Citation Nr: 21026415 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 13-35 432 DATE: May 3, 2021 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for rheumatoid arthritis (claimed as rheumatism) is denied. Entitlement to service connection for arthritis is denied. Entitlement to an initial compensable rating for pulmonary tuberculosis (PTB), minimal, inactive, from February 8, 2001 to April 27, 2010, is denied. Entitlement to a rating of 30 percent, but no higher, for PTB, minimal, inactive, with a right mid-lung granuloma, from April 28, 2010 to February 11, 2018, is granted. Entitlement to a rating of no more than 10% for PTB, minimal, inactive, with a right mid-lung granuloma, from February 12, 2018, is denied. FINDINGS OF FACT 1. Hypertension is first shown many years after active service and is unrelated to the Veteran's military service. 2. The preponderance of the evidence establishes that the Veteran does not currently have rheumatoid arthritis which is related to service. 3. Arthritis is first shown many years after active service and is unrelated to the Veteran's military service. 4. During the time from February 8, 2001, to April 27, 2010, the Veteran's PTB, minimal, inactive, was manifested by complaints of a cough and fatigue as well as chest pain, but pulmonary function testing revealed his forced expiratory volume after one second (FEV-1) was 117% of predicted. 5. During the time from April 28, 2010, to February 11, 2018, the Veteran's PTB, minimal, inactive, with a right mid-lung calcific granuloma, was manifested by pulmonary function testing results of FEV-1 of 62% of predicted. 6. Since February 12, 2018, the Veteran's PTB, minimal, inactive, with a right mid-lung calcific granuloma, has been manifested by the ratio of FEV-1 to forced vital capacity (FVC) of 77% of predicted. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for rheumatoid arthritis (claimed as rheumatism) have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for arthritis have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for an initial compensable rating for PTB, minimal, inactive, from February 8, 2001, to April 27, 2010, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6731. 5. The criteria for a rating of no more than 30% for PTB, minimal, inactive, with a right mid-lung granuloma, from April 28, 2010, to February 11, 2018, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6731. 6. The criteria for a rating of no more than 10% for PTB, minimal, inactive, with a right mid-lung granuloma, from February 12, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6731. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1956 to October 1956. An October 30, 2012, rating decision granted service connection for PTB, minimal, inactive, and assigned an initial noncompensable rating, all effective February 8, 2001 (date of an RO hearing at which the Veteran sought to reopen a claim for service connection for PTB). The procedural history of this case was extensively set forth by the Board of Veterans' Appeal (Board) in August 11, 2016. Therein it was noted that the Veteran testified at a Board hearing in Manila, Philippines, on January 29, 2015 before another Veterans Law Judge Dannaher. Subsequently, on January 27, 2016, the Veteran again testified in Manila, Philippines, on these issues at a Board hearing before VLJ Osborne. Both hearing transcripts are of record. In an April 2016 letter, he was afforded the opportunity to have a hearing before a third VLJ of the panel, but he waived the right for the additional hearing in a June 2016 response form. See Arneson v. Shinseki, 24 Vet. App. 379 (2011). Because the Veteran did not testify at the two Board hearings regarding his other issues on appeal, separate Board decisions were entered on August 11, 2016 and in one of those decisions the claims now before the Board were addressed by a panel of three VLJS, which included the VLJs who conducted the Board hearings. See generally 38 C.F.R. § 20.707. That decision remanded claims for service connection for (a) hypertension; (b) arthritis; (c) rheumatoid arthritis (claimed as rheumatism); (d) right ear hearing loss with deformed tympanic membrane; and (e) right mid-lung calcific granuloma (claimed as granuloma prominent aorta); and remanded (f) a claim for an initial compensable disability rating for PTB, minimal, inactive. In pertinent part, a January 7, 2019, rating granted service connection for right mid-lung calcific granuloma (claimed as granuloma prominent aorta) which was evaluated together with the service connected PTB, minimal, inactive, as 10%, effective September 26, 2012. By a Board letter of January 13, 2021, the Veteran was informed that the VLJ that presided at the January 2015 travel hearing was no longer employed by the Board and that the law required that a presiding VLJ must participate in any decision made on that appeal. 38 U.S.C. § 7107(c); 38 C.F.R. § 20.707. His various hearing options were explained, as was his right to submit additional evidence, and it was stated that if he did not respond within 30 days it would be assumed that he did not want another hearing and the Board would proceed to adjudicate his appeal. No response was received from the Veteran. Thus, the Judge who heard testimony in January 2016 will be the sole Judge issuing a decision in this appeal. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Service Connection Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curium, 78 F.3d 604 (Fed. Cir. 1996) (table); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a), (d). Service connection may be granted for any disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). However, not every manifestation of joint pain during service will permit service connection for arthritis first shown as a clear-cut clinical entity at some later date. 38 C.F.R. § 3.303(b). Certain chronic diseases, such as hypertension and arthritis, will be presumed related to service, absent an intercurrent cause, if shown as chronic in service; or, if manifested to a compensable degree within a presumptive period following separation from service; or, if noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Reasonable doubt will be favorably resolved but if the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1365-66 (Fed. Cir. 2001). 1. The claim for service connection for hypertension It is undisputed that the Veteran now has hypertension. His blood pressure at the February 1956 examination for enlistment was 148/88 and this is the only blood pressure reading during service and for many years thereafter. In a January 2021 Informal Hearing Presentation, the Veteran's service representative argues that this was a "prehypertensive" blood pressure reading, but cites to no medical authority for this proposition. Under VA regulations, the term hypertension means that the diastolic blood pressure is predominantly 90 millimeters of mercury (mm/Hg) or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 mm/Hg or greater with a diastolic blood pressure of less than 90 mm/Hg. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). Accordingly, the Board must conclude that there was no evidence of hypertension at service entrance. The Veteran was hospitalized for PTB during service and even after service at a VA facility for an extended period of time. However, none of these records reflect any blood pressure readings. The Veteran's service representative argues that medications prescribed during this time, i.e., Rifampin and Isoniazid, for treatment of the Veteran's now service-connected PTB, can cause increased blood pressure, and cites to an Internet source. That source only states that some foods and drinks, e.g., cheese and red wine, may cause sudden, severe high blood pressure when taking these medications. However, there is no allegation that the Veteran actually had any adverse reaction at any time to these medications and, moreover, the Internet source does not otherwise implicate the development of the Veteran's hypertension as a result of these medications. Equally significant is the Veteran's testimony at the 2015 and 2016 Board hearings that he did not recall when hypertension had first been diagnosed. Thus, Board finds that there is no issue of medical complexity or controversy and, so, there is no merit to the service representative's request to have this matter remanded for further development or to obtain an independent medical opinion. See 38 U.S.C. § 7109; 38 C.F.R. § 20.901(d). In a January 1980 statement Dr. G. DeGuzman reported that the Veteran had a blood pressure of 140/100. The Veteran's service representative argues that this means that the Veteran had likely had hypertension for a long time. It is noteworthy to mention that Dr. DeGuzman did not opined that the Veteran had hypertension which was incurred in service or that he had hypertension within one year after the Veteran's service discharge. Even if hypertension did exist for an extended period of time prior to Dr. DeGuzman's 1980 statement it would require a resort to speculation to find that the amount of such time dated back several decades to the Veteran's military service or a time within one year after service discharge in 1956. In fact, there are no clinical records which relate a history of the Veteran having hypertension dating back to his military service or to a time within one year after his October 1956 discharge. This includes multiple statements of private physicians and VA records. Similarly, the private physicians have not rendered a medical opinion that the Veteran's hypertension had its onset during service or manifested within one year thereafter. On the other hand, the Veteran's records were reviewed by VA clinicians in February 2018, when he was also examined, and in March 2019. Both rendered opinions that it was less likely as not that hypertension had its onset during active service or within one year thereafter. Essentially, the rationale of each was that there was insufficient medical documentation of record linking hypertension to military service or a time within one year thereafter. Citing to Dalton v. Nicholson, 21 Vet. App. 23 (2007), the Veteran's service representative argues that these VA medical opinions relied on the absence of contemporary clinical records for many years after service, which does not preclude service connection. This does not mean that that the absence of contemporary clinical records for many years after service weighs in favor of a claim for service connection, or that the absence of such evidence must be ignored. Here, none of the physicians that treated the Veteran for many years after service have reported treating the Veteran for hypertension until decades after service or related it to military service. See statements by Dr. DeGuzman of January 1980; Dr. M. Manibog of February 2001 and January 2004; Dr. J. Casipit of October 2012 and March 2015; Dr. V. Manuel of September 2016; and Dr. A. Diaz-Vinluan of June 2019. If in fact the Veteran had had hypertension during the first few decades after his military service it would be expected that the private physicians, who treated him beginning in at least 1980, would have reported it, but they did not. To the contrary, they have not rendered a favorable medical opinion or even related a history of hypertension dating back to a time even remotely close to the Veteran's military service. When this is taken together with the VA medical opinions that hypertension is unrelated to military service, the Board finds that the preponderance of the evidence is against the claim for service connection for hypertension. 2. The claim for service connection for rheumatoid arthritis (claimed as rheumatism) It is undisputed that the Veteran now has arthritis of knees, ankles, shoulders, and the thoracic and lumbar spinal segments, but X-rays have only confirmed this since 1980, several decades after service. The service records, and clinical records for several decades after service, are negative for signs, symptoms, complaints, history, treatment or diagnosis of rheumatoid arthritis. The earliest evidence pertaining to rheumatoid arthritis is the January 1980 statement of Dr. DeGuzman who reported that at that time the Veteran had deformity, tenderness, and swelling of the knees, ankles, and shoulders, which dated back to 1972 and while the diagnosis was rheumatoid arthritis, anti-rheumatic drugs had only provided temporary relief. However, Dr. DeGuzman's report does not demonstrate that the Veteran has rheumatoid arthritis of service origin for several reasons. First, that physician only related the putative symptoms of rheumatoid arthritis back to 1972, which is a decade and a half after the Veteran's discharge from service in 1956. Second, Dr. DeGuzman did not report that the diagnosis of rheumatoid arthritis had been confirmed by laboratory testing of the type which distinguishes rheumatoid arthritis from other forms of arthritis. Third, the February 2018 VA examiner reported that the Veteran did not have any joint deformities due to rheumatoid arthritis. Similarly, no other VA or private physician has reported that the Veteran has any joint deformities suggestive of rheumatoid arthritis. Also, the Internet source cited by the service representative also states that while rheumatoid arthritis is of unknown etiology and can occur at any age, it most commonly begins in middle age. Thus, to this extent, the Internet article does not support the claim as it does not serve to show that the Veteran currently has rheumatoid arthritis and that such is related to service or was diagnosed within one year of service discharge. Significantly, the February 2018 VA examiner specifically found and opined that the Veteran did not have rheumatoid arthritis. Also, upon a review of records in March 2019 a VA physician stated that the earlier description of the Veteran's symptoms did not match with a diagnosis of rheumatoid arthritis, and that X-rays in 2018 had revealed only degenerative changes consistent with osteoarthritis due to the normal aging process. Additionally, the Veteran testified in 2015 that he did not recall when he was first diagnosed as having rheumatoid arthritis. Further, the reports of numerous other private physician's over the years have never reported that the Veteran had rheumatoid arthritis, much less rendered a diagnosis of rheumatoid arthritis or related any rheumatoid arthritis to the Veteran's military service or a time within one year of his 1956 discharge from service. Accordingly, the Board finds that the preponderance of the evidence establishes that the Veteran has never had rheumatoid arthritis. Additionally, there is no probative evidence of a diagnosis of rheumatoid arthritis which is due to service. Thus, service connection for rheumatoid arthritis is not warranted. 3. The claim for service connection for arthritis The Veteran has arthritis of knees, ankles, shoulders, and the thoracic and lumbar spinal segments, but X-rays have only confirmed this since 1980, several decades after service. Although the Veteran testified that he believed his arthritis is due to hard work in a hot and humid environment when he operated a dish washing machine during service, the service records, and clinical records for several decades after service, are negative for signs, symptoms, complaints, history, treatment or diagnosis of arthritis. In a January 1980 statement, Dr. DeGuzman reported the Veteran had joint symptoms which dated back to 1972. The service representative argues that this means that the Veteran likely had arthritis for a long time prior to 1972. But this is not what Dr. DeGuzman reported and, in fact, that physician did not indicate how long the Veteran had had arthritis. Even if arthritis did exist prior to Dr. DeGuzman's 1980 statement, and even for an extended period of time prior to 1972, it would require a resort to speculation to find that the amount of such time dated back several decades to the Veteran's military service or a time within one year after service discharge in 1956. In fact, there are no clinical records which relate a history of the Veteran's having had arthritis dating back to his military service or to a time within one year after his October 1956 discharge. This includes multiple statements of private physicians and VA records. Similarly, the private physicians have not rendered a medical opinion as to whether the Veteran's arthritis had its onset during service or manifested within one year thereafter. On the other hand, the Veteran's records were reviewed by VA clinicians in February 2018, when he was also examined, and in March 2019. Both rendered opinions that it was less likely as not that arthritis had its onset during active service or within one year thereafter. Essentially, the rationale of each was that there was insufficient medical documentation of record linking arthritis to military service or a time within one year thereafter. To the extent that these medical opinions relied on the absence of contemporary clinical records for many years after service does not mean that that the absence of contemporary clinical records for many years after service weighs in favor of a claim for service connection, or that the absence of such evidence must be ignored. Here, none of the physicians that treated the Veteran for many years after service have reported treating the Veteran for arthritis until at least one and a half decades after service or related it to military service. See statements by Dr. DeGuzman of January 1980; Dr. M. Manibog of February 2001 and January 2004; Dr. J. Casipit of October 2012 and March 2015; Dr. V. Manuel of September 2016; and Dr. A. Diaz-Vinluan of June 2019. If in fact the Veteran had had arthritis during the first few decades after his military service it would be expected that the private physicians, who treated him beginning in at least 1980, would have reported it, but they did not. When this is taken together with the VA medical opinions that arthritis is unrelated to military service, the Board finds that the preponderance of the evidence is against the claim for service connection for arthritis. General Rating Principles Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § Part 4. If there is a question as to which of two evaluations shall be applied, the higher rating is assigned if the disability picture more nearly approximates the criteria required therefor; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. Any reasonable doubt is to be favorably resolved. 38 C.F.R. §§ 3.102, 4.3. A veteran's entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where an increase in the disability rating is at issue, the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made, by reason of which separate ratings for each time period may be assigned. Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007). Under 38 C.F.R. § 4.97, Diagnostic Code 6731, initial ratings after August 19, 1968 for chronic but inactive pulmonary tuberculosis will be rated on the specific findings, with residuals rated as interstitial lung disease, restrictive lung disease, or when obstructive lung disease is the major residual, a chronic bronchitis, under DC 6600. Here, the evidence shows that the Veteran's service-connected PTB with a right mid-lung calcific granuloma, has caused restrictive and not obstructive lung disease. Thus, rating the service-connected disorder as chronic bronchitis under DC 6600 is not warranted. Under the General rating Formula for Restrictive Lung Disease, DCs 6840 through 6845, a 10% rating is assigned when the Forced Expiratory Volume in one second (FEV-1) is 71% to 80% of predicted; or the ratio of FEV-1 to Forced Vital Capacity (FVC) (FEV-1/FVC) is 71% to 80% of predicted; or the Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO SB) is 66% to 80% of predicted. A 30% rating is assigned when the FEV-1 is 56% to 70% of predicted; or the FEV-1/FVC is 56% to 70% of predicted; or the DLCO SB is 56% to 65% of predicted. A 60% rating is assigned when the FEV-1 is 40% to 55% of predicted; or the FEV-1/FVC is 40% to 55% of predicted; or the DLCO SB is 40% to 55% of predicted; or the maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit). Reasonable doubt will be favorably resolved but if the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Ortiz v. Principi, 274 F.3d 1361, 1365-66 (Fed. Cir. 2001). 4. An initial compensable rating for PTB, minimal, inactive, from February 8, 2001, to April 27, 2010 An October 2012 rating decision granted service connection for PTB, minimal, inactive, and assigned an initial noncompensable rating, all effective February 8, 2001 (date of RO hearing at which the Veteran expressed a desire to reopen a claim for service connection for PTB). Service connection was based upon inservice aggravation of pre-existing PTB, but the preservice level of disability was "zero, [and so] no deduction is necessary." The Board similarly finds that the baseline of any pre-existing level cannot be determined and, so, no deduction based on inservice aggravation is warranted. See 38 C.F.R. §§ 3.322(a), 4.22. An August 11, 2016 Board decision by a panel of three VLJs remanded a claim for service connection for a right mid-lung calcific granuloma, and remanded a claim for an initial compensable rating for PTB, minimal, inactive. A January 2019 rating decision granted service connection for a right mid-lung calcific granuloma, and rated it together with the service-connected PTB, minimal, inactive, and assigned a 10% rating, all effective September 26, 2012, as the date of receipt of claim which was continuously prosecuted through the appellate process. Initially, the Board notes that the Veteran's claim as to the rating for his service-connected PTB stems from an initial grant of service connection in October 2012 which was retroactive to February 8, 2001. Thus, the rating for the entire time since February 8, 2001 must be considered. The Veteran was transferred from a military medical facility in August 1956 for continued treatment for PTB to a VA hospital where he continued the same treatment from October 1956 to April 1957. The pertinent discharge diagnosis was PTB, inactive, with maximal involvement being minimal. There is evidence that he had taken medication for a number of years after his military service. However, the evidence clearly demonstrates that his PTB has been inactive since 1957 and, so, any medication which he may take is solely for the purpose of preventing any reactivation of the PTB. On VA respiratory examination of March 13, 2001, it was reported that the Veteran had minimal and inactive PTB. He denied any fever, cough or significant weight loss. He related having back pain and exertional dyspnea. Pulmonary function testing revealed his FVC was 84% of predicted and his FEV-1 was 110% of predicted. The ratio of FEV-1 to FVC was not reported. It was stated that the results of the pulmonary function testing were normal. A September 2001 report from Dr. R. Magat reflects that a chest X-ray that month revealed no active lung infiltrates but a small calcific nodule in the outer right mid-lung, consistent with a granuloma. At a July 2003 videoconference, in conjunction with his application to reopen a claim for service connection for PTB, the Veteran testified that his PTB caused back pain and coughing. On VA examination on August 30, 2007 it was reported that since 1956, the Veteran's course as to PTB had been stable. He complained of chest pain, a cough, and exertional dyspnea. He had no history of wheezing, swelling, fatigue, fever, night sweats, weakness or other symptoms. There were no signs of significant weight loss or malnutrition. The diagnosis was that his PTB was inactive since 1957, with the residuals appearing to be a restrictive respiratory condition. Pulmonary function testing revealed his FVC was 113% of predicted and his FEV-1 was 117% of predicted. It was opined that his PTB pre-existed service entrance and active service less likely as not increased or aggravated the PTB. The Veteran's reports of any chest pain, coughing, or difficulty breathing are encompassed in a noncompensable disability rating. He has related that his PTB has caused back pain, but there is also objective, radiological, evidence of arthritis of his thoracolumbar spine. In any event, the proper rating is assigned on objective criteria as determined by pulmonary function testing. During the time from February 8, 2001, to April 27, 2010, the only pulmonary function test results were those of the March 13, 2001 and August 30, 2007 VA examinations. To have warranted a compensable rating his FEV-1 would have had to be at least 71% to 80% of predicted. However, the cited examinations revealed the readings of his FEV-1 were 110% and 117% of predicted, respectively. Thus, even with consideration given to the Veteran's subjective complaints, when the objective findings are applied to the governing rating criteria a compensable rating was not warranted from February 8, 2001, to April 27, 2010. 5. A rating of no more than 30% for PTB, minimal, inactive, with a right mid-lung calcific granuloma from April 28, 2010, to February 11, 2018 On VA pulmonary examination on April 27, 2010, it was noted that the Veteran did not have a non-productive cough; wheezing; non-anginal chest pain; hemoptysis; fever; anorexia; night sweats; respiratory failure; cor pulmonale, right ventricular hypertrophy or pulmonary hypertension; asthma; bronchiectasis; pulmonary embolism; or pleurisy with empyema. Also, there was no sign of significant weight loss or malnutrition. The report of the April 27, 2010, examination reflects that pulmonary function testing had revealed a mild restrictive ventilatory pattern. However, the actual report did not record the results of any pulmonary function testing. However, a May 4, 2010, VA outpatient treatment (VAOPT) record shows that pulmonary function testing of April 28, 2010, revealed a mild restrictive ventilatory pattern and that FVC was 63% of predicted and that FEV-1 was 62% of predicted, although the ratio of predicted FEV-1/FVC was not reported. A FEV-1 of 62% warrants a 30% rating under the General rating Formula for Restrictive Lung Disease. Accordingly, while the report of the pulmonary function testing of April 28, 2010 indicated that the Veteran had a mild restrictive ventilatory pattern, the actual results of that testing demonstrate that a 30% rating was warranted as of that date. 6. A rating of no more than the current 10% for PTB, minimal, inactive, with a right mid-lung calcific granuloma from February 12, 2018 Following the April 2010 VA rating examination, a subsequent VA rating examination of February 12, 2018, found that on pulmonary function testing the Veteran's FEV-1, post-bronchodilator, was 30% of predicted. However, the examiner reported that the FEV-1/FVC, which was 77% of predicted, most accurately reflected the Veteran's level of disability. In this regard, the contrast between the FEV-1 of only 30% and the FEV-1/FVC of 77% is striking because an FEV-1 of less than 40% would warrant a 100% schedular rating, but in this case the evidence as a whole does not indicate that the Veteran's PTB was ever more than, at most, of minimal degree. Consistent with this is the fact that the Veteran has never required the use of any device or even medication to assist his breathing. Thus, the February 2018 examiner's choice of using the FEV-1/FVC of 77% as most accurately reflecting the Veteran's level of impairment is consistent with the findings of that examination and the evidence in the record overall. The FEV-1/FVC of 77% warrants no more than a 10% rating. Thus, the preponderance of the evidence establishes that since February 12, 2018, no more than a 10% rating is warranted. K. OSBORNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Fussell, 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.