Citation Nr: 21000757 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 16-48 899 DATE: January 6, 2021 ORDER Entitlement to a compensable rating for granulomatous lung disease is denied. FINDING OF FACT For the entire period on appeal, the Veteran’s granulomatous lung disease has been manifest by Forced Vital Capacity (FVC) of 92 percent predicted; it has not been manifest by 75- to 80-percent predicted, or; DLCO (SB) of 66- to 80-percent predicted. CONCLUSION OF LAW The criteria for a compensable initial rating for granulomatous lung disease are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. § 4.97, Diagnostic Code 6828. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1969 to August 1973. This matter comes before the Board of Veterans’ Appeals (Board) from June 2016 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared for a hearing before the undersigned in August 2019. A transcript of the proceeding is of record. This claim was previously remanded by the Board in November 2019 for further development, to include providing a VA examination. The Board finds substantial compliance with the remand directives and therefore another remand is not necessary. Stegall v. West, 11 Vet. App. 268 (1998). Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Entitlement to a compensable rating for granulomatous lung disease Generally, the effective date of compensation based on a claim for increase will be on the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C.§ 5110 (a); 38 C.F.R. § 3.400. However, the effective date for an increased rating claim may date back as much as one year before the date of the claim for increase if it is factually “ascertainable that an increase in disability had occurred” within that timeframe. See 38 U.S.C. § 5110 (b)(2). The Board notes the Veteran filed the instant claim for an increased rating in April 2016. As an increased rating claim, the Board looks at the evidence in the year prior to this date to see the earliest date that it is factually ascertainable that an increase occurred. 38 C.F.R. § 3.400. The VA’s Schedule for Rating Disabilities is used to determine disability ratings once a disability is service-connected. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In the Rating Schedule, Diagnostic Codes (DC) are assigned to specific disabilities. These DCs designate percentage ratings based on the average functional impairment of the Veteran due to a service-connected disability. 38 C.F.R. §§ 3.321, 4.10. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A claimant may experience multiple distinct degrees of disability that may result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The following analysis is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. The Veteran is currently assigned a noncompensable rating for granulomatous lung disease under Diagnostic Code (DC) 6828. The Veteran also claims that the lung disease meets a higher rating than 0 percent due to FVC of 75 to 80 percent predicted. See March 2017 VA 646. At the August 2019 Board hearing, the Veteran contended his condition worsened since the May 2016 VA examination. Diagnostic Code 6828 provides for ratings based on the results of pulmonary function tests (PFTs). A 10 percent rating is assigned for a Forced Vital Capacity (FVC) of 75 to 80 percent predicted, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO) of 66 to 80 percent predicted. A 30 percent rating is assigned for an FVC of 65 to 74 percent predicted, or; DLCO of 56 to 65 percent predicted. A 60 percent rating is assigned for an FVC of 50 to 64 percent, or; DLCO of 40 to 55 percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limitation). A 100 percent rating is assigned for an FVC less than 50 percent, or; DLCO less than 40 percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or pulmonary hypertension (shown by Echo or cardiac catheterization), or; the requirement for outpatient oxygen therapy. 38 C.F.R. § 4.97. In this regard, PFTs are required to rate respiratory conditions except in certain situations, such as when the PFTs are inconsistent with the other clinical evidence of record and the examiner states why they are not a valid indication of respiratory functional impairment in a particular case. 38 C.F.R. § 4.96(d)(3). Further, post-bronchodilator PFT studies should be used except when the results of pre-bronchodilator tests are normal or when the examiner determines that post-bronchodilator studies should not be done and states why. 38 C.F.R. § 4.96(d)(4). When evaluating a disability based on PFTs, post-bronchodilator results should be used unless such results are poorer than the pre-bronchodilator results, in which case the latter should be applied. 38 C.F.R. § 4.96(d)(5). When there is a disparity between the results of different PFTs (FEV-1, FVC, etc.) so that the level of evaluation would differ depending on which test result is used, use the test result that the examiner states most accurately reflects the level of disability. 38 C.F.R. § 4.96(d)(5). At a September 2014 VA examination, the Veteran reported shortness of breath with exertion which got worse following open-heart surgery in approximately 2004. He was not prescribed any medications at the time of the examination or previously. Pulmonary function tests (PFTs) reflected an FEV-1 of 92 percent predicted pre-bronchodilator and 89 percent predicted post-bronchodilator. The June 2015 VA examination showed FVC of 85 percent predicted pre-bronchodilator and 82 percent predicted post-bronchodilator. In May 2016 VA treatment records, the Veteran reported slightly more cough and phlegm and mild shortness of breath. Physical examination was normal. VA treatment records from April 2015 to May 2016 do not diagnose any respiratory condition other than granulomatous lung disease. The May 2016 VA examination indicated that the Veteran’s current functioning is reflected by the PFTs completed on that date. However, the examiner also noted that a PFT is not able to show the level of disability as to the Veteran’s pulmonary disease because the PFT is used to diagnosis obstructive lung disease and not granuloma disease. Further, a DLCO is not advised due to the claimant’s cardiovascular condition and age. Therefore, if one parameter is required to assess the current severity of the Veteran’s lung condition, the FVC would be more reflective than other indices. On testing, FVC was 92 percent predicted pre-bronchodilator and 97 percent predicted post-bronchodilator. Finally, the examiner noted that the Veteran is also diagnosed with chronic bronchitis and bronchiectasis, but that granulomatous lung disease is predominately responsible for the limitation in pulmonary function. The February 2020 examiner was asked to clarify and comment on the May 2016 VA examiner’s statements regarding the Veteran’s current diagnoses and whether PFT results accurately reflect his lung functioning. On examination, the Veteran reported shortness of breath on activities, but indicated that he was not sure if it was from his heart, age, or lung condition. The examiner noted that the Veteran did not present with symptoms of any lung condition on examination; thus, she did not provide the diagnoses of bronchitis or bronchiectasis Additionally, the Veteran denied having bronchitis or bronchiectasis. The Veteran does not require the use of corticosteroid medications, inhaled medications, oral bronchodilators, antibiotics, or outpatient oxygen therapy. Chest x-rays have been stable over the course of his condition. Accordingly, regarding PFT results, the examiner stated the May 2016 results reflect his current pulmonary function, most accurately by referencing FVC results. Viewed in its entirety, the February 2020 VA examination report indicates that, in light of the Veteran’s report of mild shortness of breath of unclear etiology, stable chest x-rays, and lack of prescribed medications, the PFT results from May 2016 adequately reflect his current pulmonary functioning. Therefore, though the Veteran contends the May 2016 PFTs are outdated, the February 2020 VA examiner provided a clear rationale to support her conclusion that the May 2016 PFTs were adequate to assess current functioning. Having reviewed the evidence, the Board finds the Veteran’s granulomatous lung disease does not warrant a compensable rating. The evidence shows the Veteran has some shortness of breath but PFTs are not significantly limited. Though a 10 percent rating is assigned for an FVC of 75 to 80 percent predicted, May 2016 FVC was 92 percent predicted pre-bronchodilator, and 97 percent predicted post-bronchodilator. Chest x-rays have been stable. The Veteran has not been prescribed any medication to control his lung condition. The Veteran has not reported any other symptoms or limitations related to his lung condition that more closely approximates the criteria for a compensable rating. Further, there is no medical evidence in filing showing treatment for any lung condition after May 2016. Accordingly, as the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K.L. Blevins, 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.