Citation Nr: 18158666 Decision Date: 12/18/18 Archive Date: 12/17/18 DOCKET NO. 08-28 255 DATE: December 18, 2018 ORDER Entitlement to service connection for right ear hearing loss, is denied. Entitlement to service connection for diabetes mellitus type 2 (DM), to include as secondary to service-connected asthma disability is denied. Entitlement to service connection for an eye disorder, to include diabetic retinopathy, glaucoma, cataracts and blindness, as secondary to service-connected asthma disability, is denied. Entitlement to service connection for hypertension (HTN), to include as secondary to service-connected asthma disability, is denied. Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as secondary to service-connected asthma disability, is denied. Entitlement to service connection for residuals of cerebrovascular accident (claimed as stroke), to include as secondary to service-connected asthma disability, is denied. Entitlement to an initial disability rating for asthma of 30 percent prior to November 21, 2006 is granted, but an evaluation higher than 30 percent prior to June 16, 2008, is denied, and an evaluation higher than 60 percent thereafter, is denied. FINDINGS OF FACT 1. The Veteran does not have right ear hearing loss for VA compensation purposes. 2. The Veteran is not shown to have served at a location for which exposure to an herbicide agent may be presumed nor is he shown to have been otherwise exposed to herbicide agents or specific chemical compounds, including asbestos, during active service. 3. Diabetes mellitus type II was not manifest during service or within one year of active service discharge; and, the preponderance of the evidence fails to establish that it is etiologically related to service to include as secondary to a service-connected disability. 4. Gastroesophageal reflux disease was not manifest during service and, the preponderance of the evidence fails to establish that it is etiologically related to service to include as secondary to a service-connected disability. 5. Hypertension was not manifest during service or within one year of active service discharge; and, the preponderance of the evidence fails to establish that it is etiologically related to service to include as secondary to a service-connected disability. 6. Cerebrovascular accident was not manifest during service or within one year of active service discharge; and, the preponderance of the evidence fails to establish that it is etiologically related to service to include as secondary to a service-connected disability. 7. An eye disorder including glaucoma, cataracts, blindness-left eye, pseudophakia right eye, central retinal vein occlusion left eye, was not manifest during service or within one year of active service discharge; and, the preponderance of the evidence fails to establish that it is etiologically related to service to include as secondary to a service-connected disability. 8. Prior to November 21, 2006, the Veteran's asthma required daily inhalational or oral bronchodilator therapy and inhalational anti-inflammatory medication. 9. Prior to June 16, 2008, the preponderance of the evidence does not demonstrate that the Veteran's FEV-1 or FEV-1/FVC measurements were 55 percent or less of predicted value or that the Veteran sought monthly physician treatment for exacerbation, or required at least three per year courses of systemic high-dose corticosteroids or immunosuppressive medications. 10. From June 16, 2008, the preponderance of the evidence does not demonstrate that the Veteran's FEV-1 or FEV-1/FVC measurements were 40 percent or less of predicted value or that the Veteran suffered from weekly asthma attacks or required the use of daily systemic high-dose corticosteroids or immunosuppressive medications. CONCLUSIONS OF LAW 1. The criteria for service connection for right ear hearing loss have not been met. 38 U.S.C. §§ 101, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.385. 2. The criteria for service connection for diabetes mellitus type II are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 3. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 4. The criteria for service connection for cerebrovascular accident are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 5. The criteria for service connection for eye disorder are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 6. The criteria for service connection for gastroesophageal reflux disease are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 7. The criteria for entitlement to an initial disability rating for asthma higher than 10 percent prior to November 21, 2006 is met, and an evaluation in excess of 30 percent disabling prior to June 16, 2008, is denied, and an evaluation higher than 60 percent thereafter, has not been met. 38 U.S.C. § 1155, 38 C.F.R. §§ 3.159, 3.321, 4.3, 4.7, 4.97, DC 6602. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1974 to February 1977 when he was discharged Under Honorable Conditions. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated in September 2006 which denied service connection for DM and an eye disorder (claimed as glaucoma, cataracts, and blindness), a July 2008 rating decision that increased the rating for asthma to 30 percent effective November 21, 2006, a May 2011 rating decision which denied service connection for cerebrovascular accident/stroke, HTN, and GERD, and a January 2012 rating decision which increased the rating for asthma to 60 percent effective June 17, 2008. Testimony was taken regarding these claims during a December 2015 hearing before the undersigned Veterans Law Judge in Houston, Texas, of which a transcript is of record. This matter was last before the Board in March 2016 where it was remanded for further development that has since been substantially complied, to include updated treatment records and new VA examinations and opinions. The issue of entitlement to a cardiac disorder was previously before the Board, but as this claim was awarded in an October 2018 rating decision, it is no longer on appeal. Service Connection In order to establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus, or link, between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Alternatively, secondary service connection may be granted for disability that is proximately due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310 (a) (2008). The evidence must show that a current disability exists and that the current disability was either caused by or aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc) (holding that when aggravation of a non-service-connected disability is proximately due to or the result of a service connected condition, such disability shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation). 1. Entitlement to service connection for right ear hearing loss Hearing loss is considered to be a disability for VA purposes when the threshold level in any of the frequencies 500, 1000, 2000, 3000 and 4000 Hertz is 40 decibels or greater; or the thresholds for at least three of these frequencies are 26 decibels or greater; or speech recognition scores are less than 94 percent. 38 C.F.R. § 3.385. The Veteran's available service treatment records are silent for any recorded evidence of hearing loss. In March 2012 the Veteran underwent a VA audiological examination. Pure tone thresholds, in decibels, were, in pertinent part, as follows: 500 1000 2000 3000 4000 RIGHT 15 20 20 20 25 Speech recognition ability, using the Maryland CNC test, was 98 percent in the right ear. In August 2018, the Veteran underwent another VA audiological examination. Pure tone thresholds, in decibels, were, in pertinent part, as follows: 500 1000 2000 3000 4000 RIGHT 15 15 25 30 35 Speech recognition ability, using the Maryland CNC test, was 100 percent in the right ear. The reported audiometric findings from the March 2012 and August 2018 VA audiological examinations conducted during the appeal period have not demonstrated right ear hearing loss disability for VA purposes. 38 C.F.R. § 3.385. Absent evidence of current hearing loss disability, an award of service connection for hearing loss disability is not appropriate. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Thus, the positive correlation between the Veteran’s service and his current right ear hearing acuity set out by the August 2018 VA examiner is irrelevant as there is no actual disability for VA purposes for which to award service connection. In addition, as acknowledged in the March 2016 Board remand, there is medical evidence of record indicating hearing impairment given the use of bilateral hearing aids, but audiometric testing data associated with the record does not meet the threshold requirements for hearing loss disability for VA purposes. Accordingly, the Board finds that service connection for right ear hearing loss is not warranted. The Board finds that the preponderance of the evidence weighs against the claim, and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for DM, to include as secondary to service-connected asthma disability. 3. Entitlement to service connection for eye disorder, to include as secondary to service-connected asthma disability. 4. Entitlement to service connection for HTN, to include as secondary to service-connected asthma disability. 5. Entitlement to service connection for GERD, to include as secondary to service-connected asthma disability. 6. Entitlement to service connection for cerebrovascular accident, to include as secondary to service-connected asthma disability The Veteran is seeking entitlement to service connection for DM, HTN, GERD, cerebrovascular accident and an eye disorder as secondary to his asthma disability and prescribed medication leading to weight gain and associated chronic disabilities. See August 2018 IME of Doctorate of Nursing Practice D.P. (“Domino effects of asthma and prednisone…systemic and multi-faceted. Weight gain is a risk factor for developing HTN and DM…have also been identified as causes for glaucoma and stroke/cerebral vascular accident…prednisone causes GERD or acid reflux and weight gain”); see also June 2015 Board Hearing transcript. As an initial matter, the foregoing analysis addresses the aforementioned “domino” theory of entitlement. However, the Board notes that during the earlier portion of the appeal period the Veteran alternatively argued exposure to toxins including asbestos and Agent Orange as the cause for the claimed disabilities. The record reflects, however, that the Veteran has explicitly abandoned these theories of presumptive service connection, focusing on the secondary contentions identified above and as testified to at his June 2015 Board hearing. Compare June 2015 Board Hearing transcript with July 2014 DRO Hearing transcript (“contended it was as a result of exposure to herbicide, but you just mentioned it in connection with asthma…so are we now changing the contention as to this?...Correct…why I put in withdraw project SHAD…because that was where he believed he was exposed to Agent Orange…and as we discussed the other issue is the asbestos…he could easily have had that but he doesn’t have either mesothelioma or asbestosis”). In light of the Veteran’s abandonment of these theories of entitlement as reiterated by the lack of testimony concerning it at the June 2015 Board hearing and demonstrated by the record which does not reflect any herbicide or asbestos exposure other than the unsupported and later abandoned statements of the Veteran, the following analysis will not elaborate any further on theories of entitlement concerning exposure to herbicide or asbestos. See May 2011 JSRRC Memo; see also 38 C.F.R. § 20.204. The Board will begin by addressing the theory of direct service connection. As noted above, the first element of direct service connection requires medical evidence of a current disorder. Here, a current diagnosis has been established for DM, HTN, GERD, cerebrovascular accident and an eye disorder via medical records and the multiple VA examinations afforded the Veteran in conjunction with his claims. Accordingly, the existence of a current disability is not in question. See i.e. August 2010 VA brain and spinal cord examination (“problem: stroke…date of onset: 2002…placed on Plavix for 2 years…course since onset: stable”); July 2018 VA eye condition examination (“glaucoma bilateral…cataracts…blindness-left eye…pseudophakia right eye…central retinal vein occlusion left eye…diagnoses with glaucoma about 15y/o, lost complete vision in left eye around 2005”); August 2018 VA esophageal conditions examination (“GERD…date of diagnosis: 2008”); August 2018 VA diabetes mellitus examination (“Diabetes Mellitus…date of diagnosis: 1994”); August 2018 VA hypertension examination (“hypertension…date of diagnosis: 1995”). The second element of direct service connection requires medical evidence, or in certain circumstances, lay testimony, of in-service incurrence or aggravation of an injury or disease. Here, the Veteran does not contend that his DM, HTN, GERD, cerebrovascular accident or eye disorders began in service or shortly thereafter, a notion corroborated by the record as STRs are silent for documentation of the ailments or their precursors arising during active duty. The Board acknowledges a notation of defective distant vision upon discharge examination, but this finding has not been medically linked to the current eye disorders or contended by the Veteran. See i.e. February 1977 Report of Medical Examination (“sys. 116/ dias. 84…defective distant vision 20/25”). As noted above, the record indicates that the Veteran was first diagnosed with DM and HTN in the mid-90’s, suffered a stroke in 2002, began experiencing vision problems shortly after, and was diagnosed with GERD in 2008. The Veteran's active military service ended in February 1977. This lengthy period without documented or alleged treatment for these ailments weigh heavily against any contention, there was any relevant in-service disease or injury to which current disability relates. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000) (holding that service incurrence may be rebutted by the absence of medical treatment of the claimed disorder for many years after the military discharge). Lastly, the third element of direct service connection requires medical evidence of a nexus between the current disorder and the in-service disease or injury. Here, the only medical opinions of record regarding direct service connection are the VA examinations which are negative as the August 2018 IME limited comment to the secondary theory of service connection as discussed below. The VA examiners determined that it was less likely than not that the Veteran's current DM, HTN, GERD, stroke and eye disorders were related to his military service, providing alternative etiological theories based upon the medical evidence of record. See i.e. July 2018 VA medical opinion (“cataract…glaucoma…central retina occlusion…blindness…often caused by diabetes”); August 2018 VA medical opinion (“likely cause of the CVA is diabetes”). The examiners clearly reviewed the STRs and other evidence in the claims folder and provided opinions that are supported by and consistent with the evidence of record. There is no positive evidence to the contrary of these opinions in the claims file as treatment records do not dispute these opinions, nor does the Veteran himself assert any theory of direct connection. For all of these reasons, direct service connection for DM, HTN, GERD, stroke and eye disorders are not warranted. The Board will now address the Veteran’s main theory of entitlement via secondary service connection for his current DM, HTN, GERD, stroke and eye disorders by way of their relationship with his service-connected asthma and associated steroidal treatment. As noted above, a current diagnosis has been established for these illnesses and the Veteran is currently service-connected for asthma. Thus, the Veteran has satisfied the first and second elements of secondary service connection. The third element of secondary service connection requires medical nexus evidence establishing a connection between the service-connected disability and the current disorder. In this regard, there are positive and negative medical opinions of record. As for the positive evidence, there is the August 2018 private medical opinion authored by a Doctorate of Nursing Practice. She asserts that the Veteran’s current disorders are a result of “gained weight over the years” due to his asthma related shortness of breath which caused decreased activities and the weight-gain side-effects of steroidal prednisone medication. The examiner explained that the weight gain “leads to a domino theory of medical issues,” beginning with the diagnoses of DM and HTN that led to the stroke and vision issues, and that the GERD was a side-effect of the everyday prednisone. Notably, however, this opinion did not have the benefit of an in-person examination or interview with the Veteran. In addition, the supporting logic appears to be inconsistent with the evidence of record. Significantly, she does not cite to any medical records reflecting the Veteran’s actual pre- and post-prednisone weight which has largely remained consistent since his service through to the present day and accordingly undermines the entire basis of the opinion. Compare February 1977 Report of Medical Examination (“Weight 212”) with July 2006 VA examination (“217 pounds”); June 2009 VA examination (“204lbs…bronchial asthma…condition does not affect body weight”); September 2018 VAMC Medication note (“211.5 lbs.”). Concerning the Veteran’s GERD, the examiner concluded that the disorder was a side-effect of the Veteran’s prednisone but does not provide any further analysis of this etiological relationship including any explanation for the gap in time between prescription and diagnosis of the disorder as identified by the VA examiner. As such, this opinion is accorded little probative value. Regarding the negative evidence, the September 2018 VA medical opinions were based upon in-person examinations and interviews with the Veteran in addition to a review of the medical evidence of record including the Veteran’s statements and articles submitted in support of his contentions. Regarding GERD, unlike the August 2018 private opinion the VA examiner explained that the specific type of medications taken by the Veteran are not associated with GERD, unlike the high-dose oral or systemic steroids that he is not prescribed. The examiner further identified that the Veteran’s asthma “pre-dated the GERD substantially.” Concerning the DM, the VA examiner, like the private medical opinion, acknowledged an etiological relationship between the Veteran’s DM and his stroke, vision and even HTN. However, the VA examiner explained that there was no relationship between the asthma or its medications with DM identifying that while “steroids in high does can impair glucose metabolism” such a finding is “usually limited” and in the Veteran’s case he was not prescribed such doses. Lastly, the VA examiner noted review of the articles submitted by the Veteran, however it was identified that these materials were not peer-reviewed and thus could not serve as a basis of scholarly support. The Board finds the negative evidence outweighs the positive on the issue of secondary service connection. It is to be noted that the Board is not free to substitute its own judgment for as such a medical expert. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). However, the Board is required to assess the credibility and weight to be given to the evidence. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). As the VA examiners provided detailed explanations as to why the Veteran's DM, HTN, GERD, stroke and vision disorders are not related to his service-connected disabilities, the Board finds the probative value of the VA examination reports are greater than the cursory conclusions of the private examiner. The Board is not persuaded by the August 2018 private medical opinion because it does not indicate that it was based on all of the pertinent facts, and no underlying reason for the opinion was provided for the statements. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Thus, the private opinion cannot be considered as probative medical evidence of an etiological relationship between the Veteran's current disorders and his service-connected asthma. In contrast, the September 2018 VA examiner accurately and thoroughly characterized the evidence of record. The reports of the Veteran's medical history and the clinical findings are consistent with the entire body of medical evidence of record. There is no basis on which to find that the September 2018 VA medical opinion is deficient. The treatment records do not provide contrary evidence. As such, service connection on a secondary basis for DM, GERD, HTN, stroke and vision disorders is not warranted. In reaching this decision, the Board has considered the Veteran's arguments in support of his claim, including his June 2015 Board testimony. The Board acknowledges that the Veteran is competent, even as a layperson, to attest to factual matters of which he has first-hand knowledge. However, the cause of the conditions is an inherently medical question which requires medical professionals to determine. The medical evidence has been discussed at length above and is found to be more persuasive (and competent) on the issue of nexus in this case. As the preponderance of the evidence is against the Veteran's claim, the benefit of the doubt provision does not apply. The Veteran's claim of entitlement to service connection for DM, GERD, HTN, stroke and eye disorders, to include as secondary to asthma, is not warranted. 7. Entitlement to a disability rating for asthma higher than 30 percent from November 21, 2006 to June 16, 2008, and higher than 60 percent thereafter. Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The percentage ratings in VA's Schedule for Rating Disabilities (Rating Schedule) represent as far as can practicably be determined the average impairment in earning capacity resulting from such disabilities and their residual conditions in civil occupations. 38 C.F.R. § 4.1. 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3. Staged ratings are appropriate where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007).] Respiratory illnesses are rated under 38 C.F.R. Sections 4.96 and 4.97. Section 4.96(a) provides, "Rating coexisting respiratory conditions. Ratings under diagnostic codes 6600 through 6817 and 6822 through 6847 will not be combined with each other. Where there is lung or pleural involvement, rating under diagnostic codes 6819 and 6820 will not be combined with each other or with diagnostic code 6600 through 6817 or 6822 through 6847. A single rating will be assigned under the diagnostic code which reflects the predominant disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation." 38 C.F.R. § 4.96 (a). The Veteran's asthma is service-connected and is currently rated as 10 percent disabling from February 2, 2006, 30 percent disabling from November 21, 2006, and 60 percent since June 17, 2008 under 38 C.F.R. § 4.97, DC 6602. DC 6602 provides for a 30 percent disability where pulmonary function tests (PFTs) show any of the following: FEV-1 of 56 to 70 percent predicted, FEV-1/FVC of 56 to 70 percent; or daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication. A 60 percent disability evaluation is warranted where PFTs show any of the following: FEV-1 of 40 to 55 percent predicted, 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 100 percent evaluation is warranted where PFTs show any of the following: FEV-1 less than 40 percent predicted, FEV-/FVC less than 40 percent; or more than one attack per week with episodes of respiratory failure, or where the use of systemic high dose corticosteroids or immuno-suppressive medications are required on a daily basis. 38 C.F.R. § 4.97, DC 6602. The Veteran was first afforded a VA respiratory examination in July 2006. Following a review of the record and physical evaluation of the Veteran, diagnoses of asthma and shortness of breath were identified. At the time, the Veteran reported experiencing monthly asthma attacks and visits to the physician 3 times a year with antibiotics. Reported use of anti-inflammatory medication and bronchodilator on an intermittent basis with no episodes of respiratory failure. PFT revealed pre-bronchodilator results of FVC 63% predicted and FEV-1 66% predicted. Post bronchodilator results were 73 % FVC and 73% FEV-1. VAMC treatment records reflect a prescription for anti-inflammatory and bronchodilator oral inhalers beginning on November 21, 2006. The Veteran was next afforded a VA respiratory examination in June 2009. Veteran reported experiencing shortness of breath after walking a city block and wheezing, symptoms occurring 3 times a year lasting for two weeks with infections and requiring antibiotics. Veteran reported daily albuterol inhaler and no respiratory failure. The examiner identified that the “spirometry results are unreliable due to poor claimant’s effort,” and PFT revealed pre-bronchodilator results of FVC 34% predicted and FEV-1 34% predicted. A July 2010 private pulmonary treatment record reflects a finding of dyspnea with shortness of breath on exertion. Veteran was advised to continue with his albuterol, Asmanex and Foradil inhalers and PFT testing revealed pre-bronchodilator results of FEV-1/FVC of 73%. The Veteran was next afforded a VA respiratory examination in June 2012. Veteran reported 3 intermittent courses of systemic corticosteroids over the past year, daily bronchodilator and anti-inflammatory medication and 4 physician visits for exacerbation over the last year without respiratory failure. PFT revealed pre-bronchodilator results of FEV-1 70 % predicted. At his June 2015 Board hearing the Veteran testified as to worsening symptoms and increased treatment including a five-year immunosuppressive therapy course of injected medication, inability to walk more than half a block without wheezing, and increased wheezing and additional medications. August 2018 private pulmonary treatment from the Knapp Medical Center reveals a PFT reading of FEV-1/FVC 76% predicted. The interpretation report reflected a suggested diagnosis of “severe restrictive dysfunction.” The Veteran was most recently afforded a VA respiratory examination in August 2018. Veteran reported experiencing the same symptoms as before, including shortness of breath and cough, but that they were more “severe.” Anti-inflammatory and bronchodilator inhalation therapy was noted without the use of corticosteroid medication. In the past year the Veteran visited the physician three to four times for exacerbations of breath shortness without use of antibiotics. Restrictive lung disease was identified and PFT revealed pre-bronchodilator results of FEV-1 47% predicted and FEV-1/FVC of 83% predicted. The examiner concluded that the etiology of the Veteran’s restrictive disease was unknown but likely related to the asthma and that his symptoms result in limits of strenuous activity with shortness of breath coming from more than mild exertion. Considering the Veteran's contentions, including his consistent testimony of wheezing, coughing and dyspnea, as well as the evidence of record and the applicable law, the Board finds the Veteran's asthma evaluation should be increased to 30 percent disabling from the beginning of the appeal period until June 17, 2008, after which no more than a 60 percent is warranted. In this case, prior to November 21, 2006, the Veteran's PFT results show that he did have pre-bronchodilator FEV-1 or FEV-1/FVC of less than 70 percent of predicted, but not less than 55 percent, as demonstrated on VA examination in July 2006. In addition, while the prescription for daily inhalational therapy dates from November 2006, it pre-supposes a need that pre-dates that encounter. This would reasonably support an evaluation of a 30 percent rating under DC 6602, from February 2006. Prior to June 2008, none of the pulmonary function tests results meet the criteria for a 60 percent or higher rating, nor do they show the necessary physicians visits or medical treatment. From June 17, 2008, the PFT values do not meet the criteria for the next higher schedular rating of 100 percent. The Board acknowledges the sub-40 percent reading identified in the June 2009 VA examination, but this reading appears to be an outlier when considering contemporaneous medical records and the Veteran’s failure to properly participate in the physical evaluation as noted by the examiner. In addition, the Veteran had not suffered weekly attacks or used daily courses of systemic, oral or parenteral, corticosteroids. The Board also notes the Veteran’s testimony of the RO having “granted…100 percent and then took it away.” In this regard, there appears to be a typographical error in the January 2012 rating decision that is the basis for the confusion. Namely, the January 2012 rating decision identifies the ruling as “Evaluation of asthma, which is currently 30 percent disabling, is increased to 60 percent effective June 17, 2008,” but in the body of the opinion there is a reference to an award of 100 percent disabling. This errant notation is clearly wrong in light of the entirety of the January 2012 rating decision which explains below that reference why an award of 100 percent disabling is not warranted. Accordingly, the Board concludes that the preponderance of the evidence is in favor of an initial disability evaluation of 30 percent disabling prior to June 16, 2008, and against the assignment of a rating in excess of 60 percent for asthma at any time during the relevant time frame. MICHAEL KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Marcus J. Colicelli