Decision Date: 12/14/95 Archive Date: 12/14/95 DOCKET NO. 94-04 693 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama THE ISSUE Entitlement to an increased rating for sarcoidosis, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Elizabeth Gallagher, Associate Counsel INTRODUCTION The veteran had active service from April 1984 to February 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 1993 rating decision. The veteran appeared at a hearing before a member of the Board at the RO in March 1994. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in essence, that the symptoms of his service-connected sarcoidosis of his lungs have become more severe and warrant more than a 10 percent disability evaluation. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the assignment of more than a 10 percent disability rating for the veteran's service-connected sarcoidosis. FINDINGS OF FACT 1. Sufficient evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The veteran's service-connected sarcoidosis of the lungs is manifested by subjective complaints of shortness of breath, extreme fatigue upon minor exertion, stiffness in his bones, and occasional severe chest pain. The objective manifestations consist of clinical evidence of bilateral hilar fullness with radiating streaks of fibrosis, and mild restriction of pulmonary function. 3. The objective clinical findings indicate that the veteran's sarcoidosis is in remission and causes no more than mild dyspnea. CONCLUSION OF LAW The evidence does not warrant an evaluation in excess of 10 percent for sarcoidosis. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.20, 4.97, Code 6699-6802 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board notes that the veteran's claim is well- grounded within the meaning of 38 U.S.C.A. § 5107, and that all relevant facts have been properly developed for this appeal. Disability evaluations are determined by the application of a schedule for rating disabilities. Separate Diagnostic Codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. § Part 4 (1994). The veteran's service medical records show that his sarcoidosis was not discovered until his January 1987 pre- separation examination. At that time X-ray studies revealed bilateral hilar lymphadenopathy. The veteran filed a claim in March 1987 for service connection for sarcoidosis. In March and April 1987 the veteran was examined and treated at VA medical facilities. A transbronchial biopsy showed non-caseating granuloma consistent with sarcoidosis. Following the biopsy, the veteran developed pneumothorax, requiring a chest tube. His pneumothorax resolved without complications. X-ray studies showed findings consistent with Stage I sarcoidosis. Pulmonary function tests showed mild restrictive defects. The diagnosis was sarcoidosis. A VA examination for compensation purposes was conducted in April 1987. The report of that examination shows that the veteran's pulmonary function tests were within normal limits. His heart was found to be normal, and his lung fields clear to percussion and auscultation. X-ray studies showed bilateral hilar masses, minimal pleural thickening within the fissures, and a normal sized heart. The diagnoses included asymptomatic sarcoidosis by history and X-ray. In July 1987, the RO granted service connection for sarcoidosis and assigned a 10 percent disability rating under Code 6699-6802, effective from March 1, 1987, the day after the veteran's separation from service. 38 C.F.R. § 4.97, Code 6699-6802 (1994). Code 6699-6802 was used to rate the disability as the rating code does not contain a separate listing for sarcoidosis. When an unlisted condition is encountered it is permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical location and symptomatology are closely analogous. 38 C.F.R. § 4.20. Thus, the veteran's sarcoidosis was evaluated by analogy to pneumoconiosis. 38 C.F.R. § 4.97, Code 6802. This was the most appropriate code since only lung involvement was demonstrated, and the symptoms are essentially the same. In May 1988, the veteran filed a notice of disagreement with the assignment of a 10 percent evaluation, but did not perfect an appeal on the issue at that time. The report of a September 1989 VA examination states that the veteran complained of shortness of breath while jogging. He reported he worked as a clerk at the Post Office for approximately 10 hours per week. The veteran had normal spirometry on his pulmonary function test. His heart and lungs were found to be in good condition and it was noted that he had a well-healed thoracotomy scar. X-ray studies showed that his hila were prominent, though much less so than on his previous examination. His pulmonary fields were found to be clear and his bony thorax intact. The radiologist's impression was that the right paratracheal adenopathy was no longer identified, and that the studies showed partial interval resolution of the veteran's bilateral hilaradenopathy. The examiner's assessments included sarcoidosis diagnosed April 1987 by biopsy. The RO issued a rating decision in October 1989 confirming the 10 percent evaluation previously assigned. That decision was based on the fact that the clinical test results showed that the veteran's spirometry was normal. In July 1993, the veteran filed a claim for an increase in the disability rating evaluation for his sarcoidosis. In support of this claim, he submitted a record from his June 1993 examination by Gregory K. Parker, M.D. of Mobile, Alabama. Dr. Parker's one page examination report shows that the veteran presented complaining of severe dyspnea and dull chest pain. Diffuse coarse rales were noted. The report states that the veteran had severe exertional fatigue and inability to work, although it is unclear whether this was a complaint made by the veteran or a clinical finding made by the physician. Dr. Parker noted that the veteran had progressive sarcoidosis, possible cardiomyopathy, and coronary artery disease. The report indicates that laboratory and X-ray findings showed bilateral hilar adenopathy and parenchymal fibrosis. The veteran's prognosis was listed as fair. The veteran was afforded a VA examination in August 1993. The report states that the veteran was not on medication for his disability, that he did not appear short of breath, and that his heart and lungs were normal to physical examination. It was noted that no apparent joint or bone disease, or lymphadenopathy of the cervical axillary, epitrochlear or inguinal nodes were shown. The veteran had normal range of motion in all joints, and his pulmonary function studies showed a mild restrictive effect. X-ray studies of the veteran's chest showed bilateral hilar fullness and radiating streaks of fibrosis, which were essentially unchanged since the last VA examination X-ray studies. No active pulmonary infiltrate was seen, and the heart was not enlarged. The radiologist's impression was that the veteran had a stable chest. The examiner's diagnosis was pulmonary sarcoidosis, in remission. The RO's September 1993 decision confirmed the 10 percent disability rating previously assigned. The veteran filed a notice of disagreement with this decision and stated that he had missed 16 days from work in the past year due to his illness. He further stated that the symptoms of his disability disrupt his sleep. The veteran filed his appeal in November 1993 and indicated that the VA examiner's evaluation of his condition conflicted with Dr. Parker's. During his March 1994 hearing before a member of the Board at the RO, the veteran testified that he is employed as a postal worker in a rural Post Office and that his work involves some medium lifting as well as fast sorting of mail. He stated that he has missed numerous days from work due to his disability and that he notices that his disability causes him to slow down when performing his tasks. He remarked that the dust on the mail causes problems with his breathing when it gets into his lungs. The veteran testified that three times in the past year he had to go get oxygen at the U.S.A. Medical center or the Springhill Memorial Hospital in Mobile due to his problems breathing. He stated that he usually received the oxygen for one to one and a half hours during those treatments. Additionally, the veteran testified that he can only play with his young son for about five minutes at a time and then must stop because he gets short of breath. He stated he can't engage in normal activities such as washing a car, or going outdoors in hot weather, due to his breathing problems. He further testified that he has stiffness in his bones, and that he experienced severe chest pain about three weeks prior to the hearing. He reported that he takes Motrin to relieve his pain. After reviewing all the evidence of record, the Board finds that the 10 percent disability evaluation currently in effect for the veteran's sarcoidosis is appropriate. In order for the veteran to receive a higher rating for sarcoidosis by analogy to pneumoconiosis, his symptomatology must meet the criteria set forth in Diagnostic Code 6802 for those ratings. To receive a 30 percent rating, there must be moderate disability as manifested by considerable pulmonary fibrosis and moderate dyspnea on slight exertion, confirmed by pulmonary function tests. For a 60 percent rating, there must be severe disability, as manifested by extensive fibrosis, and severe dyspnea on slight exertion with corresponding ventilatory deficit confirmed by pulmonary function tests, with marked impairment of health. 38 C.F.R. § 4.97, Code 6802. In this case, the veteran's subjective complaints of fatigue, shortness of breath, and stiffness in his bones, are not supported by the clinical findings in the record. Although the report from the veteran's private physician might seem to indicate a higher level of disability, upon review, it appears that Dr. Parker's analysis of the severity of the veteran's symptoms was derived principally from the veteran's subjective complaints. By contrast, the examinations and tests conducted by the VA in 1987 and 1993, which included X-ray studies and pulmonary function tests, led the VA examiner to conclude in August 1993 that the veteran's sarcoidosis was in remission and caused only mild respiratory dysfunction. In view of such findings, the veteran's symptoms cannot be said to be more than mild in severity and thus do not warrant an increase to a 30 percent disability evaluation at the present time. As the range of motion of the veteran's joints was found to be normal during his August 1993 VA examination, and no apparent joint or bone disease was shown, it does not appear that his sarcoidosis involves areas of his body other than his lungs. Therefore, the veteran's disability is most appropriately evaluated by analogy to pneumoconiosis under Code 6802. Since the evidence taken as a whole indicates that the veteran's sarcoidosis causes only mild symptoms, the Board finds that the 10 percent evaluation is correct and should not be increased at present. In reaching its decision, the Board has considered the complete history of the disability in question as well as the current clinical manifestations and the effect the disability may have on the earning capacity of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.16 (1994). The nature of the original disease has been reviewed and the functional impairment which can be attributed to pain or weakness has been taken into account. 38 C.F.R. § 4.40 (1994). Further, the Board has found that in this case the disability picture is not so exceptional or unusual as to warrant an evaluation on an extraschedular basis. ORDER A rating in excess of 10 percent for sarcoidosis is not established and this appeal is denied. JAMES R. ANTHONY Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. 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. - 2 -