Citation Nr: 21032359 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 17-52 313 DATE: May 26, 2021 ORDER A 20 percent rating, but no higher, for optic neuropathy with bilateral central scotomas is granted. A total disability rating due to individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. During the appeal period, the Veteran's optic neuropathy has manifested in bilateral centrally located scotomas. 2. As of November 4, 2015, the evidence indicates that the Veteran's service-connected disabilities precluded him from maintaining substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for a 20 percent rating for optic neuropathy with bilateral central scotomas are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.79, Diagnostic Code (DC) 6081. 2. The criteria for a TDIU are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1984 to November 1984 and from August 1986 to December 2010. Disability ratings are determined by the application of VA's Schedule for Rating Disabilities. 38 C.F.R. Part 4. 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999). The Veteran contends that a higher rating is warranted for bilateral optic neuropathy with central scotomas (hereinafter "eye disability"). The Veteran's eye disability has been assigned a 10 percent rating under DC 6081, for scotomas. Under DC 6081, unilateral scotoma affecting at least one-quarter of the visual field (quadrantanopsia) or with centrally located scotoma of any size is assigned a minimum 10 percent rating. Alternatively, DC 6080 instructs to evaluate based on visual impairment due to scotoma if that would result in a higher evaluation. 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). To determine the evaluation for visual impairment when both decreased visual acuity and visual field defect are present in one or both eyes and are service connected, visual acuity and visual field defects are evaluated separately, and then combined under the provisions of § 4.25. 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). DC 6066 provides ratings where vision in one eye (the poorer eye) is 10/200 or better. Where the visual acuity in both eyes is 20/40, a 0 percent rating is warranted. Where the visual acuity in the poorer eye is 20/50, a 10 percent rating is warranted where vision in the other eye is either 20/50 or 20/40. Medical records indicate that subsequent to suffering a stroke in November 2015, the Veteran temporarily lost vision. His vision returned, but blind spots remained centrally in both eyes. Initial complaints of diplopia with near vision were addressed in physical therapy, but no specific findings were included in physical therapy notes. Per a physical therapy discharge note, the diplopia resolved. At VA examinations in June 2016, November 2017 and February 2020, the Veteran's corrected distance vision was 20/40 in both eyes. The examiners found no evidence of astigmatism or diplopia. The examiners noted a visual field defect in the form of blind spots. The November 2017 and February 2020 examiners explicitly found these blind spots to be centrally located scotomas. The October 2020 examiner specified that these scotomas had existed since November 2015. There was no contraction or loss of visual field found at any examination. All three examiners found that the eye disability had no impact on the Veteran's ability to work. VA and private medical records are consistent with VA examination reports, indicating 20/40 corrected vision in both eyes and persistent centrally located blind spots, bilaterally. The Veteran has reported that the blind spots make it very difficult to read or focus on things close up. A June 2016 private medical opinion from an orthopedic surgeon found that the Veteran's optic ischemic neuropathy affected his vision making it difficult to read due to blind spots, and that he is not employable due ot the visual disturbance. In correspondence dated in August 2016, an ophthalmologist noted that the Veteran had residual central scotomas, creating blind spots making it difficult for him to track images and unable to read small to medium print. Based on the foregoing evidence, the Board finds that the Veteran's eye disability more nearly approximates a 20 percent rating. The Veteran has been assigned a 10 percent rating under DC 6081, for unilateral scotoma. However, the evidence indicates that the Veteran's blind spots are bilateral. Therefore, the minimum 10 percent rating for unilateral centrally located scotoma is warranted for each eye, for a combined rating of 20 percent. However, the Board finds that the preponderance of the evidence is against a finding that a rating higher than 20 percent is warranted for the Veteran's eye disability. The evidence indicates that the Veteran's visual acuity has remained 20/40 or better during the appeal period. There is no indication that the Veteran has contraction or loss of a visual field, or other visual impairment that would allow for a higher rating under the rating criteria, including DC 6080. Therefore, a rating higher than 20 percent is not warranted. Accordingly, the Board finds that a 20 percent rating, but no higher, is warranted for the Veteran's eye disability. Therefore, the claim for increased rating is granted. TDIU Additionally, the Board finds that the issue of a TDIU has been raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009). A TDIU may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). As of January 1, 2017, the Veteran was assigned a combined rating of 80 percent, with at least one disability at the 40 percent rating considering the bilateral factor. The central inquiry is determining whether a TDIU is warranted is "whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to a veteran's level of education, special training, and previous work experience, but advancing age and the impairment caused by nonservice-connected disabilities are not for consideration in determining whether such a total disability rating is warranted. See 38 C.F.R. §§ 4.16, 4.19. The evidence, including the Veteran's TDIU application form shows that he has a four-year college education and worked for many years as a maintenance supervisor. In November 2015, the Veteran experienced a cerebrovascular accident secondary to hip surgery, leading to multiple residuals which have been service connected. Most notably, the Veteran has neurocognitive deficiencies, vision disturbances, and lower extremity weakness. While VA examinations during the appeal period addressed functional impact of individual disabilities, no VA opinion addressed the combined effects of the Veteran's service-connected disabilities on employment. However, in correspondence dated in November 2018, the Veteran's private doctor reported that the Veteran has complicated physical and mental sequela following his 2015 stroke, including neurocognitive disorder, which has aspects of attention deficit disorder and mood disorder. Despite aggressively working with varying medications to improve the Veteran's condition, the provider opined that he continues to have complications that preclude him from sustaining fulltime employment. Other evidence of record corroborates the combined functional impact of the Veteran's service-connected disabilities, specifically residuals related to his 2015 stroke. Based on this evidence, the Board finds that the functional impairment associated with the residuals of the Veteran's stroke for which he is service-connected, would preclude the Veteran from returning to his prior work as a maintenance supervisor, and that it is unlikely that he would be able to obtain gainful employment in a different profession. Therefore, a TDIU is warranted. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Ahmad, 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.