ASTHMA

JOHN R. DOOLITTLE, II · 2026 · Case ID: A26039869

MIXED

Summary

The veteran, who served in the United States Marine Corps from September 2004 to September 2008, appeals the denial of an increased rating for PTSD and insomnia, and the denial of an initial compensable rating for asthma. The Board granted service connection for asthma at a 10% rating, finding that the veteran's condition required intermittent inhalational bronchodilator therapy, but did not meet the criteria for a higher rating as daily therapy or anti-inflammatory medication was not required, nor were pulmonary function tests indicative of more severe impairment. For PTSD and insomnia, the Board denied an increased rating beyond 50%, concluding that while the veteran experienced some symptoms consistent with a 70% rating, such as difficulty adapting to stressful circumstances, the overall level of impairment more closely approximated that of a 50% rating, with reduced reliability and productivity. The Board remanded claims for PLMD, UARS, skin disability (including pruritus), and eustachian tube disorder for further development. For PLMD and UARS, the Board requires additional opinions addressing onset in service and nexus to toxic exposures (burn pits, JP8, fumes, dust), as well as secondary service connection. For the skin disability, a new VA dermatology exam is needed to assess onset, nexus to exposures, and secondary service connection. For eustachian tube disorder, the Board requires clarification on vestibular disequilibrium and its relation to hearing loss.

Rationale

Asthma rated under DC 6602; Requires intermittent inhalational use; Does not require daily therapy or anti-inflammatory medication; Pulmonary function tests do not meet criteria for higher rating

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6602

Docket No.

250606-553756

Full Decision Text

Citation Nr: A26039869
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 250606-553756
DATE: April 29, 2026

ORDER

Entitlement to an initial compensable rating for asthma is granted.

Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) and insomnia is denied.

REMANDED

Entitlement to service connection for organic periodic limb movement disorder (PLMD) is remanded.

Entitlement to service connection for upper airway resistance syndrome (UARS) is remanded.

Entitlement to service connection for a skin disability, to include pruritus, is remanded.

Entitlement to an initial compensable rating for eustachian tube disorder is remanded.

FINDINGS OF FACT

1. The Veteran's asthma requires intermittent inhalational use; it has not required daily inhalational or oral bronchodilator therapy and has never required inhalational anti-inflammatory medication. In addition, FEV-1 has not been 70% predicted or less, and FEV-1/FVC has not been 70 percent or less.

2. The severity, frequency, and duration of the Veteran's PTSD and insomnia symptoms have not more closely approximated occupational and social impairment with deficiencies in most areas.

CONCLUSIONS OF LAW

1. The criteria for an initial rating of 10 percent, but no higher, for service-connected asthma have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.96, 4.97, Diagnostic Code 6602.

2. The criteria for a rating in excess of 50 percent for PTSD and insomnia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service in the United States Marine Corps from September 2004 to September 2008.

This matter comes before the Board of Veterans' Appeals (Board or BVA) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in July and August 2024.

The Appeals Modernization Act (AMA) automatically applies to all claims for which VA issues notice of an initial decision on or after February 19, 2019. See 38 C.F.R. § 3.2400(a)(1). Because the rating decisions on appeal were issued in 2024, they constitute initial decisions. Therefore, the AMA applies.

In the June 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the July and August 2024 rating decisions on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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 claims, 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 claim of entitlement to service connection for PLMD, UARS, and a skin disability, 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).

Increased Ratings

Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes.
, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Increased Ratings

Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

1. Entitlement to an initial compensable rating for asthma

The Veteran contends that a 10 percent rating is warranted for his asthma and noted that he had been prescribed albuterol.

The Veteran's asthma has been rated pursuant to 38 C.F.R. § 4.97, Diagnostic Code 6602.

Under this diagnostic code, a 10-percent rating is warranted where FEV-1 (Forced Expiratory Volume in one second) is 71- to 80-percent predicted; or, where the FEV-1/FVC (Forced Expiratory Volume in one second to Forced Vital Capacity) is 71 to 80 percent; or, where there is intermittent inhalational or oral bronchodilator therapy. 38 C.F.R. § 4.97, Diagnostic Code 6602.

A 30-percent rating is warranted where the FEV-1 is 56- to 70-percent predicted; or, where the FEV-1/FVC is 56 to 70 percent; or, where the condition requires daily inhalational or oral bronchodilator therapy; or, where the conditions require inhalational anti-inflammatory medication. Id.

A 60-percent rating is warranted where the FEV-1 is 40- to 55-percent predicted; or, where the FEV-1/FVC is 40 to 55 percent; or, where at least monthly visits to a physician are required for care of exacerbations; or, where the condition requires intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. Id.

A 100-percent rating, the highest available, is warranted where the FEV-1 is less than 40-percent predicted; or, where the FEV-1/FVC is less than 40 percent; or, where there is more than one attack per week with episodes of respiratory failure; or, where the condition requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications. Id.

By law, evaluations based on pulmonary function testing (PFT) must use post-bronchodilator results in applying the rating criteria unless the post-bronchodilator results were poorer than the pre-bronchodilator results, in which case the pre-bronchodilator values are used. 38 C.F.R. § 4.96(d)(5). Additionally, where there is a disparity between the results of different PFTs (e.g., between FEV-1 and FEV-1/FVC) such that the rating would differ depending on which test is used, the test used should be the one the examiner states most accurately reflects the level of disability. 38 C.F.R. § 4.96(d)(6).

VA treatment records indicate that the Veteran has been prescribed albuterol in November 2023 for exercise-induced asthma. In January 2024, the Veteran was seen in the emergency room for complaints of upper respiratory symptoms and coughed up blood two to three times. He denied having shortness of breath but noted that he did have "a little" shortness of breath with activity and was recently prescribed an albuterol inhaler. He reported using "a couple of puffs last night."

The Veteran underwent VA examination in March 2024 at which time he reported that his asthma required intermittent inhaled medication. Chest x-ray in February 2024 was normal, pulmonary function testing (PFT) showed FVC 89 percent predicted, FEV-1 96 percent predicted, and FEV-1/FVC 107 percent.

The Board finds that a rating
was seen in the emergency room for complaints of upper respiratory symptoms and coughed up blood two to three times. He denied having shortness of breath but noted that he did have "a little" shortness of breath with activity and was recently prescribed an albuterol inhaler. He reported using "a couple of puffs last night."

The Board finds that a rating of 10 percent, but no higher, is warranted for the Veteran's asthma under Diagnostic Code 6602. The evidence indicates that the Veteran's asthma requires intermittent inhalational use.

A rating higher than 10 percent, however, is not warranted as the Veteran has never required daily inhalational or oral bronchodilator therapy and has never required inhalational anti-inflammatory medication. In addition, FEV-1 has not been 70% predicted or less, and FEV-1/FVC has not been 70 percent or less.

2. Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) and insomnia

The Veteran contends that a 70 percent rating is warranted for his PTSD and insomnia and noted that he had difficulty in adapting to stressful circumstances (including work or a worklike setting).

Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 70 percent or higher.

The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 70 percent or higher. The Veteran's symptoms more closely approximated the symptoms associated with a 50 percent rating and resulted in a level of impairment that most closely approximated the level of impairment associated with a 50 percent rating.

A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity.

A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name.

The Veteran underwent VA examination in January 2024 at which time the examiner found that the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation with symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty adapting to stressful circumstances
; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name.

The Board finds the level of impairment caused by the Veteran's symptoms more closely approximates the level associated with a 50 percent rating. The Veteran experienced occupational and social impairment with reduced reliability and productivity. Although the Veteran did experience one symptom contemplated by a 70 percent rating- difficulty adapting to stressful circumstances including work or a work like setting-the evidence overall does not demonstrate the level of impairment associated with a 70 percent rating. As noted above, the Veteran's other remaining symptoms were either contemplated by or more consistent with a 50 percent rating.

In short, the evidence of record persuasively weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 70 percent rating. The criteria for a 70 percent or higher rating have not been met.

REASONS FOR REMAND

3. Entitlement to service connection for PLMD

The Veteran contends that he has PLMD as a result of exposures during his active-duty service. Specifically, he contends that his difficulty is due to exposure to smoke from burn pits, jet propellant 8 (JP8), exhaust fumes from trucks, and sand and dust.

The service treatment records show that on a June 2007 post deployment health assessment, the Veteran noted having problems sleeping or still feeling tired after sleeping.

The Veteran underwent VA examination in January 2024 at which time the examiner opined that PLMD was "less likely than not ... caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran." The examiner stated,

PLMD is a CNS 'movement' disorder of only partially known etiology (some genetic predispositions, sometimes occurring in the setting of metabolic disorders, etc.). However, there is currently no epidemiologic evidence for a causative link between this condition and the types of toxic exposures which occur during SW Asia service.

The Board notes that the examiner did not address whether PLMD had its onset in service as on a June 2007 post deployment health assessment, the Veteran noted having problems sleeping or still feeling tired after sleeping as well as having respiratory problems. As such, an additional VA medical opinion should be obtained that addresses all service connection theories of entitlement.

4. Entitlement to service connection for UARS

The Veteran contends that he has UARS as a result of exposures during his active-duty service. Specifically, he contends that his difficulty is due to exposure to smoke from burn pits, jet propellant 8 (JP8), exhaust fumes from trucks, and sand and dust.

The service treatment records show that on a June 2007 post deployment health assessment, the Veteran noted having problems sleeping or still feeling tired after sleeping as well as having respiratory problems.

The Veteran underwent VA examination in July 2008 at which time he denied having asthma, tuberculosis, pulmonary fibrosis, or sleep apnea. Physical examination of the lungs demonstrated that they were clear to auscultation and percussion; breath sounds were bilaterally symmetric with no evidence of wheezing, rhonchi, or rales; and the expiratory phase was within normal limits.

The Veteran underwent VA examination in March 2024 at which time he was diagnosed as having upper airway resistance syndrome. The examiner stated,

The claimed condition is less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the veteran. Rationale is that claimant has a history of issues with sleep. He has had sleep studies was normal but was clear in the documentation. There is record that notes that after his sleep study in 2016 he had mild obstructive sleep apnea but that was only given for insurance purposes but his AHI was normal. He has an AHI of less than 5. Upper airway resistance syndrome is when the airway of the upper respiratory tract are narrow, but not so narrow as to cause apnea. There is some evidence that he has this based on the history and records. He was exposed to burn pits while in service. Although there has been speculation as to the burn pits leading to sleep apnea or upper airways resistance syndrome, there is no definitive direct causal evidence. Thus it is less likely than not that claimant[']s upper airway resistance syndrome is due to toxic exposures related to burn pits while in service.

The VA examiner added,

[T]he records show evidence of asthma and allergic rhinitis which is a different diagnosis that upper airways resistance syndrome. Thus, it is less likely than not that claimant's upper airway resistance syndrome is due to toxic exposures while in service. As per NIH, [t]he upper airway resistance syndrome (UARS) is a recently described form of sleep-disordered breathing in which repetitive increases in resistance to airflow within the upper airway lead to brief arousals and daytime somnolence.

The examiner also stated,

I have reviewed the conflicting medical evidence and am providing the following opinion. ... There are records rather noting his allergic rhinitis and asthma. Thus it is less likely than not that claimant's upper airway resistance syndrome is due to Gulf War toxic exposures during deployment in Iraq and Kuwait while in service.

The Board finds the medical opinions unclear as to whether the Veteran's upper airway resistance syndrome is due to his allergic rhinitis and asthma. In addition, the examiner did not address whether UARS had its onset in service as on a June 2007 post deployment health assessment, the Veteran noted having problems sleeping or still feeling tired after sleeping as well as having respiratory problems. As such, an additional VA medical opinion should be obtained that addresses all service connection theories of entitlement.

5. Entitlement to service connection for a skin disability, to include pruritus

The Veteran contends that he has a skin disability, to include pruritus, as a result of exposures during his active-duty service. Specifically, he contends that his difficulty is due to exposure to smoke from burn pits, jet propellant 8 (JP8), exhaust fumes from trucks, and sand and dust. Alternatively, the Veteran contends that his skin disability is secondary to service-connected allergic rhinitis.

In August 2024, the Veteran stated that he was willing to undergo VA examination. The Veteran was scheduled to undergo VA dermatology examination in July 2024; however, the examination was cancelled as the Veteran failed to confirm his appointment.

There is no legal provision regarding the establishment of an "RSVP" for purposes of scheduling required examinations. Instead, a written notice should have been dispatched to the Veteran as to the time, date, and location of the scheduled examination.

The Veteran has a duty to report at the scheduled time and place and to actively participate in the development of the claims (unless good cause for the absence has been shown), but the Veteran was never given the opportunity to do so.

Accordingly, a remanded is warranted to provide the Veteran with an additional opportunity to report for a VA dermatology examination. The Veteran is advised that VA's duty to assist in developing facts and evidence in conjunction with a claim is not a one-way street; failure to cooperate in such development such as reporting for an examination may result a denial of his claim. 38 C.F.R. § 3.655; see Wood v. Derwinski, 1 Vet. App. 190, 193 (1991).

6. Entitlement to an initial compensable rating for eustachian tube disorder

The Veteran's service-connected eustachian tube disorder has been rated pursuant to 38 C.F.R. § 4.87, Diagnostic Codes 6299-6204. As the Veteran's specific disability is not listed on the Rating Schedule, Diagnostic Codes 6299-6204 have been assigned pursuant to 38 C.F.R. § 4.27, which provides
in such development such as reporting for an examination may result a denial of his claim. 38 C.F.R. § 3.655; see Wood v. Derwinski, 1 Vet. App. 190, 193 (1991).

6. Entitlement to an initial compensable rating for eustachian tube disorder

The Veteran's service-connected eustachian tube disorder has been rated pursuant to 38 C.F.R. § 4.87, Diagnostic Codes 6299-6204. As the Veteran's specific disability is not listed on the Rating Schedule, Diagnostic Codes 6299-6204 have been assigned pursuant to 38 C.F.R. § 4.27, which provides that unlisted disabilities requiring rating by analogy will be coded as the first two numbers of the most closely related body part and "99." See 38 C.F.R. § 4.20. Diagnostic Codes 6299-6204 rate injuries and diseases of the ear, and more particularly, peripheral vestibular disorders.

Diagnostic Code 6204 assigns a disability rating of 10 percent for "occasional dizziness," and a disability rating of 30 percent for "dizziness and occasional staggering." The Board notes that 30 percent is the highest schedular rating available under Diagnostic Code 6204. The note in this diagnostic code indicates that objective findings supporting the diagnosis of vestibular disequilibrium are required before a compensable evaluation can be assigned under this code. Hearing impairment or suppuration shall be separately rated and combined. 38 C.F.R. § 4.87, Diagnostic Code 6204.

The Veteran underwent VA examination in May 2024 at which time he noted current symptoms of fullness/pressurized feeling in his ears which affected his hearing and that he usually pinched his nose to resolve the fullness/pressurized feeling. The Veteran stated,

I can still do everything. If I cannot hear or understand what someone is saying I turn my head towards them and ask them to repeat themselves. If I am on the phone I might ask them to spell out any words I cannot understand using phonetic alphabet. If I get lightheaded it usually doesn't last more than a few seconds. If I bump my shoulder or bump into a wall or whatever due to loss of balance I just keep doing what I am doing, it does not happen that often.

The Veteran denied falls from imbalance.

Physical examination demonstrated that the Veteran tended to lean/stumble to the right when putting his right foot in front of his left foot; however, the examiner found that the Veteran did not have any findings, signs, or symptoms attributable to a peripheral vestibular condition such as staggering. In addition, the examiner found that the Veteran had hearing impairment and/or tinnitus and noted that tinnitus was bilateral and a little louder when his ears felt plugged. A June 2024 VA examination for hearing loss and tinnitus indicated that the Veteran had a diagnosis of right ear hearing loss and tinnitus; however, no etiology opinion was provided.

The Board finds that the May 2024 VA examination is inconsistent as to whether the Veteran's eustachian tube disorder causes imbalance and unclear as to whether the Veteran's eustachian tube disorder causes hearing loss. As such, an additional VA examination and medical opinion should be obtained. As noted above, the Note to Diagnostic Code 6204 provides that objective findings supporting the diagnosis of vestibular disequilibrium are required before a compensable evaluation can be assigned under that code. On remand, the examiner will be asked to reconcile findings set out above and opine on the presence of a diagnosis of vestibular disequilibrium.

The matters are REMANDED for the following action:

1. Obtain addendum opinions from an appropriate clinician, preferably a neurologist, regarding whether the Veteran's PLMD (i) had its onset during service or (ii) is at least as likely as not related to his active-duty service including due to his exposure to burn pits, JP8, exhaust fumes from trucks, and sand and dust.