Citation Nr: 20022044 Decision Date: 03/30/20 Archive Date: 03/30/20 DOCKET NO. 18-27 533 DATE: March 30, 2020 ORDER Entitlement to an evaluation in excess of 20 percent for duodenal ulcer is denied. Entitlement to an initial evaluation in excess of 10 percent for bilateral allergic conjunctivitis is denied. FINDINGS OF FACT 1. The Veteran's duodenal ulcer symptoms have not been productive of anemia and weight loss, or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year. 2. The Veteran has chronic bilateral allergic conjunctivitis that results in dry, itchy, eyes when the condition is active. Corrected distance vision is 20/40 or better bilaterally and there is no impairment of visual field or muscle function. There are no other related residuals. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 20 percent for duodenal ulcer are not met. 38 U.S.C. § 1155; 38 C.F.R.§§ 4.7, 4.114, Diagnostic Code (DC) 7305. 2. The criteria for an initial evaluation in excess of 10 percent for bilateral allergic conjunctivitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.40, 4.45, 4.79, Diagnostic Code (DC) 6018. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service in the United States Army from March 1966 to October 1967. The Veteran was granted service connection for duodenal ulcer with an evaluation of 10 percent in a February 1970 rating decision. In October 2015, the Veteran filed a claim for an increased rating for his duodenal ulcer and for service connection for bilateral allergic conjunctivitis. A May 2016 rating decision increased the rating for duodenal ulcer to 20 percent effective September 2015 and granted the claim for service connection for bilateral allergic conjunctivitis with a 10 percent evaluation. The Veteran filed a Notice of Disagreement (NOD) for higher evaluations of both disabilities and timely perfected his appeal. Increased Rating Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Rating Schedule. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505, 510 (2007). 1. Entitlement to an evaluation in excess of 20 percent for a duodenal ulcer The Veteran's duodenal ulcer is rated as 20 percent disabling under Diagnostic Code (DC) 7305. Under DC 7305, a 20 percent rating is warranted for a moderate disability picture with recurring episodes of severe symptoms two to three times a year averaging 10 days in duration, or with continuous moderate manifestations. A 40 percent rating is warranted for a moderately severe disability picture, less than severe but with impairment of health manifested by anemia and weight loss or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year. The highest 60 percent rating is warranted for a severe disability picture with pain only relieved by standard ulcer therapy, periodic vomiting, recurrent hematemesis or melena, with manifestations of anemia and weight loss productive of definite impairment of health. See 38 C.F.R. §§ 4.114, 7305. Words such as "mild," "moderate," "moderately severe," and "severe" are not defined in the Rating Schedule or in the regulations. Consequently, the Board must evaluate all of the evidence to ensure that its decisions are "equitable and just." 38 C.F.R. § 4.6. For the following reasons, an increased rating in excess of 20 percent for duodenal ulcer is not warranted. During a January 2016 VA examination, the Veteran reported an increase in symptomatology for about six months. He reported near constant epigastric burning and denied nausea or vomiting. There was no evidence of anemia or weight loss. The examiner noted that he underwent an esophagogastroduodenoscopy (EGD) in December 2015 which revealed antral erosions with erythema and he was instructed to increase his dosage of omeprazole. The Veteran reported continuous abdominal pain with no incapacitating episodes. In May 2016, the Veteran was seen at a VA hospital for chest pain. The provider advised him that it was gastroesophageal reflux disease (GERD) mimicking a heart attack. The Veteran had not filled his prescription for omeprazole since December 2015 and was advised that he must take it daily. The Veteran underwent another EGD in June 2016 that was normal with no evidence of erythema, erosions, or ulcers. The previously seen gastric erosions had healed. In July 2016, the Veteran complained of epigastric pain, and his VA physician added sucralfate to his medication regime. In his October 2016 Notice of Disagreement (NOD), the Veteran stated that his ulcer causes incapacitating episodes up to 12 times per year. The Veteran was afforded another VA examination in March 2018 whereby the Veteran stated that he had no current abdominal pain, but has left epigastric pains a few times a month with partial relief from his medications. He reported some ongoing issues with gas and burning in the esophagus intermittently, but no incapacitating episodes. The examiner noted no melena or weight loss. Although the Veteran reported incapacitating episodes up to 12 times per year in his NOD, and he is competent to report his observable symptoms, the Board does not find this assertion to be consistent with his reports to VA providers and examiners. Specifically, in his January 2016 and March 2018 VA examinations, the Veteran reported no incapacitating episodes. Further, the Veteran’s medical records do not contain any complaints of incapacitating episodes due to his duodenal ulcer. The Board notes that there is one record whereby the Veteran was seen at the hospital for chest pain which the examiner opined was likely due to GERD. However, even if related to his duodenal ulcer, this evidence only indicates one significant episode during the entire appeal period. Further, the evidence, including the Veteran’s assertions, do not indicate that any incapacitating episodes averaged 10 days or more in duration. The evidence does not show that the Veteran suffers from a moderately severe duodenal ulcer, defined as less than severe but with impairment of health manifested by anemia and weight loss. Further, the evidence does not show recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year. Therefore, a higher rating of 40 percent is not warranted. The medical evidence and the Veteran’s own assertions indicate that the Veteran’s symptoms more closely approximate the 20 percent rating for moderate duodenal ulcer, manifested by recurring episodes of severe symptoms two or three times a year averaging 10 days in duration or with continuous moderate manifestations. The Board accordingly finds that the weight of the evidence is against the claim. The criteria for a disability rating higher than 20 percent for service-connected duodenal ulcer are therefore not met and the benefit-of-the-doubt doctrine does not apply. 2. Entitlement to an initial evaluation in excess of 10 percent for bilateral allergic conjunctivitis The Veteran's conjunctivitis is rated pursuant to 38 C.F.R. § 4.79, DC 6018, for chronic conjunctivitis. During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Both the former and revised criteria indicate that a 10 percent rating is warranted for active conjunctivitis and that inactive conjunctivitis is to be evaluated on the basis of residuals such as visual impairment and disfigurement. Additionally, the revised criteria do not contain substantive changes to §§ 4.75, 4.76, or the table of Impairment of Central Visual Acuity. The Veteran's bilateral allergic conjunctivitis manifests in the following symptoms: dryness, redness, irritation, burning or stinging, discomfort, itching, blurred vision, and sensitivity to light. In large part, these symptoms were noted on the February 2016 and April 2018 VA examinations. The Veteran is also followed by VA for this condition, and these symptoms consistently appear throughout his treatment records. The Veteran is shown to already have been afforded the maximum evaluation of 10 percent for an active disability under the rating schedule. He was afforded VA examinations in February 2016 and April 2018. Both VA examinations showed that the Veteran's bilateral conjunctivitis was active, which warrants a 10 percent rating, but not higher, under Diagnostic Code 6018. However, in order to afford the Veteran the broadest interpretation of his claim, the Board will consider deficiencies in visual acuity, muscle function, and visual field, as well as disfigurement, to cover any periods when the Veteran’s disability may have been inactive. 38 C.F.R. § 4.75(a). In this regard, there is no indication of any worsened visual acuity, visual field defect, muscular defect, or disfigurement specifically related to his service-connected conjunctivitis. As to visual acuity, the next higher rating, a 20 percent, is warranted where vision in the other eye is 20/50. 38 C.F.R. § 4.79, table of Impairment of Central Visual Acuity. Here, the Veteran's corrected distance vision was 20/40 or better in both eyes in both the February 2016 and April 2018 VA examinations. Accordingly, a higher rating is not warranted on the basis of visual acuity. As to impairment of visual field and muscle function, both the February 2016 and April 2018 VA examiners specifically noted that the Veteran does not have vision field or muscle function defects. The February 2016 VA examiner noted that the patient has very mild blurring of the vision that is caused by other eye conditions including Fuchs endothelial dystrophy and non-proliferative diabetic retinopathy. A February 2016 addendum to that opinion clarified that the Fuchs endothelial dystrophy and diabetic retinopathy are separate and distinct disabilities not caused by or aggravated by the service-connected allergic conjunctivitis. Likewise, the April 2018 VA examiner noted some mild blurring, and stated that his other eye conditions are not caused by or aggravated by his allergic conjunctivitis. Accordingly, a higher rating is not warranted on the basis of visual impairment. As to disfigurement, which is evaluated on under Diagnostic Code 7800, the evidence affirmatively shows that the Veteran does not have scarring or disfigurement of the eyes. Accordingly, a higher rating is not warranted on the basis of disfigurement. Therefore, at no time during the relevant appeal period did the Veteran's service-connected conjunctivitis manifest a severity more than 10 percent. As the preponderance of the evidence is against the Veteran's claim for an evaluation in excess of 10 percent for his service-connected conjunctivitis, the benefit-of-the-doubt doctrine is inapplicable and the claim must be denied. 38 U.S.C. § 5107. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Sneeringer, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.