Citation Nr: 21003991 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 16-12 753 DATE: January 25, 2021 ORDER For the period prior to July 29, 2019, entitlement to an increased rating, in excess of 10 percent, for ischemic heart disease (IHD), is denied. For the period beginning July 29, 2019, entitlement to an increased rating, in excess of 30 percent, for IHD, is denied. For the period prior to August 28, 2014, an increased, 30 percent disability rating, for hairy cell leukemia with immune thrombocytopenia, is granted. For the period beginning August 28, 2014, an increased, 70 percent rating, for hairy cell leukemia with immune thrombocytopenia, is granted. FINDINGS OF FACT 1. For the period prior to July 29, 2019, the Veteran’s IHD is not approximated by a workload greater than 5 METs and less than 7 METs, that results in dyspnea, fatigue, angina, dizziness, or syncope; there is no evidence of cardiac hypertrophy or dilatation; and lower ventricular ejection fraction was at least 52 percent. 2. For the period beginning July 29, 2019, the Veteran’s IHD is approximated by workload greater than 5 METs and less than 7 METs, that results in fatigue. 3. For the period prior to August 28, 2014, the Veteran’s hairy cell leukemia with immune thrombocytopenia is characteristic of a stable platelet count that falls between 70,000 and 100,000, without bleeding. 4. For the period beginning August 28, 2014, the Veteran’s stable platelet count falls between the range of 20,000 and 70,000, with no evidence of bleeding. CONCLUSIONS OF LAW 1. For the period prior to July 29, 2019, the criteria for an increased rating, in excess of 10 percent, for IHD, have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 3.102, 4.1, 4.3, 4.7, 4.104, Diagnostic Code (DC) 7005. 2. For the period beginning July 29, 2019, the criteria for an increased rating, in excess of 30 percent, for IHD, have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 3.102, 4.1, 4.3, 4.7, 4.104, DC 7005. 3. For the period prior to August 28, 2014, the criteria for an increased, 30 percent disability rating, for hairy cell leukemia with immune thrombocytopenia, have been met. 38 U.S.C. § 1155; 38 C.F.R. § 3.102, 4.1, 4.3, 4.7, 4.117, DC 7705 (Revised December 9, 2018). 4. For the period beginning August 28, 2014, the criteria for an increased, 70 percent rating, for hairy cell leukemia have been met. 38 U.S.C. § 1155; 38 C.F.R. § 3.102, 4.1, 4.3, 4.7, 4.117, DC 7705 (Revised December 9, 2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1966 to September 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. In April 2017, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of this hearing is of record. In October 2018, the Board remanded the case to the RO for further evidentiary development. In a June 2020 rating decision, the RO increased the disability rating for IHD to 30 percent, effective July 29, 2019; and the disability rating for hairy cell leukemia with immune thrombocytopenia, to 30 percent, effective August 28, 2014. However, as these increases are not a 100 percent disability rating, and/or are not representative of a total grant of the benefits sought on appeal, the claims for increase remain before the Board. AB v. Brown, 6 Vet. App. 35 (1993). Increased Rating Disability ratings are determined by application of the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155 (West 2012); 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 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 making disability evaluations. 38 C.F.R. § 4.1 (2019); Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might 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). 1. Ischemic Heart Disease The Veteran has been assigned a 10 percent disability rating for his service-connected IHD for the period prior to July 29, 2019, and a 30 percent disability rating for the period beginning July 29, 2019, under DC 7005. He asserts entitlement to an increased rating of 30 percent. See July 2014 Notice of Disagreement. Nonetheless, the Board has also considered whether he is entitled to a rating, in excess of 30 percent, for the period beginning July 29, 2019. Under DC 7005, the rating criteria for arteriosclerotic heart disease (coronary artery disease), a 30 percent rating is assigned when a workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; there is evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. A 60 percent rating is assigned for more than one episode of acute congestive heart failure in the past year, or; when workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; for left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent rating is assigned for chronic congestive heart failure, or; when workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope; or for left ventricular dysfunction with an ejection fraction of less than 30 percent. See 38 C.F.R. § 4.104, DC 7005. Under Note (2) of 38 C.F.R. § 4.104, one MET is defined as the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. Id. At his April 2017 videoconference hearing, the Veteran provided an explanation of how his heart condition affects him on a daily basis. Specifically, he testified that he gets a little fatigued, and that although he does not do any exercises in a gym, he walks approximately a mile and a half a day, as part of his daily routine. Additionally, the Veteran asserted, in pertinent part, that his examination at Denver VA was not much of an examination, but rather, a conversation, from which the VA RO assigned a 10 percent disability rating. Nonetheless, the Veteran also testified that he had the same symptoms at the time of his telephonic examination/interview with the VA examiner as the ones he described at this videoconference hearing. In this regard, the Board notes that the February 2016 VA examination report, in question, clarifies that the method in which a VA examiner undertook to obtain medical information about the Veteran’s IHD was by a review of available records, in conjunction with a telephone interview with the Veteran (without an in-person or telehealth examination), using the ACE process. Further, this February 2016 VA examination report clarified that this approach was undertaken because the existing medical evidence, supplemented by a telephone interview, provided sufficient information, for purposes of preparing the DBQ, whereas conducting an examination “would likely provide no additional relevant evidence.” Further, the Board additionally notes that other than this DBQ/examination report, there is sufficient evidence in the claims file, overall, including other VA examination reports and medical treatment records, for the Board to determine whether the Veteran is entitled to a disability rating that is higher than what he has already been assigned, for both periods of the appeal. A. Period Prior to July 29, 2019 As noted above, the Veteran has been assigned a 10 percent disability rating for IHD, for the period prior to July 29, 2019. For this period of the appeal, although medical treatment records reflect that the Veteran did not manifest symptoms of shortness of breath, dyspnea, angina, or syncope, due to his heart condition, other symptoms and impairments of his IHD are noted. See e.g. January 2014 Private Treatment Progress Notes; see also September 2014 Private Treatment Progress Notes; see too, October 2014 Private Treatment Progress Notes. Specifically, for example, a January 2014 private treatment progress note indicates that the Veteran denied having cardiovascular symptoms of angina, palpitations, claudication, or edema. On cardiovascular examination, heart rate and rhythm were regular; and there were no murmur, rub, or gallop. A September 2014 private treatment progress note indicates that the Veteran reported that he was feeling fine; he had been very active; he often found, in his daily activities, that he ended up walking more; and that he felt that he could exercise more. This progress notes also indicates that the Veteran did not have any chest pain; he denied having palpitations, and he did not have any dizziness or syncope. In an April 2016 private treatment progress note, the Veteran provides some details about the activities he had been able to able to undertake during this period of the appeal, despite his IHD. Specifically, he stated that “he thinks his heart is ok.” Additionally, in pertinent part, he noted that he likes to be active, and that he takes the dog out daily; he walks a lot, goes shopping, and goes to the museum. While he mentioned having some neck and shoulder aches and pain, which get worse with his activities, he also stated that he has no problems shoveling the snow. Treatment records also indicate that his left ventricular ejection fraction (LVEF) exceeded 50 percent. See e.g. September 2014 Private Treatment Progress Notes; see also April 2016 Private Treatment Progress Notes; see November 2017 Private Treatment Progress Notes (noting that an October 2017 echocardiogram reflected that the Veteran’s ejection fraction was 52 percent). Pertinently, a November 2017 private treatment progress note indicates that in October 2017, the Veteran was hospitalized for complaints associated with weakness/dizziness, with findings of myocardial infarction. This progress note further reflects that since his discharge appointment, and two days prior to the consultation pertaining to this treatment note, the Veteran reported feeling ok, with no recurrent anginal symptoms; no dyspnea on exertion; no palpitations; and no syncope, but rather, his only complaint was that he was feeling bloated. The Veteran was also afforded VA examinations for an assessment of the severity of his IHD. Specifically, a June 2013 VA examination for IHD notes that the Veteran “was asymptomatic, [and] for certain reasons had an ETT[,] the report of which was said to be abnormal[,] followed by an angiogram[,] followed by [coronary bypass graft] x4 grafts.” With respect to his abnormal ETT, the VA examination report notes that the Veteran reported that he had no symptoms prior to having the initial stress, and he denied ever having a myocardial infarction, heart failure, and/or arrhythmia; and he can walk for miles without symptoms. Further, the VA examination report notes that continuous medication is required for management of the Veteran’s heart condition. Additionally, the VA examination report reiterates and notes that the Veteran has not had myocardial infarction; congestive heart failure; arrhythmia; heart valve conditions; infectious heart conditions; and/or pericardial adhesions. On physical examination, the Veteran’s heart rate was 70; the rhythm of his heart was normal; point of maximal impact was not palpable; heart sounds were normal; and there was no evidence of jugular-venous distension. The VA examination report also notes that the Veteran has scars that are related to his IHD. However, no other pertinent physical findings, complications, conditions, signs, and/or symptoms related to his IHD were noted. On diagnostic testing, the VA examiner found no evidence of cardiac hypertrophy or cardiac dilatation. EKG results were normal; and based on a June 2013 echocardiogram, left ventricular ejection fraction (LVEF) was 59 percent, with normal wall motion, and normal wall thickness. Although a stress test was not provided, an interview based METs test was undertaken, in which the Veteran denied experiencing symptoms with any level of physical activity. The VA examination report further notes that the METs level limitation is solely due to the Veteran’s heart conditions; and that the Veteran does not have any non-cardiac medical condition, such as musculoskeletal or pulmonary conditions limiting the METs level. In support of his claim for increase, the Veteran has submitted a private disability benefits questionnaire (DBQ) from a private cardiologist, D.R. This July 2014 DBQ notes, in pertinent part, that the Veteran’s treatment plan does not include taking continuous medication for his IHD; and that he does not have congestive heart failure. On diagnostic testing, there was no evidence of cardiac hypertrophy or dilation, and based on an August 2009 test, LVEF was 60 – 65 percent. Although an exercise test was not undertaken, D.R. elicited an interview based METs test, from which she determined that the Veteran’s METs level was greater than 3 and less than 5, and thus, is consistent with activities, such as light yard work (weeding), mowing lawn (power mower), and/or brisk walking 4 miles per hour). However, in determining the lowest level of activity at which the Veteran reports symptoms, D.R. failed to identify the applicable symptoms that result in a METs level that is higher than 3 but less than 5. The Board finds that this DBQ is not persuasive evidence and is not afforded any significant probative weight. In addition to not associating symptoms when assigning a MET level, some of the findings in this DBQ are inconsistent with the medical records. For example, while treatment records and all other VA examination reports noted that the Veteran is taking medication for management of his heart condition, this DBQ stated to the contrary, as noted above. A February 2016 VA examination report/DBQ notes that continuous medication is required for management of the Veteran’s heart conditions; but that the Veteran does not have a history of myocardial infarction; congestive heart failure; arrhythmia; heart valve conditions; infectious heart conditions; and/or pericardial adhesions. A history of coronary artery bypass surgery is, however, noted. On diagnostic testing, there was no evidence of cardiac hypertrophy and/or cardiac dilation. The VA examination report notes that the Veteran’s echocardiogram from June 2013 reflects a LVEF of 59 percent, with wall motion, normal, and wall thickness, normal. Further, the VA examiner elicited an interview based METs testing. However, she noted that the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity. She further noted that the METs level limitation is solely due to the heart condition. Additionally, the VA examiner remarked that an e-mail from a decision review officer indicated that a new echocardiogram was not required for this VA examination report; and that the Veteran was asymptomatic at the time of the examination. However, it is not clear as to whether a new echocardiogram was not required for this report because the Veteran was asymptomatic at the time of the examination; or whether the VA examiner was simply noting, independently, that the Veteran was asymptomatic at the time of this examination. Nonetheless, given this ambiguity, as well as the VA examiner’s reliance on a three-year old echocardiogram result, this VA examination report shall be attributed limited probative value. Overall, based on a review of all probative evidence, the Board finds that an increased, 30 percent rating is not warranted for this period prior to July 29, 2019. The medical evidence does not show that the Veteran’s service-connected heart disability had a history of cardiac hypertrophy or dilatation; and/or a workload if greater than 5 METs but not greater than 7 METs that results in dyspnea, fatigue, angina, dizziness, or syncope, to warrant an increased, 30 percent disability rating. Although he was hospitalized and treated for myocardial infarction during this period of the appeal, his LVEF exceeded 50 percent, and at his follow-up appointment, a couple of weeks after, he reported that he was feeling ok, with no recurrent anginal symptoms; dyspnea on exertion; no palpitations; and/or syncope. Thus, the evidence does not support a finding of a workload greater than 5 METs and no greater than 7 METs that results in dyspnea, fatigue, angina, dizziness or syncope; and therefore, an increased rating, in excess of 10 percent, for the period prior to July 29, 2019, must be denied. B. Period Beginning July 29, 2019 As noted above, the Veteran has been assigned a 30 percent disability rating for IHD for the period beginning July 29, 2019. For this period of the appeal, medical treatment records reflect that the Veteran denied having chest pains, shortness of breath, and/or dyspnea. See e.g., January 2020 Private Treatment Notes; see also, April 2020 Treatment Notes. A July 2019 VA examination report reflects that the Veteran’s current symptoms are general fatigue, and that he is not able to lift too much weight. The VA examiner also noted that the Veteran reported that the impact of his condition enables him to still get around ok, but he needs to monitor his physical activity. Further, the VA examination report notes that continuous medication is required for control of his heart condition; and that the Veteran had a myocardial infarction in 2017. The VA examination report notes that there is no history of congestive heart failure; cardiac arrhythmia; heart valve condition; infectious heart conditions; and/or pericardial adhesions. However, the VA examination report notes that the Veteran has undergone non-surgical or surgical procedures, and specifically, percutaneous coronary intervention; coronary artery bypass surgery; and additional stent placement by a Kaiser Permanente cardiologist in 2017. On physical examination, the Veteran’s heart rate was 68; heart rhythm was regular; point of maximal impact was “5th intercostal space”; heart sounds were normal; and there was no evidence of jugular-venous distention. No other pertinent findings, complications, conditions, signs or symptoms related to the Veteran’s IHD were noted. However, the VA examination report noted that the Veteran has scars that are related to his IHD. There was no evidence of cardiac hypertrophy or cardiac dilation. Additionally, July 2019 EKG results and chest X-rays were normal. This VA examination report further reflects that a July 2019 echocardiogram indicated that LVEF was 57 percent; wall thickness was normal; and wall motion was abnormal, in which the VA examiner described this abnormality as “[diastolic] filling pattern [indicating an] impaired relaxation, grade 1.” Although an exercise stress test was not undertaken, the VA examiner elicited an interview based METS test. She determined that the lowest activity at which the Veteran reports symptoms is more than 5 and less than 7 METs, which has been found to be consistent with activities, such as walking 1 flight of stairs, golfing (without a cart), mowing law (push mower, heavy yard work (digging)), which results in fatigue. The VA examiner also noted that the Veteran’s METs level is solely due to his heart conditions. Based on a review of all probative evidence, a rating in excess of 30 percent is not warranted. The evidence does not show that the Veteran has had more than one episode of acute congestive heart failure in the past year; or that the IHD is manifested by a workload that is greater than 3 METs and less than 5 METs, resulting in dyspnea, fatigue, angina, dizziness, or syncope; and/or that LVEF is 30 to 50 percent, to warrant a higher rating of 60 percent. Rather, the Veteran does not have any history of congestive heart failure; his IHD is manifested by a workload greater than 5 and less than 7 METs, which results in fatigue, and his LVEF was 57 percent (greater than 50 percent), as noted above in his most recent VA examination report. The Board has considered whether separate, additional ratings are attributable to the Veteran’s service-connected IHD. However, the Veteran has also been service-connected for residual scars, due to his coronary artery bypass grafting, which is associated with his IHD. No other issues, pertaining to the service-connected IHD, have been raised by the record; and the Veteran has not raised any other issues, in relation to his increased rating claim for IHD. See July 2014 Notice of Disagreement (noting that the Veteran was seeking an increased rating of 30 percent for his service-connected IHD). Therefore, based on the foregoing reasons, an increased rating, in excess of 30 percent, for IHD, for the period beginning July 29, 2019, must be denied. 2. Hairy Cell Leukemia with Immune Thrombocytopenia The Veteran has been assigned a zero, non-compensable rating for his service-connected hairy cell leukemia with thrombocytopenia, for the period prior to August 28, 2014; and a 30 percent disability rating for the period beginning August 28, 2014, under DC 7705. He asserts entitlement to a higher rating. During the pendency of this appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the hematologic and lymphatic systems. Effective December 9, 2018, the final rule updated medical terminology, added certain hematologic diseases, and provided detailed and updated criteria for evaluating conditions pertaining to the hematologic and lymphatic systems. In cases where rating criteria are amended during the course of the appeal, such as this case, the Board must consider both the former and current schedular criteria. If an increased rating is warranted under the new, revised criteria, the award may not be made effective before the effective date of change. See Kuzma v. Principi, 341 F.3d 1327, 1328 (Fed. Cir. 2003). Under DC 7705, the old rating criteria for “primary, idiopathic or immune thrombocytopenia, which was effective prior to December 9, 2018, a 30 percent disability rating is assigned for a stable platelet count between 70,000 and 100,000, without bleeding. A 70 percent disability rating is assigned for a platelet count between 20,000 and 70,000, not requiring treatment, without bleeding. A 100 percent rating is assigned for a platelet count less than 20,000 with active bleeding, requiring treatment with medication and transfusions. 38 C.F.R. § 4.117 (2017). Under the revised, updated criteria for DC 7705, which has now been renamed as the rating criteria for “immune thrombocytopenia,” effective December 9, 2018, a 10 percent disability rating is assigned for a platelet count higher than 30,000 but not higher than 50,000, not requiring treatment. A 30 percent rating is assigned with a platelet count higher than 30,000 but not higher than 50,000, with either immune thrombocytopenia or mild mucous membrane bleeding which requires oral corticosteroid therapy or intravenous immune globulin. A 70 percent rating is assigned when the thrombocytopenia requires immunosuppressive therapy; or for a platelet count higher than 30,000 but not higher than 50,000, with history of hospitalization because of severe bleeding requiring intravenous immune globulin, high-dose parenteral corticosteroids, and platelet transfusions. A maximum, 100 percent rating is assigned if chronic refractory thrombocytopenia requires chemotherapy; or with a platelet count 30,000 or below despite treatment. 38 C.F.R. § 4.117 (Revised December 9, 2018). At his April 2017 videoconference hearing, the Veteran testified that ever since his diagnosis of leukemia, his platelet count has always been below the statistical average of 15,000 to 400,000, and that at the time of this videoconference hearing, his platelet count was at 77,000. The Veteran further explained that since January 2014 until the time of this hearing (in April 2017), from looking at approximately seven blood labs, his platelet count had been running from about 100,000, all the way down to 67,000. A. Period Prior to August 28, 2014 As noted above, the Veteran has been assigned a zero, non-compensable rating for his service-connected hairy cell leukemia with thrombocytopenia, for the period prior to August 28, 2014. For this period of the appeal, medical treatment records reflect a decrease in the Veteran’s platelet count. Specifically, for example, an April 2017 private treatment note documents the Veteran’s blood results, which indicated that in January 2014, the Veteran’s platelet count was 91,000, and in February 2014, his platelet count was at 105,000. A January 2014 progress note indicates that the Veteran denied having any bleeding, bruising, frequent infections fever, chills or night sweats at his follow up visit. This progress note, however, that the Veteran was started on the prescription, Pravastatin, in October 2013, the Veteran noted that he had a slight decrease in his platelets, and that he stopped the Pravastatin at the beginning of January 2014. Additionally, this progress note documents the Veteran’s blood results, noting that the Veteran’s platelet count was at 112,000 in December 2012; in January 2013, at 106,000; in February 2013, at 110,000; and thereafter, decreasing to 99,000 in November 2013; further decreasing to 93,000 in December 2013; and further decreasing to 91,000 in January 2014. The Veteran’s claims file also entails disability benefits questionnaires (DBQs) and/or VA examinations on the severity of the Veteran’s hairy cell leukemia with immune thrombocytopenia. Specifically, a June 2013 VA examination report notes that the Veteran’s hairy cell leukemia, which was diagnosed in 2002, was in remission, and that the Veteran has completed treatment for his leukemia. The VA examination also notes that the Veteran did not have any complications of residuals of his treatment. However, this VA examination does not provide any information about the Veteran’s platelet count. A July 2014 DBQ also notes that the Veteran had completed treatment for his leukemia, and that there were no complications or residuals requiring transfusion of platelets or red cells; no complications or residuals causing recurring infections; and no complications or residuals related to anemia. However, this DBQ is also inadequate, as it does not provide any information about the Veteran’s platelet count. After a review of all probative evidence, the Board finds that the Veteran manifested a stable platelet count between 70,000 and 100,000, with no evidence of bleeding, for the period prior to August 28, 2014. Although the Veteran’s platelet count was at 105,000 in February 2014, this was the only time the Veteran’s platelet count exceeded 100,000, as it dropped again, to 90,000, for the next blood test in August 2014. Immediately prior to this February 2014 blood test, the Veteran’s blood result, from a January 2014 blood test, reflected a platelet count of 90,000. Prior to that, the Veteran’s platelet count had been decreasing to a count below 100,000, and specifically, his platelet count, as noted above, was 99,000 in November 2013; 93,000 in December 2013; and 91,000 in January 2014. While the Veteran would not be entitled to an increased, compensable rating under the new criteria for DC 7705, an increased, compensable rating of at least 30 percent, under the old criteria for DC 7705, is warranted. On assessment, medical treatment records do not show that the Veteran’s platelet count was anywhere between 20,000 and 70,000, with no treatment required for the period prior to August 28, 2014, and thus, a 70 percent rating is not warranted. Therefore, a rating of 30 percent, but no higher, is warranted for the service-connected hairy cell leukemia with immune thrombocytopenia, for the period prior to August 28, 2014. B. Period Beginning August 28, 2014 As noted above, the Veteran has been assigned a 30 percent disability for his service-connected hairy cell leukemia with thrombocytopenia, for the period beginning August 28, 2014. During this period of the appeal, medical treatment records continued to reflect the Veteran’s platelet level at “chronically low counts.” See e.g. September 2014 Progress Notes; see also May 2017 Progress Notes. The Veteran consistently denied having any new bleeding symptoms, but he reported having worsening fatigue, associated with the general decline of platelet counts. See May 2017 Progress Notes; see also November 2017 Progress Notes. Pertinently, for this period of the appeal, the Veteran’s platelet count consistently remained below 100,000, with the lowest platelet count reported at 47,000. See e.g. November 2017 Progress Notes; see also January 2018 Progress Notes; see too, May 2018 Progress Notes; see too, November 2018 Progress Notes; see too, April 2019 Progress Notes; see too, May 2019 Progress Notes; see too, June 2019 Progress Notes. In July 2019, the Veteran was afforded a VA examination for hematologic and lymphatic conditions, including leukemia. The VA examination report notes that the Veteran’s current symptoms, include chronic low platelet count (60,000) and bruising. However, bleeding was not specifically noted. The VA examination report also notes that the Veteran’s hematologic or lymphatic condition is in “remission.” In pertinent part, the VA examination report also notes that the Veteran underwent a platelet transfusion in June 2019. However, the VA examination report notes that the Veteran does not have anemia or thrombocytopenia, including that caused by treatment for a hematologic or lymphatic condition. The VA examination report also indicates that the status of the Veteran’s leukemia is “asymptomatic, Rai Stage 0.” On diagnostic testing, the Veteran’s platelet count was 66,000. A September 2019 DBQ, which was completed by the VA examiner who conducted the July 2019 VA examination, notes that the Veteran’s condition is in remission. The VA examiner, however, noted that the Veteran currently has complications of residuals of treatment. She indicated that the Veteran has complications or residuals requiring transfusion of platelets or red cells at least once a year, but less than once every three months. However, the VA examiner noted that there are no complications or residuals causing recurring infections; and that there are no complications or residuals related to anemia. In a June 2020 addendum to the prior, September 2019 DBQ, the VA examiner clarified that the Veteran’s platelets are above 50,000, requiring platelet transfusions. (Continued on the next page)   After a review of all probative evidence, the Board finds that the Veteran manifested a stable platelet count that fell within the range of 20,000 and 70,000, for the period beginning August 28, 2014. The Veteran consistently denied having any bleeding symptoms, and further, there was no evidence of bleeding symptoms, during this period of the appeal. According to the most recent, July 2019 VA examination, his hematologic/lymphatic condition is in remission; he does not have anemia or thrombocytopenia, including that caused by treatment for a hematologic or lymphatic condition; and the status of his leukemia is “asymptomatic, Rai Stage 0.” Although he would not be entitled to an increased, 70 percent disability rating, under the new criteria for DC 7705, the Board finds that the severity of the Veteran’s hairy cell leukemia with thrombocytopenia more closely approximates a 70 percent disability rating, under the old criteria for DC 7705. On assessment, medical treatment records do not show that the Veteran’s platelet count was less than 20,000, with active bleeding, requiring treatment with medication and transfusions. Therefore, the maximum, 100 percent rating is not warranted for this period of the appeal. The Board has considered whether separate, additional ratings are warranted for the Veteran’s service-connected hairy cell leukemia with immune thrombocytopenia. However, no other issues, pertaining to the Veteran’s increased rating claim for hairy cell leukemia with immune thrombocytopenia, have been raised by the Veteran or the record, to warrant separate, additional ratings. Therefore, based on the foregoing reasons and bases, a rating of 70 percent, but no higher, is warranted for the service-connected hairy cell leukemia with immune thrombocytopenia, for the period beginning August 28, 2014. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board V-N. Pratt 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.