Citation Nr: 9926768 Decision Date: 09/17/99 Archive Date: 09/28/99 DOCKET NO. 98-08 173 ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office Center in Wichita, Kansas THE ISSUES 1. Entitlement to a disability rating greater than 10 percent for asthma. 2. Entitlement to a compensable disability rating for allergic rhinitis. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Michelle L. Nelsen, Associate Counsel INTRODUCTION The veteran had active duty from July 1977 to July 1997. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 1997 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Little Rock, Arkansas. The claims folder was subsequently transferred to the Medical and Regional Office Center in Wichita, Kansas. FINDINGS OF FACT 1. The RO has obtained all relevant evidence necessary for the equitable disposition of the veteran's appeal. 2. The evidence reveals that the veteran's asthma required the use of inhalational anti-inflammatory steroid medication currently and before her separation from service. 3. The medical evidence fails to reveal the presence of nasal polyps or any amount of blockage of the nasal passages. CONCLUSIONS OF LAW 1. The criteria for a 30 percent disability rating for asthma have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.102, 4.1-4.7, 4.21, 4.97, Diagnostic Code 6602 (1998). 2. The criteria for a compensable disability rating for allergic rhinitis have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.7, 4.21, 4.97, Diagnostic Code 6522 (1998). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS When a claimant is awarded service connection for a disability and subsequently appeals the RO's initial assignment of a rating for that disability, the claim continues to be well grounded as long as the rating schedule provides for a higher rating and the claim remains open. Shipwash v. Brown, 8 Vet. App. 218, 224 (1995). Accordingly, the Board finds that the veteran's claims for increased ratings are well grounded. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.102 (1998). The Board is also satisfied that all relevant facts have been properly and sufficiently developed to address the issues at hand. Factual Background The veteran's service medical records reveal intermittent treatment for asthma and allergic rhinitis. Notes dated in November 1996 indicated that the veteran was being followed up for perennial allergic rhinitis with secondary occasional reactive airway disease. She was responding well to a metered dose inhaler. She also used environmental controls and nasal steroid spray. In December 1996, the veteran presented with wheezing and shortness of breath. The Proventil inhaler was not helpful. Pulmonary function tests revealed forced expiratory volume in one second (FEV-1) of 60 percent of predicted. The ratio of forced expiratory volume in one second to forced vital capacity (FEV-1/FVC) was 75 percent. The assessment was acute exacerbation of reactive airway disease. She was to continue frequent use of her metered dose inhaler. The physician prescribed prednisone and noted that the veteran would need a Medical Board Evaluation. The January 1997 retirement physical examination was significant for asthma. The veteran's medications included Naldecon, Ventolin inhaler, and Beconase nasal spray. On the accompanying report of medical history, it was noted that her allergies were treated with Seldane and Beconase with good results. She used Naldecon at night. Her last episode of allergies was in September 1996. The veteran's asthma was treated with a Ventolin inhaler. She had used prednisone steroids for two weeks. The last episode of asthma was in November 1996. Chest X-rays taken in January 1997 revealed findings consistent with a clinical history of asthma without evidence of alveolar infiltrate. Pulmonary function tests performed in January 1997 revealed FEV-1 of 71 percent of predicted pre-dilators and 90 percent of predicted post- dilators. FEV-1/FVC was 90 percent of predicted pre-dilators and 95 percent of predicted post-dilators. The February 1997 summary of the Medical Board Evaluation summary indicated that the veteran began experiencing difficulty breathing at age 26. Symptoms of chest tightness and wheezing were associated with seasonal allergies. She also experienced typical hay fever symptoms. Treatment included antihistamines, nasal steroid sprays, and albuterol inhaler, which eliminated all her symptoms. The veteran did not require hospitalization at any time and the medications were used only with flare-ups of her seasonal allergies in the spring and fall and with occasional respiratory infections. Skin testing revealed positive reactions to dust mites, cats, dogs, horses, and feathers. Her symptoms were never severe enough to warrant initiation of immunotherapy injections. The veteran currently had a cold with congestion and increased cough over the previous week. Her medications included Naldecon, Beconase, and Ventolin metered dose inhaler. Physical examination was normal. The examiner reviewed spirometry results from January 1997. The impression was allergic rhinitis and asthma aggravated by allergic rhinitis. The examiner started the veteran on inhaled steroids, Vanceril, and indicated that the veteran would taper off the medications as symptoms improved. He also commented that, since the veteran's symptoms were well controlled with medications, he recommended that she return to duty. Notes dated in March 1997 revealed a follow up visit for asthma. The veteran felt some occasional shortness of breath after exercise, but not enough to use her Proventil inhaler. She was to continue using a Ventolin inhaler, as well as Beclovent and Beconase. In a September 1997 rating decision, the RO established service connection for asthma and allergic rhinitis. It assigned a 10 percent and 0 percent disability rating, respectively. The veteran timely appealed that decision. The veteran submitted medical records from Little Rock Air Force Base. Notes dated in September 1997 indicated that she was doing well on Vanceril and rarely needed to use Ventolin. The lungs were clear with no wheezes. The assessment was controlled asthma. The physician prescribed an Aerobid inhaler. In November 1997, the veteran complained of congestion, painful breathing, and productive green cough. Examination of the lungs revealed diffuse wheezes without rales or rhonchi. The assessment was reactive airway disease exacerbation. It was noted that the veteran received refills of albuterol and Beconase. Notes dated in February 1998 indicated that the veteran was still using Proventil and a steroid inhaler. In her May 1998 substantive appeal, the veteran stated that the Medical Board Evaluation was done without her records, which were lost and not found until after the review was completed. She now took inhaled steroids and had not been able to taper off her medication. She used allergy medications on a daily basis. She used a nasal steroid, Aerobid, and albuterol. They helped her symptoms but did not eliminate them. In December 1998, the veteran was afforded a VA examination. She was diagnosed with asthma in 1996. She reported having periodic episodes of chest congestion and wheezing. She used a Vanceril inhaler twice a day and albuterol as needed. The veteran was also bothered with allergic rhinitis. Allergy testing revealed reactions to a variety of items including dust mites and feathers. She used Beconase nasal spray for episodes of nasal stuffiness and rhinorrhea. She denied nasal or sinus surgery or nosebleeds. Examination revealed clear nasal passages and normal mucosa. The lungs were clear to auscultation and percussion. She did not cough during the examination. The impression was bronchial asthma and allergic rhinitis. Chest X-rays were normal. Pulmonary function tests revealed FEV-1 at 106 percent of predicted and FEV-1/FVC of 97 percent of predicted. The interpretation of the results was normal spirometry. Analysis Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board observes that, in a claim of disagreement with the initial rating assigned following a grant of service connection, as is the situation in this case, separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119, 126 (1999). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the veteran, as well as the entire history of the veteran's disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). Asthma The veteran's asthma is currently evaluated as 10 percent disabling under Diagnostic Code (Code) 6602, bronchial asthma. 38 C.F.R. § 4.97. Under Code 6602, a 10 percent rating is assigned when testing reveals FEV-1 of 71- to 80- percent predicted, or; testing reveals FEV-1/FVC of 71 to 80 percent, or; when the disability requires intermittent inhalational or oral bronchodilator therapy. A 30 percent rating is awarded when testing reveals FEV-1 of 56- to 70- percent predicted, or; testing reveals FEV-1/FVC of 56 to 70 percent, or; the disability requires daily inhalational or oral bronchodilator therapy, or; the disability requires inhalational anti-inflammatory medication. A 60 percent rating is warranted when testing reveals FEV-1 of 40- to 55- percent predicted, or; testing reveals FEV-1/FVC of 40 to 55 percent, or; the disability requires at least monthly visits to a physician for required care of exacerbations, or; the disability requires intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. Considering the evidence of record, the Board finds that the evidence supports entitlement to a 30 percent disability rating for asthma. Although the pulmonary function testing does not reveal spirometry within the required parameters for a 30 percent rating, service medical records show that, at her separation from service, the veteran was placed on inhaled anti-inflammatory steroid medication. Current medical evidence shows that she continues to use steroid inhalers for treatment of asthma. Therefore, the evidence satisfies the criteria for a 30 percent rating. 38 C.F.R. § 4.7. The Board also finds that the disability picture does not more nearly approximate the criteria for a 60 percent rating. 38 C.F.R. § 4.7. Specifically, pulmonary function tests fail to establish respiratory incapacity required for a 60 percent rating. In addition, the evidence does not establish the required frequency of exacerbations. Finally, there is no evidence that the veteran's asthma has required intermittent courses of systemic corticosteroids. In summary, the Board finds that the evidence supports no more than a 30 percent disability rating for asthma. 38 U.S.C.A. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.97, Code 6602. Allergic Rhinitis The veteran's allergic rhinitis is currently evaluated as noncompensable (0 percent disabling) under Code 6522, allergic or vasomotor rhinitis. 38 C.F.R. § 4.97. Under Code 6522, a 10 percent rating is in order where there is 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. A 30 percent rating is assigned if there is rhinitis with polyps. See 38 C.F.R. § 4.31 (where the Schedule does not provide a 0 percent rating, a 0 percent shall be assigned if the requirements for a compensable rating are not met). The veteran states that she requires daily medication for symptoms from allergies. However, the service medical records at separation, the post-service medical records, and the December 1998 VA examination report reveal no evidence of polyps or any amount of nasal blockage. Therefore the Board cannot conclude that the veteran's disability picture more nearly approximates the criteria required for a 10 percent rating under Code 6522. 38 C.F.R. § 4.7. Accordingly, the Board finds that the preponderance of the evidence is against entitlement to a compensable disability rating for allergic rhinitis. 38 U.S.C.A. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.97, Code 6522. ORDER Entitlement to a 30 percent disability rating for asthma is granted. To this extent the appeal is allowed, subject to the law and regulations governing the payment of monetary benefits,. Entitlement to a compensable disability rating for allergic rhinitis is denied. HILARY L. GOODMAN Acting Member, Board of Veterans' Appeals