92 Decision Citation: BVA 92-04903 Y92 BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 DOCKET NO. 90-18 001 ) DATE ) ) ) THE ISSUE An increased rating for splenic neutropenia, with splenomegaly, leukopenia, and anemia, currently evaluated as 60 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Barry F. Bohan, Associate Counsel INTRODUCTION The appellant served on active duty from April 1944 to July 1945. In a rating decision in August 1945, the appellant was granted service connection for pernicious anemia. A 100 percent disability rating was assigned. In February 1949, the diagnosis was changed to splenic neutropenia with splenomegaly and leukopenia. In a rating decision in November 1950, the diagnosis was changed to splenic neutropenia with splenomegaly, leukopenia and anemia, and the disability rating was reduced from 100 percent to 60 percent, effective January 22, 1951. In a decision in March 1982, the Board of Veterans' Appeals (the Board) denied the appellant an increased rating for splenic neutropenia with splenomegaly, leukopenia and anemia. In August 1989, the appellant requested that an increased rating be considered for her service-connected splenic neutropenia with splenomegaly, leukopenia and anemia. The Department of Veterans Affairs Regional Office in San Diego, California (VARO) denied the appellant an increased rating in September 1989. The appellant filed a notice of disagreement in October 1989, and a statement of the case was issued by VARO in November 1989. The appellant filed an appeal to the Board of Veterans' Appeals (the Board) in February 1990. The appellant's claims folder was forwarded by VARO to the Board in Washington, D.C., where it was received in April 1990. In October 1990, the Board remanded this case so that additional medical records could be associated with the appellant's claims folder. In addition, she was to be scheduled for a VA specialist examination in order to evaluate the nature and extent of her service-connected disorder. After this development took place, VARO issued supplemental statements of the case in July and November 1991 which continued to deny the appellant an increased rating for splenic neutropenia. The appellant's claims folder was returned to the Board, where it was received on November 22, 1991. An informal hearing presentation was prepared by the appellant's representative, Disabled American Veterans, and was submitted to the Board in January 1992. The Board notes that in her February 1990 appeal, the appellant wrote: "to state (that) my illnesses and disabilities, for the past 45 years, are not directly related to my service disabilities is a falsification." Since entitlement to service connection for any other disorder has not been developed for appeal, such issues may not be considered by the Board at this time, and are referred to VARO for appropriate action. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends, in substance, that her service-connected disorder is of sufficient severity as to warrant an increased disability rating. DECISION OF THE BOARD For the reasons and bases hereinafter set forth, it is the decision of the Board that current manifestations of the appellant's service-connected splenic neutropenia with splenomegaly, leukopenia and anemia warrant no increase in the currently assigned 60 percent disability rating. FINDING OF FACT The appellant's service-connected splenic neutropenia is currently stable and has been so for many years. The service-connected disorder was described by a VA examiner in May 1991 as "not particularly of any consequence". CONCLUSION OF LAW The appellant's service-connected splenic neutropenia, with splenomegaly, leukopenia, and anemia is no more than 60 percent disabling according to the schedular criteria. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.20, 4.117, Diagnostic Code 7700. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is seeking a rating in excess of the currently assigned 60 percent for her service-connected splenic neutropenia, with splenomegaly, leukopenia, and anemia. "Neutropenia" is defined as a neutrophil count of less than 1000 per cubic millimeter. Neutrophils are components of leukocytes, which are major cellular components of the body's immune system. Harrison's Principles of Internal Medicine 278-280 (11th ed. 1987). "Splenic" is defined as pertaining to the spleen. Dorland's Illustrated Medical Dictionary 1237 (26th ed. 1974). "Splenomegaly" is defined as enlargement of the spleen. Id. "Leukopenia" is defined as a reduction in the number of leukocytes in the blood, the normal count being 5000 per cubic millimeter. Id. 729. "Anemia" is defined as a reduction below normal in the red blood count and quantity of hemoglobin. Id. 70. Initially, the Board finds that the appellant has submitted evidence which is sufficient to justify a belief that her claim is well grounded. 38 U.S.C. § 5107(a) and Murphy v. Derwinski, U.S. Vet. App. No. 90-107, slip op. at 3-5 (November 8, 1990). We base this finding on her contentions. Furthermore, we believe that the medical evidence in this case is adequate for appellate purposes and that we may therefore proceed to a disposition on the merits without the necessity of another remand for further records. In evaluating the appellant's request for an increased rating, the Board considers the medical evidence of record. The medical findings are compared to the criteria in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4 . In so doing, it is our responsibility to weigh the evidence before us. Gilbert v. Derwinski, U.S. Vet. App. No.89-53, slip op. at 13 (October 12, 1990). Since the Schedule for Rating Disabilities does not include a specific category for splenic neutropenia, we must rate by analogy to pernicious anemia. 38 U.S.C. § 1155, 38 C.F.R. §§ 4.20, 4.117, Diagnostic Code 7700. The schedular criteria call for a 60 percent disability rating for chronic pernicious anemia, with definite departures from normal blood count, with impairment of health and severe asthenia. A 70 percent disability rating is warranted for severe chronic pernicious anemia, with marked departures from normal blood count, with severe impairment of health and pronounced asthenia. "Asthenia" is defined as lack or loss of strength or energy; weakness. Dorland's, supra, 130. Words such as "definite", "marked", "severe", and "pronounced" are not defined in the Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just". 38 C.F.R. § 4.6. The Board has carefully reviewed the pertinent medical evidence, including the appellant's entire medical history. Peyton v. Derwinski, U.S. Vet. App. No 90-613 , slip. op. at 9-10 (May 30, 1991). A June 1945 Report of Medical Survey indicated that the appellant had been hospitalized after complaining of weakness and dizziness. The diagnosis was leukopenia of unknown origin. The Board of Medical Survey found her to be unfit for further service due to the disorder and she was discharged. A VA physical examination in February 1946 concluded with diagnoses of (1) leukopenia with lymphocytosis and (2) secondary anemia. However, a VA examination in August 1947 resulted in no finding of leukopenia or pernicious anemia; the diagnosis was mild unclassified anemia. The appellant was thoroughly worked up at a VA hospital in October and November 1948. The final diagnosis was splenic neutropenia with splenomegaly and leukopenia. A VA examination in October 1950 resulted in a diagnosis of anemia, probably due to hypersplenism. A VA special hematology examination in October 1952 resulted in a diagnosis of leukopenia with anemia, cause undetermined. The appellant was thoroughly worked up during a series of VA examinations and tests in the Spring of 1979. She indicated few problems referable to her service-connected disorder since 1950. Bone marrow biopsy was consistent with the appellant's chronic splenic sequestration. Iron stores were noted to be markedly depleted. Severe peripheral leukopenia was also noted. On physical examination, the spleen was markedly enlarged. The appellant was again thoroughly worked up at a VA facility in March 1981. On physical examination, her spleen was large and palpable in the left upper quadrant. A spleen scan revealed an enlarged spleen with increased activity. The conclusion was splenomegaly with hypersplenism. A large number of medical records during the 1980's have been associated with the appellant's claims folder. These records document complaints of, and treatment for, a variety of disorders. With respect to her service-connected disorder, she was evaluated on an outpatient basis at a VA facility in February 1988. The assessment of the examiner was "clinically stable with difficult problem". A VA examination was conducted in May 1991 in order to evaluate the appellant's service-connected splenic neutropenia, with splenomegaly, leukopenia, and anemia. The appellant, age 68, was 5'4" tall and weighed 188 pounds. Her state of nutrition was described as "well". It was noted by the examiner that neutropenia and splenomegaly were "not particularly of any consequence". After reviewing the appellant's medical history, the Board has concluded that symptomatology referable to her service-connected disorder has remained essentially stable for years and does not approach that required for an increased disability rating. There is no indication of anemia. In fact, the appellant, at 188 pounds appears to be robust. The Board is, of course, aware of various contentions made by the appellant, particularly in a letter to Senator Alan Cranston in January 1990, in her appeal to the Board in February 1991, and in a statement in July 1991. The letter to Senator Cranston referred to "slow deterioration of my physiological and psychological health". The Board has no reason to doubt that self-assessment; indeed, the medical records indicate that the appellant, who is approaching 70 years of age, has developed a number of physical infirmities. However, there is no medical evidence of record which indicates that the appellant's service-connected disorder has worsened, or that symptomatology attributable to that disorder approaches that which is required for a 70 percent disability rating. Lay hypothesizing, particularly in the absence of any supporting medical authority, serves no constructive purpose. Hyder v. Derwinski, U.S. Vet. App. No. 90-254, slip op. at 7 (April 15, 1991). ORDER An increased rating for splenic neutropenia, with splenomegaly, leukopenia, and anemia, currently evaluated as 60 percent disabling, is denied. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 MATTHEW J. GORMLEY, III JACK J. RHEINGOLD, M.D. KENNETH R. ANDREWS, JR. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C. § 7266 (1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a notice of disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988 (§ 402 of the Veterans' Judicial Review Act (Pub. L. 100-687)). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.