Citation Nr: 0001854 Decision Date: 01/24/00 Archive Date: 02/02/00 DOCKET NO. 94-22 108 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Manila, Philippines THE ISSUES 1. Entitlement to service connection for avitaminosis. 2. Entitlement to service connection for dysentery. 3. Entitlement to service connection for peptic ulcer disease. 4. Entitlement to service connection for post-traumatic stress disorder. 5. Entitlement to an increased evaluation for irritable bowel syndrome with helminthiasis and undernutrition, currently evaluated as 30 percent disabling. 6. Entitlement to an evaluation in excess of 30 percent for ischemic heart disease prior to January 12, 1998. 7. Entitlement to an evaluation in excess of 60 percent for ischemic heart disease for the period beginning on January 12, 1998. 8. Entitlement to an earlier effective date for service connection for ischemic heart disease. 9. Entitlement to an earlier effective date for service connection for irritable bowel syndrome, prior to April 13, 1992. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Carolyn Wiggins, Counsel INTRODUCTION The veteran served in the Armed Forces of the United States beginning in December 1941. He was a prisoner of war (POW) from April 1942 to December 1942. He was in no casualty status from December 1942 to February 1946. He was separated from the service in February 1946. This appeal arises from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Manila, Philippines. The veteran's representative in his October 1999 written argument included thirteen issues as being on appeal. In reviewing the claims folder the Board has determined that the veteran has appealed only eight issues (one of which is divided into two time periods) to the Board of Veterans' Appeals (Board). In October 1998 the RO issued a rating decision which denied an increased rating for ischemic heart disease, service connection for respiratory infection, benign prostatic hypertrophy, bladder obstruction and wound of the left ear. The RO also denied entitlement to a total rating based on individual unemployability. The RO issued a letter to the veteran in November 1998 which informed him of the October 1998 decision. The RO then issued a supplemental statement of the case which included the issues on appeal and several of the issues denied in October 1998. The claims folder does not include a notice of disagreement as to the additional issues denied in the October 1998 RO rating action. The letter enclosed with the supplemental statement of the case clearly informed the veteran that a substantive appeal was required to perfect an appeal as to any additional issues. The Board has determined that the issues presently in appellate status are those on the title page. The Board is unable to determine if the written argument of the veteran's representative is a notice of disagreement with the additional issues included in the October 1998 decision. For that reason those issues are referred to the RO for clarification of the veteran's intentions and any other appropriate action. FINDINGS OF FACT 1. The veteran has not submitted medical evidence which includes a current diagnosis of avitaminosis or any residuals of avitaminosis. 2. The veteran has not submitted medical evidence which includes a current diagnosis of dysentery or any residuals of dysentery. 3. The veteran has not submitted medical evidence which includes a current diagnosis of peptic ulcer disease. 4. The veteran has not submitted medical evidence which includes a current diagnosis of post-traumatic stress disorder. 5. The veteran's irritable bowel syndrome with helminthiasis with undernutrition causes disability which is commensurate with severe impairment under Diagnostic Code 7319. It has not resulted in periods of hospitalization and it is not of an unusual nature. 6. The veteran's ischemic heart disease prior to January 12, 1998, did not produce an acute coronary thrombosis or occlusion or substantiated angina attacks. The veteran was able to perform more than light manual labor. 7. On and after January 1998 the veteran's arteriosclerotic heart disease caused dyspnea, fatigue and chest pain. He was able to perform physical activity of 5 to 4 METs. The veteran was able to perform ordinary physical activity. 8. By a December 1998 rating decision, the RO established the effective date for the grant of service connection for ischemic heart disease as August 24, 1993, the effective date of liberalizing legislation that stated that the term ischemic heart disease was included in beriberi heart disease. 9. The veteran filed a claim for service connection for prisoner of war incurred disabilities in April 1992. 10. Helminthiasis was first diagnosed in February 1993 and irritable bowel syndrome was first diagnosed in March 1994. CONCLUSIONS OF LAW 1. The veteran has not submitted a well grounded claim for service connection for avitaminosis. 38 U.S.C.A. § 5107(a) (West 1991). 2. The veteran has not submitted a well grounded claim for service connection for dysentery. 38 U.S.C.A. § 5107(a) (West 1991). 3. The veteran has not submitted a well grounded claim for service connection for peptic ulcer disease. 38 U.S.C.A. § 5107(a) (West 1991). 4. The veteran has not submitted a well grounded claim for service connection for post-traumatic stress disorder. 38 U.S.C.A. § 5107(a) (West 1991). 5. The criteria for an evaluation in excess of 30 percent for irritable bowel syndrome with helminthiasis and undernutrition have not been met. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38 C.F.R. §§3.321, 4.114, Diagnostic Code 7319 (1999). 6. The criteria for an evaluation in excess of 30 percent for the period prior to January 1998 for ischemic heart disease have not been met. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38 C.F.R. § 4.104, Diagnostic Code 7005 (1997); 38 C.F.R. § 4.104, Diagnostic Code 7005 (1999). 7. The criteria for an evaluation in excess of 60 percent, for the period beginning in January 1998, for ischemic heart disease have not been met. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38 C.F.R. § 4.104, Diagnostic Code 7005 (1997); 38 C.F.R. § 4.104, Diagnostic Code 7005 (1999). 8. The criteria for an earlier effective date for service connection for ischemic heart disease have not been met. 38 U.S.C.A. § 5110(a) (West 1991); 38 C.F.R. § 3.400 (1999). 9. The criteria for an earlier effective date for service connection for irritable bowel syndrome, prior to April 13, 1992, have not been met. 38 U.S.C.A. § 5110(a) (West 1991); 38 C.F.R. § 3.400 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Factual Background. On April 13, 1992, a claim for compensation for "POW-incurred diseases," was received from the veteran. In December 1992 the veteran requested that his claim for service connection for wounds of the face, left forearm, upper front chest, and right knee be reopened. He also raised claims for service connection for diseases he claims were incurred as a POW. He specifically raised the issue of service connection for avitaminosis, starvation, malnutrition, other nutritional deficiencies, chronic dysentery, malaria, bronchial and gastro-intestinal diseases, stress and anxiety. VA examinations of the veteran were performed in February 1993. An examination for systemic diseases revealed diagnoses of mild undernutrition, with no evidence of avitaminosis, beri-beri or dysentery. The examination was positive for helminthiasis. The veteran weighed 63 kilograms. The diagnosis was no evidence of peptic ulcer disease. The veteran had an annular constricting defect that was probably a new growth at the hepatic flexure. A VA mental disorders examination was performed in February 1993. The diagnosis was attributable condition not related to a psychiatric disorder. The examiner specifically noted that there was no evidence of post-traumatic stress disorder. In an April 1993 rating decision the RO granted service connection for helminthiasis with undernutrition, effective December 10, 1992. A 10 percent rating was assigned. The RO denied service connection for avitaminosis, beriberi, dysentery, peptic ulcer disease and post-traumatic stress disorder. The RO received the veteran's notice of disagreement with the RO decision denying him service connection for POW incurred diseases in June 1993. In September 1993 the veteran submitted a copy of a clinical evaluation from the VA. The statement noted that the veteran had been evaluated for bladder obstruction outlet secondary to a small obstructing prostate. An electrocardiogram revealed that the veteran had sinus bradycardia. The veteran submitted a substantive appeal in October 1993. In January 1994 the veteran submitted a claim for irritable bowel syndrome. A VA intestinal examination of the veteran was performed in March 1994. The diagnoses were moderate undernutrition, irritable bowel syndrome and positive history of helminthiasis without present evidence of that disease. In April 1994 the RO denied the claim for an increased rating for helminthiasis with undernutrition. The 10 percent rating was continued. The veteran submitted a notice of disagreement with the denial of an increased rating for helminthiasis in May 1994. He submitted a substantive appeal as to that issue in July 1994. A VA examination of the digestive system was performed in May 1995. The veteran weighed 57.8 kilograms. The veteran had episodes of diarrhea and sometimes of constipation. The diagnosis was helminthiasis not seen on his stool smear and moderate undernutrition. A May 1995 RO decision continued the 10 percent rating for helminthiasis. In December 1995 the RO granted service connection for irritable bowel syndrome with helminthiasis. An increased rating to 30 percent retroactive to December 10, 1992, was granted. In June 1996 the veteran filed a notice of disagreement with the effective date of the 30 percent rating for irritable bowel syndrome with helminthiasis. The veteran submitted copies of VA treatment records in March 1996. They included a report of an EKG which revealed left ventricular hypertrophy. In April 1996 the RO found that the decision which assigned December 10, 1992, as the effective date for the grant of service connection for irritable bowel syndrome was clearly and unmistakably erroneous. An effective date of April 13, 1992, was assigned, which was date of receipt of his claim. An earlier effective date based on 38 C.F.R. § 3.114 was denied. VA examinations were performed in April 1996. Examination of the eyes included diagnoses of senile immature cataracts in the right and left eyes, senile macular degeneration and no optic atrophy in either eye. An examination of the respiratory system found no lung disease. An examination for diseases of the heart included diagnosis of arteriosclerotic heart disease. Examination of the digestive system noted constipation. In May 1996 a VA examination for systemic diseases was performed. No residuals of malnutrition were diagnosed and no evidence of avitaminosis was found. In September 1996 the RO granted service connection for ischemic heart disease. A 30 percent rating was assigned. Service connection for optic atrophy was denied. The veteran filed a notice of disagreement with the effective date of service connection for ischemic heart disease of November 20, 1995. The veteran contended that the proper date was August 24, 1993, the date of liberalizing legislation. In March 1997 the veteran submitted his substantive appeal as to that issue. VA examinations were performed in January 1998. A VA examination for mental disorders found no evidence of post- traumatic stress disorder. A VA examination for systemic conditions noted under diagnosis that no residual evidence of avitaminosis, malnutrition or dysentery was found. The veteran had mild anemia that was probably secondary to intestinal parasitism. An examination of the digestive system found no peptic ulcer disease or irritable bowel syndrome. An orthopedic examination included diagnosis of healed fracture of the right ribs and degenerative arthritis. Post traumatic arthritis was not seen on x-rays. Private medical records from April 1998 included an echocardiograph. The veteran was reexamined by the VA in April 1998. Arteriosclerotic heart disease was diagnosed. A functional assessment that the veteran could perform ordinary physical activity was noted. It was also noted that more than light manual labor might be feasible. A diagnosis of mild malnutrition probably secondary to dietary intake was noted. No helminthiasis was present. There was no evidence of malaise or dysentery. In April 1998 the RO granted an earlier effective date for service connection for ischemic heart disease, to August 24, 1993, the date of liberalizing POW legislation. Service Connection for Avitaminosis, Dysentery, Peptic Ulcer Disease and Post-Traumatic Stress Disorder Initial Matters: The United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (hereinafter, "the Court") has held that establishing service connection generally requires medical evidence of a current disability, see Rabideau v. Derwinski, 2 Vet. App. 141 (1992); medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); see also Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997) (expressly adopting definition of well-grounded claim set forth in Caluza, supra), petition for cert. filed, No. 97-7373 (Jan. 5, 1998); Heuer v. Brown, 7 Vet. App. 379 (1995); Grottveit v. Brown, 5 Vet. App. 91 (1993). Alternatively, either or both of the second and third Caluza elements can be satisfied, under 38 C.F.R. § 3.303(b), by the submission of (a) evidence that a condition was "noted" during service or during an applicable presumption period; (b) evidence showing post-service continuity of symptomatology; and (c) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. See Savage v. Gober, 10 Vet. App. 488, 495-497 (1997). A claim for service connection of a disease entitled to the presumption of service connection for prisoners of war is well grounded if the claimant (1) was a prisoner of war for at least thirty days and (2) he or she presents a current diagnosis that the disease is 10 percent disabling. See Goss v. Brown, 9 Vet. App. 109, 113 (1996); Suttman v. Brown, 5 Vet. App. 127, 137 (1993). Relevant Laws and Regulations. To establish service connection for a claimed disability, the facts as shown by evidence must demonstrate that a particular disease or injury resulting in current disability was incurred during active service or, if preexisting active service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131 (West 1991). If a veteran is a former prisoner of war and as such was interned or detained for not less than 30 days, certain diseases including avitaminosis, chronic dysentery, any of the anxiety states, post-traumatic osteoarthritis and peptic ulcer disease, shall be service-connected if manifest to a degree of 10 percent or more at any time after service discharge or release from active military service even though there is no record of such disease during service, provided the rebuttable presumption provisions of 38 C.F.R. § 3.307 are also satisfied. 38 C.F.R. § 3.309 (c) (1999). Where disability compensation is claimed by a former prisoner of war, omission of history or findings from clinical records made upon repatriation is not determinative of service connection, particularly if evidence of comrades in support of the incurrence of the disability during confinement is available. Special attention will be given to any disability first reported after discharge, especially if poorly defined and not obviously of intercurrent origin. The circumstances attendant upon the individual veteran's confinement and the duration thereof will be associated with pertinent medical principles in determining whether disability manifested subsequent to service is etiologically related to the prisoner of war experience. 38 C.F.R. § 3.304(e) (1999). Service connection for post-traumatic stress disorder requires medical evidence diagnosing the condition in accordance with Sec. 4.125(a) of this chapter; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. If the evidence establishes that the veteran was a prisoner-of-war under the provisions of Sec. 3.1(y) of this part and the claimed stressor is related to that prisoner-of-war experience, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.309 (1999). Service connection may also be granted on a presumptive basis for certain chronic disabilities, including peptic ulcer disease, when they are manifested to a compensable degree within the initial post service year. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991 & Supp. 1996); 38 C.F.R. §§ 3.307, 3.309 (1999). 38 C.F.R. § 3.304 says that satisfactory lay or other evidence that an injury or disease was incurred or aggravated in combat will be accepted as sufficient proof of service connection if the evidence is consistent with the circumstances, conditions or hardships of such service even though there is no official record of such incurrence or aggravation. Analysis. The Board has carefully reviewed the medical evidence of record for any diagnosis of avitaminosis or dysentery. The Board has also looked for any indication that residuals of these disabilities were found on examination. VA examinations have consistently noted that no diagnosis of avitaminosis or dysentery was appropriate and that no residuals of either disorder were noted on examination. In the absence of any medical evidence of diagnoses of avitaminosis or dysentery; or their residuals the veteran's claim is not well grounded. The claims folder does not include a current diagnosis of peptic ulcer disease. Therefore the claims for avitaminosis, dysentery, and peptic ulcer disease are not well grounded. The veteran has been examined on several occasions to determine if he has post-traumatic stress disorder. No evidence of post-traumatic stress disorder was found on examination. The Court has clearly indicated that a current diagnosis of post-traumatic stress disorder is required in order for a claim for service connection for post-traumatic stress disorder to be well grounded. See Cohen v. Brown, 10 Vet. App. 128, 136-37 (1997). In Gilpin v. West, 155 F.3d 1353 (Fed. Cir 1998) the United States Court of Appeals for the Federal Circuit held that the requirement of current symptomatology at the time a claim was filed for the veteran to be entitled to compensation for post-traumatic stress disorder was reasonable and consistent with the statutory scheme as a whole. The Board has concluded that the veteran's claims for avitaminosis, dysentery, peptic ulcer disease and post- traumatic stress disorder are not well grounded. Increased Rating In general, an allegation of increased disability is sufficient to establish a well-grounded claim when the veteran is seeking an increased rating. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The Board is satisfied that all relevant facts have been properly developed. No further assistance is required to comply with the duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a). Relevant Laws and Regulations. In evaluating the severity of a particular disability, it is essential to consider its history. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. §§ 4.1 and 4.2. However, where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Disability evaluations, in general, are intended to compensate for the average impairment of earning capacity resulting from service-connected disability. They are primarily determined by comparing objective clinical findings with the criteria set forth in the rating schedule. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. 38 C.F.R. § 4.1 requires that each disability be viewed in relation to its history and that there be an emphasis placed upon the limitation of activity imposed by the disabling condition. The provisions of 38 C.F.R. § 4.2 require that medical reports be interpreted in light of the whole recorded history, and that each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.10 provides that in cases of functional impairment, evaluations must be based upon lack of usefulness of the affected part or systems, and medical examiners must furnish, in addition to the etiological, anatomical, pathological, laboratory, and prognostic data required for ordinary medical classification, a description of the effects of the disability upon the person's ordinary activity. Irritable Bowel Syndrome with Helminthiasis and Undernutrition Irritable colon syndrome is evaluated as 30 percent disabling when it is severe with diarrhea or alternating diarrhea and constipation, with more or less constant abdominal distress. 38 C.F.R. § 4.114, Diagnostic Code 7319 (1999). Ratings under diagnostic codes 7301 to 7329, inclusive, 7331,7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. 38 C.F.R. § 4.114 (1999). In exceptional cases where the schedular evaluations are found to be inadequate, an extraschedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities may be approved provided 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. 38 C.F.R. § 3.321 (1999). Analysis. The veteran is currently receiving the maximum schedular evaluation for irritable bowel syndrome. For that reason the Board has considered whether the veteran may be entitled to an increased evaluation on an extraschedular basis. The Board has determined that the clinical presentation of the veteran's irritable bowel syndrome with helminthiasis and undernutrition is neither unusual or exceptional. 38 C.F.R. § 3.321(b)(1)(1999). The record does not reflect frequent periods of hospitalization because of his service- connected disability, or interference with employment to a degree greater than that contemplated by the regular schedular standards which are based on the average impairment of employment. Thus, the record does not present an exceptional case where a 30 percent evaluation is found to be inadequate. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (noting that the disability evaluation rating itself is recognition that the industrial capabilities are impaired). Accordingly, the Board finds that the criteria for submission for assignment of an extraschedular rating pursuant to 38 C.F.R. 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337, 339 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). The veteran has asserted that his helminthiasis and irritable bowel syndrome should be rated separately. As the regulations set out above specify, only a single evaluation under those rating codes is to be assigned. 38 C.F.R. § 4.114. An increased rating for helminthiasis and irritable bowel syndrome is not warranted. Ischemic Heart Disease During the pendency of this appeal VA published new regulations for rating disability of the cardiovascular system. 62 Fed. Reg. 65207-65224 (1997). Prior to January 12, 1998, VA regulations provided that arteriosclerotic heart disease during and for 6 months following acute illness from coronary occlusion or thrombosis, with circulatory shock, etc., is rated as 100 percent disabling. After 6 months, with chronic residual findings of congestive heart failure or angina on moderate exertion or more than sedentary employment precluded a 100 percent rating is provided. Following typical history of acute coronary occlusion or thrombosis as above, or with history of substantiated repeated anginal attacks, more than light manual labor not feasible is rated as 60 percent disabling. 38 C.F.R. § 4.104, Diagnostic Code 7005 (1997). Effective January 12, 1998, arteriosclerotic heart disease (coronary artery disease) with documented coronary artery disease resulting in: Chronic congestive heart failure, or; workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent is rated as 100 percent disabling. A 60 percent rating is assigned when there is more than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness or syncope, or left ventricular dysfunction with an ejection fraction of 30 to 50 percent. 38 C.F.R. § 4.104, Diagnostic Code 7005 (1999). Analysis. When a law or regulation changes after a claim has been filed or reopened, but before the administrative or judicial appeal process has been concluded, the version more favorable to the appellant applies unless Congress provided otherwise or permitted the Secretary to do otherwise and the Secretary does so. See Marcoux v. Brown, 9 Vet. App. 289 (1996); Karnas v. Derwinski, 1 Vet. App. 308 (1991). As this is an original rating claim as contemplated by the Court in Fenderson v. West, 12 Vet. App. 119 (1999), the Board has considered whether the evaluation should be divided into stages. An examination of the medical history does demonstrate that dividing the rating into stages would be appropriate in this case. The VA examination in January 1998 demonstrates increased disability. For that reason the issue has been divided into two stages, one before and one after the January 1998 examination. An April 1996 VA examination of the heart diagnosed arteriosclerotic heart disease. The veteran claimed he tired after more than normal activity. He had chest pain, was fatigued and had dizziness. An April 1996 electrocardiogram was noted to be normal. May 1996 VA X-rays revealed arteriosclerotic cardiovascular changes. They were the same in the VA examination dated in April 1996. They had not changed significantly from the chest film of May 1990. Prior to April 1998 the veteran's ischemic heart disease was rated as 30 percent disabling. The medical records do not demonstrate that the veteran had a history of acute coronary thrombosis or occlusion. There was a history of chest pain, but no substantiation that they were related to angina. Nothing in the claims folder demonstrated that more than light manual labor was not feasible. The medical evidence did not support the grant of a rating in excess of 30 percent for ischemic heart disease under the old criteria. Under the new criteria a higher evaluation than 30 percent required evidence of cardiac hypertrophy or dilation. The medical record does not include any such evidence. For the period prior to the VA examination in April 1998 the preponderance of the evidence is against the grant of an evaluation higher than 30 percent. In April 1998 the veteran was afforded a VA examination which addressed the criteria for evaluating arteriosclerotic heart disease. The veteran reported that he had dyspnea when he walked for about 500 meters or climbed a two story building. It caused chest pain. He was able to do some light household chores like pulling weeds. Examination revealed no evidence of congestive heart failure. The diagnosis was that the veteran had arteriosclerotic heart disease, NIF, CFC II B, 4- 5 METs. The examiner's functional assessment was that the veteran could perform ordinary activity and maybe more than light manual labor was feasible. The criteria in effect prior to January 12, 1998, for a 100 percent rating required evidence of chronic congestive heart failure. None was found on the VA examination. In the alternative, angina on moderate exertion warranted a 100 percent rating. The veteran was able to walk 500 meters and climb 2 stories before he had angina. If the veteran was unable to perform more than sedentary employment a 100 percent rating was appropriate. The veteran was noted to be able to perform light manual labor. The evidence does not support the grant of a 100 percent rating under the criteria in effect prior to January 12, 1998. Under the new criteria in effect as of January 12, 1998, a 100 percent rating required chronic congestive heart failure or workloads of 3 METs or less resulting in symptoms or a left ventricular ejection fraction of less than 30 percent. There were no findings of congestive heart failure. The veteran's functional assessment was that he could perform 4-5 METs. His electrocardiogram in April 1998 was noted to be normal. The veteran has not demonstrated that degree of disability required for a 100 percent rating pursuant to the criteria effective as of January 12, 1998. A rating in excess of 100 percent for ischemic heart disease is not warranted. Earlier Effective Date for Service Connection Section 5110(a) of title 38, United States Code, provides: "Unless specifically provided otherwise in this chapter, the effective date of an award based on an original claim . . . shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor." See also 38 C.F.R. § 3.400 (1999). Section 5110(g) of title 38, United States Code, "specifically" provides: Subject to the provisions of section 5101 of this title, where compensation is awarded or increased pursuant to any Act or administrative issue, the effective date of such award or increase shall be fixed in accordance with the facts found but shall not be earlier than the effective date of the Act or administrative issue. In no event shall such award or increase be retroactive for more than one year from the date of application therefor or the date of administrative determination of entitlement, whichever is earlier. 38 U.S.C.A. § 5110(g); 38 C.F.R. § 3.114(a). Thus, section 5110(g) constitutes a specific exception to the section 5110(a) stricture that an effective date of an award "shall not be earlier than the date of receipt of application therefor." The provisions of 38 C.F.R. § 3.114 provide that if review is initiated within one year of the effective date, benefits may be authorized from the date of change. If a claim is reviewed at the request of the claimant more than 1 year after the effective date of the law, benefits may be authorized for a period of 1 year prior to the date of receipt of such request where the veteran met all of the criteria of the liberalizing law when the law became effective. Ischemic Heart Disease Analysis. VA regulations were amended effective August 24, 1993, to provide that the statutory term "beriberi heart disease" included ischemic heart disease. The veteran in his November 1996 notice of disagreement indicated that August 24, 1993, was the correct effective dated based on the liberalizing legislation. In December 1998 the RO readjudicated the veteran's claim for an earlier effective date for service connection for ischemic heart disease. The effective date of the liberalizing legislation was assigned, i.e., August 24, 1993. The regulations provide that the effective date of the liberalizing law is the earliest date that may be assigned. Thus, there is no basis for the assignment of an effective date for the grant of service connection for ischemic heart disease prior to August 24, 1993. Irritable Bowel Syndrome VA regulations were amended effective May 20, 1988, to include irritable bowel syndrome as a condition for which presumptive service connection can be granted for former prisoners of war who were detained or interred for at least 30 days. The RO granted service connection for irritable bowel syndrome with undernutrition and helminthiasis effective as of April 13, 1992, the date the veteran's claim was received. In his November 1996 letter the veteran asserted that service connection should have been granted effective one year prior to the receipt of his April 1992 claim. Since the veteran's claim was reviewed more than 1 year after the effective date of the law, benefits may be authorized for a period of 1 year prior to the date of receipt of such claim only if the veteran met all of the criteria of the liberalizing law or issue at that time. The law required that the claimed disability be shown to be present by competent medical evidence. Helminthiasis was first diagnosed in February 1993 and irritable bowel syndrome was first diagnosed on VA examination in March 1994. Accordingly, there is no basis for the grant of an effective date earlier than April 13, 1992, for irritable bowel syndrome with undernutrition and helminthiasis. ORDER Service connection for avitaminosis is denied. Service connection for dysentery is denied. Service connection for peptic ulcer disease is denied. Service connection for post-traumatic stress disorder is denied. An increased rating in excess of 30 percent for irritable bowel syndrome with helminthiasis and undernutrition is denied. A rating in excess of 30 percent for ischemic heart disease, for the period prior to January 1998, is denied. A rating in excess of 60 percent for ischemic heart disease, for the period beginning in January 1998, is denied. The issue of an earlier effective date for service connection for ischemic heart disease is denied. An earlier effective date for service connection for irritable bowel syndrome is denied. Gary L. Gick Member, Board of Veterans' Appeals