Citation Nr: 21075361 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 17-40 400 DATE: December 20, 2021 ORDER Entitlement to service connection for coronary artery disease is granted. Entitlement to service connection for hypertension is granted. Entitlement to service connection for a left foot condition, to include hallux valgus, is denied. Entitlement to service connection for a left ankle condition is denied. Entitlement to service connection for residuals of a cerebrovascular accident, or stroke, is denied. Entitlement to service connection for a cervical spine condition is denied. Entitlement to service connection for varicella zoster, claimed as shingles, is denied. Entitlement to service connection for right and left eye disabilities is denied. Entitlement to an initial compensable rating prior to May 14, 2019 for right lung base calcified granuloma is denied. Entitlement to a rating in excess of 10 percent beginning May 14, 2019 for right lung base calcified granuloma is denied. FINDINGS OF FACT 1. The evidence is at least is relative equipoise as to whether the Veteran's coronary artery disease was caused or aggravated by his service-connected acquired psychiatric disorder. 2. The evidence is at least is relative equipoise as to whether the Veteran's hypertension was caused or aggravated by his service-connected acquired psychiatric disorder. 3. The evidence does not establish that the Veteran's left foot disability is related to his active military service. 4. The evidence does not establish that the Veteran has a left ankle condition related to his active military service. 5. The evidence does not relate the Veteran's cerebrovascular event or stroke to his active military service or proximately to a service-connected condition. 6. The evidence does not relate the Veteran's currently diagnosed cervical spine condition to his active military service or proximately to a service-connected condition. 7. The evidence does not relate the Veteran's varicella zoster to his active military service or proximately to a service-connected condition. 8. The evidence does not relate the Veteran's right and left eye disabilities to his active military service or proximately to a service-connected condition. 9. Prior to May 14, 2019, the Veteran's lung capacity was within normal limits. 10. From May 14, 2019, the Veteran's lung capacity was, at worst, 76% FVC predicted post-bronchodilator. CONCLUSIONS OF LAW 1. The criteria for service connection for coronary artery disease, as secondary to the service-connected acquired psychiatric disorder, have been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for service connection for hypertension, as secondary to the service-connected acquired psychiatric disorder, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria for service connection for a left foot condition, to include hallux valgus, are not met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for a left ankle condition have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.307, 3.309, 3.310. 5. The criteria for service connection for residuals of a cerebrovascular event, claimed as stroke, have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.307, 3.309, 3.310. 6. The criteria for service connection for residuals of a cervical spine condition have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.307, 3.309. 7. The criteria for service connection for residuals of a varicella zoster, claimed as shingles, have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.307, 3.309, 3.310. 8. The criteria for service connection for residuals of right and left eye disabilities have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.307, 3.309, 3.310. 9. The criteria for an initial compensable rating for right lung base calcified granuloma prior to May 14, 2019 are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3-4.7, 4.20, 4.27. 4.31, 4.97, Diagnostic Code 6828. 10. The criteria for a rating in excess of 10 percent for right lung base calcified granuloma beginning May 14, 2019, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3-4.7, 4.20, 4.27. 4.31, 4.97, Diagnostic Code 6828. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 1978 to June 1982, and from September 1982 to November 1985. In June 2020, the Board of Veterans' Appeals remanded the issues of service connection for a left foot condition and a left ankle condition. It also recharacterized the Veteran's claimed conditions of posttraumatic stress disorder (PTSD), depression, and anxiety as a single claim for service connection for an acquired psychiatric disorder, and granted service connection. This decision was effectuated in the August 2020 rating decision. Accordingly, the claim for service connection for an acquired psychiatric disorder, to include PTSD, has been granted in full, and the claim is no longer on appeal. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected condition. 38 C.F.R. § 3.310. The Board acknowledges that the Veteran has not been afforded a VA medical examination specifically addressing whether each condition had its onset during service or is otherwise etiologically related to service. VA must provide a VA medical examination when there is: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See McClendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The Board also considered the medical articles submitted by the Veteran. In certain instances, medical treatise evidence can constitute competent medical evidence, but generally, an attempt to establish a medical nexus to a disease or injury solely by generic information in a medical journal or treatise is too general and inconclusive. See Wallin v. West, 11 Vet. App. 509, 514 (1998); Mattern v. West, 12 Vet. App. 222, 229 (1999). Here, the general medical articles do not contain any information or analysis specific to the Veteran. Therefore, they are of limited probative value and less persuasive than the medical opinions which are specific to this Veteran's circumstances and supported with rationale. While the Board cannot ignore or disregard a VA examiner's medical conclusions, the Board is free to assess medical evidence and is not compelled to accept a medical opinion. Compare Willis v. Derwinski, 1 Vet. App. 66 (1991), with Wilson v. Derwinski, 2 Vet. App. 614 (1992). 1. Entitlement to service connection for coronary artery disease is granted. 2. Entitlement to service connection for hypertension is granted. The Veteran contends that he has coronary artery disease and hypertension related to active service, to include as secondary to service-connected disabilities. The Board find the preponderance of the evidence is in favor of service connection of coronary artery disease and hypertension. On VA examination in August 2020, the Veteran's heart related diagnoses were acute, subacute, or old myocardial infarction, coronary artery disease, stable angina, valvular heart disease, and hypertensive heart disease. In a June 2019 private medical opinion, Dr. H.S. opined that based on a review of the Veteran's claims file, supporting medical research, and a consultation with the Veteran in June 2019, it is at least as likely as not that the Veteran's service-connected anxiety disorder aided in the development of and permanently aggravates his hypertension and coronary artery disease. It is also as likely as not that his hypertension aided in the development of his coronary artery disease and transient ischemic attack and continues to aggravate his residual symptoms. The Veteran was diagnosed with hypertension in 2011. In an August 2020 medical opinion, the examiner addressed secondary service connection for hypertension by explaining that anxiety may cause temporary elevations in blood pressure but is not medically known to directly result in a chronic hypertensive condition requiring medications. It would be mere speculation to endorse his hypertension as being due to anxiety. Instead, the VA examiner indicated that the Veteran's diabetes and obesity, are risk factors that "can clearly contribute to the development of hypertension." The examiner pointed out that the Veteran's medical records do not support a claim for hypertension proximately due to or the result of his unspecified anxiety disorder, ultimately concluding that the Veteran's hypertension was less likely than not proximately due to or the result of his unspecified anxiety disorder. The Board finds the June 2019 opinion that the Veteran's service-connected anxiety disorder contributed to or aggravated his heart conditions to be probative. The opinion was supported by rationale based on review of the medical record, assessment of the Veteran, and additional research. The Board is also cognizant of the negative VA medical opinion, which was also supported by rationale. In light of these opinions, the Board finds that the evidence is at least in relative equipoise concerning the Veteran's heart conditions. When the evidence is in relative equipoise, the benefit-of-the-doubt doctrine provides that such reasonable doubt will be resolved in favor of the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Accordingly, service connection of coronary artery disease and hypertension is warranted. 3. Entitlement to service connection for bilateral hallux valgus is denied. 4. Entitlement to service connection for a left ankle condition is denied. The Veteran contends that he has a left foot disability and a left ankle condition which are both related to his active military service. Service treatment records indicate the Veteran was treated for a left foot injury in March 1985. He reported that he underwent arthroscopic surgery in May 1986. On VA examination in August 2015, the Veteran's foot conditions were diagnosed as bilateral hallux valgus and a status post left ankle injury with residual pain. The examiner opined that the Veteran's claimed foot condition was as likely as not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that service medical records indicate the Veteran complained of left foot pain with tenderness upon palpation, and that based on that history, his bilateral hallux valgus is as likely as not incurred in or caused by in-service injury, event, or illness. On VA examination in September 2020, the examiner found no true left foot condition had been identified. There is no indication of a chronic foot injury arising during service. Left foot pain was noted in March 1985 with no specific injury indicated, but the Veteran was noted to be doing well shortly after. It appears that the August 2015 examination attributed current foot pain to a more recent injury. There is no evidence of care post-service, and the assessment suggests a recent injury. As such, the examiner opined that it is less likely than not that any current left foot pain or condition arose during service or is due to the in-service treatment. On VA examination in October 2020, the Veteran reported that during active service, he injured his ankle on a flight deck when a tow bar rolled over his ankle and foot. He stated that his ankle was fractured shortly before discharge from service, but he continued to have trouble with his left ankle, requiring additional arthroscopic surgery in 1986. He claimed he continued to experience pain, which is worse when he stands for long periods and he must wear high top boots for support. He reported additional difficulty with his left ankle on uneven surfaces, using stairs, or carrying a load. The examiner measured left ankle range of motion, noting pain that did not result in functional loss. Radiology testing revealed no evidence of fracture or other significant bone or soft tissue abnormality in the left ankle. In the October 2020 opinion, the examiner stated that while there is mentioned of status post left ankle injury in the August 2015 examination, and the Veteran reported arthroscopy surgery in May 1986; that information is by Veteran report only. There was no mention of an ankle condition on separation examination, and an August 2015 radiology report indicated the left ankle was normal. There is no indication of a chronic injury arising in service. Left foot pain was evaluated in March 1985, with no specific injury. The Veteran was noted to be doing well four days later. Left lateral foot pain during service appears to have been acute, and resolved prior to separation. There is no evidence of care post-service, and the August 2015 examination suggested a recent injury. Therefore, it is less likely than not that any current left foot or ankle condition, including pain, arose in-service or is otherwise related to active service. However, the Board finds the September and October 2020 opinions with respect to the Veteran's left foot disability greatly outweigh the August 2015 VA examiner's opinion in terms of thoroughness and reasoning. Indeed, the August 2015 VA opinion simply notes that the Veteran had an inservice foot injury, whereas the later opinions consider that the Veteran also had a more recent post-service injury. The Court of Appeals has repeatedly found that the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Here, the September 2020 and October 2020 examiners' negative opinions were supported by a sufficiently clear and well-reasoned medical rationale and was consistent with the verifiable facts regarding the Veteran's contentions. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005). Accordingly, service connection for a left foot disability is not warranted. As a threshold matter, the Veteran must have a current disability in order to claim service connection. Here, there is no objective medical evidence of diagnosed ankle disability during the appeal period. While the Veteran reported ankle pain, there was no evidence of a functional loss or interference with earning capacity. See, c.f., Saunders v. Wilkie, 886 F.3d 1356, 1363 (Fed. Cir. 2018) ("disability" exists under 38 U.S.C. § 1110 where there is functional impairment). Additionally, the other examinations did not find a disability of the left ankle that could be linked to active service, or a service-connected condition. The Board recognizes that the Veteran reported surgery shortly after military service, but again, the evidence does not establish the existence of a current diagnosis during the appeal period. While the Board is sympathetic to the Veteran's contention, without a specific condition claimed, there is no basis for service connection for residuals of a left ankle condition. In reaching this conclusion, the Board has considered the Veteran's contentions, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue of a left ankle injury in this case, it falls outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although the Veteran is competent to report his current symptoms, this is not the type of condition that is amenable to mere lay diagnosis or probative comment regarding its etiology, as the evidence shows that specific findings are needed to properly assess and diagnose an ankle disability and determine its etiology. Jandreau; Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). In sum, the evidentiary requirement of demonstrating a current disability has not condition was caused by service or a service-connected condition, nor has a left ankle condition or residuals of a left ankle injury been diagnosed at any time during the appeal period. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). There is no doubt of material fact to be resolved in the Veteran's favor, and the claim for service connection for residuals of a left ankle condition must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 5. Entitlement to service connection for residuals of a cerebrovascular accident (CVA) is denied. The Veteran contends that he experiences residuals of a CVA that occurred as a result of service or a service-connected disability. Service connection for a right and left eye disability, to include as due to a CVA, is adjudicated elsewhere in this decision. That notwithstanding, the Board finds the evidence does not establish a nexus between any other specific CVA residuals and the Veteran's military service, or between the CVA residuals and a service-connected disability. The Veteran asserts he experienced a stroke in 2010 as a result of his psychiatric disorder. While the Veteran filed a claim for residuals of a stroke, available medical records indicate that he experienced a stroke in 2010, but there have been no specific residuals claimed as occurring during the appeal period, and there is no medical evidence linking the Veteran's 2010 stroke, or residuals thereof, to active duty or a service-connected condition, including an acquired psychiatric disorder. As a threshold matter, the Veteran must have a current disability in order to claim service connection. Here, there is no objective medical evidence of diagnosed CVA residuals during the appeal period. While the Board is sympathetic to the Veteran's contention, without a specific condition claimed, there is no basis for service connection for residuals of a CVA. In reaching this conclusion, the Board has considered the Veteran's contentions, although lay persons are competent to provide opinions on some medical issues, see Kahana, 24 Vet. App. at 435, as to the specific issue of residuals of a CVA in this case, it falls outside the realm of common knowledge of a lay person. Jandreau, 492 F.3d at 1372. Although the Veteran is competent to report his current symptoms, this is not the type of condition that is amenable to mere lay diagnosis or probative comment regarding its etiology, as the evidence shows that specific findings are needed to properly assess and diagnose a CVA and determine its etiology. Jandreau; Davidson; Woehlaert. The Board also considered the medical articles submitted by the Veteran. In certain instances, medical treatise evidence can constitute competent medical evidence, but generally, an attempt to establish a medical nexus to a disease or injury solely by generic information in a medical journal or treatise is too general and inconclusive. See Wallin v. West, 11 Vet. App. 509, 514 (1998); Mattern v. West, 12 Vet. App. 222, 229 (1999). Here, the general medical articles do not contain any information or analysis specific to the Veteran. Therefore, they are of limited probative value and less persuasive than the medical opinions which are specific to this Veteran's circumstances and supported with rationale. In sum, the evidentiary requirement of demonstrating a current disability has not been satisfied. The competent, probative evidence of record simply does not establish that a CVA was caused by service or a service-connected condition, nor has a CVA or specific residuals actually been diagnosed at any time during the appeal period. McClain, 21 Vet. App. 319, 321 (2007). Without a diagnosis, the claim for service connection fails. Brammer v. Derwinski, 3 Vet. App. 223 (1992). There is no doubt of material fact to be resolved in the Veteran's favor, and the claim for service connection for residuals of a CVA must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 6. Entitlement to service connection for a cervical spine condition is denied. The Veteran contends he has a cervical spine condition related to active service. The Board finds the preponderance of the evidence is against a claim for service connection of a cervical spine condition. Service medical records show the Veteran complained of a stiff neck in August 1985. No further treatment for a neck injury or a diagnosed neck condition are noted in the remaining service treatment records, to include at service separation in November 1985. Post service, private treatment records document the Veteran's diagnosed moderate cervical disc degeneration and neck pain, that he claims has been worsening. He reported having a history of neck surgery. There is no medical evidence linking or suggesting a link between the Veteran's in-service complaint of neck pain and his current neck condition, nor has there been evidence of continuity of symptoms from separation of service. As such, there is no basis upon which to grant service connection, and the claim is denied. In this case, because there is no evidence suggesting that the Veteran's current cervical spine condition stems from a stiff neck in 1985, or any other injuries, diseases, or events in service that could serve as a basis for service connection for a cervical spine condition, there is no duty to provide a VA medical examination. Absent evidence at least suggestive of an in-service event, injury, or disease to which a competent medical opinion could relate the claimed disability, there is no reasonable possibility that a VA examination or opinion could aid in substantiating the claim for service connection for a cervical spine condition without being speculative. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that a medical opinion based on an inaccurate factual premise is not probative). As the Veteran has made no other assertions or submitted any evidence contending onset of symptoms or actual diagnosis of a cervical spine condition in service, the Board finds that VA's duty to assist the Veteran in obtaining additional evidence to support a nexus has not been triggered. See 38 U.S.C. § 5103A(a)(2); 38 C.F.R. § 3.159(d); and Bardwell v. Shinseki, 24 Vet. App. 36, 40 (2010). For these reasons, the Board finds that a remand for a VA medical opinion is not warranted. In light of the foregoing, the Board finds that all relevant facts have been properly and sufficiently developed in this appeal, and no further development is required to comply with the duty to assist in developing the facts pertinent to the appeal. As such, there is no basis upon which to grant service connection, and the claim is denied. Consequently, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102 7. Entitlement to service connection for residuals of varicella zoster, claimed as shingles, is denied. The Veteran contends that his varicella zoster (claimed as shingles) is etiologically related to his active military service. The Board finds there is insufficient evidence to show the Veteran had varicella zoster as the result of his active military service, or as a proximate result of a service-related condition. The Veteran's service medical records are silent for treatment or diagnosis of a condition such as varicella zoster or shingles. After service separation, the Veteran's VA treatment records indicate that he reported experiencing shingles. After thorough review of the evidence of record, the competent evidence does not establish a nexus between the Veteran's reported shingles and his military service, or a service-connected disability. The record does not contain a nexus opinion provided by a credentialed, qualified medical provider, and the Veteran also has not provided any lay evidence that shingles began during service or was otherwise related to service or a service-connected disability, aside from filing a claim for service connection. To the extent that his claim alone constitutes a lay allegation of service connection either on a direct or secondary basis, shingles (and its residuals) is not the type of condition that is amenable to mere lay diagnosis or probative comment regarding its etiology, as the evidence shows that specific findings are needed to properly assess and diagnose an ankle disability and determine its etiology. Jandreau; Davidson; Woehlaert. There is no further doubt of material fact to be resolved in the Veteran's favor. As such, there is no basis upon which to grant service connection, and the claim is denied. Consequently, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 8. Entitlement to a right eye condition (claimed as retinal detachment status post-surgical correction) and a left eye condition is denied. The Veteran contends that service connection is warranted for right and left eye disabilities. Specifically, as he has separately asserted that his CVA is related to military service or to a service-connected disability, he similarly asserts that the 2010 stroke residuals of right eye retinal detachment and left eye condition are service connected on a secondary or proximate basis. After thorough review of the record, the Board finds the preponderance of the evidence is against service connection for a left and right eye condition. Service medical records are silent for complaints, treatment, or diagnosis of an eye disability, to include at the November 1985 service separation examination. Many years after service separation, a December 2010 operative report following the Veteran's 2010 stroke shows the Veteran was diagnosed with a retinal detachment, macula of the right eye. VA treatment records from January 2016 indicates that the Veteran's diagnosed right eye condition was a result of his 2010 stroke, and indicated that the Veteran's left eye conditions were related to diabetes mellitus. Service connection is not in effect for diabetes mellitus; service connection for residuals of a stroke is denied elsewhere in this decision. The Board acknowledges the assertions of the Veteran and his sincere belief that his right eye retinal detachment, and left eye residuals are attributable to service. In this regard, the Veteran is competent to relate matters that are observable through the five senses. See Layno v. Brown, 6 Vet. App. 465 (1994). However, a determination as to the appropriate diagnosis of his eye conditions, and the etiology thereof, is a complex medical determination which goes beyond lay observation of symptoms. Jandreau, 492 F.3d at 1377. There is no medical evidence linking or suggesting a link between the Veteran's active service and his claimed eye conditions. There is no further doubt of material fact to be resolved in the Veteran's favor. As such, there is no basis upon which to grant service connection, and the claim is denied. Consequently, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Increased Ratings Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Separate Diagnostic Codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Although a disability must be considered in the context of the whole recorded history, including service treatment records, the present level of disability is of primary concern in determining the current rating to be assigned. 38 C.F.R. § 4.2; Francisco v. Brown, 7 Vet. App. 55 (1994); Schafrath v. Derwinski, 1 Vet. App. 589 (1991). If a disability has undergone varying and distinct levels of severity throughout the claims period, staged ratings may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999); 38 C.F.R. § 4.2. A critical element in permitting the assignment of several ratings under various Diagnostic Codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994); 38 C.F.R. § 4.14. 9. Entitlement to an initial compensable rating prior to May 14, 2019 for right lung base calcified granuloma is denied. 10. Entitlement to a rating in excess of 10 percent beginning May 14, 2019 for right lung base calcified granuloma is denied. The Veteran contends his service connection right lung disability warrants an initial compensable rating prior to May 14, 2019, and greater than a 10 percent rating effective that date. The Veteran's right lung disability is rated under Diagnostic Code 6828, which directs that the condition be rated according to 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). On VA examination in August 2015, the Veteran's breathing was normal, as were findings on chest X-ray. On VA examination in May 2019, the examiner noted that the Veteran had dyspnea on exertion and coughing and choking due to right lung base calcified granuloma. A PFT test was conducted with the following results: Pre-bronchodilator: FVC 44% predicted, FEV-1 58% predicted, and FEV-1/FVC 99%; Post-bronchodilator: FVC 76% predicted, FEV-1 73% predicted; FEV-1/FVC 75%. The examiner noted that FVC% predicted most accurately reflected the Veteran's level of disability. The examiner remarked that the Veteran is limited physical activity due to shortness of breath. Here, prior to the May 2019 examination, the pulmonary function testing of record does not establish that there is either FVC or DLCO that meet the criteria for a compensable rating; indeed, clinical findings were normal. As such, there is no basis for a compensable rating prior to May 14, 2019. At the May 2019 examination, the examiner determined that the FVC% predicted was the most accurate indication of the Veteran's disability. The FVC% predicted was 44% pre-bronchodilator, and 76% post-bronchodilator. Regulations require the use of the post-bronchodilator because the examiner did not specify otherwise. A measure of 76% FVC predicted rating is associated with a 10 percent rating. A higher rating of 30 percent is not warranted unless the FVC measure is 74% or lower. 38 C.F.R. § 4.97. Because the May 2019 VA examination pulmonary function testing is the only competent, probative evidence for the second stage of the appeal period, greater than a 10 percent rating for right lung disability beginning May 14, 2019, is not warranted. In light of the evidence of record, the Veteran's claim for an increased rating at any part of the appeal period is denied. J. Kirby Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.E. Lee 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.