Citation Nr: 0005231 Decision Date: 02/28/00 Archive Date: 03/07/00 DOCKET NO. 93-25 483 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUES 1. Entitlement to a rating in excess of 10 percent prior to April 18, 1991 for a respiratory disorder, to include reactive airway disease and chronic obstructive pulmonary disease (COPD). 2. Entitlement to an increased rating for a respiratory disorder, to include reactive airway disease and chronic obstructive pulmonary disease (COPD), currently evaluated as 30 percent disabling. 3. Entitlement to an increased rating for postoperative residuals of an excision of a soft tissue mass from the left lower leg, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Andrew E. Betourney, Associate Counsel INTRODUCTION The veteran served on active duty from October 1986 to October 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 1992 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia, which denied the veteran's claim for an increased rating in excess of 10 percent for his service-connected respiratory disorder, and from a July 1992 rating decision by that RO, which reduced the disability rating for the veteran's service-connected postoperative excision of a soft tissue mass from the left lower leg from 10 percent to noncompensable (zero percent). The veteran filed timely appeals to these adverse determinations. Subsequent to the entry of his appeal, in a rating decision dated in September 1993, the RO increased the disability evaluation for the veteran's service-connected respiratory disability from 10 percent to 30 percent, effective April 18, 1991. In addition, in a rating decision dated in January 1999, the RO increased the disability evaluation for the veteran's service connected left leg disorder from noncompensable (zero percent) to 10 percent, effective back to October 5, 1989, the date of service connection for that disorder. The Board notes that in a claim for an increased rating, the claimant will generally be presumed to be seeking the maximum available benefit allowed by law and regulation, and it follows that such a claim remains in controversy where less than the maximum available benefit is awarded. AB v. Brown, 6 Vet. App. 35, 38 (1993). There is nothing in the record to show that the veteran expressly stated that he was only seeking a 30 percent rating for his respiratory disorder, or a 10 percent rating for his left leg disorder. On the contrary, the claims file contains explicit evidence indicating that the veteran is not satisfied with these ratings, and desires that the appeal continue. Further, there is no written withdrawal of either issue under 38 C.F.R. § 20.204 (1999). Therefore, the Board will consider the increased rating decisions on appeal. When this matter was previously before the Board in May 1997 it was remanded to the RO for further development, which has been accomplished. The case is now before the Board for appellate consideration. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appeal has been obtained by the RO. 2. Prior to April 18, 1991, the veteran's respiratory disorder was manifested by periodic bouts of shortness of breath, requiring the use of an inhaler, dyspnea on exercise, and beginning chronic airway obstruction. 3. The veteran's respiratory disorder is currently manifested by moderately severe overall symptomatology, including shortness of breath and wheezing approximately once per week, occasional cough with expectoration, minimal scattered rales, and chronic airway obstruction, as well as pulmonary function test results consistent with the criteria for a 30 percent rating. 3. The veteran's postoperative residuals of an excision of a soft tissue mass from the left lower leg are currently manifested by pain and tenderness at the excision site, with no medical evidence of functional impairment. CONCLUSIONS OF LAW 1. The schedular criteria for 30 percent rating prior to April 18, 1991 for a respiratory disorder, to include reactive airway disease and chronic obstructive pulmonary disease, have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.97, Diagnostic Code 6600 (1991). 2. The schedular criteria for a rating in excess of 30 percent after April 17, 1991 for a respiratory disorder, to include reactive airway disease and chronic obstructive pulmonary disease, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.97, Diagnostic Codes 6600, 6604 (1991, 1999). 3. The schedular criteria for a rating in excess of 10 percent for residuals of an excision of a soft tissue mass from the left lower leg have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.118, Diagnostic Code 7804 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran's claims for increased ratings for a respiratory disorder, to include reactive airway disease and chronic obstructive pulmonary disease, and for residuals of an excision of a soft tissue mass from the left lower leg are well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). The United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (Court) has held that a mere allegation that a service-connected disability has increased in severity is sufficient to render the claim well grounded. See Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). The Board is also satisfied that all relevant facts needed to adjudicate schedular evaluations of the veteran's disorders have been properly developed. No further assistance to the veteran is required on those issues to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). Disability evaluations are determined by the application of the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). 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). Any reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3 (1999). I. Respiratory disorder A. Rating in excess of 10 percent prior to April 18, 1991 As noted above, the veteran's service-connected respiratory disorder was rated as 10 percent disabling at all times prior to April 18, 1991, at which time the RO increased the disability rating for this disorder to 30 percent. Evidence relevant to the severity of the veteran's respiratory disorder prior to that date includes treatment records dated from November 1989 to June 1991 from Welch Emergency Hospital, a private health care facility. These records indicate several diagnoses of bronchial asthma, for which the veteran used an inhaler. He was seen on several occasions for acute exacerbations, including in November 1989, April 1990, and September 1990. Symptoms at the time of these exacerbations included shortness of breath, wheezing, and a productive cough with yellowish sputum. Of note are the results of a pulmonary function test (PFT) conducted in December 1989. These results were interpreted as showing a moderate obstructive lung defect, with confirmed airway obstruction. Of note is a notation indicating that the veteran had suffered from dyspnea on exertion for the previous two years, and the fact that the veteran had a cough throughout the test. Also of record is the report of a VA examination conducted in March 1990. At that time, the veteran complained of sharp chest pain and shortness of breath. The results of a PFT performed at that time were said to indicate mild obstructive ventilatory defect, with good bronchodilator response, as well as some air trapping in the lungs. The examiner diagnosed COPD, mild. Also of record are VA outpatient treatment notes dated from March 1990 to January 1991, and private treatment records from this period from several sources, including Fairmont General Hospital and Princeton Community Hospital. These records indicate that the veteran was treated on several occasions for exacerbations of bronchial asthma, including visits in March and June 1990. Prior to April 18, 1991, the veteran's respiratory disorder was evaluated as 10 percent disabling under the provisions of 38C.F.R. § 4,71a, DC 6600. Pursuant to the criteria then in effect, a 10 percent rating was warranted for moderate chronic bronchitis, with considerable night or morning cough, slight dyspnea on exercise, and scattered bilateral rales. A 30 percent rating was warranted when such chronic bronchitis was moderately severe, with persistent cough at intervals throughout the day, considerable expectoration, considerable dyspnea on exercise, rales throughout the chest, and beginning chronic airway obstruction. A 60 percent rating was warranted for severe chronic bronchitis, with severe productive cough and dyspnea on slight exertion and pulmonary function tests indicative of severe ventilatory impairment. Finally, a 100 percent rating was warranted for pronounced chronic bronchitis, with copious productive cough and dyspnea at rest, pulmonary function testing showing a severe degree of chronic airway obstruction, with symptoms of associated severe emphysema or cyanosis and findings of rightsided heart involvement. A review of the evidence detailed above reveals that during the time period in question, the veteran's respiratory disorder, generally diagnosed as either bronchitis or bronchial asthma, was manifested by periodic bouts of shortness of breath, requiring the use of an inhaler. PFTs conducted during this period showed beginning chronic airway obstruction, as indicated by the diagnoses of moderate obstructive lung defect in December 1989 and mild COPD in March 1990. In addition, while the use of an inhaler appears to have kept the veteran's disorder somewhat under control, he did experience periodic flare-ups or exacerbations of the disorder, manifested by shortness of breath, coughing, production of yellowish sputum, and chest pain. Finally, the Board observes that the veteran was noted to suffer from dyspnea on exertion at the time of the PFT in December 1989. The Board finds that this symptomatology more closely corresponds to the "moderately severe" level of disability contemplated by a 30 percent under the former criteria of DC 6600. However, the evidence does not show that the veteran suffered from either a severe productive cough or dyspnea on slight exertion. Furthermore, the results of PFTs did not indicate severe ventilatory impairment, but rather only mild to moderate ventilatory impairment. Therefore, a higher, 60 percent rating prior to April 18, 1991 is not warranted by the evidence. The Board has also considered whether the veteran was entitled to a higher disability rating during the period in question under other, related codes. In this regard, the Board has considered the application of DC 6602, pursuant to which the severity of bronchial asthma is evaluated, as the veteran was diagnosed with said disorder prior to April 18, 1991. Under the provisions of this code in effect at that time, a 60 percent rating was warranted for severe bronchial asthma, with frequent attacks (one or more attacks weekly), marked dyspnea on exertion between attacks with only temporary relief by medication, and more than light manual labor precluded. A review of the evidence reveals that while the veteran did suffer from asthma attacks, there is no evidence which indicates that the veteran suffered from such attacks on a weekly basis. Furthermore, although the veteran reported experiencing some dyspnea on exertion, the evidence does not show that such dyspnea was marked in severity. Therefore, a higher rating under DC 6602 during the time period in question is not warranted by the evidence. B. Rating in excess of 30 percent from April 18, 1991 to the present Effective from April 18, 1991, the veteran's respiratory disorder has been rated as 30 percent disabling. Evidence relevant to the current level of severity of the veteran's respiratory disorder includes testimony presented at a hearing conducted before an RO hearing officer in May 1993. At that time, the veteran stated that he suffered from difficulty breathing every day, and was required to take medication for this problem. He stated that many things caused him to suffer from these attacks, including certain colognes, warm air, or eating certain foods. He stated that he sometimes went to the hospital for treatment following these attacks. Also relevant is the report of a VA examination conducted in August 1993. At that time, the veteran reported shortness of breath and wheezing intermittently for the previous five years, occurring approximately once per week. He stated that he had an occasional cough with expectoration of yellowish sputum. On examination, his breath sounds were normal, with minimal scattered, diminished breath sounds, and no wheezes or crackles. The examiner stated that the veteran had bronchial asthma, with attacks occurring about once a week. Between these attacks, the veteran was normal. He had slight dyspnea on exertion or at rest, with shortness of breath after walking 100 yards, with wheezing. As part of this examination, the veteran also underwent pulmonary function testing. The results of this testing showed that the veteran's Forced Expiratory Volume in one second (FEV-1) level was 71 percent of predicted, and the ratio of the FEV-1 to the Forced Vital Capacity (FVC) was 78 percent of predicted. The examiner interpreted these results as indicating moderately severe and predominant small airway flow limitation on pulmonary function screening, with significant improvement after inhalation of aerosol. The examiner diagnosed bronchial asthma, in remission. In January 1997, the veteran again underwent a PFT. At that time, his FEV-1 level was 70 percent of predicted, and the ratio of FEV-1 to FVC was 66 percent of predicted. In addition, the Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO(SB)) was 63 percent of predicted. In June 1997, the veteran underwent a VA examination. At that time, the examiner noted a recent history of asthma, fairly stable between attacks, and dyspnea at rest and on slight exertion. After citing the PFT results from the January 1997 examination, set forth above, the examiner diagnosed reactive airway disease, mild chronic obstructive pulmonary disease, and asthma. The veteran again underwent a VA examination in May 1998. Although the veteran actually underwent two separate respiratory examinations on that date, the Board shall address them together, since they were conducted at the same time by the same examiner using the same data. At the time of these examinations, the veteran underwent a PFT, which showed a FEV-1 level of 47 percent of predicted, a FEV-1/FVC ratio of 60 percent of predicted, and a DLCO(SB) of 74 percent of predicted. These results were interpreted to represent a mild to moderate obstructive airway disease, with a mild degree of air trapping, a minimal reduction in diffusion capacity, and mild to moderately reduced vital capacity. Final diagnoses included COPD and bronchial asthma. The veteran also underwent a VA PFT in November 1998. Although the percentages of predicted values for the criteria of FEV-1 and FEV-1/FVC were not provided, the examiner did state that there was "an impressive improvement to almost normalization in the patient's forced vital capacity and FEV- 1" following bronchodilation. The DLCO(SB) was recorded at 47 percent of predicted. The examiner diagnosed mild to moderate obstructive airway disease, with impressive reversibility after the inhaled bronchodilators. As of April 18, 1991, the veteran's respiratory disability has been rated as 30 percent disabling under the provisions of DC 6600, the provisions of which are set forth above. Pursuant to the criteria in effect at the time of this increase, the Board again finds that the severity of the veteran's respiratory disorder more closely approximates the criteria for a 30 percent rating. The veteran reported experiencing shortness of breath and wheezing approximately once per week, with occasional cough and expectoration. The examiner who performed the August 1993 VA examination also noted the presence of minimal scatter rales. PFTs have revealed the presence of obstructive airway disease, described as "mild" in June 1997, and as "mild to moderate" in both May and November 1998. Furthermore, the veteran has reported dyspnea at rest and on mild exertion, with shortness of breath after walking 100 yards. The Board finds that, overall, this symptomatology more closely corresponds to the "moderately severe" level of severity contemplated by a 30 percent rating under the former provisions of DC 6600. However, the evidence does not show that the veteran suffers from a severe productive cough and PFT results have not shown severe ventilatory impairment, as contemplated by a 60 percent rating. On the contrary, the veteran has reported only occasional cough with expectoration, with no cough noted at the time of examinations. Furthermore, as noted above, PFTs have shown only mild to moderate ventilatory impairment. Therefore, a higher, 60 percent rating under the former criteria of DC 6600 is not warranted by the evidence. The Board notes that effective October 7, 1996, VA revised the criteria for diagnosing and evaluating respiratory disabilities, including bronchitis and bronchial asthma, as codified at 38 C.F.R. §§ 4.96-4.97. See 61 Fed. Reg. 46,720 (1996). Pursuant to Karnas v. Derwinski, 1 Vet. App. 308 (1991), where the law or regulation changes after a claim has been filed or reopened but before the administrative or judicial appeal process has been concluded, the version most favorable to the appellant normally applies, absent Congressional intent to the contrary. Thus, the Board will analyze the severity of the veteran's respiratory disorder under the revised regulations as well. Under these newer standards, a 10 percent rating is warranted when the FEV-1 level is 71 to 80 percent of predicted, or the FEV-1 to FVC ratio is 71 to 80 percent, or the DLCO(SB) is 66 to 80 percent of predicted. A 30 percent rating is warranted when the FEV-1 level is 56 to 70 percent of predicted, or the FEV-1 to FVC ratio is 56 to 70 percent, or the DLCO(SB) is 56 to 65 percent of predicted. A 60 percent rating is warranted when the FEV-1 level is 40 to 55 percent of predicted, or the FEV-1 to FVC ratio is 40 to 55 percent, or the DLCO(SB) is 40 to 55 percent of predicted, or maximum oxygen consumption is 15 to 20 ml/kg/min (with cardiorespiratory limit). Finally, a 100 percent rating is warranted when the FEV-1 level is less than 40 percent of predicted, or the FEV-1 to FVC ratio is less than 40 percent, or the DLCO(SB) is less than 40 percent of predicted, or maximum exercise capacity is less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or cor pulmonale (right heart failure) is present, or right ventricular hypertrophy is present, or pulmonary hypertension (shown by Echo or cardiac catheterization) is present, or there are episode(s) of acute respiratory failure, or the veteran requires outpatient oxygen therapy. A review of the evidence under these new standards reveals that the results of recent pulmonary function testing correspond most closely to the level of severity contemplated by a 30 percent rating under these new criteria. Although the results of the August 1993 PFT were all actually better than that which is required for a 30 percent rating, testing results in January 1997 were within the ranges listed for a 30 percent rating for all three PFT criteria. While the April 1998 PFT results showed a FEV-1 level of 47 percent of predicted, which is more severe than what is contemplated by a 30 percent rating, the DLCO(SB) was at 74 percent, which is significantly less severe than what is required for a 30 percent rating, and the FEV-1/FVC ratio was 60 percent, which is within the range contemplated for a 30 percent rating. Finally, although the percentage results from the November 1998 PFT were not provided, the Board observes that the post- bronchodilation figures for both FEV-1 and FVC were said to be almost normal. The examiner noted that there was an impressive improvement to almost normalization in the veteran's FVC and FEV-1. The Board finds that, after reviewing the evidence in its entirety, the veteran's respiratory disorder more closely approximates the level of severity contemplated for a 30 percent rating under the revised criteria of DC 6604. The Board has again considered whether the veteran is entitled to a rating in excess of 30 percent under the provisions of other, related codes. However, the Board observes that DC 6602, pursuant to which the severity of bronchial asthma is evaluated, sets out rating criteria which are almost identical to those found in DC 6600, including the same ranges of PFT results. The only added criteria for a 60 percent rating under DC 6602 include evidence of at least monthly visits to a physician for required care of exacerbations, or intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. As the evidence does not show that the veteran is treated either for his exacerbations or with corticosteroids with such frequency, a 60 percent rating is not warranted. C. Conclusion for respiratory disorder claims The Board would point out that its disposition of each of the instant increased rating claims is based solely upon the provisions of the VA's Schedule for Rating Disabilities. In Floyd v. Brown, 9 Vet. App. 88, 96 (1996), the Court held that the Board does not have jurisdiction to assign an extra- schedular evaluation pursuant to the provisions of 38 C.F.R. § 3.321(b)(1) (1999) in the first instance. In this appeal, however, there has been no assertion or showing that the disabilities under consideration have caused marked interference with employment (i.e., beyond that contemplated in the assigned evaluation) or necessitated frequent periods of hospitalization so as to render the schedular standards inadequate and to warrant assignment of an extra-schedular evaluation. The Board acknowledges that the veteran was determined to be totally disabled by the Social Security Administration (SSA) beginning in 1989. However, a review of the SSA's determination, dated in March 1991, reveals that that agency specifically determined that the veteran's "medical history and residual functional capacity," i.e., his history of reactive airway disease and obstructive lung defect, standing alone, "suggests a finding of not disabled." However, the SSA determined that the veteran's nonexertional impairments, including mental retardation and recurrent adjustment disorder with depressed mood, served to prevent the veteran from engaging in even sedentary light jobs, and thus found the veteran to be totally disabled as a result. The Board notes that the veteran has not been service connected for either of these mental disorders. Therefore, in the absence of such factors, the Board is not required to remand these matters to the RO for the procedural actions outlined in 38 C.F.R. § 3.321(b)(1). See Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). II. Residuals of an excision of a soft tissue mass from the left lower leg Evidence relevant to the current level of severity of the veteran's residuals of an excision of a soft tissue mass from the left lower leg includes testimony provided at the time of the May 1993 RO hearing. At that time, the veteran complained of swelling and an aching pain in his left leg at the site of the excision scar. He stated that his leg swelled up from 2 to 4 times per week, usually after engaging in an activity such as walking. He stated that his leg sometimes "gave out," which he described as hurting after being on it for too long. He stated that he treated the pain and swelling with an over-the-counter medication and the use of hot towels or hot packs. Also of record is an operative report dated in July 1995 from Welch Emergency Hospital. At that time, the surgeon noted that the veteran had had a cyst removed from his left calf while in the military, which was said to be a soft tissue tumor. The veteran reported that he had continued to experience pain at the excision site, and that the area had become infected at one point. He also stated that there was a persistent lump at the site, which he wanted removed. A re-excision of a lesion of the left calf was performed. In June 1997, the veteran underwent a VA examination. At that time, the veteran stated that following his surgery at Welch Emergency Hospital, he "did okay" for a while, but that recently the area had begun to swell. He also complained of some pain in the area of the excised tumor on walking. He reported that he used Motrin to help alleviate this pain. On examination, no tissue loss was evident visually, although on measurement of the left calf it was 1 centimeter smaller than the right. The scar itself was mildly to moderately tender, with some keloid formation in the center portion. There was an indefinite nodule in the center of the scar. No adhesions were found. There was no evidence of any muscle herniation or damage to the tendons, bones, nerves, or joints. There was no loss of function of either plantar or dorsiflexion of the ankle, and there was no pain present except on deep pressure over the scar itself. The examiner diagnosed postoperative residuals of excision of a benign angiomyolipoma of the left leg, with possible recurrence. In response to questions raised in a May 1997 Board remand, the examiner commented that the tumor excision did not result in any weakness, excess fatigability, or muscle atrophy, but that the veteran complained of pain on walking sometimes. The veteran again underwent a VA examination in May 1998. At that time, the examiner reviewed the veteran's medical history, as contained in the veteran's claims file, including the initial soft tissue removal in May 1987, a subsequent postoperative infection, and a second tissue mass excision in May 1997. The veteran complained of heat and swelling at the operative site, which he treated with Motrin and the use of a hot pack. He also complained of constant aching in the center of the excision scar, made worse by walking. He reported that there was no drainage. On examination, the veteran walked with an uneven gait and a questionable limp on the left. He reported pain in the left calf when attempting to squat, and when walking on his heels. The scar itself was quite tender over its entire length, with hyperpigmentation in the center portion. A small, movable, firm mass could be felt beneath the upper part of the scar, and was about 1 centimeter in diameter. He could dorsiflex and plantar flex both ankles against resistance equally well. There was no weakened movement present, and no incoordination on walking. Movement of the joints, ankle, and knee caused no pain, although the veteran reported occasional pain on walking. X-rays of the left tibia, fibula, and femur showed no abnormalities. The examiner diagnosed status post excision of a probable Baker's cyst, left calf, recurrent, located adjacent to the peroneus longus and extensor digitorum longus muscles. The veteran's residuals of an excision of a soft tissue mass from the left lower leg have been evaluated as 10 percent disabling under the provisions of 38 C.F.R. § 4.118, DC 7804, pursuant to which the severity of superficial scars which are tender and painful on objective demonstration is evaluated. Under this code, a 10 percent rating is the only, and therefore the highest, rating available. Since the veteran has already been assigned the maximum 10 percent rating, a rating in excess of 10 percent under DC 7804 is not available. The Board has therefore considered whether the veteran is entitled to a higher rating under the criteria of other, related DC sections. The veteran is not entitled to a rating under the provisions of DC 7800, as his scar is not located on his head, face, or neck. Similarly, his scar is not the result of a burn, as is contemplated by DC 7801 and DC 7802. Finally, the evidence does not indicate that the veteran's scar is poorly nourished with repeated ulceration, as is contemplated by the criteria of DC 7803. Finally, a rating under DC 7805, pursuant to which the severity of scars not specifically contemplated by other codes, would not result in a higher rating, since DC 7805 states that such scars are to be rated based on limitation of function of the part affected. In this case, the veteran's scar has been found not to affect any surrounding parts, such as his ankle or knee, and has been found not to have resulted in any weakness, excess fatigability, or muscle atrophy. Hence, an evaluation under any of these diagnostic codes is not warranted. The Board has also considered rating the veteran's disorder under DC 7819, pursuant to which the severity of benign new skin growths is evaluated. DC 7819 states that such growths are to be rated as for eczema, which is evaluated under DC 7806. Pursuant to DC 7806, a 10 percent rating is warranted for eczema with exfoliation, exudation or itching, if involving an exposed surface or extensive area. A 30 percent rating is warranted for eczema with exudation or itching which is constant, extensive lesions, or marked disfigurement. Finally, a 50 percent rating is warranted for eczema with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or when it is exceptionally repugnant. A review of the evidence reveals that the only significant symptom caused by the veteran's scar is pain and tenderness at the site. The Board finds that this symptomatology corresponds to no more than the 10 percent rating under DC 7806, particularly since the scar is not on an exposed surface or extensive area. Since there is no evidence of symptomatology such as extensive lesions or marked disfigurement, a higher, 30 percent rating is not warranted. For the foregoing reasons, the Board finds that a 10 percent rating is the appropriate rating for the veteran's residuals of an excision of a soft tissue mass from the left lower leg. The Board would again point out that its denial of the instant claim is based solely upon the provisions of the VA's Schedule for Rating Disabilities. As there has been no assertion or showing that the disability under consideration has caused marked interference with employment (i.e., beyond that contemplated in the assigned evaluation) or necessitated frequent periods of hospitalization so as to render the schedular standards inadequate and to warrant assignment of an extra-schedular evaluation, the Board is not required to remand this matter to the RO for the procedural actions outlined in 38 C.F.R. § 3.321(b)(1). See Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). ORDER A 30 percent rating prior to April 18, 1991 for a respiratory disorder, to include reactive airway disease and chronic obstructive pulmonary disease, is granted, subject to the controlling regulations governing the payment of monetary awards. A rating in excess of 30 percent for a respiratory disorder, to include reactive airway disease and chronic obstructive pulmonary disease is denied. A rating in excess of 10 percent for residuals of an excision of a soft tissue mass from the left lower leg is denied. STEVEN L. COHN Member, Board of Veterans' Appeals