Citation Nr: 0001203 Decision Date: 01/13/00 Archive Date: 01/27/00 DOCKET NO. 96-31 919 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to an increased evaluation for a cervical spine disorder described as, arthritis, cervical spine with radicular pain, right shoulder, currently rated as 10 percent disabling, to include a separate compensable rating for right shoulder impairment. 2. Entitlement to service connection for a low back disorder. 3. Entitlement to service connection for a left shoulder disorder. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Stanley Grabia, Associate Counsel INTRODUCTION The veteran had active service from April 1970 to February 1974. He also was on active duty from November 1990 to June 1991, when activated with his National Guard unit in support of Desert Storm. The claims arise from the first period of service. This appeal is before the Board of Veterans' Appeals (Board) from rating decisions of the Department of Veterans Affairs (VA) Montgomery, Alabama Regional Office (RO). The case was remanded by the Board in September 1998 to schedule a hearing before a member of the Board, at the RO. A hearing was held in November 1998, at the RO, before Michael D. Lyon, who is the Board member rendering the determination in this claim and who was designated by the Chairman to conduct that hearing, pursuant to 38 U.S.C.A. § 7102 (West 1991 & Supp. 1999). A transcript of the hearing has been included in the claims folder for review. The Board in April 1999 remanded the case for further development, it is now returned to the Board for adjudication. It is noted that in the prior Board Remands, the issue of service connection for a left shoulder disorder was described as a claim to reopen a previously denied claim. It is noted that as part of the additional development requested, the supplemental statement of the case (SSOC) notes that additional service medical records were obtained. It appears that this was taken as new and material evidence, as in the most recent SSOC, the claim regarding the left shoulder is considered on a de novo basis. As this provides the broadest possible review to the claim, the Board will undertake a similar review herein. FINDINGS OF FACT 1. All pertinent and available evidence necessary for entering an informed decision in this case has been obtained by the RO. 2. The appellant's service connected cervical spine disability is manifested primarily by subjective complaints of cervical pain without radiation to either the left or right upper extremities. 3. There are degenerative changes in the cervical spine with limitation of motion; there is slight limitation of motion of the right shoulder with moderate to moderately severe functional impairment. The right shoulder is not ankylosed nor is limitation of the arm to the shoulder level. 4. The service medical records note a history of bilateral shoulder pain which the examiner noted sounded like myalgia or fibrositis. Otherwise, the service records do not contain complaints, findings, or a diagnosis of a chronic lower back, or left shoulder disorder. 5. The evidence does not establish that the appellant has a current lower back; or, left shoulder disability that is directly related to service or to any in-service occurrence or event. CONCLUSIONS OF LAW 1. An evaluation in excess of 10 percent for a cervical spine disability is not warranted on either a schedular or extraschedular basis; however a separate 10 percent rating, but no more, for right shoulder impairment is warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 1999 ); 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.2, 4.7, 4.10, 4.14, 4.31, 4.40, 4.41, 4.45, 4.59, Part 4., diagnostic codes (DC) 5003, 5200, 5201, 5290. (1999). 2. The appellant has not submitted well-grounded claims for service connection for a lower back disorder, and/or a left shoulder disorder. 38 U.S.C.A. §§ 1110, 5107(a) (West 1991); 38 C.F.R.§ 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Entitlement to an increased evaluation for a cervical spine disorder with right shoulder impairment, currently rated as 10 percent disabling, to include a separate compensable rating for the right shoulder impairment. As a preliminary matter, the Board finds that the veteran's claim is "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a). See Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). That is, the Board finds that the veteran has presented a claim which is not implausible when the contentions and the evidence of record are viewed in the light most favorable to such claim. Generally, an allegation that a service-connected disability has increased in severity is sufficient to establish well groundedness. See Drosky v. Brown, 10 Vet. App. 251, 254 (1997); Proscelle v. Derwinski, 2 Vet. App. 629, 631-32 (1992). Likewise, the Board is satisfied that all relevant facts have been properly and sufficiently developed, such 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). The evidentiary assertions of the veteran are presumed credible for making this determination. In the evaluation of service-connected disabilities the entire recorded history, including medical and industrial history, is considered so that a report of a rating examination, and the evidence as a whole, may yield a current rating which accurately reflects all elements of disability, including the effects on ordinary activity. 38 C.F.R. §§ 4.1, 4.2, 4.10. 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, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, all pertinent evidence in the appeal period will be considered. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the veteran. 38 C.F.R. § 4.3. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. 38 C.F.R. § 4.40 (1999). In reference to joints, factors as to the extent of disability include limitation of or excessive motion, weakened motion, excess fatigability, incoordination, impaired ability to execute skilled movements smoothly, pain on movement, swelling, deformity or atrophy of disuse, instability of station, disturbance of locomotion, and interference with sitting, standing, and weight-bearing. 38 C.F.R. §§ 4.40, 4.45, 4.59. See also DeLuca v. Brown, 8 Vet. App. 202 (1995). Degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint involved. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Where there is x-ray evidence of arthritis, and limitation of motion, but not to a compensable degree under the Code, a 10 percent rating is for assignment. 38 C.F.R. § 4.71, DCs 5003. With any form of arthritis, painful motion is an important factor of disability. Crepitation either in the soft tissues such as the tendons or ligaments, or within the joint structures, should be considered as points of contact which are diseased. 38 C.F.R. § 4.59. Evaluation of the same disability under various diagnoses is to be avoided, as is the evaluation of the same manifestation under different diagnoses. 38 C.F.R. § 4.14. The VA General Counsel has issued a precedential opinion (VAOPGCPREC 23-97) holding that a claimant who has arthritis and instability of the knee may be rated separately under Diagnostic Codes 5003 and 5257, while cautioning that any such separate rating must be based on additional disabling symptomatology. In determining whether additional disability exists, for purposes of a separate rating, the veteran must meet, at minimum, the criteria for a noncompensable rating under either of those codes. Cf. Degmetich v. Brown, 104 F.3d 1328, 1331 (Fed. Cir. 1997) (assignment of zero-percent ratings is consistent with requirement that service connection may be granted only in cases of currently existing disability). Current VA regulations also provide that if the scheduler rating criteria are inadequate, an extraschedular evaluation may be assigned commensurate with the impairment of average earning capacity if there is 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 scheduler standards. 38 C.F.R. § 3.321(b)(1) (1999). Further, in evaluating increased ratings, consideration will be given to whether higher ratings are available under the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and DeLuca v. Brown, 8 Vet. App. 202 (1995). Specifically, in DeLuca, the Board was directed to consider whether a veteran's complaints of shoulder pain could significantly limit functional ability during flare-ups or when the arm was used repeatedly, thus warranting a higher evaluation under 38 C.F.R. § 4.40. Moreover, the Board will consider whether weakened movement, excess fatigability, and incoordination support higher ratings under 38 C.F.R. § 4.45. See DeLuca, 8 Vet. App. at 207. After review of the record, as will be set forth in greater detail below, there is currently a basis for a separate compensable rating for the right shoulder disorder. Thus, analysis below will be divided between the cervical spinal pathology and the right shoulder pathology. Review of the service medical record reveals that the veteran was treated for right shoulder pain, possibly bursitis, and thoracic spine pain in service. He also appeared to have a history of bilateral shoulder pain which the examiner noted sounded like myalgia or fibrositis. In the separation examination the veteran also noted painful shoulders in cold weather, and thoracic back pain. The veteran filed a claim for a trick shoulder, and back pain in April 1974, In a VA examination in September 1974, the veteran complained of bilateral shoulder and back pain. He reported no injury to his shoulders, but they began to hurt when he was pulling guard duty as a military policeman. He reported that his back was injured lifting a pool table in Vietnam. The examiner noted on musculoskeletal system, in pertinent part, that there was degenerative arthritis lower cervical spine manifested by minimal arthritis on x-ray and spurring of C5-C6 with radicular component to right trapezius manifested by deep tenderness and thickening; and, no residual bursitis. A November 1974 rating decision granted service connection for degenerative arthritis, cervical spine, spurring C5 and C6 with radicular component to right trapezius, and assigned a 10 percent evaluation under diagnostic code 5003. It was noted that there was a full range of motion of the right shoulder. In a VA examination in January 1995, the veteran reported aching in both shoulders, but denied current neck pain, restriction in the use of his shoulders, or any treatment or physical therapy for his neck. The examiner noted no postural abnormalities, or fixture deformities. The shoulders revealed no deformity, instability, swelling, or tenderness. ROM of the cervical, and thoracolumbar spine, and shoulders was normal, with no evidence of pain or tenderness with movement. X-rays of the cervical spine revealed mild degenerative arthritic changes with anterior and lateral vertebral body spurring. The diagnoses was degenerative arthritis, cervical spine; and bilateral shoulder pain, with normal examination. A hearing was held by a member of the Board sitting at the RO in November 1998. The veteran testified to back and bilateral arm pain. He reported injuring his back in an accident in service when he was moving a pool table, but could not recall the exact injury or treatment at that time. He indicated that it appeared that several of his medical records from Vietnam, as well as from treatment at the VA appeared to be missing from the file. He further testified that he received treatment from a Dr. Jackson. However his office was burnt down several times and his records were unavailable. The Board remanded this claim in April 1999 for additional development, including a search for additional VA, private, service, and National Guard medical treatment records which were not currently of file. Finally, a VA examination and an opinion was requested as to whether any left upper extremity pathology found was related to or aggravated by the service connected cervical spinal disorder. Subsequent to the remand, National Guard, and VAMC records were received. The VA records included a January 1995 x-ray reports which noted degenerative arthritis of the cervical spine, considered a minor abnormality, and normal shoulders bilaterally. In a VA examination in August 1999, the veteran complained of cervical spine pain, with no definite radiation. His neck occasionally became stiff. There was no definite evidence of pain radiation, and only minimal neck muscle tightness noted. ROM of the cervical neck was forward flexion of 30 degrees; extension to 25 degrees; lateral bending to 30 degrees; and, rotation to 35 degrees, bilaterally. The examiner noted that neck movements elicited just mild pain, and the veteran was unable to give an exact location. There was only minimal to mild paraspinal muscle tightness, without radiation. The right shoulder ROM was forward flexion to 170 degrees; external rotation to 80 degrees; and, internal rotation to 90 degrees. Abduction and external rotation was to 90 degrees, with subacromial bursitis pain. Afterwards ROM was easily to 170 degrees. Anterior and posterior shoulder was normal. The examiner noted right shoulder bursitis. It was noted that there was pain on extremes of flexion. Moderate to moderately significant functional impairment was noted. The appellant's cervical spine disorder with radicular pain, right shoulder is rated under the VA's Schedule for Rating Disabilities, 38 C.F.R. part 4, Diagnostic Codes (DC), DC 5003, Degenerative arthritis; DC 5290, Spine, limitation of motion of, cervical; and DCs 5200, 5201 Scapulohumeral articulation, ankylosis of, and limitation of arm motion. Degenerative arthritis, established by x-ray findings is rated, in pertinent part, on the basis of limitation of motion under the specific joint or joints involved. 38 C.F.R. § 4.71a, DC 5003 (1999). Under DC 5290 Spine limitation of motion of, cervical Severe findings, warrants a 30 percent rating; Moderate findings warrant a 20 percent rating; and, Slight findings warrant a 10 percent rating. Under DC 5200 Scapulohumeral articulation, ankylosis of Favorable abduction to 60 degrees, can reach the mouth and head, warrants a 30 percent rating for the major extremity. Under DC 5201 Limitation of arm motion A 20 percent rating is warranted where the major extremity is limited to the shoulder level. After reviewing the applicable rating criteria, and the reported objective findings and the subjective complaints, the Board is of the opinion that a 10 percent evaluation, but no more, for the appellant's cervical spine disorder is warranted. The veteran has consistently complained of cervical pain without radiation to either the left or right upper extremities. The most recent VA examination, revealed only some minor limitation of cervical spinal motion, and as noted, there is degenerative arthritis in the cervical spine. This warrants the assignment of a 10 percent rating, which is assigned. The complaints of pain without radiation precipitated by any sudden movement or jerking motion, more nearly approximates a 10 percent rating under DC 5290. As such, considering the provisions of 38 C.F.R. § 4.7, the Board concludes that the overall pathology more nearly approximates degenerative arthritis of the cervical spine with slight limitation of motion, warranting assignment of a 10 percent rating. With regard to the remaining pathology, however, the Board concludes, with resolution of reasonable doubt in the appellant's favor, that a separate 10 percent rating for right shoulder impairment is indicated. It is noted that the service-connected disorder of the cervical spine has always included some impairment of the right shoulder, described as radicular impairment. On examinations in 1974 and 1995, there was essentially no shoulder pathology identified. There was a full range of motion noted. On the most recent examination, however, there is some evidence of slight limitation of flexion and external rotation (when the examination findings are compared with 38 C.F.R. § 4.71, Plate I showing 180 degrees of forward flexion as normal, and 90 degrees of external rotation). It is not completely clear that this limitation of motion is attributed to the right shoulder pathology, but there is nothing on file that dissociates this from the service connected disorder. The examiner on the most recent examination noted that there was moderate to moderately significant functional impairment. There was some pain reported on the extremes of motion. Giving consideration to the doctrine of reasonable doubt, the holding in DeLuca, supra, and the provisions of 38 C.F.R. §§ 4.40, 4.45, it is concluded a 10 percent rating is warranted. It is concluded that a higher rating is not warranted, as the functional impairment is not shown to have caused an muscle atrophy, more that slight limitation of motion, and there is no evidence of nerve impairment or involvement. Moreover, limitation of motion is not limited to the shoulder level, nor is there ankylosis. Thus, under 38 C.F.R. § 4.40, 4.45, DC 5099-5003, and DeLuca, supra, a 10 percent rating, but no more, is warranted. Finally, the disorder does not appear to be so unusual as to render application of the regular schedular provisions impractical. Thus, there is no basis for referral for consideration of an extraschedular rating. 38 C.F.R. § 3.321. II. Entitlement to service connection for a low back disorder, and a left shoulder disorder. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). If a chronic disease is shown in service, subsequent manifestations of the same chronic disease at any later date, however remote, may be service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b) (1999). However, continuity of symptoms is required where the condition in service is not, in fact, chronic or where diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b) (1999). In addition, service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b) (West 1991 & Supp. 1999); 38 C.F.R. § 3.303(d) (1999). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). However, the threshold question which must be resolved with regard to each claim is whether the appellant has presented evidence that each claim is well grounded; that is, that each claim is plausible. Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). A plausible claim is "one which is meritorious on its own or capable of substantiation." Black v. Brown, 10 Vet. App. 279 (1997). The duty to assist under 38 U.S.C.A. § 5107(a) is triggered only after a well-grounded claim is submitted. See Anderson v. Brown, 9 Vet. App. 542, 546 (1996); Peters v. Brown, 6 Vet. App. 540, 546 (1994). Evidentiary assertions by the person who submits a claim must be accepted as true for the purposes of determining whether a claim is well-grounded, except where the evidentiary assertion is inherently incredible or beyond the competence of the person making the assertion. See Meyer v. Brown, 9 Vet. App. 425, 429 (1996); King v. Brown, 5 Vet. App. 19 (1993). Where the determinative issue is factual rather than medical in nature, competent lay testimony may constitute sufficient evidence to well ground the claim. See Caluza v. Brown, 7 Vet. App. 498, 504 (1995); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). For a service-connected claim to be well grounded, there must be a medical diagnosis of current disability, lay or medical evidence of in-service incurrence or aggravation of a disease or injury, and medical evidence of a nexus between the in-service injury or disease and current disability. See Epps v. Brown, s9 Vet. App. 341, 343-44 (1996), aff'd, 126 F.3d 1464 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). The chronicity provisions of 38 C.F.R. § 3.303(b) are applicable where evidence, regardless of its date, show that the appellant had a chronic condition in service, or during an applicable presumptive period, and still has such a condition. The evidence must be medical in nature, unless it relates to a situation where lay evidence is competent. However, if chronicity is not applicable, a claim may still be well grounded on the basis of continuity of symptomatology if the condition was noted during service or during an applicable presumptive period and if competent evidence, either medical or lay, related the present disorder to that symptomatology. See Savage v. Gober, 10 Vet. App. 488 (1997). Review of the service medical record reveals that the veteran was treated for right shoulder pain, and reported a history of bilateral shoulder pain which the examiner noted sounded like myalgia or fibrositis. The separation examination also noted a report of painful shoulders in cold weather, but no disorder was noted on examination. The veteran filed a claim for a trick shoulder (not specified), and back pain (not specified) in April 1974. In a VA examination in September 1974, the veteran complained of bilateral shoulder pain and back pain. He reported his shoulders began to hurt when he was pulling guard duty as a military policeman. His back was injured lifting a pool table in Vietnam. The examiner noted slight to moderate tenderness over the right shoulder, and some questionable paravertebral tenderness bilaterally over L2, and L4. Otherwise, the musculoskeletal system was entirely normal, with a full range of motion (ROM) of all joints, including the shoulders, and back. Minimal arthritis of the cervical spine was noted by x-ray, with a radicular component to the right trapezius. A November 1974 rating decision granted service connection for degenerative arthritis, cervical spine, with radicular component to right trapezius, and assigned a 10 percent evaluation. This in essence also granted service connection for the right shoulder disorder. The veteran filed a claim for a lower back disability, and a bilateral shoulder disorder in September 1994. In a VA examination in January 1995, the veteran reported periodic lower back pain, without radiation of pain to the legs; and, aching in both shoulders. He denied any restriction in the use of his shoulders. The examiner noted the back musculature was normal, as were x-rays of the lumbar spine. The shoulder examination was also normal. The diagnosis was low back pain, and bilateral shoulder pain, with normal examination. In a hearing before a member of the Board sitting at the RO in November 1998, the veteran testified that it appeared that several of his medical records from Vietnam, as well as from treatment at the VA appeared to be missing from his file. The Board remanded the claims in April 1999. Subsequent to the remand, the RO received additional records as follows; National Guard records which included normal x-rays of the lumbar spine dated in 1990. VAMC records including normal x-ray of the shoulders, bilaterally dated January 1995; and May 1999 x-rays revealing narrowing of L5-S1, considered a minor abnormality. In a VA examination in August 1999, there was some limitation of motion of the lumbar spine noted without evidence of pain radiation. Myofascial low back pain syndrome was diagnosed. Both upper extremities exhibited deep tendon reflexes, present and symmetrical, with adequate strength, and rotator cuff function intact. The examiner noted that he could not find any clinical neurological deficits of the low back and shoulders, except for some localized pain. The examiner found no history or symptoms of peripheral nerve damage in the upper or lower extremities. None of the medical evidence on file suggests a relationship with the appellant's currently diagnosed lower back disorder, and his left shoulder disorder and any complaints or injuries in service. In addition there are no medical opinions that would tie any lower back or left shoulder disorder to any in- service occurrence or event. The Board is required to base its decision on the evidence of record. See Colvin v. Derwinski, 1 Vet.App. 171 (1991). In this case, the veteran's in-service medical records, and the separation examination are negative as to any findings of a chronic lower back and/or left shoulder disorder. It is noted that the appellant reports severe back pain, in the low back, that he relates to service. Significantly, there is no credible medical evidence which would etiologically link the veteran's current lower back, and left shoulder disorders, if any, to service. There are no post service medical records of file which show continuing pertinent pathology that can be related to service. Specifically, there was no diagnosis of a chronic lower back, and/or left shoulder disorder in service, nor has any medical examiner attributed the appellants current lower back, and/or left shoulder disorders, if any, to his active service. Thus, a direct causal link between the appellant's disorders and service has not been demonstrated. The Board has thoroughly reviewed the claims file and finds no evidence of any plausible claims, nor any claims for which entitlement is permitted under the law. In conclusion, the Board has considered the appellant's statements that he has a lower back, and left shoulder disorder due to a service. Although the appellant's statements are probative of symptomatology, they are not competent or credible evidence of a diagnosis, date of onset, or medical causation of a disability. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992); Miller v. Derwinski, 2 Vet. App. 578, 580 (1992). The appellant's assertions are not deemed to be credible in light of the other objective evidence of record showing no treatment, or diagnosis of a chronic low back or left shoulder disorder in service, and no continuing findings since service indicative of the claimed disabilities. The appellant lacks the medical expertise to offer an opinion as to the existence of current medical pathology, as well as to medical causation of any current disability. Id. In the absence of competent, credible evidence of continuity of relevant symptomatology, service connection is not warranted for the disabilities claimed on appeal. Where a claim is not well grounded it is incomplete, and VA is obligated under 38 U.S.C.A. § 5103(a) to advise the claimant of the evidence needed to complete his or her application. Robinette v. Brown, 8 Vet. App. 69, 77-80 (1995). In this case, the RO informed the appellant of the necessary evidence in the claims form he completed, in its notice of rating decision and the statement and supplemental statements of the case. The discussion above informs him of the types of evidence lacking, which he should submit for a well-grounded claim. However, it has not been shown that any records, if available, would satisfy the medical nexus requirement in order to make the claims well grounded. The Board has examined all the evidence of record with a view toward determining whether the appellant notified VA of the possible existence of additional information which would render his claims plausible. However, the Board finds no such information present. See Beausoleil v. Brown, 8 Vet. App. 459, 464-65 (1996); Robinette v. Brown, 8 Vet. App. 69, 80 (1995). ORDER Entitlement to an increased rating in excess of 10 percent for a cervical spine disorder described as, arthritis, cervical spine is denied. Entitlement to a separate compensable 10 percent rating, but no more, for right shoulder impairment, is granted subject to the law and regulations governing the award of monetary benefits. Entitlement to service connection for a low back disorder, and/or a left shoulder disorder is denied on the basis that the claims are not well grounded. MICHAEL D. LYON Member, Board of Veterans' Appeals