Citation Nr: 9812697 Decision Date: 04/23/98 Archive Date: 05/08/98 DOCKET NO. 97-04 205 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to an increased evaluation for asthma, currently evaluated as 30 percent disabling. 2. Entitlement to an evaluation in excess of 10 percent for asthma, prior to October 7, 1996. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J. McGovern, Associate Counsel INTRODUCTION The veteran had active service from May 1972 to March 1976 and from February 1979 to March 1996. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from the August 1996 rating decision of the St. Petersburg, Florida Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for asthma, evaluated as 10 percent from April 1, 1996. By rating decision dated in January 1997, the RO increased the evaluation of the veteran’s asthma from 10 to 30 percent, effective from October 7, 1996. In its January 1997 rating decision, the RO noted that the 30 percent evaluation for asthma was made effective from October 7, 1996, the effective date of the changes to the diagnostic criteria for rating respiratory disorders. Inasmuch as the veteran may still receive an evaluation in excess of 30 percent for asthma, the issue of entitlement to an evaluation in excess of 30 percent for asthma is now before the Board. See Holland v. Brown, 9 Vet. App. 324 (1996); AB v. Brown, 6 Vet. App. 35 (1993). CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his asthma is more disabling than the current 30 percent evaluation reflects and that a 60 percent evaluation should be assigned, effective from April 1, 1996. He asserts that his asthma is severe and that he is taking several medications daily. He avers that he must seek medical attention for exacerbations of asthma at least eight times a year, that he has frequent attacks which occur at least four times a month or one to three times weekly, that he controls these attacks with his medications, and that he has been reduced from full time employment to part time employment due to the severity and frequency of his asthma attacks. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1997), 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 favors a 30 percent evaluation and no higher prior to October 7, 1996, and that the preponderance of the evidence is against an increased evaluation in excess of 30 percent from October 7, 1996. FINDINGS OF FACT 1. All evidence necessary for an equitable adjudication of the issues on appeal has been obtained. 2. Both prior to and since October 7, 1996, the veteran’s service-connected asthma has been manifested by Forced Expiratory Volume in one second (FEV-1) of 57 percent predicted prebronchodilator and 67 percent predicted postbronchodilator; a ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) of 59 percent prebronchodilator and 65 percent postbronchodilator; required daily use of inhalation therapy. 3. Both prior to and since October 7, 1996, the veteran’s asthma has been manifested by no more than rather frequent asthmatic attacks with moderate dyspnea on exertion between attacks, constituting moderate asthma as contemplated by the rating criteria in effect prior to October 7, 1996. CONCLUSIONS OF LAW 1. The criteria for a 30 percent evaluation for asthma prior to October 7, 1996 are met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 4.97, Diagnostic Code 6602 (1996). 2. The criteria for an evaluation in excess of 30 percent for asthma from October 7, 1996 are not met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. § 4.97, Diagnostic Code 6602 (1996 and 1997); Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Factual Background The veteran’s service medical records show that, in May 1972, an examiner noted that asthma medications were not approved “per return to S.C.” In June 1972, the veteran was hospitalized for treatment of an upper respiratory infection and the discharge diagnosis was bilateral lower lobe pneumonia. In September 1972, the veteran was treated for severe allergic conjunctivitis and rhinitis and he also complained of tightness in the chest. The impression was allergy. No relevant defects were noted at the March 1976 discharge examination. At a September 1976 VA examination, the veteran reported that he had had episodes of tightness in his chest and shortness of breath for about four years. On examination, the veteran’s lungs were clear to auscultation and percussion, there were no rales or wheezes, and there was no clubbing. The relevant diagnosis was bronchial asthma, mild. The conclusion of September 1976 VA pulmonary function tests was mild airway obstruction. Service medical records dated from February 1979 to December 1986 reveal that the veteran sought treatment on numerous occasions for allergies, sinus congestion, upper respiratory infections, and allergic rhinitis and that, on occasion, the veteran complained of wheezing. An October 1983 assessment was no contraindication noted for pulmonary function test. In December 1986, the veteran was diagnosed with acute asthma attack – resolved. He continued to seek treatment for follow-up of bronchospasm through March 1987 and the impressions included bronchospasm, secondary to cold dry air; resolved bronchospasm; bronchospasm; asthma; asthma labile airways; and asthma, possibly extrinsic. Medication for reactive airway disease was prescribed. The most recent inservice pulmonary function tests were conducted in October 1995 and showed an FEV-1 of 97 percent predicted pre-medication and 102 percent predicted post- bronchodilator and an FEV-1/FVC of 82 percent pre-medication and 87 percent post-medication. June 1989 treatment records reveal that, although the veteran reported previous problems with asthma and history of exercise intolerance, he had been on a regular exercise program and had been running five times a week. The diagnosis in a December 1989 treatment record was restrictive airway disease/asthma by history. Later in December 1989 an examiner noted that the veteran was asymptomatic and the diagnosis was asthma by history. In January 1990, an examiner stated that the veteran had been doing physical readiness tests in the past without problems, that the veteran reported that he had been taking TheoDur, that he was doing great without problems, and that the lungs were clear to auscultation and percussion. January 1990 and March 1990 assessments were normal examination, asthma by history. In June 1990 the veteran complained of a lingering cough and tightness in his chest. The assessment was restrictive airway disease, cough. In a September 1990 treatment record, an examiner noted that the veteran’s last asthma attack had been in approximately December 1986. In October 1990, the veteran requested medication refills and the examiner noted that his asthma was well controlled. The assessment was asthmatic – well controlled. In November 1990 the veteran reported that he felt winded lately, especially when the weather was colder and he stated that he engaged in aerobic exercise three times a week, except within the last three weeks due to weather/breathing problems. A May 1991 examiner noted that pulmonary function tests showed moderate obstructive component. In June 1991, the veteran reported that his asthma was improving and that he felt like he could start training. It was noted that the veteran was qualified for physical training programs without restrictions and that no further evaluation was indicated. In October 1991 and January 1992, the veteran continued to seek treatment for restrictive airway disease and to refill his asthma medications. In May 1992, an examiner noted that the veteran had a history of asthma, that he was taking Theo- Dur, and that he had had no recent attacks. In July 1992, the veteran reported that exercise sometimes induced his asthma and that he bicycled two to three times a week. The examiner noted that the veteran’s asthma was well controlled on medication. In September 1992, he sought refills of his medications but had no complaints at that time. In January 1993, the veteran again sought medication refills and the relevant impression was asthma by history. In July 1993, an examiner noted that the veteran had long-term asthma that increased with exercise and that he had problems with running but that he was usually successful with difficulty. The examiner noted that the veteran’s chest was clear to auscultation and percussion and that examination of the lungs revealed no wheezes. The veteran was cleared for his physical readiness test. In August 1993, the veteran complained of wheezing and shortness of breath, symptoms when he ran, and awakening with symptoms two to three times a week. The examiner noted that the veteran took TheoDur and Proventil, that he needed the Proventil two to four times a day, that the veteran had “Prov on shots” for two years which was of questionable help, and that pulmonary function tests showed borderline obstruction. On examination, the veteran’s lungs were clear. The relevant assessment was asthma – poor control and the examiner prescribed Azmacort and Proventil, and instructed the veteran to continue using TheoDur. In November 1993, pulmonary function tests were near normal and the assessment was asthma – better control. In April 1994, the veteran sought treatment for worsened asthma symptoms which occurred for three to four hours after waking and with exercise. The assessment was asthma, fair control but still having to use Proventil multiple times through the day. In July 1994, the examiner noted that pulmonary function tests revealed borderline obstruction and that the veteran’s lungs were clear. The assessment was asthma – fairly good control but some lability. Tilade was prescribed. In a November 1994 treatment record, the examiner noted that the veteran had a history of asthma with mild obstruction, that he had been seen in the emergency room on three occasions for exacerbations, and that he had not required steroids, hospitalization, or intubation. The veteran reported that his asthma was much improved with his current medications. The examiner noted that the veteran’s lungs were clear to auscultation and that there was good air movement. The assessment was mildly obstructive asthma. At a November 1994 “five year and overseas screening” examination, the veteran reported that he had asthma but he also indicated that he did not have shortness of breath. The examiner noted that the veteran had asthma which was controlled on medication. In December 1994 and January 1995, the veteran’s records were screened for suitability for overseas assignment and it was noted that the veteran required ongoing access to care for asthma and allergic rhinitis, that the veteran had been hospitalized twice in 1986 when asthma was first diagnosed, that it did not require intubation, that the veteran had been on TheoDur and Proventil since 1986, that he had been on Azmacort since October 1993, and that he had been on Tilade since July 1994. The record indicates that the veteran had last been seen by an allergist in January 1995, that it was felt that the asthma and allergic rhinitis were in good control, and that he needed follow-up every six months. The veteran’s overseas transfer was denied due to the fact that he needed four medications to control his asthma because such conditions worsened in the designated overseas environment and because the medical facility at the designated overseas location did not carry one of the veteran’s regular medications. A January 1995 examiner noted that pulmonary function tests revealed borderline obstruction and the assessment included asthma – good control. Also in January 1995, an examiner noted that the veteran’s asthma started in 1986, that he was presently being treated at an allergy clinic, and that he had shortness of breath which was caused by asthma. The veteran reported that he had asthma and shortness of breath and the examiner noted that the veteran had reactive airway disease, which was controlled with Proventil, Azmacort, and TheoDur. A March 1995 treatment record shows that the veteran sought refills for medication. The examiner noted that the veteran’s lungs were clear and the impression was asthma under control. A May 1995 examiner stated that pulmonary function tests were near normal and that the veteran’s lungs were clear. The assessment was asthma – near normal pulmonary function test but increased symptoms, therefore increase Azmacort dosage. In early September 1995, the veteran sought treatment and reported that he had needed increased use of Proventil in the previous two weeks. The examiner noted that the veteran’s lungs were clear and that pulmonary function tests revealed obstruction and were near normal after Albuteral. The assessment was asthma, increased lability of pulmonary function test, and increased symptoms. Later in September 1995, the veteran sought follow-up treatment for asthma and reported that he had some shortness of breath, no cough or wheeze, and chronic chest pain, discomfort, and tightness. The veteran stated that these symptoms were relieved by Proventil after a few hours. The examiner noted that pulmonary function tests were near normal, that the lungs were clear, and that the veteran was taking Azmacort, Tilade, TheoDur, and Proventil, which he needed several times a day. The assessment was asthma – increased symptoms despite a lot of medications; near normal baseline pulmonary function tests; clear lungs; and some lability on new pulmonary function test. In October 1995, the veteran sought treatment for follow-up of his asthma and the examiner noted that “added Surevent” and that there was a decreased need for Proventil, which was now only needed every few days. The examiner noted that pulmonary function tests were near normal and the assessment was asthma – good control. In November 1995, an examiner noted that the veteran was currently prescribed Azmacort, Tilade, Surevent, Seldane, Proventil, Vancenase, and TheoDur. The veteran reported that he had good control of his asthma especially since taking Azmacort and Surevent. The examiner reported that the veteran’s September 1995 pulmonary function tests were nearly normal. Examination revealed a few left basilar faint crackles and no wheezes. The impression was asthma/allergic rhinitis. At the December 1995 retirement examination, the veteran reported that he had asthma and shortness of breath and that his orders to Japan had been canceled due to his asthma. The examiner noted that the veteran had restrictive airway disease and shortness of breath and that the veteran had gained 10 pounds in the last month secondary to lack of exercise due to his asthma. The examiner reported that the veteran had been hospitalized on two occasions in 1986 when reactive airway disease was diagnosed. On examination, the examiner noted that the veteran had reactive airway disease – “not considered disqualifying.” In his April 1996 claim, the veteran reported that he worked in sales at Home Depot. At the May 1996 VA systemic conditions examination, the veteran reported that he had been diagnosed with asthma in 1986 and that he had been on immune therapy for approximately three years which failed. He asserted that he currently had approximately two to three asthma attacks a week. The examiner noted that the veteran’s medications included Serevent, two puffs every morning; Azmacort, four puffs three times daily; Tilade, two puffs three times daily; Theophylline, 300 milligrams three times daily; Naprosyn; Seldane; Beclomethasone nasal inhaler, two puffs in each nostril twice a day; and Proventil metered dose inhaler, two puffs every four hours as needed (he reportedly used approximately two puffs a day at minimum and more with exacerbations). The examiner reported that the veteran was well developed, well nourished, fairly obese, and in no apparent distress. Pulmonary examination was clear to auscultation, bilaterally, and there was symmetric mobility on breathing. The examiner noted that the veteran did have wheezing on forced supine expiration and that chest X-rays showed suboptimal inspiration with possible discoid atelectasis or scarring in the bases of the lower lobes, bilaterally. The examiner noted that FVC was 78 percent prebronchodilator and 83 percent postbronchodilator and that FEV-1 was 57 percent prebronchodilator and 67 percent postbronchodilator. The examiner reported that this represented a reversible change of approximately 17 percent. The pertinent diagnosis was asthma with a 17 percent reversible component. May 1996 VA chest X-rays showed suboptimal inspiratory effort, bibasilar discoid atelectasis and/or parenchymal scarring, slight obliquity noted on the lateral chest film, and no definite identified active infiltrates, pleural effusions, or discrete mass lesions. May 1996 VA pulmonary function tests revealed FEV-1 of 57 percent predicted prebronchodilator and 67 percent predicted postbronchodilator. The FEV-1/FVC was 59 percent before medication and 65 percent after medication. At the May 1996 VA examination for hyperthyroidism and thyroid adenoma, the veteran complained of asthma attacks “off and on.” The examiner noted that the veteran’s chest was clear and there was no relevant diagnosis. At the May 1996 VA general medical examination, the veteran reported that he had a history of adult-onset bronchial asthma. The examiner noted that the veteran was taking the following medications, mostly inhalers: Theravent metered- dose inhalers, Proventil, Azmacort, Seldane tablets, Vancenase inhaler, TheoDur inhaler, and Tilade inhaler. The veteran reported that he was currently working at Home Depot. The examiner noted that the veteran denied constitutional symptoms such as fever or weight loss and denied any other complaints at the time of the examination. The examiner reported that chest X-rays performed on the day of examination revealed a very poor inspiratory effort with bilateral discoid atelectasis. The examiner stated that the veteran was well developed, well nourished and in no apparent distress. Examination of the lungs was clear to auscultation, bilaterally. The relevant impression was adult-onset bronchial asthma and the veteran is using multiple metered-dose inhalers. By rating decision dated in August 1996, the RO granted service connection for asthma, evaluated as 10 percent disabling from April 1, 1996. In October 1996, the RO requested that the Tampa, Florida VA Medical Center (MC) provide all outpatient treatment records dated from April 1996 to October 1996. In December 1996, the Tampa, Florida VAMC provided the veteran’s outpatient treatment records dated from April 1996 to November 1996. The relevant records include a May 1996 VA outpatient treatment record that reveals that the veteran requested a refill for his inhaler. The examiner noted that the veteran’s lungs were clear. The relevant diagnostic impression was history of asthma. June 1996 VA outpatient treatment records reveal that the veteran’s lungs were clear to auscultation and that the veteran needed medication refills. There were no other relevant complaints, findings, or diagnoses. By letter dated in December 1996, the representative requested that the veteran’s claim of entitlement to an increased evaluation for asthma be adjudicated with consideration of the new rating criteria for the respiratory system. By rating decision dated in January 1997, the Board increased the evaluation of the veteran’s service-connected asthma from 10 to 30 percent, effective from October 7, 1996. Pertinent Law and Regulations In general, 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). In the instant case, there is no indication that there are additional records which have not been obtained and which would be pertinent to the present claims. Therefore, no further development is required in order to comply with VA's duty to assist mandated by 38 U.S.C.A. § 5107(a). Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), 38 C.F.R. Part 4 (1997). The percentage ratings contained in the Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (1997). In determining the disability evaluation, the VA has a duty to acknowledge and consider all regulations which are potentially applicable based upon the assertions and issues raised in the record and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Governing regulations include 38 C.F.R. §§ 4.1, 4.2, which require the evaluation of the complete medical history of the veteran’s condition. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating, otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the veteran’s favor. 38 C.F.R. § 4.3. The Schedule of ratings pertinent to the respiratory system (38 C.F.R. § 4.97 (1996)) was amended by 61 Fed. Reg. 46720, 46729 (Sept. 5, 1996), effective October 7, 1996. 38 C.F.R. § 4.97, Diagnostic Code 6602, now provides a disability evaluation of 10 percent for FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy. A 30 percent disability evaluation is warranted for FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication. A 60 percent disability evaluation is warranted for FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. A 100 percent disability evaluation is appropriate where the veteran demonstrates FEV-1 of less than 40 percent predicted, or; FEV-1/FVC of less than 40 percent, or; has more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno- suppressive medications. 38 C.F.R. § 4.97, Diagnostic Code 6602 (1997). The United States Court of Veterans Appeals (Court) has held that where a law or regulation changes after a claim has been filed, but before the administrative appeal process has been concluded, the version most favorable to an appellant applies. Karnas v. Derwinski, 1 Vet. App. 308 (1991). Thus, the review herein includes consideration of the laws and regulations in effect both prior and subsequent to October 7, 1996. Under the rating criteria in effect prior to October 7, 1996, bronchial asthma that is mild, with paroxysms of asthmatic type breathing (high pitched expiratory wheezing and dyspnea) occurring several times a year with no clinical findings between attacks, warrants a 10 percent rating. Moderate asthma, with asthmatic attacks rather frequent (separated by only 10-14 day intervals) with moderate dyspnea on exertion between attacks, is rated at 30 percent. Severe asthma, with frequent attacks of asthma (one or more attacks weekly), marked dyspnea on exertion between attacks with only temporary relief by medication, and more than light manual labor precluded, is rated at 60 percent. A 100 percent evaluation is provided for pronounced bronchial asthma with very frequent asthmatic attacks with severe dyspnea on slight exertion between attacks and with marked loss of weight or other evidence of severe impairment of health. 38 C.F.R. § 4.97, Diagnostic Code 6602 (1996). Analysis The Board finds that a 30 percent evaluation, but no more, is warranted for the veteran’s asthma prior to October 7, 1996, under on the rating criteria in effect at that time. Based on a longitudinal review of the record, it is noted that the veteran has been taking multiple medications for asthma over the last several years, that during the latter part of his active service his complaints included shortness of breath, and that prior to his retirement from the Navy, his ongoing need for access to treatment for asthma was noted and it was determined that he could not be transferred to Japan for an assignment because his asthma could worsen in such an environment and not all of his necessary medications were available there. In late 1995, his symptoms increased somewhat and his mediation had to be adjusted. However, throughout service, his pulmonary function tests reportedly remained close to normal, and the more recent service medical records show that the veteran’s symptoms were well controlled by medications and that he was able to continue full time work and physical training in the Navy. On VA examination in May 1996, wheezing was noted and the veteran was reported to be taking in excess of six different medications for asthma, primarily inhalants. Also, a chest X-ray in May 1996 showed some abnormal findings. Based on the foregoing and with consideration of the pre- October 7, 1996 rating criteria and 38 C.F.R. § 4.7, the Board concludes that the veteran’s asthma more closely approximated a moderate disorder prior to October 7, 1996. However, while he has reported approximately two to three asthma attacks a week, there is no medical evidence showing such attacks. In fact, the medical evidence generally shows good control of his asthma by medication. The only relevant outpatient treatment records from April 1996 to November 1996 reveal that, in May 1996, the veteran wanted a refill for an inhaler, and that his lungs were clear and the diagnostic impression was history of asthma. In a June 1996 VA outpatient treatment record, it was noted that the veteran had asthma, that his lungs were clear to auscultation, and that he needed medication refills. Accordingly, no more than 30 percent is warranted prior to or since October 7, 1996, under the old criteria since the asthma clearly is not shown to have been severe and has not been manifested by frequent attacks with marked dyspnea between attacks precluding more than light manual labor. 38 C.F.R. § 6602 (1996). Additionally, no more that 30 percent is warranted for the veteran’s asthma, either prior to or since October 7, 1996, under the revised rating criteria. Those criteria provide that a 30 percent disability evaluation is warranted for FEV- 1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication. A 60 percent disability evaluation is warranted for FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. The record shows that over the past several years no pulmonary function test has revealed an FEV-1 score below 56 predicted or an FEV-1/FVC score under 56. The most recent inservice pulmonary function tests were conducted in October 1995 and showed an FEV-1 score of 97 percent predicted pre- medication and 102 percent predicted post-medication and an FEV-1/FVC score of 82 percent pre-medication and 87 percent post-medication. The most recent, May 1996 VA examination showed FEV-1 of 57 percent predicted prebronchodilator and 67 percent postbronchodilator and FEV-1/FVC of 59 percent before medication and 65 percent after medication. Therefore, an increase is not warranted based on the test results. A 60 percent disability evaluation is also warranted under the new criteria when the veteran’s asthma requires at least monthly visits to a physician for required care of exacerbations. Such is not shown in this case. Although the veteran has asserted that he must seek medical attention for exacerbations of asthma at least eight times a year, the current evidence does not show that he sought medical treatment for an exacerbation of asthma at any time between April and November 1996 and that the most recent medical treatment for an exacerbation of his asthma was in service in September 1995; however, he does obtain regular medical for monitoring of his asthma. Finally, under the new criteria a 60 percent disability evaluation may be warranted when the service-connected asthma requires intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. The evidence of record shows that the veteran is currently taking several medications, most or all of which are inhalants. In any event, there is no evidence that the veteran has required intermittent courses of oral or parenteral corticosteroids during the past several years. Therefore, as the criteria for an evaluation above 30 percent since October 7, 1996, have not been met under the new or old rating criteria, the Board finds that an increased evaluation after October 7, 1996, is not warranted. ORDER Entitlement to a 30 percent evaluation for asthma, prior to October 7, 1996, is granted subject to regulations that control the payment of monetary benefits. Entitlement to an evaluation in excess of 30 percent for asthma, from October 7, 1996, is denied. JANE E. SHARP Member, Board of Veterans' Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1997), 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, 102 Stat. 4105, 4122 (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 -