal period until the December 2019 Cognitive Screening, wherein the examiner noted a mild impairment. The December 2019 clinician noted the Veteran’s report of occasionally getting lost in unfamiliar surroundings and having to use GPS. Therefore, a level of impairment of 1 is warranted from December 2, 2019, the date of the cognitive screening. The Board notes that the September 2016 VA examiner noted that the Veteran scored 2 out of 5 on visuospatial/executive testing; however, the VA examiner conducted this test in conjunction with the facet of memory, attention, concentration, and executive functions, and the Board notes that the details provided to support the 2/5 score involved executive functions of copying and drawing items, as opposed to getting lost in unfamiliar or familiar surroundings, difficulty reading maps, following directions, or judging distance as contemplated by the visual spatial orientation facet. Further, the Board finds the September 2016 VA examiner’s inclusion of the visuospatial/executive testing in the memory, attention, concentration, and executive functions facet is highly probative with respect to what functions were being evaluated by the test and the level of impairment indicated. Therefore, even if the Board considered the September 2016 visuospatial/executive testing under the facet of visual spatial orientation, the VA examiner indicated that the test reflected a mild impairment, which would warrant a level of impairment of 1 from September 21, 2016, during which a level 2 impairment has been assigned under for the facet of memory, attention, concentration, and executive functions. Regarding facet seven - subjective symptoms – the evidence shows the Veteran has consistently endorsed having facial tingling and numbness, blurred vision, migraine headaches, dizziness, and tinnitus. See VA examinations dated July 2013, September 2016, and November 2019; see also December 2019 Cognitive Screening Form. The Board notes that each of the foregoing symptoms have been attributed to comorbid conditions for which separate ratings have been assigned. Indeed, facial tingling and numbness and blurred vision have been attributed to service-connected paresthesia of the left face and bilateral vision loss/visual field constriction, respectively, and the Board will evaluate the ratings for these disabilities in this decision. The Veteran’s dizziness has also been attributed to service-connected vertigo, which was evaluated in the June 2019 Board decision that also adjudicated the rating for migraine headaches. Therefore, the Veteran’s symptoms of facial tingling and numbness, blurred vision, migraine headaches, dizziness, and tinnitus will not be considered under the subjective symptoms facet in evaluating his TBI disability. The evidence reflects that the September 2016 and November 2019 VA examiners noted that, in addition to the conditions noted above, the Veteran’s subjective symptoms included sensitivity to light and sound, which was also described as photo and phono-sensitivity. See VA TBI examinations dated September 2016 and November 2019; see also December 2019 Cognitive Screening Form. While not reflected in the September 2016 VA TBI examination report, a September 2016 VA headaches examination report reflects that the Veteran experienced sensitivity to light and sound associated with his headaches. See September 2016 VA headaches examination. Similarly, during the November 2019 VA TBI examination, the Veteran described his headaches as pounding with light sensitivity and, to a lesser degree, noise sensitivity. See November 2019 VA TBI examination. The evidence reflects that the Veteran’s sensitivity to light and sound is associated with his service-connected migraine headache disability; however, it does not appear that the Veteran’s photo and phono-sensitivity were used to form the basis of the rating assigned for his migraine headaches. See June 2019 Board decision. As noted above, the rating for headaches is based upon the frequency of any characteristic prostrating attacks and, in evaluating the increased rating claim for migraine headaches, the Board did not factor the Veteran’s photo and phono-sensitivity into its decision as to how often the Veteran experienced prostrating attacks of headache pain, primarily because the evidence does not reflect that his prostrating attacks were manifested or aggravated by sensitivity to light or sound. See Id; see also September 2016 VA headaches examination. Therefore, because the Veteran’s sensitivity to light or sound was not used to form the basis of the rating assigned for migraine headaches, the Board will consider these symptoms under the subjective symptom facet. In this regard, while the September 2016 VA examiner noted the Veteran’s photosensitivity and phono-sensitivity mildly interfered his with work, instrumental activities of daily living, or family or close relationships, these symptoms were not accompanied by one additional subjective symptom (not attributed to a comorbid condition) to warrant a level 1 impairment under this facet at that time. However, both the November 2019 VA examiner and clinician who performed the December 2019 cognitive screening noted the Veteran’s subjective symptoms included frequent insomnia, hypersensitivity to light, hypersensitivity to sound and mildly interfered with work, instrumental activities of daily living, or family or close relationships. The December 2019 examiner also noted the Veteran’s subjective symptom of hearing loss mildly interfered with work, instrumental activities of daily living, or family or close relationships. Therefore, the Board concludes that an impairment level of 1 is warranted for the subjective symptom facet from November 25, 2019, as there was evidence of three or more subjective symptoms that mildly interfered with work, instrumental activities of daily living, or family or close relationships. However, prior to November 25, 2019, a level of impairment higher than 0 is not shown by the evidence of record, as there were only two subjective symptoms not attributed to a comorbid condition. As for facet eight - neurobehavioral effects - the evidence of record does not contain any indication of neurobehavioral effects until November 2019 when the VA examiner noted the Veteran was irritable and moody with headaches and was inflexible, which were noted to occasionally interfere with workplace interaction, social interaction or both but did not preclude them. The December 2019 clinician also noted that the Veteran’s neurobehavioral effects included irritability and lack of motivation, but she stated that did not interfere with workplace or social interaction. Based on the foregoing, the Board finds that a level of impairment of 0 is applicable for neurobehavioral effects for the period prior to November 25, 2019, as there is no lay or medical evidence showing the Veteran exhibited irritability, impulsivity, unpredictability, lack of motivation, or other neurobehavioral symptoms that interfere with workplace or social interaction during that time period. However, from November 2019, a level of impairment of 1 is warranted, given the evidence of one or more neurobehavioral effects that no more than occasionally interfere with workplace or social interaction but do not preclude them. A level of impairment higher than 1 is not evident at any point during the relevant period, including after November 25, 2019, as there is no evidence that any neurobehavioral effects frequently interfere with or prevent workplace or social interaction. For the ninth facet - communication - a level of impairment greater than 0 has not been shown, as the relevant consistently evidence shows the Veteran is able to communicate and comprehend spoken and written language. Notably, the Veteran never reported having any communication problems. Finally, for the tenth facet consciousness - a “total” level of impairment, which indicates a persistently altered state of consciousness, is neither shown by the evidence of record nor asserted by the Veteran. Accordingly, after review of the impairment levels assigned under the TBI table, the Board finds that an impairment level of 2 is warranted from September 21, 2016 to November 25, 2019, based on the objective evidence on testing of mild memory loss, attention, concentration and executive functions with a mild functional impairment during that time period. However, an impairment level greater than 1 is not assigned for any facet at any time prior to September 21, 2016 or from November 25, 2019. Therefore, as impairment level 1 is the highest level assigned prior to September 21, 2016, a 10 percent disability rating, but no higher, is warranted under the criteria of DC 8045. As impairment level 2 is the highest level assigned from September 21, 2016 to November 25, 2019, a 40 percent rating, but no higher, is warranted for that time period under DC 8045. The Board notes that the RO awarded a 40 percent rating under DC 8045 from November 25, 2019 based on impairment level 2 assigned for the subjective symptom facet. See August 2020 rating decision. It appears the RO assigned impairment level 2 based on evidence of three subjective symptoms, e.g., frequent insomnia, hypersensitivity to light, and hypersensitivity to sound, that moderately interfere with work, instrumental activities of daily living, or family or close relationships. However, the Board’s review of the evidence reveals that impairment level 1 is the highest level shown by the evidence of record from November 25, 2019, as both the November 2019 VA examiner and clinician who performed the December 2019 cognitive screening noted the Veteran’s subjective symptoms, such as frequent insomnia, hypersensitivity to light, hypersensitivity to sound, and hearing loss, mildly interfered with work, instrumental activities of daily living, or family or close relationships. There is no lay or medical evidence of record dated from November 2019 to the present that shows the Veteran’s subjective symptoms moderately interfered with his work, instrumental activities of daily living, or family or close relationships. Therefore, there is no basis to assign a level of impairment higher than 1 from November 2019 and, as such, a 10 percent rating, but no higher, is warranted from November 25, 2019. As noted above, the Veteran’s service-connected paresthesia of the left face and bilateral vision loss/visual field constriction have been separately diagnosed and attributed to his TBI. Therefore, the Board must consider the appropriate rating for those disabilities under the appropriate criteria, which will be discussed below. As a final matter, the Board notes that the lay and medical evidence of record does not demonstrate the Veteran’s need for special monthly compensation (SMC) for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance, being housebound, etc. Therefore, the entitlement to SMC is not warranted in this case. See 38 C.F.R. § 4.12a. The foregoing conclusions are based upon the lay and medical evidence in this case and represent the highest level of impairment shown throughout the appeal period, i.e., since the date of receipt of the Veteran’s claim in July 2008. In summary, the Board finds that a 10 percent rating, but no higher, for TBI/post-concussive syndrome is warranted from July 24, 2008 under the pre-2008 criteria of DC 8045. See 38 C.F.R. § 4.124a, DC 8045 (2008). A rating in excess of 10 percent is not warranted under the pre or post-2008 criteria of DC 8045 from March 19, 2012 to September 20, 2016. From September 21, 2016 to November 25, 2019, a 40 percent rating, but no higher, is warranted under the post-2008 criteria of DC 8045; however, from November 25, 2019, the preponderance of the evidence is against a rating in excess of 10 percent. See 38 C.F.R. § 4.124a, DC 8045 (2020). In making this determination, all reasonable doubt has been resolved in favor of the Veteran. 2. Entitlement to an increased rating for service-connected paresthesia of the left face The Veteran’s paresthesia of the left face is rated noncompensable from March 19, 2012 until September 21, 2016, and 10 percent thereafter. See rating decisions dated August 2013 and August 2020. His disability is evaluated under 38 C.F.R. § 4.124a, DC 8205 which evaluates paralysis of the fifth (trigeminal) cranial nerve. Indeed, the preponderance of the evidence reflects that the Veteran’s paresthesia of the left face involves cranial nerve five or the trigeminal nerve. See VA cranial nerve examinations dated July 2013, and December 2019. Under DC 8205, a 10 percent rating is warranted for moderate incomplete paralysis of the nerve; a 30 percent rating is warranted for severe incomplete paralysis of the nerve; and a 50 percent rating is warranted for complete paralysis of the nerve. The rating is dependent on relative degree of sensory manifestation or motor loss. In every instance where the schedule does not provide a zero percent rating for a diagnostic code, a zero percent rating shall be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. The Veteran was afforded a VA examination in July 2013 VA examination, during which he reported having a minor tingling sensation under the left eye only with palpation that did not otherwise occur. The examiner described the Veteran’s paresthesias and/or dysesthesias as mild in nature and noted the Veteran did not endorse any other symptoms, such as pain, numbness, or difficulty chewing or speaking. Indeed, muscle strength testing for the areas impacted by cranial nerve five was normal and objective sensory examination of the left upper face/forehead, mid face, and lower face was normal to light touch with the exception of a light tingling sensation provoked by palpation. Based on the foregoing, the examiner determined that the Veteran’s impairment was sensory in nature and did not involve any impairment of cranial nerve five or impact his ability to work. He was afforded another VA examination in September 2016 VA examination, during which he endorsed tingling and numbness in the left side of his mid face, which he reported was constant and occurred on a daily basis. The examiner described the Veteran’s symptoms of paresthesias and/or dysesthesias and numbness as mild in nature and involved the left mid face. The Veteran did not report having any other associated symptoms. Muscle strength testing for the areas impacted by cranial nerve five was normal and objective sensory examination of the left upper face/forehead and lower face were normal; however, sensory examination was decreased but not absent to light touch in the left mid face. Based on the foregoing, the examiner described the Veteran’s impairment as moderate incomplete paralysis of cranial nerve five; however, the examiner noted the Veteran’s disability did not impact his ability to work. During the February 2019 Board hearing, the Veteran testified that he continues to see a doctor for left face numbness and tingling, as his symptoms have gotten worse over the years. He described his tingling as constant and feeling like pins being stuck in the left side of his face. During the December 2019 VA examination, the Veteran stated that his symptoms were the same; however, the examiner noted that the Veteran’s paresthesias and/or dysesthesias and numbness were moderate in nature and involved the left mid face, as well as the left upper face/eye/forehead. He denied having any symptoms, such as pain, but he stated that his condition interfered with eating and chewing. In fact, the record reflects that, during the November 2019 VA TBI examination, he reported that the facial numbness and tingling on the left side of his face included the left cheek toward the nose and lower mandible. However, the December 2019 VA examiner noted that muscle strength testing for the areas impacted by cranial nerve five, including the muscles of mastication, clench jaw, palpate masseter, and temporalis, was normal and, as a result, did not indicate the level of severity of any difficulty chewing or other impairment. Objective sensory examination revealed decreased but not absent senses to light touch in the mid face and upper face/forehead. As such, the December 2019 VA examiner described the Veteran’s impairment as moderate incomplete paralysis of cranial nerve five; however, the examiner noted the Veteran’s disability did not impact his ability to work. The claims file also contains VA treatment records dated from 2013 to 2020; however, the records do not contain any complaints or treatment for the service-connected paresthesias of the left face disability. Based on the foregoing, the Board finds a compensable rating is not warranted prior to September 21, 2016, as the evidence shows no more than a mild, occasional sensory impairment caused by the Veteran’s disability during that time. In making this determination, the Board notes that, while the Veteran reported having tingling in the mid left face, e.g., under his eye, during the July 2013 examination, he stated that minor tingling only occurred with palpation and objective sensory evaluation confirmed minor tingling produced by palpation. There was no additional evidence of a sensory impairment otherwise; nor was there evidence of decreased muscle strength or motor impairment. The claims file does not contain any additional evidence dated prior to September 2016 that shows the Veteran’s paresthesia of the left face was manifested by a more severe or frequent sensory impairment to more nearly approximate a moderate degree of impairment or a sensory and motor impairment to more nearly approximate a severe disability. Therefore, the Board finds that, prior to September 2016, the Veteran’s paresthesia of the left face was manifest by no more than a mild impairment of cranial nerve five as contemplated by DC 8205, which does not warrant a compensable rating. The Board also finds that a rating in excess of 10 percent is not warranted at any time from September 21, 2016. In this regard, the evidence shows that the Veteran endorsed more symptoms that occurred more frequently. Indeed, during the September 2016 examination, the Veteran endorsed tingling and numbness in his left mid face and stated that his symptoms were constant and occurred on a daily basis. Objective sensory evaluation confirmed the presence of decreased sensation to light touch in the left mid face, but the Board finds probative that, while decreased, his sensation was not absent in the left face. There was also no evidence of decreased muscle strength or motor impairment associated with the disability at that time. Therefore, the Board finds the Veteran’s paresthesia of the left face was manifest by no more than a moderate impairment of cranial nerve five in September 2016, as the Veteran’s sensory impairment was no more than moderate and there was no evidence of motor impairment of the impacted muscles. Similarly, the December 2019 VA examination report shows that the sensory impairment in the Veteran’s left face involved a greater area than affected in September 2016, as there was decreased sensation to light touch in the left mid face and left upper face/forehead. However, the Board again notes that his sensation was decreased, and not absent, which weighs against a finding of a severe sensory impairment. The Board acknowledges the Veteran’s newly reported symptoms in his left lower face, as he stated that the numbness and tingling extended to his lower mandible and that the disability impacted eating and chewing. However, the Veteran’s subjective reports of such were not confirmed by objective testing, as there was no evidence of decreased muscle strength or motor impairment of the muscles impacted by cranial nerve five, including mastication or clench jaw. The Veteran is competent to report the symptoms he experiences as a result of his service-connected disability but, without objective findings of decreased muscle strength or motor impairment in the muscles impacted by cranial nerve five, the Board finds that the functional impairment reportedly experienced by the Veteran is no more than mild. Therefore, the Board finds the Veteran’s paresthesia of the left face continued to be manifest by no more than a moderate impairment of cranial nerve five during the December 2019 examination, as his sensory impairment, while more diffuse in area, was no more than moderate in severity and his subjective reports of functional impairment were not supported by objective evidence of motor impairment or decreased strength in the muscles impacted by cranial nerve five. In evaluating this claim, the Board has considered the Veteran’s lay assertions, as well as the medical evidence of record, and resolved all reasonable doubt in favor of the Veteran. However, the preponderance of the evidence is against the grant of an initial compensable rating for service-connected paresthesia of the left face or the grant of a rating in excess of 10 percent from September 21, 2016. 3. Entitlement to an increased rating for service-connected visual impairment/bilateral vision loss The Veteran’s visual impairment was initially evaluated in combination with his TBI disability, as it did not warrant a separate compensable rating but, during the pendency of the appeal, the RO re-characterized the Veteran’s visual impairment as severe visual field constriction and awarded a 70 percent rating, effective December 10, 2019. See rating decisions dated August 2013 and August 2020. Therefore, the Board will consider entitlement to an initial, compensable rating for bilateral vision loss prior to December 10, 2019, and a rating in excess of 70 percent thereafter. 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). With respect to field of vision impairment, 38 C.F.R. § 4.76a, Table III, 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 45-degree principal meridians. The degrees lost are then added together to determine the total number of degrees lost, which are subtracted from 500. The total remaining degrees of the visual field are then divided by eight to represent the average contraction for rating purposes. 38 C.F.R. § 4.76a. Under DC 6080, visual field defects are evaluated as follows: A 10 percent evaluation for concentric contraction of visual field with remaining field of 46 to 60 degrees bilaterally or unilaterally; with remaining field of 31 to 45degrees unilaterally; with remaining field of 16 to 30 degrees unilaterally; loss of superior half of visual field bilaterally or unilaterally; loss of interior half of visual field unilaterally; loss of nasal half of visual field bilaterally or unilaterally; and loss of temporal half of visual field unilaterally. A 20 percent evaluation is assigned for concentric contraction of visual field with remaining field of 6 to 15 degrees unilaterally. A30 percent evaluation is assigned for concentric contraction of visual field with remaining field of 31 to 45 degrees bilaterally; remaining field of 5 degrees unilaterally; loss of inferior half of visual filed bilaterally; loss of temporal half of visual field bilaterally; and homonymous hemianopsia visual field defects. A 50 percent rating is assigned for concentric contraction of visual field with remaining field of 16 to 30 degrees bilaterally. A 70 percent rating is assigned for concentric contraction of visual field with remaining field of 6 to 15 degrees bilaterally. A 100 percent rating is assigned for concentric contraction of visual field with remaining field of 5 degrees bilaterally. Visual impairment is also rated based on impairment of visual acuity (excluding developmental errors of refraction). 38 C.F.R. § 4.79, Diagnostic Codes 6061-6066. 38 C.F.R. § 4.76(b) dictates that evaluation of visual acuity should be done on the basis of corrected distance vision with central fixation, unless the lens required to correct distance vision in the poorer eye differs by more than three diopters from the lens required to correct distance vision in the better eye. A 10 percent rating is warranted only when there is (1) 20/50 vision in one eye with 20/40 or 20/50 vision in the other eye; (2) 20/70 vision in one eye with 20/40 vision in the other eye; or (3) 20/100 vision in one eye with 20/40 vision in the other eye. A 20 percent rating is warranted when there is (1) 20/70 vision in one eye with 20/50 vision in the other eye; (2) 20/100 vision in one eye with 20/50 vision in the other eye; (3) 20/200 vision in one eye with 20/40 vision in the other eye; or (4) 15/200 vision in one eye with 20/40 vision in the other eye. A 30 percent rating is warranted (1) when vision in both eyes is correctable to 20/70; (2) when vision in one eye is correctable to 20/100 and vision in the other eye is correctable to 20/70; (3) when vision in one eye is correctable to 20/200 and vision in the other eye is correctable to 20/50; (4) when vision in one eye is correctable to 15/200 and vision in the other eye is correctable to 20/50; (5) when vision in one eye is correctable to 10/200 and vision in the other eye is correctable to 20/40; (6) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 20/40; and (7) when vision in one eye is no more than light perception and vision in the other eye is correctable to 20/40. A 40 percent rating is warranted (1) when vision in one eye is correctable to 15/200 and vision in the other eye is correctable to 20/70; (2) when vision in one eye is correctable to 10/200 and vision in the other eye is correctable to 20/50; (3) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 20/50; (4) when vision in one eye is no more than light perception and vision in the other eye is correctable to 20/50 or (5) when there is anatomical loss of one eye and vision in the other eye is correctable to 20/40. A 50 percent disability rating is warranted (1) when vision in one eye is correctable to 20/100 and vision in the other eye is correctable to 20/100; (2) when vision in one eye is correctable to 10/200 and vision in the other eye is correctable to 20/70; (3) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 20/70; (4) when vision in one eye is no more than light perception and vision in the other eye is correctable to 20/70; or (5) when there is anatomical loss of one eye and vision in the other eye is correctable to 20/50. A 60 percent disability rating is warranted (1) when vision in one eye is correctable to 20/200 and vision in the other eye is correctable to 20/100; (2) when vision in one eye is correctable to 15/200 and vision in the other eye is correctable to 20/100; (3) when vision in one eye is correctable to 10/200 and vision in the other eye is correctable to 20/200; (4) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 20/100; (5) when vision in one eye is no more than light perception and vision in the other eye is correctable to 20/100; or (6) when there is anatomical loss of one eye and vision in the other eye is correctable to 20/70 or 20/100. A 70 percent disability rating is warranted (1) when vision in one eye is correctable to 20/200 and vision in the other eye is correctable to 20/200; (2) when vision in one eye is correctable to 15/200 and vision in the other eye is correctable to 20/200; (3) when vision in one eye is correctable to 10/200 and vision in the other eye is correctable to 20/200; (4) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 20/200; (5) when vision in one eye is no more than light perception and vision in the other eye is correctable to 20/200; or (6) when there is anatomical loss of one eye and vision in the other eye is correctable to 20/200. An 80 percent disability rating is warranted (1) when vision in one eye is correctable to 15/200 and vision in the other eye is correctable to 15/200; (2) when vision in one eye is correctable to 10/200 and vision in the other eye is correctable to 15/200; (3) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 15/200; (4) when vision in one eye is no more than light perception and vision in the other eye is correctable to 15/200; or (5) when there is anatomical loss of one eye and vision in the other eye is correctable to 15/200. A 90 percent disability rating is warranted only (1) when vision in one eye is correctable to 10/200 and vision in the other eye is correctable to 10/200; (2) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 10/200; (3) when vision in one eye is no more than light perception and vision in the other eye is correctable to 10/200; or (4) when there is anatomical loss of one eye and vision in the other eye is correctable to 10/200. A 100 percent disability rating is warranted only (1) when vision in one eye is correctable to 5/200 and vision in the other eye is correctable to 5/200; (2) when vision in one eye is no more than light perception and vision in the other eye is correctable to 5/200; (3) when there is anatomical loss of one eye and vision in the other eye is correctable to 5/200; (4) when there is no more than light perception in both eyes; or (5) when there is anatomical loss of both eyes. To determine the rating for visual impairment when both decreased visual acuity and visual field defect are present in one or both eyes and are service-connected, separately rate 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 claims file contains VA treatment records dated from 2012 to 2020, which contain various reports of eye treatment that note the Veteran’s visual acuity. The treatment records document the Veteran’s best corrected distance vision in September 2013 (20/20- bilaterally) and April 2019 (20/30-1 in the right eye and 20/25-1 in the left eye). See VA treatment records dated June 2013 and April 2019. The treatment records contain other reports of visual acuity without correction but, as noted, the applicable regulations state that evaluation of visual acuity should be done on the basis of corrected distance vision, and there is no indication or allegation that the lens required to correct the Veteran’s distance vision in the poorer eye differed by more than three diopters from the lens required to correct distance vision in the better eye during the appeal. Therefore, the other reports of visual acuity in the VA treatment records are not relevant in evaluating the severity of the Veteran’s bilateral vision impairment during the appeal period. Likewise, the Board notes that the VA treatment records consistently reflect that the Veteran’s visual field was normal and full to finger counting (FTFC). See e.g., VA treatment records dated June 2013, October 2015 and April 2019. The Veteran was afforded a VA eye examination in July 2013 during which he was diagnosed with bilateral preoperative cataracts and pigmentary changes in the left eye. The Veteran’s best corrected distance vision was 20/40 or better in both eyes, and the examiner noted there was no evidence of anatomical loss, light perception only, extremely poor vision, blindness in either eye, astigmatism, or diplopia. As noted, there were pigmentary changes in the fundus of the left eye, but there was also no visual field defect, including contraction, visual field loss, or scotoma. The Veteran also denied having any incapacitating episodes attributable to an eye condition. The examiner noted that the Veteran’s slight decrease in visual acuity would slightly impact activities that require sharp activity, such as driving or watching television. The Veteran was afforded another VA examination in December 2019 during which he was diagnosed with severe visual field constriction bilaterally, post TBI. His best corrected distance vision was 20/20 bilaterally, and the examiner noted there was no evidence of anatomical loss, light perception only, extremely poor vision, blindness in either eye, astigmatism, or diplopia. There was evidence of visual field defect, specifically contraction, with Goldman testing as follows. For the right eye, 10 degrees up; 10 degrees up temporally; 10 degrees temporally; 15 degrees down temporally; 15 degrees down; 15 degrees down nasally; 10 degrees nasally; and 10 degrees up nasally. The remaining fields add up to 405 and the average concentric contraction is 11.875. For the left eye, 10 degrees up; 10 degrees up temporally; 5 degrees temporally; 5 degrees down temporally; 15 degrees down; 15 degrees down nasally; 10 degrees nasally; and 10 degrees up nasally. The remaining fields add up to 415 and the average concentric contraction is 10.625. The Veteran also denied having any incapacitating episodes attributable to an eye condition, but the December 2019 VA examiner noted the Veteran’s bilateral eye disability impacted his ability to work, as his visual field constriction qualifies as statutory blindness bilaterally. Based on the foregoing, the Board finds a compensable rating is not warranted prior to December 10, 2019, and that a rating in excess of 70 percent is not warranted thereafter. Indeed, the evidence dated prior to December 2019 shows the Veteran’s disability was manifested by visual acuity with best corrected vision no worse than 20/30-1 in the right eye and 20/40 in both eyes. Visual acuity with vision in both eyes of 20/40 warrants a noncompensable rating under DC 6066 and, in order to warrant a higher, 10 percent rating, there must be evidence of (1) 20/50 vision in one eye with 20/50 or 20/40 vision in the other eye or (2) 20/100 vision in one eye with 20/40 vision in the other eye. As there is no evidence of decreased visual acuity of the severity to warrant a compensable rating under DC 6066 or visual field defect or any kind to warrant evaluation under DC 6080, the Board finds a compensable rating is not warranted prior to December 2019. The only relevant evidence of record regarding the severity of the Veteran’s eye disability since December 2019 is the VA examination report which, as noted, reflects best corrected distance vision of 20/20 bilaterally, which does not warrant a compensable rating under DC 6066. However, there was evidence of bilateral visual field contraction with remaining field of 10.625 degrees in the left eye and 11.875 in the right eye. Under DC 6080, bilateral concentric contraction with remaining field of 6 to 15 degrees warrants a 70 percent rating, but no higher. In this regard, the Board notes that DC 6080 also provides that remaining field of 6 to 15 may also be evaluated as impairment of visual acuity in each affected eye as 20/200 (6/60). However, a 70 percent rating is also warranted when evaluating 20/200 visual acuity in both eyes under DC 6080. Therefore, without evidence of a visual field contraction with less than 5 degrees remaining in both eyes or evidence of a more severe visual acuity, a rating in excess of 70 percent is not warranted under any potentially applicable diagnostic code. Therefore, the claim for a rating in excess of 70 percent from December 10, 2019 must be denied. In evaluating this claim, the Board has considered the Veteran’s lay assertions, as well as the medical evidence of record, and resolved all reasonable doubt in favor of the Veteran. However, the preponderance of the evidence is against the grant of an initial compensable rating for service-connected bilateral vision loss or the grant of a rating in excess of 70 percent for bilateral, severe visual field constriction from December 10, 2019. As a final matter, the Board notes that, while the December 2019 VA examiner stated that the Veteran’s visual field constriction qualifies as statutory blindness bilaterally, the evidence does not reflect that the Veteran is entitled to any additional benefits due to blindness. Special monthly compensation (SMC) under 38 U.S.C. § 1114(k) is payable where there is blindness of one eye having only light perception. 38 C.F.R. § 3.350(a). Loss of use or blindness of one eye, having only light perception, 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. 38 C.F.R. § 3.350 (a)(4). Additionally, SMC at the aid and attendance rate is payable when a veteran, due to service-connected disability is blind in both eyes with visual acuity of 5/200 or less, among other conditions, or is permanently bedridden or so helpless as to be in need of regular aid and attendance. See 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). In this case, the evidence does not reflect that the Veteran’s bilateral eye disability has resulted in loss of use or blindness of either eye with only light perception or that his visual acuity is 5/200 or less. Therefore, the Board finds entitlement to SMC under 38 U.S.C. § 1114(k), (l) or any other ancillary VA benefits is not warranted due to the Veteran’s service-connected bilateral vision and visual field impairment. REASONS FOR REMAND 1. Entitlement to a rating in excess of 10 percent for service-connected residuals, right ankle fracture is remanded. 2. Entitlement to a rating in excess of 10 percent for service-connected residuals, left ankle sprain is remanded. The Veteran has been afforded two VA examinations in conjunction with the bilateral ankle increased rating claims and, during both examinations, he reported having flare-ups, functional loss, and functional impairment in both ankles. The Veteran described the severity, frequency, and duration of his flare-ups, in addition to the functional loss and impairment including after repetitive use of the ankles. In July 2013, the VA examiner stated that an estimate regarding additional range of motion loss during flare-ups was not feasible because the Veteran could not replicate a flare-up; however, the Veteran denied any change in function of his ankles during flare-ups. Nevertheless, during the December 2019 examination, the Veteran reported flare-ups with prolonged walking and strenuous activity and, yet, the examiner concluded an estimate regarding additional range of motion loss during flare-ups could not be provided without mere speculation or to any degree of medical certainty essentially because a flare was not present during the examination. The Veteran also provided a description of his flare-ups during the February 2019 Board hearing, which is consistent with the description he provided during the December 2019 examination. As such, the December 2019 VA opinion is inadequate, as an examiner has not indicated that they are unable to estimate functional loss due to pain during flare-ups based on a Veteran’s lay statements describing functional loss and the severity, duration, and characteristics of flare-ups. See Sharp v. Shulkin, 29 Vet. App. 29, 33 (2017). In light of Sharp, a retrospective opinion is necessary to address the Veteran’s functional loss due to flare-ups. Thus, on remand, a retrospective medical opinion of his right and left ankles disabilities for the period from December 2019 until the present is necessary. See Chotta v. Peake, 22 Vet. App. 80, 85 (2008). 3. Entitlement to an increased rating for service-connected residuals, nasal bone fracture is remanded. As noted, in January 2009, the Veteran filed a timely NOD following the January 2009 rating decision in which the RO, in pertinent part, continued a noncompensable rating for service-connected nasal bone fracture. See Janaury 2009 NOD. The RO did not, however, provide the Veteran with an SOC addressing the nasal bone fracture claim and, as a result, he has not yet had the opportunity to perfect his appeal with respect to that claim. Under these circumstances, VA must provide the Veteran with an SOC. See Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). The matters are REMANDED for the following action: 1. Provide the Veteran with a statement of the case on the issue of entitlement to a compensable rating for service-connected nasal bone fracture. 2. Obtain an addendum opinion regarding the Veteran’s right and left ankle disabilities. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Following a review of the complete record, the examiner is asked to address the following with respect to the right and left ankle disability: a) Does pain, weakness, fatigability, or incoordination significantly limit functional ability during flare-ups? b) If so, describe any additional impairment in terms of the degree of additional range of motion loss based on the descriptions provided by the Veteran regarding the severity, frequency, and durations of his flare-ups. If the examiner concludes he or she cannot feasibly provide the requested opinion(s), even considering all of the available evidence, it must be so stated, and the examiner must provide the reasons why offering such opinion(s) is not feasible. In so doing, the examiner should explain whether the inability to provide an estimate is the result of the need for additional information or a limitation of the medical community at large (as opposed to lack of expertise, insufficient testing, or unprocured testing by the examiner). M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Turnipseed, 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.