Citation NR: 9609356 Decision Date: 04/05/96 Archive Date: 04/16/96 DOCKET NO. 94-17 177 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina THE ISSUE Entitlement to an increased (compensable) rating for the service-connected anemia, secondary to vitamin B12 deficiency. REPRESENTATION Appellant represented by: North Carolina Division of Veterans Affairs WITNESSES AT HEARING ON APPEAL The veteran and her husband ATTORNEY FOR THE BOARD Roberto D. DiBella, Associate Counsel INTRODUCTION The veteran had active duty from February 1981 to November 1992. In a decision of April 1993, the RO granted service connection for anemia, secondary to vitamin B12 deficiency and assigned a noncompensable rating, effective on November 2, 1992. CONTENTIONS OF APPELLANT ON APPEAL The veteran maintains that, because she will be required to take B12 shots for the remainder of her lifetime to control her anemia, her condition is severe enough to warrant a compensable rating. DECISION OF THE BOARD The Board of Veterans’ Appeals (Board), in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence favors the claim for increase and supports the assignment of a 10 percent rating for the service-connected anemia, secondary to vitamin B12 deficiency. FINDINGS OF FACT 1. All relevant evidence for an equitable disposition of the veteran's appeal has been obtained. 2 The veteran probably has complaints of weakness related to her currently diagnosed pernicious anemia which requires monthly vitamin B12 shots for the remainder of her life. CONCLUSION OF LAW The criteria for the assignment of a 10 percent rating for the service-connected anemia, secondary to vitamin B12 deficiency has been met. 38 U.S.C.A. §§ 1155, 5107, 7104 (West 1991); 38 C.F.R. §§ 3.102, 3.321, 4.7, 4.40, 4.117 including Diagnostic Code 7700 (1995). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Historical Based on the service medical records and a VA examination performed in March 1993, the RO assigned a noncompensable rating for the service-connected anemia, secondary to vitamin B12 deficiency. The veteran was hospitalized in a private hospital in February 1993 with pertinent findings showing an iron deficiency and was started on B12 doses. The relevant diagnosis was that of a B12 deficiency, probably secondary to pernicious anemia. A May 1993 medical statement indicated that the veteran’s pernicious anemia had been treated and improved and that her prognosis was good. A November 1993 statement indicated that her diagnosed pernicious anemia was a permanent condition which required monthly intramuscular B12 injections for the remainder of her life. In connection with a VA examination in March 1993, it was noted, by way of history, that the veteran had been hospitalized in 1991 for severe anemia for which she was begun on B-12 injections. Laboratory testing at that time revealed findings of a low hemoglobin count of 11.8 g/dl and a low hematocrit count of 34.8%. On a March 1994 VA examination, the veteran complained of a lack of energy and weakness. A physical examination revealed that the conjunctiva was slightly pale; no cervical lymphadenopathy, ecchymosis or purpura of the skin or splenomegaly was noted. The hemoglobin count was 13.1 g/100 dl (with the noted normal range being from 12 to 16) and her hematocrit was 38.4% (with the noted normal range of 37 to 47); however, the examiner noted that changes in blood count could not be adequately assessed as the veteran was continuing to receive B12 shot injections. The relevant diagnosis was pernicious anemia which required B12 shots. A May 1994 statement provided by a private physician indicated that the veteran had history of pernicious anemia which required B12 shots to maintain her hematocrit to as normal level as possible, and the most recent hematocrit on May 5, 1994 was 34.5 which was slightly low. The physician believed that, without the B12 shots, her anemia would be clearly demonstrated. An April 1995 VA examination revealed laboratory findings which included a hemoglobin count was 12.8 g/dl and the hematocrit level was noted to be 36.7%. The veteran and her husband appeared at the RO in August 1994 for a personal hearing. She testified that she currently had extreme weakness in her arms and legs, and additionally had numbness or tingling in her extremities. She added that she took B12 injections intramuscularly once a month and, without these injections, she would get weaker and weaker. The veteran’s husband testified that, several days before taking her monthly injection, the veteran had, on occasion, slowed down and, once she got the injection, she perked up. II. Analysis The Board finds the veteran's claim for increased compensation benefits is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). The United States Court of Veterans Appeals (Court) has held that, when a veteran claims a service-connected disability has increased in severity, the claim is well grounded. Proscelle v. Derwinski, 2 Vet.App. 629 (1992). Where pernicious anemia results in a hemoglobin count of 8 gm/100 ml or less with findings such as weakness, easy fatigability, headaches, lightheadedness, or shortness of breath, a 30 percent evaluation is assigned. Where pernicious anemia results in a hemoglobin count of 10 gm/100 ml or less with findings such as weakness, easy fatigability or headaches, a 10 percent evaluation is assigned. Where pernicious anemia results in a hemoglobin count of 10 gm/100 ml or less, asymptomatic, a noncompensable evaluation is assigned. 38 C.F.R. § 4.117 including Diagnostic Code 7700 (1995) In order for the veteran to be assigned a 30 percent evaluation under the applicable rating criteria, her hemoglobin count would have to be 8 gm/100 ml or less. The clinical evidence demonstrates no such laboratory findings. In addition, the Board notes that related cardiovascular manifestations and findings of headaches, lightheadedness and shortness of breath are not demonstrated by the medical evidence of record. Thus, the Board finds that the assignment of a rating higher than 10 percent for the service-connected anemia, secondary to vitamin B12 deficiency is not for consideration. In order for the veteran to be assigned a 10 percent evaluation under the applicable rating criteria, her hemoglobin count would have to be 10 gm/100 ml or less with findings such as weakness, easy fatigability or headaches. The veteran’s hemoglobin counts are within normal limits, but her hematocrit levels have been low. Both VA and private physicians have diagnosed her with pernicious anemia. These clinical findings, in the Board’s opinion, more nearly approximate that level of disablement which would warrant the assignment of a 10 percent rating. Because the medical evidence establishes that her pernicious anemia is symptomatic and requires regular B12 injections, the Board finds that a 10 percent rating is assignable in this case. In reaching the determination that an evaluation 0f 10 percent is warranted, consideration has been given to the provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the appellant, as required by Schafrath v. Derwinski, 1 Vet.App. 589 (1991). However, the Board has applied all the provisions of Parts 3 and 4 that would reasonably apply in this case. 38 C.F.R. § 3.321(b)(1) provides that where the disability picture is so exceptional or unusual that the normal provisions of the rating schedule would not adequately compensate the veteran for his service-connected disability, then an extraschedular evaluation will be assigned. Nevertheless, the veteran has not submitted any evidence to show an unusual disability picture. Thus, consideration for an assignment of a higher rating on an extraschedular basis under the provisions of 38 C.F.R. § 3.321(b)(1) is not warranted ORDER An increased rating of 10 percent for the service-connected residuals of anemia, secondary to vitamin B12 deficiency is granted. The appeal is allowed subject to the regulations governing the payment of VA monetary benefits STEPHEN L. WILKINS Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741 (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 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. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). 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. - 2 -