Citation Nr: 21041685 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 12-12 086 DATE: July 9, 2021 ORDER Entitlement to service connection for hyperlipidemia is denied. Entitlement to service connection for a skin disorder, to include as due to herbicide agent exposure, is denied. Entitlement to a compensable disability rating for erectile dysfunction is denied. Entitlement to a compensable disability rating for hypertension is denied. Entitlement to a disability rating in excess of 20 percent for diabetes mellitus is denied. Entitlement to an initial compensable disability rating for diabetic nephropathy prior to October 11, 2011 is denied. Entitlement to a disability rating in excess of 60 percent for diabetic nephropathy from October 11, 2011 is denied. Entitlement to an initial compensable disability rating for bilateral nuclear cataracts prior to April 2, 2013 is denied. Entitlement to a disability rating in excess of 10 percent for bilateral nuclear cataracts from April 2, 2013 is denied. FINDINGS OF FACT 1. Hyperlipidemia is a laboratory finding and not a disability for which VA compensation benefits are payable. 2. The Veteran's tinea pedis, which preexisted his period of active service, did not undergo any worsening during that period of active service. The Veteran has no current diagnosis of a skin disorder other than tinea pedis. 3. Throughout the period on appeal, the Veteran's erectile dysfunction has been manifested by loss of erectile power, but not by penis deformity. 4. Throughout the period on appeal, the Veteran's hypertension required continuous medication, but is not manifested by diastolic pressure predominantly 100 or more or systolic pressure predominantly 160 or more. 5. Throughout the period on appeal, the Veteran's diabetes mellitus required oral hypoglycemic agents and a restrictive diet; however, there has been no prescribed insulin or required regulation of activities. 6. Prior to October 11, 2011, the Veteran's diabetic nephropathy was acute in nature, without evidence of hyaline or granular casts, slight edema, or hypertension at least 10 percent disabling under Diagnostic Code 7101. 7. From October 11, 2011, the Veteran's diabetic nephropathy is manifested by a definite decrease in kidney function, but not by persistent edema and albuminuria with a Blood Urea Nitrogen (BUN) of 40 to 80mg% or creatinine of 4 to 8 mg%. 8. Prior to April 2, 2013 the Veteran's corrected distance vision was, at worst, 20/40 in the right eye and 20/40 in the left eye. There is no evidence of impairment of muscle function or visual field defect. 9. From April 2, 2013, the average concentric contraction of the Veteran's visual field was, at worst, 52 in the right eye and 54 in the left eye. Corrected distance was, at worst, 20/40 in the right eye and 20/40 in the left eye. There is no evidence of impairment of muscle function or documented incapacitating episodes requiring treatment within a 12-month period. CONCLUSIONS OF LAW 1. The criteria for service connection for hyperlipidemia are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 2. The criteria for service connection for a skin disorder are not met. 38 U.S.C. §§ 1110, 1111, 1113, 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306, 3.308, 3.309. 3. The criteria for a compensable disability rating for erectile dysfunction are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.115b, Diagnostic Code 7522. 4. The criteria for a compensable disability rating for hypertension are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.31, 4.104, Diagnostic Code 7101. 5. The criteria for a disability rating in excess of 20 percent for diabetes mellitus are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.119, Diagnostic Code 7913. 6. Prior to October 11, 2011, the criteria for an initial compensable disability rating for diabetic nephropathy are not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.115a, 4.115b, Diagnostic Code 7541. 7. From October 11, 2011, the criteria for a disability rating in excess of 60 percent for diabetic nephropathy are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.115a, 4.115b, Diagnostic Code 7541. 8. Prior to April 2, 2013, the criteria for a compensable disability rating for bilateral nuclear cataracts are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.75-4.78, 4.79, Diagnostic Code 6080. 9. From April 2, 2013, the criteria for a disability rating in excess of 10 percent for bilateral nuclear cataracts are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.75-4.78, 4.79, Diagnostic Code 6080. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from May 1968 to February 1971. These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) and were previously remanded by the Board in July 2018 and November 2020. In an April 2014 rating decision, the RO assigned a 60 percent disability rating for diabetic nephropathy effective October 11, 2011 and a 10 percent disability rating for bilateral nuclear cataracts effective April 2, 2013. As the rating periods regarding the issues of diabetic nephropathy prior to October 11, 2011 and from October 11, 2011 and bilateral nuclear cataracts prior to April 2, 2013 and from April 2, 2013 are not the maximum allowable, the issues remain on appeal. AB. v. Brown, 6 Vet. App. 35 (1993). The Board's November 2020 remand directed the RO to issue a supplemental statement of the case (SSOC) as to the issues on appeal. The RO issued a SSOC in March 2021. The Board finds that there has been substantial compliance with its November 2020 remand directives, and it will proceed with adjudication of the issues on appeal. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted on a presumptive basis for specific diseases associated with exposure to herbicide agents. 38 C.F.R. § 3.309(e). These disabilities will be considered to have been incurred in or aggravated by service despite any lack of evidence of such disease during service. 38 C.F.R. § 3.307(a). This presumption applies to veterans who served in the Republic of Vietnam during January 9, 1962 to May 7, 1975, even if there is no record of evidence of such disease during the period of service. See 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6). 38 C.F.R. § 3.309(f). 1. Entitlement to service connection for hyperlipidemia Based on a review of the relevant evidence, the Board finds that service connection for hyperlipidemia is not warranted. While the Veteran has a diagnosis of hyperlipidemia, this disorder is not a disability in and of itself for which VA compensation benefits are payable. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996) (providing that diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are laboratory results and are not, in and of themselves, disabilities). Although hyperlipidemia may be evidence of an underlying disability or may later cause disability, service connection may not be granted for a laboratory finding alone. A disability for VA compensation purposes refers to an impairment of earning capacity due to a disease or injury, rather than to a disease or injury itself. See Allen v. Brown, 7 Vet. App. 439 (1995). Here, the evidence of record does not suggest that the Veteran's hyperlipidemia, on its own, causes him any impairment of earning capacity. Additionally, the Veteran has not alleged, and the record does not suggest, that he has a diagnosed disability due to hyperlipidemia. In the absence of proof of a current disability for which service connection may be granted, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As hyperlipidemia is a laboratory result and does not represent a disability in and of itself, the Board finds that service connection must be denied. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Entitlement to service connection for a skin disorder, to include as due to herbicide agent exposure The Veteran asserts that his claimed skin disorder is related to his active service. Specifically, he contends that his diagnosed tinea pedis was aggravated by in-service exposure to herbicide agents. A veteran is considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior to service and was not aggravated by service. See 38 C.F.R. § 3.304. In Wagner v. Principi, 370 F.3d 1089, 1096 (2004), the United States Court of Appeals for the Federal Circuit held if a preexisting disorder is noted upon entry into service, the veteran cannot bring a claim for service connection for that disorder, but the veteran may bring a claim for service-connected aggravation of that disorder. In that case, 38 U.S.C. § 1153 applies and the burden falls on the veteran to establish an increase in disability during service. If the presumption of aggravation attaches, the burden shifts to the government to show by clear and unmistakable evidence that there has been no increase in the severity of the preexisting condition or that any increase was the result of natural progression. Id.; see also 38 C.F.R. § 3.306(b). In this case, the evidence of record, including the Veteran's March 1968 entrance examination, specifically documents the Veteran's diagnosis of tinea pedis. As a result, there is clear and unmistakable evidence that the Veteran had a preexisting skin disability prior to active service and the presumption of soundness does not attach for this disorder. See 38 U.S.C. § 1153. Next, the evidence does not reflect that the Veteran's tinea pedis worsened during active service. The Board notes that the Veteran's records reflect service in the Republic of Vietnam during the Vietnam era, thus, he is legally presumed to have been exposed to herbicide agents during his military service. However, the Veteran's service treatment records are silent for an increase in severity between his March 1968 entrance examination and his February 1971 separation examination. Specifically, these records, to include the Veteran's 1971 separation examination, contain no reports of tinea pedis or symptoms thereof after the 1968 entrance examination. As the most competent and credible evidence of record does not show an increase in the severity of the Veteran's tinea pedis during service, the presumption of aggravation does not attach. As such, a discussion of clear and unmistakable evidence to rebut the presumption of aggravation is not required. Wagner, 370 F.3d at 1096. Although the Veteran's tinea pedis preexisted service, he is not precluded from establishing service connection, as due to herbicide agent exposure, for a skin disorder other than tinea pedis with proof of actual or direct causation, when all the evidence establishes that the disease was incurred in service. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The July 2018 Board decision remanded the matter of entitlement to service connection for a skin disorder to provide the Veteran with a VA examination to determine whether he has a diagnosis of a skin disability, other than tinea pedis, which may be related to service, to include herbicide agent exposure. However, in October 2019, the Veteran cancelled his VA skin examination, indicating that he did not wish to schedule an examination. Further, in a March 2021 Report of General Information, the Veteran telephoned VA to state the he wished to have his claim adjudicated as soon as possible using only the evidence that is currently of record. The presence of a disability at any time during the claim process can justify a grant of service connection, even when the most recent diagnosis is negative. McClain v. Nicholson, 21 Vet. App. 319 (2007). However, Congress specifically has limited entitlement to service connection for disease or injury to cases where such incidents have resulted in a current disability. Here, there is simply no indication in the record, to include post-service VA and private treatment records and VA examinations, that the Veteran has a current skin disorder, other than his preexisting tinea pedis, or that he has had any such disability at any time during the appeal period. Thus, where the evidence does not support a finding of a current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In conclusion, as the Board finds that the Veteran's preexisting tinea pedis did not undergo any worsening during active service, entitlement to service connection must be denied. Additionally, taking into account all the relevant evidence of record, the Board finds that the weight of the evidence is against the Veteran's claim of service connection for a skin disorder other than tinea pedis. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Increased Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. The determination of whether an increased rating is warranted is based on review of the entire evidence of record and the application of all pertinent regulations. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. While the Veteran's entire history is reviewed when making a disability determination, where service connection has already been established and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). However, staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to a compensable disability rating for erectile dysfunction The Veteran seeks a higher disability rating for his service-connected erectile dysfunction, which is currently rated as noncompensable and included with his disability rating for diabetes mellitus under Diagnostic Code 7913. 38 C.F.R. § 4.119, Schedule of ratings endocrine system. Under Diagnostic Code 7522, a 20 percent rating is assigned for evidence of penis deformity with loss of erectile power. 38 C.F.R. § 4.115b. 3. Based on a review of the relevant evidence, the Board finds that a compensable disability rating for erectile dysfunction is not warranted. Specifically, the September 2009 and March 2013 VA examiners found that the Veteran's erectile dysfunction causes loss of erectile power. However, the examiners did not find evidence of penis deformity. Moreover, post-service VA and private treatment records for the period on appeal are silent for evidence of penis deformity. Here, the 2009 and 2013 VA examinations and post-service treatment records reflect loss of erectile power, which is consistent with the current noncompensable disability rating assigned under Diagnostic Code 7913, as part of the Veteran's disability rating for diabetes mellitus. The probative evidence of record does not demonstrate that the Veteran's erectile dysfunction causes penis deformity. Accordingly, a compensable disability rating is not warranted. In conclusion, as the Board finds that the preponderance of the evidence is against the Veteran's claim for a compensable disability rating for erectile dysfunction, the claim must be denied. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Entitlement to a compensable disability rating for hypertension The Veteran seeks a higher disability rating for his service-connected hypertension, which is currently rated as noncompensable and included with his disability rating for diabetes mellitus under Diagnostic Code 7913. 38 C.F.R. § 4.119, Schedule of ratings endocrine system. Under Diagnostic Code 7101 (Hypertensive vascular disease), a 10 percent rating is assigned for diastolic pressure predominately 100 or more or systolic pressure predominantly 160 or more or minimum evaluation for a history of diastolic blood pressure predominately 100 or more requiring continuous medication. 38 C.F.R. § 4.104, Schedular of ratings cardiovascular system. A 20 percent rating is assigned for diastolic readings of predominantly 110 or more or systolic readings of 200 or more. Id. A 40 percent rating is assigned for diastolic readings of predominantly 120 or more. Id. A 60 percent rating, the highest schedular rating allowed, is assigned for diastolic readings of predominantly of 130 or more. Id. Based on a review of the relevant evidence, the Board finds that a compensable disability rating for the Veteran's hypertension is not warranted. While the medical evidence of record for the period on appeal reflects that the Veteran is treated with medication to manage his hypertension, a 10 percent rating also requires a history of diastolic pressure predominantly 100 or more. Here, out of the numerous blood pressure readings recorded throughout the Veteran's post-service VA and private treatment records and the September 2009 and March 2013 VA examinations, none reflect diastolic pressure predominantly 100 or more, nor do they demonstrate systolic pressure predominantly 160 or more. Specifically, diastolic readings predominantly range between 105 to 152, and systolic readings predominantly range between 58 and 90. While the Board acknowledges two systolic readings in the Veteran's post-service treatment records over 160, specifically, August 2016 and August 2017, these were isolated instances, as the Veteran's systolic readings recorded prior to and after these instances remained predominantly well below 160 throughout the period on appeal. The Board acknowledges that it may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria. See Jones v. Shinseki, 26 Vet. App. 56, 62-63 (2012). However, where the plain language of the diagnostic code contemplates the effects of medication, Jones is not applicable. See McCarroll v. McDonald, 28 Vet. App. 267, 271-73 (2016) (the Board may properly consider ameliorative effects of blood pressure medication in adjudicating claims for increased ratings for hypertension, because medication is specifically mentioned in Diagnostic Code 7101). In sum, there is no evidence to support a finding of diastolic pressure predominantly 100 or more or systolic pressure predominantly 160 or more to warrant a compensable disability rating for the Veteran's hypertension under Diagnostic Code 7101. Accordingly, as the Board finds that the preponderance of the evidence is against the Veteran's claim for a compensable disability rating for hypertension, the claim must be denied. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 4. Entitlement to a disability rating in excess of 20 percent for diabetes mellitus The Veteran seeks a higher disability rating for his service-connected diabetes mellitus, which is currently rated as 20 percent disabling under Diagnostic Code 7913. 38 C.F.R. § 4.119, Schedule of ratings endocrine system. Under Diagnostic Code 7913, the next-higher 40 percent rating is assigned for evidence of diabetes which requires insulin, a restricted diet, and regulation of activities. 38 C.F.R. § 4.119. Diagnostic Code 7913 provides that compensable complications of diabetes are to be rated separately unless they are part of the criteria used to support a 100 percent rating, and that noncompensable complications are considered part of the diabetic process. Id. at Note 1. Because of the successive nature of the rating criteria for diabetes, e.g., the evaluation for each higher disability rating includes the criteria of each lower disability rating, each of the three criteria listed in the 40 percent rating must be met in order to warrant such a rating. See Tatum v. Shinseki, 23 Vet. App. 152, 156 (2009). Stated another way, if a component is not met at any one level, a veteran can only be rated at the level that did not require the missing component. Id. Competent medical evidence is required to establish "regulation of activities," namely, prescribed avoidance of strenuous occupational and recreational activities, for a 40 percent rating under Diagnostic Code 7913. See Camacho v. Nicholson, 21 Vet. App. 360, 364 (2007). Based on a review of the relevant evidence, the Board finds that a disability rating in excess of 20 percent for diabetes mellitus is not warranted. Specifically, during the September 2009 and March 2013 VA examinations, the examiners found that the Veteran's diabetes is treated with prescribed oral hypoglycemic agents. The examiners found no history of regulation in the Veteran's activities as part of the medical management of his diabetes. Although the March 2013 VA examiner noted complications of diabetic nephropathy, diabetic peripheral neuropathy, and erectile dysfunction in relation to the Veteran's diabetes, these disabilities have already been service-connected and are rated separately. Additionally, post-service VA and private treatment records for the period on appeal reflect that the Veteran's diabetes is treated with oral hypoglycemic agents, as well as a restricted diet, and they are silent for evidence of regulation of activities to manage his diabetes. While the Veteran self-reported during his March 2013 VA examination that his diabetes requires restriction from walking and other forms of exercise, post-service VA treatment records reflect that the Veteran was consistently encouraged by VA physicians to exercise to manage his diabetes. Here, the 2009 and 2013 VA examinations and post-service VA and private treatment records reflect that management of the Veteran's diabetes requires treatment with prescribed oral hypoglycemic agents and a restricted diet, which is consistent with the current 20 percent disability rating assigned under Diagnostic Code 7913. While VA attempted to schedule the Veteran for a recent examination to determine the current severity of his diabetes mellitus, the Veteran cancelled the examination in March 2021. Further, in a March 2021 Report of General Information, he telephoned VA to state the he wished to have his claim adjudicated as soon as possible using only the evidence that is currently of record. Here, the probative evidence of record does not demonstrate that the Veteran requires prescribed insulin and regulation of activities to treat his diabetes. Accordingly, as the three criteria listed in the 40 percent rating are not met, a higher disability rating is not warranted. In conclusion, as the Board finds that the preponderance of the evidence is against the Veteran's claim for a disability rating in excess of 20 percent for diabetes mellitus, the claim must be denied. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 5. Entitlement to an initial compensable disability rating for diabetic nephropathy prior to October 11, 2011 6. Entitlement to a disability rating in excess of 60 percent for diabetic nephropathy from October 11, 2011 The Veteran seeks higher disability ratings for his service-connected diabetic nephropathy, which is currently rated as noncompensable (zero percent rating) prior to October 11, 2011 and is included with his disability rating for diabetes mellitus under Diagnostic Code 7913. 38 C.F.R. § 4.119, Schedule of ratings endocrine system. From October 11, 2011, this disability is rated as 60 percent disabling under Diagnostic Code 7541, Ratings of the genitourinary system, Renal involvement in diabetes mellitus. 38 C.F.R. § 4.115b. Diagnostic Code 7541 instructs to rate diabetic nephropathy under the rating criteria for renal dysfunction. Under the criteria for renal dysfunction, a 30 percent disability rating is assigned for evidence of albumin constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema or hypertension at least 10 percent disabling under Diagnostic Code 7101. 38 C.F.R. § 4.119a. A 60 percent disability rating is assigned for evidence of constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under Diagnostic Code 7101. Id. An 80 percent disability rating is assigned for evidence of persistent edema and albuminuria with BUN 40 to 80mg%; or, creatinine 4 to 8mg%; or generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion. Id. A 100 percent disability rating is assigned for evidence of a requirement for regular dialysis; or, precluding more than sedentary activity from one of the following: persistent edema and albuminuria; or, BUN more than 80mg%; or, creatinine more than 8mg%; or, markedly decreased function of kidney or other organ systems, especially cardiovascular. Id. Rating period prior to October 11, 2011 Turning first to the period on appeal prior to October 11, 2011, based on a review of the relevant evidence, the Board finds that an initial compensable disability rating for diabetic nephropathy is not warranted. For a compensable disability rating to be warranted during this period of time, the evidence must show, at minimum, albumin constant or recurring with hyaline and granular casts or red blood cells, transient or slight edema, or hypertension at least 10 percent disabling under Diagnostic Code 7101. Here, the evidence prior to October 11, 2011, to include the September 2009 VA examination and post-service VA and private treatment records, reflects that the Veteran's diabetic nephropathy was acute in nature. The 2009 VA examination diagnosed the Veteran with diabetic nephropathy. However, laboratory urinalysis results showed that his albumin, BUN, and creatinine levels were within normal range, and no hyaline casts were found. Post-service treatment records prior to October 11, 2011 also reflect normal urinalysis results regarding albumin, BUN, creatinine, and cast levels. Moreover, the Veteran is not in receipt of a 10 percent disability rating for his service-connected hypertension. As the probative evidence of record prior to October 11, 2011 does not demonstrate that the Veteran's diabetic nephropathy is manifested by symptoms of albumin constant or recurring with hyaline and granular casts or red blood cells, transient or slight edema, or hypertension at least 10 percent disabling under Diagnostic Code 7101, the currently assigned noncompensable disability rating as part of the Veteran's disability rating for diabetes mellitus under Diagnostic Code 7913 is appropriate for diabetic nephropathy and a higher disability rating is not warranted. Rating period from October 11, 2011 For the period on appeal from October 11, 2011, based on a review of the relevant evidence, the Board finds that a disability rating in excess of 60 percent for diabetic nephropathy is not warranted. For the next-higher 80 percent disability rating to be warranted, the evidence must show persistent edema and albuminuria with BUN 40 to 80mg%, creatinine 4 to 8mg%, or generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation or exertion. Here, the evidence from October 11, 2011 to the present, to include the March 2013 VA examination and post-service VA and private treatment records, reflects a definite decrease in kidney function. While, the 2013 VA examination indicates no evidence of renal dysfunction and shows laboratory urinalysis results with BUN and creatinine levels within normal range, post-service treatment records for the period on appeal reflect that the Veteran is in mild renal failure, but with BUN and creatinine levels well below 40mg% and 8mg%. While post-service treatment records reflect BUN, creatinine, and albumin levels that are on the higher side of the normal range, they remain within normal limits. Further, these medical records are silent for evidence of persistent edema and albuminuria. The 2013 VA examiner found the Veteran to be well-developed and well-nourished. While VA attempted to schedule the Veteran for a recent examination to determine the current severity of his diabetic nephropathy, the Veteran cancelled the examination in March 2021. Further, in a March 2021 Report of General Information, he telephoned VA to state the he wished to have his claim adjudicated as soon as possible using only the evidence that is currently of record. As the probative evidence of record from October 11, 2011 to the present does not demonstrate that the Veteran's diabetic nephropathy is manifested by symptoms of persistent edema and albuminuria with BUN 40 to 80mg%, or creatinine 4 to 8mg%, or generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion, the current 60 percent disability rating assigned is appropriate and a higher disability rating is not warranted In sum, as the Board finds that the preponderance of the evidence is against the Veteran's claims for an initial compensable disability rating for diabetic nephropathy prior to October 11, 2011 and a disability rating in excess of 60 percent for diabetic nephropathy from October 11, 2011, the claims must be denied. In denying such ratings, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 7. Entitlement to an initial compensable disability rating for bilateral nuclear cataracts prior to April 2, 2013 8. Entitlement to a disability rating in excess of 10 percent for bilateral nuclear cataracts from April 2, 2013 The Veteran seeks higher ratings for his service-connected bilateral nuclear cataracts. Prior to April 2, 2013, this disability is rated as noncompensable (zero percent rating) and is included with his disability rating for diabetes mellitus under Diagnostic Code 7913. 38 C.F.R. § 4.119, Schedule of ratings endocrine system. From April 2, 2013, this disability is rated as 10 percent disabling under Diagnostic Code 6080 (Visual field defects). 38 C.F.R. § 4.79, Schedule of ratings eye. 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, Diagnostic Code 6027 (Cataract) instructed to evaluate preoperative cataracts and postoperative cataracts where a replacement lens is present (pseudophakia) based on visual impairment, while postoperative cataracts without a replacement lens were to be evaluated under Diagnostic Code 6029, aphakia. 38 C.F.R. § 4.79. Under the revised criteria, Diagnostic Code 6027 instructs to evaluate preoperative cataracts and postoperative cataracts where a replacement lens is present under the General Rating Formula for Diseases of the Eye, while postoperative cataracts without a replacement lens are to be evaluated under Diagnostic Code 6029. 38 C.F.R. § 4.79. Both the former and revised criteria provide for consideration of visual impairment, which is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75(a). The amendments made no substantive changes to how visual acuity is rated. With regard to visual field and muscle function examinations, the use of a Goldmann chart is no longer required. There are otherwise no substantive changes to how those types of visual impairment are rated. Under both the former and revised criteria for Diagnostic Code 6066, visual acuity, a 10 percent rating is warranted when visual acuity in one eye (the poorer eye) is 20/50, and vision in the other eye is 20/50; when visual acuity in one eye (the poorer eye) is 20/70, and vision in other eye is 20/40; or when visual acuity in one eye (the poorer eye) is 20/100, and vision in the other eye is 20/40. 38 C.F.R. § 4.79. A 20 percent rating is warranted when visual acuity in one eye (the poorer eye) is 20/70, and vision in the other eye is 20/50; when visual acuity in one eye (the poorer eye) is 20/100, and vision in other eye is 20/50; when visual acuity in one eye (the poorer eye) is 20/200, and vision in the other eye is 20/40; or when visual acuity in one eye (the poorer eye) is 15/200, and vision in the other eye is 20/40. 38 C.F.R. § 4.79. Regarding impairment of the field of vision, 38 C.F.R. § 4.76a, Table III, provides that the normal visual field extant at the 8 principal meridians totals 500 degrees. The normal values for the 8 principal meridians are as follows: 85 degrees temporally; 85 degrees down temporally; 65 degrees down; 50 degrees down nasally; 60 degrees nasally; 55 degrees up nasally; 45 degrees up; and 55 degrees up temporally. The extent of visual field contraction in each eye is determined by recording the extent of the remaining visual fields in each of the eight principal meridians. Under both the former and revised criteria for Diagnostic Code 6080, when the remaining visual field is 46 to 60 degrees bilaterally or unilaterally, a 10 percent disability rating is assigned, or each affected eye may be evaluated as 20/50. 38 C.F.R. § 4.79. When the remaining visual field is 31 to 45 degrees unilaterally or bilaterally, 10 percent and 30 percent disability ratings are assigned respectively, or each affected eye may be evaluated as 20/70. Id. When the remaining visual field is 16 to 30 degrees unilaterally or bilaterally, 10 percent and 50 percent disability ratings are assigned respectively, or each affected eye may be evaluated as 20/100. Id. When the remaining visual field is 6 to 16 degrees unilaterally or bilaterally, 20 percent and 70 percent disability ratings are assigned respectively, or each affected eye may be evaluated as 20/200. Id. When both decreased visual acuity and visual field defect are present in one or both eyes and are service connected, the visual acuity and visual field defect are separately evaluated and combined under the provisions of 38 C.F.R. § 4.25. 38 C.F.R. § 4.77(c). The General Rating Formula for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to a particular condition or incapacitating episodes, whichever results in a higher evaluation. Under the amended regulations, where there are documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months, a 10 percent rating is assigned. 38 C.F.R. § 4.79. When 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 assigned. Id. Rating period prior to April 2, 2013 Turing first to the period on appeal prior to April 2, 2013, based on a review of the relevant evidence, the Board finds that an initial compensable disability rating for bilateral nuclear cataracts is not warranted. As the rating period on appeal prior to April 2, 2013 predates May 13, 2018, when the amended regulations went into effect, only the former criteria under Diagnostic Code 6027 are for consideration. As the Veteran's right eye and left eye cataracts are preoperative, Diagnostic Code 6027 instructs to evaluate the Veteran's bilateral cataracts based on visual impairment. For a compensable disability rating to be warranted prior to April 2, 2013, the evidence must show corrected distance measuring at least 20/50 in one eye and at least 20/40 in the other eye, impairment of muscle function, or a visual field defect. Here, the medical evidence of record, to include the September 2009 VA examination and post-service VA and private treatment records, fails to show these criteria. Specifically, the September 2009 VA examination reflects corrected distance measuring 20/25 in the right eye and 20/25 in the left eye. The examiner found no evidence of impairment of muscle function or a visual field defect. Further, post-service VA and private treatment records for this period on appeal are silent for evidence of visual acuity of at least 20/50 in one eye and 20/40 in the other eye, nor does the evidence reflect a visual field defect or impairment of muscle function, to include diplopia. Therefore, the currently assigned initial noncompensable disability rating as part of the Veteran's disability rating for diabetes mellitus under Diagnostic Code 7913 is appropriate for bilateral nuclear cataracts prior to April 2, 2013, and the Veteran is not entitled to a higher disability rating. Rating period from April 2, 2013 Turning next to the period on appeal from April 2, 2013, based on a review of the relevant evidence, the Board finds that a disability rating in excess of 10 percent for bilateral nuclear cataracts is not warranted. As the amended regulations went into effect during the rating period on appeal, both the former and revised criteria under Diagnostic Code 6027 are for consideration. As the Veteran's right eye and left eye cataracts are preoperative, under the former criteria, Diagnostic Code 6027 instructs to evaluate the Veteran's bilateral cataracts based on visual impairment. Under the revised criteria, Diagnostic Code 6027 instructs to evaluate the Veteran's bilateral cataracts based on the General Rating Formula for Diseases of the Eyes, which instructs to evaluate on the basis of either visual impairment or incapacitating episodes. For the next-higher 20 percent rating to be warranted from April 2, 2013, the evidence must show corrected distance measuring at least 20/70 in one eye and at least 20/50 in the other eye, impairment of muscle function, or a visual field defect. Specifically, the medical evidence of record, to include the April 2013 VA examination and post-service VA and private treatment records, reflects corrected distance measuring no more than 20/40 in the right eye and 20/40 in the left eye. When applying visual acuity of 20/40 for the right eye and 20/40 for the left eye, under Diagnostic Code 6066, a noncompensable disability is warranted for visual acuity. Additionally, the April 2013 VA examiner indicated the presence of bilateral visual field defects. For the 2013 VA examination, perimetry as to the Veteran's right and left eyes showed the remaining visual fields were, in degrees: Meridian Normal degrees Right Eye Left Eye Temporally 85 75 72 Down temporally 85 65 65 Down 65 58 60 Down nasally 50 42 50 Nasally 60 45 55 Up nasally 55 43 43 Up 45 36 40 Up temporally 55 53 50 Total 500 417 435 Adding the remaining visual field for the Veteran's right eye at each principal meridian results in a total remaining visual field of 417 degrees. Dividing 417 by 8 and rounding to the nearest whole number, results in an average concentric contraction of 52 degrees of the visual field for the right eye. Adding the remaining visual field for the Veteran's left eye at each principal meridian results in a total remaining visual field of 435 degrees. Dividing 435 by 8 and rounding to the nearest whole number, results in an average concentric contraction of 54 degrees of the visual field for the left eye. The Veteran's visual field defect may be evaluated based on either remaining visual field degrees or based on visual acuity assigned for remaining visual field degrees, whichever results in the higher rating. As the Veteran's remaining visual field during the period on appeal was, at worst, 52 degrees, in his right eye and 54 degrees in his left eye, a 10 percent rating is warranted for bilateral visual field defect with remaining visual field for both eyes between 46 and 60 degrees. However, remaining visual field criteria also instructs to evaluate the Veteran's right eye and left eye each as 20/50, as his average remaining visual field is 52 degrees in the right eye and 54 degrees in the left eye (when remaining visual field is 46 to 60 degrees, each affected eye is evaluated as 20/50). When applying visual acuity of 20/50 for the right eye and 20/50 for the left eye to determine visual field defect, a 10 percent rating would be warranted. Thus, taking the higher of the two evaluations (10 percent based on a bilateral rating for remaining visual field of 52 degrees for the right eye and remaining visual field of 54 degrees for the left eye, or 10 percent based on applying visual acuity of 20/50 for the right eye and 20/50 for the left eye), here, both instances result in a 10 percent evaluation for bilateral visual field defect under Diagnostic Code 6080. To the determine the evaluation for visual impairment when both decreased visual acuity and visual field defect are present, VA separately evaluates the visual acuity and visual field defect (expressed as a level of visual acuity) and combines them under the provisions of 38 C.F.R. § 4.25. Thus, when combining the Veteran's noncompensable (zero percent) disability rating for his visual acuity impairment with his 10 percent disability rating for his bilateral visual field defect, a 10 percent disability rating is achieved. Therefore, the currently assigned 10 percent disability rating for bilateral nuclear cataracts from April 2, 2013 under Diagnostic Code 6080 is appropriate, and the Veteran is not entitled to a higher disability rating. The Board has considered whether a higher disability rating is warranted for the Veteran's bilateral nuclear cataracts under another diagnostic code. Here, the medical evidence of record fails to show a finding of impairment of muscle function, to include diplopia, or any documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for the Veteran's bilateral cataracts within a 12-month period. Therefore, the Veteran is not entitled to a higher disability rating from April 2, 2013. (Continued on the next page) In sum, as the Board finds that the preponderance of the evidence is against the Veteran's claims for an initial compensable disability rating for bilateral nuclear cataracts prior to April 2, 2013 and a disability rating in excess of 10 percent for bilateral nuclear cataracts from April 2, 2013, the claims must be denied. In denying such ratings, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Houle, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.