Citation Nr: A26024924 Decision Date: 03/19/26 Archive Date: 03/19/26 DOCKET NO. 210323-149607 DATE: March 19, 2026 ORDER Entitlement to service connection for costochondritis is granted. Entitlement to a 10 percent evaluation, but no higher, for service-connected asthma is granted. FINDINGS OF FACT 1. Resolving all doubt in favor of the Veteran, evidence supports that the costochondritis disorder is attributable to service. 2. During the period on appeal, the Veteran's asthma symptomatology more nearly approximated intermittent inhalational or oral bronchodilator therapy; the disorder did not at any time during the appeal period more nearly approximate bronchial asthma FEV-1 of 56 to 70 percent predicted, or the ratio of FEV-1/FVC of 56 to 70 percent, or daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for costochondritis have been met. 38 U.S.C. §§ 1110, 1113, 1120, 1131, 5107; 38 C.F.R. §§ 3.102, 3.104, 3.303, 3.320, 4.3. 2. The criteria for entitlement to an initial increased evaluation of 10 percent, but no higher, for service-connected asthma have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.4, 4.7, 4.97, Diagnostic Codes 6602. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 2015 to June 2019. These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2021 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In a March 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On September 18, 2024, the Veteran testified at a Board hearing. A transcript of the hearing is of record. Thus, the Board may only consider the evidence of record at the time of the January 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran at the September 2024 hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted during the period after the AOJ issued the decision on appeal and prior to the Board hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim(s), considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 1. Entitlement to service connection for costochondritis is granted. The Veteran seeks service connection for costochondritis, which he asserts onset during military service. See March 2019 VA Form 21-526EZ. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated during service, the so-called "nexus" requirement. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease initially 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). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case, and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (benefit-of-the-doubt rule not for application when evidence persuasively favors one side or the other). In evaluating the evidence, the Board is charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Turning to the record, regarding the first element of service connection, the Board finds that the Veteran has a current costochondritis diagnosis. See April 2019 VA Muscle Injuries Examination Report; see also October 2019 VA Medical Record. Thus, the first element of service connection, a current disability, has been met. The second service connection element requires evidence showing in-service incurrence or aggravation of a disease or injury. The agency of original jurisdiction (AOJ) favorably found that the Veteran's service treatment records (STRs) show complaints of chest pain and conceded a qualifying event, injury, or disease had its onset during service. See January 2021 Rating Decision. Under the AMA, the Board is bound by favorable findings made by the AOJ in the absence of clear and unmistakable error. 38 C.F.R. § 3.104(c). The Board therefore finds that the second element of service connection is met. The remaining necessary element to establish service connection is evidence of a causal relationship between the present disability and the disease or injury incurred in or aggravated during service, the so-called "nexus" requirement. Here, the question for the Board is whether the current costochondritis disability began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board finds that record on appeal contains competent medical evidence that addresses the etiology of the Veteran's costochondritis disorder and provides evidence of a causal relationship between that present disability and the in-service injury. The Veteran underwent an April 2019 VA examination for the costochondritis disorder. Although the examiner listed an April 2019 diagnosis date, he indicated the history of the muscle injury as beginning during the Veteran's service in June 2016, and including symptoms of sharp, stabbing chest pain. The examiner also indicated that the disorder has continued since onset, to include consistent bilateral pain in the chest. See April 2019 VA Examination Report. The Board notes that the STRs support that the Veteran had diagnosed chest pain during service. See, e.g., December 2016, January 2017, and February 2017 STRs. The Veteran underwent a second VA examination for the claim in October 2020. Although that VA examiner indicated that the Veteran does not have a diagnosed muscle injury, she noted the history of the disorder as occurring in 2016 while the Veteran was in service. She also indicated that the Veteran continues to have intermittent chest pain. See October 2020 VA Examination Report. The Board finds that both VA examiners have training, knowledge, and expertise on which they relied to perform the examination and render the opinions. The Board observes that it is within the province of a qualified professional to determine the significance of evidence, which the VA examiners did in this case. As such, the Board finds both the April 2019 and October 2020 VA examination reports provide an adequate basis upon which to decide the claim. Although the October 2020 VA examiner did not render a diagnosis, she indicated that the Veteran had chest pain symptoms that began during service and continue to the present. That, in combination with the April 2019 examiner's thorough and comprehensive examination report as well as the other medical evidence of record, supports the Veteran's service connection claim. Based on the foregoing and resolving all reasonable doubt in favor of the Veteran, the Board concludes that the evidence supports the claim for service connection for costochondritis. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102, 4.3; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Thus, the appeal as to this claim is granted. The Board does not make any determination as to the effective date or rating percentage for this award; the assignment of those downstream elements is properly left to the AOJ in the first instance. See, e.g., Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). 2. Entitlement to a 10 percent evaluation, but no higher, for service-connected asthma is granted. The Veteran seeks an increased initial rating for service-connected asthma. See March 2021 VA Form 10182. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. A disability rating may require re-evaluation in accordance with changes in a veteran's condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1. When a claimant is awarded service connection and assigned an initial disability rating, separate disability ratings may be assigned for separate periods of time in accordance with the facts found. Where a veteran is appealing the rating for an already established service-connected condition, his present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). When adjudicating a claim for an increased initial evaluation, as is the case here, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev'd on other grounds, Moore v. Shinseki, 555 F.3d 1369 (2009). When adjudicating a non-initial increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509. A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him or her through the senses. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. In evaluating the evidence, the Board is charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). The claimant is entitled to the benefit of the doubt when there is an approximate (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021). Currently, the asthma disorder is rated noncompensable under Diagnostic Code 6602 based on a diagnosed disability with no compensable symptoms. See January 2021 Rating Decision; see also 38 C.F.R. § 4.97. Under Diagnostic Code 6602, a 10 percent disability rating is warranted for bronchial asthma with FEV-1 of 71- to 80-percent predicted; or FEV-1/FVC of 71 to 80 percent; or intermittent inhalational or oral bronchodilator therapy. A 30 percent disability rating is warranted for bronchial asthma FEV-1 of 56- to 70-percent predicted; or FEV-1/FVC of 56 to 70 percent; or daily inhalational or oral bronchodilator therapy; or inhalational anti-inflammatory medication. A 60 percent disability rating is warranted for bronchial asthma with FEV-1 of 40- to 55-percent predicted; or FEV-1/FVC of 40 to 55 percent; or at least monthly visits to a physician for required care of exacerbations; or intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. A 100 percent rating is warranted for FEV-1 less than 40-percent predicted; or FEV-1/FVC less than 40 percent; or more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications. A Note to Diagnostic Code 6602 requires that in the absence of clinical findings of asthma at time of examination, a verified history of asthmatic attacks must be of record. 38 C.F.R. § 4.97. Turning to the evidence, the Veteran underwent a VA examination in connection with the initial asthma claim. See April 2019 VA Examination Report. The VA examiner indicated an asthma diagnosis and further indicated that the condition did not require the use of inhaled medications, oral or parenteral corticosteroid medications, oral bronchodilators, antibiotics, or outpatient oxygen therapy. A pulmonary function test (PFT) was conducted, with results as follows: FVC at 103% predicted; FEV-1 at 98% predicted; and FEV-1/FVC at 807%. The examiner also noted that post-bronchodilator testing was not completed because pre-bronchodilator results were normal. See id. Based on the evidence, including the April 2019 VA examination, the AOJ denied a compensable disability evaluation for the asthma disorder. However, the Board notes that the service treatment records (STRs) clearly show that the Veteran was prescribed an albuterol inhaler during service to treat his asthma. See January and February 2017 STRs. Each medical notation regarding the albuterol inhaler noted that the Veteran should use it as needed. See id. The Veteran, too, endorsed that although there are times when he uses the inhaler for days at a time, he also goes days without using it at all. See September 2024 Board Hearing Transcript. The Board finds the Veteran's reports of asthma symptoms and inhaler usage are competent and credible. Jandreau v. Nicholson, 492 F.3d 1372, 1377, n. 4 (Fed. Cir. 2007). Thus, the Board finds that the evidence shows that during the appeal period, the asthma has been shown to result in symptoms that more nearly approximate intermittent inhalation or oral bronchodilator therapy as contemplated by a 10 percent rating under Diagnostic Code 6602. The evidence shows that the Veteran has a prescription for an asthma inhaler to be used as needed throughout the appeal period, and he used the inhaler intermittently. See, e.g., January and February 2017 STRs; September 2024 Board Hearing Transcript. However, a higher, 30 percent evaluation is not warranted, as the record contains no evidence that shows that during the period on appeal, the Veteran experienced asthma with PFT results of FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication. Rather, the Veteran had PFT results well above those required for a 30 percent evaluation, and his inhaler prescription was noted to be used as needed. See April 2019 VA Examination Report. Further, the Veteran testified that he uses his inhaler as needed and sometimes goes for days without needing it. See September 2024 Board Hearing Transcript (testifying that he sometimes will go a couple of days without using his inhaler, then go three days using it every six hours, then back to not using the inhaler). Additionally, the Veteran testified that he has never been on prednisone, a corticosteroid, to treat his asthma. See id.; see also November 2017 STR (denying that he takes prednisone, among other steroids). No additional relevant evidence, medical or otherwise, was received by the Board during the 90-day post-hearing evidentiary window. Based on the foregoing and resolving all reasonable doubt in the Veteran's favor, the Board finds that a 10 percent evaluation, but no higher, is warranted for the Veteran's asthma disability as rated under Diagnostic Code 6602. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, 21 F.4th at 779. To that extent, the appeal for an increased disability evaluation for asthma is granted. Of final note, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record on appeal, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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); see also, e.g., September 2024 VA Letter (showing the Veteran is in receipt of vocational rehabilitation subsistence allowance while he completes a course of study for a bachelor's degree). J. NICHOLS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C.Z. Noh 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.