Citation Nr: 21069472 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 19-23 635 DATE: November 18, 2021 ORDER Entitlement to an initial rating in excess of 10 percent prior to October 6, 2020, and in excess of 30 percent thereafter, for pulmonary fibrosis, residual left lung base interstitial changes with scaring, is denied. FINDINGS OF FACT 1. Prior to October 6, 2020, the Veteran's pulmonary fibrosis, residual left lung base interstitial changes with scaring, was at worst productive of DLCO of 75 percent. 2. From October 6, 2020, the Veteran's pulmonary fibrosis, residual left lung base interstitial changes with scaring, was productive of FEV-1/FVC of 68 percent. CONCLUSION OF LAW The criteria for an initial rating in excess of 10 percent prior to October 6, 2020, and in excess of 30 percent thereafter, for pulmonary fibrosis, residual left lung base interstitial changes with scaring, have not been met. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.96, 4.97, Diagnostic Codes 6825, 6845 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active naval service from February 1964 to February 1966. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. This case was previously before the Board in February 2021, at which time the issue on appeal was remanded for additional development. The matter has since been returned to the Board for further appellate action. The Veteran has asserted that his pulmonary fibrosis, residual left lung base interstitial changes with scaring ("respiratory disability") is worse than that contemplated by the currently assigned ratings. In July 2012, the Veteran was afforded a VA examination. The examiner indicated that the Veteran had restrictive lung disease diagnosed as fibrosis. A chest X-ray also revealed chronic obstructive pulmonary disease (COPD). Pre-bronchodilator pulmonary function test (PFT) results were 62 percent predicted FVC, 60 percent predicted FEV-1, and 73 percent predicted FEV-1/FVC. Post-bronchodilator PFT results were 67 percent predicted FVC, 63 percent predicted FEV-1, 71 percent predicted FEV-1/FVC, and 75 percent predicted DLCO. The examiner indicated that DLCO was the most accurate test result to measure the severity of the Veteran's service-connected pulmonary fibrosis. The examiner noted that the Veteran was massively obese which was an etiologic factor for his restrictive changes. The examiner added that the abnormal DLCO showed that the Veteran's dyspnea was associated with his massive obesity, and not intrinsic lung disease. The Veteran had a VA examination in November 2018. He complained of dyspnea on exertion with walking. From the July 2012 chest X-ray, the examiner observed that the Veteran had residual, left lung base interstitial changes (scarring). Additionally, the examiner opined that the Veteran's COPD was unlikely secondary to his active service. Instead, the examiner stated that the Veteran's morbid obesity impaired his respiratory function. Pre-bronchodilator PFT results were 71.4 percent predicted FVC, 65.4 percent predicted FEV-1, and 72 percent predicted FEV-1/FVC. Post-bronchodilator PFT results were 73.3 percent predicted FVC, 68.4 percent predicted FEV-1, 73 percent predicted FEV-1/FVC, and 107.4 percent predicted DLCO. The examiner indicated that DLCO was the most accurate test result to measure the severity of the Veteran's service-connected pulmonary fibrosis. In April 2021, the Veteran was provided an additional VA examination, and an addendum VA medical opinion was obtained in August 2021. Chest X-rays showed parenchymal scarring which was predominantly responsible for the limitation in the Veteran's pulmonary function. The Veteran reported worsening dyspnea with exertion and walking short distances. He could not perform activities of daily living and remain physically active. He required daily inhalational bronchodilator therapy, oral bronchodilators, and antibiotics. PFT testing was conducted in October 2020. Pre-bronchodilator PFT results were 70 percent predicted FVC, 58 percent predicted FEV-1, and 65 percent predicted FEV-1/FVC. Post-bronchodilator PFT results were 63 percent predicted FVC, 72 percent predicted FEV-1, 68 percent predicted FEV-1/FVC, and 88 percent predicted DLCO. The examiner indicated that FEV-1/FVC was the most accurate test result to measure the severity of the Veteran's service-connected pulmonary fibrosis. Based on the foregoing evidence, a rating in excess of those currently assigned for the Veteran's service-connected pulmonary fibrosis is not warranted at any point during the period on appeal. Prior to October 6, 2020, the Veteran's DLCO was, at worst, 75 percent predicted, which falls within the criteria for a 10 percent rating. From October 6, 2020, the Veteran had a post-bronchodilator FEV-1/FVC of 68 percent predicted, which falls within the criteria for a 30 percent rating. At no time during the appeal period was there any indication from the record that the Veteran had FEV-1 of 40 to 55 percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; DLCO (SB) of 40 to 55 percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit). Accordingly, the Board finds that an initial rating in excess of 10 percent prior to October 6, 2020, and in excess of 30 percent thereafter, for the Veteran's respiratory disability is not warranted. 38 C.F.R. § 4.97, Diagnostic Code 6845. The Board acknowledges the Veteran's representative's argument that the November 2018 PFT test results showed a 71.4 percent predicted FVC (pre-bronchodilator) and a 73.3 percent predicted FVC (post-bronchodilator), which warranted a higher rating. While FVC does provide the basis for a higher rating under Diagnostic Code 6825, the November 2018 VA examiner determined that DLCO most accurately reflected the Veteran's level of severity of impairment resulting from his service-connected disability at that time. 38 C.F.R. § 4.96(d)(6). Consideration has been given to assignment of a higher rating under another diagnostic code pertaining to the lungs. However, there is no indication from the record that the Veteran's respiratory disability causes any other functional impairment other than that contemplated by the currently assigned ratings. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to an initial rating in excess of 10 percent prior to October 6, 2020, and in excess of 30 percent thereafter is not warranted. 38 U.S.C. § 5107 (b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Ware, 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.