Citation Nr: 21013126 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 13-28 186A DATE: March 8, 2021 ORDER Entitlement to an evaluation in excess of 10 percent for tonsillitis is denied. FINDING OF FACT The evidence supports a finding that the Veteran’s recurrent tonsillitis is manifested by intermittent hoarseness with no findings of inflammation of the cords or mucous membrane. CONCLUSION OF LAW The criteria for an evaluation in excess of 10 percent for tonsillitis are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1, Diagnostic Code 6599-6516. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had a period of active service from February 1980 to June 1981. The Veteran died in July 2020. The appellant is her surviving spouse who has been substituted as the claimant for completion of the appeal. In February 2019, the Board most recently remanded these issues for additional development. The Board finds that there was substantial compliance with the remand directives for the issue on appeal as discussed below. See Stegall v. West, 11 Vet. App. 268, 271 (1998). During the period on appeal, the Board was notified of the Veteran’s death on July 4, 2020. Increased Rating Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. A Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). The Veteran’s tonsillitis disorder has been rated under 38 C.F.R § 4.97, Diagnostic Code 6516. A 10 percent rating is assigned for hoarseness with inflammation of cords or mucous membrane. A 30 percent evaluation is assigned for hoarseness, with thickening or nodules of chords, polyps, submucous, infiltration, or pre-malignant changes on biopsy. Entitlement to an evaluation in excess of 10 percent for tonsillitis In a May 2013 VA throat, larynx, and pharynx examination, the examiner diagnosed the Veteran with recurrent tonsillitis. The examiner diagnosed the Veteran as negative for benign or malignant neoplasms. In an October 2017 VA throat, larynx, and pharynx examination, the examiner diagnosed the Veteran with recurrent tonsillitis and a history of polyps. During the examination, the examiner noted that the Veteran does not currently have an onset of chronic laryngitis. The examiner also diagnosed the Veteran with intermittent hoarseness, but did not diagnose inflammation of the vocal or mucous membranes, and vocal cord polyps was diagnosed as negative. In a November 2019 VA throat, larynx, and pharynx examination, the examiner diagnosed the Veteran with recurrent tonsillitis. The examiner did not diagnose the Veteran with any hoarseness, inflammation of her vocal cords or mucous membranes. The examiner also did not diagnose any findings of thickening or nodules of cords, polyps, submucous infiltration, or pre-malignant changes of her tonsils. In a November 2020 VA addendum opinion to the November 2019 VA examination, the examiner was asked to identify all symptoms of the Veteran’s current tonsillitis. The examiner noted that the Veteran’s recurrent tonsillitis displayed no evidence of the following: inflammation of the cords or mucous membrane; thickening of vocal cords; nodules of vocal cords; submucous infiltration of vocal cords; or vocal cord polyps. The examiner also noted that the 2017 examiner reported a history of chronic tonsillitis with polyps and intermittent exudate; however, the 2017 examiners impression was based off a prior examination and not on the objective findings of the 2017 examiner which did not show any of the historical pathology. The Board also reviewed the Veteran’s lay statements reporting that the severity of her tonsillitis disorder warrants a compensable rating. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran was competent to provide statements of symptoms which were observable to her senses. However, the Board must emphasize that the Veteran was not competent to interpret accurately clinical findings pertaining to the severity of a tonsillitis disorder as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1) (2020). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Review of the record does not provide a basis for granting a rating in excess of 10 percent for tonsillitis. The objective findings do not reveal any evidence of tonsillitis with the symptomology of thickening or nodules of chords, polyps, submucous, infiltration, or pre-malignant changes on biopsy. The November 2020 examiner opined that it is less likely than not that the Veteran had hoarseness; inflammation of vocal cords or mucous membrane; thickening of vocal cords; nodules of vocal cords; submucous infiltration of vocal cords; or vocal cord polyps due to tonsillitis during the 2017 VA examination due to lack of objective diagnosed evidence by the examiner. The Board has determined that the severity, frequency, and duration of the Veteran’s tonsillitis is manifested by intermittent hoarseness with no findings of inflammation of the cords or mucous membrane. Thus, the severity of the Veteran’s tonsillitis disorder more so approximates the maintaining of a 10 percent rating.   The Board reviewed the Veteran’s records and determined that they do not support an increased disability rating in excess of 10 percent for this disorder. The evidence for this period preponderates against an increase so reasonable doubt provisions are inapplicable. 38 C.F.R. § 3.102. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Harris, Michael E. 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.