BVA9507466 DOCKET NO. 93-08 040 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUE Entitlement to an increased (compensable) rating for a strained muscle of the dorsum of the left foot. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Milo H. Hawley, Counsel INTRODUCTION The veteran had active service from March 1946 to December 1947 and from August 1950 to August 1951. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 1992 decision by the Department of Veterans Affairs (VA) Regional Office in New Orleans, Louisiana (RO). The only disability for which service connection has been established with respect to the left foot is residuals of a strained muscle of the dorsum of the left foot. During the veteran's personal hearing, he indicated that private physicians and private orthopedists were of the opinion that disability of his foot was not related to a strained muscle for over 40 years, but that something else was wrong with his foot. During the hearing it was also noted that the veteran had degenerative joint disease in his foot and the veteran indicated that he believed that swelling in the foot could be due to nerves or circulation. Service connection has not been established for circulatory or neurologic disorders of the left foot, nor has it been established for degenerative joint disease of the left foot. The current appeal relates to an increased (compensable) rating on the basis of residuals of a muscle strain in the dorsum of the left foot. If the veteran desires to claim service connection for additional disability such as neurologic, circulatory, or degenerative joint disease, he is advised to contact the RO to initiate such claim. CONTENTIONS OF APPELLANT ON APPEAL It is contended that the veteran's service-connected muscle strain of the dorsum of his left foot is more disabling than currently evaluated. It is asserted that the veteran experiences swelling and pain in the foot, and must wear shoe inserts because he is walking on bone. 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 compensable evaluation for strained muscle of the dorsum of the left foot. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. Residuals of muscle strain of the dorsum of the left foot are not currently shown to exist. CONCLUSION OF LAW A compensable evaluation for strained muscle of the dorsum of the left foot is not warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, Part 4, Code 5310 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107. The Board is satisfied that all relevant facts have been properly developed and that no further assistance is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107. Service medical records reflect that the veteran was seen on April 11, 1951, with complaint of pain in the left foot of a duration of 11 hours. He reported that he had tripped while stepping into a foxhole at which time he turned his left foot. He immediately felt pain on the dorsum of the left foot. Examination of the left foot showed no ecchymosis or joint tenderness. There were moderate swelling of the dorsum and generalized tenderness over the dorsum. The impression was sprain. On April 12, the veteran's dorsum of the foot continued to be extremely tender. X-rays of his foot were negative. On April 17, 1951, the veteran was feeling fine and he was returned to duty. An April 25, 1951, service medical record reflects that the veteran had been unable to carry out his job because of left foot pain. Examination showed no tenderness over the lateral and medial ligaments of the left ankle joint. There was pain over the metatarsals. There was edema of the entire dorsum of the foot. The veteran was unable to bear weight on the ball of the foot because of pain. There was ecchymosis at the distal end of the third metatarsal shaft. The impression was sprain of the left foot. A May 1, 1951, service medical record states that the veteran complained of pain on the dorsum of his left foot. Examination showed that motions of the ankles were normal and nontender. There was tenderness over the dorsum of the left foot which was minimal. There was no swelling. Reflexes were normal and the pulses were good. The veteran was able to support weight on his foot with pain. The impression was strain of dorsiflexors of the left foot. The report of a July 1951 service examination states that the veteran complained of a painful left ankle from sprain in April 1951. The report of an October 1951 VA orthopedic examination reflects that the examiner had reviewed the veteran's service medical records concerning the injury to his left foot. On examination, there was slight swelling over the dorsum of the cuneiforms on the left side, but not on the right side. There was very slight prominence of the first metatarsal medial cuneiform joint and possibly the scaphoid cuneiform joint, but not definitely. There was a very slight sensation of increased warmth over this area as well. There was no loss of subastragalar motion and there was no loss of midtarsal motion. There was full range of motion of both ankles and none of the long tendons going to the foot or the toes lacked function. X-rays of the left foot revealed no fracture, dislocation, or bone pathology. The diagnosis was no diagnosis of orthopedic pathology made on the veteran's left foot. A December 1951 rating decision granted service connection for strained muscle, dorsum of the left foot, and assigned a noncompensable evaluation. That evaluation has remained in effect until the present time. An October 1955 VA treatment record reflects that sponge rubber arch supports were prescribed for the veteran. A December 1955 report of VA special orthopedic examination reflects that there was no swelling or tenderness present in the veteran's left foot. The diagnosis was no orthopedic pathology found. A February 1968 statement from Robert Holmes, M.D., a private physician, states that he had examined the veteran's left foot and ankle and found pain and paresthesia. The report of a May 1968 VA special orthopedic examination states that the veteran reported that he had sustained a fracture of the left ankle in 1963. It was the examiner's opinion that straining of the muscle on the dorsum of the foot during active service was a trivial incident. The report of an April 1978 VA orthopedic examination states that the veteran reported pain on the dorsum of his left foot and associated swelling from time to time. Physical examination revealed normal range of motion and no tenderness. There were no deformities, redness, or heat. The veteran did complain of pain in the dorsum of the foot with plantar flexion of the foot. The diagnosis was chronic extensive tendon tendonitis of the left foot. A February 1992 report by a private physician states that the veteran complained of pain in his foot. The recommendation for his foot was for him to continue with his insole or use a well-cushioned walking shoe. The report of a June 1992 VA special foot examination states that the veteran reported that his foot hurt at night. On examination, there was a decrease in the first metatarsophalangeal joint range of motion, bilaterally. Range of motion of the subtalar joint, dorsiflexion, and inversion were the same, bilaterally. X-rays revealed evidence of degenerative changes involving the first metatarsophalangeal joints of both feet and there was evidence of minimal calcaneal spurs noted bilaterally. The impression was degenerative joint disease of the first metatarsophalangeal joint, bilaterally, with degenerative joint disease affecting the joints of the midfoot tarsal region, bilaterally. During the veteran's personal hearing held before a hearing officer at the RO in October 1992, he testified that he had swelling in his left foot if he were on it for more than 1 or 2 hours. Walking would cause it to swell quicker. He also testified that private physicians and private orthopedists were of the opinion that there was something else wrong with his foot other than a strained muscle. He indicated that he had been told that he was walking on bone, without any meat left on the bottom of his foot, and that he should continue to wear shoe inserts. The veteran testified that he did not believe that the most recent VA examination was adequate because he did not feel it was complete. The Board has considered the complete history of the veteran's strained muscle of dorsum of the left foot as well as the current clinical manifestations and the effect the disability may have on his earning capacity. 38 C.F.R. §§ 4.1, 4.2, 4.41 (1994). A noncompensable evaluation is warranted for slight injury to Muscle Group X (intrinsic muscles of the dorsal aspect of the foot). A 10 percent evaluation requires either moderate or moderately severe injury. A 20 percent evaluation requires severe injury. 38 C.F.R. Part 4, Code 5310. Although the veteran has indicated that he does not believe the June 1992 VA foot examination was adequate because it was not complete, the report of that examination reflects that vascular, neurological, and musculoskeletal aspects of the veteran's feet were examined. X-rays were taken. The Board finds that the report is adequate for purposes of rating the current issue on appeal. The criteria for a compensable evaluation for strained muscle of the dorsum of the left foot have not been met or approximated. A review of the post service clinical history with respect to the veteran's left foot does not indicate that any disability with respect to the left foot has been associated with muscular strain subsequent to his service discharge. As noted previously, service connection is in effect for strained muscle of the dorsum of the left foot, and not any other disability associated with the left foot. The report of an April 1978 VA orthopedic examination indicated tendon tendinitis of the left foot, and the current examination associates reduced range of motion in the left foot with degenerative joint disease. The Board finds that the veteran's testimony is credible, but he does not possess the medical knowledge or expertise to offer an opinion which is probative with respect to whether or not current disability of the left foot is related to strained muscle of the dorsum of the left foot. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). In order for a compensable evaluation to be assigned, moderate muscle injury must be demonstrated. The evidence does not indicate that even slight muscle disability exists with respect to the dorsum of the left foot. Functional impairment which can be attributed to pain or weakness has been taken into account. However, the functional impairment indicated by the veteran to exist, has not been related, by probative evidence, to muscle strain of the dorsum of the left foot. Further, in this case, the disability picture is not so exceptional or unusual so as to warrant an evaluation on an extraschedular basis. The probative evidence does not show that muscle strain of the dorsum of the left foot has caused marked interference with employment or necessitated frequent periods of hospitalization. 38 C.F.R. § 3.321(b)(1) (1994). Accordingly, a compensable evaluation is not warranted on any basis. 38 U.S.C.A. § 5107. ORDER An increased (compensable) rating for strained muscle of the dorsum of the left foot is denied. E. W. SEERY 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.