BVA9501543 DOCKET NO. 93-04 938 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to a compensable evaluation for residuals of a fractured pubis and ischium, left side. 2. Entitlement to a compensable evaluation for residuals of a scalp laceration. 3. Entitlement to service connection for residuals of a low back injury. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Melissa F. Marquez, Associate Counsel INTRODUCTION The appellant had active service from October 1960 to October 1964. This matter came before the Board of Veterans' Appeals (hereinafter Board) on appeal from an October 1991 rating decision of the St. Petersburg, Florida, Regional Office (hereinafter RO), of the Department of Veterans Affairs (hereinafter VA), which in part, granted service connection for residuals of a fracture of the left pubis and ischium and assigned a noncompensable evaluation therewith; granted service connection for residuals of a scalp laceration, and assigned a noncompensable evaluation therewith; and denied entitlement to service connection for a low back injury. The appellant requested a hearing but failed to report to such scheduled hearing. It is unclear from the record whether the appellant intends to raise a claim for service connection for a low back disability secondary to his service-connected fractured pelvis. As the Board is limited to issues developed for appellate review, our decision below will be limited to direct service connection for a low back injury. If the appellant intends to raise such a secondary service connection claim, he should contact the RO, and the RO should then take appropriate action. Kellar v. Brown, 6 Vet.App. 157 (1994). Furthermore, it is unclear from the record whether the appellant intends to raise a claim for entitlement to a permanent and total disability rating for pension purposes. If so, he should contact the RO, and the RO should take appropriate action. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends, in essence, that he is entitled to a compensable evaluation for residuals of a fractured pelvis and residuals of a scalp laceration, as well as service connection for a low back injury. He asserts that he currently suffers from degenerative arthritis of the lower spine, as well as increasing back and hip pain, which he believes are residuals of his service connected fractured pelvis. 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 appellant's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the appellant's claims for entitlement to a compensable evaluation for residuals of a fractured left pubis and ischium; entitlement to a compensable evaluation for residuals of a scalp laceration; and entitlement to service connection for residuals of a low back injury. FINDINGS OF FACT 1. All available, relevant evidence necessary for disposition of the appeal has been obtained by the RO. 2. During service, the appellant suffered a simple fracture to the left pubis and ischium, with no artery or nerve involvement, as well as a scalp laceration. 3. Residuals of the appellant's fractured pelvis, left side, are manifested by subjective complaints of right hip pain which radiate down the right leg, as well as lower back pain. The objective clinical evidence reveals well-healed fractures of the left pubis and ischium with excellent position and solidity, and with no tenderness on palpation, loss of joint motion or bony abnormality. There is no objective evidence of malunion of the pelvis, nor any associated knee or hip disability. 4. Residuals of the appellant's scalp laceration are manifested by clinical evidence of an irregularity of the left parietal area, which is subcutaneous in nature with no depression of the bony surface. There is no objective clinical evidence of scar tenderness or a moderate, disfiguring scar. 5. Residuals of the appellant's scalp laceration are no more than mild. 6. Service medical records do not show any complaints, findings or diagnoses of a back injury or low back pain. Degenerative changes of the lumbosacral spine were initially medically diagnosed more than 26 years after separation from service, and are not reasonably related thereto. 7. Degenerative arthritis of the lumbosacral spine was not shown during service, or within the one year presumptive period allowed by regulation. Degenerative arthritis of the spine related to inservice pelvic trauma has not been shown by the medical evidence of record. 8. The appellant does not have a chronic low back disorder related to military service. CONCLUSIONS OF LAW 1. The criteria, either schedularly or extraschedularly, for a compensable evaluation for residuals of a left pelvic fracture have not been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 1991); 38 C.F.R. §§ 3.102, 3.321, Part 4, §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.71, 4.71a, Diagnostic Code (DC) 5299-5255 (1993). 2. The criteria, either schedularly or extraschedularary, for a compensable evaluation for residuals of a scalp laceration have not been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 1991); 38 C.F.R. §§ 3.102, 3.321, Part 4, §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.118, DC 7800 (1993). 3. A low back disability was not incurred in or aggravated by the appellant's active service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(a) (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, we find that the appellant's claims are well grounded within the meaning of 38 U.S.C.A. §5107(a) (West 1991), in that he has presented three claims which are plausible. This being so, we must examine the record to determine whether the VA has a further obligation to assist in the development of facts pertinent to such claims. 38 U.S.C.A. §5107(a) (West 1991). Service medical records currently associated with the claims folder appear complete, and it is not otherwise contended. The evidentiary record contains a clinical record from St. Vincent's Center for Occupational Health dated in August 1991, and a September 1991 VA orthopedic examination with accompanying x- rays. The Board finds these records adequately detail the entire history of the appellant's service-connected disabilities, particularly as they affect the ordinary conditions of daily life, as required by provisions of 38 C.F.R. §§ 4.1, 4.2, 4.10 and other applicable provisions. Schafrath v. Derwinski, 1 Vet.App. 589 (1991). During an examination by a private physician pertaining to an intercurrent back injury in July 1991, the appellant reported that he had been told by a VA physician that he had a possible pinched nerve in his lower back. However, the appellant did not report when he was treated by such VA physician, nor which VA facility from which he received treatment. Furthermore, he has never asserted that any such alleged VA medical report was relevant to his current claim. The Board's duty to assist is not a "one way street," nor is it a license for a "fishing expedition" to determine if "there might be some unspecified information which could possible support a claim." See Gobber v. Derwinski, 2 Vet.App. 470, 472 (1992); Wood v. Derwinski, 1 Vet.App. 190, 193 (1991). Therefore, after a review of the record, we are satisfied that all relevant facts available have been properly developed by the RO and that no useful purpose would be served by remanding the case with instructions to provide additional assistance to the appellant. In adjudicating a well-grounded claim, the Board determines whether (1) the weight of the evidence supports the claim or (2) the weight of the "positive" evidence in favor of the claim is in relative balance with the weight of the "negative" evidence against the claim. The appellant prevails in either event. However, if the weight of the evidence is against the appellant's claim, the claim must be denied. 38 U.S.C.A. § 5107(b) (West 1991); 38 C.F.R. § 3.102 (1993); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). With this in mind, we will proceed with the discussions below. I. Entitlement to service connection for a low back disability. Service connection may be granted for a chronic disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Service connection may be shown directly or, for certain "chronic diseases," presumed if the disease manifested to a degree of 10 percent or more within one year after the date of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991). If a disorder is not shown to be chronic during service, continuity of symptomatology after service is required to establish that a disorder is chronic. 38 C.F.R. § 3.303 (1993). Service medical records indicate that the appellant was struck by an automobile while walking in January 1961, resulting in a simple fracture of the left superior pubis, the inferior ischium and the ischial pubic junction on the left with no artery or nerve involvement. In addition, he suffered a laceration of the scalp. There was some muscle spasm in the left sacroiliac area, but otherwise there are no complaints, findings, or diagnoses related to a lower back injury or related symptomatology associated with such accident, nor in any other recordings in the service medical records. The examination upon separation from service revealed no complaints or findings of any residuals of the above mentioned fractures, nor were there any complaints or findings of lower back pain or degenerative arthritis. There are no postservice medical reports of record dated prior to 1991, approximately 26 years after separation from service, and it is not otherwise contended. Postservice medical reports of record include a clinical record from St. Vincent's Center for Occupational Health dated in August 1991, and a September 1991 VA orthopedic examination with accompanying x-rays. Such clinical record from St. Vincent's indicates that the appellant complained of a pinched nerve due to an injury in July 1991. Upon examination, the examiner diagnosed low back sprain with possible nerve root compression, and recommended that he not return to work until evaluated by an orthopedist. During a September 1991 VA orthopedic examination, the appellant reported that he had previously been employed at a desk job for 20 years until he began a new job requiring manual labor planting grass. He further reported that while he had been experiencing hip pain for approximately two or three years, he sustained increased pains in his right hip and leg, with associated numbness of his right thigh and pain in the soles of his feet, as well as lower back pain beginning in July 1991. He further stated that although he currently had no pain in his left hip, he suffered from aching pain and numbness in his right hip which radiated down his right leg to his ankle, causing weakness upon walking. Upon examination, the examiner reported that the appellant walked with a slight limp of the right leg and used a cane for support, but was able to walk on heels and toes and perform a deep knee bend. Objective range of motion studies of the lumbosacral spine revealed mild limitation of motion, and mild degenerative changes of the lumbosacral spine were found on accompanying x-ray. Additional x-rays indicated well-healed fractures of the pelvis with barely perceptible old fracture residuals. The examiner concluded by specifically finding that residuals of the appellant's fractured pelvis "bear no relation to the present recent complaint of low back and right leg pain. The latter in all probability resulting from his injury to the back when doing manual labor in July 1991." Upon review of the all the evidence of record, the Board concludes that the appellant did not sustain a low back injury during service, nor does he currently suffer from a chronic back disability attributable to such service. Service medical records do not contain any evidence of an injury to the lower back. Furthermore, degenerative changes of the lumbosacral spine were not diagnosed in service, nor was associated arthritis diagnosed within the one year presumptive period. See 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1993). Degenerative changes in the lumbosacral spine were initially medically diagnosed approximately 26 years after separation from service, and there is no competent credible evidence indicating such current back disability is attributable to the appellant's active service. See Grottveit v. Brown, 5 Vet.App. 91, 93 (1993) (lay persons not competent to render testimony concerning medical causation); Espiritu v. Derwinski, 2 Vet.App. 91, 93 (1992); Miller v. Derwinski, 2 Vet.App. 578, 580 (1992) (lay persons not competent to render testimony concerning date of onset of present disability). In fact, the only medical evidence of record specifically attributes the appellant's current lower back symptomatology to an intercurrent 1991 lower back injury. Since the preponderance of the evidence is against the allowance of this issue, the benefit of the doubt doctrine is inapplicable. 38 U.S.C.A. § 5107(b) (West 1991). II. Entitlement to a compensable evaluation for residuals of a fracture pelvis, left side, and residuals of a scalp laceration. Disability evaluations are determined by the application of a schedule of ratings which is based upon an average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.1 (1993). Separate diagnostic codes identify the various disabilities. When an unlisted condition in encountered, it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20 (1993). Where there is a reasonable doubt as to the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. §§ 3.102, 4.3, 4.7 (1993). In addition, the Board will consider the potential application of the various other provisions of 38 C.F.R., Parts 3 and 4, whether or not they were raised by the appellant, as well as the entire history of the appellant's disability in reaching its decision, as required by Schafrath v. Derwinski, 1 Vet.App. 589 (1991). The rating schedule does not provide a specific diagnostic code for evaluating residuals of a pelvic fracture, so the disability must be rated by analogy. 38 C.F.R. § 4.20 (1993). In light of the location and potential functional impairment of the left- sided pelvic fractures, analogous rating codes would be those pertaining to the hip. DC 5255 provides a 10 percent evaluation for the residuals of a femur fracture, with malunion, resulting in slight knee or hip disability; moderate knee or hip disability warrants a 20 percent evaluation. 38 C.F.R. Part 4, § 4.71(a), DC 5255 (1993). Under DC 7800, a noncompensable evaluation is assigned for slight scars to the head, face or neck. A 10 percent evaluation is warranted upon a showing of a moderate, disfiguring scar. 38 C.F.R. Part 4, § 4.118, DC 7800 (1993). As discussed above, service medical records indicate that the appellant was struck by an automobile while walking in January 1961, resulting in a simple fracture of the left superior pubis, the inferior ischium and the ischial pubic junction on the left with no artery or nerve involvement, as well as a laceration of the scalp. Records further indicate that he remained hospitalized for approximately four weeks, at which time he underwent physiotherapy and repeated exercises. Upon discharge, the appellant was reported to be essentially asymptomatic, was able to ambulate around the ward satisfactorily, and was therefore returned to full duty with few restrictions. Service records reveal that he was evaluated approximately three weeks later, and was reported to be healed. The examination upon separation for service revealed no complaints or findings of any residuals of the above mentioned fractures or the scalp laceration. The record reflects that the appellant stated that he did not receive any relevant medical treatment until July 1991, when he injured his lower back. At that time, he was treated at St. Vincent's for a low back sprain with possible nerve root compression. Furthermore, he reported treatment by a VA physician for an alleged "pinched nerve between L-3 and L-4 vertebrae." During a subsequent September 1991 VA orthopedic examination, the appellant reported pain in his right hip which radiated down his right leg to this right ankle, and affected his ability to walk long distances or stand for long time periods. Of significance is the fact the he reported no pain associated with his left hip. Upon examination of the lower extremities, objective range of motion studies for both hips, knees and ankles were normal, albeit painful in the right lower extremity only. Palpation of the symphysis pubis, the pubic rami, and the ischium revealed no tenderness or bone irregularities. Furthermore, accompanying x- rays revealed a "just perceptible" fracture of the left pubis in the areas of the ascending and descending rami "with excellent position and headed solidly." The examiner concluded with a diagnosis of an asymptomatic healed pelvic fracture in excellent position. Upon examination of the appellant's scalp, the appellant reported no complaints or residuals except for a knot near the affected area. The examiner found an irregularity near the mid portion and to the left of the parietal suture which appeared to be subcutaneous in nature, with no depression of the bony surface and no associated tenderness. Furthermore, the examiner indicated no scars were visible or measurable. The examiner concluded with a diagnosis of healed laceration of the scalp. The objective clinical evidence of record simply does not support compensable evaluations for residuals of a fractured pelvis, left side, and residuals of a scalp laceration. There is no objective evidence of a malunion of the left pelvis, nor any associated left hip or knee disabilities. There is no limitation of motion of the left hip, rendering inapplicable DC's 5250 through 5253, which provide compensable evaluations based on various degrees of limited motion. While the appellant has reported pain in his hips, the medical evidence of record indicates that such pain is associated with the right hip and lower extremity, and is unrelated to the inservice left pelvic fracture. Furthermore, the medical evidence of record does not indicated that the appellant possesses a moderate, disfiguring scar, nor any other residual, associated with his inservice scalp laceration to warrant compensable evaluation therewith. In addition, there is no evidence of record of significant or marked interference with job activities or frequent hospitalizations attributable to the appellant's service connected disabilities. While the appellant has reported that he is currently unemployed, such employment is associated with a lower back disability, for which service connection is not in effect. Furthermore, there is no evidence of any postservice hospitalizations related to such service-connected disabilities. Thus, the Board does not find that this is such an unusual or exceptional disability picture as to render the provisions of the rating schedule inadequate, and therefore warrant an extraschedular evaluation. 38 C.F.R. § 3.321(b) (1993). Moreover, there is no clear interference with normal employability shown, any interference being caused by the low back disorder as noted above, and a compensable evaluation for the two noncompensable service-connected disabilities under 38 C.F.R. § 3.324 (1993) is not for application. Since the preponderance of the evidence is against allowance of this issue, the benefit of the doubt doctrine is inapplicable. 38 U.S.C.A. § 5107(b) (West 1991). ORDER Entitlement to a compensable evaluation for residuals of a fractured pubis and ischium, left side, and for residuals of a scalp laceration is denied. Entitlement to service connection for residuals of a low back injury is denied. HOLLY E. MOEHLMANN 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.