Citation Nr: 22013585 Decision Date: 03/10/22 Archive Date: 03/10/22 DOCKET NO. 10-34 236 DATE: March 10, 2022 ORDER Entitlement to service connection for bilateral eye disability, other than retinal hole surrounded by a ring of pigment, inferiorly, left eye, is denied. Entitlement to service connection for respiratory disability, other than exercise induced anaphylaxis, is denied. Entitlement to an initial 60 percent rating, from May 1, 2009, for exercise induced anaphylaxis, is granted, subject to controlling regulations governing the payment of monetary awards. Entitlement to an initial rating higher than 60 percent for exercise induced anaphylaxis is denied. FINDINGS OF FACT 1. The evidence persuasively weighs against finding that the Veteran has had any eye disability, other than retinal hole surrounded by a ring of pigment, inferiorly, left eye, at any time during or approximate to the pendency of his claim. 2. The evidence persuasively weighs against finding that the Veteran has had any respiratory disability, other than exercise induced anaphylaxis, at any time during or approximate to the pendency of his claim. 3. The evidence is at least evenly balanced as to whether the Veteran's exercise induced anaphylaxis has involved skin manifestations that have involved more than 40 percent his entire body or exposed areas during the entire claim period since the May 1, 2009 effective date of service connection; there has been no associated scarring or compensable respiratory impairment. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral eye disability, other than retinal hole surrounded by a ring of pigment, inferiorly, left eye, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for respiratory disability, other than exercise induced anaphylaxis, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. With reasonable doubt resolved in favor of the Veteran, the criteria for an initial 60 percent rating, but no higher, from May 1, 2009, for exercise induced anaphylaxis are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.118, Diagnostic Code (DC) 7806 (2009, 2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1989 to April 2009. These matters initially came before the Board of Veterans' Appeals (Board) from a November 2009 rating decision. In June 2016, the Board remanded these matters to schedule the Veteran for a Board hearing before a Veterans Law Judge (VLJ). The Veteran testified before a VLJ at a January 2017 hearing. The Board subsequently sent the Veteran a letter in January 2018 which informed him that the Board was unable to produce a written transcript of the January 2017 hearing and asked him to indicate whether he wanted to attend a new hearing. The Veteran responded in February 2018 that he wished to attend a new Board hearing. He subsequently testified before the undersigned VLJ at an October 2018 hearing and a transcript of the hearing has been associated with his claims file. In April 2019, October 2020, and October 2021, the Board remanded these matters for further development. In November 2021, a Decision Review Officer (DRO) assigned a 10 percent rating, from February 12, 2020 through November 21, 2021, and a 60 percent rating, from November 22, 2021, for exercise induced anaphylaxis. As a final preliminary matter, in the April 2019, October 2020, and October 2021 remands, the Board instructed the agency of original jurisdiction (AOJ) to, among other things, ask the Veteran to identify any outstanding treatment records and to complete the appropriate authorization form to allow VA to obtain any outstanding private medical records, obtain all outstanding VA treatment records, and afford the Veteran examinations to determine the nature of any current respiratory disability, to assess the severity of his service-connected exercise induced anaphylaxis, and to obtain a retrospective medical opinion as to the severity of his exercise induced anaphylaxis during the entire claim period. Pursuant to the Board's remands, the Veteran was asked to identify any outstanding treatment records and to complete the appropriate authorization form to allow VA to obtain any outstanding private medical records by way of December 2019 and October 2020 letters. Copies of the authorization forms (VA Forms 21-4142a and 21-4142) were included with the letters. Also, all relevant outstanding VA and private treatment records were obtained and associated with the claims file, the Veteran was afforded a VA respiratory examination in February 2020, he was most recently afforded a VA examination for his exercise induced anaphylaxis in November 2021, and the examiner who conducted the November 2021 examination provided a retrospective medical opinion as to the severity of the exercise induced anaphylaxis during the entire claim period. Therefore, the AOJ substantially complied with the Board's pertinent remand instructions. See Dyment v. West, 13 Vet. App. 141, 146- 47 (1999); Stegall v. West, 11 Vet. App. 268 (1998). I. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, air, or space service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Entitlement to service connection for bilateral eye disability (other than retinal hole surrounded by a ring of pigment, left eye) and respiratory disability (other than exercise induced anaphylaxis) In the absence of proof of present disability there can be no successful claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). See also Degmetich v. Brown, 104 F.3d 1328 (1997) (also interpreting 38 U.S.C. § 1131 as requiring the existence of a present disability for VA compensation purposes). To be present as a current disability, there must be evidence of the condition at some time during the claim period. Gilpin v. West, 155 F. 3d 1353, 1356 (Fed. Cir. 1998); see also McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (the Gilpin requirement that there be a current disability is satisfied when the disability is shown at the time of the claim or during the pendency of the claim, even though the disability subsequently resolves). The question for the Board is whether the Veteran has any current eye disability (other than retinal hole surrounded by a ring of pigment, left eye) and respiratory disability (other than exercise induced anaphylaxis) that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board finds, for the following reasons, that while the Veteran did experience eye and respiratory problems in service, he does not experience any eye disability (other than retinal hole surrounded by a ring of pigment, left eye) or respiratory disability (other than exercise induced anaphylaxis), and has not experienced any such disabilities at any time since his service connection claim was received in January 2009 or approximate thereto. Cf. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013) (Board erred in failing to address pre-claim evidence in assessing whether a current disability existed, for purposes of service connection, at the time the claim was filed or during its pendency); McClain, 21 Vet. App. at 321. The Veteran contended in his January 2009 claim that he experienced residuals of pneumonia and photorefractive keratectomy (PRK) eye surgery in service. His service treatment records confirm that he experienced various respiratory problems (including pneumonia) and underwent PRK surgery in service. However, he has not reported, and the evidence does not otherwise reflect, that he has experienced any respiratory problems (other than exercise induced anaphylaxis) or eye problems (other than retinal hole surrounded by a ring of pigment, left eye) at any time during the claim period. He reported during the October 2018 hearing that he felt as if he had decreased lung capacity, but that he did not experience any respiratory problems other than the episodes of shortness of breath associated with his service-connected exercise induced anaphylaxis. Also, he acknowledged that the PRK surgery in service was successful and that he did not experience any residual eye symptoms from the surgery. A VA eye examination was conducted in April 2009, during which the Veteran reported that he had a lesion removed from his upper eyelid in 1994, that he had PRK vision correction surgery in both eyes in 2001, and that he experienced degradation of his vision. Examination revealed that his uncorrected visual acuity was 20/30 at far and 20/20 at near bilaterally, but that his vision was corrected to 20/20 near and far bilaterally. His pupils were round, equal, and reactive, his extraocular movements were full, his color vision was intact, and his visual field by confrontation was full. The Veteran was diagnosed as having a retinal hole, surrounded by a ring of pigment, inferiorly, of the left eye. There was no pathology to render a diagnosis with respect to his status-post surgical removal of a lesion on the left upper lid in 1999. Also, he experienced blurred distance vision following PRK vision correction surgery in both eyes in 2001, but his vision was correctable with glasses. The Board points out that the law provides that refractive error of the eyes is a developmental defect and not a disease or injury within the meaning of applicable legislation. In the absence of superimposed disease or injury, service connection is not granted for refractive error of the eyes, even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. See 38 C.F.R. §§ 3.303 (c), 4.9. Developmental defects, such as refractive error, automatically rebut the presumption of soundness and therefore are considered to have pre-existed service. Id.; See also Quirin v. Shinseki, 22 Vet. App. 390, 397 (2009); Winn v. Brown, 8 Vet. App. 510, 516 (1996). Moreover, VA regulations provide that the usual effects of medical and surgical treatment in service, having the effect of ameliorating disease or other conditions incurred before enlistment, will not be considered service-connected unless the disease or injury is otherwise aggravated by service. 38 C.F.R. § 3.306 (b)(1). With respect to the Veteran's claimed respiratory disability, he was afforded a VA respiratory examination in February 2020. He reported that he was treated for symptoms of breathing difficulty in service, which progressed into anaphylactic type reactions that seemed to occur after eating certain foods and exercising. These episodes became more frequent and unpredictable, until the Veteran began to be treated by an allergist and received a formal diagnosis of food/exercise induced anaphylaxis. His symptoms were persistent and static, and he treated his symptoms by avoiding certain exercise activities and foods. The examiner who conducted the examination diagnosed the Veteran as having exercise induced anaphylaxis. There is no other evidence that the Veteran has experienced or been diagnosed as having any acquired eye disability (other than retinal hole surrounded by a ring of pigment, inferiorly, left eye) or respiratory disability (other than exercise induced anaphylaxis) at any time during the pendency of his January 2009 claim or approximate thereto, and neither he nor his representative have alluded to the existence of any such evidence. As explained above, all of the Veteran's eye and respiratory symptoms are already contemplated by his service-connected retinal hole surrounded by a ring of pigment, inferiorly, left eye and exercise induced anaphylaxis, and there is no evidence that any refractive error/developmental defect was subject to a superimposed chronic disease or injury in service. Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. §§ 1110, 1131. Thus, where, as here, the evidence establishes that the Veteran does not have the disability for which service connection is sought, there can be no valid claim for service connection. See Gilpin, 155 F.3d at 1353; Brammer, 3 Vet. App. at 225. As such, service connection for bilateral eye disability (other than retinal hole surrounded by a ring of pigment, inferiorly, left eye) and respiratory disability (other than exercise induced anaphylaxis) is not warranted because the first criterion for an award of service connection-evidence of current disability upon which to predicate such an award-has not been met. For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for bilateral eye disability (other than retinal hole surrounded by a ring of pigment, inferiorly, left eye) and respiratory disability (other than exercise induced anaphylaxis) is warranted. Rather, the evidence persuasively weighs against the claims. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to these claims. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). II. Higher Initial Rating Disability ratings are determined by the application of rating criteria set forth in the VA Schedule for Rating Disabilities (38 C.F.R. Part 4) (Rating Schedule) based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155. Where service connection has been granted and the assignment of an initial rating is disputed, separate ratings may be assigned for separate periods of time based on the facts found. In other words, the ratings may be "staged." Fenderson v. West, 12 Vet. App. 119, 125-126 (1999). If two ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. In evaluating a disability, the Board considers the current examination reports considering the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. Entitlement to a higher initial rating for exercise induced anaphylaxis, rated noncompensable prior to February 12, 2020, 10 percent disabling from February 12, 2020 through November 21, 2021, and 60 percent disabling from November 22, 2021 As an initial matter, the Board points out that when a claimant's medical history indicates that his condition undergoes periods of remission and recurrence, VA may be required to provide a medical examination during the period of recurrence in order to provide a proper disability rating. Ardison v. Brown, 6 Vet. App. 405, 407 (1994). In Ardison, the United States Court of Appeals for Veterans Claims (Court) found that an examination during the remission phase of the condition did not "accurately reflect the elements of the present disability." Id. In the present case, the evidence reflects that the Veteran experiences flare ups or exacerbations of his service-connected exercise induced anaphylaxis. However, he has not reported any specific or predictable periods during which flare ups of symptoms occur. Given this history, it would be difficult, if not impossible to more precisely schedule an examination during a period of flare up. See Voerth v. West, 13 Vet. App. (1999) (feasibility of scheduling an examination during an exacerbation is a factor in determining whether VA has a duty to provide such an examination). The most recent November 2021 examination was thorough, contained all pertinent findings, and responded to the inquiries posed by the Board. Also, the examiner specifically described the estimated severity of the Veteran's skin disability during a period of flare up. Hence, a new VA examination to assess the severity of the service-connected exercise induced anaphylaxis is not necessary. The Veteran's exercise induced anaphylaxis is rated under 38 C.F.R. § 4.118, DC 7806. VA amended the criteria for rating skin disabilities during the claim period, effective from August 13, 2018. With regard to the effective date of the new criteria, VA indicated in the Supplementary Information to the Final Rule that its "intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied." The Veteran's claim in this case was pending prior to the August 13, 2018 effective date of the new criteria, and therefore, the Board will consider both the old and new criteria and apply the more favorable criteria. Under the old version for DC 7806, a noncompensable (0 percent) rating is warranted if less than 5 percent of the entire body or less than 5 percent of exposed areas are affected; or if no more than topical therapy was required during the past 12-month period. A 10 percent rating is warranted if at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas are affected, or; if intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of less than six weeks during the past 12-month period. A 30 percent rating requires that 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas be affected, or that systemic therapy such as corticosteroids or other immunosuppressive drugs be required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A maximum 60 percent rating requires that more than 40 percent of the entire body or more than 40 percent of exposed areas be affected, or that constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs be required during the past 12-month period. 38 C.F.R. § 4.118, DC 7806 (in effect prior to August 13, 2018). Under the amended criteria, a note preceding 38 C.F.R. § 4.118 provides that, for the purposes of this section, "systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin." DC 7806 continues to apply to dermatitis or eczema, but is rated under the General Rating Formula for the Skin (General Rating Formula). Under the General Rating Formula, a noncompensable (0 percent) rating is warranted where no more than topical therapy is required over the past 12-month period and there is at least one of the following: characteristic lesions involving less than 5 percent of the entire body; or characteristic lesions involving less than 5 percent of exposed areas. 38 C.F.R. § 4.118, DC 7806 (effective August 13, 2018). A 10 percent rating is warranted where at least one of the following is present: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period. Id. A 30 percent rating is warranted where at least one of the following is present: Characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. Id. A 60 percent rating is warranted for characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required over the past 12-month period. Id. Since "systemic therapy," which is the type of therapy that creates compensability, is connected to the phrase "corticosteroids or other immunosuppressive drugs" by "such as," those drug types do not constitute an exhaustive list of all compensable systemic therapies, but rather serve as examples of the kind and degrees of treatments used to justify a particular disability rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Consequently, the types of systemic treatment that are compensable under DC 7806 are not limited to "corticosteroids or other immunosuppressive drugs." Compensation is available for all systemic therapies that are like or similar to corticosteroids or other immunosuppressive drugs. Warren v. McDonald, 28 Vet. App. 194 (2016). In Johnson v. Shulkin, 862 F.3d 1351, 1354-56 (Fed. Cir. 2017), the United States Court of Appeals for the Federal Circuit found that "systemic" is defined as "pertaining to or affecting the body as a whole" and "therapy" is defined as "treatment of diseases". In Burton v. Wilkie, 30 Vet. App. 286, 291 (2018), the Court discussed two ways that a treatment could be shown to be systemic: (1) The method by which the treatment works to treat the medical condition and (2) the side effects that are possible or actually experienced as a result of the treatment. Considering the pertinent evidence in light of the applicable rating criteria and considerations, the Board finds, for the following reasons, that the evidence is at least evenly balanced as to whether the Veteran's exercise induced anaphylaxis has met or approximated the criteria for a 60 percent rating during the entire claim period since the May 1, 2009 effective date of service connection. An April 2009 VA examination report, a May 2009 statement from the Veteran, private treatment records dated from January 2012 to April 2015, a July 2016 statement from the Veteran, his testimony during the October 2018 Board hearing, and a February 2020 examination report from Allergy Partners of Lynchburg indicate that the Veteran experienced numerous attacks of exercise induced anaphylaxis (some of which required treatment at the emergency room), which were manifested by hives, welts, itching, and occasional shortness of breath. He was prescribed an Epi-pen auto-injector to treat his anaphylaxis episodes. Examinations revealed that the Veteran's skin was clear of rashes, lesions, and swelling, and that there were no signs of any skin disease. Pulmonary function testing (PFT) revealed that his forced expiratory volume (FEV-1) was 94 percent predicted before bronchodilator and 96 percent predicted after bronchodilator. The Veteran provided a good effort and there was no discrepancy between the PFT findings and the clinical examination. A Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) test was not conducted because the PFT results were sufficient to evaluate the Veteran's pulmonary status. He was diagnosed as having exercise induced anaphylaxis. The reports of VA skin and respiratory examinations dated in February 2020 indicate that the Veteran reported that he experienced giant raised "head to toe hives" and occasional difficulty breathing during periods of allergic exercise-related episodes, and that his disability had been persistent and static ever since its onset in service. He avoided certain exercise activities and foods due to his disability, but had not been treated with any medication for his disability during the previous 12 months (to include oral or parenteral corticosteroid medications, inhaled medications, oral bronchodilators, antibiotics, or outpatient oxygen therapy) and had not received any treatments or procedures other than systemic or topical medications during the previous 12 months. Examinations revealed that the Veteran did not have any visible characteristic lesions at the time of the examination, but the examiner indicated that the skin manifestations of the Veteran's disability involved at least 5 percent, but less than 20 percent, of his total body area and exposed areas. There were no benign or malignant neoplasms or metastases related to the Veteran's disability, there was no scarring associated with his disability, and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. Pre-bronchodilator pulmonary function testing revealed that the Veteran's FEV-1 was 93 percent predicted and his FEV-1/forced vital capacity (FVC) was 85 percent. The examiner who conducted the examination indicated that the FEV-1 result most accurately reflected the Veteran's level of disability and that post-bronchodilator testing was not conducted because the pre-bronchodilator results were normal. DLCO (SB) testing was not conducted because it was not indicated for the Veteran's condition. The Veteran was diagnosed as having exercise induced anaphylaxis. This disability impacted his ability to work in that he had missed 1 to 2 weeks of work during the previous 12 months and the disability negatively impacted any occupation requiring strenuous exercise. The report of a VA skin diseases examination dated in January 2021 reveals that the Veteran experienced flare ups of giant, raised "head to toe hives" during periods of exercise induced anaphylaxis episodes, which lasted for over one hour at a time. He had not been treated with any medications during the previous 12 months and had not received any treatments or procedures other than systemic or topical medications during the previous 12 months. The Veteran did not have any visible characteristic lesions due to his disability at the time of the January 2021 examination. There was no scarring associated with the Veteran's disability and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. A diagnosis of exercise induced anaphylaxis was provided. This disability did not impact the Veteran's ability to work. The examiner who conducted the January 2021 examination opined that there was no point at which the Veteran's disability increased in severity, based on his history and the physical examination. He had not used his Epi-pen for an anaphylactic episode or required emergency room treatment since the February 2020 examination. The Veteran reported during a November 2021 VA skin diseases examination that he experienced episodes of hives, itchy skin, and shortness of breath due to his exercise induced anaphylaxis. The skin rashes and wheals occurred after exercise and randomly radiated over his chest, legs, arms, and groin region. The disability had stayed the same since its onset in service and the Veteran used epinephrine as needed. He had not been treated with medication for his skin condition during the previous 12 months and had not received any treatments or procedures other than systemic or topical medications during the previous 12 months. Examination revealed that the Veteran did not have any visible characteristic lesions due to his disability at the time of the examination. He did not have any benign or malignant neoplasms or metastases related to his disability, there was no scarring related to his disability, and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. The Veteran was diagnosed as having exercise induced anaphylaxis. This disability did not impact his ability to work. In November 2021, the physician who conducted the November 2021 VA skin examination opined that the skin manifestations of the Veteran's exercise induced anaphylaxis affected 50 percent of his entire body during flare ups of the disability. This opinion was based on the Veteran's statements and a picture of the Veteran that was taken during a flare up. Also, the physician explained that based on the Veteran's treatment records and statements, there did not appear to be any increase in the severity of the stage, nature, extent, or duration of his exercise induced anaphylaxis. The above evidence reflects that the Veteran's service-connected exercise induced anaphylaxis has been manifested by a skin rash during periods of flare up of the disability. The Veteran was not experiencing any visible skin symptoms at the time of the examinations conducted during the claim period, but the examiner who conducted the February 2020 examination indicated that the skin manifestations of the Veteran's disability involved at least 5 percent, but less than 20 percent, of his total body area and exposed areas. The examiner who conducted the November 2021 examination opined that, based on the Veteran's statements and a picture of the Veteran that was taken during a flare up, the skin manifestations of his exercise induced anaphylaxis affected 50 percent of his entire body during flare ups of the disability. Moreover, the Veteran has consistently reported that his disability has remained the same/static since its onset in service, and the November 2021 examiner explained that based on the Veteran's treatment records and statements, there did not appear to be any increase in the severity of the stage, nature, extent or duration of his exercise induced anaphylaxis. In light of the above evidence, the Board finds that the evidence is at least evenly balanced as to whether the Veteran's exercise induced anaphylaxis has involved more than 40 percent his entire body or exposed areas during periods of flare up during the entire claim period. As the reasonable doubt created by the relative equipoise in the evidence must be resolved in favor of the Veteran, an initial 60 percent rating for exercise induced anaphylaxis, from May 1, 2009, is warranted. This is the maximum schedular rating under both the old and the amended version of DC 7806. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.118, DC 7806. The Board also finds that a rating higher than 60 percent is not warranted for exercise induced anaphylaxis at any time since the effective date of service connection. The Veteran has not experienced any scarring associated with his disability and has not experienced any other skin disability that may warrant a higher rating. The Board acknowledges that the Veteran has reported occasional shortness of breath during episodes of exercise induced anaphylaxis and that he believes he experiences reduced lung function. The Rating Schedule provides rating criteria for various diseases of the trachea and bronchi that impair lung function, to which the Veteran's disability could be rated by analogy (to include chronic bronchitis, bronchial asthma, pulmonary emphysema, and chronic obstructive pulmonary disease), as well as criteria for rating restrictive lung diseases. Under the diagnostic codes for each of these diseases, a compensable (10 percent) rating for impairment of lung function is warranted if FEV-1 is at least 71 to 80 percent predicted or FEV-1/FVC is at least 71 to 80 percent. See 38 C.F.R. § 4.97, DCs 6600-6604, 6840-6845. As explained above, the pulmonary function testing conducted in April 2009 revealed that the Veteran's FEV-1 was 94 percent predicted before bronchodilator and 96 percent predicted after bronchodilator. A DLCO (SB) test was not conducted because the PFT results were sufficient to evaluate the Veteran's pulmonary status. Pulmonary function testing conducted in February 2020 revealed that pre-bronchodilator testing was normal (FEV-1 of 93 percent predicted and FEV-1/FVC of 85 percent) and that DLCO (SB) testing was not conducted because it was not indicated for the Veteran's condition. Moreover, the Veteran has not regularly taken any medications to treat the respiratory manifestations of his exercise induced anaphylaxis, has not required any outpatient oxygen therapy or any other treatment for respiratory symptoms, and has not been diagnosed as having any respiratory disability other than exercise induced anaphylaxis. Therefore, a separate and/or higher rating is not warranted on the basis of respiratory manifestations of exercise induced anaphylaxis at any time during the claim period. As a final point, in conjunction with the appeal for a higher initial rating for exercise induced anaphylaxis, neither the Veteran nor his representative have raised any other related issues, nor have any other such issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Elwood, 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.