Citation Nr: 18157779 Decision Date: 12/13/18 Archive Date: 12/13/18 DOCKET NO. 11-21 173 DATE: December 13, 2018 ORDER 1. Entitlement to an initial 70 percent rating, but no higher, for the service-connected major depressive disorder and generalized anxiety disorder (psychiatric disorder), effective September 14, 2009, is granted. 2. The 60 percent disability rating for asthma is restored, effective October 1, 2010 and April 14, 2017, and the appeal is granted. 3. Entitlement to an increased rating in excess of 60 percent for the service-connected asthma, since April 10, 2008, is denied. FINDINGS OF FACT 1. Since September 14, 2009, the Veteran’s psychiatric disorder has been manifested by symptoms that most nearly approximate occupational and social impairment with deficiencies in most areas. 2. The RO’s October 2008 rating decision, which increased the Veteran’s rating for his service-connected asthma, from 30 percent to 60 percent, with an effective date of April 10, 2008, was not a clear and unmistakable error. 3. The reduction of the assigned rating for service-connected asthma from 60 percent to 30 percent, effective April 14, 2017, was not proper. 4. Throughout the entire appellate period, the Veteran’s asthma was not manifested by FEV-1 less than 40-percent predicted, or; FEV-1/FVC less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; required daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications. CONCLUSIONS OF LAW 1. The criteria for a 70 percent rating from September 14, 2009 for the psychiatric disorder are met. 38 U.S.C. §§1110, 1155, 5107 (2012); 38 C.F.R. § 4.130, Diagnostic Code (DC) 9434 (2017). 2. The reduction of the 60 percent rating for the service-connected asthma for the period between October 1, 2010 and December 3, 2015 was improper. 38 U.S.C. §§ 7105 (2012); 38 C.F.R. §§ 3.105, DC 6602 (2017). 3. The reduction of the 60 percent rating for the service-connected asthma, effective April 14, 2017, was improper. 38 U.S.C. §§ 1155, 5103, 5103(a), 5112(b)(6) (2012); 38 C.F.R. §§ 3.103(b), 3.105(e), 4.1, 4.2, 4.7, 4.115(a), 4.115(b), DC 6602 (2017). 4. The criteria for entitlement to an increased rating in excess of 60 percent for asthma have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.7, 4.10, 4.97, DC 6602 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1988 to November 1993. These matters come before the Board of Veterans’ Appeals (Board) on appeal from October 2008 and May 2010 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. Jurisdiction has since been transferred to the RO in Indianapolis, Indiana. In June 2014, the Board denied the Veteran’s claim of entitlement to an effective date prior to April 10, 2008, for the grant of a 60 percent rating for asthma and remanded the issue of entitlement to a disability rating in excess of 30 percent for asthma as of October 1, 2010. The Board also granted entitlement to an initial disability rating of at least 50 percent for the psychiatric disorder and remanded the issue of entitlement to an initial disability rating in excess of 50 percent for the psychiatric disorder. In a March 2015 decision, the Board denied an initial disability rating in excess of 50 percent for the psychiatric disorder and remanded the issue of entitlement to a disability rating in excess of 30 percent for asthma as of October 1, 2010. In a January 2016 rating decision, the RO granted the Veteran’s asthma a 60 percent rating effective from December 3, 2015. The Veteran appealed the Board’s March 2015 decision to the United States Court of Appeals for Veterans Claims (Court) which, in an April 2016 memorandum decision, vacated and remanded the decision. In March 2017, the Board remanded the appeal to complete additional development, as instructed by the April 2016 memorandum decision. Most recently, in a September 2018 rating decision, the RO awarded a 70 percent disability rating for the psychiatric disorder, effective April 11, 2017. The RO also reduced the Veteran’s disability rating for his service-connected asthma from 60 percent to 30 percent, effective April 14, 2017. The Board notes that the codesheet accompanying the September 2018 rating decision incorrectly lists the effective date for the reduction as April 11, 2017. However, based upon the date of the applicable examination, the Board finds that April 14, 2017 is the intended effective date. Increased Rating 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. § 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. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate for an increased rating claim whenever the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 50 (2007). 1. Entitlement to an initial 70 percent rating, but no higher, for the psychiatric disorder effective September 14, 2009, is granted. The Veteran contends that an increased disability rating is warranted for his psychiatric disorder. He was awarded service connection in a May 2010 rating decision and assigned a 30 percent rating effective September 14, 2009. In December 2010, he filed a notice of disagreement in response to the assigned rating. In June 2014, the Board granted a 50 percent rating effective September 14, 2009. As noted above, a September 2018 rating decision awarded a 70 percent rating effective April 11, 2017. Thus, the Board will evaluate entitlement to a rating in excess of 50 percent prior to April 11, 2017, and in excess of 70 percent thereafter. Under DC 9434, a 50 percent rating is warranted where there is an occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect, circumstantial, circumlocutory, or stereo-typed speech, panic attacks more than once a week, difficulty in understanding complex commands, impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks), impaired judgment, impaired abstract thinking, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and the inability to establish and maintain effective relationships. Id. A 100 percent evaluation is warranted for a psychiatric disorder when there is evidence of total occupational and social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. The use of the term “such as” in the general rating formula for mental disorders in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). It is not required to find the presence of all, most, or even some, of the enumerated symptoms recited for particular ratings. Id. The use of the phrase “such symptoms as” followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant’s social and work situation. Id. The United States Court of Appeals for the Federal Circuit has acknowledged the “symptom-driven nature” of the General Rating Formula and that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116 (Fed. Cir. 2013). The Federal Circuit has explained that “symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating.” Id. at 117. The Veteran was afforded three VA psychiatric examinations during the course of this appeal. During his February 2010 VA examination, he contended that he was depressed, anxious, and had trouble sleeping. He described decreased motivation in his hobbies and that he felt irritable and angry. He also stated that he had problems controlling his anger with his co-workers. The Veteran denied panic attacks, suspiciousness, delusions, hallucinations, and obsessive rituals. He also denied suicidal or homicidal ideations and it was noted that his judgment and memory were intact. The examiner described the Veteran as oriented to person, place, time and purpose and that his appearance and hygiene were appropriate. The Veteran’s affect was depressed, but his speech, thought process, and concentration were noted to be normal. It was also noted that he could perform activities of daily living. The examiner opined that the Veteran’s psychiatric symptoms caused occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks. The examiner further noted that he understood simple and complex commands and that he was not a danger to himself or others. The Veteran was afforded another VA examination in November 2014. He reported depressed mood, sleep impairment, difficulty thinking and concentrating, panic attacks that occurred weekly or less often, mild memory loss, and disturbances of motivation and mood. The Veteran denied difficulty with activities of daily living and did not endorse suicidal or homicidal ideations. It was noted that the Veteran was oriented to person, place, time, and situation and that it appeared that his memory abilities were intact. It was also noted that his thought process was logical and organized and that there was no evidence of delusional thought. The Veteran described significant irritability and agitation, which required him to remove himself from such situations. He further stated that he experienced notable difficulties when interacting with other people, including strained relationships with his family members, which impacted his quality of life. The examiner concluded that the Veteran was “generally functioning quite well in some areas” and that his psychiatric symptoms resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks. In April 2017, the Veteran was afforded a third VA examination to evaluate his psychiatric disorder. He reported a long history of arguing with his wife, as well as a decline in his relationships with his daughters. He further stated that he became agitated and irritable during daily phone calls with his mother. The Veteran worked in information technology and described feeling agitated with his supervisor at that time. He planned on beginning online classes to obtain a Bachelor’s degree in information technology in May 2017. He reported symptoms including depression, daily anxiety, panic attacks that occurred weekly or less often, concentration difficulties, feelings of worthlessness, sleep impairment, mild memory, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining relationships, and difficulty in adapting to stressful circumstances. The examiner noted that the Veteran demonstrated appropriate hygiene, as well as normal psychomotor skills, speech, eye contact, judgment, and thought processes. His affect was flat, but he was oriented and alert throughout the examination. He denied experiencing hallucinations, as well as homicidal or suicidal ideation. The Veteran was able to manage his financial affairs and perform activities of daily living. The examiner concluded that the Veteran demonstrated occupational and social impairment with deficiencies in most areas. VA treatment records have consistently documented the Veteran’s reports of irritability and anger issues. See VA Treatment Records dated November 23, 2009, November 28, 2011, and May 19, 2014. Notably in August 2010, the Veteran reported that he was forced to reduce his amount of social interaction due to his temper and aggressive behavior towards others. See VA Treatment Record dated August 27, 2010. In August 2011, he stated that he experienced five or more explosive outbursts while taking his daughter to college. See VA Treatment Record dated August 15, 2011. On March 28, 2012, the Veteran reported that he had not improved his ability to control his anger. Based on the above evidence, the Board finds that the Veteran’s symptomatology most nearly approximated occupational and social impairment with deficiencies in most areas since throughout the appeal period. Put differently, his psychiatric disorder symptomatology has warranted a 70 percent rating, but no higher, throughout the appeal period since September 14, 2009. Since the date of service connection, the evidence of record indicates that the Veteran’s psychiatric disorder has resulted in irritability and angry outbursts, which have negatively impacted his ability to maintain relationships with family members and co-workers. Indeed, the VA examination reports and VA treatment records have documented his reports of increased irritability, anger issues, explosive outbursts, and aggressive behavior. The Veteran explained that such symptoms resulted in strained relationships with others, as well as a tendency to avoid social interaction altogether. Giving the Veteran the benefit of the doubt, the Board finds that his reported symptomatology is indicative of impaired impulse control to the degree warranting a 70 percent disability rating. The evidence contains consistent reports of irritability and angry outbursts that have resulted in occupational and social impairment in most areas throughout the appeal period. The Board realizes that the symptoms noted in the rating criteria are not intended to be an exhaustive list, but are examples of the type and severity of symptoms that indicate a certain level of disability. Examining the Veteran’s symptoms as a whole; however, the Board concludes that his symptomatology more nearly approximate the criteria for a rating of 70 percent. However, symptoms do not suggest the presence of total occupational and social impairment due to symptoms such as gross impairment in thought processes or communication, persistent delusions or hallucinations, persistent danger of hurting self or others, intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene, disorientation to time and place, memory loss for names close relatives, own occupation, or own name or any similar symptoms. Indeed, although the Veteran continues to have interpersonal difficulties due to his psychiatric disorder, he has maintained a marriage and stated that he maintains communication with his children and mother. Thus, it cannot be said that the Veteran experiences total social impairment, and a 100 percent rating for the psychiatric disorder is not warranted. In conclusion, the Board finds that based on the overall record evidence, including the Veteran’s lay statements, the effects of the Veteran’s psychiatric symptoms are of a type, frequency, and severity that are in accord with the level of impairment contemplated by the criteria for a 70 percent schedular rating, but no higher, from September 14, 2009. 2. The 60 percent disability rating for asthma is restored, effective October 1, 2010 and April 14, 2017; however, entitlement to a rating in excess of 60 percent is denied. The RO originally granted service connection for asthma in an April 2003 rating decision, awarding a 30 percent disability rating effective September 30, 2002. The current appeal stems from a claim for an increased rating submitted by the Veteran in April 2008. An October 2008 rating decision awarded a 60 percent rating for the service-connected asthma, effective April 10, 2008. The Veteran again submitted a claim for an increased rating in September 2009. The RO proposed to reduce the 60 percent rating in a May 2010 rating decision, which was put into effect in July 2010, at which time a 30 percent rating was awarded effective October 1, 2010. The Veteran filed a notice of disagreement with the reduction in December 2010 and later certified the appeal to the Board. In January 2016, the RO awarded a 60 percent rating effective December 3, 2015. Most recently, in a September 2018 rating decision, the RO reduced the disability rating for the service-connected asthma to 30 percent effective April 14, 2017. Thus, the Board will evaluate the propriety of the two reductions implemented during the appeal period, as well as whether the Veteran is entitled to a rating in excess of 60 percent for his asthma at any point since April 10, 2008. Rating Reductions The Veteran’s asthma has been evaluated under 38 C.F.R. § 4.97, DC 6602. DC 6602 assigns a 30 percent evaluation with a FEV-1 of 56 to 70 percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication. A 60 percent evaluation is assigned with a FEV-1 of 40 to 55 percent predicted, or; FEV- 1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. A. Reduction from 60 percent to 30 percent, effective October 1, 2010 The Board finds that the first reduction of the Veteran’s rating for his service-connected asthma from 60 percent to 30 percent was improper, and thus restores the 60 percent rating effective October 1, 2010. In July 2010, the RO reduced the Veteran’s disability rating for his asthma to a 30 percent rating based upon what it considered to be a clear and unmistakable error in granting the 60 percent rating. The RO found it had improperly used the post-bronchodilator FEV-1 value from the May 2008 VA examination in assigning the 60 percent rating, as it was worse than the pre-bronchodilator measurement. The Court has consistently stressed the rigorous nature of the concept of clear and unmistakable error (CUE). “Clear and unmistakable error is an administrative failure to apply the correct statutory and regulatory provisions to the correct and relevant facts: it is not mere misinterpretation of facts.” Oppenheimer v. Derwinski, 1 Vet. App. 370, 372 (1991). Clear and unmistakable errors “are errors that are undebatable, so that it can be said that reasonable minds could only conclude that the original decision was fatally flawed at the time it was made.” Russell v. Principi, 3 Vet. App. 310, 313-4. “It must always be remembered that CUE is a very specific and rare kind of ‘error.’” Fugo v. Brown, 6 Vet. App. 40, 43 (1993). The Court has propounded a three-prong test to determine whether clear and unmistakable error is present in a prior determination: (1) [E]ither the correct facts, as they were known at the time, were not before the adjudicator (i.e., more than a simple disagreement as to how the facts were weighed or evaluated) or the statutory or regulatory provisions extant at that time were incorrectly applied; (2) the error must be “undebatable” and of the sort “which, had it not been made, would have manifestly changed the outcome at the time it was made”; and (3) a determination that there was CUE must be based on the record and law that existed at the time of the prior adjudication in question. Damrel v. Brown, 6 Vet. App. 242, 245 (1994), quoting Russell v. Principi, 3 Vet. App. 310, 313-14 (1992) (en banc). As noted in the applicable rating decision, the Veteran’s 60 percent evaluation was based upon a May 2008 VA examination report. In that examination report, among other things, the examiner noted a post-bronchodilator FEV-1 reading of 47 percent. The RO later awarded the 60 percent rating based upon that result. The Board finds that assigned a 60 percent rating for the Veteran asthma was not a clear and unmistakable error. Notably, the May 2008 pre-bronchodilator FEV-1 value was 56 percent, which is only one percent higher than the 55 percent reading required for a 60 percent rating. Additionally, the Veteran required twice monthly visits to a physician for his asthma attacks according to the May 2008 examination report. Under DC 6602, a 60 percent rating is warranted for at least monthly visits to a physician for required care of exacerbations. Thus, the evidence indicates that the Veteran’s symptomatology did, in fact, meet the criteria for a 60 percent rating at the time of the May 2008 examination. The Court has held that for CUE to be demonstrated, if must be “absolutely clear that a different result would have ensued,” or else the error complained of cannot be, ipso facto, clear and unmistakable. Fugo v. Brown, 6 Vet. App. 40, 43-44 (1993). In this case, given the additional criteria set forth by the 60 percent rating that was met at the time of the May 2008 VA examination, one cannot conclude that the RO’s increase of the Veteran’s asthma evaluation to 60 percent in October 2008 was CUE. The alleged error must be of fact or of law and, when called to the attention of later reviewers, compel the conclusion to which reasonable minds could not differ that the result would have been manifestly different but for the error. Id. Accordingly, the Board finds that the Veteran’s 60 percent evaluation was improperly reduced, and that the 60 percent evaluation for the Veteran’s asthma should be restored, effective October 1, 2010. B. Reduction from 60 percent to 30 percent, effective April 14, 2017 The provisions of 38 C.F.R. § 3.105 (e) allow for the reduction in evaluation of a service-connected disability when warranted by the evidence, but only after following certain procedural guidelines. The agency of original jurisdiction (AOJ) must issue a rating action proposing the reduction and setting forth all material facts and reasons for the reduction. The veteran must then be given 60 days to submit additional evidence and to request a predetermination hearing. Then a rating action will be taken to effectuate the reduction. 38 C.F.R. § 3.105 (e). The effective date of the reduction will be the last day of the month in which a 60 day period from the date of notice to the veteran of the final action expires. 38 C.F.R. § 3.105 (e), (i)(2)(i). In this case, the Veteran did not receive the 60-day notice of proposed reduction in the assigned rating for his service-connected asthma. However, as noted in the September 2018 rating decision that effectuated the reduction, the Veteran’s combined disability rating did not decrease. Therefore, the regulation governing procedural steps in rating reductions (38 C.F.R. § 3.105 (e)) do not apply. See Stelzel v. Mansfield, 508 F.3d 1345, 1349 (Fed. Cir. 2007) (holding that VA was not obligated to provide a veteran with sixty days’ notice before making a disability ratings decision effective if the decision did not reduce the overall compensation paid to the veteran); see also VAOPGCPREC 71-91 (Nov. 7, 1991) (where the evaluation of a specific disability is reduced, but the amount of compensation is not reduced because of a simultaneous increase in the evaluation of one or more other disabilities, section 3.105(e) does not apply). Notwithstanding the procedural steps as may be appropriate for a reduction, a rating reduction is not proper unless the veteran’s disability shows actual improvement in his or her ability to function under the ordinary conditions of life and work. See Faust v. West, 13 Vet. App. 342, 349 (2000) (noting that VA must review the entire history of the veteran’s disability, ascertain whether the evidence reflects an actual change in the disability, and ascertain whether the examination reports reflecting such change are based upon thorough examinations) (citing Brown v. Brown, 5 Vet. App. 413, 421 (1993)). Therefore, having decided that the procedural requirements for rating reductions are not applicable in this case, the next question to be addressed is whether, given the available evidence, a reduction to a 30 percent rating was proper. As noted in the applicable rating decision, the Veteran’s 60 percent evaluation was based upon a December 2015 VA examination report. In that examination report, the examiner noted intermittent courses of systemic corticosteroids were used to treat the Veteran’s asthma. The September 2018 rating decision reduced the 60 percent rating based upon the PFT readings taken at the time of the April 2017 VA examination. Specifically, pre-bronchodilator testing revealed a FEV-1 level of 101 percent predicted and a FEV-1/FVC ratio of 81 percent, while post-bronchodilator testing resulted in a FEV-1 reading of 107 percent predicted and a FEV-1/FVC ratio of 85 percent. Such testing did not fall between the 40 and 55 percent requirement necessary for a 60 percent rating. However, comparing the demonstrated symptomatology at the time of the assignment of the Veteran’s pre-reduction 60 percent disability rating versus the demonstrated symptomatology since that time, the Board concludes that the evidence does not show actual improvement in the Veteran’s ability to function under the ordinary conditions of life and work. Rather, the April 2017 examiner concluded that there had been a progression in the Veteran’s symptoms. Additionally, the Veteran continued to require daily inhalational bronchodilator therapy and anti-inflammatory medication. Thus, affording the Veteran the benefit of the doubt, the evidence of record serves to support the continuance of the 60 percent evaluation, as it indicates that the Veteran’s symptomatology had progressed and continued to require inhalational treatment. Improvement under the ordinary conditions of life and work is not demonstrated. Therefore, the Board finds that the reduction of the 60 percent disability rating was improper and that the restoration of the 60 percent rating for service-connected asthma is warranted, effective April 14, 2017. See 38 C.F.R. §§ 4.2, 4.10; Brown, 5 Vet. App. at 421. Increased Rating The Veteran contends he is entitled to a 100 percent rating for his service-connected asthma. As the 60 percent rating has been restored in the discussion above regarding the two reduction periods, that rating has been in place for the duration of the appeal period. As noted above, the Veteran’s service-connected asthma is rated under DC 6602. 38 C.F.R. § 4.97, DC 6602. DC 6602 provides ratings for asthma, in part using the results of pulmonary function tests (PFTs). Forced Expiratory Volume in one second (FEV-1) of less than 40-percent predicted value, or; the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) of less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications, is rated 100 percent disabling. In addition, the Board notes that, when evaluating based on PFTs, VA is to use post-bronchodilator results unless the post-bronchodilator results were poorer than pre-bronchodilator results, in which case the pre-bronchodilator results should be used instead. 38 C.F.R. § 4.96 (d)(5). When there is a disparity between the results of different PFTs (e.g., FEV-1, FVC, or FEV-1/FVC) such that the evaluation would be different depending on which test was used, the Board must use the test result that the examiner states most accurately reflects the level of disability. 38 C.F.R. § 4.96 (d)(6). The Board finds that the rating criteria do contemplate the use of medications as they are cited in the regulations and recognize the effects of bronchodilators and inhalational therapy. There have been seven VA examinations conducted to evaluate the Veteran’s asthma throughout the appeal period. At the May 2008 examination, the Veteran described symptoms including coughing, orthopnea, wheezing, sleep apnea, and shortness of breath with physical activity. PFTs revealed pre-bronchodilator results of FVC of 61 percent predicted, FEV-1 of 56 percent predicted, and FEV-1/FVC of 76.9 percent. Post-bronchodilator results showed FVC of 51 percent predicted, FEV-1 of 47 percent predicted, and FEV-1/FVC of 91 percent. DLCO results were not obtained at that time. He visited a physician twice monthly for required care of his asthmatic attacks. He stated that he contracted infections from the condition and required antibiotics three times annually, as well as bedrest two times per month during these episodes. There had been no episodes of respiratory failure requiring assistance from a machine. The condition was treated with oral bronchodilator therapy. In March 2010, the Veteran underwent another VA examination for his asthma. PFTs revealed pre-bronchodilator results of FVC of 102 percent predicted, FEV-1 of 95 percent predicted, and FEV-1/FVC of 77 percent. Post-bronchodilator results showed FVC of 91 percent predicted, FEV-1 of 89 percent predicted, and FEV-1/FVC of 81 percent. DLCO results were not obtained based upon the sufficient PFT results. The examiner indicated that the FEV-1/FVC reading more accurately reflected the severity of the condition. The Veteran described symptoms including coughing, orthopnea, and shortness of breath at rest. He visited a physician twice annually for required care of his weekly asthmatic attacks. He stated that he required nearly constant antibiotic treatment for infections, as well as bedrest one time per month during these episodes. There had been no episodes of respiratory failure requiring assistance from a machine. The condition was treated with oral bronchodilator therapy. In October 2010, the Veteran was afforded a third VA examination to assess the severity of his asthma. PFTs revealed pre-bronchodilator results of FVC of 66 percent predicted, FEV-1 of 63 percent predicted, and FEV-1/FVC of 79 percent. Post-bronchodilator results showed FVC of 77 percent predicted, FEV-1 of 79 percent predicted, and FEV-1/FVC of 85 percent. DLCO results were not obtained based upon the sufficient PFT results. The examiner indicated that the FEV-1 reading more accurately reflected the severity of the condition. The Veteran described symptoms including loss of appetite, coughing, orthopnea, and shortness of breath at rest. He visited a physician six times monthly for the required care of his weekly asthmatic attacks. He stated that he required antibiotic treatment for infections six times annually, as well as occasional bedrest during these episodes. There had been no episodes of respiratory failure requiring assistance from a machine. The condition had been treated with Xolair injections every two weeks for the past two months, as well as with oral bronchodilator therapy. At the April 2012 examination, PFTs revealed pre-bronchodilator results of FVC of 100 percent predicted, FEV-1 of 91 percent predicted, FEV-1/FVC of 74 percent, and DLCO of 29.2 percent predicted. Post-bronchodilator results showed FVC of 102 percent predicted, FEV-1 of 101 percent predicted, and FEV-1/FVC of 80 percent. Post-bronchodilator results for DLCO were not obtained. The examiner indicated that the FEV-1/FVC reading more accurately reflected the level of disability. The Veteran reported shortness of breath with physical activity. He visited a physician monthly for required care of his asthmatic attacks. The Board notes that, in May 2012, the examiner amended the examination report to clarify that the Veteran visited a physician for asthmatic attacks less than monthly. There had been no episodes of respiratory failure requiring assistance from a machine. The condition was treated with daily oral bronchodilator therapy. The Veteran underwent another VA examination in November 2014. The report noted a pre-bronchodilator FEV-1/FVC ratio of 76 percent, as well as a post-bronchodilator FEV-1/FVC ration of 81 percent. The examiner indicated that the indicated that the FEV-1/FVC reading most accurately reflected the level of disability. He visited a physician less frequently than monthly for required care of his asthmatic attacks, but reported four hospital visits in the past 12 months due to such episodes. There had been no episodes of respiratory failure requiring assistance from a machine. The condition was treated with daily oral bronchodilator therapy, as well as intermittent courses of systemic corticosteroids. In December 2015, another VA examination was conducted to evaluate the Veteran’s asthma. PFTs revealed pre-bronchodilator results of FVC of 102 percent predicted, FEV-1 of 100 percent predicted, FEV-1/FVC of 79 percent, and DLCO of 97 percent predicted. Post-bronchodilator results showed FVC of 109 percent predicted, FEV-1 of 108 percent predicted, and FEV-1/FVC of 81 percent. Post-bronchodilator results for DLCO were not obtained. The examiner indicated that the FEV-1/FVC ratio more accurately reflected the level of disability. The Veteran visited a physician less than monthly for required care of his asthmatic attacks. His visits for Xolair injections were not considered visits for required care of exacerbations. There had been no episodes of respiratory failure requiring assistance from a machine. The condition was treated with daily oral bronchodilator therapy, as well as intermittent courses of systemic corticosteroids. In April 2017, another VA examination was conducted to assess the current severity of the Veteran’s asthma. PFTs revealed pre-bronchodilator results of FVC of 98 percent predicted, FEV-1 of 101 percent predicted, FEV-1/FVC of 81 percent. Post-bronchodilator results showed FVC of 99 percent predicted, FEV-1 of 107 percent predicted, and FEV-1/FVC of 85 percent. DLCO results were not obtained. The examiner indicated that the FVC value more accurately reflected the level of disability. The Veteran reported symptoms including shortness of breath with exertion, as well as seasonal flare-ups. He had not visited a physician for required care of his asthmatic attacks. There had been no episodes of respiratory failure requiring assistance from a machine. The condition was treated with daily oral bronchodilator therapy. The evidence shows that the Veteran has not had PFT results consistent with a rating in excess of 60 percent (i.e., FEV-1 and FEV-1/FVC values were all greater than 40 percent), that he did not experience more than one attack per week with episodes of respiratory failure, or required daily use of systemic high dose corticosteroids or immuno-suppressive medications. Indeed, the VA examination reports and VA treatment records do not show evidence of FEV-1 values less than 40 percent predicted, nor of FEV-1/FVC ratios of less than 40 percent. Additionally, there have been no reported attacks of respiratory failure during the appeal period. There is also no evidence that the Veteran required daily use of systemic high dose corticosteroids or immuno-suppressive medications. The Board notes that in assessing the severity of the Veteran’s asthma, the Board has considered his assertions, as well as those assertions of his family and friends, regarding his symptoms, which they are competent to provide. See Layno v. Brown, 6 Vet. App. 465 (1994); see also Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). The Veteran’s history and symptom reports have been considered, including as presented in the medical evidence discussed above, and have been contemplated by the disability rating that has been assigned. Moreover, the Board finds that the competent medical evidence offering detailed specific findings pertinent to the rating criteria is the most probative evidence with regard to evaluating the pertinent symptoms of the Veteran’s asthma. As such, while the Board accepts the Veteran’s statements with regard to the matters he is competent to address, the Board relies upon the medical evidence with regard to the specialized evaluation of functional impairment, symptom severity, and details of clinical features of the service-connected asthma. Based on the preponderance of the evidence, the Board finds the criteria are not met to assign a 100 percent rating for the Veteran’s service-connected asthma. As the preponderance of the evidence is against this claim, the benefit-of-the-doubt rule is inapplicable, and the claim for a rating in excess of 60 percent for asthma must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App 49, 55-57 (1990). Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Erin J. Trojanowski, Associate Counsel