DERMATITIS OR ECZEMA

RICHARD KETTLER · 2022 · Case ID: 22012047

MIXED

Summary

The veteran, who served honorably in the U.S. Air Force from May 1982 to May 2008, appeals the denial of a compensable rating for pseudofolliculitis barbae (PFB) and an increased rating for bilateral tinea pedis and open-angle glaucoma. The Board granted a 10 percent rating for bilateral tinea pedis prior to December 25, 2009, and a 30 percent rating from December 25, 2009, to December 25, 2010, based on the need for intermittent and then continuous systemic therapy. However, after December 25, 2010, the veteran's tinea pedis only required topical therapy and affected less than 5 percent of his body, thus warranting a non-compensable rating. For PFB, despite the veteran's contentions of worsening symptoms and laser treatment, the Board found the evidence persuasively weighed against a compensable rating under both pre- and post-August 13, 2018, criteria, as the condition consistently affected less than 5 percent of his body and did not require systemic therapy. Regarding open-angle glaucoma, the Board denied an increased rating beyond 10 percent, noting that while continuous medication was required and visual field defects warranted a 10 percent evaluation, the veteran's visual acuity remained 20/40 or better bilaterally, and no incapacitating episodes requiring treatment visits were documented.

Rationale

Intermittent systemic therapy prior to 12/25/2009 met criteria for 10% rating.; Continuous systemic therapy for 3 months (more than 6 weeks) from 12/25/2009 to 12/25/2010 met criteria for 30% rating.; No systemic therapy after 12/25/2010 and less than 5% body involvement warranted non-compensable rating.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

16-11 745

Full Decision Text

Citation Nr: 22012047
Decision Date: 03/02/22 Archive Date: 03/02/22

DOCKET NO. 16-11 745
DATE: March 2, 2022

ORDER

Entitlement to a 10 percent rating prior to December 25, 2009 for bilateral tinea pedis is granted.

Entitlement to a 30 percent rating for bilateral tinea pedis from December 25, 2009 to December 25, 2010 is granted.

Entitlement to a compensable rating for bilateral tinea pedis after December 25, 2010 is denied.

Entitlement to a compensable rating pseudofolliculitis barbae (PFB) is denied.

Entitlement to a rating higher than 10 percent for open angle glaucoma is denied.

FINDINGS OF FACT

1. Prior to December 25, 2009, the Veteran's bilateral tinea pedis required intermittent systemic therapy for less than six weeks and covered less than 5 percent of his entire body, with less than 5 percent of his exposed areas affected.

2. From December 25, 2009 to December 25, 2010, the Veteran's bilateral tinea pedis required systemic therapy for a total duration of six weeks or more, but not constantly and covered less than 5 percent of his entire body, with less than 5 percent of his exposed areas affected.

3. After December 25, 2010, the Veteran's bilateral tinea pedis required no more than topical therapy and covered less than 5 percent of his entire body, with less than 5 percent of his exposed areas affected.

4. During the entire review period, the Veteran's pseudofolliculitis barbae (PFB) has been manifested by less than 5 percent of his entire body and less than 5 percent of exposed areas, with no more than topical therapy required during the past 12-month period.

5. The Veteran's open angle glaucoma is productive of visual acuity no worse than 20/40 and bilateral concentric contraction of visual field no worse than 48 degrees of visual field preserved in the right eye and 51 degrees of visual field preserved in the left eye, but no muscle dysfunction or incapacitating episodes.

CONCLUSIONS OF LAW

1. The criteria for a 10 percent rating prior to December 25, 2009 for bilateral tinea pedis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7813-7806.

2. The criteria for a 30 percent rating from December 25, 2009 to December 25, 2010 for bilateral tinea pedis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7813-7806.

3. The criteria for a compensable rating after December 25, 2010 has not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7813-7806.

4. The criteria for a compensable disability rating for pseudofolliculitis barbae (PFB) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7899-7806.

5. The criteria for entitlement to a rating higher than 10 percent for open angle glaucoma have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.79, Diagnostic Code 6013.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served honorably in the U.S. Air Force from May 1982 to May 2008. These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2009 rating decision of a Department of Veterans Affairs (RO) Regional Office (RO) in Pittsburgh, Pennsylvania. The claims were previously remanded by the Board in January 2019.

Increased Rating

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule). 38 U.S
4.3, 4.6, 4.7, 4.79, Diagnostic Code 6013.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

Increased Rating

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. Part 4. Ratings are assigned based on the average impairment of earning capacity resulting from a service-connected disability. 38 C.F.R. § 4.1. Where two disability ratings are potentially applicable, 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. All reasonable doubt material to the determination is resolved in the Veteran's favor. 38 C.F.R. § 4.3.

In deciding this appeal, the Board has considered whether separate ratings are warranted for different periods of time, based on the facts found, a practice known as "staged" ratings that is employed irrespective of whether an initial or established rating. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008).

1. Entitlement to a 10 percent rating prior to December 25, 2009 for bilateral tinea pedis is granted.

2. Entitlement to a 30 percent rating for bilateral tinea pedis from December 25, 2009 to December 25, 2010 is granted.

3. Entitlement to a compensable rating for bilateral tinea pedis after December 25, 2010 is denied.

4. Entitlement to a compensable rating pseudofolliculitis barbae (PFB) is denied.

The Veteran contends that he is entitled to a compensable rating for both his PFB and his bilateral tinea pedis. Of note, he contended in his May 2018 informal hearing presentation (IHP) that his skin disabilities covered more than 40 percent of his exposed skin of the face and neck. He further contended that his feet were more irritated and painful, resulting in an impact on his daily living.

The Veteran's bilateral tinea pedis and PFB are both rated under Diagnostic Code 7806, which is the General Rating Formula for skin conditions. Specifically, the Veteran's tinea pedis is rated under Diagnostic Codes 7813-7806, which is for dermatophytosis rated as dermatitis. Diagnostic Code 7813 provides ratings for dermatophytosis (or ringworm) in various locations on the body, including the body (tinea corporis), the head (tinea capitis), the feet (tinea pedis), the beard (tinea barbae), the nails (tinea unguium), and the inguinal area, also known as jock itch (tinea cruris).

Diagnostic Code 7813 provides that dermatophytosis is to be rated as disfigurement of the head, face, or neck (Diagnostic Code 7800), scars (Diagnostic Codes 7801, 7802, 7803, 7804, or 7805), or dermatitis (Diagnostic Code 7806), depending upon the predominant disability. 38 C.F.R. § 4.118. Scarring is not noted in the treatment record; therefore, the Board will rate based on dermatitis. PFB is not listed in the rating schedule, therefore has been rated by analogy to dermatitis under Diagnostic Code 7806.

VA amended the criteria for rating skin disabilities effective from August 13, 2018. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after August 13, 2018. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period
criteria for rating skin disabilities effective from August 13, 2018. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after August 13, 2018. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal.

Prior to August 13, 2018, under Diagnostic Code 7806, a noncompensable rating is assigned for less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and; no more than topical therapy required during the past 12 months. A 10 percent rating is assigned for at least 5 percent, but less than 20 percent, of the entire body, or; at least 5 percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. A 30 percent rating is assigned for 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly during the past 12-month period. A 60 percent rating is assigned for more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or constant or near- constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12- month period.

For claims filed prior to August 13, 2018, the Court held that a systematic therapy is one that that affects the entire body in its treatment of the condition at issue, and that the Board must determine (1) whether a topical treatment affects the body as a whole in treating a veteran's skin condition; and (2) whether the given treatment is "like" a corticosteroid or other immunosuppressive drug." Burton v. Wilkie, 30 Vet. App. 286 (2018). Only the second question need be addressed if the treatment is clearly systemic. Id.

Effective August 13, 2018, VA regulations explicitly state that systemic therapy is treatment that is administered through any route other than the skin, and topical therapy is treatment that is administered through the skin. 38 C.F.R. § 4.118(a).

Additionally, effective August 13, 2018, a new General Rating Formula for the Skin applies to Diagnostic Codes 7806, 7809, 7813 to 7816, 7820 to 7822, and 7824. See 38 C.F.R. § 4.118. Under this formula, a noncompensable rating is assigned for no more than topical therapy required over the past 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected. A 10 percent rating is assigned for at least one of the following: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12- month period. A 30 percent rating is assigned at least one of the following: characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is assigned for at least one of the following
VA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12- month period. A 30 percent rating is assigned at least one of the following: characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is assigned for at least one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. Or rate as disfigurement of the head, face, or neck (Diagnostic Code 7800) or scars (Diagnostic Codes 7801, 7802, 7803, 7804, or 7805), depending on the predominant disability. 38 C.F.R. § 4.118, General Rating for the Skin for Diagnostic Codes 7806, 7809, 7813-7816, 7820-7822, and 7824.

Bilateral tinea pedis

Entitlement to a 10 percent rating prior to December 25, 2009 for bilateral tinea pedis is granted.

In April 2009, the Veteran underwent a VA examination in which it was recommended that he treat his bilateral tinea pedis with systemic therapy. The April 2009 examiner provided examples of such therapies including Itraconazol, or Terbinafin. To this end, the examiner also noted the Veteran was currently (in 2009) being treated intermittently with the oral systemic antifungal medication Fluconazole to treat his bilateral tinea pedis. This is also noted in the Veteran's subsequent September 2015 VA examination. Thus, the Board finds the Veteran is entitled to a 10 percent rating prior to December 25, 2009 for his bilateral tinea pedis.

Entitlement to a 30 percent rating for bilateral tinea pedis from December 25, 2009 to December 25, 2010 is granted.

Beginning December 25, 2009 until December 25, 2010, for the following reasons, the Board finds the Veteran is entitled to a higher 30 percent rating for his bilateral tinea pedis. A March 25, 2010 treatment note indicates that the Veteran had been taking Lamisil continuously for the previous three months (so, since at least December 25, 2009). Notably, Terbinafin is the generic name for Lamisil. Both drugs, as noted by the April 2009 examiner are types of systemic antifungal medications commonly used to treat conditions like tinea pedis. Consequently, the Veteran is entitled to a higher 30 percent from December 25, 2009 to December 25, 2010, as the Veteran was prescribed systemic therapy to treat his bilateral tinea pedis for a total duration of six weeks or more (in this case, three months), but not constantly during the 12-month period from December 25, 2009 to December 25, 2010.

Entitlement to a compensable rating for bilateral tinea pedis after December 25, 2010 is denied.

After December 25, 2010, treatment records and VA examinations do not indicate that the Veteran received systemic treatment for his bilateral tinea. In fact, in March 2016, treatment notes specifically indicate that, while the Veteran was previously treated with oral Lamisil, that he did not wish to have oral treatment at that time. Subsequent VA examinations similarly note the Veteran was instead provided topical treatments.

In total, the Veteran was afforded VA examinations in April 2008, April 2009, March 2010, September 2015, and March 2021. The Board acknowledges that in his May 2016 IHP, the Veteran reported experienced bleeding of the feet due to his skin condition. Indeed, treatment notes have indicated the Veteran's feet are intermittently dry with thickened skin and a March 2010 VA examiner notes the Veteran reported bleeding as a result of cracking and scaling. Notably, however, at the time of the September 2015 VA examination, the examiner noted that the Veteran's tinea pedis covered less than 5 percent of the Veteran's exposed body area and did not reflect that the Veteran experienced pain or bleeding of the feet. Later treatment notes do not indicate the Veteran's feet bled as a result of his skin condition and his March 2021 VA examination was similarly silent as to bleeding of the feet. Moreover, the Veteran reported using over the counter, topical antifungal spray (Naftifine 1% cream), in other words, did not use systemic treatment.

While the systemic treatments described above in previous sections were noted during several of these examinations, examiners consistently indicated that the Veteran's bilateral tinea pedis covered less than 5 percent of his entire body, with less than 5 percent of his exposed areas affected. No scarring was noted. This is also reflected in treatment records, as treatment providers have also consistently indicated the condition is located solely on the Veteran's feet. Consequently, as systemic therapies are not noted after March 25, 2010, and the Veteran's condition is not noted to affect at least 5 percent of his total body or total exposed area, a compensable rating after December 25, 2010 is unwarranted.

PFB

As previously noted, the Veteran was afforded VA examinations in April 2008, April 2009, March 2010, September 2015, and March 2021 to assess his skin conditions, including his PFB. While the systemic treatments for his bilateral tinea pedis described above were noted during several of these examinations, examiners did not indicate such treatments were needed for his PFB. Similarly, the Veteran's PFB has consistently been found to cover less than 5 percent of his entire body, with less than 5 percent of his exposed areas affected and without scarring that would warrant consideration under a different diagnostic code. This is also reflected in treatment records, as treatment providers have also consistently indicated the condition is located solely on his beard area and have resulted in the need to shave less often and use topical treatments.

As his May 2016 statement was construed as an indication his condition was worsening, the Veteran was afforded an additional VA examination in March 2021. As to his PFB, he reported experiencing small reddish papules and ingrown hair of his beard area after shaving. He has asserted that these papules cover nearly 40 percent of his body. Treatment records also indicate he received laser treatment for this condition and is using topical hydrocortisone cream. The March 2021 examiner noted that the Veteran's PFB covered less than 5 percent of the Veteran's body (including exposed and total). As to the PFB, the examiner noted small reddish papules and ingrown hair on the Veteran's neck and cheek region. As to the tinea pedis, the examiner noted peeling and thickening of the skin in the plantar and interdigital area of the Veteran's feet. No scarring was noted, and treatment records are silent for evidence of scarring that can be attributed to either condition throughout the review period.

Consequently, as to the Veteran's PFB, the Board finds that the evidence of record persuasively weighs against the assignment of a compensable evaluation under the pre-August 13, 2018, regulations because the Veteran's PFB does not separately more nearly approximate at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or; require intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period.

The Board also finds that the evidence of record persuasively weighs against the assignment of a compensable evaluation under the August 13, 2018, regulations because the Veteran's PFB does not more nearly approximate characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than
5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or; require intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period.

The Board also finds that the evidence of record persuasively weighs against the assignment of a compensable evaluation under the August 13, 2018, regulations because the Veteran's PFB does not more nearly approximate characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy required for a total duration of less than 6 weeks over the past 12- month period.

The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms, to include his May 2016 statement indicating his symptoms had worsened, and his reports are credible. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, medical treatment records do not show that the Veteran's disability more nearly approximates the criteria in the next higher rating.

The Board has considered whether any other Diagnostic Codes related to disabilities of the skin would provide for a higher disability evaluation. However, the evidence does not reflect that he would warrant a higher rating under a different diagnostic code. See 38 C.F.R. § 4.118.

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a compensable rating for PFB. As the evidence of record persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, No. 2020-2067, 2021 U.S. App. LEXIS 37307 (Fed. Cir. Dec. 17, 2021).

In contrast, as to the Veteran's tinea pedis, the Board does find that prior to December 25, 2009, the Veteran was treated intermittently for less than six weeks with the oral systemic antifungal medication Fluconazole; consequently, a 10 percent rating during this period is warranted. From December 25, 2009 to December 25, 2010, the Veteran received systemic treatment for approximately three months, therefore meeting the criteria for a higher 30 percent rating. Finally, because the Veteran required no more than topical therapy and covered less than 5 percent of his entire body, with less than 5 percent of his exposed areas affected, a noncompensable rating is warranted after December 25, 2010.

Consequently, as to the Veteran's bilateral tinea pedis, the Board finds that the evidence of record weighs in favor of the assignment of a 10 percent evaluation prior to December 25, 2009; a 30 percent evaluation from December 25, 2009 to December 25, 2010. A compensable evaluation after December 25, 2010, however, is denied.

5. Entitlement to a rating higher than 10 percent for open angle glaucoma

The Veteran seeks an initial rating in excess of 10 percent for his primary open-angle glaucoma.

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.

Both the former and revised criteria indicate that a minimum 10 percent rating was warranted if continuous medication is required. The Board notes that the Veteran has been prescribed continuous medication throughout the review period.

Under the former criteria, Diagnostic Code 6013 instructed to evaluate pursuant to visual impairment due to open-angle glaucoma.

Under the revised criteria, Diagnostic Code 6013 instructs to evaluate pursuant to the General Rating Formula for Diseases of the Eye.

The General Rating Formula for Diseases of the Eye instructs to evaluate a condition based on visual impairment or its rating criteria for incapacitating episodes.
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 6013 instructed to evaluate pursuant to visual impairment due to open-angle glaucoma.

Under the revised criteria, Diagnostic Code 6013 instructs to evaluate pursuant to the General Rating Formula for Diseases of the Eye.

The General Rating Formula for Diseases of the Eye instructs to evaluate a condition based on visual impairment or its rating criteria for incapacitating episodes. Thus, the primary difference between the former and revised criteria is consideration of incapacitating episodes. With regard to 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.

The General Rating Formal for Diseases of the Eye 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.

Where there are documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months, a 10 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months, a 20 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition during the past 12 months, a 40 percent rating is warranted. Where there are documented incapacitating episodes requiring 7 or more treatment visits for an eye condition during the past 12 months, a 60 percent rating is warranted.

Note (1) indicates that, for the purposes of evaluations under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Note (2) indicates that examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. Note (3) indicates that, for the purposes of evaluating visual impairment due to a particular condition, refer to 38 C.F.R. § 4.75-4.78 and to § 4.79, Diagnostic Codes 6061-6091.

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. The table of Impairment of Central Visual Acuity encompasses Diagnostic Codes 6061-66. Pertinent to this case, visual acuity greater than 20/40 is not addressed because the evidence of record indicates that the Veteran has consistently had visual acuity measuring 20/40 or better.

The Veteran was afforded VA eye examinations in August 2009, July 2015, and July 2021.

During his August 2009 VA examination, the Veteran was noted to be taking continuous medication for his glaucoma. His visual acuity was measured at 20/20 bilaterally, with a slight reduction of his peripheral visual field noted in the lower temporal and nasal quadrants. The Board notes that visual field tests using either Goldmann kinetic perimetry or automated perimetry using Humphrey Model 750, Octopus Model 101, or later versions of these perimetric devices with simulated kinetic Goldmann testing capability were not performed in either August 2009 or July 2015.

Notably, during the Veteran's July 2015 VA examination, the Veteran reported a "dimming of visual field on inferior and lateral sectors." As noted, visual field tests were not performed however, and his visual acuity was not decreased. In fact, his visual acuity (corrected distance) measured 20/40 or better bilaterally.

In July 2021, the Veteran was afforded an additional examination. His visual acuity, again, measured 20/40 bilaterally. A loss of visual field was noted, with the examiner commenting that the Veteran had a scotoma in the lower quadrant, bilaterally. The scotoma was noted to affect less than 14 of the Veteran's visual field.

During the July 2021 examination, visual field testing revealed contraction of the right visual field to 30 degrees down (65 normal, for a loss of
field tests were not performed however, and his visual acuity was not decreased. In fact, his visual acuity (corrected distance) measured 20/40 or better bilaterally.

During the July 2021 examination, visual field testing revealed contraction of the right visual field to 30 degrees down (65 normal, for a loss of 35), 50 degrees down nasally (50 normal, for a loss of 0), 45 degrees nasally (60 normal, for a loss of 15), 50 degrees up nasally (55 normal, for a loss of 5), 40 degrees up (45 normal, for a loss of 5), 55 degrees up temporally (55 normal, for a loss of 0), 65 degrees temporally (85 normal, for a loss of 20), and 50 degrees down temporally (85 normal, for a loss of 35). The total loss of degrees of visual fields of the right eye was 115 degrees. 500 minus 115 total degrees lost equals 385 total remaining degrees of visual field divided by 8 that resulted in an average concentric contraction of 48 degrees of visual field preserved in the right eye.

Visual field testing revealed contraction of the left visual field to 30 degrees down (65 normal, for a loss of 35), 50 degrees down nasally (50 normal, for a loss of 0), 55 degrees nasally (60 normal, for a loss of 5), 50 degrees up nasally (55 normal, for a loss of 5), 45 degrees up (45 normal, for a loss of 0), 50 degrees up temporally (55 normal, for a loss of 5), 85 degrees temporally (85 normal, for a loss of 0), and 40 degrees down temporally (85 normal, for a loss of 45). The total loss of degrees of visual fields of the left eye was 95 degrees. 500 minus 95 total degrees lost equals 405 total remaining degrees of visual field divided by 8 that resulted in an average concentric contraction of 51 degrees of visual field preserved in the left eye.

At this juncture, the Veteran's worst corrected visual acuity was 20/40 or better, bilaterally for the entire review period. Thus, a compensable rating based on impairment of visual acuity is not warranted. 38 C.F.R. § 4.84a. His worst average concentric contraction was 48 degrees of visual field preserved in the right eye, and 51 degrees of visual field preserved in the left eye. Bilateral concentric contraction with remaining field of 46 to 60 degrees warrants a 10 percent evaluation. As the Veteran's visual acuity warranted a noncompensable evaluation, but his visual field defect warranted a 10 percent evaluation based on the results of his July 2021, VA eye examination, a 10 percent evaluation is warranted. The Board acknowledges that visual field testing was not properly performed during either the Veteran's 2009 or 2015 VA examinations. Consequently, the results from the most recent 2021 visual field testing will be applied to the entire review period.

Based on the foregoing, however, the Board finds that entitlement to a rating in excess of 10 percent for open-angle glaucoma is not warranted. The 10 percent rating is provided based on a diagnosis of open-angle glaucoma requiring continuous medication and visual field testing with an average concentric contraction of 48 degrees of visual field preserved in the right eye, and 51 degrees of visual field preserved in the left eye.

Ratings in excess of 10 percent are warranted based on more extensive visual impairment or, after May 2018, incapacitating episodes; however, neither are shown in the record. In fact, the Veteran's corrected distance vision has remained 20/40 or greater, bilaterally, throughout the appeal period. Under Diagnostic Code 6066, visual acuity of 20/40 or better warrants a noncompensable rating. The Veteran has competently reported blurred and worsening vision with his glaucoma; however, there are no records which show an episode of his glaucoma severe enough to require a clinic visit to a provider specifically for treatment purposes. As the Veteran has not had any incapacitating episodes related to his glaucoma, and his visual acuity as remained at a noncompensable level throughout the appeal
May 2018, incapacitating episodes; however, neither are shown in the record. In fact, the Veteran's corrected distance vision has remained 20/40 or greater, bilaterally, throughout the appeal period. Under Diagnostic Code 6066, visual acuity of 20/40 or better warrants a noncompensable rating. The Veteran has competently reported blurred and worsening vision with his glaucoma; however, there are no records which show an episode of his glaucoma severe enough to require a clinic visit to a provider specifically for treatment purposes. As the Veteran has not had any incapacitating episodes related to his glaucoma, and his visual acuity as remained at a noncompensable level throughout the appeal period, a rating in excess of 10 percent for primary open-angle glaucoma is not warranted.

Consequently, a rating in excess of 10 percent for primary open-angle glaucoma is denied.

Richard Kettler

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board C. B. Kucera

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.

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