BVA9500164 DOCKET NO. 93-04 724 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Entitlement to service connection for arthritis of the knees. 2. Entitlement to service connection for sinusitis. 3. Entitlement to a compensable evaluation for medial plica of the right knee. 4. Entitlement to a compensable evaluation for medial plica of the left knee. REPRESENTATION Appellant represented by: Mississippi Department of Veterans Affairs Commission WITNESSES AT HEARING ON APPEAL The appellant and the appellant's wife ATTORNEY FOR THE BOARD J. Fussell, Counsel INTRODUCTION The veteran had active service from February 1968 until February 1970, and he had active duty during Operation Desert Storm from October 1990 until June 1991. This matter initially came before the Board of Veterans' Appeals (the Board) from a February 1992, rating decision of the Jackson, Mississippi, Regional Office (RO) of the Department of Veterans Affairs (VA). CONTENTIONS OF APPELLANT ON APPEAL It is contended that the veteran developed not only his service- connected medial plica of the knees during his second period of active duty while in Saudi Arabia during Operation Desert Storm, but also arthritis of the knees and sinusitis. It is asserted that he had no problems with sinusitis or his knees nor was there any diagnosis of arthritis of his knees prior to his second period of active duty. It is maintained that there is no medical proof, absent an affirmative diagnosis of arthritis, that any arthritis of his knees preexisted his second period of active duty. It is averred that because he is service-connected for disability of the knees, it is more reasonable to conclude that he now has traumatic, rather than degenerative, arthritis of the knees. It is contended that the case should be remanded to the RO for an examination and an opinion as to whether he now has traumatic, as opposed to degenerative, arthritis. It is averred that his service-connected disability of the knees and arthritis of the knees, developed when he had to crawl for cover during missile raids while in Saudi Arabia and that his sinusitis had developed as a result of exposure to dust, sand, and smoke from bombs and burning oil wells during combat in Saudi Arabia. It is contended that when examined during his second period of active duty he was told that he had sinusitis which would not resolve. It is asserted that his service-connected disability of the knees is manifested by weakness, stiffness, pain and limited range of motion, as well as giving way on prolonged standing. It is maintained that he must wear knee braces for which he receives a clothing allowance from the VA and has lost approximately 60 to 75 percent of the use of his legs. It is averred that a compensable evaluation is warranted for each knee under 38 C.F.R. § 4.59 (1993). DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the claims for service connection for arthritis of the knees and sinusitis and against the claims for compensable evaluations for medial plica of each knee. FINDINGS OF FACT 1. The veteran had active duty from February 1968 until February 1970, and he had a second period of active duty from October 1990 to June 1991 during which time he served in Saudi Arabia in Operation Desert Storm. 2. The veteran's symptoms and manifestations of disability of the knees during and after service have been diagnosed as chondromalacia, patellofemoral syndrome, and medial plica of the knees, but X-rays have never disclosed the presence of any form of arthritis, although he has degeneration of knee cartilage. 3. The veteran was treated for sinusitis and upper respiratory infections during his second period of active duty and although he has post-service respiratory complaints sinusitis has not been clinically documented after service, as opposed to the clinically documented rhinitis and deviated nasal septum. 4. Although the veteran had complained of giving way of the knees, ligamentous stability of the knees has been repeatedly documented during and after service but he nonetheless wears a brace on each knee. 5. The veteran has degeneration of meniscal cartilage of the knees and numerous subjective complaints of the knees, including pain, limitation of motion and weakness but examinations disclose full range of motion and no weakness or other objective abnormality of the knees. CONCLUSIONS OF LAW 1. Arthritis of the knees was not incurred in or aggravated by active service nor may it be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137, 1154(b); 38 C.F.R. §§ 3.303, 3.304(d), 3.307, 3.309 (1993). 2. Sinusitis was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1154(b) (West 1991); 38 C.F.R. §§ 3.303, 3.304(d) (1993). 3. A compensable evaluation for medial plica of the right knee is not warranted on either a schedular or extraschedular basis. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.10, 4.31, 4.40, 4.41, 4.45, 4.59, 4.71a, Diagnostic Code 5257 (1993). 4. A compensable evaluation for medial plica of the left knee is not warranted on either a schedular or extraschedular basis. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.10, 4.31, 4.40, 4.41, 4.45, 4.59, 4.71a, Diagnostic Code 5257 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran's claims are plausible and thus "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991) which mandates a duty to assist the veteran in developing all pertinent evidence. The service medical records of the veteran's first period of active duty from February 1968 until February 1970 are not on file. However, it is not contended that arthritis of the knees or sinusitis was incurred or aggravated during that period of active duty and service connection has been granted for medial plica of each knee on the basis of incurrence during his second period of active duty. In the veteran's January 1992 VA Form 21-526, application for compensation or pension, he reported he had not received any civilian post-service treatment for his knees. However, at the May 1992 RO hearing he testified that he had been treated at a medical facility at the Keesler Air Force Base until January 1992. The hearing officer noted in his December 1992 decision that in response to a request for records that military base indicated that no outpatient or inpatient records could be located subsequent to December 1991. However, there are on file post-service clinical records which reflect that the veteran first began receiving physical therapy at that military medical facility in July 1991 until January 1992. Additionally, the veteran testified that he had received VA outpatient treatment (VAOPT) at a VA facility in Jackson, Mississippi. A request for those records reflects that no such records prior to April 1992 could be located but records of April and May 1992 were obtained and are on file. Lastly, it is requested that the veteran be afforded a VA examination to determine whether any arthritis that he now has is either traumatic in origin or degenerative in nature. However, as will be explained, repeated X-ray studies have disclosed no arthritis whatsoever, and in the absence of radiologically documented arthritis an opinion as to the nature of any so-called arthritis would be futile. The Board also observe that the veteran was scheduled for a hearing before the Board in February 1993, but by correspondence received the day prior to the hearing from a service representative it was indicated that the veteran could not attend a travel board hearing of the Board and that he wished his case to be forwarded to the Board for a decision. The record does contain a transcript of the hearing that the veteran had at the RO. In view of the foregoing, it is the determination of the Board that the evidentiary record is sufficient in scope and depth for a fair, impartial, and fully informed appellate decision. This is particularly so in light of the fact that there is no contention or allegation that there are any outstanding pertinent private or VA clinical records which are not now associated with the claims folder. Service connection is to be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110. This requires a finding that there is current disability which has a definite relationship with an injury or disease or some other manifestation of the disability during service. Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992); Cuevas v. Principi, 3 Vet.App. 542, 548 (1992). However, it need not be shown that the disability was present or diagnosed during service but only that there is a nexus between the current condition and military service, even if first diagnosed after service, on the basis of all the evidence, including pertinent service medical records. This can be shown by establishing that the disability resulted from personal injury or disease suffered in the line of duty. 38 C.F.R. § 3.303(d) (1993); Godfrey v. Derwinski, 2 Vet.App. 352, 356 (1992). "Congress specifically limits entitlement for service connected disease or injury to cases where such incidents have resulted in a disability ... In the absence of proof of a present disability there can be no valid claim [for service connection]." Brammer v. Derwinski, 3 Vet.App. 223, 225 (1992). Not every manifestation of respiratory or musculoskeletal symptomatology during service, including respectively, a cough or joint pain will permit a grant of service connection for, respectively, pulmonary disability or arthritis if first shown as a clear-cut clinical entity at some later date. 38 C.F.R. § 3.303(b). If a chronic disease is shown as such in service or within an applicable presumptive period so as to permit a finding of service connection, continuity of symptomatology is not required, unless a diagnosis of chronicity maybe legitimately questioned, and subsequent manifestations of the chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. A combination of manifestations sufficient to identify the disease and sufficient observation are required to establish chronicity but when established as such there is no requirement of an evidentiary showing of continuity of symptomatology. 38 C.F.R. § 3.303(b); Wilson v. Derwinski, 2 Vet.App. 16, 19 (1991). Where, as here, the veteran had ninety (90) days or more of war or peacetime service after December 31, 1946, and arthritis manifests to a compensable degree within a year after service, it is rebuttably presumed to be of service origin, absent affirmative evidence to the contrary, even if there is no evidence thereof during service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Under 38 U.S.C.A. § 1154(b) and 38 C.F.R. § 3.304(d) the adverse effect of the absence of service clinical records of disability incurred during combat may be overcome by satisfactory lay or other evidence sufficient to prove service incurrence if consistent with the circumstances, conditions or hardships of service and to this end all doubt will be resolved in the veteran's favor. Service connection for such a disability may be rebutted by clear and convincing evidence to the contrary. Furthermore, under 38 C.F.R. § 3.306(b)(2) not only is due regard to be given to the places, types, and circumstances of service, but particular consideration is to be accorded to combat duty and other hardships. In Godwin v. Derwinski, 1 Vet.App. 419, 424 (1991) the United States Court of Veterans Appeals held that under 38 U.S.C.A. § 1154(b) and 38 C.F.R. § 3.304(d) after satisfactory lay or other evidence of service incurrence has been submitted, only clear and convincing evidence may rebut a "presumption of service incurrence." On the other hand, the Court subsequently held that those provisions do not create a presumption in favor of combat veterans in determinations of service connection. Smith v. Derwinski, 2 Vet.App. 137, 140 (1992). [But, see also Horvath v. Derwinski, 2 Vet.App. 240 (1992) (decided several months after Smith, in which the Court again held that the provisions created "a presumption of service connection."] In Smith the Court specifically addressed the question of whether the provisions created a presumption of service connection and even noted the legislative history of the statute. For this reason, the Board concludes that these provisions do not create a legal presumption of service connection but does shift the burden of proof if a veteran submits satisfactory lay or other evidence of combat incurrence. Arthritis of the Knees The only service medical record referable to the veteran's first period of active duty is examination for entrance into active service which disclosed no abnormality. However, it is not contended that either arthritis of the knees or sinusitis was incurred or aggravated during that period of service but, rather, that each was incurred during the second period of active duty. No report of an examination for entrance into the second period of active duty is on file, and the veteran testified (at page 9 of the transcript) that he was not afforded an examination for entrance into that second period of active duty when he was called up from the Military Reserves to serve in Operation Desert Storm. Veterans are presumed to be in sound condition "when examined and accepted for" either peacetime or wartime service under 38 U.S.C.A. §§ 1111 and 1132 (West 1991). The presumption of soundness "only attaches where there has been an induction examination in which the later complained-of disability was not detected. The presumption may, however, be rebutted upon the showing of clear and unmistakable evidence." Bagby v. Derwinski, 1 Vet.App. 225, 227 (1991). Regardless of whether the presumption of soundness attaches in this case, there is no clinical evidence nor is there any lay evidence, including any report of clinical histories of disability of the veteran's knees (or sinuses) prior to or at entrance into the veteran's second period of active duty. It is conceded that the veteran had and was treated for disability of the knees during his second period of active duty and thereafter. The service and post service clinical records reflect that the disability has been variously described as chondromalacia patellae, patellofemoral syndrome, and medial plica of the knees. However, the fact that he has disability of the knees does not necessarily mean that he has arthritis of the knees. Arthritis is articular rheumatism or inflammation of a joint. Zevalkink v. Brown, 6 Vet.App. 483, 494 (1994). Chondromalacia is abnormal softening of cartilage, Hoag v. Brown, 4 Vet.App. 209, 211 (1993) and McIntosh v. Brown, 4 Vet.App. 553, 556 (1993), and chondromalacia patellae is the premature degeneration of patellar cartilage. Odiorne v. Principi, 3 Vet.App. 456, 458 (1992). In other words, the veteran is service-connected for abnormality of the soft tissue or cartilage of the knees; whereas, arthritis is pathology of the bones. A review of the claims folder reflects only two clinical notations which could possibly be construed to indicate that the veteran has arthritis of the knees. The service medical records reflect that the veteran first complained of disability of his knees in March 1991. He was afforded an orthopedic evaluation for possible patellofemoral syndrome in May 1991 and after an examination and X-rays of the knees, which were negative, the diagnoses included bilateral patellofemoral syndrome and possible early degenerative joint disease due to age. However, as indicated, degenerative joint disease or arthritis, was not radiologically documented at that time nor by X-rays several days after another in-service orthopedic evaluation in October 1991. The assessment at that time was bilateral chondromalacia patellae/patellofemoral syndrome, but X-rays of the veteran's knees several days later disclosed no acute fracture or joint effusion, although there was mild medial compartment narrowing of the left knee with no evidence of adjacent bone hypertrophy. Subsequently, a magnetic resonance imaging scan (MRI) in January 1992 disclosed degeneration of the posterior horns of the medial and lateral menisci of each knee and a subsequent notation reflects that those degenerative changes were consistent with the veteran's age and probably preexisted his deployment in Operation Desert Storm. The RO denied service connection for degenerative arthritis on the basis that it preexisted the veteran's entrance into his second period of active service. This was apparently based on the May 1991 notation of possible early degenerative joint disease due to age and the subsequent notation in January 1992 that the veteran's degenerative changes were consistent with age and probably preexisted deployment. However, it must noted that degenerative changes referred to in the January 1992 notation were in regard to the soft tissue or menisci, whereas the May 1991 notation concerned possible early degenerative joint disease due to age, suggesting degenerative arthritis of the bones of the knees as part of the aging process. However, as the X-rays in May 1991 and October 1991 did not confirm the presence of arthritis, the notation in May 1991 of possible early degenerative joint disease was merely diagnostic speculation. This is particularly true in light of the fact that X-rays in conjunction with the VA orthopedic evaluation in May 1992 disclosed no gross osseous or joint or soft tissue abnormality of the knees and, after an examination, there was no diagnosis of arthritis. The diagnosis of degenerative joint disease at the time of VAOPT in April 1991 is also not confirmed in light of the negative X-rays during and after service as well as the fact that an examination at that time disclosed no symptoms consistent with arthritis such as limitation of motion, effusion, erythema, or increased warmth of the knees. Accordingly, inasmuch as arthritis of the veteran's knees has not been clinically documented, service connection for arthritis of the knees is not warranted. We acknowledge that the basis of the denial of service connection by the RO was different from that now reached by the Board, but inasmuch as X-rays over a one-year period during and after service have not demonstrated arthritis, there can be no prejudice to the veteran within the meaning of the holding of the Court in Bernard v. Brown, 4 Vet.App. 384, (1993). Sinusitis The veteran testified that his problems with his sinuses began when he was exposed to sand and dust storms in Saudi Arabia during his second period of active duty (page 9 of the transcript) but became worse after exposure to smoke from burning oil wells (page 10 of the transcript). The service medical records do reflect that he had respiratory complaints over a 2- or 3-month period from February to March or April 1991, including complaints of headaches and congestion. The service medical records do not reflect that he was confined to bed for 20 days as he testified (page 10 of the transcript), although he was given antibiotics and Sudafed, as he testified (page 10 of the transcript). In February 1991, the veteran complained of headaches and occasional sinus congestion but it was suspected that his headaches were due to a refractive error which was subsequently diagnosed as presbyopia and for which he was given prescription lenses. In March 1991, he again complained of nasal congestion as well as coughing and headaches and it was indicated that he was a truck driver in a vehicle without a heater. The headaches occurred around the areas of the sinuses, but an examination disclosed no sinus drainage. The assessment was that he had an upper respiratory infection, for which he was given Sudafed. Later that month, he related having had no improvement in his headaches and congestion but had had no chills or cold sweats. An examination disclosed no sinus tenderness nor was there any redness, swelling or discharge from the nasal passages. Nonetheless, the assessment was an upper respiratory infection, probably sinusitis. Another clinical notation in March 1991 indicated that he had been given antibiotic medication for his sinuses. However, there is no further clinical evidence that he complained of symptoms of, or received treatment for, sinusitis during the remaining several months of his active duty and, equally important, there is no evidence that he has ever sought post service treatment for sinus symptomatology. On VA examination in May 1992, the veteran complained of frequent headaches across his eyes and temple areas and reported that the problem with headaches had started with a sinus infection during service and that he received some relief of his symptoms by taking Sudafed. The diagnoses included a history of headaches, probably secondary to sinus complaints. However, it is clear that that diagnosis was based upon, as noted on that diagnosis itself, the clinical history related by the veteran more than a year after the termination of his transitory symptoms during service. Indeed, another VA examination in May 1992, while also noting a history of sinus trouble during service, found no changes in the veteran's sinuses. However, that examination did reveal a severe or large deviation of the nasal septum with bilateral spurring causing a severe obstruction of the right nasal cavity and vasomotor hyperemia of the turbinates. It was also indicated that he had allergic vasomotor rhinitis. Both of the VA examinations in May 1992 failed to demonstrate the presence of any changes, abnormality or pathology of the veteran's sinuses. When this is taken into consideration along with the fact that the veteran did not receive or seek treatment for sinus complaints following the 2 or 3 months of actual symptomatology during service, the Board must conclude that any sinus infection that he had during service, due to exposure from smoke, dust or sand or otherwise even from combat, was no more than acute and transitory and resolved without residual sinus disability. Medial Plica of the Knees The veteran's only service-connected disabilities are medial plica of the right knee and medial plica of the left knee, each assigned a noncompensable evaluation under 38 C.F.R. § 4.71a, Diagnostic Code 5257 (1993). However, a 10 percent rating has been assigned under 38 C.F.R. § 3.324 (1993) which authorizes a 10 percent rating, which is not in combination with any other rating, if a veteran has two or more separate permanent service- connected disabilities of such character as to clearly interfere with normal employability, even if each is rated noncompensable. However, in this case it is contended that a compensable evaluation is warranted for each knee. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. The higher of two evaluations will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. An extraschedular evaluation will be assigned if the case presents an unusual or exceptional disability picture with such related factors as marked interference with employment or frequent periods of hospitalization such as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). 38 C.F.R. § 4.20 (1993) specifically states, in part, that as to unlisted conditions "it will be permissible to rate under a closely related disease or injury." 38 C.F.R. § 4.27 (1993) states that "[n]o other numbers than these listed [in the rating schedule] ... are to be employed for rating purposes [with the exception of unlisted conditions, which are to be assigned a built-up code]." Noting these regulations, the Court held in Suttman v. Brown, 5 Vet.App. 127, 134 (1993) that "[a]n analogous rating thus may be assigned only where the service- connected condition is 'unlisted'." In the evaluation of service-connected disabilities the entire recorded history, including medical and industrial history, is considered so that a report of a rating examination, and the evidence as a whole, may yield a current rating which accurately reflects all elements of disability, including the effects on ordinary activity. 38 C.F.R. §§ 4.2, 4.10, 4.41. Moreover, where the minimum schedular evaluation requires residuals and the schedule does not provided a noncompensable evaluation, a noncompensable evaluation will be assigned when the required residuals are not shown. 38 C.F.R. § 4.31. Normal flexion of the knee is to 140 degrees, 38 C.F.R. § 4.71, Plate II. Normal extension of the knee is to zero degrees, 38 C.F.R. § 4.71, Plate II. A noncompensable evaluation for limitation of motion of the knees is assigned where flexion is limited to 60 degrees or less, or where extension is limited to 5 degrees or less. 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5161. A 10 percent evaluation may be assigned for limitation of motion of the knees when flexion is limited to 45 degrees or when extension is limited to 10 degrees under Diagnostic Codes 5260 and 5161; or, a 10 percent evaluation may be assigned for slight impairment of a knee, including recurrent subluxation or lateral instability under Diagnostic Code 5257 or for symptomatic residuals of removal of a semilunar cartilage (meniscectomy) of the knee under Diagnostic Codes 5259. Under 38 C.F.R. § 4.40 functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior on motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45 factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59 painful motion is an important factor of disability from arthritis [and] actually painful joints are entitled to at least the minimum compensable rating for the joint. Flexion elicits such manifestations. As noted above, the veteran does not have arthritis of the knee joints. 38 C.F.R. § 4.40 recognizes that functional loss may be caused by pain "on use" or limitation of motion and that functional loss by either should be compensated at the same rate. Schafrath v. Derwinski, 1 Vet.App. 589, 592 (1991). Further, 38 C.F.R. §§ 4.40 and 4.45 together make clear that pain, supported by pathology and behavior, must be considered capable of producing compensable joint disability. Schafrath v. Derwinski, 1 Vet.App. 589, 592 (1991). Shortly after the veteran's second period of active duty he underwent physical therapy at a medical facility at the Keesler Air Force Base in July 1991. A physical examination at that time disclosed essentially no abnormalities except for slight guarding upon squatting and found slight limitation of motion at the end range of extension of the right knee. Testing of his strength on Cybex Isokinetic test revealed stress fatigue in the right lower extremity and decreased strength in the right quadriceps and both hamstrings. The assessment, however, was that the signs and symptoms were not consistent with chondromalacia patellae and no acute signs were demonstrated. Further evaluation was needed to determine the level of dysfunction inasmuch as he demonstrated only minimal dysfunction. The veteran has repeatedly complained of giving way of the knees and it is obviously for this reason that he has been given knee braces. However, the MRI in January 1992, while disclosing degeneration of the menisci of the knees, found that his cruciate and collateral ligaments were intact. The degeneration of the menisci is consistent with his complaints of locking. However, degeneration is not shown to be of such severity as to have necessitated removal of the semilunar cartilage (a meniscectomy) of the right knee which would warrant a compensable evaluation under Diagnostic Code 5259. Additionally, virtually all tests of ligamentous stability during and after military service have been normal which gives rise to serious questions concerning the veteran's complaints of instability of the knees, particularly when the MRI of January 1992 disclosed the ligaments were intact. The ligaments help to stabilize the knees by preventing dislocations. Odiorne v. Principi, 3 Vet.App. 456, 458 (1992). Additionally, repeated physical examination disclosed normal range of motion of the knees except for the single isolated finding when the veteran was undergoing physical therapy in July 1991 at which time he had only slightly limited range of motion at the end of extension in the right knee. In other words, a compensable degree of limitation of motion of either knee is not shown. It is nevertheless contended that a compensable evaluation is warranted because of dysfunction due to pain as evidenced by his wearing a brace on each knee. However, before a compensable evaluation for each knee can be assigned on the basis of dysfunction from pain, there must be satisfactory evidence thereof. Here, it appears that the veteran exaggerates the level of pain and dysfunction of the knees as reflected by his testimony of having loss of 60 to 75 percent of the use of his legs (page 17 of the transcript) when such exaggeration of his level of dysfunction or impairment is clearly rebutted by the majority of the clinical findings on repeated examinations which have been normal, although more subjective testing, such as for tenderness or range of motion, has either been positive or reflected some guarding. It is again noted that all of the physical findings referable to the knees have been very close to normal. The principal manifestation are the complaints of pain. Slight recurrent subluxation or lateral instability is not shown. There is virtually no positive creptius, warmth, or other sign of objective abnormality, despite repeated and comprehensive studies. In sum, the Board is not persuaded that there is adequate or satisfactory evidence of dysfunction from pain which warrants a compensable evaluation for either knee, although the combined disability of both knees may result in interference with employability warranting a compensable evaluation under 38 C.F.R. § 3.324. Moreover, the disabilities of the knees are not so unusual or exceptional as to cause marked interference with employment, and he has never been hospitalized for treatment of knee disability, such as to render the application of the regular schedular standards impractical. 38 C.F.R. § 3.321. In reaching these determinations, the Board has given due consideration to the doctrine of resolving all doubt in favor of the veteran under 38 U.S.C.A. § 5107(b) (West 1991). However, it is the determination of the Board that the evidence preponderates against the claims and, therefore, there is no doubt to resolve in favor of the veteran. ORDER Service connection for arthritis of the knees and for sinusitis is denied. Compensable evaluations for medial plica of each knee is denied. MICHAEL D. LYON Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.