BVA9507460 DOCKET NO. 93-13 944 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Denver, Colorado THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for residuals of frozen feet. 2. Entitlement to service connection for peripheral vascular disease. 3. Entitlement to service connection for a back disorder. 4. Entitlement to an increased evaluation for a skin disorder of the feet, involving the ankles, heels and toes, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD Suzie St. Vil, Associate Counsel INTRODUCTION The veteran served on active duty from September 1943 to December 1945. He has been represented throughout his appeal by the Disabled American Veterans. Service connection for residuals of frozen feet was previously denied by the Board of Veterans' Appeals (hereinafter Board) in April 1991. However the issue considered at the time was whether the veteran had submitted new and material evidence to reopen the veteran's claim for this disorder. Previously the RO in 1986 had denied the veteran's claim. In the absence of a timely substantive appeal, the 1986 decision became final. The Board will consider this case in accord with the decision of the Court of Veterans Appeals in Glynn v. Brown, 6 Vet.App. 523 (1994), as shown below. This current matter came before the Board on appeal from a rating decision of March 1992, of the Denver, Colorado Regional Office (hereinafter RO), which denied the veteran's attempt to reopen his claim of entitlement to service connection for residuals of frozen feet; this rating action also denied veteran's claims for service connection for peripheral vascular disease and a back disorder, as well as a claim for an increased evaluation for a skin disorder of the feet. In his substantive appeal, the veteran made reference to an increased rating for otitis media; during his hearing at the RO he amended his claim to include the issues of service connection for tinnitus, vertigo and a psychiatric disorder. These issues have not been developed for appellate review, nor are they inextricably intertwined with the issues set forth on the preceding page. Accordingly, they are referred to the RO for appropriate action. CONTENTIONS OF APPELLANT ON APPEAL The veteran essentially contends that he is entitled to service connection for residuals of frostbite of the feet which are attributable to exposure to cold during service. The veteran maintains that his current skin disorder was actually caused by frostbite. The veteran indicates that he was treated on several occasions during service for frozen feet, a condition which has also led to the development of peripheral vascular disease; as a result, he argues that service connection is also warranted for peripheral vascular disease. The veteran further maintains that he is also entitled to service connection for a back disorder which developed as a result of a back injury he sustained in service. The veteran asserts that service medical records clearly indicate that he was treated for a back injury while on active duty. In addition, the veteran maintains that his service-connected skin disorder is more severe than currently reflected by the assigned rating. It is requested that the case be considered under all applicable law and regulations, and that the veteran be accorded the benefit of the doubt. 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 new and material evidence has not been submitted to reopen a claim for entitlement to service connection for residuals of frozen feet, and that the preponderance of the evidence is against the veteran's claims for service connection for peripheral vascular disease, a back disorder and a rating in excess of 10 percent for his service-connected skin disorder of the feet, involving the ankles, heel and toes. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's claims has been obtained by the RO. 2. The RO denied entitlement to service connection for residuals of frozen feet in 1986. 3. The evidence submitted since that decision shows only that residuals of "frozen feet" was diagnosed many years after the veteran's discharge from military service, based on the veteran's self-reported history; similar evidence was of record in 1986. 4. During service, the veteran was hospitalized on two occasions with an admitting diagnosis of peripheral vascular disease; symptoms of peripheral vascular disease were acute and transitory in effect which resolved without resultant disability. 5. The currently diagnosed peripheral vascular disease was not present until many years after the veteran's separation from military service, and is not otherwise shown to be related to service. 6. Residuals of a back injury clearly and unmistakably existed prior to service; there was no permanent increase in severity of the pre-existing back disorder on account of service. 7. The current back disorder, lumbar fusion, was not present until many years after service and is clearly attributable to post service trauma. 8. The veteran's service-connected skin disorder is manifested principally by fissuring involving the soles of both feet and onychomycosis; constant exudation or itching, extensive lesions or marked disfigurement caused by the service-connected disorder is not shown. CONCLUSIONS OF LAW 1. Evidence received since the RO's 1986 determination denying entitlement to service connection for residuals of frozen feet in April 1991 is neither new nor material. 38 U.S.C.A. §§ 1110, 5107, 5108 (West 1991); 38 C.F.R. § 3.156(a) (1994). 2. The decision of the RO in 1986 denying service connection for residuals of frozen feet is final and is not reopened. 38 U.S.C.A. §§ 5107(b), 7105 (West 1991); 38 C.F.R. § 3.156 (1994). 3. Peripheral vascular disease was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303(b) (1994). 4. A chronic back disorder was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1994). 5. The criteria for a rating in excess of 10 percent for the veteran's skin disorder of the feet, tinea with onychomycosis, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, Part 4, Code 7813 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, we note that we have found that the veteran's claims are "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a); effective on and after September 1, 1989. That is, we find that he has presented claims which is plausible. Moreover, after careful review of the evidentiary record, we are also satisfied that all relevant facts have been properly developed. Therefore, no further assistance to the veteran is required to comply with the duty to assist as mandated by 38 U.S.C.A. § 5107(a). The record reflects that the veteran entered military service in September 1943; an enlistment examination revealed no complaints, findings or history referable to frostbite, a skin disorder, peripheral vascular disease or a back disorder. Clinical evaluation was normal. The service medical records show that the veteran was seen on several occasions for evaluation and treatment of a skin disorder involving the feet, which was initially diagnosed as trichophytosis and epidermophytosis with ulcer, cause undermined. In February 1944, he was hospitalized for approximately two weeks for a disorder characterized as "other disease of the circulatory system: acrocyanosis due to autohemagglutination involving cutaneous capillaries of the neck, body and upper extremities. At the time of discharge from hospitalization, the veteran was reported to be "improved." There were no further references to such disability in the service medical records. The records indicate that the veteran was seen in April 1945 for complaints of persistent headaches and low back pain. It was noted that his back pain had persisted since an automobile accident in 1942, which left him unconscious for 14 hours. X-ray study of the lumbar spine was negative. When seen in September 1945, it was reported that the veteran had superficial abrasions of the back and right anterior chest as a result of a motor vehicle accident which occurred on September 14, 1945. No pertinent diagnosis was reported. The service medical records further indicate that the veteran was admitted to the hospital on December 4, 1945 for evaluation of chronic ulcers of both feet. The veteran reported that he had had recurrent skin lesions on his feet and ankles since basic training during the fall of 1943; he indicated that his foot condition was aggravated by tight shoes, prolonged marching and jumping. He also stated that he had recurrent attacks of athlete's foot prior to service, during high school. That hospital summary makes no references to a history of frostbite or other indication of cold exposure, although an extensive history relating to the onset of episode of skin symptoms was recorded in detail. Vascular examination revealed no abnormalities. The veteran also reported falling out of a second story window at the age of 12; he related that since then he had had occasional back pain. However, no pertinent diagnosis of a back disorder was reported. The bones, joints and musculoskeletal system were reported to be normal. On December 15, 1945, the veteran was given a Certificate of Disability for Discharge due to ill defined condition of the skin, chronic, recurrent, manifested by patches of ecchymosis developing over the bony parts of the ankles and heels, with pain and tenderness, moderate, cause undetermined. On his initial claim for service connection, filed by the veteran in December 1945, he made no reference to frostbite, or a back disorder; he stated that dermatitis involving the feet began in December 1943. A rating action of December 1945 granted service connection for a skin disorder, ecchymosis, with pain and tenderness of the ankles and heels. A 10 percent evaluation was assigned, effective December 16, 1945. Subsequent to service, evidence of record in the 1940's demonstrate that the veteran received clinical evaluation for his service-connected skin disorder. A private treatment note dated in November 1946 reported that examination of the right ankle showed no evidence of bony injury or disease involving the bones making up the ankle joint. In a letter dated in January 1948, the veteran's employer reported that he had left his employment in December 1947 as a result of his feet. VA compensation examinations of January and April 1948 reported findings of pain and tenderness of the heels. These records reflected no history or findings referable to frostbite of the feet, a back disorder or peripheral vascular disease. Of record is a statement dated in November 1954 by a VA contact representative wherein it was reported that film of the veteran's lumbar spine in April 1945 was negative, and that there was no report of a back injury in service. It was further noted that there had been no complaints of a back disorder during VA examinations in January and April 1948. Following an examination in June 1957, the VA examiner reported that the veteran's skin disorder was apparently better at present; he noted, however, that the condition was probably more severe in cold weather. The doctor indicated that it seemed that circulation was impaired. He stated that the cause of the primary skin ulcer was undetermined, but it was probably circulatory in nature. Received in February 1976 was a certificate of attending physician from William S. Davis, M.D., who reported that he had been treating the veteran since May 1946. Dr. Davis indicated that, when he first saw the veteran in May 1946, an ulcer was excised from the right heel; the ulcer healed without any trouble. Dr. Davis noted that the ulcer again broke down in June 1946, but it healed spontaneously. Following an evaluation of the ankles, Dr. Davis reported a current diagnosis of peripheral vasoconstrictor reaction to cold, known as "Raynaud's phenomenon." The veteran was afforded a VA compensation examination in April 1976, at which time he indicated that while stationed in Italy in 1944, he developed ulcerations of the right ankle and both heels; he stated that he was told that this condition was secondary to frostbite. The veteran indicated that he was treated at the field hospital with no improvement. The veteran reported that after being transferred to hospitals in Trinidad, WI and Coral Gables, Florida, he was discharged in December 1945 with ulcers still open. On examination, there was a well-healed scar on the lateral aspect of the right ankle over the lateral malleolus. There was mild scaling on the soles, with some scaling and maceration of the toewebs, bilaterally. The skin on the heels were intact, and there was no inflammation or fissuring. The diagnoses were tinea pedis and onychomycosis. Medical evidence in the 1980's, including VA as well as private reports, reflect that the veteran continued to receive treatment for his service-connected skin disorder; as well, the veteran received extensive treatment, including surgery, for degenerative changes in the joints of the feet. These records also indicate that he underwent a laminectomy for disc herniation of the lumbar spine in February 1984. The veteran was referred for electromyogram studies by a private physician in May 1984 because of neck and back pain; at that time it was noted that the veteran had a history of injury in his job where he fell while lifting a heavy object; thereafter, he developed neck and low back pain radiating into the right leg. In a medical statement from J. T. O'Connor, Jr., D.O., dated in November 1984, it was noted that the veteran underwent 2 surgical procedures to correct lumbar disc herniation with resultant peripheral neuropathy. In a subsequent statement dated in December 1984, Dr. O'Connor reported that the veteran continued to have problems since service with chronic onychomycosis of all of the nails of his feet and also skin problems associated with same. Dr. O'Connor also reported that the veteran had problems with chronic splitting of heels with occasional purulent discharge, which had not improved with therapy. On the occasion of a VA compensation examination in February 1985, it was indicated that the veteran had had persistent pain in the heel area and had not been able to walk on his heels because of pain. He complained of cold intolerance. It was also noted that the veteran had had an on-the-job injury in February 1984 which required a lumbar laminectomy. He complained of chronic low back pain, radiating down the right leg with intermittent paresthesias in the right leg. Following the evaluation of the veteran's extremities, the examiner reported that there was no evidence of any type of neurological loss in the lower extremities except for the absence of right ankle jerk. The pertinent diagnoses were old injury of feet, by history, with chronic callosities and fissuring of the heels of the feet; and post-operative lumbar laminectomy. The examiner stated that the veteran had no ischemic changes in the feet, with normal skin temperature, normal hair growth and excellent peripheral pulsations. The veteran was afforded a VA compensation examination in July 1986, at which time he reported a history of frostbite in service, as a result of which he developed dermatitis and paresthesias of both feet. The veteran further indicated that because of the above condition, his gait had been abnormal for a number of years, causing back problems; he stated that he began to experience pain in both forefeet. The veteran reported undergoing surgery in the right ankle in the 1940's; he also reported undergoing surgery in May 1986 on the first metatarsophalangeal joint. The veteran further indicated that he was still receiving treatment for an open wound from the last surgery. The veteran also reported that he developed a fungus infection of the toenails of both feet with periodic loss of nails, thickening and discoloration of nails. Following an examination of the lower extremities, the diagnoses were residuals, frostbite, both feet with peripheral neuropathy and bilateral fungus infections, and degenerative joint disease, both feet, post-operative on the left with post-operative infection. Another medical statement from Dr. O'Connor dated in July 1986 was received, wherein he reported that the veteran suffered emersion foot as well as cold injury to both feet in "1944" which had resulted in some permanent damage. In a medical statement received from John Starinski, D.P.M., then a VA podiatrist, dated in August 1986, it was noted that the cold injury to the veteran's feet had caused damage to his microvascular system. Dr. Starinski further stated that the problems the veteran was experiencing with his lower extremities, both vascular and arthritic, were a direct result of his service injury. By rating decision of September 1986, service connection for residuals of frozen feet was denied on the basis that frostbite in service was not established by the evidence of record. In a subsequent statement dated in December 1986, Dr. Starinski and Dr. Peter Steffen, D.P.M., another VA podiatrist, both observed that since the veteran had a history of frostbite to his hands and feet while in service, his condition was not surprising. It was suggested that the veteran's vascular impairment was related to military service and that service connection for such was warranted. Subsequently received in January 1987 were duplicates of the above medical statement, as well as a duplicate of a statement from Dr. O'Connor dated in July 1986, which has already been reported above. In February 1987, the Director of Tuscon, Arizona VA Medical Center stated that the veteran's case had been discussed with one of the VA podiatrists (reflected above) and that that individual now understood that the veteran's claim was based on a subjective complaint, without the necessary medical documentation to support the claim. Also in February 1987, the RO confirmed and continued the denial of service connection for frostbite; the veteran filed a timely notice of disagreement therefrom and was provided a statement of the case. However, no timely filed substantive appeal was received. Received in April 1989, in connection with the veteran's application to reopen his claim, was information from the Office of Surgeon General which show that the veteran was admitted to military hospitals in February 1944 and December 1945 with a diagnosis of peripheral vascular disease. The veteran was afforded a VA examination in October 1990, at which time he reported that cold and wet weather bothered his feet, and that he had difficulty walking. It was also noted that the veteran had a mycotic infection of the nails. Examination of the feet revealed the presence of early cyanosis. The veteran had surgical scars over the lateral right malleolus, and the dorsalis pedis pulses were good on the anterior surface of the feet. The examiner reported that while the veteran had had several examinations during which he was told that he had microvascular disease of his feet as a result of the freezing of the feet, he had not had a true vascular surgical consultation. Following a neurological consultation and evaluation in November 1990, the examiner reported that the veteran appeared to have residuals of an S1 radiculopathy on the right with an absent ankle jerk and sensory deficit to match; nonetheless, he had fairly good strength in the involved muscles. The examining physician further reported that he did not find any evidence of atypical peripheral neuropathy, and he thought that the veteran's foot complaints were outside the scope of which was ordinarily considered neurological disease. Peripheral vascular consultation and Doppler flow studies in November 1990 revealed probable localized damage to the heels; it was noted that all other circulation was intact and normal. In a determination of April 1991, the Board found that the veteran had not submitted new and material evidence with respect to his claim for service connection for frostbite. Accordingly, the 1986 decision of the RO denying same was final and not reopened. Received in November 1991, in connection with the veteran's attempt to reopen his claim, were copies of service medical records as well as copies of information from the Surgeon General's Office, all of which have already been reported above. The veteran was again examined by the VA in January 1992, at which time he complained of constant pain in the lower extremities, including his feet, toes and ankles. It was reported that, according to the veteran, when he was stationed in Italy in 1944, he had frostbite to the feet. It was further reported that the veteran was discharged from military service and on examination was given disability for the ulcerations and persistent pain associated with the frostbite. It was noted that since that time, the had continued to experience pain and occasional ulcerations of the skin, with cracking and chronic fungal infections of both feet. The veteran indicated that he was unable to work because of the pain in his feet and back. He reported undergoing 3 surgeries for his back and 2 on his feet. The veteran further reported that his feet produced constant pain. On examination, it was observed that the veteran was mildly obese. It was noted that the feet revealed no ulcerations at the time of the exam. However, the examiner reported that both soles were thickened with mild to moderate fissuring of the bottoms of the feet. There was also tinea involvement of all of the nails. KOH scraping of the bottom of the feet was positive. Pulses in the feet were good and they were warm. There were no ulcerations in the medial or lateral aspects of the ankles or on the digits. The diagnoses were chronic tinea and chronic onychomycosis of both feet and history of frostbite. The examiner reported that there were no physical findings at that point which demonstrated vascular changes secondary to frostbite. Received in April 1992 were duplicate copies of service medical records; a medical statement from the veteran's employer dated in January 1948; private medical statements dated in March 1948, March 1985, July 1986 and December 1986. Also received were copies of the information from the Surgeon General's Office, as well as copies of morning reports. Also received in April 1992 was a medical statement from Lloyd L. Strode, D.O. who reported that the veteran was treated for vertigo in November 1991. A VA outpatient treatment dated in February 1992 reported that the veteran had multiple medical problems which would require further treatment. The veteran, accompanied by his representative, appeared at a hearing before a hearing officer at the RO in November 1992, at which time he offered testimony regarding his claimed disorders. The veteran's testimony is essentially reflected in the contentions section above. In addition, the veteran testified that he had no physical abnormalities when he entered military service in 1943; he indicated that he had no foot disorders, no back disorder and no vascular problems. The veteran reported that he developed a skin disorder in 1944. He indicated that he was hospitalized five times between January 1945 and December 1945 during which he was treated for ulcerations. The veteran indicated that a nurse at the 4th field hospital told him that he had frostbite of the feet; he stated that she told him that there was nothing that could be done for him. The veteran indicated that doctors at different VA hospitals have told him that the reason he did not have any hair on his toes and feet was because he had a vascular problem, due to poor circulation due to frozen feet. The veteran further testified that while he did fall out of a window prior to service, he did not require any treatment for his back. The veteran reported that he injured his back during a motor vehicle accident in Trinidad, BWI; he stated that they took X-rays of the back and wrote it up as back abrasions. The veteran indicated that the doctors said that he just had a bruised back. The veteran further reported that ever since the injury, he experienced constant pain in the low back region. The veteran related that he had been given pain pills for the skin disorder as well as for back pain. Submitted at the hearing was a lay statement from the veteran's mother dated in August 1992, wherein she indicated that the veteran came home on crutches with both heels oozing; she stated that she had to change his bed daily although he wore hospital patches and stockings. She reported that the veteran's skin condition caused him constant pain. She indicated that he was a regular patient at the Harrisburg VA medical center. She further indicated that while the doctors at the clinic often spoke of ulcerated feet and ankle due to the cold, the veteran's condition was nonetheless referred to as a skin disease. She stated that the ulceration became so bad that in 1947, the veteran finally went to a private physician who operated on the right ankle; thereafter, it kept close, but it was very tender. The veteran's mother explained that he had to cut his shoes so that he could wear them even in ice and snow. I. New and material evidence for service connection for residuals of frozen feet. After careful review of the entire record, the Board concludes that the additional evidence is neither "new" nor "material." A determination of whether evidence is "new and material" so as to warrant reopening of the veteran's previously denied claim must be based upon all the evidence submitted since the final denial on the merits, rather than only upon evidence received after subsequent refusal to reopen the claim for lack of new and material evidence. Glynn v. Brown, 6 Vet.App. 523 (1994). Therefore, the Board has considered all the evidence submitted since the last decision on the merits, that is, the 1986 rating decision. Much of the evidence consists of records of treatment for a skin disorder; these records also show treatment for residuals of "frostbite" of the feet long after military service. These records, it is emphasized, were compiled based on the veteran's self-reported history of frostbite. Many of these records are in fact duplicates of records already reviewed. To this extent, the additional evidence is both cumulative and redundant. We note that while the veteran has continuously reported being told that his skin disorder was due to frostbite, there is nothing in the newly submitted records, private or VA, which shows that frostbite had its inception in service. Significantly, clinical diagnosis of frostbite was not reported until 1976, many years after the veteran's separation from active service. The Board, in examining the record, observes that, contrary to the veteran's unsupported assertions, there is no contemporaneous evidence which suggests that the skin disorder resulted from frostbite, cold immersion or other cold exposure. Service medical records are quite detailed and reflect a history of recurrent skin lesions dating to the veteran's basic training in Fall 1943. These were attributed by him to tight shoes and boots. The Certificate of Disability for Discharge likewise makes no reference to any cold injury. Moreover, it cannot be ignored that the veteran himself did not report frostbite at the time he filed his initial claim in 1945 or on VA examinations in 1948 and 1957. The veteran's allegations regarding frostbite and his physician's statements referencing such history have no probative value, in view of the overwhelming evidence which suggests causes other than frostbite for the skin lesions. A thorough review of the new evidence does not raise a reasonable possibility that the new evidence, when viewed together with the old, would change the outcome in this case. Of special significance is the statement following VA examination in 1992 that there were "no physical findings" which demonstrated vascular changes secondary to frostbite. The veteran's testimony, albeit under oath, is not found to be credible in view of its contradictions with the detailed record recorded in service. Consequently, pursuant to the mandates and guidelines set forth in the recent United States Court of Veterans Appeals decisions, the veteran's claim is not reopened. Colvin v. Derwinski, 1 Vet.App. 171 (1991); Smith v. Derwinski, 1 Vet.App. 178 (1991). II. Service connection for peripheral vascular disease and lumbar fusion. The Board notes that service connection may be granted for disabilities resulting from disease or injury incurred in or aggravated by military service. 38 U.S.C.A. §§ 1110, 1131. After careful review of the evidentiary record, the Board notes that while the Surgeon General Office records indicate that the veteran was admitted to the hospital in February 1944 and December 1945 with a diagnosis of peripheral vascular disease, the treatment records do not show any treatment or clinical findings consistent with peripheral vascular disease. In fact, the final summary of December 15, 1945 reflected no findings of a peripheral vascular disease. Moreover, although the veteran has provided medical statements from doctors who have suggested that he has a vascular impairment, the recent VA examination in have been negative for any findings of a peripheral vascular disease. Examination in January 1992 was also negative for any finding of peripheral vascular disease. Consequently, the Board must conclude that the current medical evidence does not provide a reasonable basis for service connection for peripheral vascular disease. With respect to the veteran's claim for service connection for a back disorder, the Board observes that despite the fact that a back disorder was not found upon service entrance, the records indicate and the veteran has testified that he fell out of a window prior to entering military service. The records show that the veteran was seen in April 1945 for complaints of back pain. The service medical records report that the veteran was involved in a motor vehicle accident in September 1945; however, the records indicate that the veteran only sustained abrasions on the back. The records reflected no further complaints, treatment or diagnosis of a back disorder. While the Board accepts as true the veteran's claim that he had back pain in service, still there is no evidence of a chronic back disorder. Repeated physical examinations in service of the musculoskeletal system and X-ray study in April 1945 failed to reveal any pathology. The records further indicate that it is only after the veteran suffered a work injury in February 1984, more than 39 years after service discharge, that there was clinical documentation of additional back symptomatology. Private treatment records compiled at this time reflect the development of low back pain after the back injury. It is of interest that the veteran made no reference to the post-service industrial accident at his hearing. His testimony of chronic back pain since service is completely unsupported by the record and is not deemed credible, in view of later documented findings. The Board finds, therefore, that any injury to the back in service must be considered as acute and transitory in nature, resolving without residual disability. 38 C.F.R. § 3.303. The veteran's current back disorder must be found to be related to the work injury of February 1984. Consequently, a basis for a grant of service connection for a back disorder is not shown. In reaching this decision, the Board has considered the doctrine of granting the benefit of the doubt to the veteran but does not find the evidence is approximately balanced such as to warrant its application. 38 U.S.C.A. § 5107(b). III. Increased rating for a skin disorder of the feet. The Board notes that dermatophytosis is evaluated as for eczema, under the provisions of 38 C.F.R. Part 4, Diagnostic Code 7806. As with eczema, the evaluation will depend upon the location and extent of the disease and the repugnant disfigurement or other disabling characteristics of the disease. Dermatophytosis with exfoliation, exudation or itching, if involving an exposed surface or extensive area, warrants a 10 percent evaluation. A 30 percent evaluation requires constant exudation or itching, and extensive lesions or marked disfigurement. 38 C.F.R. Part 4, Code 7813. The record indicates that the veteran continues to complain of pain and occasional ulcerations of the skin, as well as cracking and fungal infections of both feet. However, the recent VA examination of January 1992 reported that the veteran had no ulcerations at the time of the examination. It was noted that the veteran had moderate fissuring on the bottom of both feet, with tinea involvement of all of his nails. We note that the veteran's skin disorder does not involve an exposed surface or an extensive area. Moreover, as required for a 30 percent evaluation, extensive lesions or marked disfigurement is not present; and, the records do not report findings of constant exudation or itching. Consequently, the Board is of the opinion that the clinical findings do not demonstrate manifestations of symptomatology which warrants the assignment of a rating above 10 percent for the veteran's service-connected skin disorder, currently diagnosed as tinea pedis with onychomycosis. We have also considered whether the veteran's tinea with onychomycosis warrants an extraschedular evaluation in accordance with the provisions of 38 C.F.R. § 3.321(b)(1). However, the evidence does not reflect frequent periods of hospitalization, marked interference with employment, or any other exceptional or unusual disability picture resulting from the veteran's service- connected disorder which would render the application of the regular schedular standards impractical. Further, the evidence is not evenly balanced as to warrant resolving doubt in the veteran's favor. ORDER New and material evidence not having been submitted to reopen a claim for service connection for residuals of frozen feet, the appeal is denied. Service connection for peripheral vascular disease is denied. Service connection for a back disorder, diagnosed as lumbar fusion, is denied. Entitlement to an evaluation in excess of 10 percent for a skin disorder of the feet, including ankles, heels and toes is denied. N. R. ROBIN 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.