Citation Nr: 21013615 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 17-47 062 DATE: March 10, 2021 ORDER Entitlement to a 20 percent disability for peripheral vascular disease of the right lower extremity is granted effective February 20, 2014, but no earlier; entitlement to a disability rating in excess of 20 percent from February 20, 2014, to October 1, 2014, is denied; entitlement to a disability rating in excess of 60 percent from October 1, 2014, to January 30, 2015, is denied; entitlement to a compensable disability rating from January 30, 2015, to January 28, 2016, is denied; entitlement to a 20 percent disability rating, but no higher, from January 28, 2016, to April 26, 2016, is granted; entitlement to a compensable disability rating from April 26, 2016, to October 17, 2017, is denied; entitlement to a disability rating in excess of 20 percent from October 17, 2017, to December 18, 2020, is denied; and entitlement to a disability rating in excess of 60 percent from December 18, 2020, is denied. Entitlement to a separate 20 percent disability rating, but no higher, for peripheral vascular disease of the left lower extremity from April 26, 2016, to December 18, 2020, is granted; entitlement to a disability rating in excess of 60 percent from December 18, 2020, is denied. Entitlement to a compensable disability rating for right common femoral artery endarterectomy, bilateral angioplasty of the common iliac arteries with kissing iliac stents scar associated with peripheral vascular diseases is denied. Entitlement to a disability rating for chronic obstructive pulmonary disease (COPD) in excess of 30 percent prior to December 15, 2016, is denied; entitlement to a 60 percent disability rating, but no higher, from December 15, 2016, to October 4, 2017, is granted; entitlement to a 100 percent disability rating from October 4, 201,7 is granted. FINDINGS OF FACT 1. The Veteran’s claim for increased rating for peripheral vascular disease (previously compensated as peripheral occlusive vascular disease) was received on December 22, 2014, and there is no evidence of a factually ascertainable increase in the severity of the condition prior to February 20, 2014. 2. From February 20, 2014, to October 1, 2014, the Veteran’s peripheral vascular disease was manifested by an ABI of less than 0.9 but greater than .7 in the right lower extremity, but without claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes (thin skin, absence of hair, dystrophic nails) or an ankle brachial index (ABI) between 0.5 and 0.7; the Veteran’s left lower extremity demonstrated a normal ABI and no chronic compensable claudication symptoms during this period. 3. From October 1, 2014, to January 30, 2015, the Veteran’s peripheral vascular disease of the right lower extremity manifested with symptoms consistent with a 60 percent disability rating but did not manifest with ischemic limb pain at rest, and: either deep ischemic ulcers or an ABI of 0.4 or less; the Veteran’s left lower extremity demonstrated a normal ABI and no chronic compensable claudication symptoms during this period. 4. From January 30, 2015, to January 28, 2016, the Veteran’s peripheral vascular disease of the right lower extremity did not manifest with claudication on walking more than 100 yards, and: diminished peripheral pulses or ankle/brachial index of 0.9 or less; the Veteran’s left lower extremity demonstrated a normal ABI and no chronic compensable claudication symptoms during this period. 5. From January 28, 2016, to April 26, 2016, the Veteran’s peripheral vascular disease was manifested by symptoms consistent with claudication on walking more than 100 yards, and diminished peripheral pulses or an ABI between 0.7 and 0.9, but without claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and: trophic changes or an ABI of 0.7 or less; the Veteran’s left lower extremity demonstrated a normal ABI and no chronic compensable claudication symptoms during this period. 6. From April 26, 2016, to October 17, 2017, the Veteran’s peripheral vascular disease of the right lower extremity was not manifested by symptoms consistent with claudication on walking more than 100 yards, and: diminished peripheral pulses or an ABI of 0.9 or less; the Veteran’s left lower extremity demonstrated a normal ABI and no chronic compensable claudication symptoms during this period. 7. From October 17, 2017, to December 18, 2020, the Veteran’s peripheral vascular disease of the right lower extremity manifested with symptoms consistent with a 20 percent rating but did not manifest with claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes or ankle/brachial index of 0.7 or less. 8. From December 18, 2020, the Veteran’s peripheral vascular disease of the right lower extremity manifested with symptoms consistent with a 60 percent disability rating but did not manifest with ischemic limb pain at rest; and either deep ischemic ulcers or ankle/brachial index of 0.4 or less. 9. From April 26, 2016, to December 18, 2020, the Veteran’s left lower extremity manifested symptoms of peripheral vascular disease consistent with claudication on walking more than 100 yards, and; diminished peripheral pulses or an ABI of .9 or less; but without claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes or an ABI of 0.7 or less. 10. From December 18, 2020, the Veteran’s peripheral vascular disease of the left lower extremity manifested with symptoms consistent with a 60 percent disability rating but did not manifest with ischemic limb pain at rest; and either deep ischemic ulcers or ankle/brachial index of 0.4 or less. 11. The Veteran’s right common femoral artery endarterectomy, bilateral angioplasty of common iliac arteries with kissing iliac stents scar associated with peripheral vascular disease is not manifest by any disabling effects not considered under Diagnostic Codes 7800-04. 12. Prior to December 15, 2016, the Veteran’s COPD manifested with pulmonary function test (PFT) results consistent with a FEV-1 of 56 to 70 percent predicted, or FEV-1/FVC of 56 to 70 percent, or DLCO (SB) of 56 to 65 percent predicted; and did not manifest with PFT results consistent with a 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 a maximum oxygen consumption of 15 to 20 ml/kg/min with cardiorespiratory limit. 13. From December 15, 2016 to October 4, 2017, the Veteran’s COPD has manifested with PFT results consistent with a FEV-1 of 40 to 55 percent predicted, or a FEV-1/FVC of 40 to 55 percent, or a DLCO (SB) of 40 to 55 percent predicted or maximum oxygen consumption of 15 to 20 ml/kg/min with cardiorespiratory limit and did not manifest with PFT results consistent with an FEV-1 less than 40 percent predicted, or a FEV-1/FVC less than 40 percent, or a DLCO (SB) less than 40 percent predicted, or cor pulmonale (right heart failure), or right ventricular hypertrophy, or pulmonary hypertension shown by echo or cardiac catheterization, or episodes of acute respiratory failure, or the requirement for outpatient oxygen therapy. 14. From October 4, 2017, the Veteran’s COPD manifested with PFT results consistent with a FEV-1 less than 40 percent predicted, or a FEV-1/FVC less than 40 percent, or a DLCO (SB) less than 40 percent predicted, or cor pulmonale (right heart failure), or right ventricular hypertrophy, or pulmonary hypertension shown by echo or cardiac catheterization, or episodes of acute respiratory failure, or the requirement for outpatient oxygen therapy; these criteria represent the highest schedular rating of 100 percent. CONCLUSIONS OF LAW 1. The criteria for entitlement to a compensable disability rating for peripheral vascular disease (previously rated as peripheral occlusive vascular disease) are not met for the period prior to February 20, 2014, because the available evidence does not show a date by which it is factually ascertainable that this condition increased in severity prior to that date. 38 U.S.C. §§ 501, 5110; 38 C.F.R. § 3.400(o)(2). 2. The criteria for a 20 percent disability rating have been met for peripheral vascular disease of the right lower extremity for the period from February 20, 2014, to October 1, 2014; the criteria for a disability rating in excess of 20 percent for peripheral vascular disease, to include a separate compensable rating for the left lower extremity, have not been met for the period from February 20, 2014, to October 1, 2014. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.104, Diagnostic Code 7114. 3. The criteria for a disability rating in excess of 60 percent for peripheral vascular disease of the right lower extremity, to include a separate compensable rating for the left lower extremity, have not been met for the period from October 1, 2014, to January 30, 2015. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.104, Diagnostic Code 7114. 4. The criteria for a compensable disability rating for peripheral vascular disease of the right lower extremity, to include a separate compensable rating for the left lower extremity, have not been met for the period from January 30, 2015, to January 28, 2016. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.104, Diagnostic Code 7114. 5. The criteria for a 20 percent disability rating are met for peripheral vascular disease of the right lower extremity for the period from January 28, 2016, to April 26, 2016; the criteria for a disability rating in excess of 20 percent for peripheral vascular disease of the right lower extremity, to include a separate compensable rating for the left lower extremity, have not been met for the period from January 28, 2016, to April 26, 2016. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.104, Diagnostic Code 7114. 6. The criteria for a compensable disability rating for peripheral vascular disease of the right lower extremity for the period from April 26, 2016, to October 17, 2017. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.104, Diagnostic Code 7114. 7. The criteria for a disability rating in excess of 20 percent for peripheral vascular disease of the right lower extremity have not been met for the period from October 17, 2017, to December 18, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.104, Diagnostic Code 7114. 8. The criteria for a disability rating in excess of 60 percent for peripheral vascular disease of the right lower extremity have not been met for the period from December 18, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.104, Diagnostic Code 7114. 9. The criteria for a 20 percent disability rating for peripheral vascular disease of the left lower extremity are met for the period from April 26, 2016, to December 20, 2020; the criteria for a disability rating in excess of 20 percent for are not met for the period from April 26, 2016, to December 18, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.104, Diagnostic Code 7114. 10. The criteria for a 60 percent disability rating for peripheral vascular disease of the left lower extremity are met for the period from December 18, 2020; the criteria for a disability rating in excess of 60 percent are not met for the period from December 18, 2020. 11. The criteria for a compensable disability rating for right common femoral artery endarterectomy, bilateral angioplasty of common iliac arteries with kissing iliac stents scar associated with peripheral vascular disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7805. 12. The criteria for entitlement to a disability rating in excess of 30 percent for COPD are not met for the period prior to December 15, 2016. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.96, 4.97, Diagnostic Code 6604. 13. The criteria for entitlement to a 60 percent disability rating, but no higher, are met for COPD for the period from December 15, 2016, to October 4, 2017. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.96, 4.97, Diagnostic Code 6604. 14. The criteria for entitlement to a 100 percent disability rating, the highest schedular award, for are met for the period from October 4, 2017. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.96, 4.97, Diagnostic Code 6604. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from June 1967 to May 1973 and from May 1979 to May 1990. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions in April 2015, October 2020, and January 2021. The Veteran originally requested a hearing before the Board when he filed his substantive appeal in September 2017 but withdrew that request for a hearing in July 2019 correspondence. 38 C.F.R. § 20.704 (e). These matters were previously before the Board in October 2019 and October 2020. The Board finds that the completed development reveals that, at the very least, substantial compliance with the prior remand directives was obtained. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Increased Rating 1. Entitlement to an increased rating for peripheral vascular disease The Veteran seeks increased compensation for his peripheral vascular disease, originally compensated as peripheral vascular occlusive disease. The primary argument advanced for the insufficiency of the rating assigned is the Veteran’s contention that he is entitled to separate ratings for each of his legs. This rating has been subdivided into multiple stages which are treated below after the appropriate legal criteria are set forth. Prior to February 21, 2014, the Veteran’s condition was rated under 38 U.S.C. § 1155; 38 C.F.R. § 4.104, Diagnostic Code 7113. At the time that the Veteran’s condition was originally rated, this diagnostic code covered aneurysms, and provided ratings from 20 to 60 percent depending on whether the aneurysm occurred in a vessel located in an upper or lower extremity, had definite or marked vascular symptoms, or had cardiac involvement. In December 2014, when the Veteran filed his claim for an increase, this Diagnostic Code had been changed and now covered Arteriovenous fistula, a condition that the Veteran has not been diagnosed with and that the medical evidence of record indicates is not applicable to an evaluation of the Veteran’s condition. Consequently, the diagnostic code was changed to 7114, a diagnostic code that awards various ratings based on the level of claudication during activity, changes to the skin, and ankle/brachial indices. Under Diagnostic Code 7114, a 20 percent disability rating is awarded for peripheral vascular disease with claudication on walking more than 100 yards, and; diminished peripheral pulses or ankle/brachial index of 0.9 or less. A 40 percent evaluation is awarded for peripheral vascular disease with claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes (thin skin, absence of hair, dystrophic nails) or ankle/brachial index of 0.7 or less. A 60 percent evaluation is awarded for peripheral vascular disease with claudication on walking less than 25 yards on a level grade at 2 miles per hour, and; either persistent coldness of the extremity or ankle/brachial index of 0.5 or less. A 100 percent evaluation is awarded for ischemic limb pain at rest, and; either deep ischemic ulcers or ankle/brachial index of 0.4 or less. 38 U.S.C. § 1155; 38 C.F.R. § 4.104, Diagnostic Code 7114. A note to this diagnostic code provides that the evaluations under 7114 are for the involvement of a single extremity and that, if more than one extremity is affected, each extremity is to be separately evaluated and combined using the appropriate regulations. Id. n. 3. The Veteran’s application for an increased rating was received on December 22, 2014. However, the appeal period includes a review of the evidence in the year preceding the date of the receipt of the claim to determine whether there is a date, based on all the evidence, during that year, by which it is factually ascertainable that the claimed condition has worsened. 38 U.S.C. §§ 501, 5110; 38 C.F.R. § 3.400(o)(2). In the present case, two dates preceding the receipt of the Veteran’s claim have been identified in the record by which time a factual worsening has been ascertained, February 21, 2014, and October 1, 2014. Consequently, the Board has reviewed the evidence from December 22, 2013 to February 21, 2014, to determine if there is any date during this time where the available evidence demonstrates that the Veteran’s condition has worsened. A review of the Veteran’s treatment records during the relevant period from December 22, 2013 to February 21, 2014 reveals that the appropriate date for the increase in the Veteran’s peripheral vascular disease condition is February 20, 2014. However, prior to February 20, 2014, the record does not indicate that the Veteran sought treatment for or complained of symptoms related to his peripheral vascular disease from December 22, 2013 to February 19, 2014. Consequently, a compensable rating is not available prior to February 20, 2014. 38 U.S.C. §§ 501, 5110; 38 C.F.R. § 3.400(o)(2). A 20 percent evaluation was originally assigned effective February 21, 2014, based on the date of a VA vascular surgery consult that discussed the Veteran’s peripheral vascular disease. At the time of the consult, the Veteran was complaining of bilateral leg pain that was not induced by activity or relieved by rest and the inability to ambulate very far due to dyspnea on exertion. The February 21 vascular surgical consult discusses then recent, taken on February 20, 2014, ABI readings that demonstrated an ABI in the right lower extremity greater than .7 and less than .9 and an ABI in the left lower extremity greater than 1.0. Therefore, because the right lower extremity ABI is revealed to have been between 0.7 and 0.9 on February 20, 2014, meeting the criteria for a 20 percent evaluation, the appropriate date where the finding of worsening can be ascertained is February 20, 2014, not February 21, 2014. Therefore, a 20 percent rating is awarded beginning February 20, 2014. The evidence of record from February 20, 2014, to October 1, 2014, however, does not warrant a rating in excess of 20 percent. As previously discussed, the Veteran’s ABIs were read on February 20, 2014, revealing an ABI in the right lower extremity between 0.7 and 0.9 and an ABI in the left lower extremity greater than 1.0. The February 21, 2014 vascular surgical consult explained that these results indicated mild disease in the right lower extremity only, and that the complaints the Veteran had regarding bilateral lower extremity pain were unlikely to be related to his peripheral vascular disease and, based on the recommendation of an EMG, suspected to be neurological in etiology. A March 2014 VA treatment note continued to document moderate peripheral vascular occlusive disease on the right side only. However, no additional evidence prior to October 1, 2014, demonstrates an ABI in either leg less than or equal to 0.7 or other symptoms that would warrant a disability rating greater than 20 percent. Consequently, the Board’s review of the evidence indicates that for the period of February 20, 2014, to October 1, 2014, the Veteran is entitled to a disability rating of 20 percent but no higher, and the Veteran’s claim for a rating in excess of 20 percent during this period is denied. The Board has also considered whether the Veteran is entitled to a separate rating for his left leg during this period in compliance with 38 C.F.R. § 7114, n. 3. However, the evidence during this period indicates that the Veteran’s disease was limited to the right lower extremity and not the left. See Treatment records Ann Arbor VA Medical Center (VAMC). Therefore, additional compensation on this basis is also denied for the period from February 20, 2014 to October 1, 2014. From October 1, 2014 to January 30, 2015, the Veteran’s peripheral vascular disease is rated 60 percent disabling. Therefore, the question before the Board is whether the evidence of record meets the criteria for a 100 percent disability rating: ischemic limb pain at rest, and; either deep ischemic ulcers or ankle/brachial index of .04 or less. 38 U.S.C. § 1155; 38 C.F.R. § 4.104, Diagnostic Code 7114. On October 1, 2014, the Veteran’s ABIs were recorded in a VA treatment record that demonstrated that he had an ABI in the right lower extremity greater than 0.5 but less than 0.7 and an ABI on the left lower extremity greater than 0.9. On October 7, 2014, the Veteran reported for treatment of right leg pain that he reported was occurring all the time and became worse with ambulation. He described it as originating in his buttock and radiating down his lateral thigh to his foot. His pulses were weak but palpable bilaterally. A December 2014 VA treatment note documents that the Veteran’s right leg symptoms remained unchanged. His right leg pain was no worse laying down than when standing or sitting and that the right foot becomes cooler when lying flat. Overall, the Veteran’s right leg symptoms were assessed as multifactorial, both due to poor arterial inflow and neurologic etiologies. A right femoral endarterectomy, angioplasty and stenting procedure was recommended for the following month. This surgical procedure was performed on January 28, 2015, and he was discharged from the hospital after a successful procedure on January 30, 2015, without the need for convalescence. Based on this evidence, the Board concludes that the criteria for the next higher disability rating were not met during the period from October 1, 2014, to January 30, 2015. While the Veteran appears to have had ischemic limb pain at rest (though in combination, apparently with neurological lower extremity pain), the Veteran’s treatment records show no indication of ischemic ulcers and the recorded ABI in the right leg was higher than 0.5 and higher than 0.9 in the left leg. Consequently, the Board finds that the record is not consistent with a disability rating in excess of 60 percent during this period; accordingly, entitlement to a disability rating in excess of 60 percent for the period from October 1, 2014 to January 30, 2015 is denied. The Board has also considered whether additional compensation is warranted for the left leg as required by 38 U.S.C. § 4.104, Diagnostic Code 7114, n. 3. However, the evidence of record during this period demonstrates the involvement only of the Veteran’s right leg. The Board acknowledges that the Veteran’s left leg may have had a slightly reduced ABI in October 2014 when compared to the study in February 2014; however, VA treatment records continue to characterize the left leg ABI as within normal limits during this period. To the extent that the diminishment of the ABI from February 2014 to October 2014 indicates symptomatic peripheral vascular disease in the left lower extremity as well, such a conclusion would not change the overall propriety of the Veteran’s 60 percent disability rating during this period. An ABI greater than .9 would not be compensable under Diagnostic Code 7114 and would not change the Veteran’s compensation for this condition or overall disability rating. Therefore, a rating in excess of 60 percent for peripheral vascular disease for the period from October 1, 2014, to January 30, 2015 is denied as not supported by the evidence. From January 30, 2015 to October 17, 2017, the Veteran’s peripheral vascular disease is rated noncompensable. Therefore, the question for the Board is whether the evidence of record meets the criteria for the next higher (a 20 percent) disability rating: claudication on walking more than 100 yards, and; diminished peripheral pulses or an ankle/brachial index of 0.9 or less. In a March 2015 VA treatment record, the Veteran was reportedly doing very well since his surgery. The Veteran denied lower extremity claudication, numbness in toes, and his right foot’s color had improved. His legs were warm, without edema, and his femoral pulses were palpable bilaterally. Later in March 2015, the Veteran attended a VA examination. The Veteran continued to deny symptoms of claudication and stated that the feeling and color had returned to his feet. This examination referred to the ABIs taken after his surgery which demonstrated an ABI in the right lower extremity greater than 0.9 and an ABI in the left lower extremity greater than 1.0. A June 2015 VA treatment record documents that the Veteran reported that he continued to do well since his surgery, he denied lower extremity claudication completely, stated that his foot was warmer. He reported occasional sharp pain in his leg that was not related to activity. Based on this evidence, the Board finds that the Veteran does not meet the criteria for a compensable evaluation for his peripheral vascular disease for the period from January 30, 2015, to January 28, 2016. As the evidence demonstrates, the Veteran was generally free of claudication symptoms during this period and his measured ABIs were generally within normal limits bilaterally, indicating a lack of peripheral vascular disease symptoms or simply noncompensable symptoms during this time. Consequently, during the period from January 30, 2015, to January 28, 2016, a compensable rating is denied. A January 28, 2016, VA treatment record documented the Veteran’s right ABI was greater than 0.7 but less than 0.9 and the left ABI was greater than 0.9 and characterized as within normal limits. The Veteran stated that he was doing generally well but reported some pain that radiated down into his thighs and calves that he believed might be secondary to back issues. The Veteran’s legs were warm and had diminished pulses bilaterally. In a February 2016 VA treatment note, the Veteran reported some progression of his claudication with pain with activity of as little as walking 10 feet that began in the bilateral glutes and progressed to the calve on the left side and to the toe on the right. This pain resolved with rest. The Veteran consequently underwent a second surgical procedure and stenting on March 21, 2016. He was discharged from the hospital the following day with strong distal pulses in his legs. In March 2016, the Veteran submitted a disability benefits questionnaire that recorded no claudication or other symptoms related to his peripheral vascular disease. During the period from January 28, 2016, to April 26, 2016, the Board finds that the evidence warrants a 20 percent rating, but no higher. The evidence demonstrates that the Veteran was experiencing claudication symptoms, though the multifactorial pain in his legs makes it difficult to establish the extent to which the pain he reported was due to claudication. However, the Veteran’s measured ABIs indicate that the Veteran’s condition during this period had increased in severity in the right lower extremity such that it met the criteria for a 20 percent rating (ABI between 0.7 and 0.9). However, the Veteran’s left ABI continued to be within normal limits. Consequently, the Board finds that entitlement to a disability rating in excess of 20 percent for peripheral vascular disease of the right lower extremity is denied and entitlement to separate compensation for the left lower extremity peripheral vascular disease is not warranted. The Veteran’s ABIs were recorded in an April 26, 2016 VA treatment note. The Veteran’s right ABI was greater than 0.9 and categorized as within normal limits. The Veteran’s left ABI was greater than 0.7 but less than 0.9. In a June 2016 VA treatment record the Veteran reported that he continued to have no claudication. At a November 2016 VA treatment visit, the Veteran reported that his claudication remained stable and had not worsened since the previous surgery. His femoral pulses were diminished bilaterally. His right ABI remained greater than .9 and his left ABI remained between .7 and .9. At an October 10, 2017 VA treatment visit, the Veteran’s ABIs were measured at greater than .9 bilaterally and characterized as within normal limits. The Veteran, however, reported that he felt his symptoms had been worsening. Based on this evidence, the Board finds that entitlement to a compensable rating is not warranted for the right lower extremity peripheral vascular disease for the period from April 26, 2016 to October 17, 2017. During this period, the Veteran’s right lower extremity was generally free from claudication symptoms and his ABI was greater than .9, indicating that he did not meet the criteria for a compensable rating in that extremity. However, it was during this period that the Veteran’s left lower extremity demonstrated compensable peripheral vascular disease symptoms for the first time. Though the Veteran was generally free of claudication symptoms, the Veteran’s ABIs in his left leg were consistent with the ABI criteria for a 20 percent rating, ABI between 0.7 and 0.9. A 20 percent rating for the left lower extremity is therefore granted from April 26, 2016 to October 17, 2017. The evidence is not consistent with a higher rating, as the Veteran was generally free of claudication symptoms during this period, no evidence of trophic changes, and no evidence that the Veteran’s ABI in his left lower extremity. Consequently, a rating in excess of 20 percent for the left lower extremity peripheral vascular disease is denied. From October 17, 2017 to December 18, 2020, the Veteran is in receipt of a 20 percent disability rating for his peripheral vascular disease. Therefore, the question for the Board is whether the Veteran’s condition during this period met the criteria for the next highest (a 40 percent) disability rating: claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes (thin skin, absence of hair, dystrophic nails) or an ankle/brachial index of 0.7 or less. 38 C.F.R. § 4.104, Diagnostic Code 7114. On October 17, 2017, the Veteran submitted an updated disability befits questionnaire indicating that the Veteran was experiencing claudication when walking more than 100 yards and had diminished peripheral pulses in both of his lower extremities. This examination also contained ABI readings revealing an ABI of greater than .9 bilaterally. No other symptoms were documented on this examination report. VA treatment records reflect that the Veteran’s ABIs were recorded again in April 2018 where both ABIs were greater than 1.0 and characterized as within normal limits. The Veteran reported that his walking distance was stable. His legs were warm, and his pulses were diminished bilaterally. His continued leg symptoms were assessed as likely neurological. A treatment records reflect that the Veteran’s ABIs were recorded again on December 10, 2018 and found to be greater than 0.7 in the right lower extremity and greater than 0.5 in the left lower extremity. The Veteran also complained of worsening claudication symptoms at this time. No more specific information was recorded. A January 2019 VA treatment record documented his ABI in the right lower extremity greater than 0.7 but less than .9 bilaterally. In August 2019, the Veteran’s right lower extremity ABI was found to be greater than .9 and the left lower extremity ABI was found to be 0.7. His femoral pulses were diminished bilaterally. Based on this evidence the Board finds that the during the period from October 17, 2017 to December 18, 2020, the Veteran’s right lower extremity peripheral neuropathy did not meet the criteria for a 40 percent disability rating. The Veteran’s ABI in the right lower extremity was consistently above 0.7 and frequently above 0.9, and there is no evidence in the record that the Veteran suffered from trophic changes in his right leg. Though the Veteran complained of leg pain and limitation to his walking, given that the other symptoms listed in the 40 percent criteria are not met, the Board finds that at least some of that pain was due to other disabilities that the Veteran had, including neurological disabilities in his legs, and that the assessment of the Veteran’s own doctor in October 2017 that described claudication upon walking more than 100 yards and diminished peripheral pulses is the best estimation of the Veteran’s right peripheral vascular disease symptoms during this period. Those symptoms do not meet the criteria for a 40 percent disability, and consequently, a disability rating in excess of 20 percent for right peripheral vascular disease is denied. The Board finds that a 20 percent disability rating, but no higher, is also warranted for the peripheral vascular disease of the left lower extremity for the period from October 17, 2017 to December 18, 2020. The evidence for the left lower extremity peripheral vascular disease is very similar to the evidence regarding the right lower extremity. Consequently, the Board finds that the evidence does not meet the criteria for a 40 percent rating. The Board acknowledges that in August 2019, the Veteran’s ABI was 0.7 and in one instance, slightly less, which is ABI range listed in the 40 percent criteria. Nevertheless, given that this decreased ABI was not accompanied by additional claudication symptoms or trophic changes listed in the 40 percent criteria, the Board finds that the criteria for a 40 percent disability rating for the left peripheral vascular disease are not met for this period. Beginning December 18, 2020, the Veteran is assigned a 60 percent disability rating for his right peripheral vascular disease. Consequently, the question before the Board is whether the evidence indicates that a rating is warranted also for the left lower extremity and whether the evidence meets the criteria for a 100 percent disability rating: ischemic limb pain at rest, and; either deep ischemic ulcers or ankle/brachial index of .4 or less. The Veteran had another VA examination on December 18, 2020. The Veteran described pain at rest in his legs, pain with walking, and typically only being able to walk 12 steps. The examination report documented claudication on walking less than 25 yards on a level grade at 2 miles per hour, persistent coldness of the extremity, diminished peripheral pulses, ischemic limb pain at rest, and trophic changes bilaterally. No deep ischemic ulcers were diagnosed. The Board finds that the results of the December 2020 VA examination warrant a 60 percent evaluation in each of the Veteran’s legs. A 100 percent evaluation requires ischemic limb pain at rest (which is present) AND either deep ischemic ulcers of an ABI of .4 or less. Neither of those last two symptoms are present here. 38 C.F.R. § 4.104, Diagnostic Code 7114. Consequently, a higher evaluation than 60 percent is not warranted for either leg during the final period of the appeal. 2. Entitlement to a compensable disability rating for surgical scar The Veteran contends that he is entitled to a higher rating for his surgical scar but has not articulated any symptoms or complaints that he believes are related to his scar condition. The Veteran’s right common femoral artery endarterectomy, bilateral angioplasty of common iliac arteries with kissing iliac stents scar associated with peripheral vascular disease is rated under Diagnostic Code 7805 for other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, Diagnostic Code 7805 was not changed by the August 13, 2018, amendments. Diagnostic Code 7805 instructs that any disabling effects not considered in a rating provided under Diagnostic Codes 7800-04 under an appropriate Diagnostic Code. The Board finds that the preponderance of the evidence is against the assignment of a compensable rating for the Veteran’s surgical scar under Diagnostic Code 7805 as there are no other disabling effects not considered in a rating provided under Diagnostic Codes 7800-04. The Veteran’s two VA examinations of his scar in March 2015 and December 2020 did not identify any symptoms associated with his scar. The scar was not unstable, not painful, measured 11 cm by 0.2 cm, for a total of 2.2 square cm, did not result in any underlying tissue damage, and was not identified as causing any other chronic symptoms. Some VA treatment records indicate that the Veteran at times felt fleeting pain at or near the site of his scar, but this fleeting pain does not appear to be disabling in any way, appears to have resolved within a reasonable time after his surgery because it was not noted on the December 2020 VA examination, and may have been unrelated to the Veteran’s scar because the Veteran also had a hernia condition that might have accounted for his symptoms. In any event, this fleeting pain not attributed to the Veteran’s scar by VA examiners, by the Veteran’s treating physicians, or specifically complained of by the Veteran in his claims for benefits is not sufficient to warrant a compensable rating under Diagnostic Code 7805. The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran’s scar is not of the head, face, or neck, is not deep and nonlinear, and is not associated with underlying soft tissue damage. Although it is superficial and not associated with underlying soft tissue damage, it does not cover an area or areas of 144 square inches or greater. Moreover, the Veteran’s scar is not unstable or generally painful. Therefore, Diagnostic Codes 7800, 7801, 7802, and 7804, both prior to and from August 13, 2018, are inapplicable, as discussed above. The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. However, the Veteran has not discussed any symptoms or disabling effects not considered by other diagnostic codes. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a compensable rating for his right femoral endarterectomy scar. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to a disability rating in excess of 30 percent prior to November 26, 2019, for COPD The Veteran seeks additional compensation for his COPD. The primary argument advanced by the Veteran is that his dyspnea on exertion is significant, limiting his activities, and that his pulmonary function test results should be interpreted in a manner that results in the greatest compensation. Beginning November 26, 2019, the Veteran’s COPD has been rated 100 percent disabling. Consequently, the Veteran is in receipt of the highest available rating for this award during that period. To the extent that the Veteran’s submissions are a claim for an increased rating during this period, that claim is denied, as there is no higher evaluation to award. Prior to November 26, 2019, the Veteran’s COPD is rated under 38 U.S.C. § 1155; 38 C.F.R. § 4.97, Diagnostic Code 6604. Under this diagnostic code, a 10 percent disability rating is awarded for an FEV-1 of 71 to 80 percent predicted, or; FEV-1/FVC of 71 to 90 percent, or; a DLCO (SB) 66 to 80 percent predicted. A 30 percent disability rating is awarded where a pulmonary function test (PFT) results in a FEV-1 of 56 to 70 percent predicted, or; FEV-1/FVC of 56 to 70 percent, or DLC (SB) 56 to 65 percent predicted. A 60 percent disability rating is awarded where pulmonary function tests result in 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. A 100 percent disability rating is awarded for FEV-1 less than 40 percent of predicted value, or; the ration of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) 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; right ventricular hypertrophy, or; pulmonary hypertension (shown by echo or cardiac catheterization), or; episodes of acute respiratory failure, or; requires outpatient oxygen therapy. 38 U.S.C. § 1155; 38 C.F.R. § 4.97, Diagnostic Code 6604. VA regulations provide that post-bronchodilator results are to be used when evaluating PFT results. 38 U.S.C. § 1155; 38 C.F.R. § 4.96(d)(5). VA has frequently conducted PFTs of the Veteran throughout the appeal period. Consequently, the PFT results recorded below are VA conducted PFTs unless otherwise stated. The Veteran’s claim for increased compensation for his COPD was received on December 22, 2104. Consequently, the Board has reviewed the evidence during the one-year period to determine if there is a date by which considering all the evidence it can be factually ascertained that the Veteran’s condition had worsened. 38 U.S.C. §§ 501, 5110; 38 C.F.R. § 3.400(o)(2). The Veteran’s pulmonary function was first evaluated during this period on May 19, 2014. The post-bronchodilator results at that time demonstrate a FEV-1 of 64 percent predicted and a FEV-1/FVC of 65 percent, and a pre-bronchodilator DLCO of 49 percent. The Veteran reported significant dyspnea and became short of breath when walking on flat ground approximately 100 feet or up 3 stairs. In September 2014, the Veteran’s PFT was evaluated again, resulting in a FEV-1 of 57 percent predicted and a FEV-1/FVC of 58 percent. The available post-bronchodilator results during the year preceding the receipt of the Veteran’s claim indicates pulmonary function commensurate with the criteria for a 30 and not a 60 percent rating. Thus, the Board finds that though the Veteran may have perceived his breathing as becoming worse, the record does not indicate a worsening during the year that preceded his claim. In March 2015, the Veteran’s PFT was evaluated again in conjunction with a March 2015 VA examination. His post-bronchodilator results indicated a FEV-1 of 63 percent predicted and a FEV-1/FVC of 67 percent. The pre-bronchodilator DLCO was 43 percent predicted. The examiner indicated that the FEV-1 percent predicted was the most accurate result of the Veteran’s respiratory condition. In April 2016, the Veteran submitted a disability benefits questionnaire that was authored in March 2016. This examination report provided only pre-bronchodilator results. A December 15, 2016 PFT indicated an FEV-1 of 40 percent and a FEV-1/FVC ratio of 43 percent. A May 2017 PFT demonstrated a FEV-1 of 42 percent predicted and FEV-1/FVC of 47 percent. An October 4, 2017 PFT, providing only pre-bronchodilator results, documented an FEV-1 of 30 percent predicted and a FEV-1/FVC of 45 percent. In October 2017, the Veteran submitted a DBQ that found similar results, reporting only pre-bronchodilator results, that examination report documents a FEV-1 of 30 percent predicted and a FEV-1/FVC ratio of 45 percent. A February 2018 PFT recorded a FEV-1 of 43 percent. An August 2018 PFT documenting only pre-bronchodilator results, indicated a FEV-1 of 45 percent predicted and a FEV-1/FVC of 44 percent. A December 2018 PFT documented a FEV-1 of 35 percent and a FEV-1/FVC of 52. An August 2019 PFT documented an FEV-1 of 30 percent predicted and a FEV-1/FVC of 39 percent. Based on this evidence, the Board finds that entitlement to a disability rating in excess of 30 percent is not warranted prior to December 15, 2016. During the period prior to December 15, 2016, the available post-bronchodilator PFT results are squarely above the results required for a 60 percent rating. (Continued on the next page)   From December 15, 2016 to October 4, 2017, the Board finds that a 60 percent evaluation is warranted. The Veteran’s available PFTs during this period demonstrate FEV-1 or FEV-1/FVC between 40 and 55 percent, but not values below 40 percent. Consequently, a 60 percent evaluation, but no higher is warranted during this period. Finally, beginning with the October 4, 2017 PFT, the Veteran’s results in the FEV-1 and FEV-1/FVC values were consistently below 40 percent. Consequently, a 100 percent disability rating is warranted during this period. Patrick M. Johnson Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Steven H. Johnston, 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.