BRONCHIAL ASTHMA

H.M. WALKER · 2026 · Case ID: A26040001

MIXED

Summary

The veteran, who served in the Navy from March 1990 to July 1998, appeals the denial of an increased disability rating for asthma and the denial of service connection for sleep apnea. The Board reviewed the evidence of record at the time of the prior decisions. For asthma, the veteran's current rating is 30 percent. The Board found that the veteran's pulmonary function tests, specifically the FEV-1/FVC ratio of 88 percent post-bronchodilator, did not meet the criteria for a higher rating. The examiner noted the veteran's daily use of bronchodilator and anti-inflammatory inhalers, but also that he did not require systemic corticosteroids and had fewer than monthly visits for exacerbations. The Board denied an increased rating, finding the evidence weighed against a higher evaluation. For sleep apnea, the veteran reported symptoms during service and a recent diagnosis. The case was remanded because the VA examiner's opinion on sleep apnea's relation to a conceded Toxic Exposure Risk Activity (TERA) was unfavorable, and no opinion addressed the reasonably raised secondary theory of entitlement based on the veteran's service-connected asthma or direct service connection for in-service symptoms. The remand directs a new VA opinion to determine the etiology of sleep apnea, its relation to service, and its potential secondary connection or aggravation by asthma.

Rationale

FEV-1/FVC ratio of 88% post-bronchodilator; Daily inhalational bronchodilator and anti-inflammatory medication use; Fewer than monthly physician visits for exacerbations

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6602

Docket No.

250801-572694

Full Decision Text

Citation Nr: A26040001
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 250801-572694
DATE: April 29, 2026

ORDER

Entitlement to an increased evaluation greater than 30 percent for asthma is denied.

REMANDED

Entitlement to service connection for sleep apnea is remanded.

FINDING OF FACT

Throughout the period on appeal, the Veteran was prescribed daily inhalational bronchodilator therapy and/or anti-inflammatory medications to treat his asthma; his FEV-1/FVC was, at worst, 88 percent.

CONCLUSION OF LAW

The criteria for a disability rating greater than 30 percent for asthma are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.96, 4.97, Diagnostic Code 6602.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from March 1990 to July 1998. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2024 (pertains to asthma) and April 2025 (pertains to OSA), decisions from the Department of Veterans Affairs (VA) Regional Office (RO).

In the August 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the September 2024 decision as it pertains to entitlement to an increased evaluation for asthma, and the April 2025 decision as it pertains to entitlement to service connection for OSA, agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

As to the issue of entitlement to an increased evaluation for asthma, 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, 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 sleep apnea, any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

1. Entitlement to an increased evaluation greater than 30 percent for asthma.

The Veteran's asthma is currently rated at 30 percent pursuant to 38 C.F.R. § 4.97, DC 6602.

A disability rating is determined by applying VA's Schedule for Rating Disabilities (Rating Schedule), 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 their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

Bronchial asthma is evaluated under DC 6602. A 10 percent rating is warranted for FEV-1 of 71- to 80-percent of predicted value, or; a FEV-1/FVC ratio of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy. A 30 percent rating is warranted for FEV-1 of 56- to 70-percent of predicted value, or; a FEV-1/FVC ratio of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication. A 60 percent rating is warranted for FEV-1 of 40- to 55-percent of predicted value, or; a
A 10 percent rating is warranted for FEV-1 of 71- to 80-percent of predicted value, or; a FEV-1/FVC ratio of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy. A 30 percent rating is warranted for FEV-1 of 56- to 70-percent of predicted value, or; a FEV-1/FVC ratio of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication. A 60 percent rating is warranted for FEV-1 of 40- to 55-percent of predicted value, or; a FEV-1/FVC ratio of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. A 100 percent rating is warranted for FEV-1 less than 40-percent of predicted value, or; a FEV-1/FVC ratio of less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications. 38 C.F.R. § 4.97, DC 6602. DC 6602 also notes that in the absence of clinical findings of asthma at time of examination, a verified history of asthmatic attacks must be of record.

If the DLCO (SB) test is not of record, evaluation should be based on alternative criteria as long as the examiner states why the test would not be useful or valid in a particular case. 38 C.F.R. § 4.96(d)(2). When the PFTs are not consistent with clinical findings, evaluation should be based on the PFTs unless the examiner states why they are not a valid indication of respiratory functional impairment in a particular case. 38 C.F.R. § 4.96(d)(3).

Post-bronchodilator studies are required when PFTs are done for disability evaluation purposes except when the results of pre-bronchodilator pulmonary function tests are normal or when the examiner determines that post-bronchodilator studies should not be done and states why. 38 C.F.R. § 4.96(d)(4). When evaluating based on PFTs, use post-bronchodilator results 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. 38 C.F.R. § 4.96(d)(5).

Finally, when there is a disparity between the results of different PFTs (FEV-1 (Forced Expiratory Volume in one second), FVC, etc.), so that the level of evaluation would differ depending on which test result is used, use the test result that the examiner states most accurately reflect the level of disability. 38 C.F.R. § 4.96(d)(6).

Private treatment records from Kaiser Permanent were received and reviewed. In a January 2024 visit Dr. T. noted he had last seen the Veteran in 2020. The Veteran reported sometimes gasping at night and daytime drowsiness, and requested a screening for sleep apnea. He had no shortness of breath, or chest pain. He had a prescription for Albuterol as needed, and Wixela for daily use.

According to VA treatment records, in May 2024 the Veteran was seen in the San Diego VAMC ER. The Veteran reported he was cleaning out his garage when he suddenly began wheezing, and his home inhalers albuterol and Spiriva, did not help. He was assessed with an acute asthma attack, and following nebulizer treatment was stabilized and discharged to home.

In a May 2024 statement, the Veteran reported being prescribed Wixela, Spiriva, and albuterol to treat his asthma. He reported at least 3 severe asthma attacks since discharge, that caused him to miss work. He reported feeling out of breath when walking to and from his car. He also reported first experiencing sleep apnea during service that has continued to present.

In June 2024 the Veteran underwent an examination. He reported a worsening of symptoms, and a recent emergency department visit due to an asthma attack. The Veteran was taking formoterol, and montelukast daily, as well as using the albuterol rescue inhaler on a daily basis. He does not use an oral or parenteral corticosteroid medication. He uses inhalational bronchodilator therapy daily, and inhalational anti-inflammatory medication on a daily basis. His condition does not require the use of oral bronchodilators, antibiotics, or oxygen therapy. In the past 12 months he has not had an asthma attack with episode of respiratory failure. He reported a recent emergency department visit as he could not catch his breath. He visited a physician for required care of exacerbations less frequently than monthly.

Pulmonary function testing (PFT) had been performed and were deemed accurate by the examiner. Pre-bronchodilator results were: FVC 69% predicted, FEV-1 42% predicted, FEV-1/FVC 61%, with no report for DLCO. Post-bronchodilator results were: FVC 95% predicted, FEV-1 84% predicted, FEV-1/FVC 88%. The examiner indicated FEV-1/FVC is the most accurate test result. The examiner concluded spirometry demonstrates severe obstruction, a significant bronchodilator response, and resting oximetry is within normal limits.

In a June 2024 statement, the Veteran reported experiencing daily asthma attacks, necessitating the use of Albuterol. He reported relying on Albuterol to keep his airway open. He reported using Dulera, Spiriva, and Montelukast daily. He noted a hope to eliminate the need for Albuterol, and use solely the 3 prescribed medications. He further reported waking every 1 to 2 hours due to difficulty breathing and a recent diagnosis of sleep apnea.

In light of the above, the Board finds that a 30 percent disability rating is warranted throughout the period on appeal pursuant to Diagnostic Code 6602 for asthma. The VA examiner opined that the FEV-1/FVC was the most accurate test to reflect the Veteran's level of disability. At worst, the FEV-1/FVC was 88 percent.

Diagnostic Code 6602 provides for a 30 percent rating when FEV-1 of 56 to 70 percent; or Forced Expiratory Volume in One Second over Forced Vital Capacity (FEV-1/FVC) ratio of 56 to 70 percent; or daily inhalational or oral bronchodilator therapy or inhalational anti-inflammatory medication. Here, the evidence reflects that the Veteran has been prescribed daily inhalational bronchodilator therapy and/or anti-inflammatory medications throughout the entire period on appeal.

The next higher evaluation of 60 percent is not warranted as he does not have PFTs of 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 three per year) courses of systemic (oral or parenteral) corticosteroids.

Accordingly, the evidence weighs persuasively against a finding that a rating higher than 30 percent is warranted at any point during the period on appeal and the claim is denied.

REASONS FOR REMAND

Entitlement to service connection for sleep apnea.

The Veteran has submitted a claim for service connection for sleep apnea. He reported developing symptoms during service.

In a September 2024 Toxic Exposure Risk Activity (TERA) Memorandum, it was confirmed the Veteran participated in a TERA. The Veteran served in the Navy, and based off his MOS, exposure to asbestos is conceded.

The Veteran has submitted a claim for service connection for sleep apnea. He reported developing symptoms during service.

In October 2024 the Veteran was afforded a VA examination. He reported snoring which wakes him in the night, and trouble staying awake during day. The examiner opined sleep apnea was less likely than not caused by the indicated TERA 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. Furthermore the examiner explained risk factors for sleep apnea include, but are not limited to, obesity, respiratory issues, and alcohol use.

In a February 2025 addendum opinion, the examiner again stated sleep apnea is note related to the indicated TERA.

There is no opinion addressing the reasonably raised secondary theory of entitlement or direct service connection (not TERA) based on the Veteran's clinical report of in-service sleep apnea symptoms and continuation since. Notably, the October 2024 examiner noted that respiratory issues are risk factors for sleep apnea and the Veteran is service connected for asthma. Therefore, remand is necessary to correct the duty to assist error on the part of the originating agency in satisfying its duties under 38 U.S.C. § 5103A, which occurred prior to the decision on appeal. See 38 C.F.R. § 20.802.

The matters are REMANDED for the following action:

1. Obtain an addendum VA medical opinion from an appropriate clinician to determine the nature and likely etiology of the Veteran's sleep apnea. If another in-person examination is necessary, one should be provided. The Veteran's claims folder and a complete copy of this Remand must be made available to the clinician.

Following a review of the claims file, the examiner should provide an opinion for the following:

a) Whether it is at least as likely as not that the Veteran's sleep apnea had its onset during service or is causally or etiologically related to any in-service injury, event or disease? The examiner is asked to address the Veteran's recent report of in-service symptoms and symptoms since.

b) Whether it is at least as likely as not that the Veteran's sleep apnea is due to or the result of his service connected asthma?

c) Is it at least as likely as not that the Veteran's sleep apnea syndrome was aggravated (ANY incremental increase in disability, regardless of is permanence) by his service connected asthma?

The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability.

The term "at least as likely as not" does not mean "within the realm of medical possibility." Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion.

The examiner is asked to address the Veteran's contentions, personnel records, and STRs.

If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to the question.

H.M. WALKER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Skiouris, Elena

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.

.F.R. § 20.1303.

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