BVA9502387 DOCKET NO. 93-09 228 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for a left shoulder disorder. 2. Entitlement to service connection for a bilateral knee disorder. 3. Entitlement to an increased (compensable) evaluation for a radial head fracture of the left elbow(minor). 4. Entitlement to an increased (compensable) evaluation for tinea. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Ronald R. Bosch, Counsel INTRODUCTION The veteran served on active duty from October 1965 to October 1967 and from March 1969 to December 1990. This appeal arose from an April 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. The RO, in relevant part, denied entitlement to service connection for left shoulder and bilateral knee disorders; and granted entitlement to service connection for radial head fracture of the left elbow and tinea, each assigned noncompensable evaluations. The case has been forwarded to the Board of Veterans' Appeals (Board) for appellate review. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that service connection is warranted for left shoulder and bilateral knee disorders. He directs the Board's attention to service medical documentation of his need for treatment of left shoulder and bilateral knee symptomatology. He argues that his left shoulder and knees continue to incapacitate him on a daily basis. The appellant further contends that due to chronic pain his left elbow disability warrants a grant of an increased (compensable) evaluation. Tinea is said to be sufficiently disabling as to warrant assignment of an increased (compensable) evaluation. 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 a grant of entitlement to service connection for a left knee disorder and increased (compensable) evaluations for a radial head fracture of the left elbow and tinea; and that the record supports a grant of service connection for a right knee disorder and a left shoulder disorder. FINDINGS OF FACT 1. Early during active service the veteran dislocated his left shoulder, has complained of chronic recurring pain since service and on post service VA examination, and has been diagnosed with arthralgia by a VA physician. 2. During active service the veteran injured his left knee while skiing, received treatment on a symptomatic basis with no resulting disability, and complained of left knee pain when examined for retirement at which time no disorder was found. 3. The post service record does not demonstrate the presence of an identifiable chronic disorder of the left knee. 4. The veteran complained of right knee pain when examined for retirement in July 1990; right chondrocalcinosis and hypertrophic changes of the right knee were reported on a July 1991 VA x-ray. 5. Radial head fracture of the left elbow is manifested by subjective complaints and by normal findings on x-ray examination. 6. Tinea is compatible with slight, if any, exfoliation, exudation or itching, on a nonexposed surface and small area. CONCLUSIONS OF LAW 1. A left shoulder disorder diagnosed as arthralgia was incurred in active service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303(b) (1994). 2. A left knee disorder was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(b). 3. Arthritis of the right knee may be presumed to have been incurred in active service. 38 U.S.C.A. 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.307, 3.309. 4. The criteria for an increased (compensable) evaluation for a radial head fracture of the left elbow have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.31, 4.40, 4.71(a), Diagnostic Code 5205. 5. The criteria for an increased (compensable) evaluation for tinea have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.118, Diagnostic Code 7806. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially the Board observes that the veteran's claims are well grounded within the meaning of 38 U.S.C.A. § 5107(a), in that he has presented plausible claims. The Board is satisfied that all relevant facts have been properly developed, and that no further assistance to the veteran is required in order to comply with 38 U.S.C.A. § 5107(a). I. Entitlement to service connection for a left shoulder disorder. The service medical records show that in June 1976 the veteran reported with complaints of a dislocated left shoulder. It was noted that he had injured his left shoulder about eight years previously. It had given him trouble ever since that time. He indicated that he had currently reinjured his shoulder on parallel bars. On examination, a knot in the shoulder was reported. It was noted that the shoulder was dislocated. A March 1982 medical history examination report shows the veteran noted having dislocated his shoulder in 1966 with no problems currently. A September 1985 medical history examination report shows the claimant noted a history of a painful or "trick" shoulder or elbow (unspecified). In October 1987 the appellant reported decreased pain with complaints of limited motion and shoulder pain secondary to a splint. Shoulder exercises were recommended. He had no shoulder complaints the following month in November. The July 1990 retirement medical history report shows the veteran stated his left shoulder gave on pressure. No left shoulder abnormalities were found on examination. At a January 1991 VA examination, the veteran reported having injured and dislocated his left shoulder in a 1967 fall. He complained that his shoulder was still painful when he raised his arms over his head. On examination there was normal range of shoulder motion in all directions. There was discomfort on abduction and external shoulder rotation. An x-ray of the left shoulder was interpreted as revealing no skeletal or joint abnormality. An April 1991 VA Agent Orange examination report shows the veteran complained of shoulder pain. Shoulder arthralgia was diagnosed. A general diagnosis of arthralgia of the left shoulder provided when the appellant was examined for Agent Orange residuals by VA was based on his subjective complaints of pain. As the Board noted above, chronic recurrent pain in the left shoulder commenced subsequent to dislocation reported in service. In view of the veteran's continued complaints of left shoulder pain stemming from trauma sustained coincident with service, the Board finds that arthralgia diagnosed by a VA physician cannot satisfactorily be dissociated from the service reported left shoulder dislocation. The Board finds that even in view of negative x-ray studies or clinical objective evidence of identifiable left shoulder abnormality, the veteran nonetheless has continued to experience left shoulder symptomatology since service which began subsequent to a dislocation. The evidentiary record in this regard is in relative equipoise. When such is the case, the veteran must prevail. Gilbert v. Derwinski, 1 Vet.App. 61 (1991). For the foregoing reasons the Board is persuaded to resolve the reasonable doubt existing in this case in the veteran's favor, thereby permitting a grant of service connection for a left shoulder disorder diagnosed as arthralgia. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(b). II. Entitlement to service connection for a left knee disorder. The service medical records show that in January 1984 the veteran injured his left knee while skiing. He noted swelling with discoloration subsiding. The appellant complained of pain when climbing stairs and on exertion. A clinical inspection of the knee disclosed no swelling. There was an ecchymotic area around the tibia. A full range of motion was demonstrated according to the examiner. There was some crepitation on flexion. The diagnostic impression was left knee injury with sprain. A September 1985 medical history report shows the veteran reported having "turned knee" in 1976 with no disability at present. The July 1990 retirement medical history report shows the veteran reported his left knee was often painful. No abnormality of the left knee was found on examination. The July 1991 VA examination report shows there was crepitus with normal range of motion of the left knee. An x-ray of the left knee was interpreted as normal. The Board's evaluation of the service and post service medical evidence of record does not permit the conclusion that the veteran currently has an identifiable disorder of the left knee related to an injury in service. Undoubtedly there is adequate documentation in the service medical records of an injury of the left knee in a skiing accident. However, residual disability related to traumatic injury has not been demonstrated either on the basis of direct clinical examination or radiographic study. The Board observes that no radiologic abnormalities were found when the appellant was examined by VA in 1991, and he demonstrated a full range of motion of the left knee. The Board concludes that service connection for a left knee disorder is not warranted. 38 U.S.C.A. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303(b). III. Entitlement to service connection for a right knee disorder. The service medical records show that when examined for retirement from service in July 1990, the claimant reported that his right knee was often painful in cold weather. No abnormality of the right knee was found on examination. The January 1991 VA examination report shows that there was crepitus of the right knee with a normal range of motion. An x- ray of the right knee disclosed chondrocalcinosis and minimal hypertrophic changes. As the Board noted earlier, the appellant was discharged from active service in December 1990. Evidence of arthritic changes in the right knee to account for complaints of right knee pain in cold weather was already demonstrated barely one month after service discharge. It is clear that such arthritic changes were already present when the veteran was still on active duty and may therefore be presumed to have been incurred in service. The Board finds that service connection for arthritis of the right knee is warranted. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.307, 3.309. IV. Entitlement to an increased (compensable) evaluation for a radial head fracture of the left elbow. The service medical records show that in October 1987, the veteran fell off a bench and sustained a fracture and dislocation of the left radial head. There was tenderness and swelling at the lateral radial head and decreased range of motion in all directions. A radiographic study confirmed a small fracture at the left radial head. At a January 1991 VA examination the veteran reported having dislocated his left elbow in 1988. He reported having been in a cast for seven weeks. He stated that he still had trouble straightening his arm. On examination the left elbow extended to 5 degrees. The examiner noted that flexion of the left elbow was normal. An x-ray of the left elbow was interpreted as normal. The appellant complained of elbow pain when VA conducted an Agent Orange examination in April 1991. He was diagnosed with arthralgia of the left elbow. The veteran's radial head fracture of the left elbow is rated noncompensable under diagnostic code 5205 and 38 C.F.R. §§ 4.31, 4.71(a), of the VA Schedule for Rating Disabilities. In other words, his minor elbow is not considered to have any residual disability related to the previous fracture as the criteria for a 30 percent evaluation for favorable ankylosis of a minor elbow between 90 degrees and 70 degrees have not been shown by the evidence of record. The Board observes that the veteran does not meet the diagnostic criteria for even a 20 percent evaluation under code 5209 as he does not have an elbow joint fracture with marked cubitus varus or cubitus valgus deformity or an ununited fracture of the head of the radius. The Board acknowledges the appellant's subjective complaints. Nonetheless, his subjective complaints have not been shown to be productive of compensable disablement. The Board has considered the criteria of 38 C.F.R. § 4.40; however, the record does not demonstrate functional disabling pain directly related to the service-connected left elbow disability such as to warrant a grant of a compensable evaluation. No question has been presented as to which of two evaluations would more properly classify the severity of a radial head fracture of the left elbow. 38 C.F.R. § 4.7. The left elbow disorder has not rendered the veteran's disability picture unusual or exceptional in nature, nor has it been shown to markedly interfere with employment. It has not required frequent inpatient care as to render impractical the application of regular schedular standards, thereby precluding the assignment of an increased (compensable) evaluation on an extraschedular basis. 38 C.F.R. § 3.321(b)(1). A grant of an increased (compensable) evaluation for a radial head fracture of the left elbow is not warranted. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.31, 4.40, 4.71(a), Diagnostic Code 5205. V. Entitlement to an increased (compensable) evaluation for tinea. The service medical records show the veteran was treated for tinea which appeared on the feet and in the groin area. At a February 1991 VA medical examination, the veteran reported he had had an ongoing problem with a rash around his right groin area as well as his feet. On examination were seen hyperkeratotic scaling of his plantar surfaces bilaterally. There was no significant involvement of the nails. There was scaling on the inner web space area between the toes. There were no vesicular or pustule lesions associated with the feet. There was no significant erythema or scaling over the right groin area. The pertinent clinical assessments were tinea pedis, questionable history of tinea cruris with no significant groin involvement, and no evidence of cystic acne. An April 1991 VA Agent Orange examination report shows the veteran complained of a rash in the groin area. Mild intertrigo in the groin area was diagnosed. The veteran's tinea is evaluated as noncompensable under diagnostic code 7806 of the VA Schedule for Rating Disabilities. The noncompensable evaluation contemplates slight, if any, exfoliation, exudation or itching, if on a nonexposed surface. The next higher evaluation of 10 percent requires exfoliation, exudation or itching, if involving an exposed surface or extensive area. The Board's evaluation of the evidence of record does not permit a conclusion that tinea is compensably disabling. He has dermatological manifestations on his feet and in the groin area. The groin area manifestation was classified by the VA examiner as mild in nature. Minimal evidence of tinea on the feet has been reported. The Board finds no basis upon which to predicate a grant of a compensable evaluation, even with consideration of the criteria under 38 C.F.R. §§ 3.321(b)(1), 4.7. The most recently dated medical evidence on file shows that the appellant suffers from noncompensably disabling dermatological disability under diagnostic code 7806. Accordingly the Board finds no basis upon which to predicate a grant of an increased (compensable) evaluation with application of all pertinent governing criteria. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.118, Diagnostic Code 7806. ORDER Entitlement to service connection for a left shoulder disorder diagnosed as arthralgia is granted. Entitlement to service connection for a left knee disorder is denied. Entitlement to service connection for arthritis of the right knee is granted. Entitlement to an increased (compensable) evaluation for radial head fracture of the left elbow is denied. Entitlement to an increased (compensable) evaluation of tinea is denied. ALBERT D. TUTERA 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.