ASTHMA

ERIC S. LEBOFF · 2026 · Case ID: A26040906

MIXED

Summary

The Veteran, a Marine Corps Veteran who served from July 1981 and June 1982 to July 1989, appeals the denial of service connection for PTSD and sleep apnea, and an increased rating for asthma and MGUS. The Board denied entitlement to an initial rating for asthma in excess of 10 percent, finding the evidence persuasively against a higher rating based on the provided pulmonary function tests. The Veteran's asthma was evaluated at 10 percent under DC 6602, with FEV-1 results not meeting the criteria for higher ratings. The Board also denied a compensable rating for monoclonal gammopathy of undetermined significance (MGUS), noting the Veteran's condition was asymptomatic and rated non-compensably under DC 7712, with no evidence of symptomatic multiple myeloma. The claims for service connection for an acquired psychiatric disorder (including PTSD) and sleep apnea were remanded due to a pre-decisional duty to assist error. The Board found the Veteran's exposure to contaminated water at Camp Lejeune to be a conceded toxic exposure risk activity, and the Veteran identified this as his PTSD stressor. A private physician's letter suggested possible PTSD. The remand instructions require a VA mental disorders examination to assess PTSD and its nexus to service, and if favorable, to assess sleep apnea's secondary connection to the psychiatric disorder. The Board also noted that appeals for hearing loss and chronic fatigue syndrome were untimely.

Rationale

Pulmonary function tests (FEV-1 85% predicted, FEV-1/FVC 78% predicted) did not meet criteria for higher rating.; Asthma evaluated at 10% under DC 6602.; No evidence of daily bronchodilator or anti-inflammatory medication use, or frequent corticosteroid bursts.

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6602

Docket No.

250204-514435

Full Decision Text

Citation Nr: A26040906
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250204-514435
DATE: April 30, 2026

ORDER

Entitlement to an initial rating for asthma in excess of 10 percent is denied.

Entitlement to a compensable rating for monoclonal gammopathy of undetermined significance (MGUS), is denied.

REMANDED

Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depression, is remanded.

Service connection for sleep apnea, to include as secondary to an acquired psychiatric disorder, is remanded.

FINDINGS OF FACT

1. The Veteran's asthma is not shown to have been manifested by FEV-1 is 56 to 70 percent of predicted, or; FEV-1/FVC is 56 to 70 percent of predicted, or; daily inhalational or oral bronchodilator therapy that is used, or; inhalational anti-inflammatory medication that is used.

2. The Veteran has been diagnosed with monoclonal gammopathy of undetermined significance (MGUS), but not symptomatic multiple myeloma.

CONCLUSIONS OF LAW

1. The criteria for an initial in excess of 10 percent for asthma have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.96, 4.97, Diagnostic Code (DC) 6602.

2. The criteria for a compensable evaluation for MGUS have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.79, DC 7712. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.117, DC 7712.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps in July 1981, and from June 1982 to July 1989.

These matters come to the Board of Veterans' Appeals (Board) on appeal from December 2024 and January 2025 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office. The December 2024 rating decision denied entitlement to service connection for sleep apnea and PTSD and an increased rating for MGUS. The January 2025 rating decision granted entitlement to service connection for asthma and assigned an initial 10 percent rating, effective from March 9, 2023. The Veteran timely appealed to the Board by filing two VA Forms 10182 (Decision Review Request: Board Appeal (Notice of Disagreement)) in February 2025, requesting direct review of the evidence considered by the agency of original jurisdiction (AOJ). 38 C.F.R. §§ 20.201, 20.202(b)(1).

The Board notes that it erroneously docketed the Veteran's two 10182s as two separate appeals under different docket numbers. For the sake of efficiency, the Board has corrected this error, and he will now be receiving one decision under the current docket number for the claims of entitlement to service connection for PTSD and sleep apnea and the claims of entitlement to an increased rating for asthma and MGUS stemming from the December 2024 and January 2025 rating decisions.

Under the direct review option, the Board may only consider the evidence of record at the time of issuance of the December 2024 and January 2025 AOJ rating decisions. 38 C.F.R. § 20.301. The Board cannot consider evidence submitted after that decision was promulgated.

With respect to the increased rating claims, if evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision on the Veteran's claims. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, he may file a VA Form 20-0995 (Decision Review Request: Supplemental Claim) and submit or identify that 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
a period of time when additional evidence was not allowed, the Board has not considered it in its decision on the Veteran's claims. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, he may file a VA Form 20-0995 (Decision Review Request: Supplemental Claim) and submit or identify that 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.

The Board also notes that on one of the February 2025 VA Forms 10182 the Veteran indicated that he wished to appeal the issues of entitlement to service connection for hearing loss and chronic fatigue syndrome, which were last adjudicated in August 2021 and October 2021 rating decisions, respectively. Inasmuch as the February 2025 VA Form 10182 was received more than a year after those decisions were issued, the attempted appeal of those decisions is untimely, and the issues adjudicated therein are not properly before the Board at present. See 38 C.F.R. § 19.52(a). If the Veteran wishes to further pursue those issues, he should file a Supplemental Claim (VA Form 20-0995). If additional evidence is presented or secured that is both new and relevant, VA will issue another decision on the claim(s), considering the new evidence in addition to the evidence previously considered.

Regarding the claims of service connection for an acquired psychiatric disorder and sleep apnea, the Board is remanding those claims to the AOJ for correction of a pre-decisional duty to assist error. The AOJ will consider any additional evidence that has been submitted when the claims are readjudicated. 38 C.F.R. § 3.103(c)(2)(ii).

As a final introductory matter, the Veteran's claim for an acquired psychiatric disorder, to include PTSD and depression, has been recharacterized to include all psychiatric disorders reasonably raised by the record. Clemons v. Shinseki, 23 Vet. App. 1 (2009).

Higher Ratings

Disability evaluations are determined by the application of a schedule of ratings, which is in turn based on the average impairment of earning capacity caused by a given disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the evaluations to be assigned to various disabilities.

The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other. Esteban v. Brown, 6 Vet. App. 259, 262 (1994); 38 C.F.R. § 4.14.

If 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. If different disability ratings are warranted for different periods of time over the life of a claim, "staged" ratings may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 125-26 (1999).

1. An initial rating in excess of 10 percent for asthma is denied.

The Veteran seeks to establish entitlement to an initial rating higher than 10 percent for asthma. Following the rating decision on appeal, the RO increased the Veteran's rating for asthma to 30 percent effective November 24, 025, in an April 2026 decision. The time for appeal of that decision has not yet elapsed. The instant appeal, for which evidence can only be reviewed up to January 2025, only entails the question of entitlement to an increase in excess of 10 percent, as then in effect.

The Veteran's asthma has been evaluated as 10 percent disabling under Diagnostic Codes 6602. 38 C.F.R. § 4.97, Diagnostic Code 6602.

Respiratory disorders are rated under Diagnostic Codes 6600 through 6817 and 6822 through 6847. Ratings under those diagnostic codes will not be combined with each other. Rather, a single rating will be assigned under the diagnostic code which reflects the predominant
decision. The time for appeal of that decision has not yet elapsed. The instant appeal, for which evidence can only be reviewed up to January 2025, only entails the question of entitlement to an increase in excess of 10 percent, as then in effect.

The Veteran's asthma has been evaluated as 10 percent disabling under Diagnostic Codes 6602. 38 C.F.R. § 4.97, Diagnostic Code 6602.

Respiratory disorders are rated under Diagnostic Codes 6600 through 6817 and 6822 through 6847. Ratings under those diagnostic codes will not be combined with each other. Rather, a single rating will be assigned under the diagnostic code which reflects the predominant disability with elevation to the next higher rating only where the severity of the overall disability warrants such elevation. 38 C.F.R. § 4.96 (a).

Effective October 6, 2006, VA added provisions that clarify the use of pulmonary function tests (PFTs) in evaluating respiratory conditions. See 71 Fed. Reg. 52459 (Sept. 6, 2006) (codified at 38 C.F.R. § 4.96 (d)). That is, 38 C.F.R. § 4.96 (d) was added to the Rating Schedule, applicable to all applications for benefits received by VA on or after October 6, 2006. In the present case, the Veteran filed his claim subsequent to the effective date of the change. Therefore, these amendments are applicable to the claim on appeal.

Diagnostic Codes 6600-6604 are classified under VA's Rating Schedule as Diseases of the Trachea and Bronchi. Id.

Under Diagnostic Code 6602 (asthma) a 10 percent rating is assigned for bronchial asthma when FEV-1 is 71 to 80 percent of the predicted value, or; FEV-1/FVC is 71 to 80 percent of the predicted value, or; intermittent inhalational or oral bronchodilator therapy is used. A 30 percent rating is assigned when FEV-1 is 56 to 70 percent of predicted, or; FEV-1/FVC is 56 to 70 percent of predicted, or; daily inhalational or oral bronchodilator therapy is used, or; inhalational anti-inflammatory medication is used. A 60 percent rating is assigned when FEV-1 is 40 to 55 percent of predicted, or; FEV-1/FVC is 40 to 55 percent of predicted, or; at least monthly visits to a physician are required for care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids are required. A 100 percent rating is assigned when FEV-1 is less than 40 percent of predicted, or; FEV-1/FVC is less than 40 percent of predicted or; there is more than one attack per week with episodes of respiratory failure, or; daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications is required. 38 C.F.R. § 4.97, DC 6602.

When evaluating based on pulmonary function testing, 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 pulmonary function testing (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 of record, in July 2024 the Veteran was afforded a VA respiratory conditions examination, at which time asthma and a pulmonary nodule were diagnosed. The Veteran indicated that his asthma has been treated with inhalers, with current symptoms to include daily shortness of breath lasting for several hours. He used Albuterol and Primatene Mist. Regarding the impact on his ability to perform occupational functioning and ordinary activities, he stated that he was incapable of performing activities because the frequency and intensity of the shortness of breath. Ordinary activities ceased as well.

The examiner stated that the Veteran's condition required intermittent courses or bursts of systemic (oral or parenteral) corticosteroids with zero courses or bursts in the past 12 months. It required the intermittent use
the Veteran was afforded a VA respiratory conditions examination, at which time asthma and a pulmonary nodule were diagnosed. The Veteran indicated that his asthma has been treated with inhalers, with current symptoms to include daily shortness of breath lasting for several hours. He used Albuterol and Primatene Mist. Regarding the impact on his ability to perform occupational functioning and ordinary activities, he stated that he was incapable of performing activities because the frequency and intensity of the shortness of breath. Ordinary activities ceased as well.

The examiner stated that the Veteran's condition required intermittent courses or bursts of systemic (oral or parenteral) corticosteroids with zero courses or bursts in the past 12 months. It required the intermittent use of inhalational bronchodilator therapy. It did not require the use of oral bronchodilators. A July 2024 chest x-ray indicated no active pulmonary disease. A PFT report reflects that the Veteran's FEV-1 was 85 percent of predicted, on post-bronchodilator testing, and that his FEV-1/FVC was 78 percent of predicted, on post-bronchodilator testing. The examiner stated that the Veteran's FEV-1 percent most accurately reflected the Veteran's level of disability. DLCO was not indicated in the Veteran's particular case. The examiner opined that the Veteran's asthma did not impact his ability to work.

In light of the above, the Board finds that the evidence is persuasively against a finding that the Veteran's asthma warrants an initial rating in excess of 10 percent at any time during the period on appeal under Diagnostic Code 6602.

The Board finds that the evidence is persuasively against an initial rating in excess of 10 percent under Diagnostic Code 6602. At no time during the appeal period does the evidence indicate, nor has the Veteran otherwise expressly contended, that his asthma has been manifested by FEV-1 that is 56 to 70 percent of predicted, or; FEV-1/FVC that is 56 to 70 percent of predicted, or; daily inhalational or oral bronchodilator therapy that is used, or; inhalational anti-inflammatory medication that is used. Accordingly, the assignment of the next highest, 30 percent, rating is not warranted.

2. A compensable rating for monoclonal gammopathy of undetermined significance (MGUS), is denied.

The Veteran seeks to establish entitlement to a compensable rating for MGUS. Inasmuch as he filed his claim for increase (a VA Form 21-526EZ) in August 2023, the appeal period begins at that time, with consideration of a possible one-year "look back" period.

The Veteran is currently assigned a noncompensable evaluation for his service-connected MGUS, pursuant to 38 C.F.R. § 4.117, Diagnostic Code 7712.

Under Diagnostic Code 7712, a noncompensable evaluation is warranted for asymptomatic, smoldering, or monoclonal gammopathy of undetermined significance (MGUS). A 100 percent evaluation is warranted for symptomatic multiple myeloma. 38 C.F.R. § 4.117, Diagnostic Code 7712.

Note (1) states that current validated biomarkers of symptomatic multiple myeloma and asymptomatic multiple myeloma, smoldering, or MGUS are acceptable for the diagnosis of multiple myeloma as defined by the American Society of Hematology (ASH) and International Myeloma Working Group (IMWG). 38 C.F.R. § 4.117, Diagnostic Code 7712.

Note (2) states that the 100 percent evaluation shall continue for five years after the diagnosis of symptomatic multiple myeloma, at which time the appropriate disability evaluation shall be determined by mandatory VA examination. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) and § 3.344(a) and (b) of this chapter. 38 C.F.R. § 4.117, Diagnostic Code 7712.

Turning to the evidence of record, in January 2024 the Veteran underwent a VA hematologic and lymphatic conditions examination at which the examiner indicated a August 2023 diagnosis of MGUS. The Veteran's symptoms included fatigue, pain in the upper left quadrant, bone pain, fevers and chills, and scattered blisters on the arms and legs. He was not undergoing any treatment. Continuous medication was not required for control of his condition. He was in a "watchful waiting" status. The examination report indicated that the Veteran did not have any other pertinent physical findings, complications, conditions, signs and/or symptoms
. 38 C.F.R. § 4.117, Diagnostic Code 7712.

In September 2024 the Veteran underwent a second VA hematologic and lymphatic conditions examination. MGUS was diagnosed. He stated that since his last VA examination he had experienced fatigue, GI stomach pain, especially in the left quadrant, bone pain all over, burning muscles, and fatigue. He underwent monthly bloodwork and was being monitored closely for MGUS. He complained of fatigue, muscle weakness, and reduced physical performance. The primary hematologic or lymphatic condition was listed as active, but continuous medication was not required for control of the condition. As to whether he had completed any treatment or was currently undergoing any treatment his status was "watchful waiting." The examination report indicated that the Veteran did not have any other pertinent physical findings, complications, conditions, signs and/or symptoms related to his disability. The examiner opined that the Veteran's disability did not impact his ability to work.

Based on the foregoing, the evidence is persuasively against a finding that the Veteran's MGUS warrants a compensable rating under Diagnostic Code 7712. At no time during the appeal period does the evidence suggest that the Veteran's MGUS was symptomatic during the period on appeal. To this point, although the Veteran complained of symptoms related to his disability on January and September 2024 VA examination neither examiner diagnosed symptomatic multiple myeloma. Thus, the Veteran's condition has not risen to the level to warrant a 100 percent rating. Accordingly, entitlement to a compensable rating for MGUS must be denied.

For all of the foregoing reasons, the Board concludes that the evidence is persuasively against the assignment of an initial compensable rating for asthma or a compensable rating for MGUS. As the evidence is persuasively against the assigment of a higher initial rating for asthma or a compensable rating for MGUS, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with respect to his claims. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

REASONS FOR REMAND

1. Service connection for an acquired psychiatric disorder, to include PTSD, is remanded.

The Veteran seeks to establish service connection for an acquired psychiatric disorder, to include PTSD.

In a December 2024 decision, the AOJ conceded the Veteran's participation in a toxic exposure risk activity. Evidence shows that the Veteran served at Camp Lejeune where he was exposed to contaminated water. The Veteran was diagnosed with a disability. VA and private treatment records confirmed diagnoses of PTSD and depression. The Board is bound by these favorable findings. 84 Fed. Reg. 138, 167 (Jan. 18, 2019).

The Veteran contends has identified his exposure to contaminated water at Camp Lejeune as his PTSD stressor. See September 2023 Statement in Support of Claim.

In March 2024 the Veteran submitted a letter from his private physician, Dr. E.P., who stated that he had "difficulty resting and confirms intrusive thoughts related to his former military assignments and potential exposure to physical toxins." She opined that he "may be suffering from untreated chronic [PTSD]."

On review, the Board finds that the failure to obtain an adequate a VA examination and medical opinion constitutes a pre-decisional duty to assist error that must be corrected.

2.
Reg. 138, 167 (Jan. 18, 2019).

The Veteran contends has identified his exposure to contaminated water at Camp Lejeune as his PTSD stressor. See September 2023 Statement in Support of Claim.

On review, the Board finds that the failure to obtain an adequate a VA examination and medical opinion constitutes a pre-decisional duty to assist error that must be corrected.

2. Service connection for sleep apnea, is remanded.

The Veteran seeks to establish service connection for sleep apnea. He contends that it is either related to exposure to contaminated water at Camp Lejeune or secondary to his acquired psychiatric disability. See September 2023 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. While an opinion has been obtained with respect to whether the claimed sleep apnea is due to the Veteran's conceded toxic risk exposures, no opinion has been obtained that considers a nexus between sleep apnea and the Veteran's PTSD or other acquired psychiatric disability. Thus, on remand, if a favorable opinion is provided that links a mental health disability to active service, then an opinion should also be sought as to whether sleep apnea is secondary to such psychiatric disorder.

The matter is REMANDED for the following action:

1. Arrange to have the Veteran scheduled for a VA mental disorders examination. The examiner should review the claims file. All indicated tests (to include psychological testing, if necessary) should be conducted and the results reported.

After examining the Veteran and reviewing the record, to include the results of any necessary testing, the examiner should indicate whether the Veteran has met the DSM-5 diagnostic criteria for PTSD.

If it is the examiner's opinion that the diagnostic criteria for PTSD have been met, the examiner should provide an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the diagnosis is related to a verified in-service stressor or fear of hostile military or terrorist activity.

If psychiatric disorders other than PTSD are diagnosed (or are found to have been present at any time pertinent to the present appeal), the examiner should provide an opinion, with respect to each such disorder, as to whether it is at least as likely as not that the disorder had its onset in, or is otherwise attributable to, service.

In providing this opinion, the examiner is requested to discuss the Veteran's contention that his PTSD is related to his exposure to contaminated water at Camp Lejeune and the private letter from Dr. E.P. stating that "difficulty resting and confirms intrusive thoughts related to his former military assignments and potential exposure to physical toxins."

A complete medical rationale for all opinions expressed must be provided.

2. If the above opinion is favorable and links a psychiatric disorder to service then arrange for a VA examiner to review the record and opine whether it is at least as likely as not (evidence approximately balanced or better) that the claimed sleep apnea is proximately due to a service-connected psychiatric disorder. If not, is it at least as likely as not (evidence approximately balanced or better) that the claimed sleep apnea has been aggravated (any incremental increase) by a service-connected psychiatric disability?

The examiner is advised that aggravation can include temporary worsening or flare-ups.??If aggravation is found, the examiner should also state, to the extent possible, the baseline level of disability prior to aggravation. This may be ascertained by the medical evidence of record and by the Veteran's statements as to the nature, severity, and frequency of his observable symptoms over time.??

ERIC S. LEBOFF

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T. Adams, Counsel

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

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