Citation Nr: 0002231 Decision Date: 01/28/00 Archive Date: 02/02/00 DOCKET NO. 97-26 639A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Oakland, California THE ISSUES 1. Entitlement to service connection for hypertension. 2. Entitlement to service connection for bronchitis. 3. Entitlement to service connection for pharyngitis. 4. Entitlement to service connection for an acquired eye disorder. 5. Entitlement to an increased (compensable) evaluation for sinusitis. 6. Entitlement to an increased (compensable) evaluation for a disability of the right wrist. REPRESENTATION Veteran represented by: California Department of Veterans Affairs WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD Jeanne Schlegel, Associate Counsel INTRODUCTION The veteran served on active duty March 1993 to March 1997. This matter comes before the Board of Veterans' Appeals (Board) from a May 1997 rating determination by the Department of Veterans Affairs (VA) Regional Office (RO) in which the RO denied service connection for hypertension, bronchitis, pharyngitis, pathology of the eyes, disabilities of the thoracic and cervical spine, and for a throat disorder; and granted service connection for a disability of the right wrist and for sinusitis, for which noncompensable evaluations were assigned. The veteran appealed all of those issues. Subsequently, by rating action of July 1999, the RO granted service connection for a disability of the thoracic spine and for allergic rhinitis, for which noncompensable evaluations were assigned. The RO also granted entitlement to a 10 percent evaluation for multiple noncompensable service connected disabilities under 38 C.F.R. § 3.324. A review of the claim folder does not reveal that a Notice of Disagreement has been filed relative to any of these issues. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) [where an appealed claim for service connection is granted during the pendency of the appeal, a second Notice of Disagreement must thereafter be timely filed to initiate appellate review of the claim concerning the compensation level assigned for the disability]. Accordingly, only the issues enumerated on the front page of this decision are before the Board for appellate consideration at this time. In hearing testimony presented by the veteran in October 1998, the veteran indicated that he was not seeking service connection for a disability of the cervical spine. Accordingly, in the July 1999 RO hearing officer's decision, it was indicated that the matter had been withdrawn. Subsequently, neither the veteran or his representative have raised the issue and the Board has concluded that it has effectively been withdrawn. However, the Board also notes that during that hearing the veteran indicated that he experienced problems in the area of the lumbar spine. That issue has not been formally adjudicated and it is referred to the RO for appropriate action. FINDINGS OF FACT 1. There is no competent medical evidence in the record demonstrating that the veteran is currently diagnosed with hypertension. 2. There is no competent medical evidence that the veteran currently has chronic bronchitis. 3. There is no competent medical evidence that the veteran currently has chronic pharyngitis. 4. There is no competent medical evidence demonstrating a nexus between any currently diagnosed eye disorder and service. 5. The veteran's sinusitis is not productive of one or two incapacitating episodes per year requiring prolonged (lasting four to six weeks) antibiotic treatment, or three to six non- incapacitating episodes per year characterized by headaches, pain, and purulent discharge or crusting. 6. The veteran's right wrist disability is productive of pain, tenderness and limitation of motion. CONCLUSIONS OF LAW 1. The veteran has not presented a well-grounded claim of entitlement to service connection for hypertension. 38 U.S.C.A. § 5107(a) (West 1991). 2. The veteran has not presented a well-grounded claim of entitlement to service connection for bronchitis. 38 U.S.C.A. § 5107(a) (West 1991). 3. The veteran has not presented a well-grounded claim of entitlement to service connection for pharyngitis. 38 U.S.C.A. § 5107(a) (West 1991). 4. The veteran's eye disorders, diagnosed as a vitreous floater of the right eye, mild astigmatism and choroidal nevus of the left eye, are either congenital or developmental defects and therefore, they are not a diseases or injuries within the meaning of applicable law or regulations providing compensation benefits. 38 C.F.R. §§ 3.303(c), 4.9 (1999). 5. The veteran has not presented a well-grounded claim of entitlement to service connection for pathology of the eye currently diagnosed as a vitreous floater of the right eye, mild astigmatism and choroidal nevus of the left eye. 38 U.S.C.A. § 5107(a) (West 1991). 6. The schedular criteria for a compensable evaluation for sinusitis have not been met at any time since the veteran's discharge from service. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.97, Diagnostic Code 6510 (1999). 7. The criteria for a 10 percent evaluation for a right wrist disability have been met effective from March 11, 1997. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.71, 4.71a, Diagnostic Code 5215 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran is seeking entitlement to service connection for hypertension, bronchitis, pharyngitis, and an acquired eye disorder and entitlement to compensable evaluations for chronic sinusitis and a disability of the right wrist. In the interest of clarity, the law and regulations will initially be set out. The issues on appeal will then be discussed separately. Law and regulations Service connection In general, the applicable law and regulations state that service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303(a) (1999). Service connection may 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 C.F.R. § 3.303(d) (1999). Service connection may also be granted for chronic disabilities such as hypertension, if shown to be manifested to a compensable degree within one year after the veteran was separated from service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). Service connection may be granted on a secondary basis if a claimed disability is found to be proximately due to or is the result of a service-connected disability. 38 C.F.R. § 3.310(a) (1999); Harder v. Brown, 5 Vet. App. 183, 187 (1993). With chronic disease shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 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. 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). Increased Evaluations Disability evaluations are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4 (1999). The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321(a), 4.1 (1999). 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. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In Fenderson v. West, 12 Vet. App.119 (1999), however, the Court 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. Since this is an appeal of an initial rating assignment, the Board is not limited to consideration of the current diagnosis of the veteran's disability. Id. Well grounded claims The threshold question in every case is whether each claim presented is well-grounded under 38 U.S.C.A. § 5107(a). A well-grounded claim is a plausible claim which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). There must be more than an allegation; the claim must be accompanied by supporting evidence that justifies a belief by a fair and impartial individual that the claim is plausible. Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). The statutory duty to assist the veteran in the development of his claims does not arise unless and until a well-grounded claim is presented. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). In order for a claim to be well-grounded, the record must contain three types of competent evidence: (1) evidence of the current disability, usually shown by a medical diagnosis; (2) evidence of incurrence or aggravation of a disease or injury in service, shown by lay or medical evidence; and (3) evidence of a nexus between the in-service injury or disease and the current disability. See Epps v. Brown, 9 Vet. App. 341, 343-44 (1996); Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed.Cir. 1996). Where the determinative issue involves either medical etiology or a medical diagnosis, competent medical evidence is generally required to fulfill the well-grounded claim requirement of 38 U.S.C.A. § 5107(a). See Heuer v. Brown, 7 Vet. App. 379, 384 (1995). Additional law and regulations will be set forth where appropriate below. 1. Entitlement to service connection for hypertension. Factual Background The service medical records reflected that upon enlistment examination conducted in September 1992, clinical evaluation of the lungs and chest, heart, and vascular system were normal. Blood pressure of 112/72 was shown. In March 1993, a blood pressure reading of 140/48 was made. A blood pressure reading of 134/69 was made in March 1994. In March 1995, blood pressure readings of 139/66 and 135/62 were made. In a January 1996 medical record, a blood pressure reading of 156/66 was shown and a notation of increased blood pressure was made. In a January 1996 medical record it was noted that the veteran was to have a 5 day blood pressure check, however it does not appear that this occurred. Blood pressure readings made in February 1996 were 146/76 and 159/67. In June 1996, a blood pressure reading of 148/58 was made. Upon separation examination conducted in January 1997, clinical evaluation of the lungs and chest, heart, and vascular system were normal. Blood pressure of 110/70 was shown. A second blood pressure reading made in January 1997 was 135/59. A VA examination was conducted in May 1997. With respect to hypertension, the veteran reported that he was told that he had elevated blood pressure reading on several occasions by physicians in the military. It was noted that he was not on medication for hypertension and had no history of stroke, heart attack or kidney failure. Blood pressure when supine was 116/78, when sitting was 122/80 and when standing was 118/80. Cardiovascular examination revealed a regular rate and rhythm, S1, S2 without murmur, rub or gallop. Lungs were clear to auscultation and percussion. An impression of status post elevated blood pressure without clinical evidence of hypertension was made. The veteran presented testimony at a hearing held at the RO in October 1998. He testified that the last time he had gone to a doctor, there had been a considerable drop in his blood pressure. He stated that he had been offered medication for high blood pressure, but declined to take it. Analysis In order for a claim to be well grounded, there must be competent evidence of (1) a current disability (a medical diagnosis); (2) incurrence or aggravation of a disease or injury in service (lay or medical evidence); and (3) a nexus between the in-service injury or disease and the current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995). That a condition or injury occurred in service alone is not enough; there must be a current disability resulting from that condition or injury. Chelte v. Brown, 10 Vet. App. 268, 271 (1997); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). All three prongs of the Caluza test must be satisfied in order for the claim to be well grounded. The Board finds that there is no competent medical evidence of record to show the veteran is suffering from the current claimed disability, i.e., hypertension, in this case. Therefore, the first prong of the Caluza test is not met. Hypertension was not diagnosed upon 1997 VA medical examination, and in fact the examiner specifically noted that there was no clinical evidence of hypertension at that time. There has been no medical evidence presented which indicates or even suggests that hypertension is currently present. Because the veteran has not submitted competent evidence of hypertension, the Board concludes that the veteran's claim of service connection for hypertension is not well grounded and must be denied. Degmetich v. Brown, 104 F.3d 1328, 1332 (Fed.Cir. 1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). The Board has also considered whether the veteran may be afforded the presumption of service connection upon application of 38 C.F.R. §§ 3.307, 3.309 (1999). However, the evidence does not reflect that hypertension manifested to a compensable degree within one year after the veteran was separated from service. In order to warrant a compensable (10 percent) evaluation under 38 C.F.R. § 4.104, Diagnostic Code 7101, the evidence would have to show diastolic pressure of predominantly 100 or more, or; systolic pressure of 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. The evidence does not so show and accordingly service connection may not be afforded upon this basis. Although the lack of a current disability, alone, is fatal to the veteran's claim, the Board observes in passing that veteran was not diagnosed in service with hypertension. Rather, there were occasional readings of elevated blood pressure shown during service and elevated blood pressure was notated. Accordingly, the second Caluza prong has also not been met. With respect to the third Caluza prong, medical nexus evidence, this, too, is lacking. The Court has held that "[i]n the absence of competent medical evidence of a current disability and a causal link to service or evidence of chronicity or continuity of symptomatology, a claim is not well grounded." Chelte v. Brown, 10 Vet. App. 268 (1997). The veteran has in essence indicated that he has hypertension which is related to service. However, where the determinative issue involves either medical causation or medical diagnosis, competent medical evidence is required; where the determinative issue does not require medical expertise, lay testimony may suffice. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494-495 (1992). A veteran's statement that he is suffering from a current disability is not by itself sufficient to make a claim well grounded since a lay person is not competent to offer evidence requiring medical knowledge. Cromley v. Brown, 7 Vet. App. 376, 379 (1995); Boeck v. Brown, 6 Vet. App. 14, 16 (1993). Thus, while the veteran is competent to testify regarding the events that are alleged to have occurred during his active service, he is not competent to diagnose a medical condition or its etiology. Therefore, the veteran's testimony and claim that he is suffering from service-related hypertension is not sufficient to make his claim well grounded and the claim is therefore denied. 2. Entitlement to service connection for bronchitis. 3. Entitlement to service connection for pharyngitis. Factual Background Upon enlistment examination conducted in September 1992, clinical evaluation of the mouth and throat was normal as was a clinical evaluation of the lungs and chest. The record shows that in March 1993, the veteran seen for complaints of cough and congestion which was assessed as a viral upper respiratory infection. In March 1994, the veteran was treated for sinusitis and was placed on profile due to a sinus infection. In December 1994, the veteran was seen for complaints of post nasal drip and a sore throat which was assessed as an upper respiratory infection. The veteran was treated for upper respiratory infection and allergies in March 1995. He was treated for allergic bronchitis in June 1995. In October and December 1995, he was again treated for upper respiratory infections. In July 1996, the veteran was treated for sinusitis. He was also treated in 1996 for tonsillitis. Upon separation examination conducted in January 1997, clinical evaluation of the mouth and throat revealed only enucleated tonsils. Clinical evaluation of the lungs and chest was normal. The examiner noted that the veteran had seasonal allergic rhinitis in 1996 and 1997 and a diagnosis of sinusitis in 1996 for which medication was diagnosed. The veteran indicated that he had experienced ear, nose and throat trouble as well as sinusitis. Additional Air Force Base medical records showed that the veteran was treated for allergic rhinitis in August 1996, October 1996 and January 1997. A VA examination was conducted in May 1997. With respect to bronchitis, it was noted that the veteran was status post treatment for bronchitis in the military. It was noted that he was not on any medications for that condition, was not using an inhaler and had no complaints of cough or asthma. With respect to a sore throat, it was noted that the veteran was status post sore throat due to upper respiratory infection. It was noted that there was no history of recurrent sore throat a the time of the examination. Head, eyes, ears, nose and throat examination revealed oropharynx without injection, tonsilar enlargement or exudate. Turbinates were without excessive secretions or inflammation. Lungs were clear to auscultation and percussion. X-ray films of the chest were negative. Impressions of status post bronchitis without evidence of bronchitis or asthma at present and status post viral pharyngitis without evidence of pharyngitis at present, were made. The veteran presented testimony at a hearing held at the RO in October 1998. He testified that he did not have any bronchial problems as of that time and that the bronchial problems which he had experienced usually occurred when he did not take his medication and had a flare up of an infection. He testified that he had a chronic cough and that he experienced problems when taking the medications Trinalin, Actifed, Biaxin and Afrin. The veteran also testified that his throat problems were on-going and that they could be related to sinusitis. He indicated that doctors had not made a diagnosis with regard to the throat. At the hearing the veteran submitted a list of medications he was taking, consisting of Trinalin, Actifed, Biaxin and Afrin and side effects which was experiencing as a result of these medications, including headaches, dizziness, dry nose and throat, hypertension and, pharyngitis. In a RO rating action dated in July 1999, service connection was granted for allergic rhinitis. The RO denied the claim of entitlement to service connection for bronchitis and pharyngitis. Analysis As stated previously, in order for a claim to be well grounded, there must be competent evidence of (1) a current disability (a medical diagnosis); (2) incurrence or aggravation of a disease or injury in service (lay or medical evidence); and (3) a nexus between the in-service injury or disease and the current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995). A review of the record does not reflect that current diagnoses of the claimed conditions, bronchitis and pharyngitis, have been made. In fact, on VA examination conducted in May 1997, the examiner specifically indicated that there was no evidence of bronchitis, asthma, or pharyngitis upon examination. Essentially, no medical evidence been presented which establishes the presence of the claimed disabilities. Accordingly, the first prong of the Caluza test, current disability, has not been met. The Board has considered the possibility that the veteran's claimed conditions may be seasonal and therefore may not be present at all times. However, even if this were so, the applicable regulations provide that seasonal and other acute allergic manifestations subsiding in the absence of or removal of the allergen are generally regarded as acute diseases, healing without residuals. See 38 C.F.R. § 3.380. Moreover, even if this was true, the post-service evidence fails to show that the claimed conditions are even seasonal or that they are etiologically related to service and therefore the claims would still fail to be well grounded. In denying the claim, the Board recognizes the fact that both bronchitis and throat problems were documented in the service medical records. The Court has held in Savage v. Gober, 10 Vet. App. 488 (1997), that the "continuity of symptomatology" provision of 38 C.F.R. § 3.303(b) may obviate the need for medical evidence of a nexus between present disability and service. See Savage, 10 Vet. App. at 497. The only proviso is that there be medical evidence on file demonstrating a relationship between the veteran's claimed disability and his post-service symptomatology, unless such a relationship is one as to which a lay person's observation is competent. However, in this case, the veteran's lay observations are not sufficient to establish a current diagnosis of the claimed conditions and moreover, as previously indicated, the post-service evidence is negative for diagnoses of the claimed conditions, Accordingly, chronicity and continuity of bronchitis and pharyngitis have not been shown. The Board also points out that the veteran has contended that his pharyngitis and possibly also his bronchitis might be attributable to his service connected sinusitis or to medication taken for that condition. In order for a claim for secondary service connection to be well-grounded, the veteran must present medical evidence to support the alleged causal relationship between the service- connected disorder and the disorder for which secondary service connection is sought. See Jones v. Brown, 7 Vet. App. 134 (1994). In this regard, the veteran has testified and presented evidence prepared by him to the effect that an etiological relationship exists between his pharyngitis and bronchitis and the service connected sinusitis and the medication taken for it. However, the Court of Appeals for Veterans Claims (Court) has held that lay assertions of medical causation cannot constitute evidence to render a claim well-grounded. See Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993), and Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). There has been no competent evidence presented in conjunction with an alleged secondary relationship between claimed pharyngitis and bronchitis and service connected sinusitis and/or medication taken therefor and accordingly, the claim considered on a secondary basis fails to be well grounded. The Court has held that "[i]n the absence of competent medical evidence of a current disability and a causal link to service or evidence of chronicity or continuity of symptomatology, a claim is not well grounded." Chelte v. Brown, 10 Vet. App. 268 (1997). Accordingly, the claims of entitlement to service connection for bronchitis and pharyngitis are not well grounded and must be denied. 4. Entitlement to service connection for an acquired eye disorder. Factual Background The service medical records reflected that upon enlistment examination conducted in September 1992, clinical evaluation of the eyes and pupils was normal. Ophthalmoscopic and ocular motility evaluations were also normal. Distant vision was 20/20 and near vision was 20/20. The records showed that in February 1996, the veteran was seen for a three day history of pink eye. The veteran reported that this initially started on the left side and moved to the right, during which time the left side resolved. He had no other complaints except for some occasional itching. The veteran reported that he occasionally experienced some allergic-type symptoms, but had never been diagnosed with allergies. An assessment of allergic/viral conjunctivitis, bilateral, worse on the right than the left, was made. Vision of 20/20 bilaterally both near and far was also noted in February 1996. Upon separation examination conducted in January 1997, clinical evaluation of the eyes and pupils was normal. Ophthalmoscopic and ocular motility evaluations were also normal. Distant vision was 20/20 and near vision was 20/15. A VA examination was conducted in May 1997, at which time a head, ears, eyes nose and throat evaluation revealed no conjunctival injection. Upon visual examination, the veteran complained of a 1 1/2 year history of a floating blurry spot on his right eye. The examiner found that there was no evidence of diplopia or visual field deficit. Diagnoses of a vitreous floater of the right eye, mild astigmatism and choroidal nevus of the left eye were made. The veteran presented testimony at a hearing held at the RO in October 1998. He testified that he was involved in competitive shooting and that his eye problems were effecting this. He stated that he had noticed a small floater in his eyes, larger on the left side. The veteran indicated that he had astigmatism but that his vision was 20/20. The veteran testified that his eye problems were possibly related to some incident of service. In a Supplemental Statement of the Case/rating action dated in July 1999, the RO denied the claim of entitlement to service connection for an eye disorder concluding that the eye disorders which has been diagnosed were developmental defects. In denying the claim, the RO noted that upon examination conducted in May 1997, diagnoses of a vitreous floater of the right eye, mild astigmatism and choroidal nevus of the left eye were made. The RO cited the Merck Manual, 17th Edition, 1999, pages 703, 704 & 741, which addressed the nature and etiology of vitreous floaters and astigmatisms and which identified both as developmental abnormalities. According to the RO, that source also stated that vitreous floaters were generally without significance and that these resulted from contraction of the vitreous gel and its separation from the retina and that astigmatisms produced errors of refraction due to the unequal curvature of the cornea or lens. The RO also pointed out that a choroidal nevus was described by OPTHALMOLOGY, Principles and Concepts, by Dr. Newell, M.D., 7th Edition, 1992, pages 280 and 281 as a benign developmental abnormality which did not require treatment. Analysis Congenital or developmental defects such as refractive error of the eyes are not diseases or injuries for the purposes of service connection. 38 C.F.R. § 3.303(c), 4.9 (1999). See Winn v. Brown, 8 Vet. App. 510, 516 (1996), and cases cited therein. The evidence shows that the veteran currently has several eye disorders, diagnosed as vitreous floater of the right eye, mild astigmatism and choroidal nevus of the left eye. Research conducted by the RO has indicated that each of the veteran's three currently diagnosed eye disorders is either congenital or developmental. In this regard, the RO cited the Merck Manual, 17th Edition, 1999, pages 703, 704 & 741 addressing the nature and etiology of vitreous floaters and astigmatisms, in which those disorders were identified as developmental abnormalities. The RO also cited a source called, OPTHALMOLOGY, Principle and Concepts, by Dr. Newell, M.D., 7th Edition, 1992, pages 280 and 281, to support a finding that and choroidal nevus of the left eye was a benign developmental abnormality which did not require treatment. The veteran was advised of the RO's decision including the findings referred to above but provided no further evidence or argument thereafter. Cf. Thurber v. Brown, 5 Vet. App. 119 (1993) The RO has cited credible medical sources in support of a finding that each of the veteran's three currently diagnosed eye disorders is either congenital or developmental. In addition, with respect to astigmatism, the Court has noted that [N]early all astigmatism is congenital (where heredity is the only known factor), it may also occur as a residual of trauma and scarring of the cornea, or even from the weight of the upper eyelid resting upon the eyeball." Browder v. Brown, 5 Vet. App. 268, 272 (1993). On the other hand no credible evidence has been submitted by the veteran which counters the evidence cited by the RO. Furthermore, the record does not contain any evidence which establishes or even suggests that the veteran's eye disorders, are anything other than either congenital or developmental. There was no evidence of eye trauma during service and the only eye symptomatology which was shown during service was an acute case of conjunctivitis. Accordingly, the Board finds the as a matter of law that the claimed eye disorders do not constitute "disabilities" under 38 C.F.R. § 3.303(c) and 4.9 (1999). In the alternative, the Board has also considered the claim under the Caluza test, without regard to 38 C.F.R. § 3.303(c), 4.9 (1999). See Holbrook v. Brown, 8 Vet. App. 91, 92 (1995) (per curiam order noting Board's fundamental authority to decide a claim in the alternative). However, even in evaluating the evidence of record on the merits, service connection is not warranted because the claim is not well grounded. As indicated, a currently manifested disability has been shown, inasmuch as eye disorders diagnosed as a vitreous floater of the right eye, mild astigmatism and choroidal nevus of the left eye, have been made. Accordingly, the first prong of the Caluza test has been met. The service medical records reflected that the veteran's vision was 20/20 bilaterally, both distant and near, upon enlistment and separation. The enlistment and separation examinations also showed that the veteran had no eye problems. The only reference to an eye problem in the service medical records was conjunctivitis which was shown in February 1996. However, that condition was not shown to have recurred at any time thereafter. Accordingly, chronicity and continuity of the condition which was treated in service, conjunctivitis, is not shown. See Savage v. Gober, 10 Vet. App. 488 (1997). Further, the record contains no competent medical evidence which etiologically links the currently diagnosed eye disorders with any incident of service, to include conjunctivitis which was treated therein. Where the determinative issue involves either medical etiology or a medical diagnosis, competent medical evidence is required to fulfill the well grounded claim requirement of 38 U.S.C. § 5107(a). Beausoleil v. Brown, 8 Vet. App. 459 (1996). Although the veteran has expressed his opinion that his eye problems are etiologically related to service, he does not meet the burden imposed by 38 U.S.C.A. § 5107(a) merely by presenting his own lay testimony, because lay persons are not competent to offer medical opinions. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Accordingly, the claim fails to be well grounded and is also denied upon that basis. Additional Matters When the Board addresses in its decision a question that has not been addressed by the RO, it must consider whether the veteran has been given adequate notice to respond and, if not, whether he has been prejudiced thereby. Bernard v. Brown, 4 Vet. App. 384 (1993). The Board finds that the veteran has been accorded ample opportunity by the RO to present argument and evidence in support of his claims. In this case, the Board has concluded that the veteran has not submitted well grounded claims for entitlement to service connection for hypertension, bronchitis, pharyngitis as did the RO in the July 1999 Supplemental Statement of the Case. The Board has also denied the claim for eye pathology on the same basis as the RO had in the July 1999 Supplemental Statement of the Case. Accordingly, no prejudice to the veteran has been shown. Further, because the claims are not well grounded, the VA is under no duty to further assist the veteran in developing facts pertinent to those claims. 38 U.S.C.A. § 5107(a). VA's obligation to assist depends upon the particular facts of the case and the extent to which VA has advised the veteran of the evidence necessary to be submitted with a VA benefits claim. Robinette v. Brown, 8 Vet. App. 69, 78 (1995). The Court has held that the obligation exists only in the limited circumstances where the veteran has referenced other known and existing evidence. Epps v. Brown, 9 Vet. App. 341, 344 (1996). In this case, the VA is not on notice of any known and existing evidence which would make the veteran's service connection claims plausible, and thereby, well-grounded. The Board's decision serves to inform the veteran of the kind of evidence which would be necessary to make his claims well grounded. 5. Entitlement to an increased (compensable) evaluation for sinusitis. Factual Background Upon enlistment examination conducted in September 1992, clinical evaluation of the nose and sinuses was normal. The record shows that in March 1993, the veteran seen for complaints of cough and congestion which was assessed as a viral upper respiratory infection. In March 1994, the veteran was treated for sinusitis and was placed on profile due to a sinus infection. In December 1994, the veteran was seen for complaints of post nasal drip and a sore throat which was assessed as an upper respiratory infection. The veteran was treated for upper respiratory infection and allergies in March 1995. He was treated for allergic bronchitis in June 1995. In October and December 1995, he was again treated for upper respiratory infections. In July 1996, the veteran was treated for sinusitis. He was also treated in 1996 for tonsillitis. Upon separation examination conducted in January 1997, clinical evaluation of the nose and sinuses was normal. Clinical evaluation of the lungs and chest was also normal. The examiner noted that the veteran had seasonal allergic rhinitis in 1996 and 1997 and a diagnosis of sinusitis in 1996 for which medication was diagnosed. The veteran indicated that he had experienced ear, nose and throat trouble as well as sinusitis. Additional service medical records showed that the veteran was treated for allergic rhinitis in August 1996, October 1996 and January 1997. A VA examination was conducted in May 1997. It was noted that the veteran had a history of allergic rhinitis which had been treated with antihistamines. It was stated that there was no history of infectious sinusitis requiring antibiotic use and that the veteran continued to have a runny nose in the morning with fairly copious discharge of nasal mucus. Head, eyes, ears, nose and throat examination revealed oropharynx without injection, tonsilar enlargement or exudate. Turbinates were without excessive secretions or inflammation. Lungs were clear to auscultation and percussion. An ECG was abnormal. X-ray films of the sinuses were negative. An impression of allergic rhinitis without evidence of rhinitis at present, was made. The veteran presented testimony at a hearing held at the RO in October 1998. He testified that he had never had allergies prior to service. He stated that shortly after being deployed to Saudi Arabia he came down with an infection and that even after his return from there he continued to experience problems. He testified that Tinalin, Actifed, Biaxin and Afrin were all prescribed and stated that he experienced side effects from these medications including headaches, dizziness, dry mouth, and possible pharyngitis. By rating action of May 1997, service connection was granted for sinusitis and a noncompensable evaluation was assigned under 38 C.F.R. § 4.97, Diagnostic Code 6510, used for the evaluation of chronic sinusitis, effective from March 11, 1997. In a rating action dated in July 1999, the RO denied a compensable evaluation for sinusitis. Service connection was granted for allergic rhinitis. Analysis Preliminary Matters As discussed above, a person who submits a claim for benefits under a law administered by the VA shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). Where a disability has already been service connected and there is a claim for an increased rating, a mere allegation that the disability has become more severe is sufficient to establish a well-grounded claim. Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). Accordingly, the Board finds that the veteran's claim for an increased rating is well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). Discussion The veteran's service-connected sinusitis is rated as noncompensably disabling under Diagnostic Code 6510, effective from March 11, 1997, the day after he left the service. See 38 C.F.R. § 3.400. Under Diagnostic Code 6510, a noncompensable evaluation is warranted when sinusitis is detected by X-ray only. A 10 percent evaluation is warranted for one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or three to six non- incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent evaluation is warranted when there are three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. (A note following this section provides that an incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician.) 38 C.F.R. § 4.97 (1999). The evidence does not reflect that a 10 percent evaluation is warranted for sinusitis. The evidence does not reflect that the veteran has experienced one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or three to six non- incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting, at any time between his discharge from service until the present time. The most recent VA examination conducted in May 1997 revealed that there was no history of infectious sinusitis requiring antibiotic use. The only symptoms which were noted at that time were a runny nose in the morning with fairly copious discharge of nasal mucus. Objective examination showed that turbinates were without excessive secretions or inflammation and X-ray films of the sinuses were negative. In fact at that time there was not even any evidence of sinusitis. In his hearing testimony, the veteran did not testify that he experienced one or two incapacitating episodes per year of sinusitis requiring prolonged antibiotic treatment, or three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. The veteran's claims of headaches and related symptoms which he has attributed to medication which he was taking for sinusitis are not substantiated by any clinical evidence and moreover, those symptoms have neither been attributed to sinusitis or medication taken therefor by any competent medical professional. Further, even if the Board were to account for those symptoms as related to sinusitis, there is no indication that such are productive of one or two incapacitating episodes per year of sinusitis requiring prolonged antibiotic treatment, or three to six non- incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. The Board is unable to identify any clinical evidence which would provide a basis for the assignment of a compensable evaluation for sinusitis at any time from March 11, 1997 forward. See Fenderson v. West, 12 Vet. App.119 (1999). Accordingly the preponderance of the evidence is against the veteran's claim and the claim is denied. 6. Entitlement to an increased (compensable) evaluation for a disability of the right wrist. Factual Background Upon enlistment examination conducted in September 1992, clinical evaluation of the upper extremities was normal. In June 1996, the veteran was seen for complaints of a 3 month history of right wrist pain, worse on exertion. Physical examination revealed mild tenderness and full range of motion. X-ray films were negative for fracture or instability pattern. An impression of strain/overuse of the right wrist was made. Upon separation examination conducted in January 1997, clinical evaluation of the upper extremities was normal. X-ray films of the right wrist taken in April 1997 showed no evidence of significant bony or joint abnormalities. A July 1997 private medical record showed that the veteran complained of wrist pain. It was noted that a bone scan conducted 3 months previously was negative. A VA examination was conducted in May 1997. With respect to right wrist problems, it was noted that the veteran had strained his wrist on an obstacle course during service. It was stated that the veteran had mild pain and diminished range of motion which seemed to be worse when he did push ups. It was also observed that there was no history of arthroscopy, inflammatory arthritis, cortisone injection or surgery. Examination of the extremities revealed minimal tenderness of the right dorsal wrist. Palmar flexion was 50 degrees, dorsiflexion was 60 degrees, ulnar deviation was 40 degrees and radial deviation was 20 degrees. There was no visible synovial thickening, palpable warmth or rheumatoid nodules appreciated. An impression of post traumatic right wrist arthralgia was made. The veteran presented testimony at a hearing held at the RO in October 1998. He testified that he was employed in law enforcement and that he was also still in the military reserves. He indicated that both required a lot of physical training and that his wrist was productive of pain and tenderness when working out. Analysis Preliminary Matters Initially, the Board concludes that the veteran's claim of entitlement to an increased evaluation for a right wrist disability is well grounded within the meaning of the statutes and judicial construction. See 38 U.S.C.A. § 5107(a) (West 1991). When a veteran is awarded service connection for a disability and appeals the RO's rating determination, the claim continues to be well grounded as long as the claim remains open and the rating schedule provides for a higher rating. See Shipwash v. Brown, 8 Vet. App. 218, 224 (1995). Discussion By rating action of May 1997, service connection was awarded for a right wrist disability for which a noncompensable evaluation was assigned under Diagnostic Code 5215, effective from March 11, 1997. Limitation of motion of the wrist to less than 15 degrees of dorsiflexion or palmar flexion limited in line with the forearm warrants a 10 percent evaluation. 38 C.F.R. § 4.71a, Diagnostic Code 5215. Normal wrist joint motion includes a range of motion from 70 degrees of dorsiflexion (extension) to 80 degrees of palmar flexion and 45 degrees of ulnar deviation to 20 degrees of radial deviation. 38 C.F.R. § 4.71, Plate I. It is clear from the May 1997 examination at which time palmar flexion was 50 degrees, dorsiflexion was 60 degrees, ulnar deviation was 40 degrees and radial deviation was 20 degrees that there is no clinically demonstrated limitation of motion to warrant a compensable rating under the above diagnostic criteria. The evaluation of a service-connected disability involving a joint rated on limitation of motion requires adequate consideration of functional loss due to pain under 38 C.F.R. § 4.40, and functional loss due to weakness, fatigability, incoordination or pain on movement of a joint under 38 C.F.R. § 4.45. See DeLuca v. Brown, 8 Vet. App. 202 (1995). As indicated, pain is an important factor in evaluating a given disability, 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown. Some functional loss supported by adequate pathology must be apparent. 38 C.F.R. § 4.40. In this case, right wrist pain has been consistently shown since service. In addition, on VA examination conducted in 1997 tenderness was documented by the examiner. Moreover, the evidence does reflect that the veteran has slightly less than full range of motion of the wrist. Accordingly, the evidence does support a finding of additional functional loss due to pain, including during flare-ups, so as to warrant a compensable rating for a right wrist disability effective from March 1997. The Board has carefully reviewed the evidence of record an has not identified any evidence which would lead to the assignment of a disability rating above 10 percent, either under the schedular criteria or with the application of any other law or VA regulation. Under 38 C.F.R. § 4.71a, Diagnostic Code 5215, 10 percent is the highest rating available. Accordingly, the aforementioned provisions of 38 C.F.R. § 4.40 and § 4.45 are not for consideration. See Johnston v. Brown, 10 Vet. App. 80, 85 (1997). The Board has also given consideration to evaluating the veteran's service-connected disability under a different Diagnostic Code. The assignment of a particular Diagnostic Code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993) (en banc). One Diagnostic Code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis and demonstrated symptomatology. Any change in a Diagnostic Code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). In this case, the Board finds that 38 C.F.R. § 4.71a, Diagnostic Code 5214, pertaining to ankylosis of the wrist, is obviously inapplicable because there is no medical evidence or even a suggestion that the veteran's right wrist is ankylosed. There are no other diagnostic codes which pertain to a wrist disability. Accordingly, the Board believes that the veteran is most appropriate under Diagnostic Code 5215. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). Accordingly, a for the reasons and bases stated above, a 10 percent disability evaluation is granted effective from March 11, 1997, the date of the veteran's claim. ORDER A well-grounded claim having not been presented, the veteran's claim of entitlement to service connection for hypertension is denied. A well-grounded claim having not been presented, the veteran's claim of entitlement to service connection for bronchitis is denied. A well-grounded claim having not been presented, the veteran's claim of entitlement to service connection for pharyngitis is denied. The claim of entitlement to service connection for eye disorders is denied both as a matter of law and because a well grounded claim has not been presented. Entitlement to a compensable disability evaluation for sinusitis is denied. Entitlement to a 10 percent evaluation for a right wrist disability is granted, effective from March 11, 1997, subject to controlling regulations applicable to the payment of monetary benefits. Barry F. Bohan Member, Board of Veterans' Appeals