BVA9503616 DOCKET NO. 92-05 302 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for peripheral neuropathy of the feet, to include service connection secondary to bilateral pes planus. 2. Entitlement to service connection for irritable bowel syndrome, to include service connection secondary to a stomach disability. 3. Entitlement to an increased evaluation for bilateral pes planus, currently evaluated as 30 percent disabling. 4. Entitlement to an increased (compensable) evaluation for a stomach disability. 5. Entitlement to an increased (compensable) evaluation for residuals of hepatitis. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD L. Jennifer Lane, Associate Counsel INTRODUCTION The veteran had active service from July 1943 to January 1946. The appeal arises from a January 1990 rating decision in which the Regional Office (RO) denied increased evaluations for bilateral pes planus, a stomach disability and residuals of hepatitis and a September 1991 rating decision in which the RO denied service connection for peripheral neuropathy of both feet. The Board remanded the case in November 1993 in order to procure additional evidence, and the RO complied with the instructions set forth in the remand. In a March 1994 rating decision, the RO assigned a 30 percent evaluation for bilateral pes planus and denied service connection for irritable bowel syndrome, secondary to the service-connected stomach disability. Both the veteran's national and local representatives subsequently expressed disagreement with the decision to deny service connection for irritable bowel syndrome. The case is now ready for appellate review. CONTENTIONS OF APPELLANT ON APPEAL The veteran essentially contends that increased evaluations are warranted for bilateral pes planus, a stomach disability and residuals of hepatitis. He asserts that he experiences constant pain and numbness in both feet and difficulty walking. He also maintains that he had to stop teaching because his feet caused him to fall and because of his nervous stomach. Additionally, the veteran contends that service connection is warranted for peripheral neuropathy of the feet, secondary to bilateral pes planus, or as a result of frostbite or trauma incurred during service. Finally, he asserts that he has irritable bowel syndrome secondary to his service-connected stomach disability. 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 entitlement to service connection for peripheral neuropathy of the feet and entitlement to increased evaluations for bilateral pes planus and residuals of hepatitis. It is also the decision of the Board that the record supports the claims for entitlement to service connection for irritable bowel syndrome and an increased evaluation for the service-connected stomach disability. FINDINGS OF FACT 1. All relevant information necessary for an equitable disposition of the appeal has been developed. 2. The issue of entitlement to service connection for peripheral neuropathy of the feet does not involve medical complexity or controversy. 3. Peripheral neuropathy of the feet was not manifested during service. 4. The veteran did not sustain trauma or frostbite to the feet during service. 5. Peripheral neuropathy is not proximately due to or the result of service-connected bilateral pes planus. 6. Irritable bowel syndrome was manifested in service. 7. The veteran's bilateral pes planus is severe with pronation, pain on use and edema and is improved with orthopedic shoes. 8. The stomach disability is productive of abdominal distress. 9. The hepatitis is nonsymptomatic and causes no liver damage or gastrointestinal disturbances. 10. Neither the veteran's bilateral pes planus, stomach disability nor residuals of hepatitis present such an unusual or exceptional disability picture so as to render impractical the application of the regular schedular standards. CONCLUSIONS OF LAW 1. The criteria for obtaining an opinion from an independent medical expert are not met. 38 U.S.C.A. § 7109 (West 1991); 38 C.F.R. § 20.901(d) (1993). 2. Peripheral neuropathy of the feet was not incurred in or aggravated by service, nor is peripheral neuropathy of the feet secondary to a service-connected disability. 38 U.S.C.A. §§ 1110, 1154, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.310(a) (1993). 3. Irritable bowel syndrome was incurred in service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1993). 4. The criteria for an evaluation in excess of 30 percent for bilateral pes planus are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.2, 4.7, 4.10, Part 4, Diagnostic Code 5276 (1993). 5. The criteria for a 10 percent evaluation for stomach disability are met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.2, 4.7, 4.10, 4.20, Part 4, Diagnostic Code 7346 (1993). 6. The criteria for a compensable evaluation for residuals of hepatitis are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.2, 4.7, 4.10, Part 4, Diagnostic Code 7345 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board finds that the claims for entitlement to service connection for peripheral neuropathy of the feet and irritable bowel syndrome and entitlement to increased evaluations for bilateral pes planus, stomach disability and residuals of hepatitis are "well-grounded" within the meaning of 38 U.S.C.A. § 5107, that is, the claims are plausible, meritorious on their own or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78 (1990). The Board further finds that the Department of Veterans Affairs (VA) has met its duty to assist in developing the facts pertinent to the veteran's claims. 38 U.S.C.A. § 5107. I. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Secondary service connection for a disability is warranted when that disability is proximately due to or the result of a service- connected disease or injury. 38 C.F.R. § 3.310(a). The veteran's representative has requested that the VA obtain an independent medical opinion as to whether the veteran's peripheral neuropathy of the feet was due to frostbite incurred during the Rhineland campaign in World War II. When, in the judgment of the Board, additional medical opinion is warranted by the medical complexity or controversy involved in an appeal, the Board may obtain an advisory medical opinion from one or more medical experts who are not employees of the VA. Opinions will be secured, as requested by the Chairman of the Board, from recognized medical schools, universities, clinics, or medical institutions with which arrangements for such opinions have been made by the Secretary of the VA. An appropriate official of the institution will select the individual expert, or experts, to provide an opinion. 38 U.S.C.A. § 7109; 38 C.F.R. § 20.901(d). The Board notes that the veteran related a history of frozen feet while in training during World War II at a VA examination in December 1993. He did not report having incurred frostbite during the Rhineland campaign. Furthermore, the diagnosis was peripheral neuropathy of the feet consistent with an incident of frostbite per the veteran's history proven by vascular examination. Thus, there is already a medical opinion of record regarding a relationship between the peripheral neuropathy of the feet and the veteran's history of frostbite in service. In light of that opinion, the Board finds the issue of entitlement to service connection for peripheral neuropathy of the feet does not involve medical complexity or controversy warranting referral of the case to an independent medical expert. 38 U.S.C.A. § 7109; 38 C.F.R. § 20.901(d). The Board will first address the issue of whether direct service connection for peripheral neuropathy of the feet is warranted. While it appears that the veteran's complete service medical records are not available, the RO has attempted to obtain such records. The response to the RO's request for service medical records from the National Personnel Records Center (NPRC) was that said records may be fire-related. Some of the veteran's service medical records which were associated with the claims file not long after service are of record. Significantly, those records include hospital records and the report of the veteran's separation medical examination. The available service medical records show that the veteran was hospitalized in December 1943, but he was treated for cellulitis and lymphadenitis and not peripheral neuropathy of the feet. Moreover, the veteran's separation examination performed in January 1946 revealed bilateral second degree pes planus. However, even though findings regarding the veteran's feet were noted on the examination report, there is no reference to peripheral neuropathy of the feet. Thus, the Board finds that peripheral neuropathy of the feet was not manifested during service. Also, a VA outpatient treatment record dated in May 1989 shows that the veteran reported having had complaints of progressive numbness in the feet for over 40 years and that the examiner's impression was peripheral neuropathy. Significantly, however, no such complaints were noted on the separation examination report or on reports of VA examinations in January 1947, June 1949, and April 1960, at which the veteran's feet were examined and he complained mainly of pain. With regard to the assertion that peripheral neuropathy of the feet is the result of frostbite incurred in service, any frostbite incurred by the veteran during service is not documented by records contemporaneous with service. Moreover, the veteran has been afforded several VA medical examinations since service and there are many VA outpatient treatment records dated over a ten year period, several of which pertain to treatment and evaluation of the veteran for complaints of numbness in his feet. Significantly, the veteran has reported a history of frostbite on only one occasion, at the VA examination in December 1993, and did not mention frostbite at the RO hearing in June 1990. Having considered the circumstances of the veteran's service, the Board finds the absence of any history of frostbite for almost 50 years and the absence of any reference to frostbite on the report of the veteran's separation examination more persuasive than the isolated history of frostbite at the December 1993 examination. 38 U.S.C.A. § 1154. The Board notes that the veteran served overseas during World War II and that his military occupational specialty was airplane sheet metal worker. Therefore, the Board finds that the veteran did not experience frostbite during service and that service connection for peripheral neuropathy of the feet as a result of frostbite in service is not warranted. The veteran also contends that peripheral neuropathy of the feet is the result of trauma sustained during service. According to a VA outpatient treatment record dated in January 1990, the veteran provided a history of having broken both feet in February 1944 while jumping over a high wall during training. Also, the assess-ment in a VA outpatient treatment record dated in August 1991 was "feet possibly secondary to service trauma". In essence, that physician was merely speculating by indicating that there "may or may not" be a relationship between trauma in service and the veteran's complaints involving the feet almost 50 years later. Tirpak v. Derwinski, 2 Vet.App. 609 (1992). Also, while breaking both feet would seem like a significant injury, the report of the January 1946 separation medical examination and VA examinations in January 1947, June 1949, and April 1960, which include medical histories and findings regarding the feet contain no reference to any such injury. The Board finds the absence of any reference to trauma of the feet on the report of the separation examination and examinations reports for many years after service more persuasive than the veteran's later account of having broken both his feet during service. Therefore, the Board concludes that the veteran's peripheral neuropathy of the feet is not the result of trauma sustained during service. It is also contended that the peripheral neuropathy of the feet is secondary to the veteran's service-connected bilateral pes planus. However, as a layperson, the veteran is not competent to render an opinion as to the issue of medical causation. Espiritu v. Derwinski, 2 Vet.App. 492 (1992); Moray v. Brown, 5 Vet.App. 211, 214 (1993). Additionally, the evidence of record includes no medical opinion that peripheral neuropathy of the feet is proximately due to or the result of the veteran's service- connected bilateral pes planus. Moreover, a VA doctor who examined the veteran in December 1993 determined that bilateral pes planus did not cause the peripheral neuropathy of the feet. Thus, the probative evidence is against finding that service connection is warranted for peripheral neuropathy of the feet secondary to bilateral pes planus. 38 C.F.R. § 3.310(a). As for irritable bowel syndrome, the veteran contends that service connection is warranted for that disorder on a secondary basis. However, he is not qualified to provide an opinion as to medical causation. Moreover, the only medical opinion of record which addresses the issue of whether irritable bowel syndrome is proximately due to or the result of the veteran's service- connected stomach disability is the opinion of the VA physician who performed an examination of the digestive system in December 1993. According to that physician, the veteran had long-standing symptoms consistent with irritable bowel syndrome and that while it was possible there was no way to determine if the gastrointestinal symptoms in service were related to irritable bowel syndrome. Thus, in essence, that physician was merely speculating by indicating that there "may or may not" be a relationship between irritable bowel syndrome and gastrointestinal related complaints in service. Tirpak v. Derwinski, 2 Vet.App. 609 (1992). Mere speculation is not sufficient to grant service connection for a disability. Moreover, the physician did not even speculate as to whether irritable bowel syndrome was due to the service-connected stomach disorder. Accordingly, service connection for irritable bowel syndrome secondary to the veteran's service-connected stomach disability is not warranted. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.310(a). With regard to whether direct service connection is warranted for irritable bowel syndrome, the report of the separation medical examination in January 1946 shows that the veteran had persistent attacks of vomiting in October 1944 with vague pains and mild intolerance to fatty foods. While it was reported that there were no known symptoms of hepatitis, hepatitis was diagnosed; and a rating decision in May 1946 granted service connection for stomach trouble and hepatitis. At the January 1947 VA examination, the veteran complained of gas pains after eating, and at the June 1949 VA examination, he complained of pain in the stomach with heartburn and emesis at times. VA outpatient treatment records dated in the 1970's and 1980's show that the veteran continued to report gastrointestinal complaints and that various disorders were diagnosed, including anxiety reaction in August 1979, reflux symptoms and a small hiatus hernia in July 1981, and anxiety with stomach related distress in May 1986. The first indication by a physician that the veteran had irritable bowel syndrome was approximately 40 years after service. A VA outpatient treatment record dated in April 1986 includes an assessment of history of irritable bowel. Also, at a VA examination in November 1987, the veteran related a history in service of nausea and vomiting associated with diarrhea when anxious. The examination report indicates that the veteran had the gastrointestinal problems at the time, and the diagnosis was possible irritable bowel syndrome. At a VA examination in January 1990, the veteran related having abdominal pains with nausea and vomiting while in service, and the diagnosis was gastric hyperacidity and abdominal cramps probably secondary to irritable bowel syndrome. According to the report of a VA examination of alimentary appendages in December 1993, the veteran related a history of stomach and gastrointestinal upset on and off since 1946. The diagnosis was probable recurrent duodenitis and diverticulosis in the descending and sigmoid colons. However, that examiner could not substantiate a diagnosis of irritable bowel syndrome with the veteran's history. Also, as previously discussed, the physician who performed the December 1993 VA examination of the digestive system reported that the veteran had long-standing symptoms consistent with irritable bowel syndrome. Also, according to that examiner, it was possible that the gastrointestinal symptoms in service were related to irritable bowel syndrome. Thus, it is the opinion of two VA physicians who examined the veteran in November 1987 and December 1993 that his long-standing gastrointestinal symptoms since service may be attributed to irritable bowel syndrome. Furthermore, a VA physician who examined the veteran in January 1990 reported that the veteran's symptoms, which were noted on the January 1946 separation examination and which the veteran has continued to complain of since service, are probably due to irritable bowel syndrome. Therefore, the Board finds that irritable bowel syndrome was incurred in service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. II. Increased Evaluations The Board notes that in VA Forms 1-9, dated in December 1991 and January 1992, the veteran related "I am currently under treatment at the [VA Medical Center in] Tampa[, Florida], also the VA facility in Buffalo, New York." However, in his testimony presented at the RO hearing in June 1990, the veteran referred to treatment at the Buffalo VA Medical Center (VAMC) as having occurred in the past. Also, in his testimony as well as in VA Forms 21-4138 (Statement In Support Of Claim) dated in November 1989, the veteran indicated that he was being treated at the VAMC in Tampa. Thus, it appears that while the veteran was once receiving treatment at the Buffalo VA facility, recent treatment, which provides the most probative evidence, in evaluating the current severity of the veteran's service-connected disabilities, has been at the Tampa VAMC. Disability ratings are based on schedular requirements which reflect the average impairment of earning capacity occasioned by the current state of a disorder. 38 U.S.C.A. § 1155. Separate rating codes identify the various disabilities. 38 C.F.R. Part 4. In determining the current level of impairment, the disability must be considered in the context of the whole recorded history, including service medical records. 38 C.F.R. § 4.2. An evaluation of the level of disability present must also include consideration of the functional impairment of the veteran's ability to engage in ordinary activities, including employment, and the effect of pain on the functional abilities. 38 C.F.R. § 4.10. Also, where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The history of the veteran's service-connected bilateral pes planus may be briefly described. According to the veteran's separation medical examination performed in January 1946, the veteran had bilateral second degree pes planus with eversion, symptomatic and aggravated in military service. A May 1946 rating decision granted service connection for pes planus and assigned a 10 percent evaluation for that disability, effective in January 1946. Under Diagnostic Code 5276, a 30 percent evaluation is warranted for severe bilateral pes planus with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities; and a 50 percent evaluation is warranted for pronounced bilateral pes planus with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, and no improvement with orthopedic shoes or appliances. 38 C.F.R. Part 4. After service, at a VA examination in January 1947, the veteran complained that his feet ached, and examination of the feet revealed pain. The examiner at a June 1949 VA examination described the veteran's bilateral pes planus as moderately symptomatic. Another VA examination performed in April 1960 revealed pain, tenderness, calluses over some of the toes, pronated feet and pain on inversion. Also, the weight bearing line shifted medially. VA outpatient treatment records dated since the 1970's show that the veteran has continued to seek treatment for complaints involving his feet. At a VA examination in November 1987, the veteran walked with a limp and used a cane. He related that he fell down. Examination revealed a blister on the right great toe. Significantly, there was no edema. The most probative evidence in evaluating the current severity of the veteran's bilateral pes planus includes recent medical evidence and the veteran's testimony at the RO hearing in June 1990. A VA examination performed in January 1990 revealed that the midtarsal joint was maximally pronated. However, the recent medical evidence does not show extreme tenderness of plantar surfaces of the feet, marked inward displacement or severe spasm of the tendo achillis on manipulation. Also, at the hearing, the veteran testified that he removed calluses from the end of his toes about once a month and experienced pain when walking and cramps in his feet while sleeping. Additionally, the December 1993 VA podiatry examination revealed bilateral +2 pitting edema of the ankles and pretibial area and that functioning was mildly to moderately pronated. Moreover, according to the examiner, the veteran's bilateral pes planus was severe in nature and was helped by footgear. Thus, the schedular criteria for a 30 percent for bilateral pes planus most closely reflect the severity of that disability. 38 C.F.R. § 4.7. With regard to the veteran's a stomach disability and hepatitis, the report of the separation medical examination in January 1946 shows that the veteran had persistent attacks of vomiting in October 1944 with vague pains and mild intolerance to fatty foods. Also, examination revealed that the liver four fingers below the rib margin was moderately tender. While it was noted that there were no known symptoms of hepatitis and that the veteran was asymptomatic at that time, the diagnosis was hepatitis. A May 1946 rating decision granted service connection for stomach trouble and hepatitis and assigned a noncompensable evaluation for that disability, effective in January 1946. At the January 1947 VA examination, the veteran complained of gas pains after meals, and examination revealed some tenderness in the epigastrium. Significantly, the diagnosis was stomach trouble and hepatitis not found. At the VA examination in June 1949, the veteran's complaints included pain in the stomach with heartburn and emesis at times. The examiner reported that liver damage was not demonstrated and that a peptic ulcer was not found at that time. VA outpatient treatment records dated in the 1970's and 1980's show that the veteran's was treated for gastrointes-tinal complaints on various occasions. According to a record dated in August 1979, the veteran complained of stomach pains. A record of a liver scan in February 1981 shows that the veteran's liver was normal. Another VA outpatient treatment record dated in July 1981 shows that the veteran complained of abdominal pain but an upper gastrointestinal series was negative. That record also reveals that there were reflux symptoms and a small hiatus hernia. In May 1986, he was treated for anxiety with stomach related distress. At a VA examination in November 1987, the veteran related a history in service of nausea and vomiting associated with diarrhea when anxious. The examination report indicates that the veteran had the gastrointestinal problems at the time of the examination but that Tagamet and Mylanta helped. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. The veteran's stomach disability has been evaluated under Diagnostic Code 7307 for gastritis. Under that Diagnostic Code, a 10 percent evaluation is warranted for chronic hypertrophic gastritis (identified by gastroscope) with small nodular lesions, and symptoms. 38 C.F.R. Part 4. However, such identification has not been made. Under the circumstances and for the reasons discussed below, the Board finds that evaluation of the veteran's stomach disability under a Diagnostic Code other than 7309 is appropriate. 38 C.F.R. Part 4. At a VA examination performed in January 1990, gastric hyperacidity and abdominal cramps secondary to irritable bowel syndrome was diagnosed. According to the report of a VA examination of alimentary appendages in December 1993, the veteran related a history of stomach and gastrointestinal upset on and off since 1946. The diagnosis was probable recurrent duodenitis and diverticulosis in the descending and sigmoid colons. Also, the examiner who performed the VA examination of the digestive system in December 1993 reported that the veteran's symptoms were most consistent with reflux disease and dated back to early adulthood, while in service, and that an upper gastrointestinal series was consistent with duodenitis which may be secondary to hyperacidity. Additionally, the physician related that the veteran had long-standing symptoms consistent with irritable bowel syndrome. In light of recent diagnoses and conclusions by VA examiners, the Board finds that the schedular criteria for evaluating a hiatal hernia is most appropriate for evaluating the veteran's service-connected stomach disability. 38 C.F.R. Part 4, Diagnostic Code 7346. Under the provisions of Diagnostic Code 7346, a 30 percent evaluation is warranted for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health, and a 10 percent evaluation is warranted for two or more of the symptoms for the 30 percent evaluation of less severity. 38 C.F.R. Part 4. The Board finds that the criteria for a 10 percent evaluation most closely approximate the severity of the veteran's stomach disability. 38 C.F.R. § 4.7, Diagnostic Code 7346. At the RO hearing, the veteran testified that he experienced a constant dull pain in the abdominal area. However, at the December 1993 VA examination of the digestive system, he complained of continuous epigastric pain which would wax and wane and left lower quadrant pain which would also wax and wane and was partially relieved by bowel movements. He also reported that intermittent nausea and vomiting and continuous "heartburn" accompanied the epigastric pain. Significantly, the heartburn was partially or temporarily relieved with antacids. The veteran related that he experienced emesis twice a week but no diarrhea or constipation. Also, examination of alimentary appendages revealed essentially negative or minimal findings, including minimal tenderness palpating left lower quadrant, occasional minimal spasm in the left lower quadrant, no nausea, no vomiting but occasional regurgitation of food, and minimal pain. Thus, the veteran experiences abdominal distress. Also, while the veteran has described the abdominal pain as constant, he has also indicated that it increases and decreases; and a VA examiner described the pain as minimal. Additionally, the veteran reported having no diarrhea or constipation. Therefore, the Board finds that the veteran's a stomach disability is productive of disability consistent with a 10 percent evaluation. 38 C.F.R. Part 4, Diagnostic Code 7346. As for hepatitis, Diagnostic Code 7345 provides for a noncompensable evaluation is warranted when the disease is healed and nonsymptomatic; and a 10 percent evaluation is warranted when there is demonstrable liver damage with mild gastrointestinal disturbance. 38 C.F.R. Part 4. However, the medical evidence shows that hepatitis is not present, and there is no medical evidence of any residuals of hepatitis. The report of the December 1993 examination of alimentary appendages shows that the examiner considered the veteran's diagnosis of hepatitis to be very doubtful. Also, according to the report of the VA examination of the digestive system, there was no evidence of chronic liver disease. With regard to borderline hepatomegaly, the examiner at the latter examination noted the size of the liver and that two previous ultrasounds had documented fatty infiltration that was most likely secondary to morbid obesity. Thus, any abnormalities of the liver as well as the veteran's gastrointestinal disturbances have been attributed to disorders other than hepatitis. Therefore, the Board finds that a compensable evaluation is not warranted for residuals of hepatitis as the veteran is nonsymptomatic and there is no evidence of liver damage or gastrointestinal disturbance due to hepatitis. 38 C.F.R. § 4.7, Diagnostic Code 7345. The Board has also considered the various other provisions of 38 C.F.R. Parts 3 and 4 in accordance with Schafrath v. Derwinski, 1 Vet.App. 589 (1991), but finds that they do not provide a basis upon which to grant an evaluation higher than that already assigned for bilateral pes planus, stomach disability or residuals of hepatitis. For example, when the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards, an extra- schedular evaluation is warranted. 38 C.F.R. § 3.321(b). The veteran contends that he had to stop teaching because his feet caused him to fall and because of his nervous stomach and that he experiences difficulty walking. However, teaching does not require a great deal of walking, and the veteran has reported that medication provides some relief for his stomach complaints. Thus, there is no probative evidence that any of the disabilities in question has caused marked interference with employment which is not adequately reflected by the evaluations already assigned. It is also significant that none of the disabilities has required frequent periods of hospitalization. Therefore, an extra- schedular evaluation for bilateral pes planus, a stomach disability or residuals of hepatitis is not warranted. 38 C.F.R. § 3.321(b). Finally, when after consideration of all evidence and material of record, there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving such matter shall be given to the claimant. 38 U.S.C.A. § 5107(b). However, the preponderance of the evidence is against the veteran's claims for entitlement to service connection for peripheral neuropathy of the feet and increased evaluations for bilateral pes planus, and residuals of hepatitis. Therefore, the resolution of doubt is not necessary, and those claims are denied. However, the evidence for the remaining issues is at least in equipoise and, therefore, all reasonable doubt is resolved in the veteran's favor as to those issues. ORDER Service connection for peripheral neuropathy of the feet is denied. Service connection for irritable bowel syndrome is granted. A 10 percent evaluation for a stomach disability is granted, subject to the provisions governing the award of monetary benefits. Increased evaluations for bilateral pes planus and residuals of hepatitis are denied. LAWRENCE M. SULLIVAN 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.