NEOPLASMS MALIGNANT ANY SPECIFIED PART OF RESPIRATORY SYSTEM

WILLIAM H. DONNELLY · 2026 · Case ID: A26039545

MIXED

Summary

The veteran, who served in the U.S. Army from August 1989 to August 1993, appeals a rating decision concerning a pulmonary coin lesion and an acquired psychiatric disorder. The Board granted an initial 10 percent disability evaluation for the pulmonary coin lesion, finding that the veteran's pulmonary function tests most accurately reflected disability under the criteria for a 10 percent rating, specifically referencing FEV-1/FVC results of 83 percent predicted. The Board determined that the veteran's FEV-1/FVC did not meet the criteria for a higher rating. The claim for service connection for an acquired psychiatric disorder, including PTSD, anxiety, and/or depression, was remanded. The Board found that VA committed a duty-to-assist error by failing to obtain a more detailed stressor statement from the veteran regarding allegations of witnessing people being hurt or killed in service, and by not providing a new VA psychiatric examination. The remand instructions require the veteran to complete a VA Form 21-0781 for mental health disorders and to attend a VA examination to determine the nature and etiology of any acquired psychiatric disorder, with the examiner to opine on nexus to service and address the specific stressor allegations.

Rationale

Pulmonary coin lesion evaluated under DC 6820 by analogy to Restrictive Lung Disease; FEV-1/FVC of 83 percent predicted meets criteria for 10 percent evaluation; Higher rating not warranted as FEV-1/FVC does not meet criteria for 30 percent evaluation

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6820

Docket No.

250530-549649

Full Decision Text

Citation Nr: A26039545
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 250530-549649
DATE: April 28, 2026

ORDER

Entitlement to an initial 10 percent disability evaluation, but no higher, for pulmonary coin lesion is granted.

REMANDED

Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), anxiety, and/or depression is remanded.

FINDING OF FACT

The Veteran's pulmonary coin lesion has manifested as no worse than post-bronchodilator FEV-1 of 91 percent of predicted; FVC of 89 percent of predicted; and FEV-1/FVC of 83 percent throughout the appellate period.

CONCLUSION OF LAW

The criteria for an initial 10 percent disability evaluation, but no higher, for pulmonary coin lesion are met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1 - 4.7, 4.21, 4.97, Diagnostic Code 6820.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from August 1989 to August 1993. These matters come before the Board of Veterans' Appeals (Board) on appeal from an April 2025 rating decision by the Oakland, California Regional Office (RO) of the United States Department of Veterans Affairs.

In May 2025, the Veteran filed a VA Form 10182, notice of disagreement (NOD), and elected direct review of the AOJ decision by the Board. 38 C.F.R. § 20.202. Under direct review, the Board considers the same record as that before the AOJ at the time of the decision on appeal. 38 C.F.R. § 20.301.

Remand is permitted only to correct a pre-decisional error or for any other error the correction of which raises a reasonable possibility of aiding in substantiating the claim. 38 C.F.R. § 20.802.

Under the Appeals Modernization Act (AMA), previously disallowed claims may be readjudicated if "new and relevant evidence" is received. 38 C.F.R. § 3.156(d). New evidence is evidence not previously part of the actual record before agency adjudicators. Relevant evidence is evidence that tends to prove or disprove a matter in issue in a claim. 38 C.F.R. § 3.2501.

In the April 2025 decision, the AOJ found that new and relevant evidence was submitted to warrant readjudicating the claim for service connection for PTSD. The Board is bound by this favorable finding. 38 C.F.R. § 3.104(c).

The Veteran's claim of entitlement to service connection for PTSD has been recharacterized to broadly reflect that the scope of the claim includes any acquired psychiatric disorder, pursuant to Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009).

The Board finds that a total rating based upon individual unemployability due to service-connected disabilities (TDIU) has not been raised by the Veteran or the record on appeal at the time of the rating decision on appeal. Rice v. Shinseki, 22 Vet. App. 447 (2009). VA treatment records document the Veteran was employed during the appellate period. TDIU is not an issue on appeal.

Increased Rating

Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1.

In evaluating the severity of a disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Separate ratings may be assigned for separate periods of time based on the facts found, however. This practice is known as "staged" ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007).

Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

The Veteran is seeking an initial compensable evaluation for her pulmonary coin lesion. The Veteran's pulmonary coin lesion is evaluated under 38 C.F.R. § 4.97, Diagnostic Code 6820.

Pursuant to Diagnostic Code 6820, for benign neoplasms, any specified part of respiratory system, evaluations are assigned using an appropriate respiratory analogy. 38 C.F.R. § 4.97, Diagnostic Code 6820.

After a review of respiratory diagnostic codes, the Board finds the most appropriate respiratory analogy is to evaluate the Veteran's pulmonary coin lesion pursuant to the General Rating Formula for Restrictive Lung Disease. The Veteran does not have pulmonary tuberculosis (Codes 6701 to 6724, 6730, 6731), pulmonary vascular disease (Code 6817), bacterial lung infections (Codes 6822 to 6824), interstitial lung disease (Codes 6825 to 6833) or mycotic lung disease (Codes 6834 to 6839).

The General Rating Formula for Restrictive Lung Disease provides that a 10 percent evaluation is assigned for Forced Expiratory Volume (FEV) of 71 to 80 percent predicted, or; the ratio of Forced Expiratory Volume in one second of Forced Vital Capacity (FEV-1/FVC) of 71 to 80 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) 66 to 80 percent predicted. 38 C.F.R. § 4.97, Diagnostic Code 6600.

A 30 percent evaluation is assigned for 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. 38 C.F.R. § 4.97, Diagnostic Code 6600.

A 60 percent evaluation is assigned for 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 in (with cardiorespiratory limit). 38 C.F.R. § 4.97, Diagnostic Code 6600.

A 100 percent evaluation is warranted for FEV-1 less than 40 percent of predicted value, or; the ratio of Forced Expiratory Volume in one second of 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 m/kg in 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. 38 C.F.R. § 4.97, Diagnostic Code 6600.

38 C.F.R. § 4.96(d)(2)(5) provides that when evaluating based on Pulmonary Function Tests (PFTs), post-bronchodilator results should be used in applying the evaluation criteria in the rating schedule unless the post-bronchodilator results were poorer than the pre-bronchodilator results. In those cases, use the pre-bronchodilator values for rating purposes.

The Veteran was afforded a VA respiratory examination in January 2025. The VA examiner noted the Veteran's diagnosis of a pulmonary coin lesion. The VA examiner also noted that the Veteran's respiratory condition does not require the use of oral or parenteral corticosteroid medications, inhaled medications, oral bronchodilators, antibiotics, nor outpatient oxygen therapy. The Veteran did not report having any symptoms. Chest x-rays taken in connection with the examination revealed no acute cardiopulmonary disease. The VA examiner acknowledged a 2006 CT scan which revealed a small, 6mm nodular density in the right upper lobe. The Veteran's FVC was 89 percent predicted (pre-bronchodilator), and 85 percent predicted (post-bronchodilator); FEV-1 was 91 percent predicted (pre-bronchodilator), and 86 percent predicted (post-bronchodilator); FEV-1/FVC was 83 percent (pre-bronchodilator) and 81 percent (post-bronchodilator). The VA examiner noted that the FEV-1 test result most accurately reflects the Veteran's level of disability (based on the condition that is being evaluated for this report).

The Board finds that the criteria for an initial disability evaluation of 10 percent, and no higher, are met for the Veteran's pulmonary coin lesion. PFT testing was conducted at the Veteran's VA examination and the VA examiner stated that the FEV-1/FVC test result most accurately reflects the Veteran's level of disability. The Veteran's FEV-1/FVC result was 83 percent predicted (pre-bronchodilator). An FEV-1 of 71 to 80 percent predicted warrants a 10 percent disability evaluation. The Board has considered whether a higher, 30 percent rating is warranted, but the Veteran's FEV-1/FVC does not meet the rating criteria for a 30 percent evaluation as his FEV-1/FVC is not 56 to 70 percent predicted (post-bronchodilator). Therefore, a rating in excess of 10 percent is not warranted.

REASONS FOR REMAND

The Board finds that a remand is required for the issue of entitlement to service connection for an acquired psychiatric disorder to include PTSD, anxiety and/or depression because VA committed a duty-to-assist error prior to issuing the decision on appeal.

The Veteran is seeking entitlement to an acquired psychiatric disorder. The Veteran's VA treatment records reflect diagnoses of anxiety disorder and depressive disorder. A VA psychiatric treatment note reflects the Veteran reported having frequent nightmares related to witnessing others being hurt or killed in the military. She did serve in the Southwest Asia theater from late 1990 to early 1991, during a period of combat operations, and such is consistent with her stressor allegations. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The threshold for determining a possibility of a nexus to service is a low one. McLendon v. Nicholson, 20 Vet. App. 79 (2006).

On remand, the Veteran should be scheduled for a VA examination to determine the nature and etiology of any currently diagnosed acquired psychiatric disorder.

In conjunction with this, the Veteran should again be asked for details regarding her stressor allegations. In VA treatment records in December 2024, the Veteran provided general statements of seeing people hurt and killed in service, which should have prompted a second request from the AOJ. The Veteran is reminded that the duty to assist is not a one
38 C.F.R. § 3.159(c)(4). The threshold for determining a possibility of a nexus to service is a low one. McLendon v. Nicholson, 20 Vet. App. 79 (2006).

On remand, the Veteran should be scheduled for a VA examination to determine the nature and etiology of any currently diagnosed acquired psychiatric disorder.

In conjunction with this, the Veteran should again be asked for details regarding her stressor allegations. In VA treatment records in December 2024, the Veteran provided general statements of seeing people hurt and killed in service, which should have prompted a second request from the AOJ. The Veteran is reminded that the duty to assist is not a one-way street, and a failure to reply to VA requests for information may negatively impact her claim. Wamhoff v. Brown, 8 Vet. App. 517, 522 (1996); Zarycki v. Brown, 6 Vet. App. 91, 100 (1993); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991).

The matter is REMANDED for the following action:

1. Contact the Veteran and request she complete a VA Form 21-0781, Statement in Support of Claimed Mental Health Disorder(s) Due To An In-Service Traumatic Event(s). She should provide details regarding her allegations of seeing people killed and injured in service.

2. Schedule the Veteran for a VA initial PTSD/mental disorders examination. The claims file must be reviewed in conjunction with the examination.

The examiner must identify all currently diagnosed acquired psychiatric disorders, and for each must opine as to whether such is at least as likely as not caused or aggravated by service. The examiner must consider and address the December 2024 stressor allegations, as well as any statements made at examination.

A full and complete rationale for all opinions expressed is required.

WILLIAM H. DONNELLY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Margaret M. Lunger

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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