Citation Nr: 0020500 Decision Date: 08/04/00 Archive Date: 08/09/00 DOCKET NO. 98-12 526 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to an increased rating for allergic rhinoconjunctivitis, currently assigned a 30 percent disability evaluation. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD P. H. Mathis, Counsel INTRODUCTION The veteran served on active duty from February 1989 to August 1993. The veteran appealed the May 1998 decision by the Department of Veterans Affairs (VA) Regional Office (RO), St. Louis, Missouri, which continued a 10 percent disability rating for the service-connected allergic rhinoconjunctivitis. Prior to the case being forwarded to the Board of Veterans Appeals (Board), by rating action in January 1999, the RO increased the disability rating from 10 to 30 percent. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The service-connected allergic rhinoconjunctivitis results in no more than obstruction of the nasal passages with polyps without evidence of current infection or the need for surgical intervention. CONCLUSION OF LAW The criteria for a disability rating greater than 30 percent for the veteran's allergic rhinoconjunctivitis have not been met or approximated. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.97, and Part 4, Diagnostic Code 6522 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board finds that the veteran's claim for an increased rating is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991); that is, a plausible claim has been presented. Murphy v. Derwinski, 1 Vet. App. 78 (1990). An allegation of increased disability is sufficient to establish a well-grounded claim seeking an increased rating. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The Board also is satisfied that the VA has obtained and fully developed all evidence necessary for the equitable disposition of the veteran's claim. Therefore, no further assistance to the veteran is required under 38 U.S.C.A. § 5107(a) (West 1991). The Board is satisfied that all relevant facts have been properly developed to their full extent, and that the VA has met its duty to assist. White v. Derwinski, 1 Vet. App. 519 (1991); Godwin v. Derwinski, 1 Vet. App. 419 (1991). Factual Background By rating action in November 1993, the RO granted service connection for allergic rhinoconjunctivitis, and assigned it a 10 percent disability rating. A 10 percent rating has been assigned effective from August 1983, until the rating was increased to 30 percent by the January 1999 rating decision by the RO. The veteran contends that his service connected allergic rhinoconjunctivitis is more severely disabling than it has been rated. When the veteran was examined by the VA in April 1998, it was reported that he had a long history of frequent rhinorrhea, sinus infections, stuffy nose, sore throat from drainage down the back of his throat, hoarseness, and some difficulty swallowing with indigestion, heartburn and possibly reflux esophagitis. The veteran had been evaluated previously by the same examiner in November 1995 when there were similar complaints. The examiner's assessment at that time was that most of the symptoms were from allergic rhinitis which was the main etiologic factor causing him to have recurrent episodes of sinusitis, eustachian tube dysfunction and ear infections. The veteran was currently taking Claritin. The examination findings were compatible with allergic rhinitis. The veteran did not have any anatomical deformities of his nose or sinus areas, and there was no evidence of polyps or infection on examination. The veteran had tried various medications in the past, but continued to have symptoms. Treatment with Zyrtec was recommended. The diagnosis was examination compatible with allergic rhinitis. In July 1998, J. M. T., M.D., reported that the veteran has both seasonal and allergic rhinitis for which he had received treatment, including immunotherapy, since December 1993, and noted that the veteran was recently diagnosed with asthma. In August 1998, Dr. J. T. reported that the veteran had a polyp in the maxillary sinus cavity caused by allergic rhinitis. On examination by VA in December 1998, it was reported that the claims file was reviewed. The veteran's past medical history included problems with epistaxis (nosebleeds) and he complained of productive cough which usually required three to four minutes in the morning to clear the airway passages. He reported green sputum production with no blood. Shortness of breath on extensive exercise was reported. The history of severe allergies was noted. Dry nasal mucosa were reported with no bleeding sites. The evaluation of the ears, nose and throat did not reveal any disease process other than allergic rhinitis. The examiner found that the veteran's allergic rhinitis was the direct causative factor of his asthma. In the January 1999 rating decision, the RO awarded a 30 percent evaluation for the veteran's service-connected allergic rhinoconjunctivitis. At that time, it granted service connection for allergic asthma, secondary to the allergic rhinoconjunctivitis, and awarded a compensable disability evaluation. During a VA outpatient visit in May 1999, it was noted that the veteran had a history of asthma and allergic rhinitis. Symptoms included frequent sneezing, itchy, watery eyes, runny nose and postnasal drip that was currently clear in nature. The veteran reported improvement on Zyrtec. The veteran had previously been on immunotherapy from 1990 to 1993 and 1994 to 1996 with inability to advance from the first vial. The veteran reported activity being limited by his asthma. On examination, tympanic membranes were clear. The nares were boggy pale. There was no skin rash. The diagnosis was allergic rhinitis. The examiner suggested continuing Zyrtec and starting a nasal steroid inhaler. In April 1999, a diagnostic imaging report, dated in September 1997, was received from Doctors Regional Medical Center, reflecting impressions of a large polyp or retention cyst involving the left maxillary sinus, mucoperiosteal thickening of the right maxillary sinus, a small polyp or retention cyst in the right maxillary antrum could not be ruled out, and congestion of nasal turbinates. In June 1999, the veteran forwarded a list of his current medications noting that he did not think he should have to pay for them since service-connected disability was involved. Analysis Disability evaluations are determined by the application of a schedule of ratings that is based on the average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4, Schedule for Rating Disabilities (rating schedule). If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1999). When entitlement to compensation has already been established and an increase in the assigned evaluation is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Although the recorded history of a particular disability should be reviewed in order to make an accurate assessment under the applicable criteria, the regulations do not give past medical reports precedence over current findings. Id. at 58. Under the revised rating schedule, in effect since October 7, 1996, 38 C.F.R. § 4.97 was changed and Diagnostic Code 6501, under which the veteran's disability was originally rated, was discontinued. See 38 C.F.R. § 4.97, Diagnostic Code 6522 (1999); 38 C.F.R. § 4.97, Diagnostic Code 6501 (1996). As of October 7, 1996, allergic rhinitis is evaluated under Diagnostic Code 6522 that provides for a rating of 10 percent for allergic or vasomotor rhinitis, without polyps, but with greater than 50 percent obstruction of the nasal passage on both sides, or complete obstruction on one side; and for a maximum rating of 30 percent when there is allergic or vasomotor rhinitis, with polyps. See 38 C.F.R. § 4.97, Diagnostic Code 6522 (1999). The Board finds the above-noted symptoms and findings warrant no more than the current 30 percent evaluation. In so finding, the Board notes the veteran's complaints of stuffy nose, frequent sneezing and postnasal drip. However, these symptoms, warrant no more than the current 30 percent rating. 38 C.F.R. § 4.97 (1999). This is especially so given the requirement for surgery in the 50 percent criteria. The salient point is that the veteran has not undergone surgery, much less any radical operation. The current criteria require that the veteran must have either undergone radical surgery or symptoms of near constant sinusitis characterized by headaches, pain and tenderness, and purulent discharge or crusting after repeated surgeries for a rating in excess of the currently assigned rating. See 38 C.F.R. § 4.97, Diagnostic Codes 6510 to 6514 (1999). The veteran may get a higher rating of 50 percent if he demonstrates that rhinoscleroma is present. 38 C.F.R. § 4.97, Diagnostic Code 6523 (1999). However, this is not established by the medical records. Here, there is no evidence of infection, necessity for surgery, or other manifestation of disability that would warrant a higher disability rating under the 6500 Series of Diagnostic Codes contained in 38 C.F.R. § 4.97 that provide for a rating higher than 30 percent. Here, the schedular rating criteria providing a 30 percent disability evaluation under Code 6522 are completely appropriate for rating the disability and no higher rating is warranted based on the objective evidence. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. § 4.97, Diagnostic Code 6522. Moreover, the evidence is not so evenly balanced as to allow for the application of reasonable doubt. 38 U.S.C.A. § 5107(b). Further, there is no evidence disclosing that the service- connected disability, alone, causes marked interference with employment or necessitates frequent periods of hospitalization as is required for a referral under 38 C.F.R. § 3.321(b)(1) (1999). Shipwash v. Brown, 8 Vet.App. 218, 227 (1995). ORDER Entitlement to an increased rating for allergic rhinoconjunctivitis is denied. D. J. DRUCKER Acting Member, Board of Veterans' Appeals