BVA9507893 DOCKET NO. 93-12 038 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUES Entitlement to service connection for degenerative changes of the left knee. Entitlement to an increased (compensable) rating for postoperative scar, Baker's cyst, left knee. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Robert A. Leaf, Counsel INTRODUCTION The appellant served on active duty from September 1950 to June 1952. A July 1992 rating decision of the Muskogee, Oklahoma, Regional Office of the Department of Veterans Affairs (VA) implemented a March 1992 decision of the Board of Veterans' Appeals (Board) granting service connection for a left knee Baker's cyst; a noncompensable rating was assigned for a disability classified as postoperative scar, Baker's cyst, left knee. A February 1993 rating decision denied service connection for degenerative changes of the left knee as adjunct to the service-connected scar from a left knee Baker's cyst; a noncompensable rating for the scar was confirmed and continued. This appeal to the Board is taken from these rating decisions. CONTENTIONS OF APPELLANT ON APPEAL It is contended, in essence, that degenerative changes of the left knee developed secondary to a postoperative residuals of a Baker's cyst. Further, it is maintained that a higher rating should be assigned for the service-connected left knee disability. 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 appellant has not met the burden of submitting evidence of a well-grounded claim for service connection for degenerative changes of the left knee; further, that the preponderance of the evidence is against the claim for an increased rating for postoperative scar, Baker's cyst, left knee. FINDINGS OF FACT 1. The claim for service connection for degenerative changes of the left knee is not plausible. 2. Postoperative scar, Baker's cyst, left knee is nontender and not productive of functional impairment. CONCLUSIONS OF LAW 1. The appellant has not submitted evidence of a well-grounded claim for service connection for degenerative changes of the left knee. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5107 (West 1991); 38 C.F.R. §§ 3.307, 3.309, 3.310 (1994). 2. A compensable rating for postoperative scar, Baker's cyst, left knee is not warranted. 38 U.S.C.A. §§ 5107, 1155 (West 1991); 38 C.F.R. Part 4, Codes 7804, 7805 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service connection for degenerative changes of the left knee The threshold question to be answered in this case is whether the appellant has presented a well grounded claim for service connection for degenerative changes of the left knee, i.e., one which is plausible. If he has not, the claim must fail and there is no further duty to assist in the development of the claim 38 U.S.C.A. § 5107; Murphy v. Derwinski, 1 Vet.App. 78 (1990). A well-grounded claim, requires more than an allegation; the claimant must submit supporting evidence. Furthermore, the evidence must justify a belief by a fair and impartial individual that the claim is plausible. Tirpak v. Derwinski, 2 Vet.App. 609 (1992). As will be explained below, the Board finds that this claim is not well grounded. Service medical records are negative for degenerative changes of the left knee, and it is not otherwise contended. A February 1964 statement from a private physician relates that a Baker's cyst was removed from the left popliteal space in September 1952. Postservice medical records first reflect the presence of degenerative changes of the left knee joint on VA x-ray examination in October 1990. The veteran was found to have a probable loose body of the left knee, most likely representing osteochondromatosis and moderate to severe bilateral degenerative changes of both knees. The veteran then related a history of removal of a cyst from the left knee and referred to left knee surgery about 25 years previously involving removal of "cartilage." He indicated continued progressive pain involving both knee joints since the surgery. The impression was postoperative degenerative joint disease, knees, bilateral, symptomatic. On VA orthopedic examination in December 1992, the veteran related that he had completed service in 1952 and had undergone removal of a left popliteal cyst about three months after service separation; in 1964, open surgery was performed on the left knee because of a cartilage problem; then he developed arthritis of the left knee and now had left knee pain daily. X-ray examination disclosed degenerative changes of both knees. The examiner commented that no connection was found between removal of the popliteal cyst and arthritis of the left knee, especially in view of the passage of time between the 1952 removal of the Baker's cyst and the apparent development of left knee arthritis in 1964. Where, as here, the determinative issue is one of medical causation, competent medical evidence is required to establish a well-grounded claim. Grottveit v. Brown, 5 Vet.App. 91 (1993). The veteran's assertion is the only evidence linking current degenerative changes of his left knee to service-connected postoperative scar, Baker's cyst, left knee. As a lay person, he is not competent to offer a medical opinion. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). No competent medical evidence has been presented showing that degenerative changes of the left knee are etiologically related to the service-connected cyst residuals. Indeed, a VA physician, who examined the veteran and recorded the veteran's history, found no evidence of a connection between left knee degenerative changes and an asymptomatic scar, the only objectively demonstrated residual of removal of the Baker's cyst from the left knee. No credible evidence has been provided to demonstrate that degenerative changes of the left knee had their onset in service as would be required for a grant of service connection on a direct basis under 38 U.S.C.A. § 1110, that degenerative changes of the left knee were present to compensable degree within one year of the appellant's separation from service as would be required for a grant of service connection on a presumptive basis under 38 U.S.C.A. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309, or that degenerative changes of the left knee are causally related to service-connected scar, postoperative residuals of Baker's cyst, left knee as would be required for a grant of service connection on an adjunct or secondary basis under 38 C.F.R. § 3.310. As previously noted, a claimant must submit supporting evidence that justifies a belief by a fair and impartial individual that the claim is plausible. As such evidence has not been presented, the claim is not well grounded. II. Increased rating for scar, postoperative residuals, Baker's cyst, left knee The Board notes that the veteran's claim for an increased rating for postoperative scar, Baker's cyst, left knee is "well- grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is plausible. The Board is also satisfied that all relevant facts have been properly developed and that no further assistance to the appellant is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). A VA dermatologic examination was conducted in April 1992. There was a history of excision of a Baker's cyst from the left popliteal area in 1952. It had not recurred and the appellant had no complaints referable to the scar. Examination revealed a 1 1/2 cm surgical scar in the left popliteal fossa. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity resulting from specific service-connected disabilities. 38 U.S.C.A. § 1155. Separate diagnostic codes identify the various disabilities and the criteria that must be shown for specific ratings. A 10 percent rating is provided for superficial scars which are tender and painful on objective demonstration. 38 C.F.R. Part 4, Code 7804. Scars may also be rated on limitation of function of the part affected. 38 C.F.R., Part 4, Code 7805. In this case, there is no objective evidence of pain or tenderness or impairment of function of the knee or leg referable to the scar of the left popliteal space from excision of a Baker's cyst. Criteria for assignment of a compensable rating under applicable diagnostic codes are not satisfied. 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 (1994). The Board does not find that the evidence presents such an exceptional or unusual disability picture as to render impractical the application of the regular schedular criteria, so as to warrant the assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1) (1994). In this regard, there is no evidence of frequent periods of hospitalization or marked interference with employment due exclusively to this disorder. There is not an approximate balance of positive and negative evidence regarding the issue of an increased rating for postoperative scar, Baker's cyst, left knee, as to warrant application of the doctrine of benefit of doubt. 38 U.S.C.A. § 5107. ORDER The appeal with regard to the issue of service connection for degenerative changes of the left knee is dismissed. An increased rating for postoperative scar, Baker's cyst, left knee is denied. (CONTINUED ON NEXT PAGE) D. C. SPICKLER 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.