Citation Nr: 0001501 Decision Date: 01/18/00 Archive Date: 01/27/00 DOCKET NO. 97-12 473 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUE Entitlement to a separate disability evaluation for chronic angioneurotic edema. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Jason R. Davitian, Associate Counsel INTRODUCTION The veteran served on active duty from August 1964 to July 1968. When this case was previously before the Board of Veterans' Appeals (BVA or Board) in September 1998, the pertinent issue was entitlement to a compensable evaluation for service- connected urticaria and chronic angioneurotic edema. The Board found that the schedular criteria for a 10 percent evaluation for urticaria had been met, and remanded the issue of entitlement to a separate evaluation for chronic angioneurotic edema to the Department of Veterans Affairs (VA) Regional Office (RO) in Lincoln, Nebraska, for additional development. Thereafter, an April 1999 rating decision granted the veteran a 30 percent evaluation for urticaria, effective the date of the veteran's claim for an increased evaluation. The rating decision also held that a separate disability evaluation for chronic angioneurotic edema, distinct from the 30 percent evaluation assigned for urticaria, was not warranted. The case is now before the Board for final appellate consideration. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The evidence of record does show that the veteran's chronic angioneurotic edema currently results in mild, infrequent eruptions involving subcutaneous tissue of the penis. CONCLUSION OF LAW The schedular criteria for a separate 10 percent disability evaluation for chronic angioneurotic edema have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 4.104, Diagnostic Code 7118 (1997); 38 C.F.R. §§ 4.1, 4.2, 4.10, 4.20, 4.104, Diagnostic Code 7118 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a preliminary matter, the Board finds that the veteran's claim is plausible and thus well-grounded within the meaning of 38 U.S.C.A. § 5107(a); 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). The Board is satisfied that all relevant evidence has been obtained with respect to this claim and that no further assistance to the veteran is required in order to comply with the duty to assist mandated by statute. In this regard, the Board notes that the veteran has been provided VA examinations and that private medical reports have been obtained. In accordance with 38 C.F.R. §§ 4.1, 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 service-connected disability. The Board 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. Moreover, the Board is of the opinion that this case presents no evidentiary considerations that would warrant an exposition of the remote clinical histories and findings pertaining to the disability at issue. 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 (1999). 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. "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." 38 C.F.R. § 4.7. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In Esteban v. Brown, 6 Vet. App. 259 (1994), the United States Court of Veterans Appeals recognized that the critical element in assigning separate ratings is that none of the symptomatology for any one of the service-connected disorders is duplicative of or overlapping with the symptomatology of other disorders. "The critical element [in determining whether appellant's disabilities may be rated separately] is [whether any] of the symptomatology for any one of these ... conditions is duplicative of or overlapping with the symptomatology of the other ... conditions." Esteban v. Brown, 6 Vet. App. 259, 262 (1994). The Board notes that the veteran's urticaria is currently evaluated as 30 percent disabling, based on analogy to eczema. 38 C.F.R. §§ 4.20, 4.118, Diagnostic Code 7806 (1999). A 30 percent evaluation under Diagnostic Code 7806 requires constant exudation or constant itching, extensive lesions or marked disfigurement. The Rating Schedule also provides criteria for the evaluation of angioneurotic edema, at Diagnostic Code 7118. During the rating period, effective January 12, 1998, the portion of the Rating Schedule addressing the cardiovascular system, including Diagnostic Code 7118, was amended. 62 Fed.Reg. 65207-65224 (Dec. 1997). Under the previous criteria, mild angioneurotic edema with infrequent attacks of slight extent and duration warrants a 10 percent evaluation. Diagnostic Code 7118. Under the new criteria, angioneurotic edema attacks without laryngeal involvement lasting one to seven days and occurring two to four times a year warrant a 10 percent evaluation. Diagnostic Code 7118. In assessing the degree of disability attributable to a service-connected disorder, the disorder is viewed in relation to its whole history. 38 C.F.R. §§ 4.1, 4.2; Schafrath 1 Vet. App. 589. The veteran was granted service connection for urticaria by a July 30, 1970 rating decision, and a noncompensable evaluation was assigned, effective from July 4, 1968, pursuant to Diagnostic Code 7806. A July 1972 rating decision expanded the service-connected disability as chronic urticaria, etiology undetermined; chronic angioneurotic edema. A 10 percent evaluation was assigned pursuant to Diagnostic Code 7118, effective from June 1, 1972. In March 1973, the Board confirmed and continued the 10 percent evaluation, citing both diagnostic codes. A July 1975 rating decision reduced the evaluation to noncompensable, effective October 1975. Clinical records dated from December 1994 to December 1995 reflect the veteran was seen monthly for receipt of an allergy vaccine. A private report dated in December 1995 provides that the veteran was treated for chronic urticaria and angioedema. The veteran was able to control his hives for the most part using hydroxyzine twice daily and avoiding certain foods. It was anticipated that he would need further ongoing therapy in the future. An April 1996 private treatment record indicates that the veteran complained of hives and other allergies which he treated with cream. On objective examination, there was dryness of the distal fingertips and hands and mild eczema of the hip. The report of an April 1996 VA consultation indicates that the veteran had recurrent hives since being in the Navy. He also complained of allergy problems. The veteran had known allergies to multiple pollens and molds, as well as food allergies. It was reported that the true source of the recurrent hives had not been found. Results of physical examination were negative for findings or symptoms of urticaria. Screening tests showed a mild reaction to dust mite and pollen mix. The impressions included chronic urticaria, true etiology uncertain although they did seem to be made worse by exposure to both inhalant and food allergies; chronic allergic rhinitis related to inhalant and food allergies. The report of an April 1996 examination by a VA skin clinic shows that the veteran complained of hives and allergies, manifested by itching and irritation of the skin. On objective physical examination, there was dryness of the distal hands and fingers and very mild plaque on the left hip. The pertinent impression included allergies and urticaria by history. The examiner opined there was nothing to see that day. The report of a July 1996 VA nose and sinuses examination noted a history including of urticaria and hives. It was reported that the veteran had been found to have chronic food and inhalant allergies. No current finding, impression or diagnosis pertaining to urticaria was provided. The examiner opined the veteran's hives might be related to the allergy problem. The examiner recapped by noting that the veteran's chronic urticaria and angioneurotic edema might be partially related to the chronic allergic problem. In correspondence received in December 1996 and March 1997, the veteran submitted a photograph of his hip and described his symptoms. He denied that his symptoms were only mild and infrequent. He noted that he required medication to control his urticaria and chronic angioneurotic edema. He described his medications, and the logistical difficulties presented by seeking medical treatment. Following the Board's remand, the RO received medical records from Sidney Medical Associates showing that the veteran was seen in August 1990 for chronic recurrent urticaria and angioedema. He continued to have office visits and receive allergy shots from that time until December 1997, and continued to have office visits until February 1999. In addition, a December 1998 private medical report provides that the veteran complained of daily itching with urticaria flares. The veteran was currently on medication and the prognosis was that the illness was likely chronic. The diagnosis was chronic urticaria, angioedema. The veteran was provided a VA examination in March 1999, the report of which notes that his medical records were considered. The veteran was noted to be allergic to airborne pollens and molds, and certain foods: gluten, tomatoes, spices and milk. Regarding current problems, the report provides that the veteran's chronic urticaria and chronic angioneurotic edema had grown worse since the last examination. Currently, the veteran ached all over after a severe attack, had constant itching that moved around everywhere, burning with urination with attacks, memory and concentration problems, and became depressed vs. panic attacks severe. The attacks were at least once every two weeks, but the veteran was noted to have itching and breaking out constantly. He said that he had not missed work, but said that he probably should have because of poor concentration. At such times, the veteran did not drive. He sometimes had a bad headache and was embarrassed if the urticaria and angioneurotic edema were in an obvious place. The assessment was chronic urticaria, angioedema: moderately severe. Based on a thorough review of the record, the Board finds that the evidence supports a separate compensable evaluation for chronic angioneurotic edema, of no more than 10 percent, under either the previous or the revised criteria set forth at Diagnostic Code 7118. The record shows that the veteran's chronic angioneurotic edema results in symptoms or manifestations that do not duplicate or overlap symptoms or manifestations of his service-connected urticaria. Esteban, 6. Vet. App. 262. There has been clinical demonstration of current attacks involving subcutaneous tissue. The Board notes that on examination in September 1989, and more recently on VA examination in March 1999, the veteran complained of burning with urination with attacks. Additionally, possible associated nasal tissue involvement was noted on VA examination in July 1996. With resolution of doubt in the veteran's favor, the Board finds that the veteran's chronic angioneurotic edema results in symptoms of involvement of subcutaneous tissue of the penis that do not duplicate or overlap the veteran's urticaria. As such, a separate 10 percent evaluation is warranted under Diagnostic Code 7118. ORDER A separate 10 percent evaluation for chronic angioneurotic edema is granted, subject to the applicable laws and regulations governing the award of monetary benefits. U. R. POWELL Member, Board of Veterans' Appeals