92 Decision Citation: BVA 92-23866 Y92 BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 DOCKET NO. 91-51 393 ) DATE ) ) ) THE ISSUE Entitlement to an increased (compensable) evaluation for polycythemia rubra vera. REPRESENTATION Appellant represented by: AMVETS WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Grace Jivens-McRae, Associate Counsel INTRODUCTION This matter came before the Board of Veterans' Appeals (hereinafter Board) on appeal from a rating decision in February 1991, of the Department of Veterans Affairs (VA) Regional Office (RO) at St. Petersburg, Florida. The veteran retired in October 1990 after more than 23 years of active duty service. The notice of disagreement was received in March 1991. The statement of the case was issued later in March 1991. The substantive appeal was received in April 1991. A hearing was held before a hearing officer at the RO in June 1991. A supplemental statement of the case was issued in September 1991. The veteran has been represented throughout his appeal by AMVETS, which presented a statement on the appeal at the RO in November 1991. The appeal was received at the Board in December 1991. AMVETS submitted additional written argument to the Board in January 1992 and the case is ready for appellate review. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in substance, that he has been found unqualified for his trained profession of pilot because of polycythemia rubra vera. Even under treatment with phlebotomies and the drug hydroxyurea, he emphasizes a platelet count in the range 600,000 to 1,600,000. He argues that this constitutes a definite employment handicap which warrants a 30 percent disability evaluation under the applicable Diagnostic Code 7704. He requests that all doubt be resolved in his favor. DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), following review and consideration of all evidence and material of record in the veteran's claims file, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence favors an increased rating for polycythemia rubra vera. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. Polycythemia rubra vera is characterized by moderate increase in platelet count, daily treatment with hydroxyurea, and medically required monitoring on a regular basis for potential cerebrovascular, coronary and abdominal occlusion, thrombosis, leukemia, hemorrhage, myelofibrosis, and/or hyperuricemia; this is a chronic, active disease with the potential for serious complications. 3. Polycythemia rubra vera is currently manifested to equate with or approximate incipient pernicious anemia with characteristic achlorhydria and changes in blood count, but it does not equate with or approximate chronic pernicious anemia following acute attacks with characteristic definite departures from normal blood count, with impairment of health and severe asthenia. CONCLUSION OF LAW A 30 percent rating is warranted for polycythemia rubra vera. 38 U.S.C.A. §§ 1155 and 5107(a) (West 1991); 38 C.F.R. Part 4, §§ 4.7, 4.117, Diagnostic Code 7704 (1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The legal and factual issue presented on the record is: Whether the veteran currently suffers from polycythemia rubra vera which more nearly approximates incipient pernicious anemia with characteristic achlorhydria and changes in blood count in order to qualify for a 30 percent disability evaluation under Diagnostic Code 7704? We find that the veteran's claim is "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, we find that he has presented a plausible claim. We are also satisfied that all relevant facts have been properly developed. No further assistance is required to comply with the duty to assist him mandated by 38 U.S.C.A. § 5107(a). In conjunction with this appeal, we sought and obtained an opinion from a Board medical adviser. The opinion was completed in July 1992. Pertinent history was indicated that the veteran had been investigated in 1981, during service, for elevated platelet counts. The edge of the spleen had been palpated. The red cell mass had been increased and the bone marrow had been active with clusters of megakaryocytes. He had been phlebotomized regularly and effectively, with a drop in hematocrit. Platelet counts had remained elevated. He also was under treatment with hydroxyurea, an antineoplastic agent. The medical adviser pointed out that the veteran's laboratory values on the VA rating examination in January 1991 included white count at 10,400; platelet count at 818,000; and hematocrit at 49. He was shown to be asymptomatic on the normal physical examination with no enlargement of his liver or spleen and blood counts normal except for moderate increase in platelet count. It was noted in the opinion that the veteran indicated during the hearing that his blood count had to be monitored every 6 to 8 weeks (hearing transcript on p. 2). The medical adviser explained that, while polycythemia rubra vera was in remission, side effects could still occur. Hyperuricemia has occurred. Since the veteran was under control with an antineoplastic drug, frequent blood counts were necessary along with blood urea nitrogen and other chemical studies. The medical adviser considered the veteran's polycythemia rubra vera to be stable, except for moderate increase in platelet counts, and daily treatment with hydroxyurea, but this was termed a serious disease with frequent monitoring required with laboratory studies as well as physical examination. He concluded that polycythemia rubra vera in the veteran was a chronic active disease with the potential for serious complications and deserving of a 30 percent disability evaluation. We note that serious complications have not been shown to date and that the disease is under relatively good control and stable though active and asymptomatic currently. There is no aesthenia or impairment of health shown currently. The evidence that the veteran has been excluded from his trained occupational specialty of aircraft pilot secondary to polycythemia rubra vera is undisputed. In conclusion, we agree with the Board medical adviser that the disability here is deserving of a 30 percent disability evaluation for chronic active disease. Nevertheless, the disability is not shown to equate with or approximate the criteria for a disability rating in excess thereof. 38 U.S.C.A. §§ 1155 and 5107(a); 38 C.F.R. Part 4, §§ 4.7, 4.117, Diagnostic Code 7704. ORDER A rating of 30 percent for polycythemia rubra vera is granted, subject to the governing regulations applicable to the payment of monetary benefits. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 * (MEMBER TEMPORARILY ABSENT) DOMENIC E. SABATINI, M.D. SAMUEL W. WARNER *38 U.S.C.A. § 7102(a)(2)(A) (West 1991) permits a Board of Veterans' Appeals Section, upon direction of the Chairman of the Board, to proceed with the transaction of business without awaiting assignment of an additional Member to the Section when the Section is composed of fewer than three Members due to absence of a Member, vacancy on the Board or inability of the Member assigned to the Section to serve on the panel. The Chairman has directed that the Section proceed with the transaction of business, including the issuance of decisions, without awaiting the assignment of a third Member. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.