Citation Nr: 0000837 Decision Date: 01/11/00 Archive Date: 01/27/00 DOCKET NO. 96-18 149A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to service connection for cardiovascular disease as secondary to service-connected inactive pulmonary tuberculosis. 2. Entitlement to increased rating for residuals of inactive pulmonary tuberculosis, currently evaluated as 30 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD B.E. Jordan, Counsel INTRODUCTION The veteran had active military service from October 1942 to October 1945. This appeal to the Board of Veterans' Appeals (Board) arises from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. In November 1997, the veteran had a hearing at the RO before the below signing Board member. The Board remanded this matter to the RO for further development in May 1998. The Board is satisfied that the RO has complied with the Remand directives. FINDINGS OF FACT 1. On the increased evaluation issue, all the evidence necessary for an equitable disposition of this matter has been obtained. 2. The claim of entitlement to secondary service connection for a cardiovascular disability is not plausible. 3. The residuals of inactive pulmonary tuberculosis are manifested by fatigue, shortness of breath, thickened pleura and calcific changes of the right lung, a restrictive lung disease, a FEVI of 69 percent and a FEV1-FEV of 92 percent in March 1996 and a FEV1 of 71 percent and a FEV1-FEV of 92 percent in January 1999. 4. No unusual or exceptional disability factors have been presented with respect to the veteran's service connected residuals of inactive pulmonary tuberculosis. CONCLUSIONS OF LAW 1. The claim of entitlement to service connection for a cardiovascular disorder is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The criteria for a disability evaluation in excess of 30 percent for residuals of inactive pulmonary tuberculosis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.97, Diagnostic Codes 6600, 6722, 6731, 6825-6733, 6840-6845 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service connection was initially granted for pulmonary tuberculosis (PTB), moderately advanced, on a presumptive basis, effective in July 1950. This disability was initially rated at 100 percent until September 1955, when, two years after becoming inactive, the schedular rating was on a graduated basis until September 1964, since which time a noncompensable schedular rating had been in effect. The veteran was awarded entitlement to a special monthly compensation in the interim. A 20 percent disability evaluation was subsequently assigned in May 1975. At that time, the veteran's disability was characterized as inactive moderately advanced pulmonary tuberculosis. X-rays dated in 1974 and 1975 showed no activity or significant interval change. Diminished breath sounds on the right were noted on a number of occasions at a VA outpatient clinic. A VA pulmonary function test showed slight diminished vital capacity. Diagnoses included inactive pulmonary tuberculosis with slight pulmonary impairment. When examined by VA in February 1981, the veteran complained of shortness of breath and fatigability. Studies revealed marked restrictive impairment consistent with the effects of the service-connected tuberculosis. X-rays of the lungs associated with the examination showed inactive tuberculosis. The diagnosis was PTB inactive. Subsequent X-rays of the lungs dated in 1982 and 1983 revealed no change. A diagnosis of a moderately advanced inactive PTB was recorded. In August 1995, the veteran filed an informal claim for an increased evaluation for his service-connected respiratory disability and a claim for service connection for a restrictive lung disease as secondary to the service- connected inactive pulmonary tuberculosis. In support of his claim, the veteran submitted a statement of Hugo D. Montenegro, M.D. dated in July 1995. In that statement Dr. Montenegro indicated that the veteran was being followed at University Hospital of Cleveland. It was noted that the veteran carried a diagnosis of restrictive lung disease which was secondary to the old tuberculosis and secondary to treatment for tuberculosis, including the induction of pneumothoraces. The doctor also stated that the veteran developed problems with the right side of his heart because of the restrictive ventilatory defect. Dr. Montenegro provided that the veteran was being treated for atypical mycobacterial disease. In a VA evaluation form dated in February 1996, the veteran complained of shortness of breath, light headedness, circulatory and heart problems. X-rays of the chest dated in March 1996 revealed extensive chronic changes with thickened pleura and calcific changes involving the pleura on the right, fibrotic and chronic markings throughout the visualized right lung parenchyma, mediastinal shift to the right, small nodule in the upper middle third of the left lung field. Otherwise, the left lung was normal. When examined by VA in March 1996, the veteran complained of easy fatigability. A cardiovascular examination revealed that the heart was not enlarged and that there were normal heart sounds with no murmur. An electrocardiogram (EKG) associated with the examination revealed normal sinus rhythm with no evidence of heart enlargement, and there were no peaked waves. X-rays of the heart were negative for cardiomegaly. The diagnoses included history of right ventricular enlargement and no cardiomegaly. The veteran also underwent a pulmonary examination in March 1996. At that time he complained of shortness of breath after climbing 14 steps. On examination, there was no shortness of breath; there was diminished breath sound on the right lung with diminished expansion of the right chest. Breaths sound on the left side were normal. No rales were detected. It was noted that tuberculosis of the right chest was inactive and that the veteran had undergone recent antituberculosis treatment (medication) 8 months ago. Pulmonary function testing indicated FEV1 at 69 percent of predicted, and a ration of FEV1/FVC of 92 percent. At the conclusion of the physical examination, a diagnosis of pulmonary tuberculosis with collapse treatment of the right lung and recent anti-tuberculosis treatment. In an addendum dated in April 1996, the physician who conducted the March 1996 examination added that the veteran had a history of pulmonary tuberculosis and chronic fibrosis that has resulted in structural impairment of the right lung. It was noted that the left lung remained normal. The physician indicated that the veteran was able to climb 14 steps without experiencing any shortness of breath. It was noted that the pulmonary function test suboptimal ability to performVA maneuvers limited interpretation. The examiner noted that pulmonary fibrosis rarely caused cor pulmonale and that the veteran did not have signs or symptoms associated with cor pulmonale. The examiner provided that it was possible that the veteran was on compensated cor pulmonale and that symptoms could result in fatigability. In an April 1996 statement, Dr. Montenegro provided the same assertions found in the July 1995 statement. In January 1997, the veteran testified at a personal hearing before a hearing officer regarding the symptoms associated with service-connected respiratory disability. The veteran testified that the symptoms are more disabling than currently evaluation. In addition, the veteran indicated that he developed an additional lung disorder as a result of the PTB. When examined by VA in April 1997, the veteran demonstrated shortness of breath and heavy breathing when walking downhill. No shortness of breath was found at rest. There was no evidence of cyanosis and agitation. There was a normal mental status. His head, eyes, nose, and throat were unremarkable. His neck was subtle. There was no lymphadenopathy. A chest examination was abnormal. The veteran had restricted motion on the right side and decreased breath sounds on the right side. There were crackles on the posterior lung field in the lower right. His left lung demonstrated distant breath sounds, but his left chest excursion was greater than the right. There was diaphragmatic motion. The examiner indicated that the EKG had not changed. It was noted that chest X-rays showed a fibroses of the right apical pleura and reticular nodular formation in the right lower lung field. There was blunting of the right costophrenic angle and elevation of the right diaphragm. There was bronchomegaly, tracheomegaly presented and hyperinflation of the left lung. The heart appeared to be normal in size, but the heart was obscured by its movement to the right side of the chest due to the collapsed right lung. As to a diagnosis, the examiner determined that the veteran had extensive fibrosis, hyperinflation compensatory reduction in the arterial tree in compensatory; it was noted that the left lung was performing actively for gas exchange. A pulmonary function test dated in March suggested a restrictive defect in the lung function. With respect to the restrictive obstructive disease, the veteran had functional deficit with exercise on exertion. There was no excluded cardiac cause. The reduction and excess performance could be attributed to reduction in lung function with age that was accelerated in the presence of the previous thoracoplasty for tuberculosis and the veteran's treatment of tuberculosis. The examiner concluded that the veteran appeared to be moderately disabled or mildly dysfunctional from performing activities that appeared to be a direct result of the fibrosis and loss of volume in the right lung rather than other cardiac or metabolic causes. At the November 1997 hearing, the veteran provided testimony consistent with the January 1997 personal hearing discussed above. The report of a VA examination dated in November 1998 reveals that there was no history, physical examination, EKG, or echocardiogram of cor pulmonale associated with pulmonary tuberculosis. The examiner opined that there was no cardiac disability involved with the veteran. Pulmonary Functions test dated in December 1998 revealed FEV1 at 71 percent of predicted; ration of FEV1/FVC was 92 percent. When examined by VA in January 1999, the veteran became tachypneic and used his accessory muscle when he walked a short distance. He recovered with a short period of rest. There was no jugular venous distention. The neck was supple without any lymphadenopathy. His chest was assymmetric being hyperinflated on the left and less inflated on the right. There was a relative decrease in breath sounds in the right lung. The left lung appeared to be normally inflated, if not overinflated. There was no wheezing, crackle, or rhonchi. The heart demonstrated a regular rate and rhythm. There was no right ventricular heave. The extremities did not show any clubbing or cyanosis. It was noted that a chest X-ray dated in December revealed a tracheobronchomegaly with a shifted trachea to the right. The left hemithorax seemed to be hyperinflated and the right was small and shrunken. The pleura on the right side were calcified ad thickened. The lung parenchyma on the right showed fibrotic changes. In comparison to previous X-rays, there was no active disease. All changes were chronic. Pulmonary functions tests dated in December 1998 revealed a reduced forced vital capacity and FEV1 with a preserved FEV1/FVC ration. Lung volumes were all reduced. Diffusion capacity on corrected alveolar was normal. The veteran's maximal inspiratory force was 70 percent predicted which was considered to be within normal limits. The veteran could not perform an expiratory maneuver to record his maximal expiratory pressure. The findings were consistent with a moderate to severe restrictive ventilatory force. Exercise pulse oximetry done by walking on a flat surface which the veteran was tachypneic failed to show any desaturation. An ECG did not show any evidence of right ventricular strain. The examiner noted that ECG dated in November 1998 revealed that the left ventricular cavity size was normal. The estimated left ventricular ejection fraction was 55 percent. The left atrium, right atrium, and right ventricle were within normal size. The right ventricular systolic function seemed to be normal. There was no significant valvular heart disease. Pulmonary artery systolic pressures could not be estimated. As to assessments and diagnoses, the examiner recorded fibrotic changes in the parenchyma secondary to old pulmonary mycobacterial disease. The extensive fibrosis was responsible for severely restrictive ventilatory defect. It was noted that such a condition could be the cause of the severe dyspnea. The degree of restriction was considered moderate to severe. It was noted that advancing age could also be a limiting factor. From the data, the examiner doubted that respiratory muscle weakness could cause the restriction. There was no evidence of cor pulmonale. The examiner opined that the worsening dyspnea was multifactorial in nature and was related to moderate to severe restrictive lung disease that the veteran had from significant fibrosis involving the right lung, some deconditioning, advancing age, and a mild degree of metabolic acidosis. In an April 1999 rating action, the RO increased the veteran's disability evaluation to 30 percent based on pulmonary impairment. II. Secondary Service Connection The threshold question to be answered is whether the veteran has presented evidence of a well-grounded claim, that is, a claim which is plausible and meritorious on its own or capable of substantiation. If he has not, his appeal must fail. 38 U.S.C.A. § 5107(a) (West 1991); Murphy v. Derwinski, 1 Vet. App. 78 (1990). The Board finds that the veteran's claim for service connection is not well grounded, and there is no further duty to assist the veteran in the development of his claim. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 1991). Certain diseases, including a cardiovascular disorder, may be presumed incurred in service if shown to have manifested to a compensable degree within one year after the date of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.307, 3.309 (1999). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a) (1999). See Allen v. Brown, 8 Vet. App. 448 (holding that when aggravation of a non-service-connected disorder is proximately due to or is the result of a service- connected disability, that extent of aggravation is service connected on a secondary basis). A claim for secondary service connection, like all claims, must be well-grounded. Reiber v. Brown, 7 Vet. App. 513 (1995). Generally, when a veteran contends that his or her service-connected disability has caused a new disability, he or she must submit competent medical evidence of a causal relationship directly between the two disabilities to establish a well-grounded claim. Jones v. Brown, 7 Vet. App. 134 (1994). The United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999)(hereinafter, "the Court") has held that a claim for service connection may not be considered to be well grounded where there is no evidence which demonstrates the presence of the disorder alleged by the veteran at any time after discharge from service. Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Service connection is not in order in the absence of any residuals or evidence of a disability currently. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Where a determinative issue involves medical causation, competent medical evidence to the effect that the claim is plausible is required to establish that the claim is well grounded. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). As stated above, in Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990), the Court defined a well-grounded claim as a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of 38 U.S.C.A. § 5107(a) (West 1991). The test is an objective one which explores the likelihood of prevailing on the claim under the applicable standards. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Although the claim need not be conclusive, it must be accompanied by evidence. Furthermore, the evidence must justify a belief by a fair and impartial individual that the claim is plausible. 38 U.S.C.A. § 5107 (West 1991). In Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd 78 F.3rd 604 (Fed. Cir. 1996) (per curiam), the Court stated that in order for a claim to be well-grounded there must be competent evidence of current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the inservice injury or disease and the current disability (medical evidence). The service medical records contain no complaint, diagnosis or treatment for a cardiovascular disability. In this case, however, the veteran does not contend and the evidence does not show that a claimed cardiovascular disorder had its onset in service or during the first year after service. The veteran claims that he is entitled to service connection for a cardiovascular disorder as secondary to his service- connected pulmonary tuberculosis. In support of his claim, the veteran submitted statements of Hugo D. Montenegro, M.D. dated in July 1995 and April 1996 wherein the doctor indicated that the veteran has a problem with the right side of his heart that stems from his service-connected tuberculosis. However, VA medical records dated in 1996, 1997, and 1999 unequivocally establish that the veteran does not have a heart disability. These records reflect that there is no evidence of cor pulmonale. Moreover, the 1997 records reflect that the heart appeared to be normal in size. In 1999, the veteran's heart rate was normal and there was no significant valvula heart disease. The Board notes that in the absence of a current disability, the veteran's claim is not plausible. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Based on the foregoing, the Board finds that a well grounded claim has not been submitted on the issue of entitlement to service connection for cardiovascular disability as secondary to inactive pulmonary tuberculosis. Because the veteran's claim for service connection is not well grounded, VA is under no duty to further assist him in developing facts pertinent to that claim. 38 U.S.C.A. § 5107(a) (West 1991). VA's obligation to assist depends upon the particular facts of the case and the extent to which VA has advised the claimant of the evidence necessary to be submitted with a VA benefits claim. The Board's decision serves to inform the veteran of the kind of evidence that is necessary to make his claim well grounded. See Robinette v. Brown, 8 Vet. App. 69, 78 (1995). While the veteran and other lay individuals are competent to provide evidence of visible symptoms, they are not competent to provide evidence that requires medical knowledge. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992). There is no objective evidence of record in the form of medical treatment or examination records that show that the veteran has a current cardiovascular disability. Absent evidence of any current disability which could be associated with a service- connected disability, the Board finds the claim is not plausible. Therefore, the Board finds that the veteran's claim for service connection is not well grounded. Although the Board has considered and denied the appeal on grounds different from that of the RO, which denied the claim on the merits, the veteran has not been prejudiced by the Board's decision. This is because in assuming that the claim was well grounded, the RO accorded the veteran greater consideration than the claim in fact warranted under the circumstances. Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993). III. Increased Evaluation The Board finds that the claim for service connection for inactive pulmonary tuberculosis is well grounded. see Proscelle v. Derwinski, 2 Vet. App. 629 (1992) (a claim of entitlement to an increased evaluation for a service- connected disability generally is a well-grounded claim). In accordance with 38 C.F.R. §§ 4.1, 4.2 (1999) and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed the veteran's service medical records and all other evidence of record pertaining to the history of the veteran's service connected PTB and has found nothing in the historical record that would lead to a conclusion that the current evidence of record is not adequate for rating purposes. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R. Part 4. The Board attempts to determine the extent to which the veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.1, 4.10 (1999). Where a law or regulation changes after a claim has been filed or reopened, but before the administrative or judicial appeal process has been concluded, the version most favorable to the veteran must be applied. Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). Consequently, the Board will consider both the current and prior rating criteria at 38 C.F.R. § 4.97, Diagnostic Code 6731, to determine which version is more favorable to the veteran's claim for increase. Public Law 90-493 repealed section 356 of title 38, United States Code which provided graduated ratings for inactive tuberculosis. The repealed section, however, still applies to the case of any veteran who on August 19, 1968, was receiving or entitled to receive compensation for tuberculosis. 38 C.F.R. § 4.89 (1999). Where a veteran was entitled to compensation on August 19, 1968, 38 C.F.R. § 4.97, Diagnostic Codes 6701-6724 provide criteria for evaluating chronic PTB. A 100 percent evaluation is warranted for active PTB and for PTB for two years following the date inactivity. Thereafter for four years, or in any event, to six years after the date of inactivity, a 50 percent evaluation is warranted. For the next 5 years, or to 11 years after the date of inactivity, a 30 percent evaluation is warranted. A 30 percent is also warranted following far-advanced lesions diagnosed at any time while the disease process was active. In cases where there were moderately advanced lesions during the active stage, etc., a 20 percent evaluation is warranted. Otherwise, a zero percent evaluation is warranted for inactive PTB. 38 C.F.R. § 4.97, Diagnostic Code 6722. The permanent 30 percent and 20 percent evaluations for inactive PTB are not to be combined with evaluations for other respiratory disabilities. Id. Under the new criteria contained in Diagnostic Code 6731 pertaining to PTB, where entitlement was effective after August 19, 1968 (effective October 7, 1996), chronic inactive PTB is rated on specific medical findings; residuals are rated as interstitial lung disease, restrictive lung disease, or, when obstructive lung disease is the major residual, as chronic bronchitis, under Diagnostic Code 6600. Thoracoplasty is rated as removal of ribs under Diagnostic Code 5297. 38 C.F.R. § 4.97, Diagnostic Code 6731 (1999). Coexisting respiratory disorders, under Codes 6600 through 6817 and Codes 6822 through 6847, will not be combined with each other. Instead, a single rating will be assigned under the diagnostic code that reflects the predominant disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. 38 C.F.R. § 4.96(a) (1999). The general rating formula for interstitial lung disease (Diagnostic Codes 6825 through 6833) provides: Forced Vital Capacity less than 50 percent predicted, or DLCO (SB) less than 40 percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption with cardiorespiratory limitation, or; cor pulmonale or pulmonary hypertension, or; requires outpatient oxygen therapy: 100 percent; FVC of 50 to 64 percent predicted, or; DLCO (SB) of 40 to 55 percent predicted, or; maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiorespiratory limitation: 60 percent; FVC of 65 to 74 percent predicted, or; DLCO (SB) of 56 to 65 percent predicted: 30 percent; FVC of 75 to 80 percent predicted, or; DLCO (SB) of 66 to 80 percent predicted: 10 percent; Where the requirements for a 10 percent rating are not met: 0 percent. 38 C.F.R. Part 4, including § 4.31 and Codes 6825- 6833, effective October 7, 1996. The general rating formula for restrictive lung disease (Diagnostic Codes 6840 through 6845) is as follows: FEV-1 less than 40 percent of predicted value, or; the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40 percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy: 100 percent; FEV-1 of 40 to 55 percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; DLCO (SB) of 40 to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit): 60 percent; FEV-1 of 56 to 70 percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56 to 65 percent predicted: 30 percent; FEV-1 of 71 to 80 percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66 to 80 percent predicted: 10 percent. 38 C.F.R. Part 4, including § 4.31 and Codes 6840- 6845, effective October 7, 1996. Chronic bronchitis will be rated as follows: FEV-1 less than 40 percent of predicted value, or; the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40 percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy: 100 percent; FEV-1 of 40 to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; DLCO (SB) of 40 to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit): 60 percent; FEV-1 of 56 to 70 percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56 to 65 percent predicted: 30 percent; FEV-1 of 71 to 80 percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66 to 80 percent predicted; 10 percent. 38 C.F.R. Part 4, including § 4.31 and Code 6600, effective October 7, 1996. 61 Fed. Reg. 46720 46728, 46729 (Sep. 5, 1996). IV. Service connection has been in effect for PTB since the veteran's separation from active service. VA medical records following separation show that PTB had been moderately advanced and has been inactive since the 1950s. Although the PTB has been inactive, the veteran has reported increased fatigability and breathing difficulty. Treatment for PTB was noted in March 1996. The veteran has received recent VA rating examinations, along with chest X-rays and pulmonary function testing. The record shows that the veteran's PTB has been inactive since the 1950s. There were no findings described as far, or moderately, advanced. When described, the veteran's PTB was moderate. The Board notes that a restrictive lung disease has been attributed to PTB. The veteran was not entitled to compensation for PTB on August 19, 1968. Therefore the veteran would not be entitled to a compensable evaluation under the criteria in effect where entitlement existed on August 19, 1968. Upon examination in 1996, 1997, and 1999 thickened pleura and calcific changes of the right lung were noted. Moreover, in 1999 the veteran could not perform expiratory maneuver for the examiner to record maximal expiratory pressure. The current 30 percent evaluation was assigned based on the pulmonary functions findings dated in March 1996 which showed that the FEVI was 69 percent and the FEV1-FEV was 92 percent and the January 1999 studies which provided that the FEV1was 71 percent and the FEV was 92 percent. The Board has considered and finds the veteran's testimony credible with respect to the severity of the disability at issue. However, the Board is of the view the aforenoted pulmonary function evaluations satisfy the criteria for the currently assigned 30 percent disability evaluation pursuant to DC 6845 (restrictive lung disease). There is no basis for a higher rating since none of the pulmonary function test results meets the criteria for a 60 percent evaluation, and under the old rating formula no more than a 20 percent rating could be assigned for inactive moderately advanced PTB. If the veteran's PTB residuals were rated under the criteria for interstitial lung disease a 60 percent rating would require FVC of 50 to 60 percent predicted. According to the current pulmonary function test results, the FVC does not meet the requirements for the assignment of a higher disability evaluation. The residuals of PTB could also be rated for bronchitis. The criteria for the next higher, 60 percent rating, are identical to the criteria for a 60 percent rating for restrictive lung disease under 6845, as discussed above. Accordingly, the veteran does not meet the criteria for the assignment of a higher disability evaluation in that regard. Consideration has also been given to the potential application of various provisions of 38 C.F.R. Parts 3 and 4 (1999), whether or not they were raised by the veteran, as required by Shafrath b. Derwinski, 1 Vet. App. 589 (1991). However, the Board finds no basis upon which to assign a disability evaluation higher than 30 percent. The evidence of record does not present such an exceptional or unusual disability picture as to render impractical the application of the regular scheduler standards and thus warrant assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1). Although the veteran testified that while employed he was absent from work on occasion because of his residuals of inactive PTB, the veteran has not asserted or offered any objective evidence that his PTB has interfered with his employment status to a degree greater than that contemplated by the regular schedular standards, which are based on the average impairment of employment. Nor does the record reflect frequent periods of hospitalization for the disability. Hence, the record does not present an exceptional case where his currently assigned 30 percent evaluation is found to be inadequate. See Moyer v. Derwinski, 2 Vet. App. 289, 293 (1992); see also Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (noting that the disability rating itself is recognition that industrial capabilities are impaired). Accordingly, in the absence of such factors, the Board determines that the criteria for submission for assignment of an extraschedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not met, and; therefore, affirms the RO's conclusion that a higher evaluation on an extraschedular basis is not warranted. See Bagwell v. Brown, 9 Vet. App. 337, 339 (1996); Floyd v. Brown, 9 Vet. App. 88, 94-95 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). ORDER Service connection for cardiovascular disorder as secondary to service-connected inactive pulmonary tuberculosis is denied. An increased rating for residuals of inactive pulmonary tuberculosis is denied. F. JUDGE FLOWERS Member, Board of Veterans' Appeals