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hypertension Bva Pulmonary Hypertension Claim Award Problem . Others Please Chime In Here.
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Capt.
Hello All,
I have been studying BVA cases and after finding several that have awarded Pulmonary Hypertension as partial percentages increase , I am finding that these may be incorrect and are not following the 38 CFR 4.96 or 4.97 dealing with Respiratory Conditions and the M21 schedulars. After carefully reading the case , and going over the law there are some important decisions that were USURPED decision authority by the BVA and will bring them problems.
Please read the 38 CFR 4.97 and look at the diagnostic code given by this court at 6604. Here is where I see the regulations were violated. There is nothing mentioned about Pulmonary Hypertension until Diagnostic Code 6608 , COPD and the only way that a Pulmonary Hypertension rating can be given is if under Diagnostic code 6608 is that the Diagnosis by Heart Cath or Echo Cardiogram shows a diagnosis of PH. which will cause the rating officer or review officer to rate the COPD at 100 Percent. A Pulmonary Hypertension rating cannot be given or assigned unless you have a Heart Cath or Echo Cardiogram. You can further read down and see where the Diagnostic codes further down also warrant 100 percent but with the same criteria necessary. Either a Heart Cath or an EchoCardiogram showing a diagnosis of Pulmonary Hypertension is listed under the correct diagnostic code or it is not. If it is found there is no such ratings that are to be adjudicated by the BVA. It is automatically 100 percent. WHHOOOOPS.... Oh but read on and see the decision by BVA and how much they steered away from the law.
As in the courts findings here the increase was given for the wrong diagnostic code and PH was given in a percentage of 30-60 percent. Nowhere do the diagnostic codes or ratings allow this. Pulmonary Hypertension is a serious disease that is listed at 100 percent by the VA. There is not really anything listed on a lesser percentage award. It was done from the BVA and is erronous and it appears they just pulled this one flat out of the air or made it up as they went along. I highlighted the areas in red to concentrate on and hope others will chime in on this.
Now I am suppose to be rated under 6608 and 6845 and have a heart cath and echo gram showing conclusively that I have Pulmonary Hypertension. The way this BVA decision went down but lacks following any diagnostic code.......HUH.....they just do what they want to and may cleverly use this law they quoted in the decision. "Any change in a
diagnostic code by a VA adjudicator must be specifically
explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 ", This is an error on the VBA that should be appealed.
I am hoping some others will chime in on this. Now with my claim they did not award the heart cath or echo cardiogram findings for the diagnostic codes 6608(COPD) and 6845( restricted lung disease) with Pulmonary Hypertension TO BE RATED AT 100 PERCENT. It is on an appeal from RO. With this claim above ,the BVA just did what they wanted to. Neither diagnostic code applies to the Ashtma nor is there mention of Pulmonary Hypertension there under the codes for Asthma, So now we have them either ignoring one claim and then making up and falsefying another asthma claim with a faulty decision. I do not think I have interpreted this wrong. It appears straightforward. Oh yes ....I found another decision where they also did it again ...different soldier and different claim. Either the RO is not spotting the diagnostic codes or the BVA kinda hip shoots their decisions. Again our Veterans need to have to deal with these decisions but are sure opening themselves up later to some real problems.
I hope some of you can check this out and see what should be done but also to make the board here aware at how BVA comes up with this stuff and no wonder we have to appeal their decisions. It might even be wise to put this to the HVAC or the OIG. A Veteran does not need to go thru these types of decisions.
NEVER GIVE UP. God Bless, C.C.
Citation Nr: 0335712
Decision Date: 12/18/03 Archive Date: 12/24/03
DOCKET NO. 03-00 902 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Muskogee,
Oklahoma
THE ISSUE
Entitlement to an increased evaluation for service-connected
asthma with asymptomatic minimal pulmonary hypertension,
currently evaluated as 60 percent disabling.
REPRESENTATION
Veteran represented by: AMVETS
ATTORNEY FOR THE BOARD
Christopher P. Kissel, Counsel
INTRODUCTION
The veteran served on active duty from August 1981 to August
1985.
This case comes to the Board of Veterans' Appeals (the Board)
on appeal from a July 2002 rating decision of the Department
of Veterans Affairs (VA) Regional Office (RO) in Muskogee,
Oklahoma.
Issues on appeal
An issue previously on appeal, entitlement to service
connection for sinusitis/rhinitis, was withdrawn by the
veteran in writing in January 2003, following the RO's grant
of service connection. The veteran's withdrawal of the issue
was unnecessary in light of the grant of the benefit sought.
It is additionally noted that the veteran filed a claim of
entitlement to secondary service connection for pulmonary
hypertension in March 2001. Such claim was granted in a July
2002 RO rating decision; pulmonary hypertension, which was
characterized as "minimal" and "asymptomatic" in medical
reports, was included as part of the service-connected
asthma. The claim of entitlement to service connection for
pulmonary hypertension on a secondary basis has been granted
and the issue is therefore moot. However, the matter of a
separate disability rating for pulmonary hypertension will be
addressed in the Board's decision below.
It appears from a statement of the veteran's representative
in February 2003 that additional claims have been raised,
specifically entitlement to a total disability rating based
on individual unemployability due to service-connected
disabilities (TDIU) and entitlement to service connection for
a chronic heart disability.
Such claims have not been adjudicated by the RO and they are
therefore not within the Board's jurisdiction. In light of
the Board's grant of a 100 percent rating for asthma,
described below in this decision, the veteran and her
representative should contact the RO and inform that agency
whether she now wishes to purse any additional claims.
FINDING OF FACT
The veteran's service-connected asthma disability requires
daily use of high dose systemic corticosteroids.
CONCLUSION OF LAW
The criteria for a schedular rating of 100 percent for the
veteran's service-connected asthma have been met. 38
U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.97, Diagnostic
Code 6602 (2003).
REASONS AND BASES FOR FINDING AND CONCLUSION
In the interest of clarity, the Board will initially discuss
certain preliminary matters. The Board will then address the
pertinent law and regulations and their application to the
facts and evidence.
The Veterans Claims Assistance Act of 2000
The Board has given consideration to the provisions of the
Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475,
114 Stat. 2096 (2000) (the VCAA) [codified as amended at 38
U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107 (West 2002)]. This
law eliminated the former statutory requirement that claims
be well grounded. Cf. 38 U.S.C.A. § 5107(a) (West 1991).
The VCAA includes an enhanced duty on the part of VA to
notify a claimant as to the information and evidence
necessary to substantiate a claim for VA benefits. The VCAA
also redefines the obligations of VA with respect to its
statutory duty to assist claimants in the development of
their claims. Regulations implementing the VCAA have been
enacted. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and
3.326(a) (2003).
The VCAA is applicable to all claims filed on or after the
date of enactment, November 9, 2000, or filed before the date
of enactment but not yet final as of that date. In this
case, the veteran's appeal remains pending before the Board
and therefore, is not final. See 38 U.S.C.A. § 7104(a). The
provisions of the VCAA and the implementing regulations are,
accordingly, applicable. See Holliday v. Principi, 14 Vet.
App. 282-83 (2001) [the Board must make a determination as to
the applicability of the various provisions of the VCAA to a
particular claim].
The VCAA alters the legal landscape in three distinct ways:
standard of review, notice and duty to assist. The Board
will now address these concepts within the context of the
circumstances presented in this case.
Standard of review
The current standard of review for all claims is as follows.
Once all the evidence has been brought together, the Board
has the responsibility to evaluate the record on appeal. 38
U.S.C.A. § 7104 (West 2002). When there is an approximate
balance of the evidence regarding the merits of an issue
material to the determination of the matter, the benefit of
the doubt in resolving each issue shall be given to the
claimant. 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R.
§§ 3.102, 4.3 (2003). In Gilbert v. Derwinski, 1 Vet. App.
49, 53 (1990), the United States Court of Appeals for
Veterans Claims (the Court) stated that "a veteran need only
demonstrate that there is an 'approximate balance of positive
and negative evidence' in order to prevail." To deny a
claim on its merits, the evidence must preponderate against
the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996),
citing Gilbert, 1 Vet. App. at 54.
The Board will apply the current standard in adjudicating the
veteran's claim.
Notice
The VCAA requires VA to notify the claimant and the
claimant's representative, if any, of any information and any
medical or lay evidence not previously provided to the
Secretary that is necessary to substantiate the claim. As
part of the notice, VA is to specifically inform the claimant
and the claimant's representative, if any, of which portion,
if any, of the evidence is to be provided by the claimant and
which part, if any, VA will attempt to obtain on behalf of
the claimant. See 38 U.S.C.A. § 5103; see also Quartuccio v.
Principi, 16 Vet. App. 183 (2002) [a letter from VA to a
claimant describing evidence potentially helpful to claimant
but not mentioning who is responsible for obtaining such
evidence did not meet the standard erected by the VCAA].
The record shows that the RO furnished the veteran a letter
in March 2002 advising her of the provisions relating to the
VCAA, to include advising her that she could provide the
names, addresses, and approximate dates of treatment for all
VA and non-VA health care providers. She was informed as
well that she could provide VA authorization to obtain any
private medical records by completing the appropriate forms
(VA Form 21-4142), copies of which were enclosed with the
letter. The Board notes that, even though the letter
requested a response within 30 days, it also expressly
notified the veteran that she had one year to submit the
requested information and/or evidence, in compliance with
38 U.S.C.A. § 5103(b). The one-year period has now expired.
In Paralyzed Veterans of America, et. al. v. Secretary of
Department of Veterans Affairs, 345 F.3d 1334 (Fed. Cir.
2003) [the PVA case], the United States Court of Appeals for
the Federal Circuit (the Federal Circuit) held that 38 C.F.R.
§§ 3.159(b)(1) and 19.9(a)(2)(ii) are invalid to the extent
they provide a claimant "not less than 30 days" to respond
to a VCAA notification letter because the regulations are
contrary to 38 U.S.C.A. § 5103(b), which provides a claimant
one year to submit evidence. In this case, the March 2002
letter sent to the veteran improperly advised the veteran,
informing her that she had only 30 days to respond. However,
the letter also expressly notified her that she had one year
to submit the requested information and/or evidence, in
compliance with 38 U.S.C.A. § 5103(b). In addition, the
veteran has indicated on multiple occasions that she wants a
decision on her case based on the evidence of record. See
e.g. Statement in Support of Claim dated in September 2001,
Report of Contact dated in July 2002, and her statement
waiving the 60-day waiting period on her case dated in
February 2003. The Board is therefore satisfied that she was
notified properly of her statutory rights. See Wensch v.
Principi, 15 Vet. App. 362 (2001) [the VCAA does not apply
where there is extensive factual development in a case which
indicates no reasonable possibility that any further
assistance would aid the claimant in substantiating his
claim].
The Board notes further that the factual scenario in the PVA
case, which involved the RO sending a VCAA notification
letter, as in this case, is simply inapplicable to the
specific circumstances of this case. The Federal Circuit was
concerned with the "premature denial" of a claim before the
one-year period for submitting evidence had expired. In
other words, the Federal Circuit wanted to ensure that a
claimant had sufficient time to submit evidence before an
adjudication was made. Here, the veteran has had more than a
year to submit evidence in support of her claim, which was
filed in March 2001. It now appears that VA has all the
information needed to decide the case. It therefore appears
pointless to wait still longer to adjudicate this appeal when
it is clear that no additional evidence is forthcoming.
Also, the Federal Circuit's concern in the PVA case that a
claimant would be unaware of the time he had left to submit
evidence is inapplicable in the specific circumstances of
this case. The veteran in this case has been made aware on
numerous occasions, in response to the various
statement/supplemental statements of the case and the 90 day
notice of transfer of the claims file to the Board that she
had more time to submit evidence. Since this claimant has,
as a matter of fact, been provided at least one year to
submit evidence after the VCAA notification, and it is clear
that she has nothing further to submit, the adjudication of
her claim by the Board at this time will proceed.
The Board finds that the foregoing information provided to
the veteran satisfies the requirements of 38 U.S.C.A. § 5103
and Quartuccio in that the veteran was clearly notified of
the evidence necessary to substantiate her claim at issue on
appeal. Under these circumstances, the Board finds that the
notification requirement of the VCAA has been satisfied.
Duty to assist
In general, the VCAA provides that VA shall make reasonable
efforts to assist a claimant in obtaining evidence necessary
to substantiate a claim for VA benefits, unless no reasonable
possibility exists that such assistance would aid in
substantiating the claim. The law provides that the
assistance provided by VA shall include providing a medical
examination or obtaining a medical opinion when such an
examination or opinion is necessary to make a decision on the
claim. An examination is deemed "necessary" if the record
does not contain sufficient medical evidence for VA to make a
decision on the claim. See 38 U.S.C.A. § 5103A; 38 C.F.R.
§ 3.159.
The Board finds that reasonable efforts have been made to
assist the veteran in obtaining evidence necessary to
substantiate her claim, and that there is no reasonable
possibility that further assistance would aid in
substantiating her claim. The record shows that the veteran
has been afforded a VA compensation examination in connection
with this appeal, which will be described below. It further
appears all known and available service, private and VA
medical records have been obtained and are associated with
the veteran's claims folder. The veteran does not contend
that additional evidence that is pertinent exists and needs
to be obtained.
In short, the Board has carefully considered the provisions
of the VCAA in light of the record on appeal, and for the
reasons expressed above finds that the development of this
appeal has been consistent with the provisions of the new
law, considering the circumstances presented in this case.
The Board can identify no further development that would aid
the Board's inquiry. See Soyini v. Derwinski, 1 Vet. App.
540, 546 (1991).
In addition, the veteran has been accorded ample opportunity
to present evidence and argument in support of her claim.
She was informed of her right to a hearing and was presented
several options for presenting personal testimony.
See 38 C.F.R. § 3.103 (2003).
It is further noted by the Board that the veteran's
representative submitted additional medical evidence in
August 2003. Such evidence had not been previously
considered by the RO and was unaccompanied by waiver of RO
consideration. This evidence was received by the RO and
forwarded to the Board for appropriate consideration.
In Disabled American Veterans, et. al. v. Secretary of
Department of Veterans Affairs, 327 F.3d 1339 (Fed. Cir.
2003) the Federal Circuit noted that 38 C.F.R. § 19(a)(2)
(2002) was inconsistent with 38 U.S.C.A. § 7104(a) (West
2002) because it denied appellants a "review on appeal"
when the Board considered additional evidence without
remanding the case to the RO for initial consideration.
However, in light of the Board's disposition of this claim,
which will result in a complete grant of the benefits sought,
the Board will proceed with a decision on this claim without
further administrative delay.
Pertinent law and regulations
Disability ratings - in general
Disability evaluations are determined by the application of a
schedule of ratings. 38 U.S.C.A. § 1155 (West 2002);
38 C.F.R. Part 4 (2003). The percentage ratings contained in
the Schedule represent, as far as can be practicably
determined, the average impairment in earning capacity
resulting from diseases and injuries incurred or aggravated
during military service and the residual conditions in civil
occupations. 38 C.F.R. §§ 3.321(a), 4.1 (2003). Separate
diagnostic codes identify the various disabilities.
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
required for that rating. Otherwise, the lower rating will
be assigned. 38 C.F.R. § 4.7 (2003).
Specific schedular criteria - bronchial asthma
The veteran's service-connected asthma disability is
currently rated under 38 C.F.R. § 4.97, Diagnostic Code 6602,
which rates bronchial asthma based on results of pulmonary
function tests, the required treatment, and the frequency and
severity of asthmatic attacks.
As noted above, the veteran's asthma disability is presently
rated 60 percent disabling. A 60 percent evaluation under
Code 6602 is assigned where forced expiratory volume in one
second (FEV-1) is in the range from 40- to 55-percent of
predicted value, or; the ratio of FEV-1 to forced vital
capacity (FVC) is in the range from 40- through 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.
The next higher and maximum schedular rating, 100 percent,
may be assigned where the FEV-1 is less that 40 percent of
predicted value, or; the ratio of FEV-1 to FVC is less than
40 percent, or; if there are more than one asthma attack per
week with episodes of respiratory failure, or; if the
condition requires daily use of systemic (oral or parenteral)
high dose corticosteroids or immuno-suppressive medications.
Factual background
A request for an increased rating must be viewed in light of
the entire relevant medical history. See 38 C.F.R. § 4.1
(2001); Peyton v. Derwinski, 1 Vet. App. 282, 287 (1991). In
a case such as this, however, where entitlement to
compensation has already been established and an increase in
the disability rating is at issue, the present level of
disability is of primary concern. See Francisco v. Brown, 7
Vet. App. 55 (1994).
Historically, the record shows that in a rating decision
dated in June 1996, service connection for compensation
purposes was established for asthma and assigned a
30 percent rating under Diagnostic Code 6602. The veteran's
present claim was filed in March 2001, at which time it was
alleged that her condition included secondary pulmonary
hypertension.
The veteran was thereafter evaluated on VA respiratory
examination in April 2002, which diagnosed her with bronchial
asthma, stable; and minimal pulmonary hypertension,
asymptomatic, which the examiner felt based on a review of
the evidence in the claims file was caused by chronic
pulmonary disease and asthma. It also was noted on this exam
that the veteran was using an inhaler, alburterol (two puffs
as needed), as well as a nasal spray, flunisolide (two sprays
twice per day). [With respect to these inhalers/sprays, the
Board observes that the veteran subsequently submitted a
medical information sheet which indicated that the nasal
spray flunisolide is a synthetic (man-made) corticosteroid
and that the usual dosage for adults is two sprays in each
nostril twice per day, which could be increased to three
times per day; a second medical info sheet submitted by the
veteran indicated that the maximum dosage for flunisolide was
four puffs twice per day].
In addition, a pulmonary function test (PFT) was completed at
the time of the April 2002 examination; this PFT was
interpreted by the examiner as showing a normal spirometry
study with FVC of 71 percent and FEV-1 of 79 percent (ratio
of FEV-1 to FVC of 87). The chest X-rays also showed a
normal study.
In addition to the above, VA and private treatment reports
dated in November 2000 to March 2001 time frame showed
ongoing medical management of her asthma condition, and these
records also showed continued treatment with the alburterol
inhaler and flunisolide nasal spray in the dosage indicated
on the April 2002 VA exam.
Also of record is a VA physician's summary report dated in
January 2001, prepared following an evaluation conducted in
December 2000, which indicated that the veteran's asthma was
moderate in severity and was being treated adequately.
A follow-up report dated in March 2001 indicated that her
asthma symptoms had improved even without use of medications.
Based on the above evidence, the RO denied entitlement to an
increased rating (above 30 percent) by rating decision in
July 2002. The veteran subsequently perfected an appeal to
the Board.
During the pendency of this appeal, additional VA treatment
records were added to the file. These records, dated through
January 2003, denoted in several reports that other treatment
regimens for asthma would be maximized. Specifically, a
report dated in September 2002 indicated that following
consultation with an allergist and implementation of a plan
to limit her exposure to known allergens, she continued to
have problems with asthma and accordingly, she was instructed
to increase her use of the inhaled corticosteroid, AeroBid
[trade name for flunisolide] to two puffs twice per day.
Subsequently, these reports indicated that she started using
an oral pill form of flunisolide in November 2002 in addition
to the nasal spray form of this medication, and that she
suffered asthmatic attacks in December 2002 and January 2003.
These reports also detailed responses to her email inquires
to her primary care VA physician, who instructed her in
December 2002 to increase her use of the inhaled flunisolide
to 4 puffs per day.
Based on these reports, a RO Decision Review Officer
increased her disability rating to 60 percent by rating
decision in January 2003 on the basis of monthly visits to
physician for required care of exacerbations of asthma.
Thereafter, the record shows that the veteran's primary care
VA physician advised her in an email dated January 29, 2003
that 4 puffs of the nasal spray flunisolide twice per day
represented the maximum dose of this medication. This same
physician also prepared a statement on January 17, 2003
indicating that the veteran would benefit from not being
exposed to low humidity environments and that she would
benefit from use of a nebulizer [device used to reduce liquid
medication to extremely fine mist, useful for delivering
medication to deeper parts of respiratory system] at home and
at work to prevent further exacerbations of her asthma.
Additional records associated with the file showed that the
veteran was taking the maximum dose of the inhaled spray-form
of flunisolide [4 puffs two times a day] by medication list
reports dated January 17, 2003, March 13, 2003 and June 14,
2003; a previously-dated report of January 4, 2003 indicated
that her dosage on that date was only 2 puffs two times a
day.
Analysis
Assignment of diagnostic code
The assignment of a particular diagnostic code is
"completely dependent on the facts of a particular case."
See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One
diagnostic code may be more appropriate than another based on
such factors as an individual's relevant medical history, the
diagnosis and demonstrated symptomatology. Any change in a
diagnostic code by a VA adjudicator must be specifically
explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629
(1992).
In this case, the Board finds that 38 C.F.R. § 4.97,
Diagnostic Code 6602 [bronchial asthma] is the most
appropriate rating criteria under which to evaluate the
veteran's asthma, based on the relevant history, diagnosis
and current symptomatology. The Board has not identified any
more appropriate diagnostic code, and the veteran has
suggested none.
Increased rating consideration
The Board has carefully reviewed the evidence of record. For
reasons explained immediately below, and resolving doubt in
the veteran's favor, the Board finds that the evidence
supports a 100 percent disability rating.
The Board emphasizes that the schedular criteria under
Diagnostic Code 6602 are set forth in the alternative, as
demonstrated by the use of "or" in the language followed by
a semicolon, such that satisfaction of one criterion for the
higher rating is sufficient. Cf. Johnson v. Brown, 7 Vet.
App. 95, 97 (1994).
In the present case, the Board finds that, with resolution of
the benefit of the doubt in the veteran's favor, the evidence
supports a grant of a total schedular rating
[100 percent] for the veteran's service-connected asthma.
The recent medical evidence discussed above confirms that the
veteran is now taking the maximum dosage of the
corticosteroid flunisolide on a daily basis. Although the
evidence of record does not establish that she meets each and
every requirement for 100 percent disability rating under
Diagnostic Code 6602, she does meet one of them, daily use of
systemic (oral or parenteral) high dose corticosteroids.
Because the schedular criteria are set forth in the
disjunctive rather than conjunctive, meeting one requirement
is sufficient basis to award the higher rating. See Johnson,
supra.
The Board observes that the RO indicated in its supplemental
statement of the case dated in February 2003 that there was
no evidence showing that the veteran was using a high-dose
corticosteroid. This assertion appears to have been refuted
by a January 2003 email from the veteran's primary care VA
physician as well as the medical information sheet submitted
by the veteran showing that the maximum dosage for the nasal
spray form of flunisolide was 4 puffs twice per day, which is
the veteran's current dosage.
The Board observes further that the evidence shows an
increase in the veteran's asthma symptoms, as demonstrated by
December 2002 and January 2003 exacerbations of her condition
which required medical treatment and evidently led to the
increase her medications and specifically to the use of both
an oral and nasal spray form of the corticosteroid
flunisolide. The recent evidence also shows that she
suffered recent asthma attacks despite her avoidance of known
allergens following a consultation with an allergist, and
that she has been advised to use a nebulizer at home and at
work to help her condition.
Hence, although her PFT test scores and frequency of
asthmatic attacks does not equate to the criteria for the 100
percent rating, the veteran does meet the criteria for such a
rating based on the current medication regimen, namely high-
dose daily use of corticosteroids. As stated above, this is
an independent basis to grant the 100 percent total schedular
rating. The Board therefore finds that the veteran meets the
schedular criteria for the 100 percent rating under
Diagnostic Code 6602. Accordingly, an increased (100
percent) schedular rating is warranted.
Esteban considerations
Except as otherwise provided in the rating schedule, all
disabilities, including those arising from a single disease
entity, are to be rated separately, unless the conditions
constitute the same disability or the same manifestation.
See 38 C.F.R. 4.25 (2003); see also Esteban v. Brown, 6 Vet.
App. 259 (1994).
As noted in the Introduction, the veteran's service-connected
asthma includes asymptomatic minimal pulmonary hypertension.
The Board has therefore given thought as to whether the
hypertension should be rated separately.
A careful review of the medical evidence of record supports
the RO's conclusion that the veteran's pulmonary hypertension
is minimal and asymptomatic. As an example, the report of a
December 2000 pulmonary consult included the examiner's note
that testing had revealed "minimal pulmonary hypertension".
No symptoms were recorded. This is consistent with the other
medical evidence of record.
It is clear from the medical evidence that to the extent that
pulmonary hypertension
exists as part of the veteran's service-connected asthma, it
is asymptomatic. Even if a separate rating were to be
assigned, it would be noncompensable. Particularly in light
of the 100 percent disability rating now assigned by the
Board, assigning a separate rating for the asymptomatic
pulmonary hypertension would be an unproductive exercise, and
the Board declines to do so.
Conclusion
In short, for the reasons and bases expressed above the
Board believes that a 100 percent disability rating may be
assigned for the veteran's service-connected asthma with
asymptomatic minimal pulmonary hypertension.
ORDER
A 100 percent disability rating is granted for the veteran's
service-connected asthma with asymptomatic minimal pulmonary
hypertension, subject to the law and regulations governing
the award of monetary benefits.
Edited by Capt.ContaminateLink to comment
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