Citation Nr: 0001071 Decision Date: 01/13/00 Archive Date: 01/27/00 DOCKET NO. 97-21 030 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for hearing loss. 2. Entitlement to service connection for a deviated septum. 3. Entitlement to service connection for bilateral conjunctivitis. 4. Entitlement to service connection for keratitis corneal injury. 5. Entitlement to service connection for right otitis media. 6. Entitlement to service connection for residuals of a septoplasty. 7. Entitlement to service connection for allergic rhinitis. 8. Entitlement to an initial compensable rating for tinnitus prior to June 10, 1999, and in excess of 10 percent from June 10, 1999. 9. Entitlement to an initial rating in excess of 10 percent for a right knee disability. 10. Entitlement to an increased (compensable) evaluation for folliculitis. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD G. A. Wasik, Associate Counsel INTRODUCTION The veteran served on active duty from December 1987 to April 1996. This matter is before the Board of Veterans' Appeals (Board) on appeal of a September 1996 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In September 1996, the RO granted service connection for right knee chondromalacia and evaluated the disability as 10 percent disabling. The RO also granted service connection for folliculitis and for tinnitus and evaluated each disability as non-compensably disabling, effective April 12, 1996. In September 1996, the RO also denied service connection for allergic rhinitis, bilateral hearing loss, for a deviated septum, for left and right eye conjunctivitis, for a keratitis corneal injury, for a right ankle condition, for right ear otitis media, for a lower back strain and for status post septoplasty. In October 1996, the veteran submitted a notice of disagreement with all the issues included on the September 1996 rating decision. A statement of the case was mailed to the veteran in November 1996. In June 1997, the veteran submitted VA Form 9 which included argument pertaining to all the issues denied by the RO in September 1996 with the exception of the claim for an initial compensable evaluation for folliculitis. Thus the Board finds the veteran has perfected appeals of all the issues included on the September 1996 rating decision with the exception of the claim pertaining to the folliculitis. In September 1998 the RO issued a rating decision wherein it denied entitlement to an increased (compensable) evaluation for folliculitis. In December 1998 the veteran submitted a statement (VA Form 9) wherein he stated he was continuing his appeal as to all issues discussed in the statement of the case previously issued in November 1996. The Board construes the above statement as a notice of disagreement with the September 1998 rating decision wherein the RO denied entitlement to an increased (compensable) evaluation for folliculitis. A statement of the case was not issued by the RO in response to the veteran's notice of disagreement. Accordingly, this issue is addressed in the remand portion of the decision. By rating decision dated in January 1999, the RO granted service connection, in pertinent part, for a right ankle ligamentous laxity and for L5-S1 degenerative disk disease. The veteran has not expressed dissatisfaction with the initial disability evaluations assigned for the right ankle and back. The issues are no longer in appellate status. By rating decision dated in June 1999, the RO granted, in pertinent part, an increased (compensable) evaluation of 10 percent for tinnitus, effective June 10, 1999. In September 1999, the RO granted a separate 10 percent evaluation for post traumatic tricompartmental arthritis of the right knee as secondary to the service-connected chronic knee ligament instability. The appellant is generally presumed to be seeking the maximum benefit available by law, and it follows that such a claim remains in controversy where less than the maximum benefit available is awarded. AB v. Brown, 6 Vet. App. 35 (1993). The veteran has not expressed satisfaction with the ratings assigned. The issues remain in appellate status. The issues of entitlement to service connection for folliculitis, and an initial evaluation in excess of 10 percent for the right knee disability, are addressed in the remand portion of this decision. FINDINGS OF FACT 1. The claims of entitlement to service connection for hearing loss, deviated septum, bilateral conjunctivitis, keratitis corneal injury, right otitis media and for residuals of a septoplasty are not supported by cognizable evidence showing that the claims are plausible or capable of substantiation. 2. The claim of entitlement to service connection for allergic rhinitis is supported by cognizable evidence showing that the claim is plausible or capable of substantiation. 3. The service-connected tinnitus has been recurrent in nature, and never shown to be persistent as a symptom of head injury, concussion, or acoustic trauma. 4. Tinnitus has not rendered the veteran's disability picture unusual or exceptional in nature, markedly interfered with employment, or required frequent inpatient care as to render impractical the application of regular schedular standards. CONCLUSIONS OF LAW 1. The claims for service connection for hearing loss, deviated septum, bilateral conjunctivitis, keratitis corneal injury, right otitis media and for residuals of a septoplasty are not well-grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The claim for service connection for allergic rhinitis is well-grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. The criteria for an initial compensable evaluation prior to June 10, 1999, and in excess of 10 percent from June 10, 1999 have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.87a, Diagnostic Code 6260 (effective prior to June 10, 1999); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.87,; Diagnostic Code 6260; 64 Fed.Reg. 25202-25210 (May 11, 1999) (effective June 10, 1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Factual Background Review of the service medical records reveals that on the report of the service entrance examination conducted in July 1987, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 15 15 15 25 LEFT 20 5 15 25 25 Pertinent diagnoses were defective distant vision and mild astigmatism. On the Report of Medical History portion of the entrance examination conducted in July 1987, the veteran reported he had experienced sinusitis. He denied, in pertinent part, eye problems, ear, nose or throat problems, hearing loss, or hay fever. Pertinent findings were occasional sinusitis without sequale and that the veteran wore glasses. An audiogram was conducted in January 1988. Pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 20 20 40 50 LEFT 10 5 10 25 20 On a dental health questionnaire completed in January 1988 the veteran denied ever having sinus problems. In September 1988, an impression of mild epithelial keratitis secondary to extended wear contact lenses was made for the left eye. A subsequent treatment record dated in September 1988 included the notation that the veteran did not have any complaints regarding his left eye. The assessment was resolved epithelial keratitis secondary to extended wear contact lenses. On a dental health questionnaire completed in August 1989 the veteran denied ever having hay fever or sinus problems. An audiogram was conducted in September 1989. Pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 20 10 30 40 LEFT 10 10 10 25 25 An audiogram was conducted in October 1989. Pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 15 5 20 35 LEFT 10 5 10 20 25 On an asbestos exposure questionnaire completed in January 1990 the veteran reported that he was near sighted and that he did not have any hearing defects. He also denied having hay fever. On a dental health questionnaire completed in March 1990 the veteran denied ever having hay fever or sinus problems. A routine eye examination was conducted in March 1990. It was noted the veteran did not have a history of eye injury or disease. The assessment was compound myopic astigmatism. No pathology was present in either eye. An audiogram was conducted in October 1990. Pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 15 15 25 35 LEFT 15 10 15 25 25 On a dental health questionnaire completed in March 1991 the veteran denied ever having hay fever or sinus problems. An audiogram was conducted in July 1991. Pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 10 25 35 LEFT 15 10 10 30 30 In November 1991, the veteran sought treatment for irritation in his left eye. A past medical history of a corneal abrasion two years prior was noted. Physical examination of the left eye did not reveal any corneal abrasion. The assessment was left eye conjunctivitis which was probably viral. The report of a periodic and audiological examinations conducted in March 1992 shows pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 10 25 35 LEFT 15 10 10 30 30 The pertinent diagnoses were decreased visual acuity and decreased hearing, neither of which were considered disabling. On a dental health questionnaire completed in March 1992 the veteran denied ever having hay fever or sinus problems. In April 1992, the veteran sought treatment for a three year history of congestion. The assessment was rhinitis. A separate treatment record dated in April 1992 also included the notation that he had chronic nasal discharge for three years. The pertinent assessment was rule out deviated septum versus chronic rhinitis. In June 1992, the veteran complained of increased post-nasal drip. The assessment at that time was rhinitis. A clinical record from an optometry clinic dated in July 1992 included assessments of no apparent ocular pathology and myopic astigmatism. In August 1992, a septal deviation was diagnosed. A septoplasty was conducted. On a dental health questionnaire completed in March 1993 the veteran denied ever having hay fever or sinus problems. On a dental health questionnaire completed in March 1994 the veteran denied ever having hay fever or sinus problems. An optometric examination was conducted in July 1994. Ocular health was determined to be normal at that time. An audiogram was conducted in September 1995. Pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 10 5 30 30 LEFT 5 5 10 25 25 The report of a December 1995 medical examination is of record. It was noted the veteran was being treated for right acute otitis media. On audiological evaluation, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 10 25 35 40 LEFT 0 0 10 25 25 The pertinent diagnosis from the December 1995 examination was bilateral high frequency hearing loss. On the Report of Medical History portion of the December 1995 examination the veteran denied experiencing hearing loss, sinusitis or hay fever. He reported that he was in good health with the exception of an ear infection and a right knee disability. The pertinent diagnosis was ear problems. Unresolved otitis media was included as an assessment in December 1995. The veteran denied hearing loss at that time. A subsequent clinical record dated the same month included an assessment of questionable unresolved ear infection. A routine eye examination was conducted in December 1995. The assessments were compound myopic astigmatism and early presbyopia. In January 1996, the veteran complained of right ear pain and decreased hearing that had been present for several weeks. The impression at that time was allergic rhinitis and Eustachian tube dysfunction. A separate treatment record dated in January 1996 included an assessment of resistant right otitis media. In March 1996, chronic right otitis media was included as an assessment. A separate treatment record dated in March 1996 included an impression of allergic rhinitis and Eustachian tube dysfunction. In March 1996, a Physical Evaluation Board determined that the veteran was unfit for duty as a result of his right knee disability. The report of a June 1996 VA vision examination has been associated with the claims file. The veteran reported that six or seven years prior to the examination some rust particles had fallen into and scratched his right eye. It was also noted that he reported two episodes of conjunctivitis (one in each eye) during active duty. The diagnoses were history of ocular foreign bodies in the right eye during service, history of bilateral conjunctivitis during active duty and bilateral compound myopic astigmatism. The examiner noted that no residuals of ocular foreign body injury or conjunctivitis were found at the time of the examination. A VA general medical examination was conducted in June 1996. The veteran reported that he had had ear infections ever since childhood and had undergone two surgeries on his ears as a child. The last ear infection he had was in December 1995. He reported constant pressure in his ears with hearing loss and tinnitus. He reported that tinnitus had begun after the last ear infection in December 1995 and had been present ever since that time. He stated that he could not hear conversations from the right side. He did not know if he had any sinus problems but did report his nose was constantly draining. He reported he had difficulty breathing through his right nostril. The veteran reported a septoplasty had been conducted in 1991 which helped his breathing somewhat but did not stop the drainage or his snoring. The pertinent diagnoses were hearing loss in the right ear secondary to otitis media, tinnitus of the right ear and rhinitis or possibly sinusitis. The examiner noted that X-rays of the sinuses and an audiogram were going to be conducted. A June 1996 X-ray of the sinuses was interpreted as revealing no gross abnormality. On audiological evaluation in June 1996 , pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 2 10 20 30 LEFT 5 5 10 25 25 Speech audiometry revealed speech recognition ability of 100 percent in the right ear and of 98 percent in the left ear. Tinnitus was present and described as constant. The veteran reported that the tinnitus was moderately severe and interfered with his sleep. The summary of the audiological testing was mild sensorineural hearing loss at 4000 Hertz in the right ear and hearing within normal limits in the left ear. VA outpatient treatment records have been associated with the claims file. The records evidence treatment for the veteran's service-connected right knee disability. A VA vision examination was conducted in December 1998. The diagnoses were bilateral corneal neovascularization, bilateral lattice retinal degeneration and hyperopia and presbyopia. The report of a December 1998 VA audiological examination has been associated with the claims file. Pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 5 10 20 25 LEFT 10 5 10 15 20 Speech audiometry revealed speech recognition ability of 98 percent in the right ear and of 98 percent in the left ear. Tinnitus was noted to be constant and unilateral. The veteran reported that tinnitus made it difficult for him to sleep. The summary of the audiological evaluation shows the veteran had normal hearing at 500 through 4,000 Hertz bilaterally. A VA hearing loss and ear disease examination was conducted in December 1998. The veteran complained of tinnitus which was loud enough to interfere with his sleep. He could override the tinnitus with background noise. He reported having a myringotomy on the right side as a child with a pressure equalization tube insertion. He reported having problems breathing through his nose since 1988. A septoplasty was performed in 1991. The surgery did not relieve the drainage or runny nose he had. The diagnoses were right greater than left hearing loss secondary to severe otitis media and middle ear disease on the right and also vasomotor rhinitis status post septoplasty with rhinorrhea. The report of a December 1998 VA orthopedic examination has been associated with the claims file. The examiner noted that two weeks prior to the examination, the veteran had undergone anterior cruciate ligament reconstruction of the right knee. At the time of the examination, he was in a long leg brace and was using crutches. He could not bear weight fully on the right and the examiner therefore did not examine the right knee further. The examiner did note that the period of disability or convalescence regarding the anterior cruciate ligament was three months. A May 1999 addendum for an ear disease, nose, sinus, larynx and pharynx examination has been associated with the claims file. The examiner noted the veteran had residuals of a perforated tympanic membrane in the right ear with scar formation but without any evidence of hearing loss. The examiner further noted there was a relationship between the deviated nasal septum while in the service to the development of right ear infection. Criteria The threshold question that must be resolved is whether the veteran has presented evidence of well-grounded claims. See 38 U.S.C.A. § 5107(a) (West 1991); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). A well-grounded claim is a plausible claim that is meritorious on its own or capable of substantiation. See Murphy, 1 Vet. App. at 81. If a claim is not well grounded there is no duty to assist the veteran with the development of that claim, and it must be denied. Morton v. West, 12 Vet. App. 477 (1999). An allegation of a disorder that is service connected is not sufficient; the veteran must submit evidence in support of a claim that would "justify a belief by a fair and impartial individual that the claim is plausible." See 38 U.S.C.A. § 5107(a); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). The quality and quantity of the evidence required to meet this statutory burden of necessity will depend upon the issue presented by the claim. Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993). In determining whether a claim is well grounded, the claimant's evidentiary assertions are presumed true unless inherently incredible or when the fact asserted is beyond the competence of the person making the assertion. King v. Brown, 5 Vet. App. 19, 21 (1993). In order for a claim to be well grounded, there must be competent evidence of a 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). Caluza v. Brown, 7 Vet. App. 498 (1995). In order to obtain service connection, there must be both evidence of a disease or injury that was incurred in or aggravated by service, and a present disability which is attributable to such disease or injury. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. A claim for service-connection for a disability must be accompanied by evidence which establishes that the claimant currently has the claimed disability. See Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); see also Brammer v. Derwinski, 3 .Vet. App. 223, 225 (1992) (absent proof of a present disability there can be no valid claim). 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) (West 1991); if no cognizable evidence is submitted to support a claim, the claim cannot be well grounded. Id. The United States Court of Appeals for Veterans Claims (hereinafter, "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 current disability and his post-service symptomatology, unless such a relationship is one as to which a lay person's observation is competent. Where a veteran served continuously for 90 days or more during a period of war and an organic disease of the nervous system to include sensorineural hearing loss becomes manifest to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.307, 3.309 (1999). Hearing status will be considered a disability for the purpose of service connection when the auditory thresholds in any of the frequencies of 500, 1,000, 2,000, 3,000, and 4,000 Hertz is 40 decibels or greater; the auditory thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (1999). The Court, in Hensley v. Brown, 5 Vet. App. 155 (1995), indicated that § 3.385 does not preclude service connection for a current hearing disability where hearing was within normal limits on audiometric testing at separation from service. As stated by the Court, "[i]f evidence should sufficiently demonstrate a medical relationship between the veteran's in- service exposure to loud noise and his current disability, it would follow that the veteran incurred an injury in service; the requirements of § 1110 would be satisfied." Id. at 160 (citing Godfrey v. Derwinski, 2 Vet. App. 352 (1992)). When a disability is not initially manifested during service or within an applicable presumptive period, "direct" service connection may nevertheless be established by evidence demonstrating the disability was in fact incurred or aggravated during the veteran's service. See 38 U.S.C.A. § 1113(b) (West 1991 & Supp. 1999); 38 C.F.R. § 3.303(d). The veteran is presumed in sound condition when examined for military service, except as to defect, infirmities or disorders noted at the time of the examination, acceptance and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. § 1111 (West 1991). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When, after consideration of all of the evidence and material of record in an appropriate case before VA, 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 such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b) (West 1991); 38 C.F.R. §§ 3.102, 4.3 (1999). I. Entitlement to service connection for hearing loss. Analysis The Board finds the claim of entitlement to service connection for hearing loss to be not well-grounded. The service medical records include the results of at least nine separate audiological evaluations. While hearing loss for VA compensation purposes in accordance with the criteria under 38 C.F.R. § 3.385 was shown on at least three of the inservice examinations, there is no post-service evidence associated with the claims file demonstrating the presence of hearing loss for VA purposes. Post-service VA audiological evaluations conducted in June 1996 and December 1998 failed to demonstrate that the veteran had auditory thresholds in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz of 40 decibels or greater; or that auditory thresholds for at least three of these frequencies were 26 decibels or greater; or that speech recognition scores using the Maryland CNC Test were less than 94 percent. The summary from the most recent VA audiological evaluation conducted in December 1998 shows that the veteran had normal hearing at 500 through 4,000 Hertz bilaterally. The Board notes that organic diseases of the nervous system to include sensorineural hearing loss are entitled to presumptive service connection if manifest to a compensable degree within one year of discharge. As there is no post- service evidence of record showing hearing loss for VA purposes, including within one year of discharge, the claim of entitlement to service connection for hearing loss is not entitled to presumptive service connection. The Board notes the diagnosis included in the report of the June 1996 VA general medical examination which found the veteran had hearing loss in the right ear secondary to otitis media. A similar diagnosis from the December 1998 VA examination of right greater than left hearing loss secondary to severe otitis media and middle ear disease on the right is also noted. The Board has found, as noted below, the presumption of soundness had not been rebutted for otitis media of the right ear. Service medical records show otitis media and hearing loss has been linked to the otitis media by competent evidence of record. Despite the above, however, the Board must still deny the claim of entitlement to service connection for hearing loss based on the fact that there is no competent evidence of record demonstrating the current existence of a hearing loss for VA compensation purposes in accordance with the criteria under 38 C.F.R. § 3.385. As stated above, a claim for service-connection for a disability must be accompanied by evidence which establishes that the claimant currently has the claimed disability. See Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); see also Brammer v. Derwinski, 3 .Vet. App. 223, 225 (1992) (absent proof of a present disability there can be no valid claim). II. Entitlement to service connection for a deviated septum. Analysis The Board finds the claim of entitlement to service connection for a deviated septum to be not well-grounded. There is no competent evidence of record showing that the deviated septum existed prior to active duty and there is competent medical evidence diagnosing the disorder in August 1992. Subsequently the same month a septoplasty was performed to correct the problem. Thus the Board finds the presumption of soundness has not been rebutted and there is competent evidence of the presence of an in-service disease or injury. The Board further finds, however, that there is no competent evidence of record demonstrating the current existence of the disorder. None of the post-service medical evidence associated with the claims files demonstrates the current existence of a deviated septum. An X-ray of the sinuses taken in June 1996 was interpreted as revealing no gross abnormality. The VA medical opinion promulgated in May 1999 to the effect that there was a relationship between the deviated septum while in service and the development of right ear infections does not the change the outcome of this decision. This opinion does not demonstrate the current existence of a deviated septum. A claim for service-connection for a disability must be accompanied by evidence which establishes that the claimant currently has the claimed disability. See Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); see also Brammer v. Derwinski, 3 .Vet. App. 223, 225 (1992) (absent proof of a present disability there can be no valid claim). As there is no competent evidence of record of the current existence of a deviated septum, the claim of entitlement to service connection for a deviated septum must be denied as not well- grounded. III. Entitlement to service connection for bilateral conjunctivitis. Analysis The Board finds the claim of entitlement to service connection for bilateral conjunctivitis to be not well- grounded. The veteran was treated once in November 1991 during active duty for conjunctivitis of the left eye. Subsequent to the November 1991 treatment, there was no diagnosis of or treatment for conjunctivitis included in the service medical records. In fact, in-service examinations of the eyes conducted in July 1992, July 1994 and December 1995 failed to reveal the presence of conjunctivitis of either eye. There is no competent post-service evidence of record demonstrating the current existence of conjunctivitis of either eye. A VA vision examination was conducted in June 1996 which specifically found no evidence of any residuals of conjunctivitis of either eye. A VA vision examination conducted in December 1998 did not result in a diagnosis of conjunctivitis. A claim for service-connection for a disability must be accompanied by evidence which establishes that the claimant currently has the claimed disability. See Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); see also Brammer v. Derwinski, 3 .Vet. App. 223, 225 (1992) (absent proof of a present disability there can be no valid claim). As there is no competent evidence of record of the current existence of conjunctivitis of either eye, the claim of entitlement to service connection for bilateral conjunctivitis must be denied as not well-grounded. IV. Entitlement to service connection for keratitis corneal injury. Analysis The Board finds the claim of entitlement to service connection for keratitis corneal injury to be not well- grounded. The veteran was treated once in-service in September 1988 for mild epithelial keratitis of the left eye secondary to using extended wear contacts. At the time of a follow-up examination conducted later the same month, it was noted the veteran did not have any complaints regarding his left eye. The assessment was that the epithelial keratitis had resolved. There was no diagnosis of or treatment for a keratitis corneal injury during the remaining seven plus years of active duty. Routine eye examinations conducted in July 1992, July 1994 and December 1995 failed to reveal the presence of keratitis corneal injury. No competent post-service evidence has been associated with the claims file demonstrating that the veteran currently has keratitis corneal injury. A VA eye examination was conducted in June 1996. The examiner found no evidence of residuals of ocular foreign body injury at that time. A keratitis corneal injury was not diagnosed. Another VA vision examination conducted in December 1998 again failed to result in a diagnosis of keratitis corneal injury. While bilateral corneal neovascularization was diagnosed in December 1998, that disorder was not linked to any incident of active duty. As there is no competent evidence of record demonstrating the current existence of keratitis corneal injury which has been linked by competent evidence to active duty, the claim of entitlement to service connection for the disorder must be denied as not well-grounded. V. Entitlement to service connection for right otitis media. Analysis The Board finds the claim of entitlement to service connection for right otitis media to be not well-grounded as there is no competent evidence demonstrating the current existence of the disorder. Review of the service medical records demonstrates that the veteran was first treated in-service for right otitis media in December 1995. The disorder was noted again in clinical records dated in January 1996 and March 1996 one month prior to discharge from active duty. Irrespective of the veteran's subjective history of ear infections during childhood, there is no evidence of a chronic worsening of such disorder in service, and otitis media of the right ear per se has not been included as a clinical finding in competent post-service evidence of record associated with the claims file. The June 1996 VA general medical examination included a diagnosis of hearing loss in the right ear secondary to otitis media. This is not a diagnosis of otitis media. It is the examiner's opinion as to the etiology of the hearing loss he observed. The same holds true for the diagnosis of right greater than left hearing loss secondary to severe otitis media and middle ear disease on the right which was included on the report of the December 1998 VA examination. This is not a diagnosis of otitis media but an opinion as to the etiology of hearing loss. As reported above, a claim for service-connection for a disability must be accompanied by evidence which establishes that the claimant currently has the claimed disability. See Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); see also Brammer v. Derwinski, 3 .Vet. App. 223, 225 (1992) (absent proof of a present disability there can be no valid claim). As there is no competent evidence of the current existence of right otitis media, the claim of entitlement to service connection for the disorder must be denied as not well- grounded. there is no competent evidence documenting the current post- service existence of otitis media. VI. Entitlement to service connection for residuals of a septoplasty. Analysis The Board finds the claim of entitlement to service connection for a septoplasty to be not well-grounded. The Board notes a septoplasty was conducted in August 1992 while the veteran was on active duty. There is no evidence, however, demonstrating current residuals of the septoplasty. X-rays of the sinuses conducted in June 1996 were interpreted as revealing no gross abnormality. A claim for service-connection for a disability must be accompanied by evidence which establishes that the claimant currently has the claimed disability. See Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); see also Brammer v. Derwinski, 3 .Vet. App. 223, 225 (1992) (absent proof of a present disability there can be no valid claim). As there is no competent evidence of the current existence of residuals of a septoplasty, the claim of entitlement to service connection for the disorder must be denied as not well- grounded. The veteran's claims that he has hearing loss, a deviated septum, bilateral conjunctivitis, a keratitis corneal injury, right otitis media, and residuals of a septoplasty as a result of active duty are predicated upon his own unsubstantiated opinions. As it is the province of trained health care professionals to enter conclusions which require medical opinions as to causation, Grivois, the veteran's lay opinions are an insufficient basis upon which to find these claims well grounded. Espiritu, King. Accordingly, as well grounded claims must be supported by evidence, not merely allegations, Tirpak, the veteran's claims for service connection for the disorders at issue must be denied as not well grounded. Although the Board considered and denied the appellant's claims of entitlement to service connection for the multiple disorders at issue on a ground different from that of the RO, which denied the claims on the merits, the veteran has not been prejudiced by the decision. This is because in assuming that the claims were well grounded, the RO accorded the appellant greater consideration than his claims in fact warranted under the circumstances. Bernard v. Brown, 4 Vet. App. 384 (1993). In light of the implausibility of the appellant's claims and the failure to meet his initial burden in the adjudication process, the Board concludes that he has not been prejudiced by the decision to deny his appeals for service connection for the multiple disorders at issue. The Board further finds that the RO advised the appellant of the evidence necessary to establish a well grounded claim, and the appellant has not indicated the existence of any post service medical evidence that has not already been obtained that would well ground his claims. 38 U.S.C.A. § 5103(a) (West 1991); McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997); Epps v. Gober, 126 F. 3d. 1464 (Fed. Cir. 1997). As the veteran has not submitted well grounded claims for service connection for hearing loss, a deviated septum, bilateral conjunctivitis, a keratitis corneal injury, right otitis media, and residuals of a septoplasty, the doctrine of reasonable doubt has no application. The Court has held that if the appellant fails to submit a well grounded claim, VA is under no duty to assist in any further development of the claim. 38 U.S.C.A. § 5107(a); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); 38 C.F.R. § 3.159(a) (1999). The appellant's representative contends that subsequent to the Court's decisions pertaining to this issue, VA expanded its duty to assist the appellant in developing evidence to include the situation in which the appellant has not submitted a well grounded claim. Veterans Benefits Administration Manual M21-1, Part III, Chapter I, 1.03(a), and Part VI, Chapter 2, 2.10(f) (1996). The appellant's representative further contends that the M21- 1 provisions indicate that the claims must be fully developed prior to determining whether the claims are well grounded, and that this requirement is binding on the Board. The Board, however, is required to follow the precedent opinions of the Court. 38 U.S.C.A. § 7269 (West 1991); Tobler v. Derwinski, 2 Vet. App. 8, 14 (1991). Subsequent to the revisions to the M21-1 Manual, in Meyer v. Brown, 9 Vet. App. 425 (1996), the Court held that the Board is not required to remand a claim for additional development, in accordance with 38 C.F.R. § 19.9 (1999), prior to determining that a claim is not well grounded. The Board is not bound by an administrative issuance that is in conflict with binding judicial decisions, and the Court's holdings on the issue of VA's duty to assist in connection with the well grounded claim determination are quite clear. Bernard v. Brown, 4 Vet. App. 384, 394 (1993); 38 C.F.R. § 19.5 (1999). In Morton v. West, 12 Vet App 477 (1999), the Court held that the Manual M21-1 provisions pertaining to the development of claims prior to a finding of well groundedness are interpretative, in that they do not relate to whether a benefit will be allowed or denied, nor do they impinge on a benefit or right provided by statute or regulation. The Court found that the Manual M21-1 provisions constituted "administrative directions to the field containing guidance as to the procedures to be used in the adjudication process," and that the policy declarations did not create enforceable rights. The Court also found that interpretative provisions that are contrary to statutes are not entitled to deference, and that in the absence of a well grounded claim, VA could not undertake to assist a veteran in developing the facts pertinent to the claim. The Board has determined, therefore, in the absence of well grounded claims for service connection for hearing loss, a deviated septum, bilateral conjunctivitis, a keratitis corneal injury, right otitis media, and residuals of a septoplasty, VA has no duty to assist the veteran in developing his case. VII. Whether the claim of entitlement to service connection for allergic rhinitis is well-grounded. Analysis The Board finds the claim of entitlement to service connection for allergic rhinitis to be well-grounded. The service medical records reveal the veteran was treated for rhinitis several times in April 1992 and one time in June 1992. Allergic rhinitis was included as an impression in January 1996 and again in March 1996. Post-service, the first clinical finding of rhinitis was included in the report of the VA general medical examination conducted in June 1996. While the rhinitis was not linked to active duty, it was diagnosed within two months after the veteran's discharge. Vasomotor rhinitis status post septoplasty with rhinorrhea was included as a diagnosis on the report of the VA ear examination conducted in December 1998. The Board notes rhinitis was not found at the time of the service entrance examination conducted in July 1987. The Board finds the presumption of soundness applies and the presumption of soundness has not been rebutted. The Court has held that, where a veteran files a claim within a month of discharge from active service and medical reports relating to his separation make reference to his claimed condition(s), then the in-service medical evidence satisfies the Caluza criteria. Hampton v. Gober, (10 Vet. App. 481 (1997). In other words, the in-service evidence demonstrates the existence of a current disorder (as of the filing date of the claim) and a relationship of that disorder to service. In the present case, the veteran filed his application for compensation within weeks of his discharge from active duty. Based on the above, the Board finds the claim of entitlement to service connection for allergic rhinitis to be well- grounded. The Board further finds, however, that the issue must be remanded for additional development which will be set out in the remand portion of this decision. VIII. Entitlement to an initial rating in excess of 10 percent for tinnitus. Criteria Disability evaluations are administered under the Schedule for Rating Disabilities that is found in 38 C.F.R. § Part 4 (1999) and is designed to compensate a veteran for the average impairment in earning capacity. 38 U.S.C.A. § 1155 (West 1991). Separate diagnostic codes identify the various disabilities. Id. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. §§ 4.1 and 4.2 (1999). The percentage ratings contained in the 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 the residual conditions in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (1999). In determining the disability evaluation, VA has a duty to acknowledge and consider all regulations which are potentially applicable based upon the assertions and issues raised in the record and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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 for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7 (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). Effective June 10, 1999, regulations applicable to rating tinnitus were revised. 63 Fed. Reg. 25206 (May 11, 1999). Prior to June 10, 1999, a 10 percent evaluation was assigned when tinnitus was "persistent as a symptom of head injury, concussion or acoustic trauma". 38 C.F.R. § 4.87a, Diagnostic Code 6260 (1999). Regulations otherwise provide that a zero percent disability rating will be assigned when the requirements for a compensable disability evaluation are not met. See also 38 C.F.R. § 4.31. The revised regulation provides for a 10 percent evaluation for recurrent tinnitus under 38 C.F.R. § 4.87, Diagnostic Code 6260 (1999). The Court has held that where a law or regulation changes after a claim has been filed, but before the administrative appeal process has been concluded, the version more favorable to an appellant applies. Karnas v. Derwinski, 1 Vet. App. 308 (1991). The Court has further held that a liberalizing regulation can not be applied to a claim prior to the effective date of the liberalizing regulation. See 38 U.S.C.A. § 5110 (g) (West 1991); Rhodan v. West, 12 Vet. App. 55, 57 (1998). When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When, after consideration of all of the evidence and material of record in an appropriate case before VA, 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 to the claimant. 38 U.S.C.A. § 5107(b) (West 1991); 38 C.F.R. §§ 3.102, 4.3 (1999). Analysis The Board notes that the veteran's claim is "well-grounded" within the meaning of 38 U.S.C.A. § 5107. That is, the Board finds that he has presented a claim which is plausible. 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 veteran's assertions concerning the severity of his service-connected tinnitus (that are within the competence of a lay party to report) are sufficient to conclude that his claim for an increased evaluation is well grounded. King v. Brown, 5 Vet. App. 19 (1993). The Board is also satisfied that all relevant facts have been properly developed to their full extent and that VA has met its duty to assist. Godwin v. Derwinski, 1 Vet. App. 419 (1991); White v. Derwinski, 1 Vet. App. 519 (1991). The RO initially assigned a noncompensable evaluation for tinnitus when it granted service connection for this disorder. The evidentiary record did not show that tinnitus was persistent as a symptom of a head injury, concussion, or acoustic trauma under the criteria then in effect. It was not until June 10, 1999, that the amended criteria for assignment of a 10 percent evaluation for recurrent tinnitus became effective. Accordingly, the RO assigned a 10 percent evaluation effective June 10, 1999. No basis exists upon which to predicate assignment of the current evaluation of 10 percent prior to the effective date of the amended criteria and such is strictly forbidden. See Rhodan v. West, 12 Vet. App. 55, 57 (1998). The veteran is in receipt of a 10 percent evaluation for tinnitus under Diagnostic Code 6260. As 10 percent is the maximum evaluation available pursuant to Diagnostic Code 6260, there is no basis upon which to assign an increased schedular evaluation. Preliminary review of the record reveals that the RO did not expressly consider referral of the case to the Chief Benefits Director or the Director, Compensation and Pension Service for the assignment of an extraschedular rating under 38 C.F.R. § 3.321(b)(1) (1999). This regulation provides that to accord justice in an exceptional case where the schedular standards are found to be inadequate, the field station is authorized to refer the case to the Chief Benefits Director or the Director, Compensation and Pension Service for assignment of an extraschedular evaluation commensurate with the average earning capacity impairment. The governing criteria for such an award is a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked inference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. The Court has held that the Board is precluded by regulation from assigning an extraschedular rating under 38 C.F.R. § 3.321(b)(1) in the first instance; however, the Board is not precluded from raising this question, and in fact is obligated to liberally read all documents and oral testimony of record and identify all potential theories of entitlement to a benefit under the law and regulations. Floyd v. Brown, 9 Vet. App. 88 (1996). The Court has further held that the Board must address referral under 38 C.F.R. § 3.321(b)(1) only where circumstances are presented which the Director of VA's Compensation and Pension Service might consider exceptional or unusual. Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). Although the RO did not expressly consider 38 C.F.R. § 3.321(b)(1), the Board has reviewed the record with these mandates in mind and finds no basis for further action on this question. VAOPGCPREC. 6-96 (1996). There is no competent evidence of record demonstrating that the service- connected tinnitus markedly interferes with employment and the veteran has not alleged such interference. There is no evidence of record showing that the veteran had been frequently hospitalized due to tinnitus. The veteran's main complaint regarding his tinnitus is that he has trouble sleeping; however, at the time of the December 1998 VA ear examination, he reported he was usually able to override tinnitus with background noise. The Board notes that this case involves an appeal as to the initial rating of tinnitus, rather than an increased rating claim where entitlement to compensation had previously been established. Fenderson v. West, 12 Vet. App. 119 (1999). In initial rating cases, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Id. at 9. In the case at hand, as an increased rating is not warranted, the Board finds that a staged rating is not appropriate. Although the veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is applicable where, as here, the preponderance of the evidence is against the claim for an initial evaluation in excess of 10 percent for tinnitus. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). ORDER The veteran not having submitted well-grounded claims of entitlement to service connection for hearing loss, deviated septum, bilateral conjunctivitis, keratitis corneal injury, right otitis media and for residuals of a septoplasty, the appeals are denied. The claim of entitlement to service connection for allergic rhinitis is well-grounded. Entitlement to an initial rating in excess of 10 percent for tinnitus is denied. REMAND The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board or by the Court for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44-8.45 and 38.02-38.03. Entitlement to service connection for allergic rhinitis. As reported above, the Board found the claim of entitlement to service connection for allergic rhinitis to be well-grounded. The veteran was diagnosed with allergic rhinitis in January 1996 and again in March 1996 which was one month prior to discharge. He was diagnosed with rhinitis or possibly sinusitis at the time of the June 1996 general medical examination. He was diagnosed with vasomotor rhinitis status post septoplasty with rhinorrhea in December 1998. It is not apparent to the Board if the diagnoses of rhinitis or vasomotor rhinitis are the same disease entities as allergic rhinitis noted just prior to service discharge or if allergic rhinitis noted just prior to discharge was transient in nature. The Board finds an opinion from a competent medical specialist is required in order to determine the nature, extent and etiology of any rhinitis found on examination. Entitlement to an increased rating for a right knee disability. The Board notes that the veteran's claim is "well-grounded" within the meaning of 38 U.S.C.A. § 5107. That is, the Board finds that he has presented a claim which is plausible. 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 veteran's assertions concerning the severity of his service- connected right knee disability (that are within the competence of a lay party to report) are sufficient to conclude that his claim for an increased evaluation is well grounded. King v. Brown, 5 Vet. App. 19 (1993). Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to pain supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. 38 C.F.R. § 4.40 (1999). The factors of disability affecting joints are reduction of normal excursion of movements in different planes, weakened movement, excess fatigability, swelling 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 malaligned 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 nonweight-bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59 (1999). Traumatic arthritis, Diagnostic Code 5010, is evaluated under the same rating criteria as degenerative arthritis under Diagnostic Code 5003. 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. The Court has held that diagnostic codes predicated on limitation of motion do not prohibit consideration of a higher rating based on functional loss due to pain or due to flare-ups under 38 C.F.R. §§ 4.40, 4.45, 4.59. Johnson v. Brown, 9 Vet. App. 7 (1997) and DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). The veteran's right knee disability can be evaluated under several different Diagnostic Codes. The schedule of ratings for the musculoskeletal system provides a 10 percent evaluation for slight impairment of either knee, including recurrent subluxation or lateral instability. A 20 percent evaluation requires moderate impairment and a 30 percent evaluation requires severe impairment. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Limitation of flexion of a leg to 45º warrants a 10 percent evaluation. Limitation of flexion of a leg to 30 degrees warrants a 20 percent evaluation. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Limitation of extension of a leg to 10 degrees warrants a 10 percent evaluation and to 15 degrees warrants an evaluation of 20 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5261. In a recent precedent opinion, the VA General Counsel held that where the medical evidence shows the veteran has arthritis of the knee and where the diagnostic code applicable to his disability is not based upon limitation of motion, a separate rating for limitation of motion may be assigned if there is additional disability due to limitation of motion. VAOPGCPREC 23-97. At the time of the most recent VA joints evaluation in May 1999 , a diagnosis of status post right anterior cruciate ligament reconstruction with mild residual instability and post-traumatic tricompartmental arthritis secondary to chronic knee ligament instability was made. The examiner did not provide an analysis of any functional loss due to pain on use or during flares the veteran may experience. The examiner further opined that the veteran had not reached his full rehabilitative state after undergoing reconstructive surgery of the knee. The examiner recommended that the veteran's knee function be evaluated approximately one year after his reconstructive surgery. Further review of the claims file shows the veteran's reconstructive knee surgery was performed in early December 1998. The Board finds, based on the above, that the veteran should be afforded another VA examination of his right knee to determine the current nature and extent of severity of the right knee disability. Such examination should quantify the amount, if any, of functional loss due to pain on use or during flares which the veteran experiences in his right knee. The Court has held that the duty to assist the veteran in obtaining and developing facts and evidence to support his claim includes obtaining pertinent outstanding medical records as well as adequate VA examinations. Littke v. Derwinski, l Vet. App. 90 (l990). This duty includes an examination by a specialist when needed. Hyder v. Derwinski, l Vet. App. 221 (l99l). In light of the above discussion, it is the opinion of the Board that contemporaneous and thorough VA examinations would be of assistance to the Board in clarifying the nature of the appellant's service connected right knee disability and the claim of entitlement to service connection for allergic rhinitis, and would be instructive with regard to the appropriate disposition of these issues submitted for appellate consideration. Littke v. Derwinski, 1 Vet. App. 90 (1990). As the Board noted earlier, the veteran filed a notice of disagreement with the September 1998 rating decision wherein the RO denied entitlement to an increased (compensable) evaluation for folliculitis. Where there is a notice of disagreement with the denial of a claim, such claim has been placed in appellate status and must be remanded to the RO for issuance of a statement of the case. Godfrey v. Brown, 7 Vet. App. 398 (1995); Malincon v. West, 12 Vet. App. 238 (1999). Accordingly, this case is REMANDED to the RO for further development as follows: 1. The RO should request the veteran to identify the names, addresses, and approximate dates of treatment for all health care providers, VA and non-VA, inpatient and outpatient, who may possess additional records pertinent his treatment for allergic rhinitis and his right knee disability. After obtaining any necessary authorization or medical releases, the RO should request and associate with the claims file legible copies of the veteran's complete treatment reports from all sources identified whose records have not previously been secured. Regardless of the veteran's response, the RO should secure all outstanding VA treatment records. 2. The RO should arrange for a VA orthopedic examination of the veteran by an orthopedic surgeon or other appropriate specialist in order to determine the current nature and extent of severity of his right knee disability. Any further indicated special studies should be conducted. The claims file, the criteria under 38 C.F.R. §§ 4.40, 4.45, 4.59, and a separate copy of this remand must be made available to and reviewed by the examiner prior and pursuant to conduction and completion of the examination and the examination report must be annotated in this regard. The examiner must record pertinent medical complaints, symptoms, and clinical findings, including specifically active and passive range of motion, and comment on the functional limitations, if any, caused by the appellant's service connected right knee disability in light of the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59. It is requested that the examiner provide explicit responses to the following questions for the right knee disability: (a) Does the service connected disability involve only the joint structure, or does it also involve the muscles and nerves? (b) Does the service connected disorder cause weakened movement, excess fatigability, and incoordination, and if so, can the examiner comment on the severity of these manifestations on the ability of the appellant to perform average employment in a civil occupation? If the severity of these manifestations cannot be quantified, the examiner should so indicate. (c) With respect to the subjective complaints of pain, the examiner is requested to specifically comment on whether pain is visibly manifested on movement of the joints, the presence and degree of, or absence of, muscle atrophy attributable to the service connected disability, the presence or absence of changes in condition of the skin indicative of disuse due to the service connected disability, or the presence or absence of any other objective manifestation that would demonstrate disuse or functional impairment due to pain attributable to the service connected disability. (d) The examiner is also requested to comment upon whether or not there are any other medical or other problems that have an impact on the functional capacity affected by the service connected disability, and if such overlap exists, the degree to which the non- service connected problem creates functional impairment that may be dissociated from the impairment caused by the service connected disability. If the functional impairment created by the non-service connected problem can not be dissociated, the examiner should so indicate. Any opinions expressed must be accompanied by a complete rationale. 3. The RO should also schedule the veteran for a VA ear, nose, and throat examination by an appropriately qualified physician to determine the nature, extent of severity, and etiology of any rhinitis which may be found on examination. The claims file and a separate copy of this remand must be made available to and reviewed by the examiner prior and pursuant to conduction and completion of the examination and the examination report must be annotated in this regard. Any necessary tests and studies should be performed and all findings must be reported in detail. The examiner must render an opinion as to whether rhinitis, if found on examination, is related to the rhinitis noted during service. Any opinions expressed must be accompanied by a complete rationale. 4. The RO should issue a statement of the case as to the denial of entitlement to an increased (compensable) evaluation for folliculitis. The veteran must be advised of the requisite time to file a substantive appeal if he wishes appellate review. 5. Thereafter, the RO should review the claims file to ensure that all of the foregoing requested development has beencompleted. In particular, the RO should review the requested examination reports and required opinions to ensure that they are responsive to and in complete compliance with the directives of this remand and if they are not, the RO should implement corrective procedures. See Stegall v. West, 11 Vet. App. 268 (1998). 6. After undertaking any development deemed essential in addition to that specified above, the RO should readjudicate the issue of entitlement to an initial rating in excess of 10 percent for the right knee disability with application of 38 C.F.R. §§ 4.40, 4.45, 4.59 (1999) and DeLuca v. Brown, 8 Vet. App. 202 (1995). The RO should document it consideration of the applicability of 38 C.F.R. § 3.321(b)(1) (1999). The RO should also readjudicate the issue of entitlement to service connection for allergic rhinitis. If the benefits sought on appeal, for which a timely notice of disagreement has been filed, are not granted to the veteran's satisfaction, the RO should issue a supplemental statement of the case. A reasonable period of time for a response should be afforded. Thereafter, the case should be returned to the Board for final appellate review, if otherwise in order. By this remand, the Board intimates no opinion as to any final outcome warranted. No action is required of the veteran until he is notified by the RO. RONALD R. BOSCH Member, Board of Veterans' Appeals