Case A26040335

R. BISIGNANI · 2026 · Case ID: A26040335

MIXED

Summary

The veteran, who served in the Army from April 1969 to April 1993, appeals the denial of an earlier effective date for migraines and seeks increased ratings for asthma and bilateral lower extremity post-phlebitic syndrome, as well as entitlement to TDIU. The Board denied the claim for an earlier effective date for migraines, finding no evidence of increased severity within the one-year look-back period. For migraines, the Board granted a 50 percent rating, finding the veteran experienced very frequent, completely prostrating, prolonged attacks productive of severe economic inadaptability, based on VA examination findings and the veteran's lay statements. For asthma, the Board granted a 60 percent rating, noting the VA examiner's finding of FEV-1 predicted at 55 percent post-bronchodilator and the veteran's need for daily inhalational bronchodilator therapy, which met the criteria for this rating. The Board denied increased ratings for bilateral lower extremity post-phlebitic syndrome, finding the evidence did not support persistent edema incompletely relieved by elevation, which is required for higher ratings under DC 7121, and that the symptoms described were contemplated by the current 10 percent evaluations. Finally, the Board granted entitlement to TDIU, finding the veteran's combined service-connected disabilities, including migraines, asthma, and bilateral post-phlebitic syndrome, prevent her from securing and maintaining substantially gainful employment, supported by VA examination findings and a private medical opinion.

Rationale

Migraines rated under DC 8100; Criteria for 50% met: very frequent, completely prostrating, prolonged attacks; Attacks productive of severe economic inadaptability

Service Branch

ARMY

Special Benefit

TDIU

Diagnostic Code

8100

Docket No.

251124-619710

Full Decision Text

Citation Nr: A26040335
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 251124-619710
DATE: April 29, 2026

ORDER

Entitlement to an effective date prior to November 6, 2023, for service-connected migraines is denied.

Entitlement to an evaluation of 50 percent for migraines is granted.

Entitlement to an evaluation of 60 percent for asthma is granted.

Entitlement to an evaluation in excess of 10 percent for left lower extremity post-phlebitic syndrome is denied.

Entitlement to an evaluation in excess of 10 percent for right lower extremity post-phlebitic syndrome is denied.

Entitlement to a total disability rating based on individual unemployability (TDIU) is granted.

FINDINGS OF FACT

1. A March 2024 rating decision granted a separate 30 percent evaluation for migraines and assigned an effective date of November 6, 2023, the date VA received the Veteran's claim for an increased rating.

2. The evidence of record shows that from November 6, 2023, the Veteran has experienced headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.

3. The Veteran's asthma had a Forced Expiratory Volume (FEV-1) of 40 to 55 percent predicted.

4. The Veteran's left lower extremity post-phlebitic syndrome has not manifested as having persistent edema, incompletely relieved by elevation of extremity with or without beginning stasis pigmentation or eczema.

5. The Veteran right lower extremity post-phlebitic syndrome has not manifested as having persistent edema, incompletely relieved by elevation of extremity with or without beginning stasis pigmentation or eczema.

6. The Veteran's service-connected disabilities preclude her from securing and following a substantially gainful occupation.

CONCLUSIONS OF LAW

1. The criteria for an effective date prior to November 6, 2023, for the award of a 30 percent evaluation for migraines have not been met. 38 U.S.C. §§ 5101, 5107, 5110; 38 C.F.R. §§ 3.151(b), 3.400, 3.2500.

2. The criteria for entitlement to a disability rating of 50 percent with an effective date of November 6, 2023, for migraines have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8100.

3. The criteria for a 60 percent evaluation for asthma have been met. 38 U.S.C. §§1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.96, 4.97 Diagnostic Code (DC) 6602.

4. The criteria for entitlement to an evaluation in excess of 10 percent for left lower extremity post-phlebitic syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.104, DC 7120.

5. The criteria for entitlement to an evaluation in excess of 10 percent for right lower extremity post-phlebitic syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.104, DC 7120.

6. The criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.16, 4.18, 4.19, 4.25.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1969 to April 1993.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2024 rating decision by a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). In the November 24, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore
.R. §§ 3.340, 3.341, 4.3, 4.16, 4.18, 4.19, 4.25.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1969 to April 1993.

Therefore, the Board may only consider the evidence of record at the time of the October 2023 and March 2024 AOJ decisions, which were subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or her attorney 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, which was subsequently subject to higher-level review 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 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.

Earlier Effective Dates

Except as otherwise provided, the effective date of an evaluation and award of pension, compensation or dependency, and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be on the date of receipt of the claim or the date entitlement arose, whichever is the latter. 38 U.S.C.§ 5110 (a); 38 C.F.R. §§ 3.400, 3.400(b)(2). If a claim is reviewed at the request of the claimant more than one year after the effective date of a liberalizing law, benefits may be authorized for a period of one year prior to the date of receipt of such request. 38 C.F.R. § 3.114 (a)(2).

When an award is based on a claim to reopen a previously denied claim, the effective date will be the date of receipt of the new (i.e., reopened) claim or the date entitlement arose, whichever is later, unless new and material evidence was received within the relevant appeal period. 38 C.F.R. § 3.400 (q). If new and material evidence other than service department records is received within the appeal period or prior to appellate decision, the effective date will be as though the former decision had not been rendered.

The U.S. Court of Appeals for Veterans Claims (Court) has held that once a rating decision which establishes an effective date becomes final, such a decision can only be revised if it contains clear and unmistakable error. See Rudd v. Nicholson, 20 Vet. App. 296, 299-300 (2006). The Court has stressed that any other result would vitiate the rule of finality, thereby recognizing that freestanding claims for earlier effective dates are impermissible. Id.

VA law and regulations provide that unless otherwise provided, the effective date of an award of increased evaluation shall be fixed in accordance with the facts found but shall not be earlier than the date of receipt of the application therefor. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. Regulations also provide that the effective date of an evaluation and award of compensation based on a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400(o)(1).

The Board notes that the effective date of an award of increased compensation may, however, be established at the earliest date as of which it is factually ascertainable that an increase in disability had occurred if the application for an increased evaluation is received within one year from that date. 38 U.S.C. § 5110(b)(2); 38 C.F.R.
.C. § 5110(a); 38 C.F.R. § 3.400. Regulations also provide that the effective date of an evaluation and award of compensation based on a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400(o)(1).

For a claim for increased rating, if the increase is factually ascertainable within one year prior to the receipt of the claim, the rating will be effective as of the date of increase; however, if the increase occurred more than one year prior to receipt of the claim, the increase will be effective on the date of claim. Further, if the increase occurred after the date of claim, the effective date will be the date of increase. 38 U.S.C. § 5110(b)(2); Harper v. Brown, 10 Vet. App. 125 (1997); 38 C.F.R. § 3.400(o)(1), (2); VAOPGCPREC 12-98 (1998).

Thus, determining an appropriate effective date for an increased rating under the effective date regulations involves an analysis of the evidence to determine (1) when a claim for an increased rating was received and, if possible, (2) when the increase in disability actually occurred. 38 C.F.R. §§ 3.155, 3.400(o)(2).

Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA's adjudication regulations be filed on a standard form. The amendments implement the concept of an intent to file a claim for benefits, which operates similarly to the informal claim process, but requires that the submission establishing a claimant's effective date of benefits must be received in one of three specified formats. The amendments also eliminate the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen under 38 C.F.R. § 3.157. See 79 Fed. Reg. 57,660 (Sept. 25, 2014) (now codified at 38 C.F.R. §§ 3.1 (p), 3.151, 3.155). The amendments apply only to claims filed on or after March 24, 2015.

In regard to the date of entitlement, the term "date entitlement arose" is not defined in the current statue or regulation. However, the Court has interpreted it as the date when the claimant met the requirements for the benefits sought. This is determined on a "facts found" basis. See 38 U.S.C. § 5110 (a); see also McGrath v. Gober; 14 Vet. App. 28, 35 (2000). It is important to note that an effective date generally can be no earlier than the facts found. DeLisio v. Shinseki, 25 Vet. App. 45 (2011). For instance, if a claimant filed a claim for benefits for a disability before he actually had the disability, the effective date for benefits can be no earlier than the date the disability first manifested. Ellington v. Peake, 541 F.3d 1364, 1369-70 (Fed. Cir. 2008).

1. Entitlement to an effective date prior to November 6, 2023, for the award of service connection for migraines

The Veteran asserts that she is entitled to an earlier effective date for her service-connected headaches. See November 2025 VA Form 10182.

Procedural Background and Analysis

Here, a September 1993 rating decision granted service connection for "reactive airways disease with asthma, allergic rhinitis, sinusitis and headaches." See September 1993 Rating Decision Narrative.

In November 2023, the Veteran filed a new application for an increased rating for headaches. See November 2023 VA Form 21-526EZ. In a March 11, 2024, rating decision a separate, 30 percent disability rating was assigned for headaches, effective November 6, 2023, the date VA received the increased rating claim. See March 2024 Rating Decision - Narrative. In September 2024, the Veteran sought higher-level review, requesting an earlier effective date for the award of the increased rating for her service-connected headaches, which was denied in a
"reactive airways disease with asthma, allergic rhinitis, sinusitis and headaches." See September 1993 Rating Decision Narrative.

In November 2023, the Veteran filed a new application for an increased rating for headaches. See November 2023 VA Form 21-526EZ. In a March 11, 2024, rating decision a separate, 30 percent disability rating was assigned for headaches, effective November 6, 2023, the date VA received the increased rating claim. See March 2024 Rating Decision - Narrative. In September 2024, the Veteran sought higher-level review, requesting an earlier effective date for the award of the increased rating for her service-connected headaches, which was denied in a December 2024 rating decision. See September 2024 VA Form 20-0996; December 2024 Rating Decision - Narrative. Subsequently, the Veteran filed the instant appeal. See November 2025 VA Form 10182.

Under 38 U.S.C. § 5110(b)(3), the Veteran will be eligible for an earlier effective date for headaches if it is factually ascertainable that the increase in severity took place within one year prior to the receipt of her increased rating claim. Otherwise, the appropriate effective date is the date of receipt of her claim.

However, upon review of the evidence that is within one year prior to the date of the Veteran's November 6, 2023, claim for increase, there is no evidence to support a factually ascertainable increase in severity of the Veteran's headaches at that time.

Specifically, there is no indication from any treatment report for the period from November 6, 2022, to November 6, 2023, which demonstrates an increase in severity of the Veteran's headaches. (For example, records from December 2022 and May 2023 indicate that the Veteran reported no headaches. See March 2026 JLV/MTF (482 pgs.) at 69; July 2023 CAPRI at 10.)

As a result, the Board finds that an effective date prior to November 6, 2023, is not warranted. As noted above, the Veteran filed her increased rating claim on November 6, 2023. VA did not receive an intent to file a claim for benefits within the year before the claim for increase was filed. Additionally, there is no evidence during the one year prior to the filing of the claim for increase that demonstrates an increase in the severity of the Veteran's headaches. As the increase in severity was not factually ascertainable within the one year prior to the receipt of the claim, VA assigned an effective date based on the date VA received the Veteran's increased rating claim. Accordingly, the effective date for this claim cannot be earlier than November 6, 2023.

Therefore, the claim for an effective date prior to November 6, 2023, must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the most persuasive evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra.

Increased Ratings

Disability ratings are determined by the application of the VA's Schedule for Rating Disabilities. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Ch. I, Part 4. Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3.

Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is
on average impairment in earning capacity. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3.

Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509.

The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. According to the United States Court of Appeals for the Federal Circuit in Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021), the proper standard of review is whether the factors are in an "approximate balance." Lynch held that the Veteran is entitled to the benefit of the doubt when the evidence is in an approximate balance, i.e., nearly equal and does not require the evidence to be in exact equipoise. Id.

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. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2021).

In this case, the Veteran is competent to testify on factual matters of which she has first-hand knowledge. Washington v. Nicholson, 19 Vet. App. 362 (2005). She is also competent to report symptoms of her service-connected conditions. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). The Veteran is competent to describe her symptoms and their effects on employment or daily activities.

2. Entitlement to an increased evaluation for migraines.

The Veteran contends her migraines warrant a rating in excess of 30 percent. The Veteran has been in receipt of a 30 percent rating for her migraines since November 6, 2023.

Migraine headaches are rated pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8100 for migraine. Under Diagnostic Code 8100, a noncompensable rating is warranted for migraines with less frequent attacks as follows:

30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on average once a month over the last several months.

50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.

The 50 percent rating is the highest schedular rating under Diagnostic Code 8100.

The rating criteria of Diagnostic Code 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018). This renders 38 C.F.R. §§ 4.7 and 4.21 inapplicable. Johnson, 30 Vet. App. at 252.

The phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under Diagnostic Code 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32nd ed. 2012), "prostration" is defined as "extreme exhaustion or powerlessness." Thus, the phrase "characteristic prostrating attacks" is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness.

The descriptive phrase "very frequent" connotes a frequency at least greater than once a month, as is required by the rating criteria corresponding to a lesser 30 percent rating. See Johnson, 30 Vet. App. at 253. The phrase "completely prostrating" generally means that the migraine attack must render the veteran entirely powerless. See Johnson, 30 Vet. App. at 253. The completely prostrating attacks must also be "prolonged," which is defined as "to lengthen in time: extend duration: draw out: continue, protract." See Johnson, 30 Vet. App. at 253 (internal citation omitted). Lastly, the 50 percent rating criteria require that the very frequent completely prostrating and prolonged attacks be "productive of severe economic inadaptability." Productive can be read as having either the meaning of "producing" or "capable of producing," and, regarding severe economic inadaptability, nothing in Diagnostic Code 8100 requires that the claimant be completely unable to work to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 56, 63 (2012).

These rating criteria do not explicitly contemplate the ameliorative effects of medication, and, therefore, the assigned rating should contemplate the nature and frequency of characteristic prostrating attacks that would occur without medication. See 38 C.F.R. § 4.124a, Diagnostic Code 8100; Jones v. Shinseki, 26 Vet. App. 56, 63 (2012).

The Veteran underwent a headache VA examination in December 2023. The Veteran reported the onset of her headaches began in 1982 and have progressed/worsened. Currently, her headaches occur three to four times per week and last several hours. She treats her headaches with Tylenol. Her symptoms included headache pain pulsating or throbbing, pain on both sides of the head and pain that worsens with physical activity. The Veteran experiences non-headache symptoms associated with her headaches to include nausea, sensitivity to light, sensitivity to sound, changes in vision and dizziness. Head pain typically lasts less than 1 day on both sides of the head. The examiner found the Veteran had characteristic prostrating attacks that were greater than once a month. She also had completely prostrating and prolonged attacks that were greater than once per month. The examiner noted the severe headaches caused decreased focus/concentration and reduced overall productivity.

In a December 2025 statement, the Veteran asserted she has migraines two to three times a month that last anywhere from half a day to an entire day. Migraines cause her to be lightheaded and light increases the severity of the pain. When a migraine starts, she has to lay down, close the blinds and cover her face. When a migraines starts, she has to stop whatever she is doing and lay down. She takes Tylenol for some relief and rests, but it does not always help.

Based on the above evidence of record, the Board finds the Veteran has experienced headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability, which warrants a 50 percent disability rating for the service-connected migraines disability. 38 C.F.R. § 4.124a, Diagnostic Code 8100.

As noted above, in the December 2023 VA examination report, the examiner noted that the Veteran had been having prostrating attacks due to headache disability greater than once per month over the previous several months. The examiner also noted that the Veteran had been having completely prostrating and prolonged attacks of migraines greater than once per month over the previous several months. As noted above, a 30 percent rating is warranted for migraines with characteristic
the Board finds the Veteran has experienced headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability, which warrants a 50 percent disability rating for the service-connected migraines disability. 38 C.F.R. § 4.124a, Diagnostic Code 8100.

As noted above, in the December 2023 VA examination report, the examiner noted that the Veteran had been having prostrating attacks due to headache disability greater than once per month over the previous several months. The examiner also noted that the Veteran had been having completely prostrating and prolonged attacks of migraines greater than once per month over the previous several months. As noted above, a 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. 38 C.F.R. § 4.124a, Diagnostic Code 8100. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Id. Per the December 2023 VA examination report, the Veteran had been having completely prostrating and prolonged attacks of migraines greater than once per month over the previous several months.

As far as severe economic inadaptability due to the Veteran's headaches disability is concerned, the Board notes that the December 2023 VA examination report reflects the severe headaches caused decreased focus/concentration and reduced overall productivity. Furthermore, the evidence of record reflects that the Veteran's headaches disability interferes with occupational/social activities during headache episodes. Indeed, the Veteran reported in a December 2025 statement that when a migraine starts, she has to lay down, close the blinds and cover her face. She has to stop whatever she is doing and lay down. She takes Tylenol for some relief and rests, but it does not always help. As noted above, the 50 percent rating criteria require that the very frequent completely prostrating and prolonged attacks be "productive of severe economic inadaptability." Productive can be read as having either the meaning of "producing" or "capable of producing," and, with regard to severe economic inadaptability, nothing in diagnostic code 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce, 18 Vet. App. at 445-46.

The Board notes the December 2023 VA examiner did not provide an opinion on the severity of the Veteran's headaches disability after discounting the ameliorative effects of medication. The Board could remand the matter to obtain a new medical opinion on the severity of the Veteran's headaches disability without the ameliorative effects of medication, but a remand would delay the process and could be construed as obtaining additional evidence for the sole purpose of denying the claim. Thus, the Board finds the Veteran has been having headaches more than once per month with completely prostrating and prolonged attacks productive of severe economic inadaptability.

Accordingly, the Board finds that entitlement to a disability rating of 50 percent for the service-connected migraines is warranted, which is the highest schedular rating under diagnostic code 8100. 38 C.F.R. § 4.124a, Diagnostic Code 8100.

3. Entitlement to a 60 percent evaluation for asthma

The Veteran contends that she is entitled to an increased evaluation for her service-connected asthma. See September 2024 VA Form 20-0996; November 2025 VA Form 10182; December 2025 Correspondence.

By way of procedural background, a September 1993 rating decision granted service connection for "reactive airways disease with asthma, allergic rhinitis, sinusitis and headaches." See September 1993 Rating Decision Narrative.

In November 2023, the Veteran filed a new application for an increased rating for headaches. See November 2023 VA Form 21-526EZ. After requesting examinations of the Veteran, a March 2024 rating decision, in part, assigned a separate, 30 percent disability rating for headaches and denied a rating in excess of 30 percent for "asthma (previously rated as reactive airways disease with asthma, allergic rhinitis, sinusitis with headache)." See March 2024 Rating Decision - Narrative. In September 2024, the Veteran sought higher-level review, requesting an increased rating for her service-connected asthma, which was denied in a December 2024 rating decision. See September 2024 VA Form 20-0996; December 2024 Rating Decision - Narrative. Subsequently, the Veteran filed the instant appeal. See November 2025 VA Form 10182.

Accordingly, the applicable rating period for this appeal commenced on November 6, 2023, which is the date VA received the increased rating claim. The Board will also consider the
"asthma (previously rated as reactive airways disease with asthma, allergic rhinitis, sinusitis with headache)." See March 2024 Rating Decision - Narrative. In September 2024, the Veteran sought higher-level review, requesting an increased rating for her service-connected asthma, which was denied in a December 2024 rating decision. See September 2024 VA Form 20-0996; December 2024 Rating Decision - Narrative. Subsequently, the Veteran filed the instant appeal. See November 2025 VA Form 10182.

The Veteran's asthma is evaluated under Diagnostic Code 6602, which contemplates bronchial asthma, in part using the results of pulmonary function tests (PFTs). 38 C.F.R. § 4.97. Under Diagnostic Code 6602, a 30 percent rating is warranted 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 warranted for 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. A maximum 100 percent disability rating is assigned for FEV-1 of less than 40 percent; or more than one attack per week with episodes of respiratory failure; or required daily use of systemic (oral or parenteral) high dose corticosteroids or immune suppressive medications.

The Board notes that, when evaluating based on PFTs, VA is to use post-bronchodilator results unless the post-bronchodilator results were poorer than pre-bronchodilator results, in which case the latter should be used instead. 38 C.F.R. § 4.96(d)(5). When there is a disparity between the results of different PFTs (e.g., FEV-1, FVC, or FEV-1/FVC) such that the evaluation would be different depending on which test was used, the Board must use the test result that the examiner states most accurately reflect the level of disability. 38 C.F.R. § 4.96(d)(6).

Turning to the evidence, the Veteran was afforded a VA examination in December 2023. The Veteran reported that her condition has progressed/worsened since onset. See January 2024 C&P Exam: Respiratory Conditions at 3. The Veteran reported symptoms of shortness of breath, cough, and wheezing which she treated with Advair and Albuterol. Id. The examiner indicated that the Veteran's asthma did not require the use of oral or parenteral corticosteroid medications. Id. It was noted that his asthma required daily inhalational bronchodilator therapy. Id. at 3-4. The examiner noted that the Veteran did not have any asthma attacks with episodes of respiratory failure in the past 12 months, and the Veteran requires two physician visits per year to treat his moderate asthma symptoms. Id. at 5.

Pre-bronchodilator results were: FVC predicted: 50 percent; FEV-1 predicted: 80 percent; and FEV-1/FVC: 121 percent. Id. at 11. The examiner indicated that FEV-1 most accurately reflected the Veteran's level of disability. Id. Post-bronchodilator results were: FVC predicted: 60 percent; FEV-1 predicted: 55 percent; and FEV-1/FVC: 70 percent. Id. The examiner stated that the Veteran's asthma impacted her ability to work by causing "shortness of breath, cough and dyspnea on exertion significantly impair exertional capacity and reduced overall mobility[.]" Id. at 12. The Board finds the VA examination to be adequate for adjudication purposes as it considers the Veteran's lay reports and is based on a review of the Veteran's relevant medical records and other evidence. Thus, the Board assigns it significant probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. At 304 (2008) ("
60 percent; FEV-1 predicted: 55 percent; and FEV-1/FVC: 70 percent. Id. The examiner stated that the Veteran's asthma impacted her ability to work by causing "shortness of breath, cough and dyspnea on exertion significantly impair exertional capacity and reduced overall mobility[.]" Id. at 12. The Board finds the VA examination to be adequate for adjudication purposes as it considers the Veteran's lay reports and is based on a review of the Veteran's relevant medical records and other evidence. Thus, the Board assigns it significant probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. At 304 (2008) ("It is the factually accurate, fully articulated, sound reasoning for the conclusion ... that contributes probative value to a medical opinion.").

After a review of the following evidence, the Board determines that a 60 percent rating for asthma is warranted. Indeed, the December 2023 VA examiner indicated that FEV-1 most accurately reflected the Veteran's level of disability and the examination results revealed FEV-1 predicted at 55 percent post-bronchodilator. The Board finds a rating in excess of 60 percent is not warranted as the evidence does not reveal FEV-1 of less than 40 percent; or more than one attack per week with episodes of respiratory failure; or required daily use of systemic (oral or parenteral) high dose corticosteroids or immune suppressive medications.

The Board notes that the evidence reflects the Veteran has used Advair and Albuterol, which are inhaled corticosteroid medications. The use of these kinds of medications does not constitute systemic corticosteroid use as described in Diagnostic Code 6602. Importantly, the VA examiners, after reviewing the record and considering the Veteran's reports, did not indicate such systemic corticosteroid use.

Accordingly, in light of the VA examination reports reflecting FEV-1 results of 40 to 55, the Board finds that a 60 percent rating under Diagnostic Code 6602 is warranted for the Veteran's service-connected asthma. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7.

4. Entitlement to an evaluation in excess of 10 percent for left lower extremity post-phlebitic syndrome

5. Entitlement to an evaluation in excess of 10 percent for right lower extremity post-phlebitic syndrome

The Veteran contends that her bilateral lower extremity post- phlebitic syndrome symptoms are more severe than contemplated by the currently assigned 10 percent ratings. See September 2024 VA Form 20-0996; November 2025 VA Form 10182; December 2025 Correspondence

The Veteran's bilateral leg condition is currently assigned a 10 percent disability rating (each leg) from May 1, 1993, under DC 7121.

Under Diagnostic Code 7121, a 10 percent rating is warranted for intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery. A 20 percent rating is warranted for post-phlebitic syndrome of any etiology which manifests with persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema. A 40 percent rating is warranted for persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration. A 60 percent rating is warranted for persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration. A 100 percent (maximum) rating is warranted for massive board-like edema with constant pain at rest. See 38 C.F.R. § 4.104, Diagnostic Code 7121.

Here, in September 2023, VA received a lower extremity physiological study single level ABI examination, which noted that the Veteran experienced bilateral intermittent claudication, numbness in feet, rest pain and swelling in both extremities. See September 2023 C&P Exam: Lower Extremity Physiological Study (Newman Medical). Further it was noted that the Veteran's right extremity ABI was normal and left extremity ABI was borderline. Id.

Also in September, the Veteran underwent a VA examination for artery and vein conditions. See September 2023 C&P Exam: Artery and Vein Conditions DBQ. The examiner conducted a records review and in-person examination of the Veteran. Id. at 1. A diagnosis of post-phlebitic syndrome (of any etiology) was confirmed. Id. at 2. The Veteran reported that her symptoms had stayed the same since onset and reported her current symptoms as intermittent swelling in and constant tingling pain of the legs, which she treats with leg pumps twice a day and compression socks. Id. at 2-3. The examiner noted that the Veteran's disability manifested by aching after prolonged standing; fatigue after prolonged standing; fatigue after prolonged walking; aching after prolonged walking; symptoms relieved by elevation and compression hosiery; persistent stasis pigmentation; and intermittent edema. Id. at 3-4. The Board notes the examiner checked the box for both under the category for constant pain at rest, but never indicated the Veteran had constant pain at rest. The examiner noted that ankle/brachial index (ABI) had been performed in September 2023, showing a right ABI of 1.05 and a left ABI of 0.98, which sufficiently reflects the severity of the Veteran's condition. Id. at 10. There were no other symptoms or findings. The examiner found that the Veteran's condition caused no functional impact. Id. at 11. Additionally, the examiner noted that there was no change in the service-connected diagnosis and no additional diagnoses were rendered. Id. at 11-12.

In December 2025, the Veteran submitted additional documents detailing her symptoms and their impact on her daily activities, including pain and heaviness in her legs, pain and fatigue with walking, foot cramps, and difficulty concentrating due to pain. See December 2025 Correspondence; December 2025 VA Form 21-4142.

Additionally, the Veteran's medical records show appointments and treatment for her bilateral lower extremity condition including the use of leg pumps and compression stockings. See e.g., March 2026 JLV/MTF (482 pgs.) at 52, 63, 65.

After a review of the record, the Board finds that higher evaluations for the Veteran's bilateral lower extremities are not warranted.

In order to merit the assignment of a higher rating under Diagnostic Code 7121, the disability must manifest with persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema. The VA examination indicated that the Veteran's disability manifested with intermittent (not persistent) edema and persistent stasis pigmentation. Although there was also evidence of aching, fatigue, and pain in the September 2023 VA examination report and the September 2023 lower extremity physiological study noted bilateral claudication, numbness in feet, rest pain and swelling, this is contemplated in her currently assigned 10 percent evaluations. Moreover, the examiner noted symptoms were relieved by elevation and compression hosiery. There was no evidence of persistent edema or eczema of the legs.

The finds the September 2023 VA examination to be adequate for rating purposes. See Nieves-Rodriguez, supra. The examiner has the appropriate training, expertise and knowledge to evaluate the claimed disability. The report set forth the results of the examiner's comprehensive review of the claims file and the Veteran's lay statements. The examination report provided the Board with a clear description of all relevant data points necessary to evaluate this claim.

The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability ratings reflects. The Board again noted that the Veteran is competent to report observable symptoms such as pain, tingling, and swelling. See Layno, supra. In this case, however, the Veteran has not offered any evidence, lay or otherwise, of persistent edema that is incompletely relieved by elevation of the extremity, or any eczema or subcutaneous induration. The medical records do not show otherwise. The lay testimony has been considered together with the medical evidence in evaluating the severity of the pertinent disability symptoms. Accordingly, ratings in excess of 10 percent are not warranted for the Veteran's bilateral lower extremity post-phlebitic syndrome.

In making its decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal
no, supra. In this case, however, the Veteran has not offered any evidence, lay or otherwise, of persistent edema that is incompletely relieved by elevation of the extremity, or any eczema or subcutaneous induration. The medical records do not show otherwise. The lay testimony has been considered together with the medical evidence in evaluating the severity of the pertinent disability symptoms. Accordingly, ratings in excess of 10 percent are not warranted for the Veteran's bilateral lower extremity post-phlebitic syndrome.

6. Entitlement to a total disability rating based on individual unemployability (TDIU)

Total disability will be considered to exist where there is present any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340 (2021). Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a) (2021).

Substantially gainful employment is defined as work which is more than marginal, and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991).

In determining whether unemployability exists, consideration may be given to the Veteran's level of education, special training, and previous work experience, but it may not be given to his or her age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19 (2021).

A request for TDIU "is not a separate claim for benefits but rather involves an attempt to obtain an appropriate rating for a disability or disabilities, either as part of the initial adjudication of a claim [] or as part of a claim for increased compensation." Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). It is raised whenever a claimant seeks a higher disability evaluation and "presents cogent evidence of unemployability." Comer v. Peake, 553 F.3d 1362, 1367 (Fed. Cir. 2009). However, while a claim for increased disability compensation encompasses the issue of possible entitlement to TDIU, the issue is not raised until evidence of unemployability is actually presented. See Roberson v. Principi, 251 F.3d 1378, 1384 (Fed. Cir. 2001) ("Once a veteran submits evidence of a medical disability and makes a claim for the highest rating possible, and additionally submits evidence of unemployability, the 'identify the benefit sought' requirement of 38 C.F.R. § 3.155(a) is met and VA must consider TDIU.") "When entitlement to TDIU is raised during the adjudicatory process of the underlying disability or during the administrative appeal of the initial rating assigned for that disability, it is part of the claim for benefits for the underlying disability." Rice v. Shinseki 22 Vet. App. 447, 454 (2009)

Analysis

In this case, the Veteran has argued that she has been unable to work a result of her service-connected disability and the issue of entitlement to a TDIU was reasonably raised by the record. See November 2025 VA Form 10182.

Because the Veteran's claim for a TDIU was raised as part-and-parcel to an increased rating claim, the earliest date the Board can look to for eligibility for TDIU is one year prior to the date of receipt of that claim. See Rice, supra; see also Gaston, supra.

The Veteran is currently service connected for total abdominal hysterectomy with bilateral salpingo-oophorectomy due to endometriosis at 50 percent (from May 1, 1993); chronic sinusitis at 30 percent (from November 6, 2023); asthma at 60 percent (from May 1, 2023); migraines at 50 percent (from November 6, 2023); hallux valgus, right foot, status post repair with transposition deep peroneal nerve for neuroma at 10 percent (from May 1, 1993); hypertension at 10 percent (from May 1, 1993); left lower extremity post-phlebitic syndrome at 10 percent (from May 1, 1993); right lower extremity post-phlebitic syndrome at 10 percent (from May 1, 1993); tinnitus at 0 percent (from May 1, 1993); Hashimoto's thyroiditis at 0 percent (from May 1, 1993); and rhinitis at 0 percent (from November 6, 2023).

Here, the central inquiry is again whether the Veteran's service-connected disabilities, alone, are of sufficient severity to preclude her from obtaining and maintaining all forms of substantially gainful employment. See Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993).

Notably, the Board finds that the most persuasive evidence demonstrates that the Veteran's service-connected disabilities prevent her from securing and maintaining substantially gainful employment.

The Veteran reported that she previously worked as security staff at US Army Regional Health Command - Atlantic from 1994 through December 2020, with her highest grossly monthly earnings being $11,000. See December 2025 VA Form 21-8940. Further, she reported that she is college education and left her last employment due to her service-connected disabilities. Id. at 8.

On a September 2023 VA examination report for the Veteran's service-connected bilateral post- phlebitic syndrome, the Veteran's symptoms were reported as intermittent swelling and constant tingling pain in legs. See September 2023 C&P Exam: Artery and Vein DBQ at 2. The examiner found that the condition did not impact her ability to work. Id. at 11.

On a December 2023 VA examination report for her service-connected headaches, the Veteran's symptoms were noted as pulsating or throbbing head pain, pain on both sides of head, pain that worsens with physical activity, nausea, sensitivity to light and sound, changes in vision, and dizziness. See December 2023 C&P Exam: Headaches DBQ at 3. Further, the examiner found that the Veteran experienced characteristic prostrating attacks more than once per month and completely prostrating and prolonged attacks more than once per month. Id. at 3-4. The examiner found that the Veteran's headaches impact her ability to work due to "severe headaches cause decreased focus/concentration and reduced overall productivity." Id. at 4.

On a December 2023 VA examination report for her service-connected asthma (received by VA in January 2024), the Veteran's reported symptoms were shortness of breath, cough, and wheezing. See January 2024 C&P Exam: Respiratory Conditions DBQ at 3. The examiner found that the Veteran's asthma impacts her ability to work due to "shortness of breath, cough and dyspnea on exertion significantly impair exertional capacity and reduced overall mobility." Id. at 12.

On a December 2023 VA examination report for her service-connected rhinitis and sinusitis (received by VA in January 2024), the Veteran's reported symptoms were intermittent sinus pressure, congestion, runny nose, and watery eyes. See January 2024 C&P Exam: Sinusitis/Rhinitis DBQ at 3. The examiner found that the Veteran's service-connected sinusitis and rhinitis impact her ability to work as "[s]inus congestion with runny nose and watery eyes cause decreased focus/concentration." Id. at 10. Notably, the examiner indicated that the Veteran's conditions had worsened. Id.

In December 2025, the Veteran submitted a statement detailing the symptoms she experiences due to her service connected disabilities and their impact on her daily activities. See December 2025 Correspondence.

Also in December 2025, the Veteran submitted a private medical opinion, which contained an opinion regarding the impacted the Veteran's service-connected impairments have on her ability to work. See December 2025 VA Form 21-4142 at 5-8. The physician reviewed the entire claims file and summarized the Veteran's symptoms related to her service-connected conditions prior to rendering the opinion. The physician noted that the Veteran reported having a Master of Science in Management and a Master of Business Administration and last worked from 1994 to 2020 at Walter Reed Army Medical Center in the Regional Health Command but was unable to continue her position due to pain and limitations related to her service-connected conditions. Id. at 7. The physician found that the Veteran would have difficulty standing or walking for more than 10 minutes (slowly and sometimes assisted with a cane due to service-connected leg condition and symptoms) and sitting for more than 15 minutes and would need to alternate between sitting, standing, and laying down frequently to alleviate pain, which would impact pace and productivity. Id. Additionally, it was noted that even with sedentary work, the Veteran's pain would disrupt her tasks (such as answering phones, computer work, and bending), and the Veteran would be unable to lift or carry more than five pounds due to the additional weight placed on her legs and increased workload on her lungs (potentially triggering an asthma attack). Id. With regard to non-exertional limitations, the physician explained that the Veteran "has difficulty concentrating and staying focused due to her constant pain and swelling. Due to her pain, swelling, and tinnitus, she sleeps poorly at night, further degrading her ability to maintain focus, patience, and mental acuity as well as impacting her ability to retain information and learn new material. This would be further hindered by her issues with motivation to do anything and handling stress. Her migraines are distracting and debilitating and require her to lie down in a dark environment for hours at a time for relief. In a typical workplace, fluorescent lights, computer lights, and smells can make head pain worse and exacerbate her symptoms. Further, she experiencing frequent swelling in her legs that requires elevation and treatment with a pump twice a day and she would need to be allowed ample workspace to be able to accommodate this." Id. Also, it was noted that the Veteran "takes ceterizine for treatment and management of her service connected conditions and notes that she has difficulties concentrating and staying awake." Id. at 8. Additionally, it was noted that the Veteran would need to miss work or leave early three or more days per month due to her symptoms. Id. Ultimately, the physician rendered a positive medical opinion finding that, "after considering the effects of her service connected asthma, chronic sinusitis, migraines, left lower extremity post-phlebitic syndrome, right lower extremity post-phlebitic syndrome, and tinnitus, including the side effects of the medications she takes to treat these conditions, as well as her past relevant work and educational background, it is my medical opinion that [the Veteran] has been unable to maintain substantially gainful employment as a result of his service-connected disabilities since at least November 6, 2023, the date of her claim." Id.

As a result, the Board finds that the medical and lay evidence establishes that the Veteran's service-connected disabilities prevent her from securing or following a substantially gainful occupation.

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In weighing the evidence, the Board finds that the evidence of record establishes that the Veteran is unable to obtain and maintain substantially gainful employment due to her service-connected disabilities. Accordingly, the Board finds that entitlement to total disability evaluation based on individual unemployability due to service-connected disorders is warranted. See 38 C.F.R. §§ 3.102, 4.16(a).

R. Bisignani

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Lewis, Aliece M.

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.

service-connected disorders is warranted. See 38 C.F.R. §§ 3.102, 4.16(a).

R. Bisignani

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Lewis, Aliece M.

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