Citation Nr: 0004473 Decision Date: 02/18/00 Archive Date: 02/23/00 DOCKET NO. 96-45 243 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Hartford, Connecticut THE ISSUES 1. Entitlement to service connection for a skin condition as due to Agent Orange exposure. 2. Entitlement to service connection for a skin condition on a direct basis. 3. Entitlement to an initial evaluation in excess of 30 percent for the veteran's service-connected splenectomy. 4. Entitlement to an initial compensable evaluation for the veteran's service-connected nodular sclerosing Hodgkin's disease. 5. Entitlement to an initial evaluation in excess of 30 percent for the veteran's service-connected post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Connecticut Department of Veterans Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Douglas E. Massey, Associate Counsel INTRODUCTION The veteran had active military service from June 1969 to January 1972. This matter originally came before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Hartford, Connecticut. In January 1998, following a hearing by the Board at the RO, the Board remanded the case for additional development. To the extent necessary, that development has been completed by the RO, and the case is once again before the Board for appellate review. The issue concerning the propriety of the initial rating for the veteran's service-connected PTSD will be discussed in the REMAND portion of this decision. Service connection for PTSD was granted by the RO following the Board's remand. The issue of entitlement to a higher initial rating was developed for appellate review; however, the RO did not schedule the veteran for a Board hearing at the RO, as he requested on his substantive appeal of this new issue. In correspondence dated in September 1997, the appears to have raised the issues of service connection for tuberculosis, liver problems, and cardiovascular disorders. The veteran also raised the issue of entitlement to a total disability rating based on individual unemployability by reason of service-connected disabilities. As these matters have not been procedurally developed for appellate review, the Board refers them back to the RO for appropriate action. FINDINGS OF FACT 1. The veteran's skin condition is not recognized by the VA as a disease for which the Secretary has determined that a presumption of service connection on the basis of Agent Orange exposure is warranted. 2. No chronic skin condition was shown in service, and there is no competent medical evidence of record relating his current skin condition to any incident of service, to include Agent Orange exposure therein. 3. There is no evidence that the veteran's splenectomy has resulted in complications such as systemic infections with encapsulated bacteria. 4. The veteran's nodular sclerosing Hodgkin's disease is currently in remission, with no clinical evidence of occasional low-grade fever, mild anemia, fatigability or pruritus. CONCLUSIONS OF LAW 1. The claim of entitlement to service connection for a skin condition as due to Agent Orange exposure is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The claim of entitlement to service connection for a skin condition on a direct basis is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. The criteria for an initial evaluation in excess of 30 percent for the veteran's splenectomy have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1-4.14, 4.117, Diagnostic Code 7706 (1995 & 1999). 4. The criteria for an initial compensable evaluation for the veteran's service-connected nodular sclerosing Hodgkin's disease have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1-4.14, 4.117, Diagnostic Code 7709 (1995 & 1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection for a Skin Condition The veteran has filed a claim for service connection for a skin condition based on several different theories. The veteran initially claimed that he suffered from chloracne on his face as a result of radiation therapy. He then clarified that this condition resulted from Agent Orange exposure while serving in Vietnam during the Vietnam era. The veteran later asserted that he was treated for a skin condition on his back while in service, and that service connection was therefore warranted on a direct basis. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303(a) (1999). If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptoms after service is required for service connection. See 38 C.F.R. § 3.303(b) (1999). In addition to these regulations, a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era, and has a disease listed in 38 C.F.R. § 3.309(e), shall be presumed to have been exposed during such service to an herbicide agent, such as Agent Orange, unless there is affirmative evidence to establish that he or she was not exposed to any such agent during that service. See 38 C.F.R. § 3.307(a)(6)(iii) (1998). If a veteran was exposed to Agent Orange during active military, naval, or air service, the following diseases shall be service-connected, if the requirements of 38 C.F.R. § 3.307(a) are met, 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, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lungs, bronchus, larynx, or trachea), and soft-tissue sarcomas. See 38 C.F.R. § 3.309(e) (1999). A veteran can also establish service connection for residuals of exposure to Agent Orange by showing that a current disorder is in fact causally linked to such exposure. Combee v. Brown, 34 F.3d 1039, 1044 (Fed. Cir. 1994), citing 38 C.F.R. § 3.303. In Combee, the United States Court of Appeals for the Federal Circuit held that when a veteran is found not to be entitled to a regulatory presumption of service connection for a given disability, the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis. That is, the material in the claims file must be evaluated to determine whether there is at least evidentiary equipoise as to the question of whether any currently diagnosed disability is related to an illness or injury sustained or manifested by the veteran while on active duty. Combee, at 1044; 38 U.S.C.A. §§ 1113(b), 1116 (West 1991 & Supp. 1999). The threshold question that must be answered in this case, however, is whether the veteran has presented well-grounded claims for service connection. A well-grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. The veteran has "the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that each of his claims is well grounded." 38 U.S.C.A. § 5107(a); Grivois v. Brown, 6 Vet. App. 136, 140 (1994); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The veteran must generally satisfy three elements for a claim for service connection to be well grounded. First, there must be competent evidence of a current disability (a medical diagnosis). Second, there must be evidence of incurrence or aggravation of a disease or injury in service, as shown through lay or medical evidence. Lastly, there must be evidence of a nexus or relationship between the in-service injury or disease and the current disorder, as shown through medical evidence. See Epps v. Gober, 126 F.3d 1464, 1468 (1997). Alternatively, the United States Court of Appeals for Veterans Claims (Court) has indicated that a claim may be well grounded based on application of the rule for chronicity and continuity of symptomatology, set forth in 38 C.F.R. § 3.303(b). See Savage v. Gober, 10 Vet. App. 488, 498 (1997). The Court held that the chronicity provision applies where there is evidence, regardless of its date, which shows that a veteran had a chronic condition either in service or during an applicable presumption period and that the veteran still has such condition. That evidence must be medical, unless it relates to a condition that the Court has indicated may be attested to by lay observation. If the chronicity provision does not apply, a claim may still be well grounded "if the condition is observed during service or any applicable presumption period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present condition to that symptomatology." Id. In the present case, the veteran's service medical records show that on a flight physical in June 1971 there were no complaints or findings of a skin disorder. In early December 1971, he was treated for moderately severe acne vulgaris on the back and when seen for other complaints in January 1972, there was no reference to any skin problems. This condition appeared to have resolved, as the remainder of the service medical records, including a separation examination report of January 1972, were negative for any other complaint, treatment or finding for any further skin problems. On the physical examination for separation, the clinical evaluation of the veteran's skin is reported to be normal. In connection with these claims, the veteran was afforded several VA examinations to determine the nature of his skin condition. A VA general medical examination report dated in November 1994 included the veteran's statements that he had been treated for acne rosacea in service and told to follow up upon discharge. Examination of the skin showed chronic facial acne. The examiner concluded with a diagnosis of "acne rosacea on nose/face." The veteran was also provided a dermatological examination by the VA in November 1994 to determine whether his acne rosacea was related to Agent Orange exposure. The examiner recorded the veteran's history that acne rosacea initially appeared during his period of military service while stationed in Vietnam. Examination of the skin revealed erythema over the forehead, cheek and nose. The diagnosis was acne rosacea with severe rhinophyma. Neither examiner provided a medical opinion as to the etiology of the veteran's acne. VA outpatient treatment reports dated in November 1994 and August 1995 show treatment for acne rosacea. Again, however, none of these reports discussed the etiology of this condition. In September 1997, the veteran testified before the undersigned member of the Board as to the nature and etiology of his skin condition. At that time, the veteran's representative pointed out that the veteran's current skin condition had been diagnosed as acne rosacea, which was not a presumptive disease listed in the regulations pertaining to Agent Orange exposure. The representative stated, however, that the veteran had been treated in service for severe acne vulgaris of the back, thereby suggesting that service connection was warranted on a direct basis. The veteran testified that he had suffered from a chronic skin condition on his face since service. He explained that the acne was just located on his back in service, but appeared on his face shortly after his separation from the Army. During the hearing the veteran was asked whether any doctor had related his skin disorder to Agent Orange exposure. The veteran testified that no body had ever said it was due to something, they just told him what he had. While not finding that the veteran's claim for a skin disorder was well grounded, the issue was remanded by the Board for development of the record and the veteran was given the opportunity to submit medical evidence in support of his claim. The RO wrote to the veteran requesting additional medical evidence. No medical evidence on this issue was received from the veteran. Pursuant to the Board's remand, the veteran underwent an additional VA dermatological examination in March 1998 to determine whether he had chloracne. A report from that examination included the veteran's statement that he had acne for over twenty-five years, which he felt was related to Agent Orange exposure in service. On examination, there was moderate to severe rhinophyma and a few scattered edematous papules over the face and forehead. The veteran's chest and back were clear. The examiner's assessment was "acne rosacea, long standing, with significant rhinophyma." The examiner did not provide an opinion as to the etiology or date of onset of this condition; however, in the absence of a well grounded claim there is no duty to assist with the development of the claim. In this regard, the supplemental statement of the case provided to the veteran noted that there was no diagnosis of chloracne or opinion relating his disability to herbicides. It was further noted that the veteran had provided no medical evidence to support his contention that his acne rosacea was related to his acne vulgaris from service. The veteran replied with a statement received in May 1999, that his skin disorder was caused by herbicides and aggravated by conditions experienced in service. Based on the foregoing, the Board finds that the veteran has not presented a well-grounded claim for service connection for a skin condition under both direct and presumptive theories of service connection. The record reflects that the veteran served in the Republic of Vietnam during the Vietnam era, and there is competent medical evidence demonstrating that he currently suffers from a skin condition. Nevertheless, this condition is not among the diseases for which the Secretary of Veterans Affairs, under the Authority of the Agent Orange Act of 1991, has determined is associated with exposure to herbicides used in the Republic of Vietnam during the Vietnam era. The veteran's current skin condition has been consistently identified as acne rosacea and acne rosacea with rhinophyma. However, chloracne or porphyria cutanea tarda are the only diseases of the skin listed in 38 C.F.R. § 3.309(e) for which service connection may be granted on a presumptive basis. As none of the clinical evidence includes a diagnosis of either chloracne or porphyria cutanea tarda, service connection can only be established with proof of actual direct causation. See Combee, supra. However, as the veteran has also failed to present medical evidence linking his current skin condition to service, or to exposure to herbicides, there is no basis for a grant of service connection on a direct basis. The veteran's service medical records show treatment for moderately severe acne vulgaris on one occasion with subsequent clinical records and the examination for separation being negative for complaints or findings of a skin disorder. Thus, a chronic skin condition was not shown to be present in service. The record also reveals that the first documented post-service complaints of a skin condition were not until 1994, over twenty years after his separation from service. More importantly, none of the post-service clinical records contain a medical opinion relating the veteran's current skin condition to his period of service, to include herbicide exposure therein. The Board observes that several examiners recorded the veteran's statements in which he alleged that his current skin condition had its onset in service and is related to Agent Orange exposure. However, the Court has held that evidence which is simply a history recorded by a medical examiner, unenhanced by any additional comment by that examiner, does not constitute competent medical evidence of the required nexus. See Leshore v. Brown, 8 Vet. App. 406, 409 (1995). As none of the examiners provided actual findings or conclusions linking the veteran's current skin disorder to service, we conclude that the veteran's self- reported history, which was noted in these reports, does not constitute competent medical evidence of a nexus between the veteran's current skin condition and his period of service. The Board also has considered the veteran's testimony and written statements submitted in support of his claims. The Court has consistently held, however, that where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. Brown, 7 Vet. App. 134, 137 (1994); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1991). The record does not reflect that the veteran possesses the medical training and expertise necessary to render an opinion as to either the cause or diagnosis of a skin condition. Therefore, his lay statements standing alone cannot serve as a sufficient predicate upon which to find the claim for service connection to be well grounded. See Heuer v. Brown, 7 Vet. App. 379, 384 (1995) (citing Grottveit v. Brown, 5 Vet. App. 91, 93 (1993)). In the absence of competent medical evidence to support the veteran's claims relating his current skin condition to service, the Board concludes that the veteran has not presented evidence sufficient to justify a belief by a fair and impartial individual that his claims are well grounded. Thus, the VA has no further duty to assist the veteran in developing the record to support the claims for service connection. See Epps, 126 F.3d at 1469 ("[T]here is nothing in the text of § 5107 to suggest that [VA] has a duty to assist a claimant until the claimant meets his or her burden of establishing a 'well grounded' claim."). The Board recognizes that these issues are being disposed of in a manner that differs from that employed by the RO. The RO denied the veteran's claim on the merits, while the Board has concluded that the claim is not well grounded. However, the Court has held that when an RO does not specifically address the question of whether a claim is well grounded but rather, as here, proceeds to adjudication on the merits, there is no prejudice to the appellant solely from the omission of the well grounded analysis. See Meyer v. Brown, 9 Vet. App. 425, 432 (1996). Finally, the Board is unaware of any information in this matter that would put the VA on notice that any additional relevant evidence may exist that, if obtained, would well ground the veteran's claims. See generally, McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997); Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995). The Board notes that the veteran testified at his hearing that he had been undergoing VA treatment once a month for his various disabilities for the past several years. The Board's January 1998 remand instructed the RO to secure these records, but it does not appear that the RO made any such attempt. Nevertheless, the veteran did not indicate that these records contain a diagnosis of chloracne or porphyria cutanea tarda, or that they contain a medical opinion which relates his current skin condition to service. The Board also emphasizes that the veteran has been afforded several VA dermatological examinations, even though there was no duty to assist the veteran. The Board also views the above discussion as sufficient to inform the veteran of the elements necessary to present a well-grounded claim for the benefits sought, and the reasons why the current claims have been denied. Id. II. Propriety of Initial Evaluations Assigned for a Nodular Sclerosing Hodgkin's Disease with Splenectomy An October 1994 rating decision granted service connection for nodular sclerosing Hodgkin's disease with splenectomy. The RO assigned a 30 percent evaluation for the splenectomy, effective as of February 1994, but deferred evaluation of the veteran's Hodgkin's disease pending a VA rating examination. In July 1995, the RO assigned a separate noncompensable (zero percent) evaluation for the veteran's Hodgkin's disease, also effective from February 1994. The veteran filed a notice of disagreement with respect to these initial ratings, and this appeal ensued. As these are claims of disagreement with the initial ratings assigned following a grant of service connection, separate ratings may be assigned for separate periods of time based on the facts found, a practice known as "staging." See Fenderson v. West, 12 Vet. App. 119 (1999). The Board finds that the veteran's claims are "well grounded" within the meaning of 38 U.S.C.A. § 5107(a), which gives rise to the VA's duty to assist. See Fenderson, 12 Vet. App. at 127. Under these circumstances, the VA must attempt to obtain all such medical evidence as is necessary to evaluate the severity of each of the veteran's disabilities from the effective date of service connection through the present. Fenderson, 12 Vet. App. at 125-127, citing Goss v. Brown, 9 Vet. App. 109, 114 (1996); Floyd v. Brown, 9 Vet. App. 88, 98 (1996); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). See also 38 C.F.R. § 4.2 (ratings to be assigned "in the light of the whole recorded history.") The Board finds that all relevant evidence has been obtained and that no further duty is required under the provisions of 38 U.S.C.A. § 5107(a). As noted, the veteran testified that he had been undergoing treatment by the VA approximately once a month since 1995 or 1996. In its January 1998 remand, the Board instructed the RO to secure copies of all VA treatment records and associate them with the claims filed. However, while the record does not reflect that the RO obtained these records, the Board finds that the veteran has been afforded several VA examinations to determine the nature and severity of his nodular sclerosing Hodgkin's disease with splenectomy. As will be discussed, each of these examination reports shows that the veteran's Hodgkin's disease is in full remission, with no complications associated with the splenectomy. Under these circumstances, the Board finds that an additional remand to obtain these treatment records is not necessary as the record as developed is sufficient to properly evaluate the veteran's disabilities. Service connection for Hodgkin's disease with splenectomy was granted based on records from the Waterbury Hospital dated from November 1979 to January 1980. These records essentially show that the veteran was diagnosed with Hodgkin's disease in November 1979, and that a splenectomy was performed in January 1980. No complications from that procedure were reported. The VA general medical examination report dated in November 1994 noted that the veteran's height was 5'11," and that his weight was 175 pounds, with a maximum weight of 185 pounds during the prior year. His temperature was 98.2 degrees. The veteran did not report complaints of fatigability, muscular weakness, anemia, or dyspnea. Examination of the lymphatic and hemic systems was unremarkable, with no adenopathy shown. Examination of the respiratory and digestive systems was also unremarkable. The examiner thus concluded with a diagnosis of Hodgkin's lymphoma in remission. The veteran also underwent an examination of the lymphatic system by the VA in November 1994. At that time, the veteran denied sweats, adenopathy and weight loss. On physical examination, the examiner commented that the disease was currently in remission, with no acute attacks and no impairment in the veteran's overall general health. The diagnosis was stage III Hodgkin's disease in remission. A November 1994 VA outpatient treatment report also showed that the veteran's Hodgkin's disease was in remission. It was noted that the veteran denied fever, sweats, and weight loss, and no adenopathy was present on examination. The clinician's impression was history of Hodgkin's disease, now no evidence of disease (NWD). At his September 1997 Board hearing, the veteran stated that his disability due to Hodgkin's disease with splenectomy should be evaluated as 60 percent disabling. He testified that his symptoms included night sweats, sleeplessness and weakness of the extremities. He also claimed that he suffered from liver and heart problems as a result of his Hodgkin's disease. Following the Board's remand, the veteran was examined again by the VA in December 1998 to determine the nature and severity of his Hodgkin's disease with splenectomy. A report from that examination included the veteran's history of having occasional fevers, chills, sweats, and fatigue over the years. However, the veteran's only current complaints involved a head cold with congestion. He denied coughing, chest pain, gastrointestinal complaints, and genitourinary complaints. Physical examination revealed that the veteran's weight was 205 pounds and that his temperature was 97.0 degrees. The abdomen was soft and non-tender, and bowel sounds were normal. There was no hepatomegaly or inguinale adenopathy. Examination of the extremities showed no edema or clubbing. Based on these findings, the examiner found no evidence of stage II Hodgkin's lymphoma, sixteen years after initial diagnosis. The examiner also commented that there was no current infection related to the splenectomy. Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. 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. See 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. Essentially, when the evidence is in relative equipoise, the veteran is accorded the benefit of the doubt. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). The RO initially evaluated the veteran's Hodgkin's disease as noncompensably disabling under Diagnostic Code 7709. See 38 C.F.R. § 4.117, Diagnostic Code 7709 (1995). At that time, a 100 percent rating was provided for one year following cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Thereafter, if there has been no recurrence or invasion of other organs, the rating was made on residuals. The minimum compensable evaluation of 30 percent required the manifestation of occasional low-grade fever, mild anemia, fatigability, or pruritus. Id. A noncompensable rating was for assignment if the required residuals were not shown. See 38 C.F.R. § 4.31. During the course of this appeal, VA issued new regulations for the evaluation of hemic and lymphatic systems, effective October 23, 1995. Where the law or regulations governing a claim change while the claim is pending, the version most favorable to the claimant applies, absent congressional intent to the contrary. See Karnas v Derwinski, 1 Vet. App. 308, 312-313 (1991). The effective date rule established by 38 U.S.C.A. § 5110(g), however, prohibits the application of any liberalizing rule to a claim prior to the effective date of such law or regulation. Id.; Rhodan v. West, 12 Vet. App. 55, 57 (1998). Thus, any increase in disability based on the revised criteria cannot become effective prior to October 23, 1995. Under the revised criteria, effective as of October 23, 1995, a 100 percent rating is assigned for acute (malignant) or chronic types of Hodgkin's disease with frequent episodes of high or progressive fever or febrile episodes with only short remissions, generalized edema, ascites, pleural effusion, or severe anemia with marked general weakness. A 60 percent rating is warranted if there is evidence of general muscular weakness with loss of weight and chronic anemia, or secondary pressure symptoms such as marked dyspnea, edema with pains and weakness of extremity, or other evidence of severe impairment of general health. A minimum 30 percent evaluation is assigned where there is evidence of occasional low-grade fever, mild anemia, fatigability or pruritus. Note to Diagnostic Code 7709 provides that 100 percent rating would be continued for one year following cessation of therapeutic procedure. If no local recurrence or invasion of other organs would then be shown, the disease is to be rated based on residuals. Id. Applying the facts of this case to the above criteria, the Board finds that the veteran's Hodgkin's disease does not warrant a compensable evaluation at any time since the initial rating. The clinical evidence clearly shows that the veteran's Hodgkin's disease has been in full remission during the pendency of this claim, with no evidence of low-grade fever, mild anemia, fatigability, or pruritus. The Board emphasizes that three VA examination reports and a VA outpatient treatment report noted that the veteran's Hodgkin's disease was in remission. The Board has considered the veteran's testimony that current symptomatology associated with his Hodgkin's disease include night sweats, sleeplessness, and weakness of the extremities. However, the veteran denied these symptoms during examinations, and none of the clinical evidence verifies that the veteran had any fever, anemia, fatigability or pruritus. In short, the Board finds that the preponderance of the evidence is against an initial compensable evaluation for the veteran's Hodgkin's disease under the former criteria, as well as the revised criteria since its effective date of October 23, 1995. In addition, the record reflects that the veteran's service- connected splenectomy is presently rated as 30 percent disabling. The Board notes that the Ratings Schedule, in pertinent part, was amended, effective September 22, 1995. Under the former criteria, a 30 percent evaluation was assigned for a splenectomy. See 38 C.F.R. § 4.117, Diagnostic Code 7706 (1995). The revised criteria now provides a 20 percent evaluation for a splenectomy, but notes that related complications should be rated separately. See 38 C.F.R. § 4.114, Diagnostic Code 7706 (1999). In this case, the veteran is currently rated higher than the maximum rating allowed under the amended rating criteria (which became effective September 22, 1995). Nevertheless, he is entitled to the 30 percent rating because of the timing of his claim. The evidence of record demonstrates that there are no present complications related to the veteran's splenectomy which require separate ratings. Therefore, the Board finds that the veteran is most appropriately evaluated at the 30 percent rate under the former criteria of Diagnostic Code 7706. Accordingly, a higher initial evaluation for a splenectomy is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against a compensable evaluation for the veteran's Hodgkin's disease, and against an evaluation in excess of 30 percent for a splenectomy, since the initial ratings of these claims. In reaching these decisions, the Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the veteran's claims, the doctrine is not for application. See 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet. App. at 55-56. The potential application of various provisions of Title 38 of the Code of Federal Regulations (1998) have been considered whether or not they were raised by the veteran as required by the Court's holding in Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). The Board has considered whether an extraschedular evaluation pursuant to the provisions of 38 C.F.R. § 3.321(b)(1) is warranted. In the instant case, however, there has been no showing that the disabilities under consideration have independently caused marked interference with employment, necessitated frequent periods of hospitalization, or otherwise rendered impracticable the application of the regular schedular standards. Under these circumstances, the Board determines that the criteria for assignment of an extraschedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell, 9 Vet. App. at 239; Shipwash v. Brown, 8 Vet. App. at 227. ORDER In the absence of evidence of a well grounded claim, service connection for a skin condition as due to Agent Orange exposure is denied. In the absence of evidence of a well grounded claim, service connection for a skin condition on a direct basis is denied. An initial evaluation in excess of 30 percent for the veteran's service-connected splenectomy is denied. An initial compensable evaluation for the veteran's service- connected nodular sclerosing Hodgkin's disease is denied. REMAND An April 1999 rating decision, following the Board's January 1998 remand, granted service connection for PTSD and assigned a 30 percent evaluation, effective as of November 1994. The veteran appealed that decision and it was developed for appellate review. In his VA Form 9 (Appeal to the Board of Veterans' Appeals), submitted in June 1999, the veteran requested that he be scheduled for a hearing before a member of the Board sitting at the RO in Hartford, on this issue. The RO then wrote to the veteran and, in subsequent correspondence, he affirmed his desire for this hearing. Although no such hearing was scheduled, the case was forwarded to the Board for review. Under these circumstances, and in light of the fact that the veteran has not waived his procedural rights, the veteran should be scheduled for a Board hearing on this claim. Accordingly, the case is REMANDED for the following action: The RO should undertake the necessary action to schedule the veteran for a personal hearing before a member of the Board at the RO during the next scheduled Travel Board with respect to the issue concerning the propriety of the initial 30 percent evaluation for his service- connected post-traumatic stress disorder. If the veteran no longer wishes such a hearing, the RO should clearly document the claims file accordingly, and return the claims file to the Board for further appellate review. The purpose of this REMAND is to afford the veteran due process of law, and the Board intimates no opinion, either favorable or unfavorable, as to the ultimate disposition warranted in this case. No action is required of the veteran until he is notified. The veteran has the right to submit additional evidence and argument on the matter the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). STEVEN L. COHN Member, Board of Veterans' Appeals