BVA9505665 DOCKET NO. 93-12 622 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Togus, Maine THE ISSUES 1. Entitlement to an increased evaluation for atopic dermatitis, currently evaluated as 30 percent disabling. 2. Entitlement to an increased evaluation for bronchial asthma with bronchitis, currently evaluated as 30 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Ronald R. Bosch, Counsel INTRODUCTION The veteran served on active duty from February 1969 to November 1989. This appeal arose from an April 1992 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Togus, Maine. The RO denied entitlement to increased evaluations for atopic dermatitis and bronchial asthma with bronchitis. The RO granted entitlement to increased evaluations of 30 percent each for atopic dermatitis and bronchial asthma with bronchitis when it issued a rating decision in November 1992. The case has been forwarded to the Board of Veterans' Appeals (Board) for appellate review. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his atopic dermatitis and bronchial asthma with bronchitis are more disabling than currently evaluated, thereby warranting entitlement to increased evaluations. The appellant argues that his need for frequent treatment is sufficient upon which to predicate grants of increased evaluations. 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 record supports a grant of an increased evaluation of 50 percent for atopic dermatitis, and the preponderance of the evidence is against a grant of an increased evaluation for bronchial asthma and bronchitis. FINDINGS OF FACT 1. Atopic dermatitis is productive of dermatological impairment compatible with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or exceptional repugnance. 2. Bronchial asthma with bronchitis is productive of not more than moderate or moderately severe impairment. CONCLUSIONS OF LAW 1. The criteria for an increased evaluation of 50 percent for atopic dermatitis have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.118, Diagnostic Code 7806 (1994). 2.. The criteria for an evaluation in excess of 30 percent for bronchial asthma with bronchitis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.97, Diagnostic Codes 6600-6602. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially the Board finds that the veteran's claims are well grounded within the meaning of 38 U.S.C.A. § 5107(a), in that he has presented claims which are plausible. The Board is satisfied that all relevant facts have been properly developed, and that no further assistance to the veteran is required in order to comply with 38 U.S.C.A. § 5107(a). In accordance with 38 C.F.R. 4.1 and 4.2, 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 atopic dermatitis and bronchial asthma and bronchitis. The Board has found nothing in the historical record which would lead to a conclusion that the current evidence of record is inadequate for rating purposes. I. Entitlement to an increased evaluation for atopic dermatitis, currently evaluated as 30 percent disabling. The service medical records show the veteran first noted pruritis in October 1983. It worsened and he required treatment in 1984. He was hospitalized in March 1985 for treatment of atopic dermatitis. Further treatment was required in May 1985. At a February 1990 VA examination the veteran reported that skin rashes had begun in 1983. He had had extensive evaluations by multiple dermatologists. He was currently being treated with Seldane and Atarax. He stated that this was his most severe problem. He experienced itching on a daily basis. At times it had become severe. He related that several times in the past his entire body had been excoriated and had required treatment with steroids and antibiotics. At present his chest, shoulders, and groin were affected. An examination of the skin revealed multiple areas affected by atopic dermatitis. The shoulders and anterior chest were noted to contain mild excoriations with erythema. The groins bilaterally and the under surface of the testicles were severely affected with a marked degree of erythema excoriations and one area measuring 5 millimeters of a blister which was draining non- cloudy material. The examiner diagnosed atopic dermatitis noted to be quite severe. On file are outpatient treatment reports from a private physician pertaining to the veteran's treatment for his skin disability in the early 1990's. At a March 1992 VA dermatology examination the veteran claimed that his skin condition had worsened since his last examination. He had been seeing a dermatologist frequently. His current treatment included Fluocinolone ointment and 50 milligrams of Benadryl which he typically took once a day. He also occasionally treated himself to a "sauna suit." Since his last examination the area of the groin had cleared up. Currently he complained of skin lesions over the face, back, chest and ankles. The lesions were constantly itching. He frequently scratched himself in these areas and the scratches healed slowly. An examination of the skin revealed multiple light pinkish hypervascular areas over the face. There were no excoriations over the face. The entire face was mildly affected. An inspection of the back revealed multiple excoriations over the shoulders bilaterally. There was a mild erythema in several large blotchy areas. This area seemed moderately affected. On the chest were seen several excoriations but no erythema or edema. An examination of the ankles disclosed severely affected areas with multiple deep excoriations and several areas of crusted over scabbing. There were multiple blotches of hyperpigmentation from the healing of multiple previous wounds about the ankles. Several excoriations were surrounded by areas of light pinkish erythema. The temperature about these areas was normal and the shade of red suggested allergy rather than infection. The diagnostic impression was atopic dermatitis. At a September 1992 RO hearing the veteran described the disabling manifestations of his atopic dermatitis. The veteran testified that his skin lesions were constantly itching, especially at night. There was seepage from his lesions and periodically they became infected requiring antibiotics. His skin lesions were said to leave residual scarring and he avoided wearing shorts so as to conceal his lower extremity affected areas. He stated that his nervousness activated his skin lesions. The veteran's atopic dermatitis is rated as 30 percent disabling as for eczema under diagnostic code 7806 of the VA Schedule for Rating Disabilities. The 30 percent evaluation contemplates exudation or itching constant, extensive lesions, or marked disfigurement. The evaluation of 50 percent requires ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or exceptional repugnance. The Board is of the opinion that the current clinical features of the appellant's atopic dermatitis more closely resemble the level of disablement contemplated in the 50 percent evaluation. 38 C.F.R. § 4.7. The veteran has testified as to nervous symptomatology associated with his dermatological disability. On two VA examinations the clinical manifestations of his skin disability have been described as severe. The veteran's entire body essentially is involved in the atopic dermatitis clinical manifestations. He has required regular treatment from a private dermatologist who has had to resort to steroids and antibiotics to control atopic dermatitis. The 50 percent evaluation is the highest rating under diagnostic code 7806. No basis has been presented upon which to warrant an evaluation in excess of 50 percent. In other words, atopic dermatitis has not rendered the veteran's disability picture unusual or exceptional in nature and has not markedly interfered with employment. It has not required frequent inpatient care as to render impractical the application of regular schedular standards as to preclude a grant of an increased evaluation on an extraschedular basis. 38 C.F.R. § 3.321(b)(1). The Board finds that a grant of an increased evaluation of not more than 50 percent for atopic dermatitis is supported by the evidence of record to date. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.118, Diagnostic Code 7806. II. Entitlement to an increased evaluation for bronchial asthma with bronchitis, currently evaluated as 30 percent disabling. The service medical records show the veteran was hospitalized in October 1983 for symptomatology which included reactive airway disease. He again required treatment in May 1985 for asthma which was considered moderately severe in nature. At a February 1990 VA examination the veteran stated that asthma was first diagnosed in 1982. His outpatient treatment had consisted of inhalers which led to improvement. When he attempted to lower his medication dosage, his wheezing increased. Resumption of his previous dosage reduced his wheezing. He had not been evaluated in emergency rooms and had not been treated for acute exacerbations. He seemed to manage his problem quite well. On examination the lungs were clear to auscultation with no wheezes, rales, or rhonchi. The examination diagnosis was history of chronic asthma with multiple allergies. At a March 1992 VA examination the veteran stated that his asthma and bronchitis continued to bother him. He had one episode of bronchitis during the winter and consequently missed four days of work. The exacerbation was treated with Amoxicillin. He continued to require 600 milligrams twice daily of Theodur. If he attempted to discontinue this drug, he developed asthma symptoms. He was taking Seldane three times daily and using a Ventolin inhaler. Currently he was not using a steroid inhaler. The veteran stated there had been no change in his condition since his last examination. Typically his respiratory disorder was worse in the summer and was exacerbated by pollen and hay fever and made worse by episodes of bronchitis. He continued to smoke a pipe three times daily. On examination the lungs sounded clear with no wheezes, rales or rhonchi. The diagnostic impression was chronic asthma with chronic bronchitis. The claims file contains a quantity of medical reports pertaining to private treatment of the veteran during the early 1990's for respiratory disability. The records include notations dated in 1992 noting the veteran was temporarily unable to work for four days because of asthma and allergy. At a September 1992 RO hearing the veteran described the disabling manifestations of his bronchial asthma and bronchitis. He testified that he wheezed alot and was short of breath especially on windy days. He tired easily and this depended on the pollen season. The veteran's bronchial asthma and bronchitis are rated under diagnostic codes 6600 and 6602 of the VA Schedule for Rating Disabilities. A 30 percent evaluation under diagnostic code 6600 requires moderately severe chronic bronchitis with persistent cough at intervals throughout the day, considerable expectoration, considerable dyspnea on exercise, rales throughout the chest, and beginning chronic airway obstruction. A 60 percent evaluation under this code requires severe chronic bronchitis with severe productive cough and dyspnea on slight exertion and pulmonary function tests indicative of severe ventilatory impairment. A 30 percent evaluation for moderate bronchial asthma requires asthmatic attacks, rather frequent (separated by only 10-14 day intervals) with moderate dyspnea on exertion between attacks. A 60 percent evaluation requires severe bronchial asthma with frequent attacks of asthma (one or more attacks weekly), marked dyspnea on exertion between attacks with only temporary relief by medication; and more than light manual labor precluded. The VA examination reports and private treatment reports of record have not substantiated that the veteran has severe bronchial asthma or bronchitis as to warrant a grant of a 60 percent evaluation under diagnostic code 6600 or 6602. The veteran's bronchial asthma with bronchitis appears to be under good control with medication and has not progressively worsened as to result in severe impairment. No question has been presented as to which of two evaluations would more properly classify the severity of bronchial asthma with bronchitis. 38 C.F.R. § 4.7. The veteran's respiratory disability has not rendered his disability picture unusual or exceptional in nature and has not markedly interfered with employment. It has not required frequent inpatient care as to render impractical the application of regular schedular standards thereby precluding a grant of an increased evaluation on an extraschedular basis. 38 C.F.R. § 3.321(b)(1). It is the judgment of the Board that bronchial asthma and bronchitis are properly evaluated as 30 percent disabling and that the record does not support a grant of an increased evaluation. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.97, Diagnostic Codes 6600-6602. ORDER Entitlement to an increased evaluation of 50 percent for atopic dermatitis is granted, subject to pertinent criteria applicable to the payment of monetary awards. Entitlement to an increased evaluation for bronchial asthma with bronchitis is denied. ALBERT D. TUTERA 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.