10-43 167
10-43 167
| Board of Vet. App. | Aug 31, 2016Background
- Veteran served multiple periods on active duty (1980–1983; 2005–2006; 2007–2008) and filed claims resulting in service connection for rheumatoid arthritis (RA), Graves' disease, and celiac disease.
- RO granted service connection in March 2010: RA (hands) 40%, celiac disease 10% (effective July 15, 2009), and Graves' disease 10% (effective March 20, 2008). TDIU denied initially and appealed.
- Multiple VA and private examinations (2008–2013) document hand pain, limited dexterity/strength, episodic diarrhea/abdominal distress responsive to gluten‑free diet, and treated thyroid disease (RAI leading to hypothyroidism managed with synthroid).
- Medical evidence showed painful hand use and limited grip but no ankylosis, no weight loss/anemia producing severe systemic impairment from RA, no sustained tachycardia or cardiovascular signs from Graves' disease after treatment, and only occasional to frequent bowel disturbances from celiac disease.
- Combined schedular rating reached 80%; Veteran claimed unemployability due primarily to hand arthritis and related conditions and submitted supporting employer statement and treating physician opinions.
- Board denied increased ratings for RA, Graves', and celiac disease, but granted TDIU based on combined service‑connected disabilities preventing substantially gainful employment.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether RA warrants >40% initial rating | RA causes painful, function‑limiting flares, decreased grip/dexterity, and multiple exacerbations impairing health and work | Exam evidence shows normal ROM, no ankylosis, no weight loss/anemia or 4+ incapacitating exacerbations; minimal objective impairment | Denied — 40% affirmed (criteria for >40% not met) |
| Whether Graves' disease warrants >10% initial rating | Prior hyperthyroid symptoms (tremor, palpitations, weight loss) justify higher rating | Post‑RAI hypothyroidism is controlled on synthroid; no persistent tachycardia, increased pulse pressure, or other signs required for higher ratings | Denied — 10% affirmed (no evidence of required manifestations) |
| Whether celiac disease warrants >10% initial rating (including secondary to Graves') | Ongoing diarrhea, malabsorption, prior anemia and biopsies support more than mild IBS analogy | Symptoms improved on gluten‑free diet; episodic diarrhea/abdominal distress correspond to 10% (moderate) under DC 7319; no malnutrition or constant distress for higher rating | Denied — 10% affirmed (symptoms approximate moderate IBS; not severe) |
| Whether TDIU is warranted | Combined service‑connected disabilities (notably RA) preclude securing/ following substantially gainful employment given prior plumbing/flight engineer work and treating‑physician opinions | Some VA reports suggest ability to perform sedentary work; however combined impact disputed | Allowed — TDIU granted (resolving doubt in Veteran’s favor; combined ratings and evidence preclude substantially gainful employment) |
Key Cases Cited
- Hartman v. Nicholson, 483 F.3d 1311 (Federal Circuit) (no additional VCAA notice required for downstream rating disputes after service connection granted)
- Stefl v. Nicholson, 21 Vet. App. 120 (Vet. App. 2007) (examination adequacy requires consideration of medical history and symptoms)
- DeLuca v. Brown, 8 Vet. App. 202 (Vet. App. 1995) (consider functional loss from pain under §4.40)
- Mitchell v. Shinseki, 25 Vet. App. 32 (Vet. App. 2011) (pain must affect normal working movements to constitute functional loss)
- Thun v. Peake, 22 Vet. App. 111 (Vet. App. 2008) (three‑step extraschedular rating inquiry)
- Johnson v. McDonald, 762 F.3d 1362 (Federal Circuit 2014) (extraschedular consideration for combined effects of multiple conditions)
- Fenderson v. West, 12 Vet. App. 119 (Vet. App. 1999) (staged ratings may be assigned when appropriate)
- Mittleider v. West, 11 Vet. App. 181 (Vet. App. 1998) (benefit of doubt application when evidence is in equipoise)
- Hatlestad v. Brown, 5 Vet. App. 524 (Vet. App. 1993) (central inquiry for unemployability is whether service‑connected disabilities alone produce unemployability)