Citation Nr: 21032554 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 11-12 295 DATE: May 27, 2021 ORDER Entitlement to a compensable rating for bilateral diabetic retinopathy and cataracts prior to June 23, 2010 is denied. Entitlement to a rating in excess of 10 percent for bilateral diabetic retinopathy and cataracts from June 23, 2010 to December 4, 2014 is denied. Entitlement to a rating in excess of 30 percent for bilateral diabetic retinopathy and cataracts from December 4, 2014 to January 5, 2015 is denied. Entitlement to a rating of 40 percent for bilateral diabetic retinopathy and cataracts from January 6, 2015 is granted. Entitlement to special monthly compensation (SMC) at the housebound rate from June 1, 2016 to January 14, 2020 is granted. FINDINGS OF FACT 1. Prior to June 23, 2010, the Veteran's bilateral diabetic retinopathy and cataracts resulted in corrected central visual acuity of 20/40 or better for both eyes. There is no medical or lay evidence of visual field impairment during this period. 2. From June 23, 2010 to December 4, 2014, the Veteran's bilateral diabetic retinopathy and cataracts resulted in corrected central visual acuity of 20/60 left and 20/40 right. 3. From December 4, 2014 to January 5, 2015, the Veteran's bilateral diabetic retinopathy and cataracts resulted in variable corrected distance visual acuity, with the most favorable to the Veteran being 20/200 left and 20/70 right. 4. From January 6, 2015, the Veteran's bilateral diabetic retinopathy and cataracts resulted in variable corrected distance visual acuity and his right visual field defect was noted to have begun following laser surgery on January 6, 2015. He had additional left visual field defect noted to have begun on May 28, 2015. His visual field defects were noted to show remaining visual field of 31 to 45 degrees. 5. From June 1, 2016 to January 14, 2020, the Veteran had a single disability (coronary artery disease) rated as 100 percent disabling, with additional disabilities (eye conditions, right elbow, and peripheral neuropathy) rated 60 percent or greater. CONCLUSIONS OF LAW 1. The criteria for entitlement to a compensable rating for bilateral diabetic retinopathy and cataracts prior to June 23, 2010 have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1-4.16,4.31, 4.75-4.79, Diagnostic Codes (DCs) 6006, 6066. 2. The criteria for entitlement to a rating in excess of 10 percent for bilateral diabetic retinopathy and cataracts from June 23, 2010 to December 4, 2014 is have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1-4.16,4.31, 4.75-4.79, DCs 6006, 6066. 3. The criteria for entitlement to a rating in excess of 30 percent for bilateral diabetic retinopathy and cataracts from December 4, 2014 to January 5, 2015 have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1-4.16,4.31, 4.75-4.79, DCs 6006, 6066. 4. The criteria for entitlement to a rating of 40 percent for bilateral diabetic retinopathy and cataracts from January 16, 2015 have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1-4.16,4.31, 4.75-4.79, DCs 6006, 6066, 6080. 5. The criteria for entitlement to SMC (s-1) (housebound rate) have been met from June 1, 2016 to January 14, 2020. 38 U.S.C. §§ 1114 (s), 5107, 5121; 38 C.F.R. § 3.350. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Coast Guard from June 1974 to May 1996 and from July 2002 to June 2006. This matter come before the Board of Veterans' Appeals (Board) on appeal from a July 2010 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In pertinent part, the July 2010 decision continued a noncompensable rating for diabetes with bilateral diabetic retinopathy and cataracts; and granted service connection for a left eye solar retinal burn, assigning a noncompensable rating, effective June 10, 2009. A June 2016 rating decision separated the Veteran's bilateral diabetic retinopathy and cataracts from his diabetes rating and assigned a noncompensable rating from June 10, 2009 and a 10 percent rating from January 14, 2016. A June 2020 rating decision provided an increased 40 percent rating from January 14, 2020. A September 2020 rating decision implemented a Board decision providing staged10 percent rating from June 23, 2010, a 30 percent rating from December 4, 2014, a 40 percent rating from May 28, 2015, and a 10 percent rating from June 1, 2016. It also provided a separate 10 percent rating for left neovascular glaucoma from June 1, 2015. A February 2021 rating decision provided the separate 10 percent for glaucoma from an earlier effective date of May 28, 2015. The Veteran's claim for an increased rating for his bilateral diabetic retinopathy and cataracts was previously before the Board in July 2015, September 2016, and September 2020. The claims were remanded for additional development. In an August 2020 appellate brief, the Veteran's attorney expressed that the Veteran was satisfied with the 40 percent rating assigned for his eye conditions from January 14, 2020. The attorney stated that they had "no argument" with the 40 percent rating. As the 40 percent rating satisfies the Veteran claim from January 14, 2020 onward, this period is no longer on appeal. The September 2016 Board remand included remand of the issue of total disability based on individual unemployability. The remand noted that the Veteran was granted a 100 percent rating for his coronary artery disease from March 7, 2015. Social Security Administration (SSA) records show that the Veteran stopped working March 7, 2015, and reported he became disabled as of that date. SSA records also include an April 13, 2015 letter from Dr. F.F. that the Veteran could not return to work presently, and it was suspected "he may be permanently disabled due to acute myocardial infarction and severe chronic systolic congestive heart failure which he barely survived." The cardiologist did not expect a full recovery. As such, the Board does not find that a claim of entitlement to TDIU is on appeal. The Veteran is also in receipt of SMC(s) (housebound rate) from March 7, 2015 to June 1, 2016 and from January 14, 2020 based on a 100 percent rating for his cardiac conditions and additional disabilities rated at 60 percent or greater. With this decision, the Veteran will be provided SMC(s) from March 7, 2015 (date of his 100 percent rating for coronary artery disease) onward. 1. Entitlement to a compensable rating for bilateral diabetic retinopathy and cataracts prior to June 23, 2010 is denied. 2. Entitlement to a rating in excess of 10 percent for bilateral diabetic retinopathy and cataracts prior to December 4, 2014 is denied. 3. Entitlement to a rating in excess of 30 percent for bilateral diabetic retinopathy and cataracts from December 4, 2014 to January 5, 2015 is denied. 4. Entitlement to a rating of 40 percent for bilateral diabetic retinopathy and cataracts from January 6, 2015 is granted. The Veteran contends that his service-connected eye conditions warrant increased staged ratings prior to January 14, 2020. The Veteran's representative noted that he was content with a 40 percent rating for his eye/vision problems, but was seeking the 40 percent rating from an earlier date than January 14, 2020. With this decision, the Board is providing the 40 percent rating from January 16, 2015. Higher staged ratings prior to January 16, 2015 are not shown to be warranted. 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. Under the former criteria, DC 6006 (retinopathy) instructed to evaluate pursuant to the General Rating Formula for Diagnostic Codes 6000 through 6009 which 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. The definition of "incapacitating episodes" for this period was prescribed bedrest by a physician. Under the revised criteria, DC 6006 instructs to evaluate pursuant to the General Rating Formula for Diseases of the Eye which instructs to evaluate on the basis of either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation. The description of "incapacitating episodes" was an episode severe enough to require a clinic visit to a provider specifically for treatment purposes. Both the former and revised criteria provide for consideration of visual impairment. 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. Prior to June 23, 2010 On December 2, 2008, the Veteran received VA treatment for his diabetes. He denied prior diagnosis of retinopathy, current diplopia or blurry vision. On evaluation the physician did not seen retinopathy and the fundoscopic examination was "benign." On October 9, 2009, the Veteran participated in a VA eye examination. The Veteran stated he had never missed work related to his visual problems. He had corrected distance vision of 20/20 bilaterally. His slit lamp examination was normal except for 1+ cortical spoking cataract, right eye greater than his left eye. He also had moderate nonproliferative diabetic retinopathy (NPDR)as evidenced by scattered dot-and-blot hemorrhages, without current significant diabetic macular edema. He also had a 1 spot in his left eye that was more likely than not the retinal burn from his in-service solar retinopathy. The examiner noted that the Veteran's moderate NPDR and mild diabetic-induced cataracts did not limit his vision at this time. He was "at a substantial risk for visual loss over the next five years." He was also noted to have a retinal burn (spot of solar retinopathy) of his left eye that did not impair his vision. Under DC 6066, corrected central visual acuity of bilateral 20/40 or better warrants a noncompensable rating. There are limited treatment records for the period on appeal prior to June 23, 2010. The available records show that the Veteran's corrected distance visual acuity warranted a noncompensable rating under DC 6066. Additionally, the lay and medical evidence of record does not indicate that the Veteran had visual field impairment at this time. The Veteran's retinopathy and cataract were shown on examination, but did not yet impact his vision. The evidence does not show that he had any incapacitating episodes of retinopathy or cataracts during this period on appeal. As such, a compensable rating is not warranted prior to June 23, 2010. From June 23, 2010 to December 4, 2014 A June 23, 2010 private treatment record (the heading does not indicate the author) showed that the Veteran had corrected distance vision of 20/40 right and 20/60 left. At that time, he did not have glaucoma. He was noted to have moderate NPDR without edema. However, he had solar retinopathy of the left eye. Under DC 6066, vision of 20/40 and 20/60 (rounded up to 20/70) warrants a 10 percent rating. On October 27, 2010, the Veteran reported decreased near and distant visual acuity. It appears to note he had halos, and possibly that his vision was "grainy;" however, the handwriting is difficult. He saw "gray spots" in the morning when he woke up, but "no floaters." There was a notation of "burn on retina from 'eclipse'." He also had diabetic retinopathy and cataracts. His corrected vision was 20/25 right and 20/50 left. A February 23, 2011 record showed corrected vision of 20/30 right and 20/50 left. Under DC 6066, vision of 20/50 and 20/40 warrants a 10 percent rating. An August 29, 2013 letter from Dr. W.J.G.D. included that the Veteran was evaluated for cataracts on March 26, 2013. His best corrected vision was 20/25 right eye and 20/60 left eye. He had cataract surgery left eye May 1, 2013. After his surgery, his corrected vision remained 20/60+. He was seen by a retina specialist, Dr. A.M., for diabetic macular edema of both eyes, severe NPDR of both eyes, and macular ischemia left eye greater than right. He had previously been treated for macular edema with focal laser and Avastin injections. Under DC 6066, vision of 20/70 in one eye and 20/40 in another warrants a 10 percent rating. A January 13, 2014 Retina Center of Charleston record included the Veteran's report that his left eye was "blind centrally" for a "few years." He stated his right visual acuity was "okay." He had left cataract surgery in May 2013. On evaluation, his right central visual acuity was corrected to 20/40-1 and his left to 20/70-1. His bilateral gross visual fields were "full." His right vitreous was clear, his left vitreous had probable PVD. He was noted to have moderate NPDR. Under DC 6066, vision of 20/70 in one eye and 20/40 in another warrants a 10 percent rating. A June 10, 2014 record from Dr. L.K. included that the Veteran's vision was 20/40 right and 20/80 left. He had macular edema. On evaluation, he had laser marks and a few small hemes central of the left macula. He had moderate NPDR of both eyes. Under DC 6066 ratings are provided based on the "worse" eye being 20/70 or 20/100. There are no ratings specifically for 20/80. Where a veteran has a reported visual acuity that is between two sequentially listed visual acuities, use the visual acuity which permits the higher evaluation. See 38 C.F.R. § 4.76 (4). Visual acuity of 20/100 and 20/40 warrants a 10 percent rating. As shown above, the Veteran's corrected distance central visual acuity was 20/40 right and 20/100 left at worse during the period on appeal from June 23,2010 to December 4, 2014. His visual acuity worsened to a compensable level, and remained within the rating criteria for a 10 percent rating during this period. The lay and medical evidence does not show that the Veteran had visual field impairment or incapacitating episodes at this time. He underwent left cataract surgery in 2013; however, the former definition of an incapacitating episode required prescribed bedrest. Cataract surgery is an outpatient procedure and the record does not indicate complications that required bedrest. As such, a rating in excess of 10 percent from June 23, 2010 to December 4, 2014 is not warranted. From December 4, 2014 to January 5, 2015 A December 4, 2014 record from Dr. L.K. included the Veteran's report of blurry right vision with black floaters. His vision was 20/60+2 right and 20/100-1 left. He was noted to have advanced NPDR of the left eye. He had an Avastin injection in his right eye due to his retinopathy. This is the first record available that showed the Veteran's visual acuity had worsened such that it warranted a higher rating under DC 6066. Under DC 6066, vision of 20/100 and 20/70 warrants a 30 percent rating. Retina Center of Charleston records show that the Veteran had intravitreal Avastin injection of the right eye on December 4, 2014. He had right eye laser treatment on January 6, 2015. He had intravitreal Avastin injections to the left eye on June 8, 2015, July 9, 2015, and November 24, 2015. He had laser treatment of the left eye on July 23, 2015 and January 19, 2016. A January 6, 2015 record from Dr. L.K. included the Veteran's report of increased floaters in the right eye. His vision was 20/60-2 right and 20/80-1 left. On January 16, 2015, the Veteran underwent laser therapy for his retinopathy. A January 22, 2015 record included the Veteran's report that his floaters are "in the way." His visual acuity was 20/70-2 bilaterally. A February 26, 2015 record showed vision was 20/50 right and 20/60-2 left. Under 6066, these findings would show ratings of 30 percent, 30 percent, and 20 percent, respectively. For the period from December 4, 2014 to January 5, 2015, the Veteran's vision variably met the criteria for30 percent and 20 percent ratings for corrected distance visual acuity. To provide the Veteran the greater benefit, the Board will provide a 30 percent rating from December 4, 2014 to January 5, 2015. An increased rating is provided from January 6, 2015 because in 2021 (further discussed below), the examiner provided an addendum opinion that the visual fields impairment shown in the 2020 examination likely began in the right eye with the January 2015 laser treatment. Private treatment records indicate that the Veteran had right laser treatment on January 6, 2015. The evidence does not support that the Veteran had visual fields defect prior to January 6, 2015; the Veteran did not make complaints of visual field impairment to his various treatment providers and treatment records did not note visual field impairment. Additionally, although the record had injections and laser treatments from December 2014, the regulations changing the definition of an incapacitating episode prescribed bedrest (former) to requiring a clinic visit for treatment purposes did not come into effect until 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. As such, the Veteran's treatment during this period cannot be considered under the revised incapacitating episodes definition. A rating in excess of 30 percent for the period from December 4, 2014 to January 5, 2015 is not warranted. From January 6, 2015 Prior to this decision, the Veteran had staged ratings of 40 percent from May 28, 2015, 10 percent from June 1, 2015, and 40 percent from January 14, 2020. An April 28, 2015 record from Dr. L.K. included the Veteran's report that he still had floaters in his right eye, with "questionable interference with his visual acuity." His left visual acuity was "ok." He was noted to have had a heart attack with stents and hospitalization for a month in March 2015. His visual acuity was corrected to 20/50 right and 20/60-3 left. His periphery showed right eye PRP (panretinal photocoagulation) superior and moderate NPDR of the left eye. Large parts of this record are illegible due to handwriting. Under DC 6066, corrected central visual acuity of 20/70 and 20/50 warrants a 20 percent rating. A May 29, 2015 record from Lowcounty Eye Specialists (Dr. J.E.T.) included that the Veteran had been seen in the Trident ER the night before for "loss of left eye vision." He stated his vision went "completely dark yesterday." Some of the vision had returned but it felt like there was a film over his left eye. His corrected vision was 20/50-2 right and 20/80+1left. His confrontation visual fields were normal bilaterally. The impression was of hyphema, bilateral proliferative diabetic retinopathy, and age-related cataract of the left eye. His 0.5mm hyphema of the left eye was likely due to neovascularization of the iris and was noted to be diabetes-related. He was given Timolol Maleate and prednisolone acetate (both drops) for his left eye. Under DC 6066, vision of 20/70 and 20/50 warrants a 20 percent rating. A June 1, 2015 Lowcounty Eye Specialists follow-up included that with use of his Timolol and prednisolone the Veteran could "see a lot better today." He had moderate left eye pain upon waking which lasted an hour. His visual acuity was "90 percent better than last week." On evaluation, his vision was 20/50 right and 20/80+1 left. His hyphema was "resolved through 2+ RBCs" and he was to continue his medication. Under DC 6066, vision of 20/70 and 20/50 warrants a 20 percent rating. A June 5, 2015 Lowcounty Eye Specialists record included that the Veteran's left eye was now sore and painful. He was still using his medication as directed. He stated the pain kept him awake and his visual acuity had worsened. On testing his vision was 20/40 right and 20/400 left. He had a trace hyphema inferior rubeosis of the left eye. The assessment was of "reactivated" hyphema. He was referred to Dr. L.K. due to rubeosis with hyphema of left eye. His hyphema was noted to be "presumably due to rubeosis from PDR. Appears to have been small rebleed since last visit." It was noted his intraocular pressure was 39. It was "discussed at length" that his PDR needed to be addressed. He was referred for a tube shunt and given pain medication. Confrontation visual fields were normal. Under DC 6066, no more than light perception in one eye, and the other eye 20/40 warrants a 30 percent rating. A June 8, 2015 record from Dr. L.K. included the findings of neovascular glaucoma left eye, and proliferative diabetic retinopathy (PDR)bilateral. His visual acuity was 20/40 right and 20/200 left. The handwriting is illegible on the slit lamp evaluation. Under DC 6066, vision of 20/200 and 20/40 warrants a 20 percent rating. A June 10, 2015 Lowcounty Eye Specialists record included the Veteran's report that his left eye was still painful and blurry. His visual acuity was 20/40 right and 20/200 left. He had rubeosis of the iris and a 1 mm hyphema of the anterior chamber. It was noted that his hyphema was larger, but his intraocular pressure had improved. His visual fields were normal to confrontation. A June 17, 2015 record included his continued report blurry vision and burning/watering of his left eye. His vision was 20/40-1 right and 20/200 left eye. His visual fields were again noted to be normal to confrontation. Under DC 6066, vision of 20/200 and 20/40 warrants a 20 percent rating. A June 24, 2015 Lowcounty recheck of the left hyphema included that the Veteran's visual acuity was 20/50 right and 20/100+1 left. Normal visual fields to confrontation. Under DC 6066, corrected central visual acuity of 20/100 and 20/50 warrants a 20 percent rating. A July 1, 2015 Lowcounty record showed the Veteran's vision was 20/40-2 right and 20/100 left. He had normal bilateral confrontation visual fields. He had right 2+ nuclear sclerotic cataracts and 2+ cortical cataracts. He had left PCIOL, and rubeosis. He had reactivated hyphema. Under DC 6066, corrected central visual acuity of 20/100 and 20/40 warranted a 10 percent rating. A July 9, 2015 Retina Center of Charleston record noted that the Veteran had an Avastin injection in his left eye. His vision had improved to 20/40 right and 20/70 left. On July 23, 2015, the Veteran complained that his vision was not sharp. He had laser treatment for his left PDR. His corrected central visual acuity remained 20/40 right and 20/70 left. These records also noted left neovascular glaucoma. Under DC 6066, vision of 20/70 in one eye and 20/40 in another warrants a 10 percent rating. An October 20, 2015 Retina Center record included the Veteran's report of "ok" left vision and "foggy" right vision. His corrected visual acuity was 20/40-2 right and 20/50-2 left. He had prior laser treatment of the left eye on July 23, 2015, Avastin injections in June and July 2015 (left eye) and December 2014 (right eye), as well as laser treatment of the right eye on January 16, 2015. Under DC 6066, vision of 20/40 and 20/50 warranted a 10 percent rating. A November 24, 2015 Retina Center record included that the Veteran had been seen by Dr. N the day before for increased intraocular pressure in his left eye, "has glaucoma symptoms." He did not feel his visual acuity was any better following his Avastin injection on July 9, 2015. His corrected vision was 20/50 right and "CF at face?" left. He was on Prednisone and Dorzolamide for his left eye. The impression is difficult to read but appears to note neovascular glaucoma left eye, PDR both eyes, "schedule for tube? New hyphema left eye" (this is an estimation due to handwriting). He underwent a shunt/valve and drain (date unknown) and was seen on December 22, 2015 noting that his left eye felt better, with minimal pain. He had Avastin injection one month prior in the left eye. His corrected vision was 20/50 right and 20/100 left. Under DC 6066, corrected distance central visual acuity of 20/50 and 20/100 warrant a 20 percent rating. On January 13, 2016, the Veteran participated in a VA eye examination. The Veteran had a "visually insignificant scar in his left retina" from service. He also had PDR of both eyes, vitreous hemorrhage left eye, neovascular glaucoma left eye, bilateral cataracts, multiple laser treatments both eyes, intravitreal injections both eyes, cataracts surgery left eye, neovascular glaucoma and seton tube in left eye. These were all noted to be due to his diabetes. His eye/vision problems had "escalated in the last year." His corrected distance vision was 20/40 right and 20/70 left. He did not have diplopia. On external eye evaluation, the Veteran had left seton superior temporal/seton tube and intraocular lens. He had no current neovascularization of the left iris. He had mild cataracts of the right eye and intraocular lens replacement of the left eye. On internal eye examination, the Veteran had scars from diabetic focal laser of both macula, and a left scar from solar retinopathy. He had bilateral attenuated vessels. He had left inferior blood of the vitreous. The examiner selected that the Veteran did not have a visual field defect or loss of visual field. Visual field testing was not completed. The examiner noted that the Veteran's right cataracts and left pseudophakia did not result in visual impairment. He had left open-angle glaucoma that required continuous medication for treatment as he "required FML [fluorometholone] for maintenance of his seton tube." The examiner found that the Veteran's glaucoma did not result in his visual impairment. The Veteran's retinopathy/maculopathy/retinal hemorrhages resulted in his visual impairment, which was specified as diabetic retinopathy. The examiner noted that the Veteran had an incapacitating episode due to an eye condition in that he suffered a vitreous hemorrhage of his left eye with total vision loss lasting at least 2 weeks, but less than 4 weeks. Regarding functional impact, the examiner noted that the Veteran's best vision was "barely 20/40 in his better eye." He required multiple treatments to maintain his vision even at this level, and it was difficult for him to read normal print or drive with his vision loss. Under the prior regulations, the General Rating Formula for DCs 6000 to 6009 provided a 40 percent rating for incapacitating episodes with a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months. As noted above, under DC 6066, central visual acuity of 20/70 and 20/40 warrants a 10 percent rating. The Board notes that the Veteran experienced left vision loss (hyphema) beginning May 28, 2015. Incapacitating episode ratings are based on 12-month periods, so the 40 percent rating based on his incapacitating episode would be for the period from May 28, 2015 to May 28, 2016. The General Rating Formula directs to rate on visual acuity or incapacitating episodes, whichever provides the higher rating. Incapacitating episodes provide the higher (40 percent rating) for this period. In the September 2020 decision, the Board provided a 40 percent rating based on incapacitating episodes (former definition) from May 28, 2015 to May 28, 2016. When the RO implemented the grant, they provided the 40 percent rating to May 31, 2016. A January 19, 2016 Retina Center record showed corrected distance vision of 20/100 and 20/40. Under DC 6066, this warrants a 10 percent rating. An April 21, 2016 Lowcountry Eye Specialist letter from Dr. J.T. noted that the Veteran had sudden loss of vision and increased intraocular pressure on May 29, 2015 due to a hyphema. The hyphema was most likely due to neovascularization on the iris and his vision was only correctable to 20/80 with his "current glasses prescription." He was seen on June 5, 2015 for a possible rebleed and injections were performed on his eye. When he was seen again and the hyphema was still present, he was placed on strict bedrest. By June 24, 2015 his hyphema, intraocular pressures, and symptoms had improved. He did not have a return of symptoms from June to November 2015. However, by November 19, 2015, he was referred to Dr. N. to be evaluated for surgical treatment due to his intraocular pressures fluctuating. He was operated on and a tube shunt was placed in his left eye. His pressures had remained at an acceptable level following surgery. May 26, 2016 and July 12, 2016 Retina Center records showed his corrected vision was 20/40 right and 20/60 left. Under DC 6066 this warrants a 10 percent rating. An August 8, 2016 Retina Center record showed right eye vision as "HM [hand movement] @ face" and left vision was 20/70-1. He had hit his head and had not been able to see out of his right eye since August 5, 2016. His vitreous was diffuse red vitreal hemorrhage. The assessment was illegible. No visual acuity was listed for his right eye on September 6, 2016. Roper St. Francis records from September 12, 2016, October 26, 2016 and February 8, 2017 noted that the Veteran underwent vitrectomy with removal of vitreous hemorrhage and Endolaser pan retinal. Retina Center of Charleston records from February 16, 2017 and March 20, 2017 showed the Veteran had intravitreal Avastin injections. His vision was 20/25 right and 20/60+2 left on March 20, 2017. On April 18, 2017 and May 23, 2017, his uncorrected vision was 20/25 right and 20/70 left. Under DC 6066, vision of 20/70 and 20/40 or better warrants a 10 percent rating. A May 3, 2018 Retina Center record noted that the Veteran's right vitreous hemorrhage was treated with a laser in October 2016 and February 2017 without recurrence. He also had bilateral macular edema with no recurrent after laser treatment, inactive PDR, and neovascular glaucoma of the left eye. On January 14, 2020, the Veteran participated in a second VA eye examination. He was diagnosed with proliferative diabetic retinopathy, neovascular glaucoma, and pseudophakia (lens replacement due to cataracts). The medical history included that the Veteran had proliferative diabetic retinopathy with multiple lasers and intravitreal injections to both eyes. He had a vitreous hemorrhage in his left eye, left eye cataract surgery, and neovascular glaucoma of the left eye with tube shut placement. His corrected distance vision was 20/70 left and 20/20 or better right. On slit lamp evaluation, the veteran had a well-covered valve plate in the left conjunctiva/sclera, and a tube in the superior temporal anterior chamber of the left eye. He had bilateral PCIOL. On internal eye evaluation, the Veteran had laser scars in both eyes and a solar retinopathy scar in the left eye, bilateral attenuated vessels, and an undescribed problem with the bilateral peripheries. He did not have diplopia on evaluation. The examiner tested the Veteran's visual field and found contraction of both visual fields. His right remaining visual field was 329 degrees, or concentric contraction with remaining visual field of 41.125. His left remaining visual field was 331 degrees, or concentric contraction with remaining visual field of 41.375. He did not have loss of any visual field, and did not have a scotoma. He did not meet the standards for statutory blindness. Under DC 6080, concentric contraction of a visual field with remaining field of 31 to 45 degrees warrants a 30 percent rating if bilateral. Regarding his left neovascular glaucoma, he was noted to have had surgery, but he was not on "drops." His visual impairment was noted to be due to his glaucoma. He had post-operative bilateral cataracts with intraocular lens replacement, without aphakia or dislocation of the crystalline lens. His visual impairment was not due to his cataracts, as he had "clear lenses." He had bilateral diabetic retinopathy, which also contributed to his visual impairment. The examiner selected that the Veteran had not had any incapacitating episodes in the prior 12 months. The remarks section included that the Veteran had proliferative diabetic retinopathy and diabetic macular edema with multiple laser treatments and intravitreal injections to both eyes. He had a vitreous hemorrhage of the left eye secondary to his diabetic retinopathy. He had cataract surgery with lens implantation of both eyes. He developed neovascular glaucoma of the left eye secondary to his glaucoma and underwent glaucoma tube shunt placement. His visual acuity and visual field loss were noted to be due to diabetic eye conditions. On the August 12, 2020 Appellate Brief, the Veteran's representative noted that they did not have an argument for a rating in excess of 40 percent. The Veteran only sought to have the 40 percent rating be provided "retrospectively." In other words, the representative noted that the Veteran was not appealing for a rating in excess of 40 percent, but felt that a 40 percent rating could apply for the entire period on appeal. On January 27, 2021, a VA examiner reviewed the record to provide an addendum retrospective opinion regarding the Veteran's glaucoma and visual fields. She noted that the Veteran began taking pressure-lowering medication for his glaucoma in May 2015 until his November 2015 shunt surgery. Regarding his visual fields, the examiner was unable to locate any record of visual field testing prior to his 2020 VA examination. His constriction of the superior visual field of his right eye is likely a result of the superior panretinal laser photocoagulation he had done by Dr. K for his PDR in January 2015. His left visual field defects were likely related to his neovascular glaucoma and increased eye pressure that began in May 2015. The damage to his optic nerve from the increased eye pressure would have occurred during the time from presentation of neovascular glaucoma in May 2015 through his pressure controlled surgery in November 2015. Once the nerve had been damaged by the high eye pressure resulting in visual field defect, the defect would remain and would not improve. His left field constriction was documented in the 2020 visual field but would have been present form the time period involving the onset of his neovascular glaucoma. As such, the 2021 examiner has indicated that the visual field findings presented in the 2020 examination should be applied to the Veteran's right vision from January 16, 2015 (laser treatment) and May 28, 2015 (earliest date of diagnosis of neovascular glaucoma). Under DC 6080, remaining visual field of 31 to 45 degrees should be treated as 20/70 under DC 6066 or warrants a 10 percent rating. From May 28, 2015, the 30 percent rating under DC 6080 for bilateral remaining visual field of 31 to 45 degrees is warranted. Visual field findings are combined under 4.25 with ratings for central visual acuity ratings. From January 6, 2015 to May 28, 2015, the Veteran warrants a 10 percent rating for visual fields. His visual acuity fluctuated (as detailed above) with vision warranting 20 and 30 percent from January 6, 2015 to May 28, 2015. Providing the Veteran the greatest benefit, and considering his visual acuity as warranting a 30 percent rating for the period, then combining the 30 percent rating for visual acuity with the 10 percent rating for visual field impairment shows that the Veteran's eye disabilities warranted a 40 percent rating from January 6, 2015 to May 28, 2015. Next, the Board must determine if a higher rating is warranted for the period from May 28, 2015 now that the addendum 2021 medical opinion has shown that the Veteran's bilateral visual field impairment should be considered to have been in effect since May 28, 2015. From May 28, 2015, the Veteran's visual acuity fluctuated with readings warranting 30 percent, 20 percent, and 10 percent despite his visual acuity readings taking place just days apart. The Board finds that from May 28, 2015 to July 1, 2015 the Veteran's visual acuity more nearly approximated a 20 percent rating. Under 38 C.F.R. § 4.25 combining a 30 percent rating for visual fields impairment with a 20 percent rating for visual acuity warrants a 40 percent rating. From July 1, 2015, the Veteran's visual acuity more nearly approximates the criteria for a 10 percent rating. Under 38 C.F.R. § 4.25 combining a 30 percent rating for visual field impairment with a 10 percent rating for visual acuity warrants a 40 percent rating. As such, the Board finds that an increased 40 percent rating is warranted for the period from January 6, 2015 onward. The Board has considered whether the Veteran would warrant an increased rating under the provisions for incapacitating episodes; however, the Veteran's visits to care providers for treatment (injections and laser treatments) occurred prior to May 13, 2018 and would not be considered incapacitating episodes from 2014 to 2017 when the treatments occurred. As noted above, the Veteran's incapacitating episode for his left eye hyphema warranted a 40 percent rating from May 28, 2015 to May 31, 2016. Ratings may be provided based on visual impairment or incapacitating episodes. The Veteran's incapacitating episode would not provide him with a rating greater than 40 percent. As such, an increased rating based on incapacitating episodes is not warranted. 5. Entitlement to special monthly compensation (SMC) at the housebound rate from June 1, 2016 to January 14, 2020 is granted. (Continued on the next page) The Veteran is entitled to SMC (s) based on a single disability(coronary artery disease) rated as 100 percent disabling, with additional disabilities(eye conditions, right elbow, and peripheral neuropathy of lower extremities and right upper extremity) rated 60 percent or greater for the period from June 1, 2016 to January 14, 2020. See 38 U.S.C.§ 1114 (s); 38 C.F.R.§ 3.350(i). The Veteran is already in receipt of SMC (s) for the period from March 7, 2015 (grant of 100 percent rating for coronary artery disease) to June 1, 2016 and from January 14, 2020. This grant will provide the benefit for the entire period from the grant of his 100 percent rating for coronary artery disease. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. H. Stubbs, 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.