CATARACT EXTRACTION

JAMES G. REINHART · 2020 · Case ID: A20016392

MIXED

Summary

The veteran, who served from February 1978 to May 1999, including service in Southwest Asia from December 1990 to April 1991, appeals the denial of an increased rating for his service-connected right eye cataract. The Board reviewed the case under the legacy system and the Appeals Modernization Act (AMA), considering evidence of record at the time of the AMA opt-in and evidence submitted by the hearing date. The veteran testified at a hearing in July 2020. The Board noted that the veteran's left eye is not service-connected and the paired organ rule for severe bilateral vision impairment does not apply. Under both former and revised VA rating criteria for eye conditions, the Board considered visual acuity and incapacitating episodes. The veteran's corrected vision was 20/40 or better bilaterally, and his visual field constriction in the right eye averaged 26.875 degrees, while the left averaged 20.625 degrees. The Board found that while the right eye visual field impairment warranted a 10 percent rating under DC 6080, the criteria for a higher rating were not met. Service connection for chronic fatigue syndrome (CFS) was remanded for a VA examination to determine diagnosis, etiology, and service connection. The Board granted a 10 percent rating for the right eye cataract.

Rationale

Service-connected right eye cataract; Visual field impairment warrants 10% rating under DC 6080; Criteria for higher rating not met

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6080

Docket No.

181228-2120

Full Decision Text

Citation Nr: A20016392
Decision Date: 11/03/20 Archive Date: 11/03/20

DOCKET NO. 181228-2120
DATE: November 3, 2020

ORDER

A 10 percent rating, but not more, for right eye cataract is granted.

REMANDED

Service connection for chronic fatigue syndrome (CFS) is remanded.

FINDING OF FACT

The Veteran’s right eye cataract manifests as right eye visual acuity impairment no worse than 20/40 and right eye visual field contraction no worse than 26.875.

CONCLUSION OF LAW

The criteria for a 10 percent rating, but not more, for right eye cataract have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.75-4.79, Diagnostic Codes 6000-6090.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from February 1978 to May 1999, including service in Southwest Asia from December 1990 to April 1991.

This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

A rating decision was issued under the legacy system in August 2016. In June 2018, the Veteran opted into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a Rapid Appeals Modernization Program (RAMP) election form and selecting the higher-level review (HLR) lane. The agency of original jurisdiction (AOJ) issued a RAMP HLR decision in November 2018, which is the decision on appeal.

In the December 2018 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket.

Therefore, the Board may only consider the evidence of record at the time of the RAMP opt-in, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a).

The Veteran testified at a video conference hearing before the undersigned Veterans Law Judge in July 2020. A transcript of the hearing is associated with the claims file.

1. A compensable rating for right eye cataract

The Veteran was originally granted service connection for right eye cataract in a December 1999 rating decision. At that time, this disability was rated noncompensable (0 percent) effective June 1, 1999. His current increased rating claim was received June 18, 2015.

Disability ratings are determined by applying the criteria set forth in the 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 evaluations 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.

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).

If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21.

In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as “staging the ratings.” See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008).

As an initial matter, the Board notes that the Veteran is not service connected for a
expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21.

As an initial matter, the Board notes that the Veteran is not service connected for a left eye disability. When only one eye is service connected, the other eye considered 20/40 for rating purposes regardless of the actual level of impairment. 38 C.F.R. § 4.75 (c). Generally, the maximum evaluation for visual impairment of one eye is 30 percent unless there is anatomical loss of one eye. 38 C.F.R. § 4.75 (d). The exception to this is the paired organ rule which allows severe bilateral visual impairment to be rated as if both eyes were service connected. See 38 C.F.R. § 3.383 (a)(1). “Severe bilateral vision impairment” is visual acuity of 20/200 or less in both eyes of peripheral field of vision to 20 degrees or less in both eyes. See id. Severe bilateral vision impairment is not shown here; therefore, the paired organ rule does not apply.

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. 15,316 (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, the General Rating Formula for Diagnostic Codes 6000 through 6009 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.

Where incapacitating episodes have a total duration of at least 1 week, but less than 2 weeks, during the past 12 months, a 10 percent rating is warranted. Where incapacitating episodes have a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months, a 20 percent rating is warranted. Where incapacitating episodes have a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months, a 40 percent rating is warranted. Where incapacitating episodes have a total duration of at least 6 weeks during the past 12 months, a 60 percent rating is warranted.

A Note following the General Rating Formula indicates that, for VA purposes, an incapacitating episode is a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider.

Under the revised criteria, 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 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
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, DCs 6061-6091.

When both decreased visual acuity and visual field defect are present in one or both eyes and are service connected, the evaluation is determined by separately evaluating the visual acuity and visual field defect (expressed as a level of visual acuity) and combined under the provisions of 38 C.F.R. § 4.25. See 38 C.F.R. § 4.77 (c).

Impairment of central visual acuity is evaluated on the basis of corrected distance vision with central fixation, even if a central scotoma is present. 38 C.F.R. § 4.76. Visual acuity is evaluated from noncompensable to 100 percent based upon the degree of the resulting impairment of visual acuity or field loss, pain, rest-requirements, or episodic incapacity, combining an additional rating of 10 percent during continuance of active pathology. 38 C.F.R. § 4.79, DCs 6061 to 6066.

A 10 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) if corrected visual acuity is 20/100 in one eye and 20/40 in the other eye; (2) if corrected visual acuity is 20/70 in one eye and 20/40 in the other eye; (3) if corrected visual acuity is 20/50 in one eye and 20/40 in the other eye; (4) or when corrected visual acuity is 20/50 in both eyes. 38 C.F.R. § 4.84a, DCs 6078, 6079; 38 C.F.R. § 4.79, DC 6066.

A 20 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) if corrected visual acuity is 15/200 in one eye and 20/40 in the other eye; (2) if corrected visual acuity is 20/200 in one eye and 20/40 in the other eye; (3) if corrected visual acuity is 20/100 in one eye and 20/50 in the other eye; or (4) corrected visual acuity of 20/70 in one eye and 20/50 in the other eye. 38 C.F.R. § 4.84a, DCs 6077, 6078; 38 C.F.R. § 4.79, DC 6066.

A 30 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity in both eyes is 20/70; (2) corrected visual acuity in one eye is 20/100 and the other eye is 20/70; (3) corrected visual acuity in one eye is 20/200 in one eye and 20/50 in the other eye; (4) corrected visual acuity in one eye is 15/200 and 20/50 in the other eye; (5) corrected visual acuity in one eye is 10/200 and 20/40 in the other eye; (6) corrected visual acuity in one eye is 5/200 and 20/40 in the other eye; or (7) blindness of one eye and corrected vision to 20/40 in the other eye. 38 C.F.R. § 4.84a, DCs 6070, 6074, 6076, 6077, 6078; 38 C.F.R. § 4.79, DCs 6064, 6065, 6066.

A 40 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity of one eye is
200 and 20/40 in the other eye; (6) corrected visual acuity in one eye is 5/200 and 20/40 in the other eye; or (7) blindness of one eye and corrected vision to 20/40 in the other eye. 38 C.F.R. § 4.84a, DCs 6070, 6074, 6076, 6077, 6078; 38 C.F.R. § 4.79, DCs 6064, 6065, 6066.

A 40 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity of one eye is to 20/200 and 20/70 in the other eye; (2) corrected visual acuity of one eye is to 15/200 and 20/70 in the other eye; (3) corrected visual acuity in one eye is to 10/200 and 20/50 in the other eye; (4) corrected visual acuity is to 5/200 in one eye and 20/50 in the other eye; or (5) blindness or anatomical loss of one eye and corrected vision in the other eye to 20/50 and 20/40, respectively, in the other eye. 38 C.F.R. § 4.84a, DCs, 6066, 6070, 6073, 6076; 38 C.F.R. § 4.79, DCs 6064, 6065, 6066.

A 50 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity is to 20/100 in both eyes; (2) corrected visual acuity is to 10/200 in one eye and to 20/70 in the other eye; (3) corrected visual acuity is to 5/200 in one eye and 20/70 in the other eye; or (4) blindness or anatomical loss of one eye and corrected vision in the other eye to 20/70 and 20/50, respectively. 38 C.F.R. § 4.84a, DCs, 6065, 6069, 6073, 6076, 6078; 38 C.F.R. § 4.79, DCs 6064, 6065, 6066.

A 60 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity of one eye is to 20/200 and the other eye is 20/100; (2) corrected visual acuity of one eye is to 15/200 and the other eye is to 20/100; (3) corrected visual acuity of one eye is to 10/200 and the other eye is to 20/100; (4) corrected visual acuity of one eye is to 5/200 and the other eye is to 20/100; or (5) blindness or anatomical loss of one eye and corrected vision in the other eye to 20/100 or 20/70 or 20/100, respectively. 38 C.F.R. § 4.84a, DCs, 6065, 6069, 6073, 6076; 38 C.F.R. § 4.79, DCs 6064, 6065, 6066.

A 70 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity of one eye is to 20/200 and the other eye is 20/200; (2) corrected visual acuity of one eye is to 15/200 and the other eye is to 20/200; (3) corrected visual acuity of one eye is to 10/200 and the other eye is to 20/200; (4) corrected visual acuity of one eye is to 5/200 and the other eye is to 20/200; or (5) blindness or anatomical loss of one eye and corrected vision in the other eye to 20/200. 38 C.F.R. § 4.84a, DCs 6064, 6068, 6072, 6075; 38 C.F.R. § 4.79, DCs 6064, 6065, 6066.

An 80 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity of one eye is to 15/200 and the other eye is 15
corrected visual acuity of one eye is to 5/200 and the other eye is to 20/200; or (5) blindness or anatomical loss of one eye and corrected vision in the other eye to 20/200. 38 C.F.R. § 4.84a, DCs 6064, 6068, 6072, 6075; 38 C.F.R. § 4.79, DCs 6064, 6065, 6066.

An 80 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity of one eye is to 15/200 and the other eye is 15/200; (2) corrected visual acuity of one eye is to 10/200 and the other eye is to 15/200; (3) corrected visual acuity of one eye is to 5/200 and the other eye is to 15/200; or (4) blindness or anatomical loss of one eye and corrected vision in the other eye to 15/200. 38 C.F.R. § 4.84a, DCs 6064, 6068, 6072, 6075; 38 C.F.R. § 4.79, DCs 6064, 6065, 6066.

A 90 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity of one eye is to 10/200 and the other eye is 10/200; (2) corrected visual acuity of one eye is to 5/200 and the other eye is to 10/200; or (3) blindness or anatomical loss of one eye and corrected vision in the other eye to 10/200. 38 C.F.R. § 4.84a, DCs 6064, 6068, 6072, 6075; 38 C.F.R. § 4.79, DCs 6064, 6065, 6066.

A 100 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity of one eye is to 5/200 and the other eye is 5/200; (2) blindness or anatomical loss of one eye and corrected vision in the other eye to 5/200; or (3) blindness or anatomical loss of both eyes. 38 C.F.R. § 4.84a, DCs 6061, 6062, 6063, 6067, 6071 (2008); 38 C.F.R. § 4.79, DCs 6064 and 6065.

Impairment of field of vision is evaluated pursuant to 38 C.F.R. § 4.79, Diagnostic Codes 6080-81. As stated, separate evaluations for loss of visual acuity and visual field defect are permissible, effective December 10, 2008. See 38 C.F.R. § 4.77 (c) (“separately evaluate the visual acuity and visual field defect (expressed as a level of visual acuity), and combine them under the provisions of § 4.25”).

Regarding visual field impairment, compensable ratings are provided for loss of temporal half of visual field, loss of nasal half of visual field, loss of inferior half of visual field, loss of superior half of visual field, or concentric contraction of visual field with the remaining field of at most 60 degrees. 38 C.F.R. § 4.79.

According to Table III in 38 C.F.R. § 4.76a (2008), the normal visual field extent at the 8 principal meridians, in degrees, is: temporally, 85; down temporally, 85; down, 65; down nasally, 50; nasally, 60; up nasally, 55; up, 45; and up temporally, 55. The total visual field is 500 degrees.

Diagnostic Code 6080 provides that concentric contraction of visual field to 5 degrees warrants a 100 percent disability rating for bilateral loss, a 30 percent disability rating for unilateral loss, or is rated as 5/200 (1.5/60). Concentric contraction of visual field to 15 degrees, but not to 5 degrees, warrants a 70 percent disability rating for bilateral loss, a 20 percent disability rating for unilateral loss, or is rated as 20/200 (6/60). Concentric contraction of visual field to 30 degrees, but not to 15 degrees, warrants a 50 percent disability rating for bilateral loss, a 10 percent disability rating for unilateral loss, or is rated as 20/100 (6/30). Concentric contraction of visual field to 45 degrees, but not to 30 degrees, warrants a 30 percent disability rating for bilateral loss, a 10 percent disability rating for unilateral loss, or is rated as 20/70 (6/21). Concentric contraction of visual field to 60 degrees, but not to 45 degrees, warrants a 20 percent disability rating for bilateral loss, a 10 percent disability rating for unilateral loss, or is rated as 20/50 (6/15). Bilateral loss of the temporal half of the visual field warrants a 30 percent disability rating, unilateral loss warrants a 10 percent disability rating, or is rated as 20/70 (6/21). Bilateral loss of the nasal half of the visual field warrants a 20 percent disability rating, unilateral warrants a 10 percent disability rating, or is rated as 20/50 (6/15). 38 C.F.R. § 4.84a, Diagnostic Code 6080 (2008).

The normal visual field extent at eight principal meridians is (expressed in degrees): Temporally: 85, Down temporally: 85, Down: 65, Down nasally: 50, Nasally: 60, Up nasally: 55, Up: 45, Up temporally: 55. The combined sum is 500. To calculate the visual field, determine the average concentric contraction of the visual field of each eye by measuring the remaining visual field (in degrees) at each of eight principal meridians 45 degrees apart, adding them, and dividing the sum by eight. 38 C.F.R. § 4.76a.

The rating criteria dictate that when the remaining visual field is 46-60 degrees, a 10 percent rating is applied for unilateral or bilateral impairment; alternatively, each affected eye may be evaluated as 20/50. When the remaining visual field is 31-45 degrees, a 10 percent rating is applied for unilateral and a 30 percent rating is applied for bilateral; or alternatively each affected eye may be evaluated as 20/70. When the remaining visual field is 16-30 degrees, a 10 percent rating is applied for unilateral and a 50 percent rating is applied for bilateral; or alternatively each affected eye may be evaluated as 20/100. 38 C.F.R. § 4.79.

A November 2015 VA treatment record found left eye branch retinal vein occlusion, mild hypertensive retinopathy, and refractive error. His visual field was full in the left eye and “grossly full” in the right. His distance visual acuity was 20/30 in the right and 20/25 in the left.

February 2015 treatment records note refractive errors (myopia, hypermetropia, presbyopia, and astigmatism), benign choroid eye neoplasm, dry eyes, and peripheral retinal degeneration. He was prescribed eyeglasses. With corrective lenses, his vision was 20/20 bilaterally.

The Veteran underwent an eye conditions disability benefits questionnaire (DBQ) in August 2015. At that time, his uncorrected vision was 20/50 for distance in right eye, 20/40 or better for distance in left eye, and 20/100 for near vision bilaterally. His corrected vision was 20/40 or better for both near and distance bilaterally. His pupils were round and reactive to light. There was no afferent pupillary defect. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. He did not have a corneal irregularity that results in severe irregular astigmatism. He did not have diplopia. His eye pressure was
in August 2015. At that time, his uncorrected vision was 20/50 for distance in right eye, 20/40 or better for distance in left eye, and 20/100 for near vision bilaterally. His corrected vision was 20/40 or better for both near and distance bilaterally. His pupils were round and reactive to light. There was no afferent pupillary defect. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. He did not have a corneal irregularity that results in severe irregular astigmatism. He did not have diplopia. His eye pressure was 15 bilaterally. He had bilateral anterior cortical cataracts, but otherwise his slit lamp and external eye examination was normal. He had ischemic optic neuropathy bilaterally, but otherwise his internal eye examination was normal. He did not have a scotoma. He had a visual field defect that caused constriction of the visual field. He did not have a scotoma. He did not have statutory blindness based on visual field loss. He had bilateral preoperative cataracts. There was no aphakia or dislocation of the crystalline lens. No decrease in visual acuity or other visual impairment was attributable to this disability. His ischemic optic neuropathy resulted in visual impairment. The Veteran did not have any associated scars or any other eye conditions, pertinent physical findings, complications, conditions, signs and/or symptoms. He did not have any incapacitating episodes attributable to his eye conditions. His eye conditions impacted his ability to work in that the remaining field of vision was too narrow to operate a computer in most cases and made his activities of daily living unsafe. The accompanying visual field perimeter chart showed some loss of visual field as described below:

Meridian Normal Right Eye Left Eye

Up 45 25 20

Up temporally 55 25 25

Temporally 85 25 25

Down temporally 85 30 25

Down 65 35 25

Down nasally 50 25 15

Nasally 60 25 15

Up nasally 55 25 15

Total: 500 215 165

Average Concentric

Contraction 62.5 26.875 20.625

A January 2016 VA treatment record found left eye idiopathic branch retinal vein occlusion. His visual field was full in the left eye and “grossly full” in the right.

In June 2016, the Veteran underwent another eye conditions DBQ. At that time, his uncorrected vision was 20/50 for distance in right eye, 20/40 or better for distance in left eye, and 20/100 for near vision bilaterally. His corrected vision was 20/40 or better for both near and distance bilaterally. His pupils were round and reactive to light. There was no afferent pupillary defect. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. He did not have a corneal irregularity that results in severe irregular astigmatism. He did not have diplopia. His eye pressure was 15 bilaterally. He had bilateral anterior cortical cataracts, but otherwise his slit lamp and external eye examination was normal. He had severe glaucoma cupping bilaterally, but otherwise his internal eye examination was normal. He did not have a scotoma. He had a visual field defect that caused constriction of the visual field. He did not have a scotoma. He did not have statutory blindness based on visual field loss. He had bilateral preoperative cataracts. There was no aphakia or dislocation of the crystalline lens. He had bilateral open-angle glaucoma that did not require continuous medication for treatment. He had glaucoma optic neuropathy. His visual impairment was attributable to cataracts and glaucoma. The Veteran did not have any associated scars or any other eye conditions, pertinent physical findings, complications, conditions, signs and/or symptoms. He did not have any incapacitating episodes attributable to his eye conditions. His eye conditions impacted his ability to work in that he was unable to drive a commercial vehicle and had difficulty on ladders due to the need for depth perception. The accompanying visual field perimeter chart showed some loss of visual field as described below:

Meridian Normal Right Eye Left Eye

Up 45 40 20

Up temporally 55 40 20

for treatment. He had glaucoma optic neuropathy. His visual impairment was attributable to cataracts and glaucoma. The Veteran did not have any associated scars or any other eye conditions, pertinent physical findings, complications, conditions, signs and/or symptoms. He did not have any incapacitating episodes attributable to his eye conditions. His eye conditions impacted his ability to work in that he was unable to drive a commercial vehicle and had difficulty on ladders due to the need for depth perception. The accompanying visual field perimeter chart showed some loss of visual field as described below:

Meridian Normal Right Eye Left Eye

Up 45 40 20

Up temporally 55 40 20

Temporally 85 40 25

Down temporally 85 40 35

Down 65 45 35

Down nasally 50 45 45

Nasally 60 40 35

Up nasally 55 40 30

Total: 500 330 245

Average Concentric

Contraction 62.5 41.25 30.625

A July 2016 VA treatment record found stable left eye idiopathic branch retinal vein occlusion. His visual field was full in the left eye and “grossly full” in the right.

A July 2017 VA treatment records notes visual acuity of 20/20 bilaterally. The Veteran had a history of left eye idiopathic branch retinal vein occlusion. He also had age-related nuclear sclerotic cataracts bilaterally, right eye posterior vitreous detachment, myopia, astigmatism, and presbyopia.

At his July 2020 hearing, the Veteran testified that it was very hard for him to see out of his right eye without glasses. He had difficulty with his distance vision and his visual field.

Based on the above, the Veteran’s right eye visual acuity impairment is no worse than 20/40 and his right eye visual field contraction is no worse than 26.875. As noted above, the Veteran’s nonservice-connected left eye is treated as 20/40. See 38 C.F.R. § 4.75 (c). Visual acuity of 20/40 or better in both eyes is not compensable. 38 C.F.R. § 4.79, 6066. Turning to his visual field impairment, unilateral visual field impairment with a remaining field between 16 and 30 degrees warrants a 10 percent rating under DC 6080. 38 C.F.R. § 4.79. A higher rating under this diagnostic code would require an average concentric contraction of 15 degrees or less in the right eye. See 38 C.F.R. § 4.79, DC 6080. This is not shown here. Thus, the preponderance of the evidence is in favor of a 10 percent rating, but not more, for his right eye disability and the claim is granted to that extent.

REASONS FOR REMAND

1. Service connection for chronic fatigue syndrome (CFS) remains denied. is remanded.

The Board cannot make a fully informed decision on the issue of chronic fatigue syndrome because no VA examination has been provided. The Veteran served in Southwest Asia and has reported ongoing fatigue in his lay statements. The Veteran is competent to report lay-observable symptoms like fatigue despite the absence of a diagnosed condition in the medical evidence. An examination is necessary to determine whether the Veteran has chronic fatigue syndrome or any related disability that can be linked to his active duty military service.

The matters are REMANDED for the following action:

Ensure that the Veteran is scheduled for a VA examination for his claimed chronic fatigue syndrome. The examiner must review the claims file.

The examiner is asked to provide a response to the following:

(a.) The examiner must determine whether the examination results, including the Veteran’s reported symptoms support a diagnosis of chronic fatigue syndrome.

(b.) If not, are the symptoms described attributable to a known clinical diagnosis?

(c.) If not, is his disability pattern consistent with an undiagnosed illness, a medically unexplained chronic multi-symptom illness, or a chronic multi-symptom illness with partially explained etiology and pathophysiology?

(d.) For any diagnosed disability, is the disability at least as likely as not related to service, to include his service in Southwest Asia?

Provide a rationale to support the opinion(s).

JAMES G. REINHART

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board B. Houbeck

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

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