Citation Nr: 1018046 Decision Date: 05/14/10 Archive Date: 05/26/10 DOCKET NO. 09-07 774 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to an increased rating for bronchial asthma, currently evaluated as 30 percent disabling. ATTORNEY FOR THE BOARD Siobhan Brogdon, Counsel INTRODUCTION The Veteran served on active duty from October 1964 to September 1968. This appeal comes before the Department of Veterans Affairs (VA) Board of Veterans Appeals (Board) from a May 2008 rating decision of the VA Regional Office in Waco, Texas that denied an evaluation in excess of 30 percent for bronchial asthma. Following review of the record, the appeal is REMANDED to the RO via the Appeals Management Center (AMC) in Washington, DC. VA will notify the appellant if further action is required. REMAND The Veteran is currently in receipt of a 30 percent disability evaluation for service-connected asthma under 38 C.F.R. § 4.97, Diagnostic Code 6602, which provides for a 30 percent rating when there is FEV-1 of 56 to 70 percent of predicted value; an FEV-1/FVC of 56 to 70 percent; daily inhalational or oral bronchodilator therapy; or inhalational anti-inflammatory medication. A 60 percent evaluation is awarded in cases where there is FEV-1 of 40-to 55 percent of predicted value; FEV-1/FVC of 40 to 55 percent; 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 evaluation is warranted for FEV-1 of less than 40-percent of predicted value; FEV-1/FVC less than 40 percent; more than one attack per week with episodes of respiratory failure; or the requirement of daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications. The Veteran essentially contends that his service-connected bronchial asthma has increased in severity. In a detailed statement received in April 2009, he listed Asmanex (mometasone furoate inhalation powder), a corticosteroid, Proventil, and Albuterol sulfate inhalation aerosol as the medications he is required to take for asthma. The Veteran maintains that the use of such indicates aggressive treatment for a more severe asthmatic condition, and that his required long-term use of a corticosteroid may be contributing to the impairment of his overall health. He maintains that his symptoms more nearly approximate the schedular criteria for the 60 percent disability evaluation for asthma. The record reflects that the Veteran most recently had a VA compensation and pension examination for bronchial asthma in September 2007. At that time, the examiner noted that the Veteran used a Combivent bronchodilator twice daily, and an Albuterol nebulizer during the pollen season, and that with these, he had maintained his breathing without disabling shortness of breath. VA outpatient clinic notes dated in late March 2008 indicate that the Veteran's symptoms were getting worse. It was recorded at that time that there had been a significant change in his pulmonary function tests since September 2007, and it was felt that his asthma had never been properly treated. A "stepwise treatment plan" with frequent follow-up was ordered, starting with a "steroid burst", taper and a high dose inhaled corticosteroid (ICS) for one week to try and get better control of the inflammation and the appellant's symptoms. It was noted that he would be started on mometasone and continue with Combivent. VA outpatient clinical entries of record date only through April 28, 2008. Therefore, it is unknown as to what transpired after implementation of the increased treatment regimen. Furthermore, there is no clinical data as to the current status of the service-connected bronchial asthma. The Board finds that the evidence received since VA examination in September 2007 suggests possible, though not necessarily consistently worsening, pulmonary symptomatology for which more aggressive treatment was implemented. As noted previously, the Veteran indicates that his condition has worsened. Based on a review of the record as a whole, the Board is of the opinion that a VA examination to assess the current status of the service-connected bronchial asthma is warranted. The Board point outs that, although it is not required to request a new examination simply because of the passage of time, VA's General Counsel has held that a new examination is appropriate when the record demonstrates or the claimant asserts that the disability in question has undergone an increase in severity since the last examination. See VAOPGCPREC 11-95 (April 7, 1995). Accordingly, the case is REMANDED for the following actions: 1. Obtain VA outpatient clinic notes dating from April 2008 showing treatment for bronchial asthma and associate them with the claims folder. 2. After receipt of all updated treatment records, schedule the Veteran for an examination to determine the nature and severity of his bronchial asthma. The claims folder should be made available to the examiner and all tests and studies deemed necessary by the examiner should be performed with findings being reported in detail. The examiner should indicate whether the Veteran has at least monthly visits to a physician for required care of exacerbations, and/or the frequency of courses of systemic (oral or parenteral) corticosteroids or immuno- suppressive medications. 3. After taking any further development deemed appropriate, re-adjudicate the issue on appeal. If the benefit is not granted, the appellant and his representative should be provided a supplemental statement of the case and afforded an opportunity to respond before the case is returned to the Board for appellate disposition. The purpose of this REMAND is to obtain additional development and the Board does not intimate any opinion as to the merits of the case, either favorable or unfavorable, at this time. The Veteran is free to submit any additional evidence and/or argument he desires to have considered in connection with his current appeal. Kutscherousky v. West, 12 Vet. App. 369 (1999). No action is required of the Veteran until he is notified. This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). _________________________________________________ Kristi Barlow Acting Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2009).