BVA9507977 DOCKET NO. 91-36 941 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in San Juan, Puerto Rico THE ISSUES 1. Entitlement to a rating in excess of 10 percent for a skin condition. 2. Entitlement to service connection for bronchial asthma. REPRESENTATION Appellant represented by: Puerto Rico Public Advocate for Veterans Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Frank L. Christian, Counsel INTRODUCTION The veteran served on active duty from January 1972 to May 1974. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions of January 1987 and April 1990 from the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. The case was Remanded by the Board to the RO in 1991 and 1993. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that his currently manifested bronchial asthma was incurred during his period of active service, and that service connection for that disorder is warranted. It is contended that he initially developed breathing problems, including asthma, while stationed at Fort Leonard Wood, Missouri, in October or November 1973, that he was hospitalized for treatment of that disorder, and that he remained on medication for 60 days following that hospitalization. It is further contended that he sustained another attack of asthma while stationed in Germany and was again hospitalized. The appellant contends that his service-connected skin condition is more disabling than currently evaluated and that an increased rating is warranted for that disorder. DECISION OF THE BOARD The 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 evidence of record supports a grant of an increased rating of 30 percent for a skin condition. It is further the decision of the Board that the preponderance of the evidence is against the claim for entitlement to service connection for bronchial asthma. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the instant appeal has been obtained by the RO. 2. The veteran's service-connected skin disorder is currently manifested by subjective complaints of itching and clinical findings of extensive lesions, without objective clinical findings of ulceration, extensive exfoliation or crusting, systemic or nervous manifestations, exceptionally repugnant disfigurement, marked discoloration, color contrast, or tissue loss. 3. Symptoms of a respiratory disorder shown on one occasion during active service were representative of an acute and transitory disorder, resolving without residual impairment. 4. Bronchial asthma was not shown during active service, on service separation examination, on VA examination in November 1986, or at any time prior to VA outpatient clinic treatment in March 1987, more than 13 years following final service separation. CONCLUSIONS OF LAW 1. Bronchial asthma was not incurred in or aggravated by wartime service. 38 U.S.C.A. §§ 1110, 5107(a) (West 1991). 2. The criteria for a rating of 30 percent for a skin disorder have been met. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.2, 4.41 and 4.42 and Part 4, Diagnostic Codes 7806, 7899 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board finds that the veteran's claim for an increased rating for a service-connected skin disorder as well as his claim for service connection for bronchial asthma are well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, the Board finds that these claims are plausible. The Board is also satisfied, with respect to each claim, that all relevant facts have been properly developed, and that no further assistance to the veteran is required to comply with 38 U.S.C.A. § 5107(a). Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R. Part 4 (1994). 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; 38 C.F.R. §§ 4.1, 4.10 (1994). Service connection is in effect for acne vulgaris scars on the face, chest and back; and folliculitis, evaluated as 10 percent disabling from July 1, 1986. In accordance with 38 C.F.R. §§ 4.1, 4.2, 4.41 and 4.42 (1994), and Schafrath v. Derwinski, 1 Vet.App. 589 (1991), the Board has reviewed the service medical records and all other evidence of record pertaining to the history of the veteran's service- connected skin disorder, the disability for which entitlement to an increased rating is asserted. The Board has found nothing in the historical record which would lead it to conclude that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations which would warrant an exposition of the remote clinical history and findings pertaining to the disability for which entitlement to an increased rating is asserted on appeal. Entitlement to a Rating in Excess of 10 Percent for Acne Vulgaris Scars on the Face, Chest and Back and Folliculitis Under the schedular criteria, a 10 percent evaluation is warranted for eczema with exfoliation, exudation or itching and involvement of an exposed surface or extensive area. A 30 percent evaluation requires constant exudation or itching, extensive lesions, or marked disfigurement. A 50 percent evaluation requires ulceration or extensive exfoliation or crusting and systemic and nervous manifestations or exceptionally repugnant disfigurement. 38 C.F.R. Part 4, Code 7806. A compensable evaluation for scars (other than burn scars or disfiguring scars of the head, face, or neck) requires that they be poorly nourished, with repeated ulceration; that they be tender and painful on objective demonstration; or that they produce limitation of function of the body part which they affect. 38 C.F.R. Part 4, Codes 7803, 7804, and 7805. The medical evidence of record shows that the veteran's service- connected skin disorder is currently manifested by subjective complaints of itching and objective clinical findings of marked acne vulgaris scarring on the face, chest, and back; recurrent follicular papules and pustules on the back and thighs; and maceration and scaliness of the feet. In the Board's view, the veteran's complaints of itching and the clinical presence of extensive lesions shown on recent VA dermatological examination warrant assignment of an increased rating of 30 percent for the veteran's service- connected skin disorder. However, the current findings show no more than moderate disfigurement, without objective clinical findings of ulceration or extensive exfoliation, crusting and systemic or nervous manifestations, exceptionally repugnant disfigurement, poorly nourished scars with repeated ulceration, tenderness and pain on objective demonstration, or limitation of function of the body part affected. Based upon the foregoing, the Board finds that the criteria for an increased rating of 30 percent for the veteran's service- connected skin disorder have been met. Consideration has also been given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet.App. 589 (1991). In particular, we find that the evidence discussed above does not suggest that the veteran's service-connected skin disorder presents such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards so as to warrant an assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1). For example, the disability did not recently require frequent periods of hospitalization nor does it present marked interference with employment that has not already been contemplated by the increased evaluation assigned. Entitlement to Service Connection for Bronchial Asthma In order to establish service connection for a claimed disability, the facts, as shown by evidence, must demonstrate that a particular disease or injury resulting in current disability was incurred during active service or, if preexisting active service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). The veteran's service entrance examination, conducted in January 1972, disclosed no history or findings of asthma or shortness of breath. His lungs and chest were normal. In February 1972, the veteran was hospitalized for four days at Fort Jackson Army Hospital for treatment of measles. A chest X-ray was normal. In November 1972, the veteran was hospitalized for two days at Fort Leonard Wood Army Hospital with complaints of a sore throat and headaches. A chest X-ray disclosed no significant abnormality. Examination revealed rhonchi in the right lower lobe, changing with cough. The veteran improved and was discharged. The diagnosis at hospital discharge was acute respiratory disease. The veteran's service medical records are silent for complaint, treatment, or findings of bronchial asthma or other respiratory disorder during his remaining period of active service. A history prepared by the veteran in connection with his service separation examination denied any history of asthma, chronic cough, or shortness of breath. His service separation examination disclosed no abnormalities of the lungs or chest. VA outpatient clinic records dated in November 1974 reflect no complaint, treatment, or findings of a respiratory disorder. The veteran's original claim for VA disability compensation benefits, received in December 1974, made no mention of bronchial asthma or of a respiratory disorder. A report of medical history prepared by the veteran in February 1978 in connection with a medical examination for Army Reserve service denied asthma, shortness of breath, or a chronic cough. A report of medical examination for Army Reserve service, conducted in February 1978, shows that his lungs and chest were normal. Private treatment records from Centro de Diagnostico y Tratamiento, dated from March 1980 to December 1982, show that the veteran recounted a history of bronchial asthma and allergic rhinitis and was treated with decongestants. On examination in September 1981, December 1981, March 1982 and April 1982, his chest was clear. No diagnosis of bronchial asthma was offered. A report of VA examination, conducted in November 1986, cited a history offered by the veteran of bronchial asthma while on active duty, with increasing intensity recently. Examination of the respiratory system disclosed no abnormalities, and the lungs were clear to percussion and auscultation. His nose, sinuses, mouth and throat were essentially negative. A chest X-ray disclosed no evidence of pleural or pulmonary pathology. The diagnosis was bronchial asthma by history (no lung abnormality found today). A personal hearing on appeal was held at the RO in October 1988. The veteran testified that he was hospitalized at Fort Leonard Wood Army Hospital in October or November 1973, after getting wet and developing a stuffy nose and difficulty breathing. He stated that he was released after eight hours, and given medication to last him for 60 days. He stated that asthma was not diagnosed. He stated that he had no further asthmatic attacks until January or February 1974, while on exercises in Germany. He stated that he was hospitalized only 6 to 8 hours and given pills. He reported no further asthma attacks while on active duty, but noted that another attack occurred in 1975, after service separation. The veteran testified that his efforts to obtain records of his private post service treatment for asthma were unavailing. He called attention to his treatment at Centro de Diagnostico y Tratamiento in the years following service separation. A transcript of his testimony is of record. VA outpatient clinic records dated from March 1987 to September 1988 show that the veteran was seen in March 1987 with complaints of episodic shortness of breath. He offered a history of bronchial asthma. Physical examination was negative and his lungs were clear. The diagnosis was bronchial asthma. A Hearing Officer's decision, dated in December 1989, continued the denial of service connection for bronchial asthma. VA outpatient clinic records dated from September 1988 to July 1991 show that the veteran was seen in November 1990 with a 10- year history of bronchial asthma, recently increasing in frequency. Physical examination disclosed moist nasal mucosa and a reddened pharynx, while examination of the lungs revealed normal bronchovesicular breathing. Pulmonary function tests disclosed moderate obstruction to airflow, responsive to bronchodilators. No diagnosis was given, but the veteran's history of bronchial asthma was noted and appropriate medications were prescribed. Records dated in January and February 1991 show that the veteran underwent followup testing for bronchial asthma, including testing for allergies. An entry dated in March 1991 stated that the veteran had occasional asthmatic exacerbations. Examination disclosed that his lungs were clear and a chest X-ray was normal. He was shown to be currently stable. Records dated in May 1991 show that the veteran was seen for treatment of allergies and was found to be allergic to dust and to southern grass pollen. Records dated in July 1991 show that the veteran was seen for problems which included bronchial asthma and chronic sinusitis. Examination of the lungs disclosed no wheezes, rales or rhonchi, and chest X-ray was negative. The clinical assessment was exacerbation of bronchial asthma, stable. The Board finds that bronchial asthma was not manifest during active service, on service separation examination, on examination for Army Reserve service in February 1978, or on VA examination in November 1986. Bronchial asthma was initially diagnosed on VA outpatient clinic treatment in March 1987, approximately 13 years following final service separation. The Board is of the opinion that the symptoms of an acute respiratory disease shown on one occasion during active service were representative of an acute and transitory disorder, resolving without residual impairment. While the Board has considered the veteran's testimony and finds it generally credible, the record is devoid of objective clinical findings of bronchial asthma during service, on service separation examination, or for many years thereafter. Based upon the foregoing, the Board finds no basis in the evidence which would support a grant of service connection for bronchial asthma. Accordingly, that claim is denied. ORDER Entitlement to an increased rating of 30 percent for a skin disorder is granted, subject to controlling regulations governing the payment of monetary benefits. Entitlement to service connection for bronchial asthma is denied. F. JUDGE FLOWERS Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (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.