Citation Nr: 0005267 Decision Date: 02/29/00 Archive Date: 03/07/00 DOCKET NO. 95-32 803 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES Entitlement to service connection for a skin disability as a residual of Agent Orange exposure. Entitlement to service connection for asthma. Entitlement to service connection for post-traumatic stress disorder. Entitlement to service connection for coronary artery disease, including hypertension. Entitlement to an increased (compensable) evaluation for a laceration scar of the right knee. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD Hilary L. Goodman, Counsel INTRODUCTION The veteran had active service from September 1967 to September 1969, including a tour of duty in Vietnam, and apparently had periods of active duty for training, including in June 1979. The medals awarded to the veteran included the Combat Infantryman Badge (CIB). This appeal arises from a January 1994 rating decision which continued a non-compensable disability evaluation for a laceration scar of the right knee and from a September 1996 rating decision which denied the veteran's claims for service connection for exposure to herbicides, coronary artery disease with hypertension, asthma and post-traumatic stress disorder. The issue of an increased evaluation was previously before the Board of Veterans' Appeals (Board) in January 1998 and was remanded for further development. The veteran, at a hearing on appeal before the undersigned Board Member, apparently raised the issue of service connection for arthritis of the right knee. This issue is referred to the Regional Office (RO) for appropriate action. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the originating agency. 2. The veteran was shown to have acne vulgaris in 1986; no medical evidence demonstrating a relationship between this disability and exposure to Agent Orange has been submitted. 3. The initial diagnosis of hypertension was made in 1986; no medical evidence demonstrating a relationship between this disability and active service has been submitted. 4. There is no clear and unmistakable evidence demonstrating that the veteran had chronic asthma previous to service. 5. Symptoms consistent with chronic asthma were initially exhibited during the veteran's period of active service. 6. The veteran served in combat in Vietnam and was awarded the CIB. 7. The veteran has post-traumatic stress disorder precipitated by combat. 8. The veteran's laceration scar of the right knee has not resulted in any limitation of function and the scar has not been shown to be poorly nourished with repeated ulceration or tender and painful on objective demonstration. CONCLUSIONS OF LAW 1. The veteran has not submitted evidence of well-grounded claims for service connection for coronary artery disease with hypertension and a skin disability as a residual of Agent Orange exposure. 38 U.S.C.A. § 5107 (West 1991). 2. Chronic asthma was incurred in service. 38 U.S.C.A. §§ 1110, 1111, 5107 (West 1991); 38 C.F.R. § 3.303 (1999). 3. Post-traumatic stress disorder was incurred in service. 38 U.S.C.A. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304 (1999). 4. A compensable disability evaluation for a laceration scar of the right knee is not for assignment. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § Part 4, Code 7805 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Factual Background Service clinical records reflect that the veteran was seen in September 1968 because of bronchial asthma as he was concerned about having asthma when in the field. On examination, his chest was clear to auscultation and percussion and there were no wheezes. Benadryl and Tedral were prescribed as was a Medihaler for emergencies. In February 1969 he reported that he had had some asthma with the change of climate on rest and relaxation in Taipei and had to be hospitalized and that also upon returning here with the cooler weather than usual. On examination, he had rhinorrhea and an occasional rale in the lung, right lower base. The impression was rhinitis, atopic, slight asthmatic propensity. It was noted that the veteran requested to be seen for asthma in March 1969 and that his lungs were found to be clear. On examination in August 1969 for separation from service his lungs and chest, heart and vascular system and skin were found to be normal. He was also found to be psychiatrically normal. His blood pressure was reported to be 144/88. The service medical records covering the veteran's period of active duty included no references to skin, cardiovascular or psychiatric disabilities by way of complaints, treatment or diagnosis. At the time of an August 1973 quadrennial examination for the Reserves, it was reported in the veteran's medical history that he had had asthma since he was twelve years old. On examination, his lungs and chest, heart and vascular system and skin were found to be normal and he was also found to be psychiatrically normal. His blood pressure was reported to be 134/75. On a quadrennial examination for the Reserves, conducted in February 1979, his lungs and chest, heart and vascular system and skin were again found to be normal and he was also found to be psychiatrically normal. His blood pressure was reported to be 122/86. At the time of a July 1983 quadrennial examination for the Reserves, it was reported in the veteran's medical history that he had had asthma for the past year. It was reported that his blood pressure had been elevated but that he was currently not on any medication; he had been referred to a local physician several months ago and his blood pressure there reportedly had been alright. On examination, his lungs and chest, heart and vascular system and skin were found to be normal and he was also found to be psychiatrically normal. His blood pressure was reported to be 160/100 and was 180/120 in the left arm while sitting. Service department clinical records dated in July 1984 reflect that the veteran was seen for right knee complaints and at this time his blood pressure was reported to be 150/102. It was noted that he had injured his right knee in August 1979 and required seventeen stitches. Two days later in July 1984 his blood pressure was reported to be 148/107. An assessment of post-traumatic right knee pain with disability by subjective symptoms was made. A Department of Veterans Affairs (VA) examination of the veteran was conducted in November 1984. The findings included a vertical three-inch, well-healed scar overlying the right kneecap. The knee did not appear swollen and there was no crepitation of the joint. There was normal range of motion of the right knee joint without pain. The following month, in a rating decision, service connection was granted for the residuals of a right knee laceration and a non- compensable disability evaluation was assigned. VA outpatient treatment records show that the veteran was seen in March 1986 for elevated blood pressure. A two-year history of high blood pressure was noted as was a history of asthma, one to two attacks yearly. There was noted to be no history of previous treatment for high blood pressure. The assessment was high blood pressure. An electrocardiogram was interpreted to show left ventricular hypertrophy with no strain pattern and on X-ray examination of the chest, the lung fields were clear and the cardiovascular structures appeared normal. In April 1986, at the time of a VA Agent Orange examination the veteran reported that ever since he served in Vietnam he had skin bumps that came and went and left dark spots. On examination, his skin was found to be dry with scattered one to two millimeter pustules, papules and macules, areas of discrete hyperpigmentation of the arms, legs and trunk with no other lesions or inflammations noted. Additional VA medical records show that in June 1986, the veteran's chest, abdomen and back were reported to show mostly hyperpigmented macules/ probable post-inflammatory closed comedones and papules. There were closed comedones on the forehead as well as pitted scarring of the cheeks. The assessment was rule out chloracne, acne vulgaris. It was reported in July 1986 that the skin pathology was reported to be consistent with resolving inflammatory follicular process. An assessment of acne vulgaris was made. It was also reported in July 1986 that the veteran's hypertension was controlled. In January 1994 it was reported that the veteran, who had chronic right knee problems, had been experiencing flare-ups of pain. The veteran underwent psychological testing in February 1994. After reviewing the test results, a VA clinical psychologist concluded that, due to the invalid nature of the test results, it was not possible to make a specific diagnosis based on the test results. It was indicated that, based on history material, diagnoses of alcohol dependence and post-traumatic stress disorder should be ruled out. A hearing on appeal was conducted in February 1995. At this time the veteran testified that he was having a number of problems with his right knee, including pain and swelling as well as the knee giving out. He indicated that he had difficulty walking up and down steps and had been given a knee brace. At the time of a March 1995 VA orthopedic examination, it was reported that the veteran stood erect with normal posture. He walked carrying a cane in his right hand. It was noted that he could walk without requiring any assisted device. There was normal symmetrical configuration of the right knee compared to the left with old healed traumatic scar over the anterior aspect of the patella. There was no joint swelling or redness. The knee had full pain-free range of motion with no evidence of ligamentous instability or internal derangement. There was no noted atrophy about the quadriceps or gastrocnemius muscle on the right. The impression was healed laceration of the right knee. The examiner noted that he was of the opinion that there was no residual knee problem as the result of the laceration. VA outpatient treatment records show that in March 1995 the veteran reported that he was having nightmares four to five times a week which were getting progressively worse. He indicated that he was having intrusive thoughts of Vietnamese. He also complained of poor sleep, early morning awakening and hearing a voice at times. During 1995 the veteran continued to receive treatment for hypertension and asthma. In September 1995 the veteran was seen in the VA Mental Health Clinic. His main complaint was nightmares about Vietnam. He reported seeing the faces of some of his friends who had died in Vietnam. It was noted that he had been a platoon sergeant and had been in active combat. He indicated that he witnessed lots, including his friend "blown away and killed." The assessment following examination included probable post-traumatic stress disorder, chronic. At a hearing on appeal in January 1996 the veteran testified that the area of the right knee scar was tender and painful. He indicated that other problems with the knee prevented prolonged standing and precluded him from climbing stairs. VA medical records reflect that in May 1996 an assessment of asthma exacerbation and blood pressure still poorly controlled was made. In November 1996 his asthma was stable and his hypertension was poorly controlled. In January 1997 it was reported that his blood pressure was stable. In December 1997 the veteran reported that he was having nightmares on and off; an assessment of chronic post- traumatic stress disorder was made. The veteran complained of right knee pain in March 1998 and an assessment of chondromalacia was made. Following the Board's January 1998 remand, the veteran was scheduled for two VA examinations for the purpose of determining whether he had any other tissue, muscle or underlying structure injury due to the right knee laceration scar. The record shows that the veteran failed to report for the scheduled examinations. In a report of contact dated in June 1998 it was indicated that the veteran's residence was contacted by telephone and that the individual who answered the phone acknowledged that the veteran had received notifications of the examinations and had not reported for them. Analysis A. Skin Disability and Coronary Artery Disease with Hypertension The veteran is claiming entitlement to service connection for skin disability due to Agent Orange exposure and coronary artery disease with hypertension. Service connection may be granted if the evidence demonstrates that the current disability resulted from an injury or disease incurred in or aggravated coincident with service in the Armed Forces. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). However, "[a] determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service." Watson v. Brown, 4 Vet. App. 309, 314 (1993). In addition, a disability is service connected if it is proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a) (1998). Moreover, when aggravation of a veteran's non-service connected condition is proximately due to or the result of a service- connected condition, such veteran shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen v. Brown, 7 Vet. App. 439, 448 (1995); Tobin v. Derwinski, 2 Vet. App. 34, 39 (1991). Before the Board may address the merits of the veteran's claims it must, however, first be established that the claims are well grounded. In this regard, a person who submits a claim for VA benefits shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well-grounded. 38 U.S.C.A. § 5107(a). A well-grounded claim is "a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of [38 U.S.C.A. § 5107]." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). If the veteran has not presented a well-grounded claim in any instance, his appeal must fail as to that issue. If the claim is not well grounded there is no duty to assist. Struck v. Brown, 9 Vet. App. 145 (1996). In order for a claim to be well-grounded, three discrete types of evidence must be present in order for a veteran's claim for benefits to be well grounded: (1) There must be competent evidence of a current disability, usually shown by medical diagnosis; (2) There must be evidence of incurrence or aggravation of a disease or injury in service. This element may be shown by lay or medical evidence; and (3) There must be competent evidence of a nexus between the inservice injury or disease and the current disability. Such a nexus must be shown by medical evidence. Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997), cert. denied sub nom. Epps v. West, 118 S. Ct. 2348 (1998); Caluza v. Brown, 7 Vet. App. 498, 506 (1995). In determining whether a claim is well grounded, the Board is required to presume the truthfulness of evidence. Robinette v. Brown, 8 Vet. App. 69, 77-8 (1995); King v. Brown, 5 Vet. App. 19, 21 (1993). In the alternative, the chronicity provisions of 38 C.F.R. § 3.303(b) are applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service, or during an applicable presumptive period, and still has such condition. Such evidence must be medical unless it relates to a condition as to which under case law of the Court, lay observation is competent. If chronicity is not applicable, a claim may still be well grounded on the basis of 38 C.F.R. § 3.303(b) if the condition is noted during service or during an applicable presumptive period, and if competent evidence, either medical or lay, depending on the circumstances, relates the present condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488, 498 (1997). In a secondary service connection claim, there must be a service-connected disability, a medial diagnosis of a separate disability, and competent medical evidence of a nexus between the two. Where the determinative issue involves a medical diagnosis, there must be competent medical evidence to the effect that the claim is plausible; lay assertions of medical status do not constitute competent medical evidence. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992); see Jones v. Brown, 7 Vet. App. 134 (1994) (citing Grottveit in holding that secondary service connection claim for glaucoma was not well grounded). In this case the veteran does not contend nor does the evidence suggest that either of the claimed disabilities at issue were incurred in or otherwise the result of his active duty for training. Rather, he maintains that the skin disability is etiologically related to his exposure to Agent Orange while he served in Vietnam and that his cardiovascular disability is stress-related to his service as a platoon leader while in Vietnam. However, there is no competent medical evidence or opinion of any causal relationship between either of the claimed disorders and his active duty service. The veteran's personal opinion as to the etiological relationship between his service in Vietnam and any claimed disorders is not competent medical evidence required of a well grounded claim. Grottveit, 5 Vet. App. at 93; Espiritu, 2 Vet. App. at 494. Moreover, the veteran is not competent to relay what he maintains a doctor told him. See Warren v. Brown, 6 Vet. App. 4 (1993) (veteran's statement as to what a doctor told him was insufficient to establish a medical diagnosis); but see Flynn v. Brown, 6 Vet. App. 500 (1994) (a physician's findings related indirectly through a second physician is probative evidence). With respect to the veteran's claim for service connection for a skin condition as a residual of Agent Orange exposure, a VA Agent Orange examination was conducted in 1986. Following completion of this VA Agent Orange examination, no abnormalities caused by Agent Orange were revealed. Rather the findings were reported to be consistent with resolving inflammatory follicular process and an assessment of acne vulgaris was made. The VA has issued final regulations implementing the decision of the Secretary that a positive association exists between exposure to herbicides and the subsequent development of chloracne, non-Hodgkin's lymphoma, soft tissue sarcoma, Hodgkin's disease, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, multiple myeloma and respiratory cancers. 38 C.F.R. §§ 3.307, 3.309; 59 Fed. Reg. 5106, 07 (February 3, 1994), 59 Fed. Reg. 29723, 24 (June 9, 1994), 61 Fed. Reg. 57586, 89 (November 7, 1996). The Secretary has also determined that there was no positive association between exposure to herbicides and any other condition for which he has not specifically determined a presumption of service connection is warranted. 59 Fed. Reg. 341-46 (January 4, 1994). Under the provisions of 38 C.F.R. § 3.309(e) (1999), if a veteran was exposed to an herbicide agent during active military, naval, or air service, the diseases set forth in 38 C.F.R. § 3.309(e) (1999), shall be service connected if the requirements of 38 C.F.R. § 3.307(a)(6) (1999) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of § 3.307(d) are also satisfied. No medical opinion affirmatively linking the veteran's skin condition to Agent Orange exposure is of record. Although the veteran has expressed his opinion that such a relationship exists, again, he is not qualified, as a lay person, to furnish medical opinions or diagnoses. Espiritu, supra. With respect to the veteran's claim for service connection for coronary artery disease, including hypertension, the current record does not include any evidence of a diagnosis of coronary artery disease. While, at the time of the veteran's 1969 separation examination, his systolic blood pressure was 144, the next reported elevated blood pressure reading was not until 1983 and the initial diagnosis of hypertension was made several years later. No medical evidence linking the veteran's hypertension to his active duty service is currently of record. The veteran has not submitted any medical opinion or other evidence which supports either of these claims. Given the evidence that is of record, these claims may not be considered well grounded. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. Since these claims are not well grounded, they must, accordingly, be denied. Grottveit v. Brown, 5 Vet. App. 91 (1993); Edenfield v. Brown, 8 Vet. App. 384 (1995). Although the Board has considered and disposed of the veteran's claim for service connection for coronary artery disease with hypertension on a ground different from that of the originating agency; that is, whether the veteran's claim is well grounded rather than whether he is entitled to prevail on the merits, the veteran has not been prejudiced by the Board's decision. In assuming that the claim was well grounded, the originating agency accorded the veteran greater consideration than his claim warranted under the circumstances. Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993). To remand this case to the originating agency for consideration of the issue of whether the veteran's claim is well grounded would be pointless, and in light of the law cited above, would not result in a determination favorable to the veteran. VA O.G.C. Prec. Op. 16-92, 57 Fed. Reg. 49, 747 (1992). To submit well-grounded claims, the veteran would need to offer competent evidence, such as a medical opinion, that there is a relationship between a currently manifested disability and service. Robinette v. Brown, 8 Vet. App. 69 (1995). Under these circumstances, the Board finds that the veteran has not submitted well grounded claims for service connection for a skin disability as a residual of Agent Orange exposure or for coronary artery disease, including hypertension. 38 U.S.C.A. § 5107(a). Therefore, the duty to assist is not triggered and VA has no obligation to further develop the veteran's claims. See Epps, 126 F.3d at 1469; Grivois v. Brown, 5 Vet. App. 136, 140 (1994). B. Asthma and Post-Traumatic Stress Disorder The veteran is also seeking service connection for asthma and post-traumatic stress disorder. The Board finds that these claims are "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented claims that are plausible. The Board is also satisfied that all relevant facts have been properly developed and no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). The veteran will be considered to have been in sound condition when examined and accepted for service except as to disorders noted at entrance into service or where clear and unmistakable evidence demonstrates that the disability existed prior thereto. 38 C.F.R. § 3.304(b). As the veteran's examination in 1967 for entry into service is not currently of record, it may not be found that asthma was noted on his entrance exam and he must be considered to have been in sound condition. The service clinical records demonstrate that the veteran reported experiencing problems with asthma a number of times in service. While he did report in 1973 that he had had problems with asthma since the age of twelve, there is no competent medical evidence that he received treatment for asthma or that a diagnosis of asthma was made prior to service. Although he has indicated that he began having such problems before service, without clear and unmistakable evidence demonstrating that the disability existed prior to service, the veteran must be considered to have been in sound condition when he entered service. 38 U.S.C.A. § 1111. Service connection may be granted if the evidence demonstrates that the current disability resulted from an injury or disease incurred in or aggravated coincident with service in the Armed Forces. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). In the alternative, the chronicity provisions of 38 C.F.R. § 3.303(b) are applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service, or during the applicable presumptive period, and still has such condition. The veteran's service medical records repeatedly refer to asthmatic problems and the veteran has continued to have these problems a number of years after service. After considering the entire record, the Board has concluded the evidence as to whether the veteran's asthmatic problems during service represented the onset of his chronic asthma is in equipoise. Therefore, service connection for chronic asthma is warranted. 38 U.S.C.A. §§ 1110, 1111, 5107; 38 C.F.R. §§ 3.303, 3.304. All doubt has been resolved in the veteran's favor. 38 U.S.C.A. § 5107. Turning to the issue of service connection for post-traumatic stress disorder, 38 C.F.R. § 3.304(f) states, in pertinent part, that service connection for post-traumatic stress disorder requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); 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. While the service medical records do not reflect treatment for a chronic psychiatric disability, 1995 VA medical records indicate that the veteran was seen for having nightmares four to five times a week as well as having intrusive thoughts of Vietnamese, poor sleep, early morning awakening and hearing a voice at times. At the time of the veteran's September 1995 psychiatric evaluation, the stressors elicited were all combat-related and the diagnosis was probable post-traumatic stress disorder, chronic. The examining physician did not specifically conclude that the veteran's post-traumatic stress disorder was related to the veteran's combat experience. However, the claimed stressors were all combat-related and were consistent with the circumstances, conditions, or hardships of the veteran's service. As the veteran did engage in combat, as shown by the awarding of the CIB, resolving reasonable doubt in favor of the veteran, service connection for post-traumatic stress disorder is granted. 38 U.S.C.A. §§ 1110, 5107: 38 C.F.R. §§ 3.303, 3.304. C. Laceration Scar The veteran is seeking a compensable evaluation for a laceration scar of the right knee. A veteran's assertion of an increase in severity of a service-connected disorder constitutes a well-grounded claim requiring the VA fulfill the statutorily required duty to assist 38 U.S.C.A. § 5107(a) (West 1991) because it is a new claim and not a reopened claim. The Board finds that all relevant facts have been properly developed and that no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). In accordance with 38 C.F.R. §§ 4.1, 4.2, 4.41, and 4.42 (1999) and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed the veteran's service medical records as well as all other evidence of record pertaining to the history of the disability for which the veteran is now seeking a higher disability evaluation. The Board has identified nothing in the historical record which suggests that the current evidence of record is not adequate to fairly determine the rating to be assigned for this disability. Moreover, the Board has concluded that this case presents no evidentiary considerations which would warrant an exposition of the remote clinical history and findings pertaining to this disability. In reaching its decision, the Board has considered the complete history of the disability in question as well as the current clinical manifestations and the effect the disability may have on the earning capacity of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.10 (1999). Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. The veteran has contended that his right knee condition is growing worse and that a compensable rating is warranted. The Board notes that, where an increase in an existing disability rating based on established entitlement to compensation is at issue, the present level of disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. As noted above, separate diagnostic codes identify the various disabilities. The veteran's right knee scar has been rated as noncompensable (0 percent disabling) under Diagnostic Code (Code) 7805. Under that Code, the scar is rated on limitation of function of the part affected. Where there is no limitation of function of the part affected, a 10 percent disability evaluation is for assignment under Code 7803 for superficial scars which are poorly nourished with repeated ulceration or under Code 7804 for superficial scars which are tender and painful on objective demonstration. In the instant case, while the veteran has complained of frequent right knee difficulties, no limitation of function of the veteran's right knee as the result of the scar was demonstrated on VA examination conducted in 1995 as the examiner concluded that the veteran had no residual knee problem as the result of the laceration. Moreover, although he complained that the scar was tender and painful, efforts to examine the veteran's right knee proved unsuccessful as the veteran failed to report for two scheduled VA examinations. In addition, when he was seen for right knee pain in March 1998, the cause of the pain was found to be chondromalacia, not the laceration scar. There is not shown to be limitation of function of the part affected as the result of the scar and the scar is not shown to be either poorly nourished with repeated ulceration or tender and painful on objective demonstration. As the veteran is not shown to have experienced any of the required manifestations, a compensable disability evaluation is not for assignment for the right knee scar. 38 U.S.C.A. § 1155; 38 C.F.R. § Part 4, Code 7805. In reaching its decision, the Board has considered the complete history of the disability in question as well as any current clinical manifestations and the effect the disability may have on the earning capacity of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41 (1999). Further, the Board finds in this case the disability picture is not so exceptional or unusual so as to warrant an evaluation on an extraschedular basis. The Board finds that the veteran has not contended nor is there anything in the record to suggest that his right knee scar has been shown to have caused marked interference with employment or necessitated frequent periods of hospitalization. 38 C.F.R. § 3.321(b)(1) (1999). ORDER Entitlement to service connection for a skin disability as a residual of Agent Orange exposure and coronary artery disease, including hypertension, is denied as is an increased (compensable) evaluation for a laceration scar of the right knee. Entitlement to service connection for asthma and for post- traumatic stress disorder is granted. To this extent the appeal is allowed, subject to the law and regulations governing the payment of monetary benefits. RENÉE M. PELLETIER Member, Board of Veterans' Appeals