ASTHMA

SCOTT W. DALE · 2026 · Case ID: A26032534

MIXED

Summary

The veteran, who served in the Army Reserve from January 2012 to May 2012, with additional service until January 2020 (nature unverified), appealed the denial of service connection for xerosis cutis and the initial rating for asthma. The Board granted entitlement to a 10 percent disability rating for asthma, finding the criteria met based on intermittent inhalational bronchodilator therapy, as supported by the December 2024 VA examination. However, the Board denied a higher rating for asthma, noting the absence of evidence for more severe PFT results or daily bronchodilator use. For xerosis cutis, the Board denied a compensable rating, concluding that the evidence did not meet the criteria for a higher rating, as the December 2024 VA examination noted less than 5 percent body/exposed area affected and no prescribed medication use, despite the veteran's assertion of more severe symptoms and need for prescription topicals. The Board found the evidence persuasively weighed against the claim. The claims for a right upper extremity neurological disability and a left upper extremity neurological disability were remanded for a new VA medical opinion to address service connection for bilateral carpal tunnel syndrome, considering the veteran's assertions of hand numbness and tingling from driving heavy vehicles, vibration exposure, and gripping during service.

Rationale

December 2024 VA exam noted asthma diagnosis and intermittent bronchodilator use.; PFT results indicated FEV-1 of 73% pre-bronchodilator and 96% post-bronchodilator.; Board found criteria for 10% rating met, but not for 30% or higher.

Service Branch

ARMY RESERVE

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6602

Docket No.

250116-510874

Full Decision Text

Citation Nr: A26032534
Decision Date: 04/08/26 Archive Date: 04/08/26

DOCKET NO. 250116-510874
DATE: April 8, 2026

ORDER

Entitlement to an initial 10 percent disability rating for asthma, but no higher, is granted, subject to the applicable regulations concerning the payment of monetary benefits.

Entitlement to a compensable initial rating for xerosis cutis is denied.

REMANDED

Entitlement to service connection for a right upper extremity neurological disability is remanded.

Entitlement to service connection for a left upper extremity neurological disability is remanded.

FINDINGS OF FACT

1. The evidence demonstrates that the Veteran's asthma requires treatment by intermittent inhalational or oral bronchodilator therapy but persuasively weighs against finding that the evidence demonstrates pulmonary function testing showing FEV-1 of 56 to 70 percent predicted, or FEV-1/FVC of 56 to 70 percent or daily inhalational or oral bronchodilator therapy or inhalational anti-inflammatory medication.

2. The evidence is persuasively weighted against finding that greater than 5 percent of the Veteran's entire body and exposed areas are affected by xerosis cutis and/or has required treatment with intermittent systemic therapy.

CONCLUSIONS OF LAW

1. The criteria for a 10 percent rating for asthma, but no higher, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.96, 4.97, DC 6602.

2. The criteria for a compensable rating for xerosis cutis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DC 7806.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran has a period of active service in the Army Reserve from January 2012 to May 2012. He had additional service in the Army Reserve until January 2020; however, the nature of this service has not been verified.

These matters were appealed to the Board of Veterans' Appeals (Board) from a December 2024 rating decision through submission of a January 2025 VA Form 10182 with election of the direct review appeal docket.

Therefore, the Board may only consider the evidence of record at the time of the December 2024 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claims below, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

As an initial note, the January 2025 VA Form 10182 also lists issues of service connection for a neck condition, a left knee strain and a lower back disability to also be appealed to the Board. These issues are sought to be appealed from rating decisions issued more than one year prior to the submission of the January 2025 VA Form 10182. Consequently, this submission is not timely to appeal these issues to the Board and they are not part of the present appeal.

The Board notes that the AOJ requested the Veteran submit any relevant private treatment records or submit information with which VA can assist the Veteran in obtaining private treatment records. Required notice and information were provided in the claim form which the Veteran signed, certifying to the fact that such notice was received and further than they have included or identified relevant evidence. VA requested records for which the Veteran submitted a proper release and/or adequately identified. The duty to assist is not a one-way street. If a Veteran desires help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining evidence. Wood v. Derwinski, 1
these issues to the Board and they are not part of the present appeal.

The Board notes that the AOJ requested the Veteran submit any relevant private treatment records or submit information with which VA can assist the Veteran in obtaining private treatment records. Required notice and information were provided in the claim form which the Veteran signed, certifying to the fact that such notice was received and further than they have included or identified relevant evidence. VA requested records for which the Veteran submitted a proper release and/or adequately identified. The duty to assist is not a one-way street. If a Veteran desires help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining evidence. Wood v. Derwinski, 1 Vet. App. 190 (1991). Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA's duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002).

The standard set forth in 38 C.F.R. § 3.103(c)(2)(iii) only permits constructive receipt of Veterans Health Administration (VHA) records that not only existed prior to the issuance of the AOJ decision on appeal, but also for which the claimant furnished sufficient information to make the Veterans Benefits Administration (VBA) aware of the existence of those records. Thus, the Board's consideration of VHA records is limited to the same. Here, the Board finds that VA treatment records were obtained and reviewed consistent with 38 C.F.R. § 3.103(c)(2)(iii) and the AMA framework.

Increased Ratings

Disability ratings are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Where there is a reasonable doubt as to the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7.

Where the appeal concerns the initial rating assigned a service-connected disability, as is the case here, VA assesses the level of disability from the effective date of service connection, here, May 22, 2023. See Fenderson v. West, 12 Vet. App. 119, 125 (1999); 38 U.S.C. § 5110; 38 C.F.R. § 3.400. Because the level of disability may have varied over the course of the claim, the rating may be "staged" higher or lower for segments of time during the period under review in accordance with such variations, to the extent the evidence shows distinct time periods where the service-connected disability has exhibited signs or symptoms that would warrant different ratings under the rating criteria. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson, 12 Vet. App. 119, 126 (1999).

VA is required to take due consideration that the beneficial effects of medication are discounted unless such effects are otherwise contemplated in a particular diagnostic code. In so doing, an examiner must discount any ameliorating effects of medication and indicate that such effects were not considered and were, in fact, discounted in formulating opinions pertaining to range of motion and functional impairment. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012), see also Ingram v. Collins, 23 Vet. App. 1798 (2025).

1. Entitlement to an initial compensable rating for asthma

Rating Criteria

Under the DC 6602, for asthma, a 10 percent rating is assigned for asthma, by pulmonary function testing (PFT) with forced expiratory volume (FEV-1) of 71 to 80 percent of predicted value, or the ratio of FEV-1/forced vital capacity (FVC) of 71 to 80 percent, or intermittent inhalational or oral bronchodilator therapy. A 30 percent rating is assigned for FEV-1 of 56 to 70 percent predicted, or FEV-1/FVC of 56 to 70 percent or daily inhalational or oral bronchodilator therapy or inhalational anti-inflammatory medication. A 60 percent rating is assigned for an FEV-1 of 40 to 55 percent predicted, or FEV-1/FVC of 40 to 55 percent, or at least monthly visits to a physician for required care of exacerbations, or intermittent (at least 3 times per year) course of systemic (oral or parenteral) corticosteroids. A 100 percent rating is assigned under DC 6602 for bronchial asthma with an FEV-1 of less than 40 percent predicted, or FEV-1/FVC less than 40 percent, or more than 1 attack per week with episodes of respiratory failure or requires daily use of systemic (oral or parenteral) high dose corticosteroids or immunosuppressive medications. 38 C.F.R. § 4.97, DC 6602.

When evaluating disability based on PFTs, post-bronchodilator results are used in applying the rating criteria unless the post-bronchodilator results were poorer than the pre-bronchodilator results. In those cases, the pre-bronchodilator results are used. See 38 C.F.R. § 4.96 (d)(5). DC 6602, for asthma, specifically contemplates ameliorating effects of medication. Jones v. Shinseki, 26 Vet. App. 56, 63, Ingram, 23 Vet. App. 1798.

Factual Background & Analysis

A December 2024 VA examination notes diagnosis of asthma. The Veteran noted that his symptoms have continued to worsen. He stated that he continues to feel short of breath, feeling the need to catch deep breaths, and persistent cough. His symptoms worsen on exertion and with heat and poor air quality. Current treatment was for asthma was noted as Albuterol PRN and Montelukast QD. Use of inhalational bronchodilator therapy intermittently was noted. The results of PFT revealed pre-bronchodilator FVC of 85 percent, FEV-1 of 73 percent, and FEV-1/FVC of 71 percent, and post-bronchodilator FVC of 89 percent, FEV-1 of 96 percent, and FEV-1/FVC of 89 percent; the examiner reported that the most accurate predictor of the Veteran's level of disability is his FEV-1. The examiner indicated that the Veteran's disability had no impact on his ability to work.

In a February 2025 correspondence the Veteran stated that the December 2024 VA examination did not account for his "ongoing functional limitations, environmental triggers, or the frequency of inhaler use."

The Veteran's asthma has been assigned an initial noncompensable rating under DC 6602.

After reviewing the evidence of record the Board finds that an initial 10 percent rating is warranted for asthma with evidence of treatment by intermittent inhalational or oral bronchodilator therapy. The criteria for the next higher rating of 30 percent however has not been demonstrated by at least an approximate balance of the evidence. There is no evidence documenting an FEV-1 of 56 to 70 percent predicted, or FEV-1/FVC of 56 to 70 percent or daily inhalational or oral bronchodilator therapy or inhalational anti-inflammatory medication.

To the extent that the Veteran's increased rating claim is being denied, the Board has considered the applicability of the benefit of the doubt doctrine. As the evidence is persuasively weighted against granting the maximum benefit allowable, his claim is denied to that extent and the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to
or daily inhalational or oral bronchodilator therapy or inhalational anti-inflammatory medication.

2. Entitlement to an initial compensable rating for xerosis cutis

Rating Criteria

Under the current criteria, DC 7806 is rated under the General Rating Formula for the Skin, or, depending upon the predominant disability, it may be rated as disfigurement of the head, face, or neck (DC 7800), or scars (DCs 7801, 7802, 7804, or 7805). 38 C.F.R. § 4.118.

The General Rating Formula for the Skin provides a noncompensable rating for a condition which requires no more than topical therapy required over the past 12-month period and at least one of the following: (i) characteristic lesions involving less than 5 percent of the entire body affected; or (ii) characteristic lesions involving less than 5 percent of exposed areas affected.

A 10 percent rating is warranted for at least one of the following: (i) characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; (ii) at least 5 percent, but less than 20 percent, of exposed areas affected; or (iii) intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period.

A 30 percent rating is provided for at least one of the following: (i) characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or (ii) systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period.

A 60 percent rating is provided for at least one of the following: (i) characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or (ii) constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. Under this formula, a 60 percent evaluation is the highest available rating.

C.F.R. § 4.118(a) provides that, for the purposes of this section, "systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin." See Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017).

Factual Background & Analysis

A December 2024 VA examination note s a diagnosis for xerosis cutis. The Veteran reported symptoms of intermittent dry, red and itching, stinging and burning rash that began during field training. The examiner indicated that the Veteran has not been treated with medication in the past 12 months for any skin conditions. The examiner did not observe any scarring or disfigurement of the head, face or neck. He stated that his symptoms occur when he goes to the beach, goes camping, or otherwise being outside for extended periods. The Veteran skin rashes were noted to cover less than 5 percent of his total body area and exposed area. The Veteran stated that his symptoms are aggravated at work.

In a February 2025 statement the Veteran stated that, "My symptoms are more severe than described in the decision letter, as they affect multiple areas of my body, including my hands, arms, and face, and have required prescription topical treatments. I request a re-evaluation of my condition with consideration of my medical history and treatment requirements."

A review of VA and private treatment records pertaining to the evidentiary review
of the head, face or neck. He stated that his symptoms occur when he goes to the beach, goes camping, or otherwise being outside for extended periods. The Veteran skin rashes were noted to cover less than 5 percent of his total body area and exposed area. The Veteran stated that his symptoms are aggravated at work.

A review of VA and private treatment records pertaining to the evidentiary review period does not document the use of any prescribed medications to treat this disability.

The Veteran's xerosis cutis has been assigned an initial noncompensable rating under DC 7806.

After reviewing the evidence, the Board concludes that the evidence reflects that the Veteran's xerosis cutis does not warrant a compensable rating because less than 5 percent of the Veteran's entire body and exposed areas were noted to be affected during the December 2024 VA examination. Further, the Veteran indicated in the February 2025 correspondence that his xerosis cutis has required treatment by prescription topical medications. This was not corroborated by the December 2024 VA examiner and there are no VA or private treatment records documenting any prescribed medications to treat xerosis cutis.

In reaching this conclusion, the Board acknowledges the Veteran's belief that his xerosis cutis is more severe than the current disability evaluation reflects. In this regard, the Board must consider the entire evidence of record when analyzing the criteria set forth in the ratings schedule. Although the Board recognizes that the Veteran is competent to provide evidence regarding his symptomatology, for the reasons discussed above, the Board finds that his symptomatology does not meet the criteria for a higher disability rating.

For these reasons, the Board concludes that the Veteran is not entitled to an initial compensable rating for xerosis cutis. The Board concludes that the evidence persuasively weighs against the claim and it is denied. 38 U.S.C. § 5107(b); see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

REASONS FOR REMAND

3. Entitlement to service connection for a right upper extremity neurological disability

4. Entitlement to service connection for a left upper extremity neurological disability

The matters are REMANDED for the following action:

BACKGROUND INFORMATION FOR THE REGIONAL OFFICE ADJUDICATOR:

" The Veteran claimed service connection for bilateral upper extremity neurological symptoms due to the vibrations from driving heavy vehicles during service. See August 2024 VA Form 21-525EZ (Fully Developed Claim). The Veteran has been diagnosed with bilateral carpal tunnel syndrome per a December 2024 VA examination. A VA medical opinion was not obtained addressing this direct service connection theory of entitlement. This is a pre-decisional duty to assist error that must be corrected on remand.

THE REMAND DIRECTIVES FOLLOW:

1. Obtain a medical opinion from a qualified medical professional which addresses the following:

Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's bilateral carpal tunnel syndrome had its onset in, or is otherwise etiologically related to active service? Why or why not?

The examiner must review the entire record in conjunction with rendering the requested opinions.? The examiner's attention is drawn, but not limited to, the following evidence:?

" December 2024 VA examination report contains reports from the Veteran that during service he would have to drive thousands of miles, often through rough terrain for upwards of 12 hours daily during trainings which would cause bilateral hand numbness and tingling which has continued to the present.

" February 2025 correspondence noting that during the service the Veteran had to perform repeated gripping, had vibration exposure and physical strain from steering and controlling vehicles. He also shot high caliber weapons.

The Board notes that the claims folder must be provided to and reviewed by the examiner for all post-remand cases per AOJ policy. See VBA Manual M21-1, Part IV.i.2.A.8.b. Thus, the examiner must specifically note that the claims folder was received and reviewed in the body of the examination report.

The examiner is informed by the Board that chronicity is not required to find a nexus to service or for service connection to be granted.

All requested opinions must be supported with
has continued to the present.

The examiner is informed by the Board that chronicity is not required to find a nexus to service or for service connection to be granted.

All requested opinions must be supported with a rationale based on generally accepted medical principles and the examiner's medical training and expertise.

2. Thereafter, the AOJ must readjudicate the Veteran's appealed issues in light of the totality of evidence of record. If any benefit sought is not granted to the fullest extent, the AOJ must provide the Veteran and his private attorney with a copy of the readjudication and afford them an appropriate period to respond.

Scott W. Dale

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Mckone, Kyle

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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