Citation Nr: 0003114 Decision Date: 02/08/00 Archive Date: 02/15/00 DOCKET NO. 98-17 973A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for residuals of cold injury to both hands. 2. Entitlement to a disability evaluation in excess of 10 percent for eczema. 3. Entitlement to a compensable disability evaluation for chondromalacia of the knees. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. L. Krasinski, Counsel INTRODUCTION The veteran served on active duty from November 1974 to November 1978. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Atlanta, Georgia, Department of Veterans Affairs (VA), Regional Office (RO). FINDINGS OF FACT 1. Competent evidence medically relating residuals of cold injury to the hands to the veteran's period of service has not been presented. 2. All relevant evidence necessary for an equitable disposition of the veteran's claims for increased evaluations has been obtained insofar as possible by the RO. 3. The veteran's service-connected eczema is principally manifested by complaints of itching and exfoliation with objective findings of minimal xerosis; there is no objective evidence of exudation, extensive lesions, marked disfigurement, ulceration or extensive exfoliation or crusting, systemic or nervous manifestations, or exceptionally repugnant disfigurement due to the eczema. 4. The veteran's service-connected chondromalacia of the knees is principally manifested by complaints of pain on motion and tenderness of the patella, without objective evidence of limitation of motion or painful motion, instability, swelling, or degenerative joint disease of the knees. CONCLUSIONS OF LAW 1. The claim of entitlement to service connection for residuals of a cold injury to the hands is not well-grounded. 38 U.S.C.A. § 5107 (West 1991). 2. The criteria for a disability evaluation in excess of 10 percent for eczema have not been met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.118, Diagnostic Codes 7806, 7813 (1999). 3. The criteria for a compensable disability evaluation for chondromalacia of the knees have not been met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5003 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Entitlement to Service Connection for Cold Injury to the Hands Pertinent Law and Regulations In order to establish service connection, the facts, as shown by evidence, must demonstrate that a disease or injury resulting in current disability was incurred during service or, if pre-existing active service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131 (West 1991). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "Chronic." When the disease identity is established, there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1999). Service connection may also be granted for a disability initially diagnosed after service when shown to be related to service. 38 C.F.R. § 3.303(d) (1999). A veteran claiming entitlement to VA benefits has 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) (West 1991). The United States Court of Appeals for Veterans Claims (formerly the Court of Veterans Appeals) (the Court) has defined "well- grounded claim" as a "plausible claim, one which is meritorious on its own or capable of substantiation." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). Such a claim need not be conclusive, but only possible to satisfy the initial burden of 38 U.S.C.A. § 5107(a). Id. A claim must be more than just an allegation; a claimant must submit supporting evidence. Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). If a claim is not well- grounded, the Board does not have jurisdiction to adjudicate the claim. Boeck v. Brown, 6 Vet. App. 14 (1993). A not well-grounded claim must be denied. Edenfield v. Brown, 8 Vet. App. 384 (1995). If the initial burden of presenting evidence of a well-grounded claim is not met, the VA does not have a duty to assist the veteran further in the development of the claim. 38 U.S.C.A. § 5107(a); Murphy, 1 Vet. App. at 81-82. In Caluza v. Brown, 7 Vet. App. 498, 506 (1995), the Court held that in order for a claim to be well grounded there must be competent evidence of current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the in-service injury or disease and the current disability (medical evidence). Where the determinant issue involves a question of medical diagnosis or medical causation, competent medical evidence to the effect that the claim is plausible or possible is required to establish a well-grounded claim. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Lay assertions of medical causation cannot constitute evidence to render a claim well grounded under 38 U.S.C.A. §5107(a); if no cognizable evidence is submitted to support a claim, the claim cannot be well grounded. Id. The Court has also held that the chronicity provision of 38 C.F.R. § 3.303(b) is applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service or during an applicable presumption period and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under the Court's case law, lay observation is competent. If the chronicity provision is not applicable, a claim may still be well grounded if the condition is observed during service or any applicable presumption period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488 (1997). Analysis The veteran asserts that he incurred cold injury to the hands in service and he is entitled to service connection for residuals of cold injury to his hands. At a hearing before the Board in November 1999, the veteran and his representative asserted that the service medical records show that at the time the veteran was treated for cold injury to the feet, he also complained of cold injury to his hands. Hearing Transcript, hereinafter Tr. 2 and 3. He stated that when his hands were frost-bitten in service, he was in basic training and it was right before the Christmas break. Tr. 4. The veteran stated that the cold injury occurred in December 1974, right around Christmas time, and he incurred cold injury to the feet in 1976 or 1977. Tr. 10. He was at Fort Leonard Wood in Missouri. Tr. 10. He did not go to a doctor for treatment of his frostbitten hands in service. Tr. 4. Since service, the veteran has not had any injuries to his hands. Tr. 5. He believed that the problems that he now had with his hands were due to the initial exposure in service. Tr. 5. He stated that when it was cold, his hands started to burn when he touched anything cold. Tr. 3. The veteran stated that he has the same symptoms now that he did in the military, except that now, his hands were more sensitive. Tr. 3. The veteran has submitted competent medical evidence which establishes a current diagnosis of cold injury to the hands. The April 1998 VA examination report reflects a diagnosis of cold injury to the hands. The service medical records are silent for a diagnosis of cold injury to the hands. A December 1976 service medical record indicates that the veteran reported having "frozen feet and hands." He stated that he had cold injury in 1974 to his hands and feet without pain presently. He had feeling. Examination revealed mild blanching to the tips of the toes without edema or blistering. He had good sensation in all digits. The impression was cold injury, probable chilblains. There was no indication that the veteran had cold injury to his hands. The Board notes that a June 1978 service medical record indicates that the veteran had eczema on the left second and third digits. An August 1978 service medical record indicates that the veteran had dyshidrosis of the fingers. It was noted that the veteran had three or four papules in the area of the heads of the fingers. The Board notes that service connection for eczema was established in February 1987, and a 10 percent disability evaluation was currently assigned. The veteran has not submitted competent medical evidence of a medical nexus between the current diagnosis of cold injury to his hands and his period of service. The evidence of record shows that cold injury to the hands was first diagnosed 20 years after service. In his original claim for compensation benefits, dated in November 1978, the veteran did not file a claim for cold injury to the hands. VA examination reports, dated in October 1978, December 1980, July 1985, August 1986, January 1989, February 1990, and April 1997, are silent for a diagnosis of cold injury to the hands. The VA examination reports reflect diagnoses of dyshidrotic eczematous dermatitis of the hands. As noted above, service connection is in effect for that disorder. In January 1998, the veteran filed a claim for service connection for frostbite of the hands and feet. The clinical evidence of record, including the VA examination reports, do not provide a medical nexus between the veteran's current diagnosis of cold injury to the hands and his period of service. The April 1998 VA examination report indicates that the veteran reported that he sustained exposure to the cold, severe frostbite, of his hands when he was on guard duty in service. The examiner indicated that he had no records to review. Signs and symptoms at the time of acute injury were reportedly discoloration of the hands and subsequent swelling and blistering of the skin, on and off, with peeling and feeling of extreme cold or hot. Paresthesia was noted. Examination revealed that the veteran had blisters over the radial aspect of his index fingers, bilaterally. The blisters were punctate and small. There was no evidence of infection. The veteran had full range of motion of all of the fingers and he was able to make a fist without pain. He had good sensation in all of the fingers. No deformities were noted. The color of the tips of the fingers was normal. The veteran had some cold sensitization at that time, which was similar to Raynaud's phenomenon. There was no chronic pain or arthralgia at that time. The impression, in pertinent part, was cold injury to both hands and feet. The Board finds that the April 1998 examination is not competent medical evidence of a nexus between the current diagnosis of cold injury to the hands and the veteran's period of service. The examiner noted that the veteran reported that he had sustained frostbite in service. However, the examiner further indicated that he did not have the veteran's clinical records to review. As discussed in detail above, the service medical records do not establish that the veteran sustained severe frostbite to the hands in service. The Court has held that evidence which is simply information recorded by a medical examiner, unenhanced by any additional medical comment by that examiner, does not constitute competent medical evidence. LeShore v. Brown, 8 Vet. App. 406, 409 (1995). Thus, the Board finds that the notations in the April 1998 VA examination report, that the veteran experienced severe frostbite in service, is not competent evidence of service incurrence of cold injury to the hands or competent evidence of a nexus between the veteran's current diagnosis of cold injury to the hands and his period of service. The veteran asserts that his current diagnosis of cold injury to the hands was caused by exposure to cold in service. Although the veteran and other lay persons are competent to provide an account of the veteran's symptoms, "the capability of a witness to offer such evidence is different from the capability of a witness to offer evidence that requires medical knowledge." See Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The veteran himself does not possess the technical or specialized knowledge to provide a probative conclusion with respect to the issue of whether the current diagnosis of cold injury to the hands is medically related to his period of service. See Espiritu, supra. Thus, the veteran's statements do not establish a medical nexus. The Board also points out that lay assertions of medical causation cannot constitute evidence to render a claim well grounded under 38 U.S.C.A. §5107(a); if no cognizable evidence is submitted to support a claim, the claim cannot be well grounded. See Grottveit v. Brown, 5 Vet. App. at 93. The veteran has not submitted any other medical opinion to support his claim. As discussed in detail above, there is no medical evidence of record which establishes a diagnosis of cold injury to the hands in service. Because the evidence of record does not establish a diagnosis of cold injury to the hands in service, the provisions of 38 C.F.R. § 3.303(b) do not assist the veteran in the submission of a plausible claim. The Board also finds that the veteran's statements that he has had the same symptomatology since service are insufficient to establish continuity of symptomatology under 38 C.F.R. § 3.303(b). There are no clinical records to support the veteran's assertion that he has continuity of symptomatology of cold injury to the hands since service. Furthermore, as noted above, the veteran has not submitted competent medical evidence which relates his current cold injury to the hands to his complaints of numbness, paresthesia, and tingling for the past 20 years. Thus, the Board finds that the provisions of 38 C.F.R. § 3.303(b) do not assist the veteran in the submission of a plausible claim. In light of the absence of competent medical evidence of a nexus between the current diagnosis of cold injury to the hands and the veteran's period of service, the veteran's claim is implausible and not well grounded. Therefore, the claim must be denied. 38 U.S.C.A. § 5107(a). II. Entitlement to an Increased Evaluation In general, an allegation of increased disability is sufficient to establish a well-grounded claim seeking an increased rating. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The Board is satisfied that all relevant facts have been properly developed. The veteran was afforded VA examinations in 1997 and 1998. Pertinent treatment records were obtained. No further assistance is required to comply with the duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a). Pertinent Law and Regulations In evaluating the severity of a particular disability, it is essential to consider its history. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. §§ 4.1 and 4.2 (1999). However, where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). In Fenderson v. West, 12 Vet. App. 119 (1999), it was held that evidence to be considered in the appeal of an initial assignment of a rating disability was not limited to that reflecting the then current severity of the disorder. Cf. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Disability evaluations are determined by the application of a schedule of ratings that is based on average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 1991). Percentage evaluations are determined by comparing the manifestations of a particular disorder with the requirements contained in the VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can practically be determined, the average impairment in earning capacity resulting from such disease or injury and their residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (1999). Where there is a question as to which of two evaluations shall be applied, 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 (1999). When an unlisted condition is encountered it will be permissible to rate under a closely related disease to injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20 (1999). The provisions of 38 C.F.R. § 4.40 state that the 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. According to this regulation, it is essential that the examination on which ratings are based adequately portrays the anatomical damage, and the functional loss, with respect to these elements. In addition, the regulations state that the functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40 (1999). The provisions of 38 C.F.R. § 4.45 state that when evaluating the joints, inquiry will be directed as to whether there is less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. 38 C.F.R. § 4.45 (1999). With any form of arthritis, painful motion is an important factor of disability. The intent of the Rating Schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or maligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and non weight-bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59 (1999). After reviewing all the evidence and material of record, where there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given the claimant. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. § 3.102 (1999). Thus, when a veteran seeks benefits and the evidence is in relative "equipoise," the law mandates that the veteran prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Analysis Entitlement to a Disability Evaluation in Excess of 10 Percent for Eczema Service connection for eczema was established in a February 1987 rating determination. A noncompensable disability evaluation was assigned effective July 29, 1986. The award was based upon service medical records which show that eczema was diagnosed in June 1978. An October 1986 VA examination report indicates that examination of the skin revealed that the veteran had residuals of some tiny vesicles that were ruptured and were drying up on the back and the front of his hands. The vesicles were about 1 millimeter in diameter and were grouped in clusters. Some had a firm consistency, along the sides of the fingers. There were no lesions between the toes and feet. The diagnosis was dyshidrotic eczematous dermatitis of both hands, chronic and mild. In February 1997, the veteran filed a claim for an increased rating. In an October 1997 rating decision, the RO assigned a 10 percent evaluation to the eczema effective February 13, 1997. The veteran contends that he is entitled to a higher evaluation. The RO assigned the 10 percent disability evaluation to the veteran's service-connected eczema under Diagnostic Code 7806, eczema. Under this diagnostic code, a noncompensable evaluation is warranted for eczema with slight, if any, exfoliation, exudation, or itching on a nonexposed surface or small area. 38 C.F.R. § 4.118, Diagnostic Code 7806. A 10 percent evaluation requires exfoliation, exudation, or itching and involvement of an exposed surface or extensive area. Id. A 30 percent evaluation requires constant exudation or itching, extensive lesions, or marked disfigurement. Id. A 50 percent evaluation requires ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations or exceptionally repugnant disfigurement. 38 C.F.R. § 4.118, Diagnostic Code 7806 (1999). In applying the law to the existing facts, the record does not demonstrate the requisite objective manifestations for a disability evaluation in excess of 10 percent for the eczema under the provisions of Diagnostic Code 7806. The medical evidence of record shows that upon VA dermatological examination in April 1997, small dyshidrotic palmar-solar cutaneous junction pompholyx, consistent with dyshidrotic eczema, were detected on the hands and feet. There were isolated eczematoid lesions on the back and on the antecubits. The diagnosis was eczema with palmar solar dyshidrosis and isolated body lesions, in fair remissions, on therapies. The veteran reported that he used some creams and emollients for the condition he applied amcinonide ointment to the hands and applied an ammonium lactate solution, twice daily, topically. A March 1997 VA dermatological treatment record indicates that the veteran had minimal xerosis. An October 1997 VA treatment record indicates that the dyshidrosis was well controlled on medication. An April 1998 VA examination report indicates that examination revealed no evidence of eczema on the back. Examination of the feet revealed that the veteran had some blisters, which were reddish, small, and punctate, over the second and fourth toes, bilaterally. There were several blisters on the plantar aspect of both feet, in the mid-section, that were well-healed, without infection. There were blisters over the radial aspect of the index fingers, bilaterally. The blisters were punctate and small, over the distal interphalangeal joint region. There was no evidence of infection. At the hearing before the Board in November 1999, the veteran stated that the eczema affected him from head to toe. Tr. 8. The worst part was on his back around his buttocks up to his shoulder, where he had scaly, dry skin. Tr. 8. That was the hardest part to get to when applying medication; he could not reach around his back. Tr. 8. He indicated that his skin flaked off and itched; the itching became painful sometimes. Tr. 13. The eczema did not stop the veteran from doing anything; it was just uncomfortable. Tr. 13. There is no medical evidence of constant exudation, extensive lesions, or marked disfigurement. As noted above, the eczema was in fair remission upon examination in April 1997. Only isolated lesions were detected on the back and antecubits in 1997. Upon examination in April 1998, there was no evidence of eczema on the back and no evidence of lesions. There is no medical evidence of ulceration or extensive exfoliation or crusting, systemic or nervous manifestations, or exceptionally repugnant disfigurement due to the eczema. The medical evidence of records indicates that the veteran had a nodule on the right temple excised in April 1997. The wound healed well and there is no medical evidence of residuals. Thus, the Board finds that overall, the objectively demonstrated manifestations associated with the service- connected eczema does not support an evaluation in excess of 10 percent. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.118, Diagnostic Codes 7806. As shown above, the Board has considered all potentially applicable provisions of 38 C.F.R. Parts 3 and 4, whether or not they have been raised by the veteran or his representative, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In this case, the Board finds no provision upon which to assign a higher rating for the eczema. The Board finds the preponderance of the evidence is against the claim for an increased rating for eczema. In summary, a disability evaluation in excess of 10 percent is not warranted for the veteran's service-connected eczema for the reasons discussed above. Entitlement to a Compensable Evaluation for Chondromalacia of the Knees Service connection for chondromalacia of bilateral knees was established in a February 1987 rating determination. A noncompensable disability evaluation was assigned effective July 29, 1986. The award was based upon service medical records and the findings of the October 1986 VA examination. The service medical records show that in December 1975, chondromalacia of the left knee was assessed and in October 1976, chondromalacia of the right knee was assessed. An October 1986 VA examination report indicates that flexion of the right knee was to 135 degrees, and extension was to zero degrees. Flexion of the left knee was to 132 degrees and extension was to zero degrees. There was no swelling or effusion. There was crepitus on motion but no pain on pressure. The patella was in a good position and nontender. McMurray's test was negative. There was no wasting of the quadriceps or circulatory disturbance. He was able to squat and arise on his heels and toes and stand on either foot alone. He did not wear a knee brace or use a walking aid. He walked with a normal gait. X-ray examination was normal. The diagnosis, in pertinent part, was residual injuries to both knees. An April 1998 VA examination report indicates that the veteran reported having pain in both knees, the right worse than the left. He took aspirin for his pain. Examination revealed that the veteran had full range of motion of the knees. There was no swelling or evidence of deformity. There was tenderness of the patella, bilaterally. McMurray's sign was negative. There was no instability medially or laterally. There was no calf tenderness. The veteran had full strength in his quadriceps. It was noted that X-ray examination of the knees, which was performed in June 1997, revealed that bone density was within normal limits; there were no findings of arthritis. The veteran walked normally without an antalgic gait. No atrophy was noted. Reflexes were within normal limits. There was no sensory loss, motor weakness, or atrophy noted. The impression was pain, both knees, without objective findings and without any limitation of motion. The examiner noted that the knee disability did not impair his regular activities. X-ray examinations of the knees were within normal limits. There was no evidence of fracture or dislocation. No knee effusion was appreciated. At a hearing before the Board in November 1999, the veteran stated that he had painful motion of the knees. Tr. 6. He indicated that when sitting, he experienced pain if he stayed in one position for too long. Tr. 6. He experienced the pain daily. Tr. 6. He took medication for the pain and would sit down and stretch out his legs. Tr. 6. The veteran stated that aspirin helped and he did not take other pain medications. Tr. 7. The veteran took one aspirin in the morning and one at night for the pain in his knees. Tr. 12. The RO assigned a noncompensable disability evaluation to the chondromalacia of the knees, by analogy, under the provisions of Diagnostic Code 5003, degenerative arthritis. Diagnostic Code 5003 specifies that 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 or joints involved (DC 5200 etc.). 38 C.F.R. § 4.71a, Diagnostic Code 5003 (1999). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Diagnostic Codes 5260 and 5261, are utilized to rate limitation of flexion and extension of the knee joint. 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5261 (1999). Under Diagnostic Code 5260, limitation of flexion of the knee to 60 degrees warrants a noncompensable evaluation, limitation of flexion to 45 degrees will result in the assignment of a 10 percent rating, limitation of flexion to 30 degrees warrants a 20 percent evaluation and limitation of flexion to 15 degrees warrants a 30 percent evaluation, the highest schedular evaluation under this diagnostic code. 38 C.F.R. § 4.71a, Diagnostic Code 5260 (1999). Under Diagnostic Code 5261, limitation of extension of the knee to 5 degrees warrants a noncompensable evaluation, limitation of extension of the knee to 10 degrees warrants 10 percent evaluation, limitation of extension to 15 degrees warrants a 20 percent evaluation and limitation of extension to 20 degrees warrants a 30 percent evaluation. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Limitation of extension of the knee to 30 degrees warrants a 40 percent evaluation and limitation of extension of the knee to 45 degrees warrants a 50 percent evaluation, the highest schedular evaluation under this diagnostic code. Id. The Rating Schedule provides that the range of motion of the knee is zero degrees on extension to 140 degrees on flexion. 38 C.F.R. § 4.71, Plate II (1999). In applying the law to the existing facts, the record does not demonstrate the requisite objective manifestations for a compensable disability evaluation for chondromalacia of the knees under Diagnostic Codes 5260 or 5261. The medical evidence of record demonstrates that there was tenderness to the patellae and complaints of pain with motion of the knees. The Board notes that there is no X-ray evidence of degenerative arthritis of the knees, and stresses that the bilateral knee disability was rated under Diagnostic Code 5003 by analogy. The medical evidence demonstrates that the veteran had a full flexion of the knees. In order for a disability evaluation of 10 percent to be assigned under Diagnostic Code 5260, flexion must be limited to 45 degrees or less. Thus, the Board concludes that a compensable evaluation is not warranted under Diagnostic Code 5260. 38 C.F.R. § 4.71a, Diagnostic Code 5260. In order for a disability evaluation of 10 percent to be assigned under Diagnostic Code 5261, extension of the left knee must be limited to 10 degrees or more. The medical evidence of record establishes that extension of the knees is full. The veteran complains of pain with motion. Thus, the Board concludes that a compensable disability evaluation is not warranted under Diagnostic Code 5261. 38 C.F.R. § 4.71a, Diagnostic Code 5261. The Board has examined the provisions of 38 C.F.R. §§ 4.40, 4.45 and 4.59 in order to evaluate the existence of any functional loss due to pain, or any weakened movement, excess fatigability, incoordination, or pain on movement of the veteran's knee joints. See DeLuca v. Brown, 8 Vet. App. 202 (1995). In this case, the veteran complains of pain on motion of the knees. However, the medical evidence does not include objective signs of pain on motion or limitation of motion. The April 1998 VA examination report indicates that the impression was pain, both knees, without objective findings or limitation of motion. There was no instability, sensory loss, or motor weakness upon examination. No atrophy was noted. The veteran had full strength of the quadriceps. He walked normally, without an antalgic gait. Reflexes were normal. The veteran reported that aspirin helped his knee pain. Thus, the Board finds that 38 C.F.R. §§ 4.40, 4.45 and 4.59 do not provide a basis for a compensable disability rating for the chondromalacia of the knees. The veteran asserts that he was not hired by the post office due to impairment caused by his service-connected bilateral knee disability. The Board finds that the evidence of record does not support this contention. The correspondence from the post office indicates that the veteran had a significant history of nonparalytic orthopedic impairments and this condition was not compatible with activities required by the postal position. However, the Board points out that the post office did not indicate that the orthopedic impairment was due to the service-connected chondromalacia of the knees, as opposed to the service-connected residuals of the left shoulder injury, which was 10 percent disabling, or the service-connected postoperative status dislocation of the right shoulder, which was 20 percent disabling. Thus, the Board finds that the medical evidence of record does not establish that the veteran has occupational impairment due to the service-connected chondromalacia of the knees. The veteran's service-connected bilateral knee disability may also be rated under the provisions of Diagnostic Code 5257, impairment of the knee, recurrent subluxation and lateral instability. Under Diagnostic Code 5257, a 10 percent disability evaluation requires slight impairment of either knee. A 20 percent evaluation requires moderate impairment. A 30 percent evaluation requires severe impairment. 38 C.F.R. § 4.71a, Diagnostic Code 5257 (1999). The medical evidence of record does not demonstrate that the veteran has instability of the knees. Examination did not reveal any evidence of swelling or deformity. Thus, the Board finds that a compensable disability rating is not warranted under Diagnostic Code 5257 for the bilateral knee disability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. As noted above, there are situations in which the application of 38 C.F.R. §§ 4.40 or 4.45 is warranted in order to evaluate the existence of any functional loss due to pain, or any weakened movement, excess fatigability, incoordination, or pain on movement of the veteran's joints. See DeLuca v. Brown, 8 Vet. App. 202 (1995). However, in this case, where the diagnostic code under which the veteran is rated, 38 C.F.R. § 4.71, Diagnostic Code 5257, is not predicated on loss of range of motion, §§ 4.40 and 4.45, with respect to pain, do not apply. See Johnson v. Brown, 9 Vet. App. 7 (1996). The Board has examined all other diagnostic codes pertinent to the knee. There was no evidence of ankylosis of the knees. Consequently, Diagnostic Code 5256 is not for application. See 38 C.F.R. § 4.71a, Diagnostic Code 5256 (1999). There is no evidence of semilunar cartilage. Thus, Diagnostic Codes 5258 or 5259 are not for application. See 38 C.F.R. § 4.71a, Diagnostic Codes 5258 and 5259 (1999). There is also no evidence of malunion or nonunion of the tibia and fibula; Diagnostic Code 5262 for impairment of the tibia and fibula is not for application in this case. See 38 C.F.R. § 4.71a, Diagnostic Code 5262 (1999). There is no evidence of genu recurvatum. Thus, Diagnostic Code 5263 is not for application. See 38 C.F.R. § 4.71a, Diagnostic Code 5263 (1999). As shown above, and as required by Schafrath, the Board has considered all potentially applicable provisions of 38 C.F.R. Parts 3 and 4, whether or not they have been raised by the veteran. In this case, the Board finds no provision upon which to assign a compensable rating to the bilateral knee disability. As shown above, and as required by Schafrath, the Board has considered all potentially applicable provisions of 38 C.F.R. Parts 3 and 4, whether or not they have been raised by the veteran. In this case, the Board finds no provision upon which to assign a compensable evaluation for the chondromalacia of the knees. After considering all possible rating criteria, the Board finds that a compensable evaluation is not warranted for the chondromalacia of the knees, bilateral. The preponderance of the evidence is against the veteran's claim. In summary, a compensable disability evaluation for chondromalacia of the knees is not warranted for the reasons described above. ORDER Entitlement to service connection for a cold injury to the hands is denied. Entitlement to a disability evaluation in excess of 10 percent for eczema is denied. Entitlement to a compensable disability evaluation for chondromalacia of the knees is denied. THOMAS J. DANNAHER Member, Board of Veterans' Appeals