BVA9504902 DOCKET NO. 92-15 108 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for bilateral pes planus. 2. Entitlement to service connection for situational stress reaction. 3. Entitlement to service connection for explosive personality disorder. 4. Entitlement to service connection for duodenal ulcer. 5. Entitlement to service connection for otitis media and externa, claimed as ear pain. 6. Entitlement to service connection for a chronic disorder manifested by enuresis. 7. Entitlement to service connection for a chronic disorder manifested by bilateral hand and wrist pain. 8. Entitlement to service connection for torticollis of the cervical spine. 9. Entitlement to service connection for obstructive sleep apnea. 10. Entitlement to an increased evaluation for lumbosacral strain with congenital tightness of the hamstring muscles, currently evaluated as 20 percent disabling. 11. Entitlement to an increased evaluation for hiatal hernia, currently evaluated as 10 percent disabling. 12. Entitlement to an increased (compensable) evaluation for bilateral hearing loss. 13. Entitlement to an increased (compensable) evaluation for chondromalacia of the right knee. 14. Entitlement to an increased (compensable) evaluation for chondromalacia of the left knee. 15. Entitlement to an increased (compensable) evaluation for meralgia paresthesia, right thigh. 16. Entitlement to an increased (compensable) evaluation for meralgia paresthesia, left thigh. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Ronald R. Bosch, Counsel INTRODUCTION The veteran served on active duty from January 1971 to September 1991. This appeal arose from a September 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The RO granted entitlement to service connection for: low back strain with congenital tightness of the hamstring muscles, assigned a 10 percent evaluation; hiatal hernia, assigned a noncompensable evaluation; bilateral high frequency hearing loss, assigned a noncompensable evaluation; chondromalacia of both knees, assigned a noncompensable evaluation; meralgia paresthesia of the right thigh, assigned a noncompensable evaluation; and meralgia paresthesia of the left thigh, assigned a noncompensable evaluation. The RO denied entitlement to service connection for pes planus, situational stress reaction, explosive personality, duodenal ulcer, enuresis, pain in hands and wrists, sleep apnea, otitis media and externa which were claimed as ear pain, and torticollis of the cervical spine which was claimed as neck pain. In a rating decision issued in November 1991, the RO assigned a separate noncompensable evaluation for chondromalacia of each knee. The Board of Veterans' Appeals (Board) REMANDED the case to the RO for further development in August 1993. In a March 1994 rating decision, the RO affirmed the determinations previously entered and granted an increased evaluation of 20 percent for low back strain with congenital tightness of the hamstring muscles and an increased (compensable) evaluation of 10 percent for hiatal hernia. The case has been returned to the Board for final appellate review. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that service connection is warranted for bilateral pes planus, situational stress reaction, personality disorder, duodenal ulcer, otitis media and externa, enuresis, painful hands and wrists, torticollis, and sleep apnea. He argues that a VA examiner has diagnosed bilateral pes planus and one has not. He states that the denial is arbitrary in nature as the RO has selected one opinion over another. He argues that he was treated for enuresis in service on one occasion but never again submitted to treatment because of the embarrassing nature of this condition. He states that enuresis was aggravated in service. The claimant argues that he definitely suffers from pain in his hands and wrists as well as his neck and that the RO has ignored the clinical findings of private physicians he has submitted with respect to these disorders. The appellant argues that his sleep apnea was aggravated by his service and has been a problem since service. The veteran argues that his low back, knee, thigh and hearing disabilities are more disabling than currently evaluated thereby warranting entitlement to increased evaluations. He argues that evidence of increased impairment has been substantiated by records he has submitted from his private attending physicians. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the veteran has not submitted evidence of well grounded claims for service connection for bilateral pes planus, situational stress reaction, duodenal ulcer, otitis media and externa, enuresis, and a chronic disorder claimed as painful hands and wrists; that the record supports a grant of service connection for sleep apnea and an increased evaluation of 30 percent for hiatal hernia; and that the preponderance of the evidence is against grants of service connection for explosive personality disorder, and torticollis of the cervical spine; and increased evaluations for chronic lumbosacral strain with congenital tightness of the hamstring muscles, bilateral high frequency hearing loss, chondromalacia of the right knee, chondromalacia of the left knee, meralgia paresthesia of the right thigh, and meralgia paresthesia of the left thigh. FINDINGS OF FACT 1. The claims for service connection for bilateral pes planus, situational stress reaction, duodenal ulcer, otitis media and externa claimed as ear pain, enuresis, and a chronic disorder claimed as painful hands and wrists are not supported by cognizable evidence showing that the claims are plausible or capable of substantiation. 2. Explosive personality disorder and congenital torticollis of the cervical spine are not recognized as disabilities under the law for VA compensation purposes. 3. The veteran required treatment for obstructive sleep apnea in service, and such disorder has continued to require treatment post service. 4. Chronic lumbosacral strain with congenital tightness of the hamstring muscles is productive of not more than moderate impairment or limitation of motion. 5. Hiatal hernia is productive of persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal arm or shoulder pain, productive of considerable impairment of health. 6. An August 1991 VA audiology examination disclosed that right pure tone thresholds were 15, 20, 30, and 40 decibels with an average of 26 decibels at 1000, 2000, 3000, and 4000 hertz with a speech recognition ability of 94 percent. 7. An August 1991 VA audiology examination disclosed that left pure tone thresholds were 15, 15, 40, and 45 decibels with an average of 29 decibels at 1000, 2000, 3000, and 4000 hertz with a speech recognition ability of 94 percent. 8. A September 1993 VA examination disclosed a full range of motion of both knees with no abnormalities on clinical examination or radiographic study resulting in a diagnosis of bilateral chondromalacia of the knees by history. 9. A September 1993 VA examination disclosed neurologic sensory evaluation revealed intact pinprick and light touch over the distribution of the lateral femoral cutaneous nerve bilaterally as well as in the remainder of each extremity resulting in a diagnosis of bilateral meralgia paresthesia by history. CONCLUSIONS OF LAW 1. The claims for service connection for bilateral pes planus, situational stress reaction, duodenal ulcer, otitis media and externa claimed as ear pain, enuresis, and a chronic disorder claimed as painful hands and wrists are not well grounded. 38 U.S.C.A. § 5107 (West 1991). 2. An explosive personality disorder was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303(c) (1994). 3. Torticollis of the cervical spine was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.303(c). 4. Obstructive sleep apnea was incurred in service. 38 U.S.C.A. §§ 1110, 1131, 5107. 5. The criteria for an evaluation in excess of 20 percent for chronic lumbosacral strain with congenital tightness of the hamstring muscles have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.40, 4.71(a), Diagnostic Codes 5292-5295. 6. The criteria for an increased evaluation of 30 percent for hiatal hernia have been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.114, Diagnostic Code 7346. 7. The criteria for an increased (compensable) evaluation for bilateral high frequency hearing loss have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.85, Diagnostic Code 6100. 8. The criteria for an increased (compensable) evaluation for chondromalacia of the right knee have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.31, 4.40, 4.71(a), Diagnostic Codes 5257, 5260, 5261. 9. The criteria for an increased (compensable) evaluation for chondromalacia of the left knee have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.31, 4.40, 4.71(a), Diagnostic Codes 5257, 5260, 5261. 10. The criteria for an increased (compensable) evaluation for meralgia paresthesia of the right thigh have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.20, 4.31, 4.40, 4.124(a), Diagnostic Code 8529. 11. The criteria for an increased (compensable) evaluation for meralgia paresthesia of the left thigh have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.20, 4.31, 4.40, 4.124(a), Diagnostic Code 8529. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Entitlement to service connection for bilateral pes planus, situational stress reaction, duodenal ulcer, otitis media and externa claimed as ear pain, enuresis, and a chronic disorder claimed as painful hands and wrists. Section 5107 of Title 38, United States Code unequivocally places an initial burden upon the claimant to produce evidence that his claims are well grounded; that is, that they are plausible. Grivois v. Brown, 6 Vet.App. 136, 139 (1994); Grottveit v. Brown, 5 Vet.App. 91, 92 (1993). Because the veteran has failed to meet this burden, the Board finds that his claims for service connection for bilateral pes planus, situational stress reaction, duodenal ulcer, otitis media and externa claimed as ear pain, and a chronic disorder claimed as painful hands and wrists are not well grounded and should be dismissed. Service connection may be granted for any disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5107. Where the determinative issue involves causation or a medical diagnosis, competent medical evidence to the effect that the claim is possible or plausible is required. Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). The claimant does not meet this burden by merely presenting his lay opinion because he is not a medical health professional and does not constitute competent medical authority. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Consequently, the veteran's lay assertions cannot constitute cognizable evidence, and as cognizable evidence is necessary for a well grounded claim, Tirpak v. Derwinski, 2 Vet.App. 609, 611 (1992), the absence of cognizable evidence renders a veteran's claims not well grounded. The service medical records contain no evidence or finding of pes planus. An August 1991 VA examination report shows the examiner noted the veteran had second degree pes planus. Flat feet was diagnosed. At a September 1993 VA examination the veteran reported not specifically recalling ever having been diagnosed as having flat feet or pes planus. He reported that after entering service he experienced frequent foot pain during prolonged standing. The veteran had never presented himself for examination for same and had never been seen by an orthopedist or podiatrist for flat feet. He had never received arch supports, orthopedic shoes, etc. On examination of the feet there was no evidence of pes planus of either foot. X-rays of both feet were negative for any abnormalities. The service medical records show that in 1972 the veteran reported that he was a very nervous individual and very angry over his duty assignment station. He was hospitalized in December 1975 for psychiatric evaluation. Two weeks before admission, during an argument, he struck his wife. They then separated. Due to his agitated state, he was referred for psychiatric evaluation. The veteran's admission diagnosis was depressive neurosis. He was ultimately found to have a situational stress reaction of adult life secondary to marital disruption. He was counseled regarding the situational nature of his difficulties, his needs for self-control, realistic action, future plans, and planned disposition of his case. In December 1981 it was noted that the veteran was counseled concerning adjustment difficulties and situational stress. In August 1984 an examiner noted there was no evidence of psychopathology. A September 1984 consultation report concluded in findings including no psychiatric disorder. The September 1991 VA psychiatric examination shows the veteran complained of nervousness. The evaluation shows the veteran had been treated for stress on several occasions. He was noted to have been hospitalized for anxiety state and treated with tranquilizers. Anxiety state was diagnosed. Situational stress reaction reported in active service was an acute and transitory abnormality or reaction to marital stress and resolved without any finding of such disorder during the remaining years of service and has not been found on post service psychiatric examination. Anxiety state reported post service was not shown in service and as will be seen below, was no longer shown to exist on the basis of a later conducted VA examination. The service medical records show that on several occasions, when seen for gastrointestinal complaints, the appellant reported a history of treatment for a duodenal ulcer in 1965, prior to his entrance in service when in college. He got better and supposedly had another flare-up in 1972. A December 1982 upper gastrointestinal x-ray revealed no evidence of peptic ulcer disease. An August 1991 VA upper gastrointestinal x-ray revealed no evidence of an ulcer. Peptic ulcer disease is not shown by the evidence of record. The service medical records show that on numerous occasions the veteran was treated for complaints of bilateral ear pain which were diagnosed as reflective of bilateral otitis media and externa. The post service VA examinations conducted in July 1991 and September 1993 are negative for any evidence of otitis media or externa in either ear. Otitis media and externa are not shown by the evidence of record. The service medical records show that no genitourinary abnormalities were reported when the veteran was examined in February 1971. He denied a history of bedwetting. In June 1981 it was reported that the appellant was having intermittent enuresis only when deployed. In April 1982 he was again noted to be having problems with enuresis. He denied dysuria. The appellant reported having had enuresis as a child to age 15 or 16. He had never had a urology consultation. There was marked diminution in his enuresis when he was not deployed at sea. An examination disclosed no positive findings. The clinical assessment was enuresis of undetermined etiology. An August 1984 general medical examination report shows there was an isolated episode of bedwetting not accompanied by any abnormal genitourinary abnormality. There was no evidence of genitourinary pathology. It was noted that the veteran did not have true enuresis. On the medical history part of the examination the veteran reported bedwetting on active duty in 1973 with no recurrence since. A urology consultation report shows that the claimant's past and present genitourinary history was essentially negative. An episode of bedwetting occurred after heavy alcoholic intake and there was no history suggesting a neurological problem. The genitourinary examination and urinalysis were noted as negative. The diagnostic impression was negative genitourinary examination. The examiner noted that an episode of bedwetting following heavy drinking did not signify enuresis. At a July 1991 VA examination the veteran complained of bedwetting. On evaluation of the genitourinary system, the examiner noted the veteran reported he had enuresis and that no cause for it had been found. He had been seen by a urologist. The examiner provided no clinical findings or a diagnosis. A September 1993 VA general medical examination of the genitourinary system shows the veteran was a normal circumcised male. Testicles and appendages were within normal limits. No genitourinary diagnosis was provided. The service medical records specifically show that enuresis had occurred prior to service, and that during service it occurred only when the veteran was assigned at sea or after heavy alcohol intake. A comprehensive urology examination conducted during service disclosed that the veteran did not have true enuresis and there was no evidence of any genitourinary problem or a neurological cause for enuresis reported by the veteran to have occurred after heavy alcohol intake. The post service VA examinations are negative for any chronic genitourinary disorder manifested by enuresis. The service medical records show that when examined in March 1972, the veteran was noted to have a 1/2 inch circular scar on the middle finger of the left hand. In May 1982 he reported with complaints of burning fingers in the left hand. He explained that he had been working on television and picking up the wrong end of coding. An examination disclosed a severe first degree burn with vesicle formation. In June 1982 the appellant reported for treatment after having fallen and struck the ulnar side of the right wrist and having hyperextended the wrist. There was pain to palpation of the distal radius and carpal. A navicular fracture was to be ruled out. An August 1984 medical history examination report shows the veteran reported having fractured his wrist as child. There were no residuals. The appellant underwent a neurology evaluation in February 1985 for symptomatology including numbness of the left hand. He had a history of intermittent paresthesias on the ulnar side of the left hand effecting the index finger when severe. No specific abnormality of the left hand was noted. At a July 1991 VA general medical examination the veteran complained of pain in the hands and wrists. There were no clinical findings as to any abnormalities of either hand or wrist. At a September 1993 VA examination the claimant related onset of hand and wrist problems to 1989 or 1990 while on active duty. Currently he noted pain in the mid dorsum of each wrist with the left being more symptomatic than the right. The pain was intermittent and not associated with any swelling, redness or increased warmth to the touch. The veteran stated that many x- rays of his hands and wrists over the years had been normal. He denied any pain or swelling of the small joints of the hand. An examination of the hands and wrists disclosed a full range of motion with no abnormalities. X-rays of the hands and wrists were interpreted as negative for any abnormalities. The examiner diagnosed wrist pain by history. The Board's evaluation of the evidence of record does not permit a determination that service connection is warranted for bilateral pes planus, situational stress reaction, duodenal ulcer, otitis media and externa claimed as ear pain, enuresis, and a chronic disorder claimed as painful wrists and hands. The above discussed evidence of record does not show that the veteran incurred or aggravated any of these claimed disorders coincident with active service, and in the case of situational stress reaction, although reported in service, resolved without residual disability. None of the subject disorders are shown to currently exist. There is no competent medical evidence of record showing that the veteran now has any of these subject claimed disorders. In response to the veteran's contention presented on appeal as to pes planus, this disorder was not shown in service. While it was noted by a VA examiner in July 1991, it was not shown when the veteran was examined in September 1993. The fact remains that it was not incurred in service and is not currently shown to exist. There is no cognizable evidence of record showing that the veteran has bilateral pes planus, situational stress reaction, duodenal ulcer, otitis media and externa claimed as ear pain, enuresis, and a chronic disorder manifested by painful hands and wrists. The absence of such cognizable evidence renders the veteran's claims not well grounded. The Board recognizes that this part of the veteran's appeal has been disposed of in a manner different from that utilized by the RO. The Board therefore considered whether the claimant has been given adequate notice to respond, and if not, whether he has been prejudiced thereby. Bernard v. Brown, 4 Vet.App. 384 (1993). In light of the implausibility of the appellant's claims and his failure to meet his initial burden in the adjudication process, the Board concludes that he has not been prejudiced by the decision. In this regard, the Board points out that by the action of dismissing his claims, the Board has not burdened the veteran with a prior final adjudication on the merits. Thus if he is able to submit well grounded claims in the future, he will not be faced with the higher hurdle of providing new and material evidence to reopen his claims after a prior final adjudication. 38 U.S.C.A. §§ 5108, 7104, 7105; McGinnis v. Brown, 4 Vet.App. 239, 244 (1993). The Board also observes that the RO, in assuming that the veteran's claims were well grounded, accorded him greater consideration than his claims in fact warranted under the circumstances. Bernard. To remand the case to the RO for consideration of the issue of whether the appellant's claims are well grounded would be pointless and, in light of the law cited above, would not result in a determination favorable to him. VA O.G.C. Prec. Op. 16-92, 57 Fed.Reg. 49,747 (1992). II. Entitlement to service connection for explosive personality disorder and torticollis of the cervical spine. With respect to the claims of entitlement to service connection for explosive personality disorder and torticollis of the cervical spine, the Board does not need to reach the question of whether or not these claims are well grounded because the law concerning awards of service connection as to these disorders is dispositive. In this regard, 38 C.F.R. § 3.303(c) provides that explosive personality disorder and congenital torticollis of the cervical spine are not diseases or injuries within the meaning of applicable legislation governing the awards of compensation benefits. As such, regardless of the character or the quality of the evidence which the veteran could submit, these disorders cannot be recognized as disabilities under the law. The service medical records show that on numerous occasions the veteran was reported to have congenital torticollis since childhood. At a July 1991 VA examination the appellant complained of a stiff neck. There were no specific findings. An August 1992 private magnetic resonance imaging of the cervical spine disclosed a very small epidural defect at the C7-T1 level. The radiologist expressed the belief that the defect was causing a slight bulging of the annulus fibrosus and small osteophyte formation. There was very slight anterior osteophyte formation as well. These were described as minimal degenerative changes. A February 1993 magnetic resonance imaging of the cervical spine disclosed, among other things, disc space narrowing. When examined by VA in September 1993, the veteran was noted to have undergone a magnetic resonance imaging of the spine in July 1992 which reportedly revealed degenerative disc disease of the cervical spine. The examiner noted that his history of cervical spine difficulties involved the degenerative disc disease as well as a history of torticollis of the right sternocleidomastoid muscle. The appellant noted that this was diagnosed when he was 14 years old and at that time he underwent surgical release of that muscle. The veteran did well until 1979 when he noticed occurrence of spasm in his right sternocleidomastoid muscle. The claimant stated that he did not seek medical evaluation for torticollis while in service; however, it was noted on several routine examinations. The diagnosis was cervical spine pain secondary to congenital torticollis, degenerative disc disease, and degenerative arthritis by history. An x-ray of the cervical spine was interpreted as negative. It is well to point out at this time that the only cervical spine disability which is the subject of the current appeal is congenital torticollis. The veteran has submitted private medical evidence of other disorders of the cervical spine which are not subjects of the current appeal. His torticollis, classified as congenital in nature by VA and non-VA health care professionals is not recognized as a disability under the law thereby precluding a grant of entitlement to service connection. 38 U.S.C.A. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303(c). As to psychiatric disability, the Board observes that while on active duty in June 1972, the veteran reported that he was a very nervous individual and very angry over his duty assignment station. He was hospitalized in December 1975 for psychiatric evaluation. Two weeks before admission, during an argument, he struck his wife. They then separated. Due to his agitated state, he was referred for psychiatric examination. The veteran's admission diagnosis was depressive neurosis. He was ultimately found to have disorders including a mild to moderate explosive personality disorder. He was counseled regarding the personality nature of his difficulties, his needs for self-control, realistic action, future plans, and planned disposition of his case. In December 1981 it was noted the veteran was counseled concerning adjustment difficulties. In August 1984 an examiner noted there was no evidence of psychopathology or personality disorder evident. A September 1984 consultation report concluded in findings of no psychiatric disorder or personality disorder; and narcissistic personality features, mildly evident. The September 1991 VA general medical examination report shows the veteran complained of nervousness. The psychiatric evaluation shows the veteran had been treated for stress on several occasions. He was noted to have been hospitalized for anxiety state and treated with tranquilizers. Anxiety state was diagnosed. At a September 1993 VA special psychiatric examination the veteran gave a history of his efforts to control his explosiveness and expressed apprehensions over the possibility of his becoming explosive again. The examination concluded in a diagnosis of intermittent explosive personality disorder. As was the case of congenital torticollis of the cervical spine, the veteran is not shown to have a chronic psychiatric disorder which is recognized as a disability under the law. His service diagnosed explosive personality disorder, and narcissistic personality features, and currently diagnosed intermittent explosive personality disorder are not recognized as disabilities for VA compensation purposes. A clinical finding of anxiety state diagnosed by VA in July 1991 was not shown in service and such diagnosis was replaced by the diagnosis of an intermittent explosive personality disorder most recently reported by VA to account for the appellant's psychiatric symptomatology. Accordingly, the Board finds that service connection for explosive personality disorder must be denied as a matter of law. 38 U.S.C.A. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303(c). As to the remaining issues for appellate review, the Board observes that the veteran's claims are well grounded, all relevant facts have been properly developed, and there is no further duty to assist him in the development of such claims. III. Entitlement to service connection for obstructive sleep apnea. The February 1971 report of general medical examination pursuant to enlistment shows no pertinent abnormality and the clinical evaluation of the neurological system was normal. In March 1989 the veteran reported with an 8 year history of being very tired, weak, and very prone to sleeping instantly. He had had increased snoring to the point of gagging and not letting others sleep. His wife was sure that he stopped breathing for up to 30 seconds. The provisional diagnosis was possible sleep apnea. The veteran noted that his symptoms had been worsening during the last 8 years. He had currently developed an ability to sleep in an instant. He stated that 8 fellow servicemen had departed their common sleeping quarters because of his snoring. A clinical evaluation resulted in assessments of sleep disorder, snoring, and sleep apnea. The veteran was referred for an ear, nose, and throat evaluation in April 1989. He complained of excessive daytime somnolence and occasional morning headache, lethargy, snoring, and sleep apnea up to 25 seconds by history. On examination the oral pharynx was narrow with closure observed in oral nasopharynx with Muller maneuver with no narrowing at the base of the tongue on closure there with Muller maneuver. The diagnostic impression was sleep apnea, obstructive. At a July 1991 VA examination the veteran complained of snoring and fatigue. There were no pertinent clinical findings and no diagnosis was provided. On file is an August 1991 4-channel polysomnogram report from a private physician. The veteran underwent the above procedure for excessive daytime sleepiness and to rule out obstructive sleep apnea. The 4-channel polysomnogram procedure resulted in clinical impressions noting that the veteran's clinical history and the 4-channel polysomnogram were suggestive of obstructive hypopnea and probably obstructive sleep apnea with associated excessive daytime sleepiness. It was recommended that the veteran avoid alcohol and lose 25-30 pounds. A September 1991 private surgical pathology report shows the specimen source was septal cartilage. The clinical information noted chronic nasal obstruction with sleep apnea; septoplasty and turbinectomy, bilateral were performed. It is the judgment of the Board that the veteran does have residuals of surgery to correct obstructive sleep apnea, a disorder initially reported in the service medical records. The private medical documentation submitted by the veteran shows that his symptomatology involving excessive fatigue, instant sleep during the daytime, and snoring required surgical intervention. His symptomatology, shown both during and subsequent to service, was diagnosed as obstructive sleep apnea, also both during and subsequent to service. The record clearly demonstrates continuity of symptomatology of an identified chronic disorder initially reported in service. The Board concludes that service connection is warranted for obstructive sleep apnea. 38 U.S.C.A. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303(b). IV. Entitlement to an increased evaluation for chronic lumbosacral strain with congenital tightness of the hamstring muscles, currently evaluated as 20 percent disabling The service medical records show the veteran was seen with complaints of low back symptomatology in 1980. Muscle spasm was found on examination. Mild scoliosis and facet disease at L5-S1 was seen on a 1983 radiographic study. The service medical records show the veteran was treated for intermittent low back pain which was caused or aggravated by congenitally tightened hamstring muscles. The above disorder was ultimately determined to have been aggravated by active service. At a July 1991 VA general medical examination the veteran complained of back pain. On musculoskeletal examination the veteran reported having had problems with his back. On prolonged standing his pain radiated into both legs, and when he coughed or sneezed. On examination leg raising was essentially negative. Forward flexion was to 45 degrees. The claimant could stand on his toes. The examiner diagnosed low back syndrome. An x-ray of the lumbosacral spine disclosed that the spine was tilted towards the right which could merely be positional in etiology according to the radiologist. The lumbosacral spine was otherwise unremarkable. A July 1992 private magnetic resonance imaging of the lumbar spine noted that all lumbar discs showed a decrease in height. It was noted this may be congenital. The L3-4 and L4-5 intervertebral discs showed disc desiccation with mild bulging of the annulus fibrosus at the nerve foramina bilaterally. It was noted this was a minimal finding, however it did indicate early degenerative disc disease. There was irregularity of the inferior surface of the L1 vertebral body possibly associated with degenerative disc disease or on a congenital basis. There were no intrathecal masses. The visualized portion of the spinal cord was normal. A February 1993 magnetic resonance imaging of the lumbar spine was interpreted as revealing a moderate lower lumbar scoliosis convex left centered at L4-5. The disc spaces were relatively well preserved and there was no vertebral compression. There was mild impression into the anterior inferior endplate of L1. The posterior arches appeared intact. At a September 1993 VA general medical examination the veteran reported onset of joint pain in service in 1979 when he noted lower lumbar pain which occurred in the center of the lower lumbar spine, radiating to both buttocks to the level of the knees. His lumbar pain worsened with calisthenics. By 1980 he had to discontinue most physical exercise secondary to low back pain. On examination forward flexion of the lumbar spine was limited to 40 degrees. Backward extension was to 30 degrees. Side to side bending was to 30 degrees. Left straight leg raise was productive of pain at 40 degrees with pain radiating to the lateral thigh. On the right straight leg raising was negative to 90 degrees. An x-ray of the lumbosacral spine was interpreted as negative. The examiner diagnosed low back pain secondary to degenerative disc disease and degenerative arthritis by history. The veteran's chronic lumbosacral strain with congenital tightness of the hamstring muscles is evaluated as 20 percent disabling under diagnostic codes 5292 and 5295 of the VA Schedule for Rating Disabilities. The 20 percent evaluation under diagnostic code 5292 contemplates not more than moderate limitation of motion of the lumbar spine. The 20 percent evaluation under diagnostic code 5295 contemplates not more than lumbosacral strain productive of muscle spasm on extreme forward bending and loss of lateral spine motion. The next higher evaluation of 40 percent under diagnostic code 5292 requires severe limitation of motion of the lumbar spine. Severe limitation of motion of the lumbar spine was not demonstrated when the veteran was examined by VA in July 1991 and September 1993. It has not been shown in the private medical evidence submitted by the veteran in support of his claim. The next higher evaluation of 40 percent under diagnostic code 5295 requires severe lumbosacral strain with listing of the whole spine to the opposite side, positive Goldthwait's sign, marked limitation of forward bending in a standing position, loss of lateral motion with osteo-arthritic changes, or narrowing or irregularity of joint space, or some of the above with abnormal mobility on forced motion. The above criteria for a 40 percent evaluation have not been met on the basis of clinical findings reported by VA on examinations conducted in July 1991 and September 1993, nor on the basis of private medical documentation submitted by the veteran in support of his claim. The private medical evidence submitted by the veteran includes references to degenerative disc disease. A 20 percent evaluation may be assigned for moderate intervertebral disc syndrome with recurring attacks under diagnostic code 5293. The next higher evaluation of 40 percent requires a demonstration of severe intervertebral disc syndrome productive of recurring attacks with intermittent relief. Severe intervertebral disc syndrome as a manifestation of the veteran's service-connected low back disability has not been shown by the evidence of record. The Board acknowledges the veteran's complaints of low back symptomatology and his belief that he has submitted private medical documentation substantiating his claim of increased impairment. As the Board noted above, such is not the case. The appellant undoubtedly suffers from incapacitating symptomatology related to his low back disability but such incapacitation has not been shown to be more than moderate in nature with application of pertinent governing criteria. The medical documentation of record, VA and non-VA have not demonstrated severe low back disablement as to permit a grant of an increased evaluation under diagnostic code 5292, 5293, or 5295. No question has been presented as to which of two or more evaluations would more properly classify the severity of the veteran's low back disability. 38 C.F.R. § 4.7. The veteran's low back disability has not rendered his disability picture unusual or exceptional in nature and has not been shown to markedly interfere with his employment. It has not required frequent inpatient care as to render impractical the application of regular schedular standards, thereby precluding a grant of an increased evaluation on an extraschedular basis. 38 C.F.R. § 3.321(b)(1). V. Entitlement to an increased evaluation for hiatal hernia, currently evaluated as 10 percent disabling. The service medical records show that in 1984 the appellant was found to have a small hiatal hernia with esophageal reflux. At a July 1991 VA general medical examination the veteran complained of stomach pain. On evaluation of the digestive system the veteran reported his history of having been diagnosed with a hiatal hernia in service. The examiner diagnosed hiatal hernia with esophagitis. An upper gastrointestinal x-ray demonstrated a small hiatal hernia without evidence of complication. A March 1993 upper gastrointestinal x-ray was noted as unremarkable. It was noted that a hiatal hernia had been previously described on a barium swallow examination. The stomach and duodenum appeared normal with no mucosal ulceration, intrinsic or extrinsic mass. A barium swallow noted the veteran swallowed without difficulty. The esophageal peristalsis was normal. There was a moderate sized hiatal hernia which did not reduce during the examination. There was transient gastroesophageal reflux. There was a very slight circumferential area of narrowing at the gastroesophageal junction, but it still measured over 2 centimeters in diameter. Gastroesophageal reflux was elicited during the examination. A June 1993 esophagogastroduodenoscopy with biopsy concluded in a diagnostic impression of severe esophagitis at the gastroesophageal junction likely due to reflux hiatal hernia and absence of a sphincter appreciable endoscopically. In a June 1993 letter on file, a private physician advised that on Prilosec, the veteran was dramatically better as to his gastrointestinal symptomatology, with no further indigestion, heart burn, or dysphagia. He noted symptoms if he missed a dose of his medication. At a September 1993 VA general medical examination the veteran dated onset of his gastrointestinal problems to 1972 at which time he began to notice heartburn type symptoms with a sour mash taste and burning type chest pain. He stated that as long as he kept food in his stomach he seemed to have less discomfort. In June 1992 he underwent an upper gastrointestinal endoscopy at a private medical center. The veteran was told that he had distal esophagitis as well as marked lower esophageal sphincter dysfunction. It was felt that his dysphagia for solids was related to esophageal spasms secondary to irritation since no stricture was seen. He was currently undergoing a two week trial of Prilosec for esophageal reflux and continued to have heart burn and a sour mash taste. On examination the veteran was reported to weigh 200 pounds also noted to be his maximum weight during the prior year. He was reported to be 6 feet 3 inches tall. He was described as mildly obese and well nourished. His posture, carriage and gait were within normal limits. The abdomen was mildly obese, soft, compliant, and nontender. Liver span was 6 centimeters without edge, and there was no spleen tip. Bowel sounds were active. The rectal exam was of normal tone and no masses were in the vault. The stool was brown and guaiac negative. The examination diagnosis was hiatal hernia with gastroesophageal reflux by history. The veteran is rated as 10 percent disabled for hiatal hernia under diagnostic code 7346 of the VA Schedule for Rating Disabilities. A 30 percent evaluation under this diagnostic code may be assigned for a hiatal hernia productive of persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. The current 10 percent evaluation for hiatal hernia contemplates two or more of the symptoms for the 30 percent evaluation of less severity. The Board is of the opinion that the veteran's current gastrointestinal symptomatology more closely approximates a level of impairment contemplated in the 30 percent evaluation. 38 C.F.R. § 4.7. In this regard the Board observes that the veteran has been in receipt of private medical care for his varied gastrointestinal symptomatology. Private diagnostic studies disclosed that he had severe esophagitis at the gastroesophageal junction likely due to reflux hiatal hernia. In other words, the veteran's gastrointestinal disability has been classified as severe by a non-VA health care professional. The Board finds that severe gastrointestinal impairment noted to be due to the service-connected hiatal hernia is surely indicative of more disablement than is contemplated in the 10 percent evaluation. Accordingly, the Board is of the opinion that the record support a grant of an increased evaluation of 30 percent for the veteran's hiatal hernia. The next higher evaluation of 60 percent under diagnostic code 7346 requires a hiatal hernia productive of symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia or other symptom combinations productive of severe impairment of health. The appellant's hiatal hernia has been productive of severe gastroesophageal reflux but not severe impairment of health. More specifically, the claimant has not been shown to have lost weight or experienced vomiting, weight loss, melena, etc. He has not been shown to be anemic. In this regard, the Board observes that the September 1993 VA medical examination laboratory studies disclosed a hematocrit of 45.3 percent and a hemoglobin of 15.5 grams per decaliter. No basis has been presented to warrant a grant of an increased evaluation under the criteria 38 C.F.R. § 3.321(b)(1). The Board concludes that a record supports a grant of an increased evaluation of 30 percent for hiatal hernia. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.114, Diagnostic Code 7346. VI. Entitlement to an increased (compensable) evaluation for bilateral high frequency hearing loss. Audiology studies conducted while the veteran was on active duty revealed a high frequency hearing loss in each ear. An August 1991 VA audiology examination report shows that right pure tone thresholds were 15, 20, 30, and 40 decibels with an average of 26 decibels at 1000, 2000, 3000, and 4000 hertz with a speech recognition ability of 94 percent. Left pure tone thresholds were 15, 15, 40, and 45 decibels with an average of 29 decibels at 1000, 2000, 3000, and 4000 hertz with an average of 29 decibels at 1000, 2000, 3000, and 4000 hertz with a speech recognition ability of 94 percent. The Board acknowledges the veteran's complaints of difficulty in his efforts to hear properly. However, the August 1991 VA audiology examination reported above shows that his bilateral high frequency hearing loss is not of such an extent as to warrant a grant of an increased (compensable) evaluation. The August 1991 VA examination disclosed that right defective hearing was manifested by an average loss of 26 decibels with a speech recognition ability of 94 percent and that left defective hearing was manifested by an average loss of 29 decibels with a speech recognition ability of 94 percent. These audiology findings result in a numeric designations of I for each ear on Table VI of 38 C.F.R. § 4.85 of the VA Schedule for Rating Disabilities. The numeric designations of I for each ear equate to a noncompensable evaluation of 0 percent under diagnostic code 6100 on Table VII. Higher average decibel losses and lower speech recognition ability in each ear is needed for a grant of an increased (compensable) evaluation. No basis has been presented upon which to warrant a grant of an increased evaluation for bilateral high frequency hearing loss under the criteria of 38 C.F.R. §§ 3.321(b)(1), 4.7. As compensable disablement has not been demonstrated by the medical evidence of record, it is the judgment of the Board that an increased (compensable) evaluation for bilateral high frequency hearing loss is not warranted. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.85, Diagnostic Code 6100. VII Entitlement to increased (compensable) evaluations for bilateral knee chondromalacia. The service medical records show that beginning in 1985 the appellant was seen with complaints of pain in both knees. His repeated complaints of symptomatology were ultimately found to be reflective of chondromalacia. At a July 1991 VA examination the veteran complained of sore knees. On musculoskeletal evaluation the veteran stated that he was discharged from service because of bilateral knee chondromalacia. On examination he could squat easily. The knees were not swollen but were tender on manipulation especially when the examiner pressed the patellae. Flexion, lateral and medial motion did not bother the knees. X-rays of the knees were negative for any abnormalities. The examiner diagnosed pains in the knees secondary to chondromalacia. At a September 1993 VA examination the veteran reported that in service by 1979 he had to stop most physical exercise because of joint pain which included his knees. He reported that his bilateral knee pain worsened beginning in 1984 while stationed aboard a submarine which required that he go up and down vertical ladders. In 1986 he was removed from a submarine tender due to knee pain. On examination the knees were without deformity, effusion, increased warmth to the touch, or redness. Anterior drawer sign and McMurray's tests were negative bilaterally. The examiner noted there was a full range of motion bilaterally with 130 degrees of flexion and 0 degrees of extension. X-rays of the knees, noting the veteran's history of popping and pain, were interpreted as negative for any abnormalities. The examiner diagnosed bilateral chondromalacia patellae, by history. The veteran's bilateral knee chondromalacia is evaluated noncompensable under diagnostic code 5257 of the VA Schedule for Rating Disabilities. The noncompensable evaluation is predicated upon the evidentiary record which has shown no residual disability related to the service-connected chondromalacia. 38 C.F.R. § 4.31. Under diagnostic code 5257 a 10 percent evaluation may be assigned for slight recurrent subluxation or lateral knee instability. A 10 percent evaluation may be assigned for limitation of leg flexion to 45 degrees under diagnostic code 5260. A 10 percent evaluation may be assigned for limitation of leg extension to 10 degrees under diagnostic code 5261. As the Board noted earlier, VA examinations conducted in July 1991 and September 1993 have demonstrated no residual disability related to the appellant's service-connected bilateral knee chondromalacia. The VA examiner noted the veteran had full range of motion of his knees and noted absence of other clinical manifestations of disablement. The VA examiner reported bilateral knee chondromalacia by history. The examiner found no abnormality or disablement of either knee. The Board finds there exists no basis upon which to predicate grants of increased (compensable) evaluations for bilateral knee chondromalacia. The veteran's subjective complaints of pain have not resulted in any functional impairment of either knee as to warrant assignments of increased (compensable) evaluations under the criteria of 38 C.F.R. § 4.40. In similar manner, the Board finds that no basis has been presented upon which to warrant grants of increased (compensable) evaluations with application of the criteria under 38 C.F.R. § 3.321(b)(1), 4.7. The Board concludes that in the absence of clinical evidence of compensable disablement of either knee, there exists no basis upon which to predicate grants of increased evaluations for bilateral knee chondromalacia. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.20, 4.31, 4.71(a), Diagnostic Codes 5257, 5260, 5261. VIII. Entitlement to increased (compensable) evaluations for bilateral thigh meralgia paresthesia. The service medical records show that the veteran was evaluated for complaints of numbness in the area of the thigh muscles which was aggravated by prolonged standing in 1984, and thereafter on occasion for similar symptomatology. He was diagnosed with bilateral meralgia paresthetica. At a July 1991 VA general medical examination the veteran complained of numbness in his legs and pain while standing, sitting long periods, walking, or when climbing stairs. In his diagnoses, the examiner noted the veteran had expressed complaints of leg cramps. At a September 1993 VA examination the veteran reported that his joint pain began in 1979 when he noted insidious onset of lower lumbar pain which occurred in the center of his lower lumbar spine radiating to both buttocks to the level of the knees. By 1980 he had to stop most physical exercise secondary to low back pain, bilateral knee pain, and numbness in both thighs. On neurologic examination motor evaluation was 5 out of 5 in all groups tested. Deep tendon reflexes were 2+ and symmetric. Sensory examination revealed intact pinprick, light touch over the distribution of the lateral femoral cutaneous nerve bilaterally, as well as in the remainder of each extremity. The examiner noted that the veteran had normal vibration and position sense. Toes were down going. The examiner diagnosed bilateral neuralgia paresthetica by history. The veteran's meralgia paresthesia of each thigh is rated by analogy to mild or moderate paralysis of the external cutaneous nerve of a thigh under diagnostic code 8529 of the VA Schedule for Rating Disabilities. In order to qualify for a 10 percent evaluation under this diagnostic code, the veteran must have severe to complete paralysis of the external cutaneous nerve of each thigh. As the Board noted above, the September 1993 VA neurology examination disclosed no evidence of meralgia paresthesia of either thigh. In fact meralgia paresthesia of each thigh was reported by history only; in other words, it was not shown on examination. The Board acknowledges the veteran's complaints of pain and/or numbness in his thighs, and such symptomatology is considered in his noncompensable evaluation which is predicated on mild or moderate paralysis of the external cutaneous nerve of each thigh. His symptomatic pain is not shown to be productive of any functional impairment of either thigh as no impairment of either thigh was shown when the appellant was examined by VA in July 1991 and September 1993. Thus increased (compensable) evaluations under 38 C.F.R. § 4.40 are not warranted. No basis has been presented upon which to predicate grants of increased (compensable) evaluations under the criteria of 38 C.F.R. §§ 3.321(b)(1), 4.7. It is the judgment of the Board that no evidentiary basis has been presented upon which to predicate assignments of increased (compensable) evaluations for bilateral thigh meralgia paresthesia with application of pertinent criteria. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.20, 4.40, 4.124(a), Diagnostic Code 8529. As to all issues adjudicated on appeal, the Board has considered the statement on file from the veteran's wife. ORDER The claims for service connection for bilateral pes planus, situational stress reaction, duodenal ulcer, otitis media and externa claimed as ear pain, enuresis, and a chronic disorder claimed as painful hands and wrists are dismissed. Entitlement to service connection for an explosive personality disorder and torticollis of the cervical spine is denied. Entitlement to service connection for sleep apnea is granted. Entitlement to an increased evaluation for chronic lumbosacral strain with congenital tightness of the hamstring muscles is denied. Entitlement to an increased evaluation of 30 percent for hiatal hernia is granted, subject to pertinent criteria governing the payment of monetary benefits. Entitlement to an increased (compensable) evaluation for bilateral hearing loss is denied. Entitlement to an increased (compensable) evaluation for right knee chondromalacia is denied. Entitlement to an increased (compensable) evaluation for left knee chondromalacia is denied. Entitlement to an increased (compensable) evaluation for meralgia paresthesia of the right thigh is denied. Entitlement to an increased (compensable) evaluation for meralgia paresthesia of the left thigh is denied. ALBERT D. TUTERA Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.