Citation Nr: 21067025 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 16-32 433 DATE: November 3, 2021 ORDER A rating higher than 60 percent for asthma is denied. FINDING OF FACT The Veteran's asthma does not manifest with FEV-1 less than 40 percent predicted, or; FEV-1/FVC less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications. CONCLUSION OF LAW The criteria for a rating higher than 60 percent for asthma have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.96, 4.97, Diagnostic Code 6602. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably on active duty in the United States Navy from September 2009 to September 2012. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2020, the Board remanded this matter for further development. Asthma Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. The Veteran contends that her asthma warrants a higher rating. For the following reasons, the Board disagrees and finds that a higher rating is not warranted. The Veteran's asthma is currently rated as 60 percent disabling under Diagnostic Code (DC) 6602. A 60 percent rating is warranted for a Forced Expiratory Volume in one second (FEV-1) of 40- to 55-percent predicted, or; FEV-1/FVC (Forced Vital Capacity) 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 maximum 100 percent rating is assigned for an FEV-1 less than 40-percent predicted, or; FEV-1/FVC less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications. Pulmonary Function Test (PFT) results are generally reported before and after the administration of bronchodilator therapy. PFT's are required for the application of evaluation criteria for diagnostic codes 6600, 6603, 6604, 6825-6833, and 6840-6845 with post-bronchodilator results required in determining disability ratings for these DCs, unless post-bronchodilator results are poorer than pre-bronchodilator results. 38 C.F.R. § 4.96(d). There are no regulations specifying whether PFT's are required and if performed whether pre- or post-bronchodilator results should be used when determining disability ratings under DC 6602. As a matter of convenience, this decision relates pre- and post-bronchodilator scores alike in summarizing PFT studies. In March 2014, the Veteran underwent a VA examination for her claim. The examiner indicated that the Veteran's asthma required intermittent courses or bursts of systemic corticosteroids with the Veteran undergoing four or more courses over the past twelve months. The Veteran also required daily inhalational bronchodilatory therapy, inhalational anti-inflammatory medication, and oral bronchodilators. The examiner found the Veteran to have no asthma attacks with respiratory failure in the past twelve months, but it was noted that the Veteran had been in the emergency department at least ten times in the past twelve months for her asthma. PFT studies revealed FEV-1 at worst 65 percent predicted and FEV-1/FVC was 80 percent at its worst. In June 2015, the Veteran underwent another VA examination. The Veteran reported she used an albuterol inhaler two to three times a week and a second inhaler twice a week. She experienced flares every time she goes on an airplane or travels to another climate. The Veteran also reported going to the emergency room twice in the last twelve months for asthma flares due to flying. The examiner noted that treatment notes showed that the Veteran received oral steroids once in the last twelve months. They also indicated that the Veteran's asthma required intermittent courses or bursts of systemic corticosteroids along with intermittent inhalational bronchodilator therapy and inhalational anti-inflammatory medication. The examiner found the Veteran to have no asthma attacks with respiratory failure in the past twelve months. PFT studies revealed FEV-1 at worst 80 percent predicted and FEV-1/FVC was 80 percent at its worse. After remand, the Veteran underwent a VA examination in July 2020. The examiner found the Veteran's asthma to not require the use of oral or parenteral corticosteroid medications. They also indicated that the Veteran's asthma required the use of daily inhalation bronchodilator therapy and anti-inflammatory medication and intermittent oral bronchodilators. The examiner found no asthma attacks with episodes of respiratory failure in the past twelve months, but the Veteran did have a physician visit for required care of exacerbations described as headache, cough, congestion, and two days of wheezing. PFT studies were not performed during this examination. The Veteran underwent another VA examination in September 2020. The examiner indicated that Veteran's asthma required intermittent courses or bursts of systemic corticosteroids with the Veteran undergoing four or more courses over the past twelve months. The Veteran also required daily inhalational bronchodilator therapy and inhalational anti-inflammatory medication. The examiner found no asthma attacks with episodes of respiratory failure in the past twelve months, but the Veteran did have eight emergency room visits in the past six months for exacerbations described as mild to moderate. PFT studies were not performed during this examination. Another VA examination was conducted in January 2021. The examiner indicated that Veteran's asthma required intermittent courses or bursts of systemic corticosteroids with the Veteran undergoing four or more courses over the past twelve months. The Veteran also required daily inhalational bronchodilator therapy and inhalational anti-inflammatory medication. The examiner found no asthma attacks with episodes of respiratory failure in the past twelve months, but the Veteran did have five physician visits in the past six months for exacerbations. PFT studies were not performed during this examination. VA treatment records have been associated with the claims file. They show that PFT studies were performed in October 2020. The studies revealed FEV-1 at worst 57 percent predicted and FEV-1/FVC was 72 percent at its worst. Treatment records also document many emergency department visits for asthma during the appeal period, but at none of them was it noted that the Veteran was experiencing respiratory failure. Furthermore, VA treatment records do not show that the Veteran was prescribed high dose corticosteroids or immuno-suppressive medications. The Board finds that the evidence does not support a higher rating. At no point have PFT studies shown FEV-1 less than 40 percent predicted or FEV-1/FVC less than 40 percent. Though the Veteran has reported to the emergency department multiple times for asthma throughout the appeal period, she has never been found to have respiratory failure and these exacerbations did not occur at a frequency of once a week. Furthermore, the Veteran has not been prescribed high dose corticosteroids or immuno-suppressive medications to be taken daily for her asthma. Therefore, the preponderance of the evidence is against awarding a higher rating and the claim is denied. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael Chandeck, 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.