Citation Nr: 21022882 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 20-15 685 DATE: April 19, 2021 ORDER Entitlement to an initial evaluation of 60 percent, but no higher, from August 22, 2018 for chronic iritis of bilateral eyes is granted. FINDING OF FACT During the entire appeal period, the Veteran’s bilateral chronic iritis has required a treatment visit for corticosteroid drops once a month in a 12-month period. CONCLUSION OF LAW The criteria for a 60 percent rating, but no higher, for chronic iritis of bilateral eyes been met for the entire appeal period. 38 U.S.C. § 1155 ; 38 C.F.R. §§ 4.1-4.14, 4.21, 4.75, 4.76(a), 4.77, 4.79, Diagnostic Codes 6000. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 2012 to May 2017. The Board previously remanded the issue for further development in July 2020. While the case was in Remand status, a 60 percent rating for the eye disability was assigned, effective February 11, 2020. That is the maximum rating as of that date, and the earlier period is now before the Board concerning the date as of the time service connection was established. That effective date was August 22, 2108. The case has now been returned to the Board for appellate review. Increased Rating Initial evaluation for chronic iritis of bilateral eyes Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155 ; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2 ; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. When a claimant is awarded service connection and assigned an initial disability rating, separate disability ratings may be assigned for separate periods of time in accordance with the facts found. Such separate disability ratings are known as staged ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999) (noting that staged ratings are assigned at the time an initial disability rating is assigned). The Veteran’s chronic iritis is currently rated under Diagnostic Code 6000, choroidopathy, including uveitis, iritis, cyclitis, and choroiditis. 38 C.F.R. § 4.79. Diagnostic Code 6000 provides that the disability should be evaluated under the General Rating Formula for Diseases of the Eye. The General Rating Formula for Diseases of the Eye indicates that the disability should be rated on the basis of either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where there are documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months, a 10 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months, a 20 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition during the past 12 months, a 40 percent rating is warranted. Where there are documented incapacitating episodes requiring 7 or more treatment visits for an eye condition during the past 12 months, a 60 percent rating is warranted. Note (1) indicates that, for the purposes of evaluations under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Note (2) indicates that examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. 38 C.F.R. § 4.79. 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) Evaluation of visual acuity is based on corrected distance vision with central fixation. 38 C.F.R. § 4.76 (b)(1). The measurements for each eye are applied to the table for Impairment of Central Visual Acuity. Generally, the table is divided into steps corresponding to different levels of visual acuity for one eye, and each step is further divided into subsections of visual acuity for the other eye, with corresponding ratings. Where a reported visual acuity is between two sequentially listed visual acuities, the visual acuity which permits the higher evaluation will be used. 38 C.F.R. § 4.76 (c). In this case, the Veteran’s corrected distance vision was 20/40 or better for the entire appeal period. See September 2018, February 2020, and October 2020 VA examination reports. There is further no other visual acuity testing of record showing that a compensable evaluation would be warranted for impaired visual acuity. Evaluation of visual field is based on the remaining field of vision in each eye. 38 C.F.R. § 4.77. The table of Ratings for Impairment of Visual Fields provides ratings for visual field loss. The first half of the table provides ratings based on loss of an entire half of field of vision in an eye. The second half of the table provides ratings based on the average concentric contraction of the visual field of each eye. Evaluation of visual field is based on the remaining field of vision in each eye. 38 C.F.R. § 4.79. In this case, defect of visual field was noted in the February 2020 VA examination. However, the examiner determined that the contracted visual field is unrelated to the service-connected disability and a separate diagnosis. As such, a compensable evaluation is not warranted for visual field defect due to the service-connected chronic iritis. Evaluations of visual impairment of muscle function is based on the degree of diplopia. 38 C.F.R. § 4.78. In this case, there is no evidence that the Veteran’s service-connected eye disability results in any impairment of muscle function. Therefore, the Board considers the other rating criterion based on incapacitating episodes under the General Rating Formula. Here, the weight of the evidence is for finding that his chronic iritis has been severe enough to require a clinic visit to a provider specifically for treatment purposes once a month in a 12-month period for the entire appeal period. The Veteran submitted a private treatment record, dated July 2018, which documents that he was seen for treatment due to severity of his iritis once a month for a year and the treatment consisted of cycloplegic drops. The clinician further stated that the flareups impacted his ability to function and travel outside home and prevented from completing his work. It also notes that the Veteran was on Pred Forte, a class of corticosteroids. An August 2018 VA treatment record indicates that the Veteran had history of recurrent bouts of iritis over the last 5 years. In a statement received in November 2019, the Veteran reported that the prescribed eye drops lessened the effect of flareups. In a November 2019 notice of disagreement, the Veteran reported that during a flareup, vision became blurry and he was more sensitive to light. He reported pain, redness, and swelling. With the steroid eye drops, his eye condition would return to normal in about 3 weeks. He indicated that he was seeking treatment once a month for the drops while he had insurance to cover the visits. The evidence of record does not indicate that his eye disability has improved at any time during the appeal period. Therefore, under the General Rating Formula, the Veteran’s bilateral eye disability warrants a rating of 60 percent for the entire appeal period. This is the maximum rating for incapacitating episodes under the General Rating Formula. (The Veteran has a 100 percent rating assigned, with additional disabilities resulting in a special monthly compensation award. As such a total rating issue involving the eye disorder has not been raised, and there is no additional benefit that would attach.)   The Board has also considered whether the schedular evaluation is inadequate. The evidence does not reflect any unusual or otherwise exceptional symptoms. The primary symptoms are fully contemplated by the rating criteria for incapacitating episodes. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Y. Taylor 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.