Citation Nr: 0005227 Decision Date: 02/28/00 Archive Date: 03/07/00 DOCKET NO. 90-49 047 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia THE ISSUES 1. Entitlement to service connection for residuals of hepatitis. 2. Entitlement to service connection for prostate cancer, claimed as a residual of herbicide exposure. 3. Entitlement to service connection for tinnitus. 4. Entitlement to an increased (compensable) rating for prostatitis. WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD K. Parakkal, Associate Counsel INTRODUCTION The veteran served on active duty from March 1956 to March 1976. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a January 1990 RO decision which denied the veteran's claims. In July 1991, October 1994, May 1995, and January 1998, the Board remanded the veteran's claims to the RO for further development. The case was returned to the Board in December 1999. By a January 1998 Board decision, the veteran's claim for an increased rating for tenosynovitis of the right wrist was granted, and his claims of service connection for a bladder neck obstruction (with postoperative residuals of surgery and retrograde ejaculation) and dyshidrosis of the hands and feet were denied. As the Board's 1998 decision is final, the aforementioned claims are no longer before the Board for appellate review and will not be discussed in the following decision. Additionally, in September 1999, the RO granted the veteran's appeal for service connection for bilateral hearing loss. As an award of service connection is considered a full grant of benefits on appeal, this matter, too, is not before the Board. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). FINDINGS OF FACT 1. The veteran has not presented competent evidence of a plausible claim of service connection for residuals of hepatitis. 2. The veteran has not presented competent evidence of a plausible claim of service connection for prostate cancer, claimed as a residual of herbicide exposure. 3. The veteran has not presented competent evidence of a plausible claim of service connection for tinnitus. 4. The veteran's service-connected prostatitis is manifested by complaints of urgency with a daytime voiding interval of between two and three hours. CONCLUSIONS OF LAW 1. The veteran's claim of service connection for residuals of hepatitis is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The veteran's claim of service connection for prostate cancer, claimed as a residual of herbicide exposure, is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. The veteran's claim of service connection for tinnitus is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 4. The criteria for no more than a 10 percent rating for prostatitis have been met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.115a, 4.115b, Diagnostic Code 7527 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background The veteran served on active duty from March 1956 to March 1976, including active service in Vietnam. His service personnel records reflect that his military occupational specialty was that of an anesthetist. His service medical records show that when he was examined for preinduction purposes, in December 1955, no pertinent abnormalities were indicated. The veteran underwent a routine physical examination in December 1957 and no pertinent findings were made. In June 1958, he was treated for ear problems, including otitis media. There were no complaints, treatment, or a diagnosis of tinnitus. A January 1959 examination report shows no pertinent abnormalities. On an associated medical history form, the veteran reported a history of ear, nose, or throat trouble. Routine physical examinations performed in January 1960, May 1961, and December 1961 show no relevant findings. A December 1961 medical history form shows that the veteran again reported a history of ear, nose, or throat trouble. He underwent a routine examination in August 1962, and no pertinent findings were made. In November 1962, the veteran was hospitalized at St. Joseph's Hospital. The admission diagnosis was infectious hepatitis. During the course of the hospitalization, he reported, that a few days prior to his departure from Korea he began experiencing general malaise and a complete loss of appetite. He said he later noticed that his skin was becoming yellow, his urine was dark, and his stools were very light. He related that there had been many cases of hepatitis within his group in Korea. Following an examination, the impression was infectious hepatitis. Routine examinations, performed in December 1963 and December 1964, are not reflective of any pertinent abnormalities. Medical records, dated in June and July 1966, show that the veteran was treated for prostatitis. Prostate cancer was not indicated. A December 1966 medical history form shows that the veteran reported having a history of jaundice. A physician summarized that the veteran had prostatitis, and a history of jaundice due to hepatitis in 1962. An August 1967 examination report shows no pertinent abnormalities. On an associated medical history form, the veteran reported having a history of ear, nose, or throat trouble, running ears, jaundice, and stomach, liver, or intestinal problems. He also said he had hepatitis in 1962 and prostatitis in 1966. In January 1968, the veteran was treated for ear problems, including pain. There were no complaints, treatment, or a diagnosis of tinnitus. In May 1972, the veteran underwent a routine physical examination and no pertinent abnormalities were noted. In June 1974, the veteran presented with complaints of low back pain, dysuria, and urgency, among other symptoms. It was objectively noted that his prostate was tender. The examiner opined that he had prostatitis. The veteran was examined for separation purposes in March 1976, and chronic prostatitis was diagnosed. An associated medical history form shows that he reported a history of ear, nose, or throat trouble, stomach, liver, or intestinal trouble, and jaundice or hepatitis. He further related he had hepatitis in 1962. In October 1976, the veteran was examined for VA compensation purposes. During the examination, he reported he had hepatitis in November 1961 and had been treated for such. He said he was supposed to receive follow-up treatment but got too busy and never received such. He related that in 1966, he had acute prostatitis which was treated vigorously. He said he now had intermittent mild pain every six to eight months and took medication for such, which usually stopped the difficulty immediately. On examination, he had a normal prostate gland with no nodules or tenderness to palpation. In November 1976, the veteran underwent a consultation examination, during which he complained of intermittent whistling tinnitus. The impression was normal hearing. In June 1987, the veteran was hospitalized at a private facility for treatment of daytime urinary frequency, dribbling, and nocturnal incontinence. During the course of the hospitalization, he underwent a transurethral resection of the prostate (TURP). The final hospital diagnoses included benign prostatic hypertrophy and an incomplete neurogenic bladder. Prostate cancer was not indicated. Additionally, it was noted that the veteran had a past history of being hospitalized for hepatitis. In April 1989, the veteran was seen by a private physician. Following an examination, the impression was a foreign body of the left ear, vallecular cyst. Tinnitus was not indicated. In October 1989, the veteran was examined for VA compensation purposes. He complained of constant tinnitus which was increasing in severity and Agent Orange exposure, among other things. He also related he had experienced an episode of hepatitis in 1961 or 1962, while stationed in Korea. He said his liver function tests were normal, and he said he did not know the status of his hepatitis antigens or antibodies. He also indicated that he was disturbed because he was not able to donate blood. He related he had no prostatitis since 1987, had normal erectile function, and a cessation of urinary incontinence. On examination, it was noted that his prostate was bi-lobed, normal in consistency, and without nodules or tenderness. The diagnoses were status-post infection, hepatitis; worsening tinnitus and deafness; and status-post recurrent prostatitis secondary to a bladder neck obstruction. An October 1989 VA laboratory report shows that the results of a "HEPATITIS A VIRUS AB, IGM" test was negative. Another October 1989 VA laboratory report reflects the veteran was positive for hepatitis B antibodies and negative for hepatitis B surface antigen and hepatitis B core antigen. A February 1990 private audiogram from Memorial Hospital shows that the veteran complained he had tinnitus of the left ear for about 1 year. The diagnosis was Meniere's disease. At a June 1990 RO hearing, the veteran related he had a bout of hepatitis in 1962 and was hospitalized for such. He said his liver recuperated but he was left with residuals including intermittent bouts of diarrhea and an inability to donate blood. He said he had not sought any treatment for hepatitis since his initial bout in 1962. He also related he had been exposed to Agent Orange; and he said if he developed cancer as a result of such exposure, he wanted his wife to receive adequate benefits. The veteran asserted he had tinnitus which used to be intermittent but was now constant. He said he first began noticing he had tinnitus sometime around 1972. He said his ear problems might have resulted from noise exposure, ear infections, or perhaps use of equipment in his ear, during service. He related he had been exposed to noise from huge exhaust turbines which were located in the operating room he worked in, from 1971 to 1976; and he said an ear, nose, and throat (ENT) Board certified physician had told him that such noise exposure caused his tinnitus. He also mentioned he had used an ear mold (in his left ear) to monitor his patients' heart rate in his capacity as an anesthetist. With respect to his prostate, he said he underwent surgical treatment in 1987, after which he did not have any problems with urinary leakage and frequency. He said his prostatitis no longer existed and that he no longer received treatment for such; however, he did say he continued to have problems with retrograde ejaculation. In October 1991, the veteran underwent audiometric testing at VA and reported having tinnitus of the left ear. An ENT consult was recommended. An October 1991 VA ENT consultation report reflects he reported he had noise exposure (from turbines) during service from 1971 to 1976. He said he had experienced tinnitus in the left ear for 20 months. He said his tinnitus was high-pitched and non-pulsatile. Following an examination, the impressions included noise exposure during service. An October 1991 VA Audiological evaluation reflects that the veteran had tinnitus of the left ear. VA medical records, dated in January 1992, show that the veteran reported having unilateral tinnitus, with the left ear being effected. He said his tinnitus had occurred approximately 2 years ago and had gradually worsened. A provisional diagnosis of tinnitus of the left ear was made. During a February 1996 VA examination, the veteran reported that VA had diagnosed him as having tinnitus in 1976. He said he now had constant tinnitus of the left ear, which was high-pitched. He said the tinnitus had been bad and was getting worse. As part of his job (as an anesthetist), he said he had used an ear device in his left ear which was hooked up to a heart monitor. He suggested that use of the ear device might be one of the reasons for his current ear problems. He said he developed prostatitis while in Vietnam. He said he was treated with a prostatic massage and medication (Septra). As for current problems, he said he did not have problems with urinary frequency. He related he urinated about 4 to 5 times per day and had no frequency at night. He said he did not have incontinence which required pads or an appliance. It was noted that his urine was clear and that he had no pain or dysbymis. There were no pertinent diagnoses. A February 1996 VA audiology examination report reflects that the veteran reported he was exposed to a significant amount of noise while in the Army. While working as an anesthetist, he said, he was exposed to high frequency loud noise from turbines which powered gas evacuation equipment in the operating room. He said he had been exposed to noise from weapons' fire, and was required to do rifle qualification training on a yearly basis, which was sometimes completed without the use of hearing protection devices. He said he first noticed he had tinnitus in 1988. He described the tinnitus as constant, high pitched, and more prominent in his left ear. He said he was not sure if the tinnitus was also present in the right ear. He said that the loudness was in the mid-range and did not fluctuate. He said that he considered the severity of the tinnitus to be moderate. He said he did not change his daily activities because of his tinnitus, but also said it sometimes drove him crazy. During a March 1996 VA Audio-Ear Disease examination, the veteran complained of ringing in his ears. He related he was a nurse anesthetist and was around noisy equipment. Following an examination, the impressions included tinnitus by history. A March 1996 medical record reflects that the veteran indicated he saw a urologist three to four times a year for treatment of prostatitis. He said he was usually given antibiotics. He said his urinary frequency problems had improved since his surgery (TURP). However, he did say he had dysuria, dribbling, and did double voiding. He said he had a reasonably strong urine stream. The veteran said his prostate specific antigens (PSAs) had been within the normal range. On examination, he had what the examiner described as a prostatitic stone low on the right side of his gland. In a January 1997 statement, the veteran indicated he was claiming service connection for prostate cancer, based on Agent Orange exposure. In a February 1997 statement, the veteran indicated he had not been diagnosed as having prostate cancer. By a January 1998 Board decision, service connection for bladder neck obstruction (with postoperative residuals of surgery and retrograde ejaculation) was denied. In a July 1999 VA audiology examination report, the examiner indicated that the claims file had been reviewed prior to the examination. It was pointed out that tinnitus was not indicated in the veteran's active duty medical records. The veteran reported he had worked as a nurse anesthetist while in the Army. In such a capacity, he said he was exposed to noise from large exhaust turbines in the operating room. He also said he was exposed to noise, during service, from weapons fire during periodic qualification training and while hunting. He said he was treated for ear trouble during service. He complained of current tinnitus and said that such was a constant ringing sensation in his left ear, which was loud, bothersome, and moderate in severity. He said he first noticed he had tinnitus about 10 years ago. He did not report making any changes in his daily activities as a result of his tinnitus. The examiner opined that tinnitus was not related to the veteran's active duty service as it was first noticed about 10 years ago, according to the veteran's self- reported history. In a July 1999 VA genitourinary examination report, the examiner (Dr. Ford) noted that the claims file was not available for review in conjunction with the examination. Dr. Ford noted that the veteran reported having hepatitis in 1962. The veteran explained that shortly before leaving Korea, a woman served him with (what he thought to be) infected eating utensils. Despite feeling poorly, he said he managed to leave Korea and return to the United States. He said he was jaundiced and was hospitalized at St. Joseph's Hospital for treatment. In the past, he said, he had not been completely emptying his bladder and got a reverse of urine that caused a continuous infection of the prostate gland. He said he underwent cystoscopy which showed he had a bladder neck obstruction and later underwent corrective surgery in 1987. With respect to his prostate problem, he said he sometimes had problems with urgency. He said he occasionally urinated during the day (i.e. four times in the morning and three to four times in the afternoon), and did not have to get up to urinate at night. He had no incontinence. He said he had diarrhea which lasted until he took Imodium. It was noted he had a rare urinary tract infection but had not been hospitalized for such. He had no colic, bladder or kidney stone problems, or acute nephritis. He had no malignancies. His prostate glands were described as smooth and tender with benign prostatic hypertrophy. Dialysis, pumps, implants, counseling, catheterization, dilatation, drainage procedures, and invasive or noninvasive procedures had not been necessary as treatment measures. It was also noted that he was not on medication or a diet. His hepatitis panel was completely normal, including Hepatitis C plus antibodies, Hepatitis B surface antigen, Hepatitis B core, and antibody Immunoglobulin G. The diagnoses were status-post hepatitis (with no disease or liver damage), benign prostatic hypertrophy (with no evidence of prostatitis and a normal urine examination), and status-post bladder neck obstruction requiring surgery (with normal urinalysis and improved symptoms). Following the July 1999 VA genitourinary examination, the RO requested Dr. Ford to review the claims folder, the Board's 1998 remand, and provide an addendum to his examination report (discussed above). This request was made in light of Dr. Ford's comment that the claims file had been unavailable for review at the time of the July 1999 examination. In his addendum, it was noted that the claims file had not been reviewed in direct conjunction with the July 1999 examination but had been reviewed when the veteran presented for prior examinations. It was also pointed out that pursuant to the RO's (July 1999) request, the claims file and the Board's remand had again been reviewed. Dr. Ford indicated that there was no need for the veteran to be reexamined and that all of the Board's remand inquiries had been properly answered in the July 1999 examination report, discussed above. II. Legal Analysis A. Service Connection Claims Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110; 1131; 38 C.F.R. § 3.303. The veteran has the initial burden of submitting evidence to show that his claims of service connection are well grounded, meaning plausible. 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78 (1990). If he has not done so, there is no VA duty to assist him in developing the claims, and the claims must be denied. For a service connection claim to be well grounded, there must be competent evidence of a current disability (a medical diagnosis); competent evidence showing incurrence or aggravation of a disease or injury in service (medical evidence or, in certain circumstances, lay evidence); and a nexus between the in- service injury or disease and the current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995). Where the determinative 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. Lay assertions of medical causation cannot constitute evidence to render a claim well grounded. Grottveit v. Brown, 5 Vet. App. 91 (1993). 1. Residuals of Hepatitis In November 1962, during his period of active duty, the veteran was hospitalized at a private facility and was treated for infectious hepatitis. (The type of hepatitis was not specified.) Subsequently dated service medical records, including his separation examination, are entirely silent for any objective findings of chronic hepatitis or residuals of such. Moreover, there is no post-service medical evidence of chronic hepatitis or residuals of such. While results of a hepatitis panel, performed in October 1989, reflect that the veteran had hepatitis B antibodies, such is merely a laboratory finding not a diagnosis of hepatitis or residuals or such. (In this regard, it is noted that although infectious hepatitis is a disability which is ratable under the VA Schedule for Rating Disabilities, see 38 C.F.R. § 4.114, Diagnostic Code 7345, there is no provision in law under which the presence of hepatitis antibodies in the blood, by itself, is service-connectable or compensable as a disability.) More recent medical evidence, including a July 1999 VA examination report, indicates that the veteran's hepatitis panel was negative or normal; and the diagnosis was status-post hepatitis, with no current disease or liver damage. Service connection requires more than the occurrence of a disease or injury during service. For the veteran's claim of service connection to be deemed plausible, there must be competent medical evidence in the record which demonstrates that he currently has the disability for which service connection is claimed. See Gilpin v. West, 155 F.3d 1353 (Fed.Cir. 1998); Degmetich v. Brown, 104 F.3d 1328 (Fed.Cir. 1997); Caluza, supra; Brammer v. Derwinski, 3 Vet. App. 223 (1992). In the instant case, while there is evidence showing that he had infectious hepatitis during active duty, there is no current medical evidence of chronic hepatitis or residuals of such. Again it is pointed out that a 1999 VA compensation examination report reflects the opinion that he had no resultant disease or liver damage stemming from his bout with hepatitis. It is noted that the veteran claims that he is unable to donate blood as a result of inservice hepatitis. A disability, to be service-connected, must be that which produces impairment in the ability to pursue an occupation. Hunt v. Derwinski, 1 Vet. App. 292 (1991). Even assuming that the veteran is unable to donate blood as a result of contracting infectious hepatitis during service, the inability to donate blood certainly does not constitute a disability which impairs his ability to work; and thus, it may not be service-connected. In the absence of competent medical evidence of a current diagnosis of hepatitis or residuals of such, the veteran has not met his initial burden of presenting evidence of a well- grounded claim of service connection; and thus, his claim must be denied. Caluza, supra. 2. Prostate Cancer A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era, and who has one of the herbicide-related diseases listed in the law, is presumed to have been exposed during such service to certain herbicide agents (e.g., Agent Orange), unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. If a veteran was exposed to an herbicide agent during active military service, the following diseases will be rebuttably presumed to have been incurred in service if manifest to a compensable degree within specified periods, even if there is no record of such disease during service: chloracne or other acneform diseases consistent with chloracne, Hodgkin's disease, multiple myeloma, non-Hodgkin's lymphoma, acute and subacute peripheral neuropathy (for purposes of this section, the term acute and subacute peripheral neuropathy means transient neuropathy that appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset), porphyria cutanea tarda, prostate cancer, respiratory cancers, and soft-tissue sarcomas. 38 U.S.C.A. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e); McCartt v. West, 12 Vet. App. 164 (1999). With specific respect to prostate cancer, service incurrence will be presumed if it becomes manifest to a 10 percent level at any time after service. A review of the claims file shows that the veteran did indeed serve on active duty in Vietnam during the Vietnam era. A review of his service medical records does not reveal any objective medical evidence which is reflective of prostate cancer. While he was treated for prostatitis (which is now service-connected) on several occasions during active service, prostate cancer was never indicated. Further, there is absolutely no post-service medical evidence which shows the veteran has prostate cancer. Historically, it is noted that when he was examined by VA in October 1976, shortly after his service discharge, his prostate gland was described as normal with no nodules or tenderness on palpation. When he was hospitalized in 1987, to undergo surgical treatment for prostatitis, prostate cancer was not indicated. During a VA examination in October 1989, his prostate was normal in consistency, and without nodules or tenderness. While it was noted, in March 1996, that he had a prostatic stone, there is no evidence that such was cancerous. Notably, during that March 1996 examination, the veteran mentioned that his PSAs had been negative; and in a 1997 statement, he admitted he had not been diagnosed as having prostate cancer. Finally, the most recent medical evidence of record, a July 1999 VA genitourinary examination report, includes the considered opinion that the veteran had no malignancies. When, as here, a claimed disability (prostate cancer) has not been shown by competent medical evidence to currently exist, the claim of service connection is not well grounded and must be denied. Caluza, supra; Rabideau v. Derwinski, 2 Vet. App. 141 (1992). While the claim must be denied at this juncture due to the lack of current medical evidence showing prostate cancer, the veteran is hereby invited to submit another claim of service connection in the future, when, if ever, prostate cancer is diagnosed. 3. Tinnitus The veteran's service medical records (1956-1976) reveal no evidence of complaints, treatment, or a diagnosis of tinnitus. Shortly after his service discharge, on an isolated occasion in November 1976, the veteran complained of intermittent whistling tinnitus. Thereafter, there is no evidence of tinnitus until 13 years later, in October 1989. From October 1989 onward, tinnitus is consistently diagnosed. In order for the claim to be well grounded, there would have to be competent medical evidence to demonstrate an etiological relationship between the veteran's service and his tinnitus. Caluza, supra; Grottveit, supra. No such competent medical evidence of causality has been submitted. Rather, evidence on file, including a 1999 VA examination report, reflects the opinion that tinnitus is not related to the veteran's active duty service. In 1999, a VA examiner pointed out that there was no evidence of tinnitus in the veteran's service medical records and noted that the veteran, himself, did not assert he had tinnitus in service but rather asserted he first had such about 10 years earlier (in the late 1980s). Additionally, it is noted that the veteran, who has training as a nurse anesthetist, has variously asserted that his tinnitus might have resulted from noise exposure, ear infections, or perhaps use of an ear mold, during service. In this regard it is noted that in Black v. Brown, the U.S. Court of Veterans Appeals (now known as the U.S. Court of Appeals for Veterans Claims (Court)) held that in order for a nurse's statement to constitute probative evidence, the nurse must have specialized knowledge in the area of medicine in question. 10 Vet. App. 279 (1997). Here, the veteran does not appear to have specialized knowledge in the area of audiology; as such, his opinion does not constitute competent medical evidence. While the veteran is indeed competent to say that he had ringing of the ears in service and even competent to say he currently has tinnitus, he is not competent to render an opinion regarding an etiological link between the two. While the veteran contends an ENT Board certified physician told him that standing in front of turbines for 5 years, during active duty, caused his tinnitus, there is no corroborative medical evidence of such on file. In this regard, the Board made exhaustive attempts to locate any outstanding records of the veteran's. While some outstanding records were located and associated with the claims file, no records were recovered which attribute the veteran's tinnitus to service or to a service-connected disability. Without corroborative medical evidence, the veteran's account of what a doctor told him does not constitute competent medical evidence to well ground his claim, since he is a layman with respect to audiological matters. Dean v. Brown, 8 Vet. App. 449 (1995). Since the veteran has not met his initial burden of presenting evidence of a well-grounded claim for service connection for tinnitus, his claim must be denied. Grottveit, supra; Grivois, supra. B. Increased rating for prostatitis The veteran's claim for an increased rating for prostatitis is well-grounded within the meaning of 38 U.S.C.A. § 5107(a), meaning that it is not inherently implausible. Evidentiary development requested by the Board in 1991, 1994, 1995, and 1998 has been completed to the fullest extent possible. VA has fulfilled its obligation to assist the veteran and his claim must now be adjudicated. See Murphy v. Derwinski, 1 Vet. App. 78 (1990); Littke v. Derwinski, 1 Vet. App. 90 (1990). When rating the veteran's service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). However, the present level of disability is of primary concern in a claim for an increased rating. The more recent evidence is generally the most relevant in such a claim, as it provides the most accurate picture of the current severity of the disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. During the course of the veteran's appeal, the regulations pertaining to prostatitis were revised. The Court has held that when the regulations concerning entitlement to an increased rating undergo a substantive change during the course of an appeal, the veteran is entitled to resolution of his claim under the criteria which most favorable. Karnas v. Derwinski, 1 Vet. App. 308 (1991). Under the old rating criteria, Diagnostic Code 7527 provided that prostate infections were evaluated as chronic cystitis under Diagnostic Code 7512, in accordance with resulting functional disturbance of the bladder. Under Diagnostic Code 7512, a 0 percent evaluation was warranted for chronic cystitis of a mild degree. A 10 percent evaluation was assigned for moderate chronic cystitis with pyuria and diurnal and nocturnal frequency. A 20 percent evaluation contemplated moderately severe cystitis with diurnal and nocturnal frequency with pain and tenesmus; and a 40 percent evaluation required severe cystitis with urination at intervals of one hour or less and a contracted bladder. 38 C.F.R. § 4.115a, Diagnostic Codes, 7512, 7527 (prior to February 17, 1994). Under the new rating criteria, Diagnostic Code 7527 provides that prostate gland injuries, infections, hypertrophy, and postoperative residuals will be rated as a voiding dysfunction or urinary tract infection, whichever is predominant. 38 C.F.R. § 4.115a, b, Diagnostic Code 7527. There are various criteria for rating voiding dysfunction, depending on whether the condition involves urine leakage, urinary frequency, or obstructed voiding. Voiding dysfunction involving continual urine leakage, post surgical urinary diversion, urinary incontinence, or stress incontinence is rated 20 percent disabling when the wearing of absorbent materials, which must be changed less than 2 times per day, is required. A 40 percent evaluation contemplates requiring the wearing of absorbent materials which must be changed 2 to 4 times per day. 38 C.F.R. § 4.115a. Voiding dysfunction involving urinary frequency is rated 10 percent disabling with a daytime voiding interval between two and three hours or where there is awakening to void two times per night. A 20 percent rating is warranted where there is a daytime voiding interval between one and two hours, or there is awakening to void three to four times per night. A 40 percent rating contemplates a daytime voiding interval of less than one hour or there is awakening to void five or more times per night. 38 C.F.R. § 4.115a. Voiding dysfunction involving obstructed voiding is rated 0 percent when there is obstructive symptomatology with or without stricture disease requiring dilatation 1 or 2 times per year; and such condition is rated 10 percent when there is marked obstructive symptomatology (hesitancy, slow or weak stream, decreased force of stream) with one or more symptoms such as post void residuals greater than 150 cc, markedly diminished peak flow rate (less than 10 cc/sec) per uroflowmetry, recurrent urinary tract infections secondary to obstruction, and stricture disease requiring periodic dilatation every 2 to 3 months. 38 C.F.R. § 4.115a. Finally, the criteria relating to urinary tract infections provide that a 10 percent rating is assigned where long term drug therapy, 1-2 hospitalizations per year and/or intermittent intensive management is required. A 30 percent rating contemplates recurrent symptomatic infection requiring drainage/frequent hospitalization (greater than two/times a year), and/or requiring continuous intensive management. 38 C.F.R. § 4.115a. A review of the record shows that the veteran was treated for prostatitis on several occasions during his period of active service from 1956 to 1976. After service, in June 1987, he underwent a TURP. Following surgery, the diagnoses included benign prostatic hypertrophy. When examined by VA in 1989 and at a 1990 RO hearing, the veteran related he had not experienced prostatitis symptomatology since his 1987 surgery. Specifically, at the RO hearing, he said he no longer had any problems with urinary leakage and frequency. More recent medical evidence includes VA compensation examinations performed in February and March 1996 and July 1999. When examined in February 1996, he related he had no problems with frequency, and urinated 4 to 5 times per day, with no frequency at night. He said he did not have incontinence at night and did not require the use of pads or an appliance. When examined in March 1996, he reported he saw a urologist three to four times per year for treatment of prostatitis. He said he typically received antibiotics as treatment. He related that his urinary frequency problems had improved since his surgery but that he did have dysuria and some dribbling. He said he had a reasonably strong urine stream. When he was examined in July 1999, it was noted that he sometimes had problems with urgency. He specifically related that he occasionally urinated during the day (i.e. four times in the morning and three to four times in the afternoon) and said he did not have to get up at night. He said he had no incontinence. He related that he had a rare urinary tract infection but had not been hospitalized for such. Treatment including dialysis, pumps, implants, catheterization, dilatation, drainage procedures, counseling, and invasive or noninvasive procedures had not been performed. The diagnoses were benign prostatic hypertrophy with no evidence of prostatitis and a normal urine examination. Applying the old criteria to the veteran's claim, it is noted that he does not meet the criteria for an increased rating for prostatitis. While the veteran does indeed have some problems with diurnal urinary frequency, there is no evidence which is reflective of moderate cystitis with pyuria. As both diurnal and nocturnal frequency and moderate cystitis with pyuria are required for a 10 percent rating, the veteran's claim for an increased rating must fail under the old criteria pertaining to prostate conditions. 38 C.F.R. § 4.115a, Diagnostic Codes, 7512, 7527 (prior to February 17, 1994). With respect to the new criteria, pertaining to voiding dysfunction involving urinary frequency, it is noted that the veteran reported during a 1996 VA examination that he urinated 4 to 5 times per day, with no frequency at night. Most recently, in 1999, he related having problems with urgency. He indicated he had to urinate about four times in the morning and three to four times in the afternoon. In sum, it appears that his urinary frequency has increased over the years, and equates to daytime voiding at an interval between two to three hours; and such is productive of an increased rating to 10 percent. The veteran's condition is not deserving of a rating higher than 10 percent as his daytime voiding interval is not between one to two hours, and does not involve awakening to void three to four times per night. 38 C.F.R. § 4.115a. With respect to the urine leakage criteria, it is noted that during an examination in 1996 he related that he was continent. In 1999, he again indicated he was continent; however, he did mention having some dribbling. He has consistently maintained that he does not use any pads as a result of urine leakage. Even with due consideration of any dribbling, the veteran's urine leakage does not meet the criteria for an increased rating, to 20 percent, as his condition does not require the use of pads. 38 C.F.R. § 4.115a. There is no evidence that the veteran experiences obstructed voiding. During a 1996 VA compensation examination, it was noted that he had a reasonably strong urine stream. In 1999, it was noted that his condition had not required dilatation or drainage procedures. In sum, there is absolutely no evidence of obstructive symptomatology including hesitancy, slow or weak stream, or decreased force of stream, among other things. Based on the aforementioned evidence, it is reasonable to conclude that the veteran's condition is not deserving of an increased rating under the criteria pertaining to obstructed voiding. 38 C.F.R. § 4.115a. With respect to the criteria relating to urinary tract infections, it is noted that during a 1999 VA genitourinary examination, it was pointed out that the veteran had a "rare" urinary tract infection but had not been hospitalized for such. It was also noted that medication had been unnecessary. Thus, it must be concluded that a higher rating is not warranted as neither hospitalization nor long- term drug therapy, among other things, is required as treatment. 38 C.F.R. § 4.115a. In sum, despite the finding, in a 1999 VA genitourinary examination report, that there is no current evidence of prostatitis, the Board finds that other objective evidence on file is to the contrary. The record, as a whole, supports an increased rating, to 10 percent, for the veteran's service- connected prostatitis, based on a voiding dysfunction involving urinary frequency; as such, the claim is granted. ORDER Service connection for residuals of hepatitis is denied. Service connection for prostate cancer, claimed as a residual of herbicide exposure, is denied. Service connection for tinnitus is denied. An increased rating, to 10 percent, for prostatitis is granted. G. H. SHUFELT Member, Board of Veterans' Appeals