Citation Nr: 18158446 Decision Date: 12/17/18 Archive Date: 12/14/18 DOCKET NO. 17-00 436 DATE: December 17, 2018 ORDER Entitlement to a compensable rating for calcified pleural plaques is denied. REMANDED Entitlement to service connection for a skin disorder, to include melanoma of the ear, is remanded. FINDING OF FACT The Veteran’s calcified pleural plaques has been manifested by FVC readings greater than 80 percent predicted, FEV-1 readings greater than 80 percent predicted, and FEV-1/FVC readings greater than 80 percent. CONCLUSION OF LAW The criteria for an initial compensable rating for calcified pleural plaques have not been met. 38 U.S.C. §§ 1155, 5103A, 5106, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.130, Diagnostic Code 6845-6833 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1966 to February 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, that reasonable doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, and the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Calcified Pleural Plaques In June 2015, the Veteran was granted service connection for calcified pleural plaques and assigned a noncompensable rating under hyphenated Diagnostic Code 6845-6833. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27. In this case, the hyphenated diagnostic code indicates that pleural plaques, under Diagnostic Code 6845, is the service-connected condition and asbestosis, under Diagnostic Code 6833, is a residual condition. Diagnostic Code 6833 provides, in pertinent part, for a 10 percent disability rating is warranted for Forced Vital Capacity (FVC) of 75 to 80 percent predicted, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCBO (SB)) of 66 to 80 percent predicted. FVC of 65 to 74 percent predicted, or; DLCO (SB) of 56 to 65 percent predicted warrants an evaluation of 30 percent. FVC of 50 to 64 percent predicted, or; DLCO (SB) of 40 to 55 percent predicted, or; maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiorespiratory limitation warrants an evaluation of 60 percent. FVC less than 50 percent predicted, or; DLCO (SB) less than 40 percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption with cardiorespiratory limitation, or; cor pulmonale or pulmonary hypertension, or; requires outpatient oxygen therapy warrants an evaluation of 100 percent. 38 C.F.R. § 4.97, Diagnostic Codes 6825-6833. Diagnostic Code 6845 provides, in pertinent part, for a 10 percent evaluation with a FEV-1 of 80 to 71 percent predicted, or a FEV-1/FVC of 80 to 71 percent, or DLCO (SB) of 66 to 80 percent predicted. A 30 percent evaluation with a FEV-1 of 56 to 70 percent predicted, or a FEV-1/FVC of 56 to 70 percent, or DLCO (SB) of 56 to 65 percent predicted; 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 60 percent evaluation with a FEV-1 of 40 to 55 percent predicted, or a 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 100 percent evaluation is assigned with a FEV-1 of less than 40 percent predicted, or; FEV-1/FVC of less than 40 percent, or; DLCO (SB) of less than 40 percent predicted, or; maximum exercise capacity less than 15 ml/kg/min (with cardiac or respiratory limit), 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. 38 C.F.R. § 4.97, DC 6845. In evaluating certain respiratory disorders, including the one at issue, pulmonary function tests (PFTs) are required, except in the following circumstances: (i) when the results of a maximum exercise capacity rest are of record and are 20 ml/kg/min or less; if a maximum exercise capacity test is not of record, evaluation is based on alternative criteria; (ii) when pulmonary hypertension (documented by an echocardiogram or cardiac catheterization), cor pulmonale, or right ventricular hypertrophy has been diagnosed; (iii) when there have been one or more episodes of symptoms of acute respiratory failure or; (iv) when outpatient oxygen therapy is required. 38 C.F.R. § 4.96 (d)(1). Post-bronchodilator results are required when PFTs are done for disability evaluation purposes except when the results of the pre-bronchodilator PFTs are normal or when the examiner determines that post-bronchodilator studies should not be done and states why. 38 C.F.R. § 4.69 (d)(4). Turning to the evidence of record, the Veteran first received a VA examination in connection with his claim in June 2015. The examiner noted an October 2014 computed tomography (CT) scan which revealed calcified pleural plaques bilaterally that were consistent with prior asbestos exposure. The FVC results indicated 82 percent predicted and the FEV-1 results indicated 87 percent predicted. The Veteran received another VA examination in March 2016, and the examiner noted a current diagnosis of asbestosis. Pulmonary function testing revealed that FVC results were 82 percent predicted, FEV-1 results were 87 percent predicted, and FEV-1/FVC results were 82 percent predicted. The examiner indicated that the FEV-1/FVC test most accurately reflected the Veteran’s level of disability. DLCO testing had not been completed because the examiner noted that it was not indicated for the Veteran’s condition. As the results of both the June 2015 and March 2016 VA examinations were issued following a review of the Veteran’s record and an in-person examination of the Veteran and are not contradicted by any evidence of record, the Board has afforded them significant probative weight. The evidence indicates that neither the Veteran’s FEV-1, FVC, nor FEV-1/FVC results were ever less than 80 percent predicted and, therefore, the results from both his June 2015 and March 2016 examinations do not meet the criteria for a compensable rating under Diagnostic Code 6833 or 6845. As such, the claim for entitlement to a compensable rating for calcified pleural plaques must be denied. REASONS FOR REMAND Skin Disorder The Veteran’s medical records establish a diagnosis or persistent symptoms of a skin disorder. There is also an indication, through assertions of the Veteran, that the disability may be related to service. Therefore, the Board finds that a medical examination with an opinion is necessary to decide the claims. 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 70 (2006). Specifically, a remand is required to afford the Veteran a VA examination to determine the nature and etiology of this disability The matter is REMANDED for the following action: Schedule the Veteran for a VA examination to determine the nature, onset and etiology of any diagnosed skin disorder. The claims file must be made available to the examiner. The examiner is asked to opine as to whether it is as least as likely as not that any diagnosed skin disability had its onset in service or are otherwise the result of an incident in service. The examiner should consider all evidence, including lay statements, medical records, and other medical opinions of record. Any opinions offered should be accompanied by a clear rationale consistent with the evidence of record. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Daniels, Associate Counsel