Citation Nr: 18151285 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 08-02 769 DATE: November 16, 2018 ORDER New and material evidence having been received, the appeal to reopen service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), depression, schizophrenia, and bipolar disorder, is granted. Service connection for the acquired psychiatric disorder is denied. New and material evidence having been received, the appeal to reopen service connection for the complex partial seizure disorder is granted. Service connection for the complex partial seizure disorder is denied. For the rating period from August 31, 2006 to April 23, 2007, a disability rating in excess of 60 percent for the service-connected status post tuberculosis pneumonia with scarring in right upper lung (referred to as TB) is denied. For the rating period from April 23, 2007 to April 27, 2011, a disability rating of 100 percent for the service-connected TB is granted. For the rating period from April 27, 2011 to May 18, 2015, a disability rating in excess of 60 percent for the service-connected TB is denied. For the rating period from May 18, 2015, a disability rating of 100 percent for the service-connected TB is granted. REMANDED Service connection for diabetes mellitus type II, claimed as secondary to the service-connected TB, is remanded. FINDINGS OF FACT 1. An April 2002 rating decision denied service connection for the acquired psychiatric disorder for lack of an in-service stressor. 2. The Veteran did not file a timely notice of disagreement (NOD) to appeal the April 2002 denial of service connection for the acquired psychiatric disorder and new and material evidence was not received during the one-year appeal period following that decision. 3. New evidence received since the April 2002 rating decision relates to establishing an in-service stressor, which is necessary to substantiate a claim for service connection for the acquired psychiatric disorder. 4. The Veteran has a currently diagnosed acquired psychiatric disorder of bipolar disorder. 5. The currently diagnosed acquired psychiatric disorder did not have its onset in service and is not otherwise related to service. 6. The Veteran is not currently diagnosed with PTSD. 7. An April 2002 rating decision denied service connection for the seizure disorder, finding no nexus between the current disability and active duty service. 8. The Veteran did not file a timely NOD to appeal the April 2002 denial of service connection for the seizure disorder and new and material evidence was not received during the one-year appeal period following that decision. 9. New evidence received since the April 2002 rating decision relates to a current diagnosis and a nexus between a current diagnosis and an in-service event, which are necessary to substantiate a claim for service connection for the seizure disorder. 10. The Veteran is currently diagnosed with complex partial seizure disorder, referred to as a seizure disorder. 11. Symptoms of the seizure disorder were not chronic in service, were not continuous since service separation, and did not manifest to a compensable degree within one year of service separation. 12. The currently diagnosed seizure disorder did not have its onset in service and is not otherwise related to active duty service. 13. The Veteran’s current seizure disorder is not caused or worsened in severity by any service-connected disabilities. 14. For the rating period from August 31, 2006 to April 23, 2007, the TB disability did not manifest in a Forced Expiratory Volume in one second (FEV-1) less than 40 percent of predicted value, or; the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy. 15. For the rating period from April 23, 2007 to April 27, 2011, the TB disability did manifest a FEV-1/FVC less than 40 percent. 16. For the rating period from April 27, 2011 to May 18, 2015, the TB disability did not manifest in an FEV-1 less than 40 percent of predicted value, or; the FEV-1/FVC less than 40 percent, or; DLCO (SB) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy. 17. For the rating period from May 18, 2015, the TB disability did manifest in an FEV-1 less than 40 percent of predicted value. CONCLUSIONS OF LAW 1. The April 2002 rating decision, which denied service connection for the acquired psychiatric disorder, to include PTSD, depression, schizophrenia, and bipolar disorder, became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. 2. Evidence received since the April 2002 rating decision is new and material to reopen service connection for the acquired psychiatric disorder, to include PTSD, depression, schizophrenia, and bipolar disorder. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for service connection for an acquired psychiatric disorder, to include PTSD, depression, schizophrenia, and bipolar disorder, have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.326, 4.125. 4. The April 2002 rating decision, which denied service connection for the seizure disorder, became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. 5. Evidence received since the April 2002 rating decision is new and material to reopen service connection for the complex partial seizure disorder. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 6. The criteria for service connection for complex partial seizure disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 7. The criteria for a disability rating in excess of 60 percent, for the service-connected TB disability have not been met for the rating period from August 31, 2006 to April 23, 2007. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.97, Diagnostic Code (DC) 6845. 8. Resolving reasonable doubt in the Veteran’s favor, the criteria for a disability rating of 100 percent for the service-connected TB disability have been met for the rating period from April 23, 2007 to April 27, 2011. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.97, DC 6845. 9. The criteria for a disability rating in excess of 60 percent, for the service-connected TB disability have not been met for the rating period from April 27, 2011 to May 18, 2015. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.97, DC 6845. 10. Resolving reasonable doubt in the Veteran’s favor, the criteria for a disability rating of 100 percent for the service-connected TB disability have been met for the rating period from May 18, 2015. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.97, DC 6845. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Navy from December 1963 to April 1965, and was subsequently transferred from active duty service to the Navy Reserve. The Veteran was honorably discharged from the Navy Reserve in December 1969. The Veteran later served in the New York Army National Guard from March 1976 to March 1978. This matter is on appeal from multiple rating decisions issued by the Regional Office (RO) in Roanoke, Virginia. The Veteran testified at the Central Office in Washington, D.C. in June 2012 before the undersigned Veterans Law Judge. The hearing transcript has been associated with the record. The Veteran’s representative has filed multiple requests for a Board hearing in response to the August 2018 Supplemental Statement of the Case (SSOC). See September 2018 Third Party Correspondence, October 2018 Third Party Correspondence. As the representative is aware, the Veteran received a Board hearing in June 2012. At that hearing, the Veteran testified about his claims for service connection for the acquired psychiatric disorder, seizure disorder, and diabetes mellitus type II as secondary to the service-connected TB as well as an increased rating for the TB. There is no assertion of good cause for a second Board hearing on these issues. See 38 C.F.R. §§ 20.700, 20.1304. With regard to a TDIU issue, the June 2012 Board hearing did not address the TDIU claim. For this reason, the attorney’s request for a Board hearing does apply to the TDIU issue. The Board will schedule a Board videoconference hearing as per the representative’s request. See Locklear v. Shinseki, 24 Vet. App. 311 (2011) (bifurcation of a claim generally is within VA’s discretion). The TDIU issue is not part of the current Board decision. The Board has recharacterized the psychiatric issues on appeal, which include PTSD, depression, schizophrenia, and bipolar disorder, as a claim for service connection for an acquired psychiatric disorder that has been variously diagnosed. See Clemons v. Shinseki. See 23 Vet. App. 1 (2009) (holding that a claim for benefits of one psychiatric disorder also encompassed benefits based on other psychiatric diagnoses and should be considered by the Board to be within the scope of the filed claim). Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. See 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326. Neither the Veteran nor the representative has raised any question regarding the duty to notify or duty to assist. See Scott v McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when a veteran fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument). Based on the foregoing, the Board finds that all relevant documentation, including VA treatment records, VA examinations, and private treatment records, has been secured and all relevant facts have been developed. There remains no question as to the substantial completeness of the issues on appeal. 38 U.S.C. §§ 5103, 5103A, 5107; 38 C.F.R §§ 3.159, 3.326. The duties to notify and assist have been met. Legal Authority for New and Material Evidence Generally, a claim which has been denied may not thereafter be reopened and allowed based on the same record. 38 U.S.C. § 7104. However, pursuant to 38 U.S.C. § 5108, if new and material evidence is presented or secured with respect to a claim which has been disallowed, the VA Secretary shall reopen the claim and review the former disposition of the claim. The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). 1. New and Material Evidence to Reopen Service Connection for the Acquired Psychiatric Disorder An April 2002 rating decision denied service connection for the acquired psychiatric disorder for lack of an in-service stressor. The Veteran did not file a timely NOD to appeal the April 2002 denial of service connection for the acquired psychiatric disorder, and new and material evidence was not received during the one-year appeal period following that decision. For this reason, the April 2002 rating decision became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. Since the April 2002 rating decision, which denied service connection for the acquired psychiatric disorder, VA has received additional lay and medical evidence. Lay and medical evidence including, but not limited to, the Veteran’s lay statements at the June 2012 Board hearing and the April 10, 2017 VA examination, expound upon the claimed in-service stressor. When the credibility of such evidence is presumed for the purposes of reopening the claim, such evidence relates to unestablished facts of an in-service stressor and could reasonably substantiate the issue of service connection for the acquired psychiatric disorder. For this reason, the Board finds that the additional evidence is new and material to reopen service connection for an acquired psychiatric disorder. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 2. New and Material Evidence to Reopen Service Connection for the Seizure Disorder An April 2002 rating decision denied service connection for the seizure disorder, finding no nexus between the current disability and active duty service. The Veteran did not file a timely NOD to appeal the April 2002 denial of service connection for the seizure disorder and new and material evidence was not received during the one-year appeal period following that decision. For this reason, the April 2002 rating decision became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. Since the April 2002 rating decision,VA has received additional lay and medical evidence. Lay and medical evidence including, but not limited to, the Veteran’s lay statements at the June 2012 Board hearing and the April 10, 2017 VA examination expound upon the nexus between the claimed disability and an in-service event. When the credibility of such evidence is presumed for the purposes of reopening the claim, such evidence relates to unestablished facts of a nexus between an in-service event and the claimed disability, and could reasonably substantiate the issue of service connection for the seizure disorder. For this reason, the Board finds that the additional evidence is new and material to reopen service connection for a seizure disorder. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). Legal Authority for Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. The Veteran is currently diagnosed with a seizure disorder. The seizure disorder (as an organic disease of the nervous system) is a “chronic disease” listed under 38 C.F.R. § 3.309(a); therefore, the presumptive service connection provisions under 38 C.F.R. § 3.303(b) for service connection based on “chronic” symptoms in service and “continuous” symptoms since service are applicable. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013) (holding that continuity of symptomatology is an evidentiary tool to aid in the evaluation of whether a chronic disease existed in service or an applicable presumptive period). Under 38 C.F.R. § 3.303(b), service connection will be presumed where there are either chronic symptoms shown in service or continuity of symptomatology since service for diseases identified as “chronic” in 38 C.F.R. § 3.309(a). With a chronic disease shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). Service connection may be established on a secondary basis for a disability that was either: (1) caused by, or (2) aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310(a). Service connection on a secondary basis requires evidence that a current, non-service-connected disability was caused or aggravated (beyond its natural progression) by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448-49 (1995); El-Amin v. Shinseki, 26 Vet. App. 136 (2013). Compensation based on secondary aggravation will be awarded only for the degree of disability over and above the degree of disability prior to aggravation. Allen v. Brown, 7 Vet. App. 439 (1995). 3. Service Connection for the Acquired Psychiatric Disorder The Veteran contends that the acquired psychiatric disorder is related to active duty service. More specifically he claims that he started experiencing symptoms after he was put in the Naval Air Station Brig (hereinafter referred to as the brig) in 1964. The Veteran explains that while he was in the brig, he was woken up at 4:30 a.m., beaten, made to run during physical training, fight other service members who were also in the brig, and forced to drink alcohol. See June 2012 Board Hearing. After a review of the lay and medical evidence of record, the Board finds that the Veteran has a current acquired psychiatric disability of bipolar disorder, but also finds that he does not have PTSD in accordance with VA diagnostic criteria. See April 10, 2017 VA examination. While the record indicates that the Veteran was committed to the brig, contemporaneous service records do not provide evidence of the Veteran’s account of the brig altercations but rather is evidence to the contrary as it does not support the Veteran’s recent assertions of head injury in service or other bodily injuries that would ensue following alleged fighting of a severity to cause such injury. The Board concludes that the weight of the evidence is against finding that there was any in-service injury or disease or event as now claimed by the Veteran. Upon review of the service treatment records, there is only one in-service psychiatric treatment record associated with the record, an April 1965 psychiatric examination that was administered at the request of the Veteran. The Veteran reported that he requested the examination because he was “constantly getting into trouble.” See April 1965 VA Service Treatment Records. During the April 1965 psychiatric examination, the Veteran admitted that he was committed to the brig for 15 days when he was accused of stealing a radio while he was intoxicated. See April 1965 Service Treatment Records. Further, the Veteran listed several instances of his own misconduct including getting into several fights with peers and superiors, stealing a radio while intoxicated, and having at least eight unauthorized absences from duty. Id. According to military personnel records, the Veteran was cited for several unauthorized absences, impeding traffic, and theft. See April 1964 military personnel records, July 1964 military personnel records, February 1965 military personnel records. At the conclusion of the April 1965 psychiatric examination, the examiner noted that the Veteran had no insight and that his judgment was clouded by his immaturity and narcissism. Ultimately, the VA examiner recommended that the Veteran be discharged from service. See April 1965 VA Service Treatment Records. The Veteran does not mention or complain of any mistreatment in the brig during this examination. There are also no service treatment records to indicate that the Veteran incurred any injuries associated with the claimed incidents in the brig. The October 2001 Application for Compensation or Pension was the first post-service complaint of record related to symptoms of the acquired psychiatric disorder. This complaint was made approximately 35 years after the claimed in-service event occurred, and was made for the purposes of compensation. The RO denied this previous claim in April 2002 because the Veteran did not provide evidence of an in-service stressor. The Veteran filed another claim for service connection for the acquired psychiatric disorder in August 2006 and it was denied by the RO again in June 2007 for lack of a diagnosis and in-service event. In an April 10, 2017 VA examination, the examiner diagnosed bipolar disorder and concluded that the Veteran did not meet the criteria for PTSD. The VA examiner opined that the etiology or the timing of the onset of psychiatric symptoms cannot be determined. Moreover, the VA examiner explained that a nexus opinion would be based on speculation. In considering the VA examination reports of record, the Board notes that a VA medical examination is not inadequate merely because the medical examiner states he or she cannot reach a conclusion without resort to speculation. Jones v. Shinseki, 23 Vet. App. 382 (2011). While VA has a duty to assist a veteran by providing a medical examination in certain situations, that duty does not extend to situations where an in-service event has not been established. Bardwell v. Shinseki, 24 Vet. App. 36, 40 (2010) (holding that, for VCAA, where the weight of the evidence has failed to establish an in-service injury, disease, or event, VA is not obligated to provide a medical examination or nexus opinion). The Board finds that the VA examination is not probative in regard to establishing a nexus and that VA is not required to administer another examination because an in-service event has not been established. For the reasons above, the Board finds the weight of the lay and medical evidence demonstrates that the acquired psychiatric disorder is not related to an in-service event; therefore, the preponderance of the evidence is against service connection for an acquired psychiatric disorder, to include PTSD, and the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 4. Service Connection for the Seizure Disorder The Veteran contends that his seizures began in service and names two in-service events. The Veteran claims that during active duty service in 1964 he and other servicemembers in the brig were forced to fight each other with sticks. See June 2012 Board Hearing. The Veteran explained that he was hit in the head several times. Id. The Veteran also claims that his seizures began after he sustained a gunshot wound to the head in 1969. See March 2013 VA Treatment Records. The Veteran described his seizures by testifying that he would wake up with blood in his mouth and a headache, and was disoriented. See June 2012 Board Hearing. At the June 2012 Board hearing, the Veteran asserted that the seizure disorder was related to the acquired psychiatric disorder and alcoholism on a secondary basis. After a review of all the evidence, the Board finds that the Veteran is currently diagnosed with a complex partial seizure disorder. See April 25, 2017 VA Examination. The weight of the lay and medical evidence shows that the seizure disorder did not have its onset during service, symptoms were not chronic in service or continuous since service separation, did not manifest to a compensable degree within one year of service separation, and was not caused by or worsened in severity by any service-connected disabilities. The July 1963 service entrance examination indicates normal neurologic and psychiatric conditions. Service treatment records do not reflect any history, complaints, diagnosis, or treatment for symptoms of the seizure disorder. The April 1965 service separation examination indicates normal neurologic and psychiatric conditions. A September 1966 Navy Reserve treatment record also indicates normal neurologic and psychiatric conditions. Service treatment records and Navy Reserve treatment records associated with the record do not indicate any complaints of or treatment for symptoms of the seizure disorder. These records also do not indicate treatment for physical injuries associated with the claimed brig altercations or the claimed in-service gunshot wound to the head. The first complaint of record related to symptoms of the seizure disorder is made in August 1981, more than three years after separation from the National Guard, 12 years since being discharged from the Navy Reserves, and more than 17 years after the Veteran claimed a seizure disorder began. Additionally, the Veteran made this complaint after he experienced two separate, post-service injuries: a car accident and a fall from an elevator shaft. See March 1976 Service Entrance Exam (upon entering the National Guard the Veteran reported that he was in a car accident but did not provide a specific date of the accident and the accident was not noted in service treatment records); see also December 1981 Private Treatment Records (noting that the Veteran had a history of alcoholism and was admitted into a neuropsychiatric ward in August 1981 after a blackout and fall from an elevator shaft). The Veteran submitted to two VA examinations related to the seizure disorder in April of 2017. In the April 25, 2017 VA examination, the VA examiner diagnosed complex partial seizure disorder. The Veteran reported that he was not shot in 1969, as he previously reported, but rather he was shot in the head in either the 1980s or 1990s. See April 25, 2017 VA Examination. In the April 10, 2017 VA examination, the VA examiner could not render an opinion about direct service connection without speculation. Moreover, the VA examiner opined that it was least as likely as not that the seizure disorder is secondary to any psychiatric disorder for the purposes of secondary service connection. The Board notes that the Veteran was not and currently is not service connected for any psychiatric disorder. The April 25, 2017 VA examiner also noted that “the seizure threshold is raised by alcohol drinking and declines on cessation of drinking . . . As a result, during withdrawal from alcohol . . . seizures may occur.” See April 25, 2017 VA Examination. In considering these two April 2017 VA examinations, the Board finds that the VA examinations are not probative in regard to establishing a nexus on either a direct or secondary basis. Moreover, as explained above, the Board finds that VA is not required to administer another examination because an in-service event has not been established. See Bardwell, 24 Vet. App. at 40. The Veteran’s statements are internally inconsistent and inconsistent with the other, more probative evidence of record. The weight of the lay and medical evidence shows that the Veteran did not sustain any relevant injury while he was in the brig, which he claims caused his seizure disorder. The record does not contain evidence of an in-service gunshot wound to the head. Indeed, the Veteran explained that he was not shot in 1969 as he reported originally but was shot several years after discharge from service. The Board finds that the Veterans statements are not credible in regard to substantiating an in-service event and a nexus for the seizure disorder. For the reasons above, the Board finds the weight of the lay and medical evidence demonstrates no in-service injury, disease, or event in service to which a seizure disorder could be related; therefore, the preponderance of the evidence is against all theories of service connection for the seizure disorder. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Disability Rating Criteria Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating 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. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of a veteran’s condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). When a claimant is awarded service connection and assigned an initial disability rating, separate disability ratings may be assigned for separate periods of time in accordance with the facts found. Such separate disability ratings are known as staged ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999) (noting that staged ratings are assigned at the time an initial disability rating is assigned). The Board has considered whether staged rating is warranted with respect to the issue of entitlement to a higher rating for the deviated septum, and finds that the severity of the disability on appeal has changed during the course of the appeal so as to warrant staged ratings, as explained below. The service-connected TB is currently rated at 60 percent from August 31, 2006 under 38 C.F.R. § 4.97, DC 6845. Under DC 6845, a 60 percent rating for chronic pleural effusion or fibrosis, claimed as TB, is assigned for FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit). A maximum 100 percent is assigned under DC 6845 for FEV-1 less than 40 percent of predicted value, or; the FEV-1/FVC less than 40 percent, or; DLCO (SB) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy. Pulmonary function test results are generally reported before and after the administration of bronchodilator therapy. VA regulations instruct that post-bronchodilator results be used when considering pulmonary function test (PFT) criteria for ratings under DC 6600, 6603, 6604, 6825-6833, and 6840-6845. See 38 C.F.R. § 4.96(d)(4) (“Post-bronchodilator studies are required when PFT’s are done for disability evaluation purposes except when the results of pre-bronchodilator pulmonary function tests are normal or when the examiner determines that post-bronchodilator studies should not be done and states why.”). 5. Rating the TB Disability from August 31, 2006 to April 23, 2007 After a review of the lay and medical evidence of record, the Board finds that an increased rating in excess of 60 percent is not warranted for the TB disability from August 31, 2006 to April 23, 2007. The Veteran was granted service connection in May 1981 at a noncompensable rating for the TB, effective from November 13, 1979. A November 2011 rating decision increased the TB disability rating from 0 percent to 60 percent, effective from August 31, 2006, based on the results from the April 27, 2011 VA examination, which is discussed below. The record contains no probative evidence to support a higher rating than 60 percent from August 31, 2006 to April 23, 2007. For these reasons, the Board finds that a rating in excess of 60 percent for the TB from August 31, 2006 to April 23, 2007 is not warranted. 6. Rating the TB Disability from April 23, 2007 to April 27, 2011 After review of the lay and medical evidence of record, and resolving reasonable doubt in the Veteran’s favor, the Board finds that an increased rating of 100 percent is warranted for the TB disability from April 23, 2007 to April 27, 2011. In an April 23, 2007 VA examination, the PFTs revealed that, before bronchodilator, the Veteran had an FEV-1 of 1.46 or 45 percent predicted, FVC of 2.44 or 60 percent predicted, and FEV-1/FVC of 60 percent predicted. After the bronchodilator, the PFTs revealed a FEV-1 of 1.41 or 43 percent predicted, FVC of 2.90 or 71 percent predicted, and FEV-1/FVC of 36 percent predicted. A DLCO (SB) was not conducted because the PFT results were sufficient to evaluate the lung status. In consideration of the foregoing, and because there are no contrary findings in treatment records relevant to the rating period, the Board finds that an increased rating of 100 percent is warranted under DC 6845 from April 23, 2007 to April 27, 2011. 38 C.F.R. §§ 4.3, 4.7. 7. Rating the TB Disability from April 27, 2011 to May 18, 2015 After a review of the lay and medical evidence of record, the Board finds that an increased rating in excess of 60 percent is not warranted for the TB disability from April 27, 2011 to May 18, 2015. In an April 27, 2011 VA examination, the PFTs revealed that, before bronchodilator, the Veteran had an FEV-1 of 1.20 or 46 percent predicted, FVC of 2.27 or 60 percent predicted, and FEV-1/FVC of 52.9. After the bronchodilator, the PFTs revealed a FEV-1 of 1.26 or 48 percent predicted, FVC of 2.99 or 79 percent predicted, and FEV-1/FVC of 42.2. The examiner found that the FEV-1/FVC more accurately reflected the severity of the condition, and there were no discrepancies between the PFTs findings and clinical examination. A DLCO(SB) was not conducted because the PFTs results were sufficient to evaluate the pulmonary status. In consideration of the foregoing, the Board finds that an increased rating in excess of 60 percent is not warranted under DC 6845 from April 27, 2011 to May 18, 2015. 38 C.F.R. §§ 4.3, 4.7. 8. Rating the TB Disability from May 18, 2015 After a review of the lay and medical evidence of record, and resolving reasonable doubt in the Veteran’s favor, the Board finds that an increased rating of 100 percent is warranted for the TB disability from May 18, 2015. In a May 18, 2015 VA examination, the PFTs revealed that, before bronchodilator, the Veteran had an FEV-1 of 29 percent predicted, FVC of 37 percent predicted, and FEV-1/FVC of 68.6 percent predicted. After the bronchodilator, the PFTs revealed a FEV-1 of 33 percent predicted, FVC of 40 percent predicted, and FEV-1/FVC of 72.2 percent predicted. The examiner found that the FEV-1/FVC more accurately reflected the severity of the condition. A DLCO(SB) was not conducted because the testing was not indicated in the Veteran’s particular case. In an April 25, 2017 VA examination, the PFTs revealed that, before bronchodilator, the Veteran had an FEV-1 of 44 percent predicted, FVC of 65 percent predicted, FEV-1/FVC of 67 percent predicted, and a DLCO(SB) of 15 percent predicted. After the bronchodilator, the PFTs revealed a FEV-1 of 34 percent predicted, FVC of 52 percent predicted, and FEV-1/FVC of 65 percent predicted. The examiner found that FEV-1 more accurately reflected the severity of the condition. In consideration of the foregoing, and because there are no contrary findings in treatment records relevant to the rating period, the Board finds that an increased rating of 100 percent is warranted under DC 6845 from May 18, 2015. 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 9. Service Connection for Diabetes Mellitus Type II is remanded. The Veteran contends that he was prescribed a medication called Prednisone to treat the service-connected TB and that the medication aggravated the diabetes mellitus type II. The Veteran has provided private treatment records to substantiate this claim. See September 2009 private treatment record, September 2012 private treatment record, September 2015 private treatment record. The Board has reviewed the private treatment records submitted by the Veteran and finds that the records are too speculative to rely upon for the purposes of rendering a decision on this issue. See Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992) (favorable evidence which does little more than suggest possibility of causation is insufficient to establish service connection). Pursuant to VA’s duty to assist, VA will provide a medical examination or obtain a medical opinion based upon a review of the evidence of record if VA determines it is necessary to decide a claim. 38 C.F.R. § 3.159 (c)(4)(i). The matter is REMANDED for the following action: 1. Schedule an appropriate VA examination to assist in determining the nature and etiology of the claimed diabetes mellitus type II. The VA examiner should consider the Veteran’s asthma, which pre-existed service, weight, and history of smoking. The VA examiner should offer the following opinions: A. Is the Veteran currently taking Prednisone? B. What was the Prednisone prescribed to treat? C. If the Veteran was prescribed Prednisone to treat the service-connected TB, did the Prednisone cause the diabetes mellitus type II? D. If the Veteran was prescribed Prednisone to treat the service-connected TB, and Prednisone did not cause the diabetes mellitus type II, does the Prednisone aggravate the diabetes mellitus type II? The term “aggravation” is defined for legal purposes as a worsening of the underlying condition versus a temporary flare-up of symptoms. If it is the examiner’s opinion that there is aggravation, the examiner should identify the baseline level of severity of the type II diabetes mellitus prior to onset of worsening, or by the earliest medical evidence created at any time between onset of worsening and receipt of medical evidence establishing the current level of severity. E. If the Veteran discontinues taking the Prednisone, would that affect the volatility of the diabetes mellitus type II? F. Can the Veteran take a different medication to replace the Prednisone that would not affect the diabetes mellitus type II? G. What are the risk factors and causes for this Veteran’s diabetes mellitus type II? 2. Thereafter, readjudicate the issue of secondary service connection for the claimed diabetes mellitus type II. If the benefit sought on appeal is not granted, the Veteran and representative should be provided with a supplemental statement of the case. An appropriate period of time should be allowed for response before the case is returned to the Board. J. PARKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Danielle Costantino, Associate Counsel