Citation Nr: 1305334 Decision Date: 02/13/13 Archive Date: 02/21/13 DOCKET NO. 05-05 362 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUES 1. Entitlement to a higher rating for sinusitis, currently rated as noncompensable for the time period prior to April 11, 2006, and as 10 percent disabling beginning on April 11, 2006. 2. Entitlement to a higher rating for asthma, currently rated as noncompensable prior to March 31, 2006, as 10 percent disabling beginning on March 31, 2006 but prior to June 1, 2011, and as 30 percent disabling beginning on June 1, 2011. 3. Entitlement to a compensable rating for allergic rhinitis. 4. Entitlement to a compensable rating for bilateral hearing loss. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD E. Joyner, Counsel INTRODUCTION The Veteran served on active duty from November 1977 to November 1981 and from May 1988 to October 1996. He also had service with the U.S. Naval Reserves from March 1983 to May 1988. This case comes before the Board of Veterans' Appeals (Board) on appeal of a June 2003 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona. The June 2003 rating decision, in pertinent part, denied a compensable rating for reactive airway disease with allergic rhinitis and chronic sinusitis and denied a compensable rating for bilateral hearing loss. The Veteran appealed the decision. Thereafter, in a March 2008 rating decision, the RO granted an increased rating of 10 percent for asthma, effective March 31, 2006; assigned a separate 10 percent rating for chronic sinusitis, effective April 11, 2006; and assigned a separate noncompensable rating for allergic rhinitis, effective November 1, 1996. The March 2008 rating decision also denied a compensable rating for bilateral hearing loss. Thereafter, in a September 2012 rating decision, the RO granted an increased rating of 30 percent for the Veteran's service-connected asthma, made effective on June 1, 2011. As the highest possible ratings for asthma and sinusitis have not been awarded, the appeals continue. See AB v. Brown, 6 Vet. App. 35 (1993). In December 2009 the Veteran testified at a Travel Board hearing held before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing is in the claims file. The issues of entitlement to service connection for chest pains and entitlement to an increased rating for the Veteran's service-connected back disability have been raised by the record. However, these claims have not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over them, and they are referred to the AOJ for appropriate action. The issue of entitlement to a compensable rating for bilateral hearing loss is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. For the time period prior to April 11, 2006, the Veteran's sinusitis was manifested by no incapacitating episodes and less than three non-incapacitating episodes a year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. 2. For the time period beginning on April 11, 2006, the Veteran's sinusitis was manifested by no incapacitating episodes and less than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. 3. For the entire appeal period, the Veteran's asthma required inhalational anti-inflammatory medication. 4. For the time period prior to December 2, 2009, the Veteran's allergic rhinitis was manifested by, at most, 30 percent nasal obstruction on the right and 70 percent nasal obstruction on the left without polyps. 5. For the time period beginning on December 2, 2009, but prior to September 1, 2010, the Veteran's allergic rhinitis was manifested by two polyps in his right nasal canal. 6. For the time period beginning on September 1, 2010, the Veteran's allergic rhinitis was manifested by greater than 50 percent obstruction of nasal passage on both sides without polyps. CONCLUSIONS OF LAW 1. The criteria for a compensable rating for sinusitis prior to April 11, 2006 have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A (West 2002); 38 C.F.R. §§ 3.159, 3.321, Part 4, 4.7, 4.97, Diagnostic Code 6513 (2012). 2. The criteria for a rating in excess of 10 percent for sinusitis beginning on April 11, 2006 have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A (West 2002); 38 C.F.R. §§ 3.159, 3.321, Part 4, 4.7, 4.97, Diagnostic Code 6513 (2012). 3. The criteria for a 30 percent rating, but no higher, for asthma for the entire appeal period have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A (West 2002); 38 C.F.R. §§ 3.159, 3.321, Part 4, 4.7, 4.97, Diagnostic Code 6602 (2012). 4. The criteria for a compensable rating for allergic rhinitis for the time period prior to December 2, 2009, have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A (West 2002); 38 C.F.R. §§ 3.159, 3.321, Part 4, 4.7, 4.97, Diagnostic Code 6522 (2012). 5. The criteria for a 30 percent rating, but no higher, for allergic rhinitis for the time period beginning on December 2, 2009 but prior to September 1, 2010, have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A (West 2002); 38 C.F.R. §§ 3.159, 3.321, Part 4, 4.7, 4.97, Diagnostic Code 6522 (2012). 6. The criteria for a 10 percent rating, but no higher, for allergic rhinitis for the time period beginning on September 1, 2010, have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A (West 2002); 38 C.F.R. §§ 3.159, 3.321, Part 4, 4.7, 4.97, Diagnostic Code 6522 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), codified in pertinent part at 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2011), and the pertinent implementing regulation, codified at 38 C.F.R. § 3.159 (2012), provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. They also require VA to notify the claimant and the claimant's representative, if any, of any information, and any medical or lay evidence, not previously provided to the Secretary that is necessary to substantiate the claim. As part of the notice, VA is to specifically inform the claimant and the claimant's representative, if any, of which portion, if any, of the evidence is to be provided by the claimant and which part, if any, VA will attempt to obtain on behalf of the claimant. The United States Court of Appeals for Veterans Claims (Court) has held that the plain language of 38 U.S.C.A. § 5103(a) requires that notice to a claimant pursuant to the VCAA be provided "at the time" that, or "immediately after," VA receives a complete or substantially complete application for VA-administered benefits. Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). In this case the record reflects that VA provided the Veteran with the required notice by letters mailed in March 2003, August 2004, March 2006, June 2008, August 2008, December 2009, and May 2011. Although the March 2006 letter, which contained the initial notice regarding disability ratings and effective dates, was sent after the initial unfavorable decision, following the provision of the required notice and the completion of all indicated development of the record, the originating agency readjudicated the claims in a September 2012 supplemental statement of the case. As such, there was not prejudice to the Veteran concerning the timing of these notice elements. See Prickett v. Nicholson, 20 Vet. App. 370 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim is sufficient to cure a timing defect). The Veteran's service treatment records, VA medical treatment records, identified private medical records, and lay statements are of record. The Veteran was provided VA examinations in September 2004, October 2004, April 2006, December 2007, August 2008, and June 2011. The examination reports reflect that the examiners examined the Veteran, reviewed his medical records, documented his current medical condition, and together, these examination reports contain sufficient information to rate the Veteran's disabilities under the appropriate diagnostic criteria. The Board therefore concludes that the VA examination reports are adequate for evaluation purposes. See 38 C.F.R. § 4.2 (2012); see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). There is no indication in the record that any additional evidence relevant to the issues decided is available and not part of the claims file. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). In this regard, the AMC sent the Veteran a letter in May 2011 requesting additional information regarding treatment for his disabilities, to include sending him consent to release and authorization forms so that VA could obtain any outstanding evidence. The Veteran did not respond to the May 2011 letter or send in any additional evidence. Therefore, as there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of the case, the Board finds that any such failure is harmless. Mayfield, 20 Vet. App. at 543; see also Dingess/Hartman, 19 Vet. App. at 486. The Board finds that the RO has substantially complied with the Board's May 2011 remand instructions. In this regard, the May 2011 remand instructed the RO/AMC to obtain any outstanding VA treatment records since December 2004. The RO/AMC was also instructed to obtain authorization from the Veteran in order to obtain all treatment records from Drs. Patel, Crockett, Feeney, and Singer. Finally, a VA respiratory examination was to be scheduled in order to assess the current severity of the Veteran's service-connected sinusitis, allergic rhinitis, and asthma. The Board notes that the AMC sent the Veteran a letter in May 2011 indicating that VA treatment records had been obtained from December 2004 to the present. The letter also requested that the Veteran complete and return the authorization and consent to release information forms for Drs. Patel, Crockett, Feeney, and Singer. The Veteran did not respond to the May 2011 letter and no authorization forms or treatment records were submitted by the Veteran. Finally, the Veteran underwent a VA respiratory examination in June 2011 which addresses the Veteran's disabilities and the pertinent rating criteria for the disabilities. Under these circumstances, an additional remand to comply with the Board's directives is not required. See Stegall v. West, 11 Vet. App. 268 (1998). In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the United States Court of Appeals for Veterans Claims (Court) held that 38 C.F.R. 3.103(c)(2) requires that the RO Decision Review Officer (DRO) or Veterans Law Judge (VLJ) who conducts a hearing fulfill two duties to comply with the above the regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. Here, during the hearing, the VLJ noted the issues on appeal and questioned the Veteran about the existence of other treatment records as well as clarified the extent of the current disabilities. Moreover, neither the Veteran nor his representative has asserted that VA failed to comply with 38 C.F.R. 3.103(c)(2) nor has identified any prejudice in the conduct of the Board hearing. In contrast, the hearing focused on the elements necessary to substantiate the claims and the Veteran, through his testimony, demonstrated that he had actual knowledge of the elements necessary to substantiate his claims for benefits. In addition the Veteran was represented by a qualified Veterans Service Officer from his representative, Disabled American Veterans. As such, the Board finds that, consistent with Bryant, the VLJ complied with the duties set forth in 38 C.F.R. 3.103(c)(2), or if there was error, it was harmless due to the Veteran's actual knowledge of what was needed, and that the Board can adjudicate the claims based on the current record. In view of the foregoing, the Board finds that VA has fulfilled its duty to notify and assist the Veteran in the claims under consideration. Adjudication of the claims at this juncture, without directing or accomplishing any additional notification and/or development action, poses no risk of prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). The Board concludes the Veteran was provided the opportunity to meaningfully participate in the adjudication of his claims and did in fact participate. Washington v. Nicolson, 21 Vet. App. 191 (2007). Hence, there is no error or issue that precludes the Board from addressing the merits of this appeal. Factual Background An April 2001 private treatment record notes that the Veteran's medications included Albuterol and Nasalide. A July 2002 CT scan of the head revealed no significant intracranial abnormality. The impression was bilateral ethmoid sinus disease. A December 2002 private treatment record notes that the Veteran was placed on an antibiotic two days earlier for congestion and infection. Examination was remarkable for bilateral boggy nasal turbinates with increased mucoid production. There was a mild cobblestoning pattern to the posterior oropharynx. There was mild tenderness with percussion of the bilateral maxillary and right frontal sinuses. The assessment was acute sinusitis and allergic rhinitis. A November 2003 private treatment record notes that the Veteran complained of increased runny nose and itchy watery eyes over the last week. He denied any fever, nausea, vomiting or diarrhea. He has no cough, congestion or shortness of breath. Objective evidence revealed increased mucoid production at the bilateral turbinates, otherwise unremarkable. The assessment was allergic rhinitis. A January 2004 private treatment record notes a diagnosis of asthma. It was noted that the Veteran was to begin Advair. It was also noted that the Veteran was taking Albuterol as needed. A June 2004 private treatment record notes that the Veteran developed a cough with chest congestion over the past two to three weeks. Examination revealed increased mucoid production at the bilateral turbinates, otherwise remarkable. The assessment was acute bronchitis and allergic rhinitis. The Veteran was diagnosed with chronic cough. Current medications were noted to be Lansoprazole, Celebrex, and Benazepril. A September 2004 VA examination report reflects that the Veteran has chronic sinusitis. He reported that he has episodes of sinusitis twice a year requiring treatment with antibiotics. He does not recall any diagnosis of allergic rhinitis. He takes Loratadine and Flunisolide nasal spray. His symptoms include nasal drainage, headache, cough, occasional fever requiring antibiotic treatment. Examination revealed no maxillary sinus tenderness; the nasal mucosa was pink without exudates. There was minimal occlusion of nare when opposite compressed. The diagnosis was chronic sinusitis with twice a year symptoms requiring antibiotic treatment, was allergic rhinitis, stable on Loratadine, no functional loss, and bronchitis, episodic, occurring twice a year, requiring antibiotic therapy. VA pulmonary function testing results dated in October 2004 revealed adequate effort, no evidence of obstruction or restriction. DLCO was normal. FEV-1/FVC was 89 percent. There were no oxygen requirements and weight was stable. The Veteran denied any history of reactive airway disease. Asthma was not diagnosed. A November 2005 treatment record reflects that the Veteran's active medications included Albuterol, two puffs three times a day for asthma. A January 2006 treatment record notes complaints of headache, sinus pain, cough and wheezing. There were no nasal or throat symptoms. Examination revealed pink nasal mucosa. Flaring nasal alae were not observed. There were no abnormalities of the buccal mucosa. Oropharynx was normal. Lungs were clear to auscultation. Normal breath sounds were heard. Wheezing, rales and crackles were not heard. The diagnosis was cough. The Veteran was given an Albuterol treatment with Budesonide and he stated that he was feeling much better. It was noted that the Veteran's Albuterol prescription, written to take two puffs three times a day for asthma was last filled on September 15, 2005. A March 2006 treatment record notes that the Veteran was seen for follow-up of his asthma. He complained of tightness in his chest. Examination revealed no head symptoms and no headache. There was sinus pain. There were no otolaryngeal symptoms. Nasal symptoms included congestion and a sore of the left nares. Pulmonary symptoms included cough and some wheezing with a deep breath, as well as some chest tightness. Nasal mucosa was pink. Flaring nasal alae were not observed. There were no abnormalities of the buccal mucosa. There was slight erythema and cluster of vesicles at the right nasal ala. Lungs were clear to auscultation. Normal breath sounds were heard. No wheezing, rales, or crackles were heard. Exaggerated use of accessory muscles for inspiration was not observed. The diagnosis was asthma, mild intermittent. Medications noted were Albuterol and Fluticasone. The Albuterol was instructed to be used as two puffs three times daily for asthma. April 2006 VA treatment records reflect that postbronchodilator FVC was 107 percent. FEV-1 was 99 percent. FEV-1/FVC was 113 percent. DLCO was 90 percent. An April 2006 VA examination report notes that the Veteran has four to five sinus infections a year for the past three years. His current symptoms were pressure in the forehead, peri-orbital edema, pain in the posterior left side of the head, pain in the left ear, and yellow nasal drainage. He is treated with antibiotics on a short term basis for infection episodes. He also uses Flonase nasal inhalation daily. Functional loss from the sinusitis includes staying home from work at least two days with each sinus infection. The Veteran's allergic rhinitis symptoms seemed to occur more often than in the past. He has allergic symptoms at least 15-20 days out of the month. Treatment for his allergic rhinitis is Flonase daily. There is no functional loss from the allergic rhinitis. The Veteran was also noted to be diagnosed with asthma. Treatment for his asthma is accomplished with Flovent, Albuterol MDI, and the emergency room for Albuterol Nebulizer twice in the past 12 months. Symptoms include tightening chest, difficulty drawing in air. In the hot months he has an episode of this every other day and in the cooler months he has an episode of this about once a week. These attacks have occurred twice in the past 12 months. He has had no overnight hospitalizations during the past 12 months. He does not have any incapacitating episodes requiring bedrest and treatment by a physician. His weight is stable within two pounds and he has no oxygen requirements. Examination revealed that the lungs were clear to auscultation. Oropharynx was clear without exudates. Nares obstruction was 25 percent on the right and 25 percent on the left. The examiner found that there was mild functional loss from the chronic sinusitis. There was mild nares obstruction due to the allergic rhinitis, but no functional loss. There was no functional loss due to the reactive airway disease. There was no obstruction or restriction from the reactive airway disease, and normal pulmonary functions. A November 2007 VA treatment record reflects that FVC (postbronchodilator) was 121 percent. FEV-1 was 111 percent. FEV-1/FVC was 74 percent. A December 2007 VA examination report notes that the Veteran was currently employed full time as a tractor mechanic. It was noted that he had lost eight weeks of time from work due to service-connected condition. It was noted that the Veteran has had four to five sinus infections a year for the past three years. His current symptoms included pressure in the forehead, peri-orbital edema, pain in the posterior left side of the head, pain in the left ear, and yellow nasal drainage. He takes antibiotics on a short term basis when he has infections, and daily Flonase by nasal inhalation. He stays home from work at least two days with each sinus infection. He averages three sinus infections over a two-month period. The diagnosis was chronic sinusitis. The examination report also notes that the Veteran has allergic symptoms at least 15 to 20 days out of the month. He indicated that he seems to have allergic symptoms more days now than in the past. Current symptoms include clear drainage from the nose and eyes, and pain in the ears. Treatment for his allergic rhinitis is Flonase nasal spray. There is no functional loss due to allergic rhinitis. The diagnosis was allergic rhinitis poorly controlled on one daily nasally inhaled medication. Further noted was that the Veteran has reactive airway disease diagnosed as asthma. He takes Flovent and Albuterol. He went to his primary care provider's office for Albuterol Nebulizer twice in the past 12 months. This was followed by home nebulizer with Albuterol that he tapered to twice a week over a six month period, discontinuing in November 2007. Symptoms include chest tightness and it gets difficulty to draw in air. He cannot get his breath. In the very hot months he has an episode of this type every other day and in the cooler months he has an episode of this about once a week. He has coughing with sputum production. His asthma attacks have occurred twice in the past 12 months. He has had no overnight hospitalizations during the past 12 months. He has had no incapacitating episodes requiring bedrest by a physician. His weight has been stable within two pounds. He does not require oxygen. The diagnosis was asthma with normal pulmonary function tests and normal physical examination. A March 2008 private treatment record notes that the Veteran complained of a hacking productive, persistent cough. He also experienced shortness of breath and wheezing. Respiratory examination was positive for wheezing. Auscultation was described as bilateral decreased breath sounds. Cough was non-productive and respiratory effort was normal. The Veteran's nasal mucosa was bluish and boggy. The turbinates displayed mild hypertrophy bilaterally. There was cobblestoning of the oropharynx. Buccal mucosa was normal. The assessment included allergic rhinitis, not otherwise specified, and the Veteran was to continue his medication Allegra. The diagnosis also included asthma with acute exacerbation. Prednisone and Albuterol nebulizer were part of the plan. Albuterol was prescribed for use four times daily. Prednisone and Singulair were also prescribed. An April 2008 private treatment record notes that examination was positive for nasal drainage. Also noted was that the Veteran was seen for his asthma. It was noted that he has less trouble breathing. He stopped Prednisone after three days due to insomnia. He felt that it helped but he could not sleep. The Albuterol was prescribed for use four times daily. An August 2008 VA examination report notes that the Veteran has periodic episodes of sinusitis about twice a year, usually treated with antibiotics. His sinusitis is intermittent with remissions. It is treated with medication (Singulair daily and Flunisolide nasal spray during bad periods). There is no history of neoplasm. He has seasonal nasal allergies. There is no history of osteomyelitis. It was noted that the diagnosis was not made by X-ray only. There is no history of incapacitating episodes. There is a history of non-incapacitating episodes which occur twice a year and last for 14 days. Symptoms during such episodes include headache, fever, purulent drainage, and sinus pain. His current rhinitis symptoms are nasal congestion and excess nasal mucous. There are no current sinus symptoms. There is constant breathing difficulty and no speech impairment. There was no evidence of sinus disease or soft palate abnormality. The diagnosis was seasonal allergic rhinitis with episodic sinusitis by history and residual mild deviated septum status post septoplasty. The problem associated with the diagnosis was chronic sinusitis. The sinusitis was noted to have significant effects of the Veteran's usual occupation in terms of lack of stamina, weakness or fatigue, and pain, which cause increased tardiness. The sinusitis has a moderate effect on sports, a mild effect on exercise, and no effect on chores, shipping, recreation, traveling, feeding, bathing, dressing, toileting, and grooming. An August 2008 VA examination report further notes that the Veteran's current rhinitis symptoms are nasal congestion and excess nasal mucous. Examination revealed signs of nasal obstruction. There was a 70 percent left nasal obstruction and a 30 percent right nasal obstruction. Nasal polyps were not present. There was septal deviation due to trauma. There is no permanent hypertrophy of turbinates from bacterial rhinitis. Rhinoscleroma was not present. There was no tissue loss, scarring, or deformity of the nose. There was no evidence of Wegener's granulomatosis or granulomatous infection. There were no residuals of an injury to the pharynx, including nasopharynx. The Veteran's seasonal allergic rhinitis was not noted to have any associated problems. A September 2009 private treatment record notes that the Veteran was seen for allergies of one month duration. The Veteran was assessed with acute sinusitis. He was prescribed a 10 day course of Amoxicillin. Examination of the nares revealed crusty discharge bilaterally. Examination of nasal mucosa revealed swollen turbinates. There was tenderness bilaterally on the frontal and maxillary sinuses. Also on examination, the lungs were clear to auscultation. There was no cough or chest wall tenderness. A December 2009 private treatment record notes that the Veteran complained of sinus trouble, having trouble with pressure, possible polyps. Examination revealed that the right nasal canal had two small polyps. A September 2010 private treatment record notes that on examination lungs were clear to auscultation and percussion. They were symmetric in expansion and there was no dyspnea. Nasal turbinates were moderately swollen bilaterally. Examination of the oropharynx revealed normal mucosa, dentition, gingival, and posterior pharynx. The report of a June 2011 VA examination notes that the Veteran has sinusitis which is intermitted with remissions. He suffered nasal fractures and traumatic deviated septum in service. He underwent a septoplasty in 1995 which was no successful. He still has a deviated septum. The left side is especially blocked. The Veteran gets frequent sinus infections. His sinusitis is treated with medication (Flonase nasal spray daily and Kenalog IM long acting injections twice a year). These treatments reduce the frequency of sinusitis episodes. There is no history of neoplasm. He has a history of nasal allergy. The diagnosis of sinusitis was made by X-ray only, not clinical findings. There is no history of incapacitating episodes. There is a history of non-incapacitating episodes, which occur three times a year and last more than 14 days. Symptoms during such episodes are headache, fever, purulent drainage, and sinus pain. Physical examination revealed no evidence of sinus disease. There was no soft palate abnormality or speech impairment. Physical examination revealed signs of nasal obstruction. The left side nasal obstruction was 80 percent and the right side was 70 percent. Nasal polyps were not present. There was septal deviation due to trauma. There was no permanent hypertrophy of turbinates from bacterial rhinitis. Rhinoscleroma was not present. There was no tissue loss, scarring, or deformity of the nose. There is also no evidence of Wegener's granulomatosis or granulomatous infection. There has been no laryngectomy and there are no residuals of an injury to the pharynx, including nasopharynx. Sinus X-rays revealed that the paranasal sinuses were well aerated. It was noted that the Veteran's chronic recurrent sinusitis has significant effects on the Veteran's usual occupation in terms of decreased concentration, lack of stamina, weakness or fatigue, and pain. The resulting work problem is increased absenteeism. There is no effect on the Veteran's usual daily activities. The examiner summed up the Veteran's episodic sinusitis as resulting in episodic symptoms of sinus pain, headaches, fever, and purulent nasal drainage. When these symptoms are active, the Veteran suffers increased malaise and decreased stamina which results in absenteeism. The June 2011 VA examination report further reflects that the Veteran developed wheezing, shortness of breath, frequent bronchitis in service. He was diagnosed with asthma. Even between exacerbations he does not feel that his breathing is completely normal. He is treated with medication (intermittent inhaled bronchodilator and inhaled anti-inflammatory). He does take oral steroids twice a year for one to two weeks at a time. He takes Prednisone orally on a tapering dose for exacerbations. The exact dose was not known. He does not take parenteral steroids. He uses antibiotics. He does not almost continuously use antibiotics. The takes a less than four week course of antibiotics two times a year. He does not take a four to six week course of antibiotics. He does take another immunosuppressive medication (Montelukast, 10 mg) at least daily. The Veteran has no history of hospitalization or surgery, respiratory system trauma, swelling, dizziness, syncope, or angina. There is a history of hypertension, fatigue, and dyspnea on moderate exertion. There is no history of non-productive cough, productive cough, non-anginal chest pain, hemoptysis, fever, anorexia, night sweats, respiratory failure, cor pulmonale, RVH, pulmonary hypertension, chronic pulmonary mycosis, sleep apnea symptoms, spontaneous pneumothorax, bronchiectasis, gunshot wound with retained missile in lung, pulmonary embolism, or pleurisy with emphysema. There is a positive history of wheezing, dyspnea, and asthma. Wheezing occurs whenever he exerts himself and during exacerbations, which probably occur weekly. The Veteran has several clinical visits a year for exacerbations of his asthma. He has several acute attacks of asthma a year. On examination there was no evidence of congestive heart failure or pulmonary hypertension. Pulmonary examination revealed no evidence of abnormal breath sounds. Between asthma attacks the Veteran is mildly impaired by his asthma. Diaphragm excursion and chest expansion were normal. The examiner stated that there are no conditions that may be associated with pulmonary restrictive disease. There was no chest wall scarring, deformity of the chest wall or signs of significant weight loss or malnutrition. Chest X-ray studies revealed possible emphysematous changes were present. There were no definite new pulmonary infiltrate or pleural effusion. The osseous structures do not appear significantly changed. The impression was no definite new pulmonary infiltrate or pleural effusion. The results of pulmonary function test reflected mild obstruction with significant improvement following bronchodilator. There was no restriction and normal diffusion. Postbronchodilator FVA was 108 percent. FEV-1 was 97 percent. FEV-1/FVC was 71 percent. TLC was 114 percent. DLCO was 121 percent. The examiner noted that the Veteran's asthma cases increased absenteeism at work, as well as sometimes decreased productivity due to having to work at a slower pace. His asthma also results in lack of stamina. It affects his usual daily activities in terms of decreased exercise capacity and limitation for exertional chores and other activities. The Veteran is currently employed full time in tractor maintenance. He has been employed in this field for 10 to 20 years. In the past 12-months he has lost four weeks of work. There is no evidence of pulmonary hypertension or RVN. Chemical or stress tests were not indicated for the evaluation of asthma. Also, the examiner felt that exercise stress test was no warranted solely for the purposes of a disability exam. The examiner stated that it is widely accepted that FEV1 is the best measure of severity of asthma. In evaluations of asthma, maximum exercise capacity is not indicated, as it does not provide additional information regarding the severity of asthma. The examiner summed up the Veteran's asthma s resulting in chronic exertional dyspnea, which during exacerbations is increased and accompanied by wheezing. This condition results in increased absenteeism, and decreased stamina for work and exercise. Law and Analysis Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. 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. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2 ; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where an increase in the disability rating is at issue, the present level of the veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where VA's adjudication of an increased rating claim is lengthy, a claimant may experience multiple distinct degrees of disability that would result in different levels of compensation from the time the increased rating claim was filed until a final decision on that claim is made. Thus, VA's determination of the "present level" of a disability may result in a conclusion that the disability has undergone varying and distinct levels of severity throughout the entire time period the increased rating claim has been pending. Hart v. Mansfield, 21 Vet. App. 505 (2007). The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart, at 509. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C.A. § 5107(b). When a reasonable doubt arises regarding service origin, such doubt will be resolved in the favor of the claimant. Reasonable doubt is doubt which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102. The question is whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which event the claim must be denied. See Gilbert, 1 Vet. App. at 54. Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("Although interest may affect the credibility of testimony, it does not affect competency to testify."). All of the evidence in the Veteran's claims file has been thoroughly reviewed. Although an obligation to provide sufficient reasons and bases in support of an appellate decision exists, there is no need to discuss, in detail, all of the evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the entire record must be reviewed, but each piece of evidence does not have to be discussed). The analysis in this decision focuses on the most salient and relevant evidence, and on what the evidence shows or fails to show with respect to the matter decided. The Veteran should not assume that pieces of evidence, not explicitly discussed herein, have been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). I. Sinusitis The Veteran's sinusitis is rated under Diagnostic Code 6513 for chronic maxillary sinusitis. That diagnostic code is rated under the General Rating Formula for Sinusitis. Under that regulation, sinusitis detected by X-ray only warrants a 0 percent disability rating. Sinusitis with one or two incapacitating episodes per year requiring prolonged (lasting four to six weeks) antibiotic treatment, or three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting warrants a 10 percent disability rating. Sinusitis with three or more incapacitating episodes per year requiring prolonged (lasting four to six weeks) antibiotic treatment, or more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting warrants a 30 percent disability rating. Sinusitis following radical surgery with chronic osteomyelitis, or near constant sinusitis characterized by headaches, pain, and tenderness of the affected sinus, and purulent discharge or crusting after repeated surgeries warrants a 50 percent disability rating. 38 C.F.R. § 4.97. Historically, the Board notes that a September 1997 rating decision granted service connection for reactive airway disease with allergic rhinitis and chronic sinusitis, and assigned it a noncompensable rating under 38 C.F.R. § 4.97, Diagnostic Code 6512, effective from November 1, 1996. In the June 2003 rating decision on appeal, the RO denied a compensable rating for reactive airway disease with rhinitis and sinusitis. Thereafter, in a March 2008 rating decision, the RO assigned a separate 10 percent rating for sinusitis under 38 C.F.R. § 4.97, Diagnostic Code 6513, effective April 11, 2006. Therefore, the service-connected sinusitis disability is rated as noncompensable prior to April 11, 2006 and as 10 percent disabling beginning on that date. In order to receive a compensable rating for the time period prior to April 11, 2006, it must be shown that the Veteran's sinusitis was manifested by one or two incapacitating episodes a year requiring four to six week of antibiotic treatment, or three to six non-capacitating episodes a year of sinusitis characterized by headaches, pain, and purulent discharge. The medical evidence for this time period does not show that the Veteran's sinusitis was manifested by any incapacitating episodes whatsoever. Instead, the medical evidence consistently shows that the Veteran's sinusitis is not manifested by any incapacitating episodes. Therefore, a higher rating is not warranted on that basis. With regard to non-incapacitating episodes requiring four to six weeks of antibiotic treatment, the evidence does not show such requirements. At the September 2004 VA examination, the Veteran reported having episodes of sinusitis requiring antibiotics only twice a year. Sinusitis was not diagnosed in January or March 2006. Therefore, a higher rating is not warranted on this basis. The medical evidence for the time period prior to April 11, 2006 also does not show three to six non-incapacitating episodes a year of sinusitis characterized by headaches, pain, and purulent discharge. In this regard, acute sinusitis was diagnosed in December 2002 and the Veteran was placed on an antibiotic medication. Examination revealed bilateral boggy nasal turbinates with increased mucoid production and mild tenderness to the bilateral maxillary and right frontal sinuses. However, private treatment records from November 2003 and June 2004 reflect that although mucoid production was noted to be increased at the bilateral turbinates, sinusitis was not diagnosed. Moreover, at the September 2004 VA examination, the Veteran only reported symptoms of nasal drainage, headaches, cough, and occasional fever requiring antibiotic treatment. He did not report purulent discharge, and it was noted that there were only two episodes of sinusitis a year. In January 2006 the Veteran only reported symptoms of headache and sinus pain. Sinusitis was not diagnosed and purulent discharge was not found. In March 2006, sinusitis was not diagnosed and neither purulent discharge nor headache was found. Sinus pain was noted. Therefore, the evidence for this time period does not reflect three to six non-incapacitating episodes of year characterized by headaches, pain, and purulent discharge. The Board has also considered whether a higher rating is warranted for this time period under any other diagnostic code, but has found none. In this regard, although the Veteran has traumatic deviated nasal septum, the evidence for this time period does not show 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. Therefore, a higher rating is not warranted under Diagnostic Code 6502. Additionally, there is no evidence of loss of part of the nose or scars of the nose. Therefore, a higher rating is not warranted under Diagnostic Code 6504. Moreover, laryngitis has not been diagnosed, the Veteran has not undergone a laryngectomy, and there is no evidence of aphonia, stenosis of the larynx, injuries to the pharynx, bacterial rhinitis, or granulomatous rhinitis. As such, higher ratings are not warranted under Diagnostic Codes 6516, 6518, 6519, 6520, 6521, 523, or 6524. In order to receive a rating in excess of 10 percent for sinusitis for the time period beginning on April 11, 2006, it must be shown that the Veteran's sinusitis is manifested by three or more incapacitating episodes per year requiring prolonged (lasting four to six weeks) antibiotic treatment, or more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. The medical evidence for the time period beginning on April 11, 2006 does not show that the Veteran's sinusitis is manifested by any incapacitating episodes whatsoever. Instead, it was noted at the April 2006, August 2008, and June 2011 VA examinations that the Veteran did not experience any incapacitating episodes whatsoever. With regard to non-incapacitating episodes of sinusitis, the evidence does not show that the Veteran experiences more than six such episodes a year characterized by headaches, pain, and purulent discharge or crusting. In this regard, at the April 2006 and December 2007 VA examinations, the Veteran was noted to have had four to five sinus infections each year for the past three years. The August 2008 VA examination report reflects only two non-incapacitating episodes of sinusitis a year. At the June 2011 VA examination, it was noted that the Veteran experiences three non-incapacitating episodes of sinusitis a year. Thus, there is no evidence of more than six non-incapacitating episodes of sinusitis a year. Moreover, although the majority of the evidence shows headaches, pain, and purulent discharge or crusting, there is no evidence of more than six such episodes a year. Notably, at the April 2006 and December 2007 VA examinations, the Veteran had symptoms of pain in the posterior left side of the head, pain in the left ear, and yellow nasal drainage. The Veteran found to have nasal drainage but not purulent discharge in April 2008. The Veteran was found to have purulent discharge in August 2008, bilateral crusty discharge in September 2009, and purulent discharge in June 2011. However, in June 2011, it was noted that the Veteran has three non-incapacitating episodes of sinusitis with these symptoms each year. As such, a higher, 30 percent rating is not warranted for the time period beginning on April 11, 2006. The Board has also considered whether a higher rating is warranted during this time period under any other diagnostic code, but has found none. In this regard, there is no evidence of loss of part of the nose. Therefore, a higher rating is not warranted under Diagnostic Code 6504. Moreover, laryngitis has not been diagnosed, the Veteran has not undergone a laryngectomy, and there is no evidence of aphonia, stenosis of the larynx, injuries to the pharynx, or granulomatous rhinitis. As such, higher ratings are not warranted under Diagnostic Codes 6516, 6518, 6519, 6520, 6521, or 6524. In sum, the preponderance of the evidence is against the claim for an increased rating for sinusitis at any time during the appeal period. See Hart, 21 Vet. App. 505 (2007). As such, the benefit of the doubt doctrine is inapplicable, and the claim must be denied. See 38 C.F.R. § 5107(b); Gilbert, 1 Vet. App. at 54-56. In reaching this conclusion, the Board acknowledges the Veteran's belief that his sinusitis symptoms are more severe than the current disability evaluations reflect. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the ratings schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding his symptomatology and the Board has addressed the Veteran's reported symptoms, the Board finds that the medical evidence of record is more persuasive regarding whether he is entitled to a higher disability rating in accordance with the schedular criteria. The VA examiners considered the Veteran's reported symptoms and provided the clinical findings to rate the Veteran's disability with respect to the rating criteria. Therefore, the Board finds that the medical evidence is more persuasive than the Veteran's own statements regarding his increased sinusitis symptomatology. II. Asthma Historically, the Board notes that a September 1997 rating decision granted service connection for reactive airway disease with allergic rhinitis and chronic sinusitis and assigned a noncopmensable rating under 38 C.F.R. § 4.97, Diagnostic Code 6512 effective from November 1, 1996. In the June 2003 rating decision on appeal, the RO denied a compensable rating for reactive airway disease with allergic rhinitis and chronic sinusitis. Thereafter, in a March 2008 rating decision, the RO granted an increased rating of 10 percent for the Veteran's service-connected asthma (reactive airway disease) under 38 C.F.R. § 4.97, Diagnostic Code 6602, effective March 31, 2006. [Parenthetically, the Board notes that the March 2008 rating decision also assigned a separate 10 percent rating for sinusitis effective April 11, 2006, and a separate noncompensable rating for allergic rhinitis effective November 1, 1996.] In a September 2012 rating decision, an increased rating of 30 percent was granted for the service-connected asthma, under Diagnostic Code 6602, effective June 1, 2011. Therefore, the Veteran's service connected asthma is currently rated as noncompensable for the time period prior to March 31, 2006, as 10 percent disabling beginning on March 31, 2006 but prior to June 1, 2011, and as 30 percent disabling beginning on June 1, 2011. Under Diagnostic Code 6602, bronchial asthma warrants a 10 percent evaluation if the Forced Expiratory Volume at one second (FEV-1) is 71 to 80 percent of the value predicted; or if the ratio of FEV-1/ Forced vital capacity (FVC) is 71 to 80 percent; or if intermittent inhalational or oral bronchodilator therapy is required. A 30 percent evaluation is warranted if the FEV-1 is 56 to 70 percent of the value predicted; if the FEV-1/FVC ratio is 56 to 70 percent; or if daily inhalational or oral bronchodilator therapy; or inhalational, anti-inflammatory medication, is required. A 60 percent rating is assignable where the FEV-1 is 40 to 55 percent of the value predicted; if the FEV-1/FVC ratio is 40 to 55 percent; or at least monthly visits to a physician are made for required care of exacerbations; or intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids are required. A 100 percent rating requires an FEV-1 of less than 40 percent of the predicted value; or an FEV1/FVC ratio of less than 40 percent; or more than one attack per week of 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. The Veteran is not required to meet each of the stated criteria in order for an increased rating to be assigned. Rather, he need only meet one criterion because the criteria are listed in the alternative. See Johnson v. Brown, 7 Vet. App. 95 (1994). In considering whether the Veteran is entitled to a compensable rating for the time period prior to March 31, 2006, the Board notes that the medical evidence contains an April 2001 treatment record which notes that the Veteran's medications included Albuterol and Nasalide, an inhalational anti-inflammatory medication. At the September 2004 VA examination, it was noted that the Veteran was continuing to take the inhalational anti-inflammatory medication Flunisolide. In March 2006 the Veteran was noted to be taking the inhalational anti-inflammatory medication Fluticasone. The June 2011 VA examination report notes that the Veteran's asthma is treated with inhaled anti-inflammatory medication. As such, the record demonstrates that throughout the period on appeal, the Veteran has required inhalational anti-inflammatory medication for his asthma. Consequently, a 30 percent rating is warranted throughout the entire appeal period. A rating in excess of 30 percent is not warranted at any time during the appeal period, however. In this regard, pulmonary function tests from October 2004 reflect that FEV-1 was 89 percent. Moreover, an April 2006 VA treatment record reflects that postbronchodilator FVC was 107 percent. FEV-1 was 99 percent. FEV-1/FVC was 113 percent. A November 2007 VA treatment record reflects that FVC (postbronchodilator) was 121 percent. FEV-1 was 111 percent. FEV-1/FVC was 74 percent. At the June 1, 2011 VA examination, postbronchodilator FVC was 108 percent. FEV-1 was 97 percent. FEV-1/FVC was 71 percent. Consequently, a rating in excess of 30 percent rating is not warranted based upon pulmonary function tests. A rating in excess of 30 percent is also not warranted on the basis of systemic corticosteroid use or monthly visits to a physician for required care of exacerbations. First, the evidence does not show that systemic corticosteroids were prescribed at least three times in a year at any point during the pendency of the claim. The record reflects that the first time Prednisone was prescribed was at a March 25, 2008 private treatment visit. At this visit, a three week course of Prednisone was prescribed for a cough associated with the Veteran's asthma. However, an April 3, 2008 private treatment record notes that the Veteran stopped the Prednisone after three days due to insomnia. A September 2009 private treatment record notes that the Veteran was taking Alovent (two puffs twice daily), Singular daily, Albuterol four times a day, and Nebulizer as directed. A December 2009 private treatment record notes that the Veteran was taking Albuterol as needed. September 2010 private treatment record notes that the Veteran was taking Singular daily and Albuterol as needed for his asthma. These treatment records do not reflect that the Veteran was taking systemic corticosteroids. The June 2011 VA examination report reflects that the Veteran uses an inhaled bronchodilator intermittently and inhaled anti-inflammatory medication intermittently. It was also noted that the Veteran used a course of oral steroids twice per year, with a duration of each course between one to two weeks (oral Prednisone). The examination report reflects that the Veteran does not use parenteral steroids, but the examination report notes that the Veteran uses another immunosuppressive, Montelukast daily. However, the Board notes that Montelukast (trade name Singulair) is not a high dose corticosteroid. Therefore, the evidence reflects no more than two courses of systemic corticosteroids prescribed in a year during the appeal period. The December 2007 VA examination report further notes that the Veteran had been to his primary care provider's office for Albuterol Nebulizers twice in the past 12 months. He followed up with home nebulizers with Albuterol which had been tapered to twice a week over a six month period, and which were discontinued in November 2007. Although at the December 2007 VA examination the Veteran reported getting an episode of chest tightening and difficulty drawing in air every other day in hot months and about once a week in cooler months, there is no evidence that he has at least monthly visits to a physician for required care of exacerbations. Instead, the evidence tends to show no more than two attacks requiring the care of a physician during 2007. The June 2011 VA examination report reflects the Veteran's complaints of wheezing during exacerbations of his asthma, which he stated occur weekly. However, he also indicated that he has several clinical visits a year for exacerbations and several acute attacks of asthma a year. The Board finds that "several" clinical visits a year does not amount to monthly visits. Consequently, a rating in excess of 30 percent is not warranted at any time during the appeal period, as the Veteran did not meet the pulmonary function test requirements, and the evidence does not reflect monthly visits to a physician for required care of exacerbations or intermittent courses (at least three per year) of systemic corticosteroids. At most, the evidence reflects two courses of corticosteroids a year and several clinical visits a year for exacerbations of his asthma, which amounts to less than monthly visits. In sum, a 30 percent rating is granted for the Veteran's service-connected asthma for the entire appeal period. A rating in excess of 30 percent is not warranted at any time during the appeal period. III. Allergic Rhinitis The September 1997 rating decision granted service connection for reactive airway disease with allergic rhinitis and chronic sinusitis, and assigned it a non compensable rating under 38 C.F.R. § 4.97, Diagnostic Code 6512, effective from November 1, 1996. In the June 2003 rating decision on appeal, the RO denied a compensable rating for reactive airway disease with allergic rhinitis and chronic sinusitis. In a March 2008 rating decision, the RO assigned a separate noncompensable rating for allergic rhinitis under 38 C.F.R. § 4.97, Diagnostic Code 6522, effective November 1, 1996, the date the service connection was initially established. As such, the Veteran's service-connected allergic rhinitis is rated as noncompensable under Diagnostic Code 6522 for the entire appeal period. Under Diagnostic Code 6522 allergic or vasomotor rhinitis will be rated as 10 percent disabling when it is manifested by a greater than fifty percent obstruction of both nasal passages or complete obstruction of one nasal passage without polyps. A 30 percent disability rating is warranted when polyps are present. 38 C.F.R. § 4.97, Diagnostic Code 6522. In order to receive a higher, 10 percent rating, it must be shown that the allergic rhinitis is manifested by greater than fifty percent obstruction of both nasal passages or complete obstruction of one nasal passage without polyps. As discussed in more detail below, the vast majority of the medical records reflect that nasal polyps were not present. The April 2006 VA examination report reflects that nares obstruction was 25 percent on the right and 25 percent on the left. The August 2008 VA examination report reflects that the Veteran's rhinitis symptoms were nasal congestion and excess nasal mucous. Examination revealed 70 percent left nasal obstruction and 30 percent right nasal obstruction. Polyps were not present. A September 2009 private treatment record reflects swollen turbinates. Such obstruction does not suffice to warrant a higher, 10 percent rating. Although the vast majority of the medical records reflect that nasal polyps were not found, a December 2, 2009 private treatment record indicates that on examination, two small polyps were found in the right nasal canal. As such, a 30 percent rating is warranted under Diagnostic Code 6522 as of December 2, 2009 based upon a finding of nasal polyps. A September 2010 private treatment record notes that examination of the nose revealed that turbinates were moderately swollen bilaterally. Examination of the oropharynx revealed normal mucosa, tentition, gingival, and posterior pharynx. A June 2011 VA examination report notes that the Veteran has allergic rhinitis. Initially he began having chronic nasal congestion with some eye irritation. He currently treats his allergic rhinitis with medication (Flonase nasal spray daily and Kenalog IM long acting injections twice a year). The medication possibly reduces intensity of symptoms. There is no history of neoplasm. The Veteran has perennial nasal allergies. Physical examination revealed signs of nasal obstruction. The left side nasal obstruction was 80 percent and the right side was 70 percent. Nasal polyps were not present. There was septal deviation due to trauma. There was no permanent hypertrophy of turbinates from bacterial rhinitis. Rhinoscleroma was not present. There was no tissue loss, scarring, or deformity of the nose. There is also no evidence of Wegener's granulomatosis or granulomatous infection. There has been no laryngectomy and there are no residuals of an injury to the pharynx, including nasopharynx. Sinus X-rays revealed that the paranasal sinuses were well aerated. It was noted that the Veteran's allergic rhinitis has no significant effects on his usual occupation or his usual daily activities. The examiner summed up the Veteran's allergic rhinitis results in chronic nasal congestion, but no significant disability. Because nasal polyps were not found at the September 2010 private evaluation (the date of the most recent evaluation subsequent to the December 2, 2009 private treatment record finding nasal polyps), nor were nasal polyps found at the June 2011 examination, the Board finds that the 30 percent rating is not warranted as of the September 1, 2010 private treatment record date. However, the Board finds that a 10 percent rating is warranted for the Veteran's allergic rhinitis as of September 1, 2010, based on the September 2010 private treatment record's finding of moderately swollen turbinates bilaterally, coupled with the June 2011 VA examination finding that the left side nasal obstruction was 80 percent and the right side was 70 percent. Therefore, the Board finds that a compensable rating is not warranted prior to December 2, 2009. However, as of December 2, 2009, a higher 30 percent rating is warranted for the Veteran's allergic rhinitis due to a finding of nasal polyps, and a 10 percent rating is warranted as of September 1, 2010, based upon nasal obstruction. Extraschedular Consideration An exceptional or unusual disability picture occurs where the diagnostic criteria do not reasonably describe or contemplate the severity and symptomatology of a veteran's service-connected disability. Thun v. Peake, 22 Vet. App. 111, 115 (2008). If there is an exceptional or unusual disability picture, then the Board must consider whether the disability picture exhibits other factors such as marked interference with employment and frequent periods of hospitalization. Id. at 115-116. When those two elements are met, the appeal must be referred for consideration of the assignment of an extraschedular rating to the Chief Benefits Director or the Director, Compensation and Pension Service, for consideration of an extraschedular evaluation. 38 C.F.R. § 3.321(b) (1) (2012). Otherwise, the schedular evaluation is adequate, and referral is not required. Thun, 22 Vet. App. at 116. The Board finds that the schedular ratings for the Veteran's sinusitis, asthma, and allergic rhinitis are adequate. Ratings in excess of those assigned are provided for higher levels of severity of the disabilities, but for certain manifestations which the medical evidence reflects are not present in the Veteran's clinical picture. In this regard, the Board notes that the highest available rating for allergic rhinitis was granted for a portion of the appeal period, but a lower rating was then granted for a subsequent time period because the Veteran's symptoms no longer rose to the level warranting the highest possible rating. The Board also finds that the diagnostic criteria adequately describe the severity and symptomatology of the Veteran's sinusitis, asthma, and allergic rhinitis. The record does not reflect that the Veteran has required hospitalization for treatment of these disabilities. The most recent VA examination reflects that the Veteran is currently employed full-time. The Veteran has indicated that his sinusitis, asthma, and allergic rhinitis interfere with his employment in that he must miss days from work due to sinus infections. The VA examinations reflect that there is minimal functional loss due to the Veteran's allergic rhinitis, mild functional loss from the chronic sinusitis, and some decreased stamina for work and exercise due to the Veteran's asthma. Although the Veteran reported to the June 2011 VA examiner that he loses approximately four weeks of work in the past 12-month period due to his asthma, the basis of the VA Rating Schedule is to compensate for the interference that each individual disability causes with employment. Therefore, the Veteran's disability picture is contemplated by the Rating Schedule; no extraschedular referral is required. In sum, the record does not reflect that the Rating Schedule is inadequate to contemplate the manifestations of his disabilities. Thus, no extraschedular referral is required. In denying the Veteran's claims for increased initial ratings, the Board observes that in Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court of Appeals for Veterans Claims (Court) held that a claim for a total rating based on unemployability due to service-connected disability (TDIU), either expressly raised by the Veteran or reasonably raised by the record involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. In this case, the record indicates that the Veteran is currently employed full time in tractor maintenance. Although the Veteran previously filed a claim for entitlement to TDIU, this claim was denied in a March 2008 rating decision. He did not appeal that decision, and the medical evidence does not show that he cannot work as a result of his service-connected disabilities. Accordingly, the issue of TDIU has not been raised in this case. ORDER Entitlement to a higher rating for sinusitis, currently rated as noncompensable for the time period prior to April 11, 2006, and as 10 percent disabling beginning on April 11, 2006, is denied. Entitlement to a 30 percent rating for asthma throughout the time period on appeal is granted, subject to the criteria governing the award of monetary benefits. Entitlement to a compensable rating for allergic rhinitis prior to December 2, 2009 is denied. Entitlement to a 30 percent rating for allergic rhinitis for the time period beginning on December 2, 2009 but prior to September 1, 2010, is granted, subject to the criteria governing the award of monetary benefits. Entitlement to a 10 percent rating for allergic rhinitis for the time period beginning on September 1, 2010 is granted, subject to the criteria governing the award of monetary benefits. REMAND A remand by the Board confers upon the veteran, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In May 2011, the Board remanded the issue of entitlement to a compensable rating for bilateral hearing loss in part so that a VA audiology examination could be performed. The examiner was asked to attempt to interpret the findings of the Veteran's audiological testing in the claims file, to include the VA examinations dated in October 2004, April 2006, December 2007, and August 2008, and any private audiology examinations. It was requested that, if the pure tone thresholds were obtained in graphical form, the examiner should translate the graphs of the Veteran's pure tone threshold levels into numerical form by providing the pure tone thresholds at each of the relevant frequencies and clarify whether the speech recognition scores are based on the Maryland CNC word list. Pursuant to the remand instructions, the Veteran underwent a VA audiological examination in June 2011. The examination report notes that the claims file was reviewed but the medical records were not requested. The examiner did not comment on any of the previous VA examination reports as requested by the Board remand, nor does the VA examiner address the August 2002 private audiological evaluation, which contains results in graphical form. As such, the claim must be remanded for compliance with the previous remand instructions. See id. Accordingly, the case is REMANDED for the following action: 1. Return the claims file, to include a copy of this remand to the June 2011 VA audio examiner. Request that the examiner review the claims file, to specifically include the previous VA examinations dated in October 2004, April 2006, December 2007, and August 2008, and the August 2002 private audiological evaluation. Request that the examiner translate the August 2002 pure tone threshold graphs into numerical form by providing the Veteran's pure tone thresholds at each of the relevant frequencies. The examiner should also clarify whether the speech recognition scores are based on the Maryland CNC word list. If the June 2011 VA examiner is unavailable, another qualified examiner should be requested to provide the above information. 2. When the development requested has been completed, the case should be reviewed by the RO on the basis of additional evidence. If the benefits sought are not granted, the Veteran and his representative should be furnished a Supplemental Statement of the Case and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). 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. 2012). ______________________________________________ ROBERT C. SCHARNBERGER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs