EYE IMPAIRMENT OF

S. B. MAYS · 2026 · Case ID: A26017792

MIXED

Summary

The veteran, who served in the United States Army and Air National Guard with multiple periods of active duty between January 1973 and December 2011, appeals the denial of a compensable rating for his service-connected bilateral eye disability and the denial of increased ratings for his left shoulder and right knee disabilities. The Board denied the bilateral eye disability claim, finding that the evidence was persuasively against a compensable rating under either former or revised criteria. The most probative evidence showed corrected distance visual acuity of 20/40 in each eye, which is noncompensable under DC 6066. The Board also found no basis for a rating based on visual field impairment, muscle function, or incapacitating episodes, as the VA examiner found no such issues and the record did not document them. The Veteran's reported symptoms of eye strain, headaches, and light sensitivity, while credible, did not demonstrate marked interference with employment or frequent hospitalizations to warrant extraschedular consideration. The Board remanded the left shoulder and right knee claims for increased ratings, citing duty to assist errors in the prior VA examinations. Specifically, the Board found that the examiners failed to provide retrospective medical opinions addressing functional loss after repetitive use or during flare-ups, as required by Sharp v. Shulkin, and did not adequately explain the lack of additional limitation despite acknowledging the examinations were not conducted after repeated use.

Rationale

Corrected distance vision 20/40 in each eye is noncompensable under DC 6066.; No documented visual field defect, diplopia, or incapacitating episodes.; Symptoms of eye strain and headaches did not meet criteria for extraschedular consideration.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6066

Docket No.

210111-131089

Full Decision Text

Citation Nr: A26017792
Decision Date: 02/26/26 Archive Date: 02/26/26

DOCKET NO. 210111-131089
DATE: February 26, 2026

ORDER

Entitlement to an initial compensable rating for bilateral cataracts with pigment dispersion, diminished vision, and right eye intraocular lens implants (previously rated as bilateral cataracts with diminished vision) is denied.

REMANDED

Entitlement to an initial rating higher than 20 percent for left shoulder rotator cuff tendonitis is remanded.

Entitlement to an initial rating higher than 10 percent for right knee arthritis is remanded.

FINDING OF FACT

For the entire initial rating period on appeal, the Veteran's service-connected bilateral eye disability has been manifested by corrected distance visual acuity of no worse than 20/40 in each eye, without visual field defect, diplopia, or incapacitating episodes, and it has not resulted in an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent hospitalization.

CONCLUSION OF LAW

The criteria for a compensable rating for bilateral cataracts with pigment dispersion, diminished vision, and right eye intraocular lens implants have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.3, 4.7, 4.27, 4.75-4.79, Diagnostic Codes (DCs) 6099-6027, 6029, 6066.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had service in the United States Army and Air National Guard. He had periods of active duty from January 1973 to January 1976, June 1979 to December 1979, August 1986 January 1987, September

2002 to September 2003, February 2008 to October 2008, and October 2010 to

December 2011.

In May 2020, as pertinent here, the Board granted service connection for right knee disability, bilateral eye disorder, and left shoulder disability.

A May 2020 rating decision implemented the Board's grants of service connection and assigned an initial 20 percent rating for a left shoulder disability, an initial 10 percent rating for a right knee disability, and an initial noncompensable rating for a bilateral eye disability, all effective May 30, 2014. The agency of original jurisdiction (AOJ) notified the Veteran that examinations were requested to determine the current level of disability.

After the examinations were conducted, a November 2020 rating decision denied a rating higher than 20 percent for a left shoulder disability, a rating higher than 10 percent for a right knee disability, and a compensable rating for a bilateral eye disability.

In the January 11, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on July 25, 2024. Therefore, the Board may only consider the evidence of record at the time of the November 2020 AOJ decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

Increased Rating - Laws and Regulations

Disability evaluations are determined by comparing a veteran's present symptoms with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38?U.S.C. §?1155; 38?C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38?C.F.R. §?4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the Veteran. 38?C.F.R. §?4.3.

A disability rating may require re-evaluation in accordance with changes in a veteran's condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level
?1155; 38?C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38?C.F.R. §?4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the Veteran. 38?C.F.R. §?4.3.

When a claimant is awarded service connection and assigned an initial disability rating, separate disability ratings may be assigned for separate periods of time in accordance with the facts found.? Fenderson v. West, 12 Vet. App. 119, 126 (1999). Where the veteran is appealing the rating for an?already established service-connected condition, the present level of disability is of primary concern.? See Francisco v. Brown, 7?Vet. App.?55, 58 (1994).? Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings.? Hart v. Mansfield, 21?Vet. App.?505 (2007).

Bilateral Eye Disability - Rating Criteria

The Veteran's service-connected bilateral eye disability has been rated under DC 6099-6027. Hyphenated DCs are used when a rating under one DC requires use of an additional DC to identify the specific basis for the assigned evaluation. 38 C.F.R. § 4.27. Here, the hyphenated DC indicates that the Veteran's bilateral eye disability is rated as analogous to a disease of the eye (DC 6099), under the criteria for cataracts (DC 6027). 38 C.F.R. § 4.79.

During the pendency of the appeal, VA revised the portion of the Schedule for Rating Disabilities addressing the evaluation of eye disabilities, effective May 13, 2018. When rating criteria are amended during the pendency of a claim, the Board considers the claim under both the former and revised criteria. However, a higher evaluation based on the revised criteria may not be assigned prior to the effective date of the amendment.

Both the former and revised criteria distinguish between preoperative and postoperative cataracts. Under the former criteria, preoperative cataracts and postoperative cataracts with a replacement intraocular lens (pseudophakia) were evaluated based on visual impairment, while postoperative cataracts without a replacement lens (aphakia) were evaluated under DC 6029. Under the revised criteria, cataracts are evaluated under the General Rating Formula for Diseases of the Eye, which instructs that disabilities are rated based on either visual impairment or incapacitating episodes, whichever results in a higher evaluation. 38 C.F.R. § 4.79.

Evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75(a). Examinations of visual impairment must be conducted by a licensed optometrist or ophthalmologist, and the examiner must identify the disease, injury, or other pathologic process for any visual impairment found. 38 C.F.R. § 4.75(a)-(b). Examinations of visual field or muscle function will be conducted only when medically indicated. Id.

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. Where a reported visual acuity is between two sequentially listed visual acuities, the visual acuity which permits the higher evaluation will be used. 38 C.F.R. § 4.76(c). Under DC 6066, when corrected distance visual acuity in both eyes is 20/40 or better, a noncompensable rating is warranted. 38 C.F.R. § 4.79.

The General Rating Formula for Diseases of the Eye also provides ratings based on incapacitating episodes. Under the former criteria, a 10 percent rating was warranted when incapacitating episodes had a total duration of at least one week but less than two weeks during the past 12 months; a 20 percent rating when at least
visual acuity is between two sequentially listed visual acuities, the visual acuity which permits the higher evaluation will be used. 38 C.F.R. § 4.76(c). Under DC 6066, when corrected distance visual acuity in both eyes is 20/40 or better, a noncompensable rating is warranted. 38 C.F.R. § 4.79.

The General Rating Formula for Diseases of the Eye also provides ratings based on incapacitating episodes. Under the former criteria, a 10 percent rating was warranted when incapacitating episodes had a total duration of at least one week but less than two weeks during the past 12 months; a 20 percent rating when at least two weeks but less than four weeks; a 40 percent rating when at least four weeks but less than six weeks; and a 60 percent rating when at least six weeks. A Note provided that, for VA purposes, an incapacitating episode was 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, a 10 percent rating is warranted where there are documented incapacitating episodes requiring at least one but less than three treatment visits for an eye condition during the past 12 months; a 20 percent rating where at least three but less than five visits; a 40 percent rating where at least five but less than seven visits; and a 60 percent rating where seven or more visits. Note (1) provides that an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Note (2) provides examples of treatment, including but not limited to systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. Note (3) directs that, for purposes of evaluating visual impairment due to a particular condition, the adjudicator refers to 38 C.F.R. §§ 4.75-4.78 and to 38 C.F.R. § 4.79, DC 6061-6091.

Bilateral Eye Disability - Evidence and Analysis

The Veteran has a history of radial keratotomy in 1996 and reported that his vision was good for a time but later required glasses for both distance and near vision with fatigue/strain.

A September 2020 VA eye examination documented dry eye syndrome affecting both eyes and noted corneal radial and arcuate incisions consistent with prior radial keratotomy; the lens evaluation showed a posterior chamber intraocular lens implant in the right eye with the left lens described as normal, and fundus examination was normal bilaterally. Tonometry was 18 in each eye and pupils were round and reactive without afferent pupillary defect. Uncorrected distance vision was 20/40 in the right eye and 20/50 in the left eye, while corrected distance vision was 20/40 in each eye; uncorrected near vision was 20/100 in each eye and corrected near vision was 20/40 in each eye, and the examiner found no difference equal to two or more lines between corrected near and distance vision with near being worse. The examiner found no anatomical loss, light perception only, extremely poor vision, or blindness; no corneal irregularity resulting in severe irregular astigmatism; no diplopia; and no documented visual field defect. The examiner noted postoperative cataract findings with replacement intraocular lens (pseudophakia) in the right eye, stated that any decrease in visual acuity or other visual impairment, if present, was not attributable to the identified eye conditions, found no scarring or disfigurement attributable to an eye condition, found no incapacitating episodes attributable to an eye condition in the prior 12 months, and found no impact on the ability to work.

At the July 2024 Board hearing, the Veteran described functional difficulty including eye strain with computer use, headaches/migraines, and light sensitivity ("sun blindness"), reported that he uses tinted glasses/sunglasses and that his spouse assists with reading road signs and navigation, and testified that right-eye cataract surgery with lens implantation occurred prior to the period on appeal with no additional surgeries during the relevant period.

On review, the Board finds the evidence is persuasively against a compensable rating for the service-connected bilateral eye disability at any time during the period on appeal under either the former or revised criteria. The most probative evidence reflects corrected distance visual acuity of 20/40 in each eye, which is noncompensable under DC 6066, and the record does not otherwise show corrected distance vision worse than 20/40 in either eye such that a compensable rating may be assigned based on impairment of central visual acuity, to include
spouse assists with reading road signs and navigation, and testified that right-eye cataract surgery with lens implantation occurred prior to the period on appeal with no additional surgeries during the relevant period.

On review, the Board finds the evidence is persuasively against a compensable rating for the service-connected bilateral eye disability at any time during the period on appeal under either the former or revised criteria. The most probative evidence reflects corrected distance visual acuity of 20/40 in each eye, which is noncompensable under DC 6066, and the record does not otherwise show corrected distance vision worse than 20/40 in either eye such that a compensable rating may be assigned based on impairment of central visual acuity, to include on the basis of a staged rating. 38 C.F.R. §§ 4.75, 4.76, 4.79, DC 6066. Further, a compensable rating is not warranted based on visual field impairment or muscle function, as the competent medical evidence reflects no documented visual field defect and no diplopia, and the record does not otherwise suggest such impairment during the period on appeal. 38 C.F.R. §§ 4.75, 4.77, 4.78.

A compensable rating is also not warranted based on incapacitating episodes under either the former or revised criteria, as the VA examiner explicitly found no incapacitating episodes attributable to an eye condition, and the record does not otherwise document acute symptoms requiring prescribed bed rest and treatment by a physician or other healthcare provider (former definition) or documented incapacitating episodes requiring treatment visits for an eye condition (revised definition). 38 C.F.R. § 4.79.

The Board has considered the Veteran's reports of eye strain, headaches, and light sensitivity, and the representative's assertion that such symptoms are not expressly contemplated by the schedular criteria, which focus primarily on measured visual impairment and incapacitating episodes; to the extent these symptoms are not fully contemplated by the schedular criteria, the Board finds they do not present an exceptional or unusual disability picture warranting referral for extraschedular consideration. In Thun v. Peake, 22 Vet. App. 111 (2008), the Court set forth a three-step inquiry: (1) whether the schedular rating criteria adequately contemplate the claimant's disability picture; (2) if not, whether the disability picture exhibits related factors such as marked interference with employment or frequent periods of hospitalization; and (3) if both elements are satisfied, whether referral for extraschedular consideration is warranted.

Here, even assuming the Veteran's symptoms of photophobia/light sensitivity and headache pain are not expressly contemplated by the applicable criteria, the persuasive evidence does not show the "related factors" required under the second Thun element. The Veteran remained employed full time during the relevant period, the VA examiner found that the eye disability did not impact the ability to work, and the record reflects outpatient care without frequent hospitalizations. While the Veteran credibly reported functional difficulty (including reliance on glasses and tinted lenses and assistance from his spouse with driving-related tasks), the evidence does not demonstrate marked interference with employment beyond that contemplated by the noncompensable rating assigned for the level of objective visual impairment shown, nor does it demonstrate a disability picture so unusual as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). Accordingly, referral for extraschedular consideration is not warranted.

For these reasons, the evidence is persuasively against the claim, the benefit-of-the-doubt doctrine is not applicable, and the appeal is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

REASONS FOR REMAND

Remand by the Board in the AMA is proper for correction of (1) duty to assist errors occurring prior to the date of the AOJ decision on appeal (i.e., pre-decisional duty to assist errors) and (2)?AOJ errors in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim. 38?C.F.R. §?20.802(a).

The Veteran seeks increased rating for left shoulder and right knee disabilities.

Regarding the claimed increased ratings for the left shoulder and right knee disabilities, the Board finds that the AOJ should have obtained retrospective medical opinions.

The Veteran seeks increased rating for left shoulder and right knee disabilities.

Regarding the claimed increased ratings for the left shoulder and right knee disabilities, the Board finds that the AOJ should have obtained retrospective medical opinions.

In this regard, the Veteran was afforded VA examinations in January 2016 in connection with these claims. However, the January 2016 examiner did not provide estimates of additional functional loss or range of motion after repeated use over time or during flare-ups. Instead, the examiner stated that such opinions could not be provided without resorting to mere speculation because the Veteran was not examined during a flare-up or after repeated use over time. This rationale does not reflect an attempt to elicit relevant information from the Veteran regarding the frequency, duration, characteristics, severity, or functional loss during flare-ups or after repeated use over time, nor does it otherwise explain why such information could not be used to provide an estimate, as required by Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017).

The Veteran was again afforded VA examinations in November 2020. With respect to the right knee, the November 2020 examiner indicated that pain, weakness, fatigability, and incoordination did not significantly limit functional ability with repeated use over time or during flare-ups, and no estimate of additional limitation of motion was provided. However, the examiner did not explain why such factors did not result in any additional functional loss, particularly in light of the Veteran's reports throughout the pendency of the claim. With respect to the left shoulder, the November 2020 examiner indicated that the Veteran was not examined immediately after repeated use over time, yet the estimated range of motion after repeated use over time was identical to the initial range of motion recorded during the examination, without any explanation for why no additional limitation was expected despite the examiner's acknowledgment that the examination was not conducted after repeated use over time.

The Veteran and his representative also challenged the adequacy of these examinations at the Board hearing, including asserting that the knee examination appeared to contain copied-and-pasted material and contained conflicting findings regarding functional loss and range of motion, and that the examiner's conduct and the manner in which the examinations were performed suggested they were not thorough.

In light of the foregoing, the Board finds that remand is required for the AOJ to cure the duty to assist error, that is to obtain retrospective medical opinions that comply with Sharp and adequately address functional loss after repeated use over time and during flare-ups throughout the period on appeal.

The matters are REMANDED for the following action:

1. Obtain addendum retrospective medical opinions from an appropriate VA examiner or examiners to help determine the severity of the service-connected left shoulder and right knee disabilities during the pendency of this appeal. The claims file and a copy of this remand will be made available to the examiner(s), who will acknowledge receipt and review of these materials. The need for another examination is left to the discretion of the medical professional(s) offering the addendum opinion(s).

After review of the evidence, the examiner is asked to respond to the following:

(a) Left shoulder: Provide a retrospective medical opinion as to any additional degrees of limitation of motion (in flexion, abduction, external rotation, and internal rotation, as applicable) after repetitive use over time due to pain (and any other factors such as weakness, fatigability, or incoordination), and during flare-ups, during the pendency of this appeal from May 30, 2014 to November 17, 2020.

In doing so, the examiner should consider the Veteran's lay reports regarding functional loss over time and during flare-ups and should utilize the documented range of motion findings in the January 2016 and November 2020 VA examinations.

(b) Right knee: Provide a retrospective medical opinion as to any additional degrees of limitation of motion (in flexion and extension) after repetitive use over time due to pain (and any other factors such as weakness, fatigability, or incoordination), and during flare-ups, during the pendency of this appeal from May 30, 2014 to November 17, 2020.

If it is not possible to provide such opinions or estimates without resorting to mere speculation, the examiner(s) should provide an explanation as to why this is so and note what, if any, additional evidence would permit such opinions to be made. In providing the requested estimates,
pain (and any other factors such as weakness, fatigability, or incoordination), and during flare-ups, during the pendency of this appeal from May 30, 2014 to November 17, 2020.

If it is not possible to provide such opinions or estimates without resorting to mere speculation, the examiner(s) should provide an explanation as to why this is so and note what, if any, additional evidence would permit such opinions to be made. In providing the requested estimates, the examiner(s) must attempt to elicit relevant information regarding the description of the Veteran's flare-ups and functional loss after repeated use over time, including the frequency, duration, characteristics, severity, and functional impact, consistent with Sharp v. Shulkin, 29 Vet. App. 26 (2017).

A complete rationale should be provided for all opinions expressed.

S. B. MAYS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Yaffe, 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.

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