Citation Nr: 0004186 Decision Date: 02/16/00 Archive Date: 02/23/00 DOCKET NO. 94-01 267 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUES Entitlement to service connection for arthritis of the left fifth finger, to include as secondary to the service- connected residuals of a laceration of the fifth finger of the left hand, to include a scar and vascular insufficiency. Entitlement to service connection for a left eye disorder, to include retinitis pigmentosa. Entitlement to a rating in excess of 10 percent for service- connected residuals of a laceration of the fifth finger of the left hand, to include a scar and vascular insufficiency. Entitlement to a compensable rating for service-connected bilateral hearing loss. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARINGS ON APPEAL Appellant and his father ATTORNEY FOR THE BOARD Todd R. Vollmers, Associate Counsel INTRODUCTION The veteran had active service from March 1966 to March 1970. Issues in this case came before the Board of Veterans' Appeals (Board) on appeal from a June 1993 decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania, which, in pertinent part, granted service connection and a noncompensable evaluation for residuals of a laceration of the fifth finger of the left hand, to include a scar and vascular insufficiency, and denied service connection for a left eye disorder, to include retinitis pigmentosa. The June 1993 decision also denied service connection for bilateral hearing loss. In a rating action in January 1997, the RO increased the evaluation for the veteran's service-connected residuals of a laceration of the fifth finger of the left hand to 10 percent. The RO also granted service connection and a noncompensable evaluation for bilateral hearing loss, and denied service connection for arthritis of the fifth finger of the left hand. Issues in this case were previously Remanded in October 1995 and May 1998. On March 18, 1998, a hearing was held before C.W. Symanski, who is the member of the Board rendering the final determination in this claim and was designated by the Chairman of the Board to conduct that hearing, pursuant to 38 U.S.C.A. § 7102(b) (West 1991). The issue of entitlement to service connection for a left eye disorder, to include retinitis pigmentosa, will also be addressed in the Remand immediately following this decision. FINDINGS OF FACT 1. The claim for service connection for arthritis of the left fifth finger, to include as secondary to the service- connected residuals of a laceration of the fifth finger of the left hand, to include a scar and vascular insufficiency, is not accompanied by any medical evidence to support the claim. 2. The claim for service connection for arthritis of the left fifth finger, to include as secondary to the service- connected residuals of a laceration of the fifth finger of the left hand, to include a scar and vascular insufficiency, is not plausible. 3. The claim for service connection for a left eye disorder, to include retinitis pigmentosa, is accompanied by medical evidence to support the claim. 4. The claim for service connection for a left eye disorder, to include retinitis pigmentosa, is plausible. 5. The veteran's service-connected residuals of a laceration of the fifth finger of the left hand, to include a scar and vascular insufficiency, are not manifested by swelling, skin discoloration, tissue loss, hyperhidrosis, x-ray abnormalities, or significant functional impairment, and any scarring is not shown to be poorly nourished or tender and painful upon objective demonstration. 6. The veteran has Level I hearing in the right ear, and Level II hearing in the left ear. CONCLUSIONS OF LAW 1. The claim for service connection for arthritis of the left fifth finger, to include as secondary to the service- connected residuals of a laceration of the fifth finger of the left hand, to include a scar and vascular insufficiency, is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 2. The claim for service connection for a left eye disorder, to include retinitis pigmentosa is well grounded. 38 U.S.C.A. § 5107 (West 1991). 3. The criteria for a higher evaluation for service- connected residuals of a laceration of the fifth finger of the left hand, to include a scar and vascular insufficiency, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, §§ 4.1, 4.3, Diagnostic Codes 5227, 7122, 7803, 7804, 7805. 4. The criteria for a compensable evaluation for bilateral hearing loss have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSION Factual Background The veteran's service medical records show that no abnormalities were found in the veteran's eyes, left fifth finger, or hearing during an entrance examination in February 1966. The veteran received treatment for pain in an unspecified finger and hand in May and June 1966. Records also show that the veteran was treated for a laceration on his forehead in October 1966. The veteran was later treated for a laceration on the fifth finger of his left hand in October 1968. The report of the veteran's separation examination dated in November 1969 noted a small retinitis pigmentosa, medial left eye. No other defects or diagnoses were noted on the November 1969 separation examination report. A report of a private audiological examination, dated in September 1990 and received in November 1996, noted the following data: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 35 N/A 105 LEFT 10 5 15 N/A 60 A VA eye examination report dated in August 1992 found that the veteran had a small chorioretinal scar in the left eye. No other abnormalities were noted in the left eye, and the diagnoses given were of presbyopia correctable to 20/20, with no evidence of active ocular pathology. A VA examination of the veteran's left hand in August 1992 found that the veteran had a 9.5 centimeter scar extending from the ulnar aspect across the proximal phalanx to the medial aspect of the left fifth finger. The scar was not tender, and there was no apparent deformity, swelling, or tenderness of the finger. Range of motion was described as flexion 65 degrees, and extension 0 degrees. Flexion in the proximal interphalangeal joint was 80 degrees and extension 0 degrees, with flexion in the distal interphalangeal joint 45 degrees and extension 0 degrees. The veteran was able to grasp objects with the left hand, and there was slight hypoesthesia of the scar tissue on the left fifth finger. Grip strength of the left hand was 60 pounds of force, compared to 120 pounds in the right hand. The diagnosis given was of status post laceration of the left fifth finger. A VA audiological evaluation in September 1992 showed the veteran's pure tone thresholds, in decibels, to be as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 15 40 60 105 55 LEFT 15 15 55 65 38 Speech audiometry revealed speech recognition ability of 86 percent in the right ear and of 96 percent in the left ear. During a Board hearing in April 1994, the veteran testified that he had problems with the fifth finger on his left hand when it was exposed to cold temperatures. The veteran stated that the finger became white, and that he had pain, stiffness, and a loss of feeling in the finger. The veteran also testified that the problems with his fifth finger occasionally caused problems in his job, including difficulty in typing. A VA examination of the veteran's left hand in April 1996 found no evidence of swelling or skin discoloration. The veteran had a well-healed surgical superficial scar throughout the medial aspect of the proximal interphalangeal region to the lateral aspect of the middle phalangeal region of the palmar side of the finger measuring two inches. Some localized tenderness and stiffness was noted in the area of the proximal interphalangeal joint and distal interphalangeal joint of the fifth finger, with slight hypertrophic changes noted in the proximal interphalangeal joint. The examiner found radial artery pulsation to be unremarkable, and slight coldness to the touch was noted in the fifth finger of the left hand, as compared to the right hand. Painless active range of motion of the fifth finger was 0-85 degrees flexion and extension of the metacarpophalangeal joint, 0-70 degrees in the proximal interphalangeal joint, and 0-50 degrees in the distal interphalangeal joint. Hand grip power was assessed as 55 pounds, compared to 115 pounds in the right hand, the veteran's dominant side. Pinching strength was 4/5 between the thumb and fifth finger. Sensation to pinprick was noted to be unremarkable, with the exception of slightly diminished sensation over the surgical suture region of the fifth finger. The assessment given was of residuals from a laceration injury to the left fifth finger, and to rule out segmental Raynaud's phenomenon in the fingers of the left hand. A VA x-ray of the veteran's left hand in April 1996 showed normal intrinsic skeletal structures, with no abnormalities noted concerning the fifth finger. A VA examination report, dated later in April 1996, noted that a pulse could be detected both laterally and medially, in apparent reference to the fifth finger on the left hand. The skin was normal, with full flexibility of the finger and normal capillary filling time in the nail bed of the left fifth finger. Skin temperature was normal, and no parasthesias was noted. The diagnosis given was of status post traumatic injury to the left fifth finger, with mild vascular insufficiency, described as stable. The report of a VA examination dated in April 1996 shows that the veteran was found to have mixed hearing loss in the right ear, and mild sensorineural hearing loss in the left ear. A VA audiological examination in April 1996 showed the veteran's pure tone thresholds, in decibels, to be as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 25 45 55 105 58 LEFT 10 25 65 60 40 Speech audiometry revealed speech recognition ability of 94 percent in the right ear and of 94 percent in the left ear. A VA opinion in July 1996 stated that the veteran's hearing loss may be due to a head injury sustained in 1968. A subsequent VA opinion in October 1996 noted a history of military acoustic trauma, and bilateral sensorineural hearing loss, described as worse in the right ear. VA treatment records dated in October 1996 noted the veteran's complaints of cold intolerance in the fifth finger. The veteran had normal sensation in the fifth finger, with good capillary refill. The tendons in the fifth finger were described as normal, and the impression given was of nerve compression syndrome or a vasculitic condition. A VA electromyographic examination and nerve conduction study in November 1996 found that testing of the ulnar nerve on the left side showed no significant abnormalities except suspected early ulnar neuropathy. A VA report dated in October 1996 noted that the veteran had mild peripheral vascular disease, with a difference in upper arm blood pressure. The examiner also stated that pressures in the fingers were equal, and that he doubted that the difference in pressures would cause the problems cited by the veteran. A letter from a friend of the veteran, received in November 1996, stated that he had known the veteran both prior to and after service. The veteran's friend further stated that after service, the veteran complained of hearing loss and a loss of sensation in the fifth finger of his left hand. It was also noted that the veteran's finger would turn white and ache when exposed to cold temperatures. VA treatment records dated in November 1996 noted the veteran's complaints of numbness and pain in the left hand, and the impression that he had mild left ulnar nerve compression. A VA opinion in December 1996 stated that the veteran's discharge examination revealed a bilateral, moderately severe sensorineural hearing loss in the higher tones. VA treatment records dated in January 1997 show that the veteran was given steroid injections for symptoms in his left fifth finger. A notation in the record states that the veteran possibly had vasospastic disorder. VA treatment records show that the veteran continued to be treated for symptoms related to his left fifth finger between February and December 1997. VA optometry records dated in August 1997 noted that the veteran had clogged meib glands in both eyes. The record also noted "chorioretinal atrophy c [with] pigment." VA records show that the veteran received treatment for hearing loss in November 1997, and an audiological evaluation in February 1998. The February 1998 evaluation found the following data: HERTZ 1000 2000 3000 4000 Average RIGHT 20 35 45 105 51 LEFT 15 25 60 60 40 Speech audiometry revealed speech recognition ability of 100 percent in the right and left ears. During a hearing before a Member of the Board in March 1998, the veteran testified to essentially the same symptoms and complaints concerning the fifth finger of his left hand as he had previously given in a Board hearing in April 1994. The veteran also testified that he had problems making a fist and grasping objects in conjunction with the disability in the fifth finger of his left hand. The veteran stated that he believed that he had arthritis in his left hand, and that he had trouble using it to perform ordinary tasks. The scar on the fifth finger was described by the veteran as completely healed, although sometimes painful after exposure to cold temperatures. Regarding the veteran's hearing loss, he testified that he had problems understanding speech at times and that hearing aids had been recommended for this problem. The veteran further testified that his hearing loss sometimes caused problems with his job. Concerning the veteran's claimed left eye disorder, he testified that he had sustained a laceration on his face requiring 12 stitches while he was in service. The veteran stated that he had pain and blurred vision after this incident. According to the veteran's testimony, he had had occasional problems with his eye since service, and had possibly been diagnosed with a detached retina. VA treatment records dated in August 1998 noted symptoms described as vague asthenopia, with chorioretinal scarring in the left eye. A VA examination in September 1998 found a two inch healed scar, extending from the ulnar aspect of the third phalanx of the left fifth finger to the median aspect and down to the medial side of the second phalanx. The scar was described as very faint and not tender to the touch. No deformity, swelling, or tenderness on palpation was noted in the finger. There was no apparent skin discoloration with changing of position or movement of the left fingers. Active range of motion of the metacarpal phalangeal joint was extension full to 0 degrees, flexion to 70 degrees. Active range of motion of the proximal interphalangeal joint was extension to 0 degrees, flexion to 70 degrees, and active range of motion of the distal interphalangeal joint was extension full to 0 degrees, flexion to 50 degrees. Strength in the finger for flexor muscles was in the fair plus to good minus range, and finger extensors were fair plus to good minus. The veteran was noted to be able to use the left fifth finger for activities of daily living, and grip strength in the left hand was assessed as good minus. Sensation to light touch in the left digits was normal, with the exception of slightly diminished sensation over the surgical scar. Peripheral pulses were normal in the left arm and equal to the right, and flexibility of the fingers was normal. Capillary fill time was found to be normal in the nail beds of the fingers. The skin around the veteran's scar appeared to be normal when compared to other areas, and the skin temperature of the left fingers, as compared to the right, was normal. Mild, localized tenderness on palpation of the proximal interphalangeal and distal phalangeal joints of the fingers was also noted. The examiner gave his opinion that the veteran had residual, status post traumatic injury to the left fifth finger with no significant functional impairment. The examiner also stated that he did not find any apparent vascular impairment during the examination. An x-ray in September 1998 did not reveal any abnormalities concerning the veteran's fifth finger of the left hand. A VA examination of the veteran's arteries and veins in September 1998 noted that peripheral pulses on the upper extremities were normal. Skin color was described as pink with a normal temperature, and no cyanosis was found. The examiner did note a slight limitation of motion on flexion in the fifth finger of the right hand, in apparent reference to the veteran's left fifth finger disability. The diagnoses given were of possible vasospastic syndrome, and a mild sensory change in the ulnar nerve, with a verbal report of normal vascular circulation in both hands. The examiner also stated that he did not find any evidence of ulceration or skin changes at the time of the examination, but noted the veteran's subjective complaints of pain on exposure to cold. An addendum dated later in September 1998 noted that a Doppler study done on the upper extremities indicated finger pressures were within two millimeters between the left and right digits. There were normal Adson and thoracic maneuvers. The impression given was that the study was negative for Raynaud's disease or vascular involvement. A VA audiological examination in September 1998 found the veteran's pure tone thresholds, in decibels, to be as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 25 30 50 105 53 LEFT 15 30 60 60 41 Speech audiometry revealed speech recognition ability of 94 percent in the right ear and of 90 percent in the left ear. Analysis Service Connection Claims Service connection connotes many factors, but basically means that the facts, as shown by the evidence, establish that a particular injury or disease resulting in disability was incurred coincident with military service or, if pre-existing such service, was aggravated therein. 38 U.S.C.A. § 1110. This determination requires a finding of a current disability that is related to an injury or disease incurred during service. Watson v. Brown, 4 Vet. App. 309, 314 (1993); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). A person submitting a claim for VA benefits has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107(a); see also Carbino v. Gober, 10 Vet. App. 507 (1997). A well grounded claim is a "plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of § [5107(a)]." Murphy v. Derwinski, 1 Vet. App. 79, 81 (1990). The United States Court of Appeals for Veterans Claims (Court) has held that a claim must be accompanied by supportive evidence and that such evidence "must justify a belief by a fair and impartial individual that the claim is plausible." Tirpak v. Derwinski, 2 Vet. App. 609, 610 (1992). In order for a claim to be well grounded, there generally must be (1) a medical diagnosis of a current disability; (2) medical, or in some circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. Epps v. Brown, 9 Vet. App. 341, 343-44 (1996), aff'd sub nom. Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). The quality and quantity of the evidence required to meet the veteran's burden will depend upon the issue presented by the claim. Where the issue is factual in nature, competent lay testimony, even if only consisting of the veteran's testimony, may constitute sufficient evidence to establish a claim as well grounded. However, where the issue involves medical causation or a medical diagnosis, it requires competent medical evidence establishing the claim as plausible or possible. Evidentiary assertions by the appellant must be accepted as true for purposes of determining whether a claim is well grounded, except where the evidentiary assertion is inherently incredible. King v. Brown, 5 Vet. App. 19 (1993). Nevertheless, a claimant does not meet his burden by merely presenting lay testimony, including his own, since lay persons are not competent to offer medical opinions. Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Lay assertions of medical causation or diagnosis cannot constitute evidence to render a claim well grounded under § 5107(a); if no cognizable evidence is submitted to support a claim, the claim cannot be well grounded. Tirpak v. Derwinski, 2 Vet. App. at 610-11 (1992). Entitlement to service connection for arthritis of the left fifth finger Disability which is proximately due to or the result of a service connected disease or injury shall be service connected. 38 C.F.R. § 3.310. Service connection may also be established when aggravation of a veteran's non-service- connected condition is proximately due to or the result of a service-connected condition. Allen v. Brown, 7 Vet. App. 439 (1995). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Where a veteran served 90 days or more during a period of war or during peacetime service after December 31, 1946, and a chronic disease, such as arthritis, becomes manifest to a degree of 10 percent or more within 1 year from the date of separation from service, such disease will be subject to presumptive service connection. 38 U.S.C.A. §§ 1101, 1111, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. The veteran has submitted medical evidence which is indicative of arthritis in his left fifth finger. A VA examination in April 1996 noted slight hypertrophic changes in the proximal interphalangeal joint upon physical examination of the veteran's left fifth finger. However, the veteran has not submitted any medical evidence showing that arthritis in his left fifth finger developed during service, or to a compensable degree within one year of discharge from service. The record shows that the veteran was treated for a laceration on his left fifth finger in October 1968, but there is no mention of any diagnosis or treatment for arthritis. Nor is there any medical evidence that the veteran had arthritis in his left fifth finger to a compensable degree within one year of his separation from service. Therefore, presumptive service connection does not apply. The veteran has not submitted any medical evidence that would provide a nexus between any current arthritis in his left fifth finger and an injury or disease incurred during service. Therefore, there is no medical nexus evidence which would meet the requirements for a well- grounded claim on the basis of direct service connection. Regarding service connection for arthritis in the left fifth finger as secondary to his service-connected residuals of a laceration of the fifth finger, the veteran has not submitted any medical evidence of a nexus between his service connected disability and any arthritis in the fifth finger. There is no medical evidence that the veteran's service-connected left fifth finger disability caused, aggravated, or is otherwise connected to any arthritis noted, as required for a well- grounded claim on this basis. The veteran has testified that he believes that he has arthritis in his left fifth finger which is related to service, or his service-connected fifth finger disability. Although the veteran's statements and testimony must be accepted as true for determining whether his claim is well grounded, his opinion that he has arthritis which is related to service, or is otherwise related to his service-connected left fifth finger disability, is entitled to no probative weight because as a layperson, he is not competent to offer such an opinion. Espiritu. Medical evidence regarding medical diagnosis and etiology is required. In this case, there is no medical evidence showing that any current arthritis is related to service, or to the veteran's service- connected disability in the left fifth finger. Without such evidence, the claim is not plausible and so must be denied as not well grounded. Entitlement to service connection for a left eye disorder to include retinitis pigmentosa The veteran has submitted evidence of a current diagnosis concerning his left eye. VA treatment records dated in August 1998 noted chorioretinal scarring in the left eye, along with symptoms described as vague asthenopia. Other VA treatment records dated in August 1997 noted "chorioretinal atrophy c [with] pigment" in the left eye. There is also evidence of a left eye disorder in service. The report of the veteran's separation examination in November 1969 noted a small retinitis pigmentosa in the medial left eye. Given the above evidence, the Board finds that the veteran has presented a well-grounded claim for service connection for a left eye disorder. The evidence of record shows that the veteran had retinitis pigmentosa in the left eye while in service, and the August 1997 VA treatment report noted that the veteran currently has chorioretinal atrophy with some involvement of the pigment. The statement in the August 1997 VA treatment record is sufficient to establish a nexus between the veteran's current left eye disorder and the disorder noted in service. The claim is plausible and is therefore well grounded. Claims for a Higher Evaluation In evaluating the severity of a particular disability, it is essential to consider its history. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. §§ 4.1 and 4.2. Disability evaluations, in general, are intended to compensate for the average impairment of earning capacity resulting from a service-connected disability. They are primarily determined by comparing objective clinical findings with the criteria set forth in the rating schedule. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1999). When regulations concerning entitlement to a higher rating are changed during the course of a pending claim, the veteran is entitled to a decision on his claim under the criteria which are most favorable to him. Karnas v. Derwinski, 1 Vet. App. 308 (1991). In addition, in Fenderson v. West, 12 Vet. App. 119 (1999), the Court recognized a distinction between a veteran's dissatisfaction with an initial rating assigned following a grant of service connection (as in this case) and a claim for an increased rating for a service-connected disability. The Court found two important reasons for this distinction- consideration of "staged" ratings and the adequacy of the statement of the case. The use of staged ratings will be considered in this decision. The statement of the case and supplemental statements of the case have adequately informed the veteran of the pertinent laws and regulations as well as the rationale for the RO's action. Entitlement to a rating in excess of 10 percent for service- connected residuals of a laceration of the fifth finger of the left hand, to include a scar and vascular insufficiency The Board notes that the veteran's claim relating to his service-connected residuals of a laceration of the fifth finger of the left hand was filed prior to August 1998, when the rating criteria for cold injury residuals were revised. Therefore, under Karnas v. Derwinski the veteran is entitled to consideration under the criteria in effect both before and after August 1998, and a decision which reflects the criteria most favorable to him. The RO has rated the veteran's service-connected fifth finger injury as analogous to a cold injury residual. Under the old criteria for such an injury, the following provisions apply: Frostbite of the hands, rated as analogous to residuals of frozen feet, with loss of toes, or parts, and persistent severe symptoms, unilateral, warrants a 30 percent rating. With persistent moderate swelling, tenderness, redness, etc., unilateral, a 20 percent rating is assigned. With mild symptoms, chilblains, unilateral, a 10 percent rating is assigned. 38 C.F.R. Part 4, Diagnostic Code 7122 (in effect prior to August 13, 1998). Under the new criteria for cold injury residuals, arthralgia or other pain, numbness, or cold sensitivity, plus two or more of the following: tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, X- ray abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis) of affected parts warrants a 30 percent evaluation. With arthralgia or other pain, numbness, or cold sensitivity, plus tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, or X-ray abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis) of affected parts a 20 percent rating is assigned. With arthralgia or other pain, numbness, or cold sensitivity, a 10 percent rating is granted. 38 C.F.R. Part 4, Diagnostic Code 7122 (in effect beginning August 13, 1998). Considering the criteria under Diagnostic Code 7122 for cold injury residuals, the evidence of record does not indicate that a higher evaluation is warranted under the old or new criteria. A VA examination in September 1998 did not find any swelling, and no apparent skin discoloration was noted which would warrant a higher evaluation under the old criteria. The veteran has also complained of pain and cold sensitivity in his left fifth finger. However, there is no evidence of accompanying tissue loss, hyperhidrosis, or x-ray abnormalities. Capillary fill time was found to be normal in the nail of the left fifth finger, with no color changes noted. Therefore, a higher evaluation under the new criteria for cold injury residuals is not indicated by the evidence of record. The Board notes that previous examinations also did not reveal symptoms which would warrant a higher evaluation under the old or new criteria of Diagnostic Code 7122. Separate disability ratings may be warranted for disability due to scars, pursuant to the Court's holding in Esteban v. Brown, 6 Vet. App. 259 (1994). Scars which are superficial and poorly nourished, with repeated ulceration, and superficial scars which are tender and painful on objective demonstration warrant a 10 percent evaluation. The 10 percent rating will be assigned when the requirements are met, even though the location may be on the tip of the finger or toe, and the rating may exceed the amputation value for the limited involvement. Other scars are rated on the degree of limitation of function of the affected part. 38 C.F.R. Part 4, Codes 7803, 7804, 7805 (1999). The evidence shows that the scar on the veteran's left fifth finger is well healed, and there is no evidence that it produces any functional impairment whatsoever. Additionally, the veteran's left fifth finger scar has not been shown to be tender or painful on objective demonstration. The veteran testified during his March 1998 Board hearing that the scar sometimes became painful after exposure to the cold. However, the record does not contain any objective evidence of pain caused by the scar. Accordingly, a separate rating for the scar on the veteran's left fifth finger is not warranted. The Diagnostic Code for rating disability, other than amputation, in the fifth finger as an individual finger is under Code 5227. Diagnostic Code 5227 states that ankylosis of the finger will be rated as noncompensable in the minor extremity. The Board notes that there is no evidence of ankylosis in the left fifth finger that would come under Diagnostic Code 5227, and that the rating schedule does not provide for a higher evaluation on this basis. The veteran has stated that he has functional impairment due to his service-connected left fifth finger disability. The Court held in DeLuca v. Brown, 8 Vet. App. 202 (1995), that the provisions of the Rating Schedule do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including during flare-ups. The Board notes that a September 1998 VA examination of the veteran's arteries and veins noted slight limitation of motion on flexion in the fifth finger of the right hand, in apparent reference to the left fifth finger disability. However, another VA examination in September 1998, which focused more completely on range of motion and functional ability, found that the veteran was able to use his left fifth finger for the activities of daily living, and the examiner stated that there was no significant functional impairment. The record does not contain other medical evidence showing that the veteran does suffer significant functional impairment due to his service-connected left fifth finger disability, or that he previously suffered functional impairment that would make the use of staged ratings under Fenderson proper. A higher evaluation on this basis is therefore not warranted. The Board also notes that the veteran testified in his March 1998 Board hearing that his service-connected left fifth finger disability sometimes caused problems with his job, in conjunction with his request that extraschedular consideration be given to his claim for a higher evaluation. However, the veteran has not submitted any evidence of frequent hospitalization or marked interference with employment that would warrant consideration on an extraschedular basis. In determining whether a claimed benefit is warranted, VA must determine whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In this case, the Board finds that the preponderance of the evidence is against a higher evaluation for the service-connected disability and that, therefore, the provisions of § 5107(b) are not applicable. Entitlement to a compensable rating for bilateral hearing loss The Board notes that the veteran's claim relating to his bilateral hearing loss was filed prior to June 10, 1999, when the rating criteria for hearing impairment were revised. Therefore, under Karnas v. Derwinski the veteran is entitled to consideration under the criteria in effect both before, and after June 10, 1999, and a decision which reflects the criteria most favorable to him. Modern pure tone audiometry testing and speech audiometry utilized in VA audiological clinics are well adapted to evaluate the degree of hearing impairment accurately. Methods are standardized so that the performance of each person can be compared to a standard of normal hearing, and ratings are assigned based on that standard. The assigned evaluation is determined by mechanically applying the rating criteria to certified test results. Lendenmann v. Principi, 3 Vet. App. 345 (1992). Evaluations of bilateral defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity, as measured by the results of controlled speech discrimination tests together with the average hearing threshold level as measured by pure tone audiometry tests in the frequencies 1,000, 2,000, 3,000 and 4,000 cycles per second. To evaluate the degree of disability from bilateral service-connected defective hearing, VA's rating schedule establishes 11 auditory acuity levels designated from Level I for essentially normal acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Diagnostic Codes 6100 to 6110. Under the criteria for hearing loss in effect both before and beginning June 10, 1999, a zero percent rating is assigned for bilateral defective hearing where the pure tone threshold average in one ear is 53 decibels with speech recognition ability of 94 percent correct (Level I), and in the other ear the pure tone threshold average is 41 decibels, with speech recognition ability of 90 percent correct (Level II). 38 C.F.R. § 4.85, Diagnostic Code 6100 (criteria in effect both before and beginning June 10, 1999). The most recent audiological examination of the veteran's hearing was in September 1998. The September 1998 audiological findings show that the veteran is assessed as having Level I hearing in the right ear, and Level II hearing in the left ear, which warrants a noncompensable rating under 38 C.F.R. § 4.85, Code 6100 (criteria in effect both before and beginning June 10, 1999). The Board notes that VA examinations of the veteran's hearing in September 1992, April 1996, and February 1998 do not reveal hearing loss greater than that recorded in September 1998. Therefore, the September 1992, April 1996, and February 1998 examination findings do not indicate a basis upon which a compensable rating could be granted through the use of staged ratings under Fenderson. The Board finds that the evidence does not warrant a compensable evaluation for the veteran's service- connected hearing loss. The Board notes that the veteran testified in his March 1998 Board hearing that his hearing loss sometimes caused problems with his job, in conjunction with his request that extraschedular consideration be given to his hearing loss claim. However, the veteran has not submitted any evidence of frequent hospitalization or marked interference with employment such as would warrant consideration on an extraschedular basis. In determining whether a claimed benefit is warranted, VA must determine whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In this case, the Board finds that the preponderance of the evidence is against a higher evaluation for the service-connected disability and that, therefore, the provisions of § 5107(b) are not applicable. ORDER Entitlement to service connection for arthritis of the left fifth finger, to include as secondary to the service- connected residuals of a laceration of the fifth finger of the left hand, to include a scar and vascular insufficiency, is denied. The claim for service connection for a left eye disorder, to include retinitis pigmentosa, is well grounded. Entitlement to a rating in excess of 10 percent for service- connected residuals of a laceration of the fifth finger of the left hand, to include a scar and vascular insufficiency, is denied. Entitlement to a compensable rating for service-connected bilateral hearing loss is denied. REMAND The Department of Veterans Affairs (VA) has a duty to assist the appellant in the development of facts pertaining to his claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1999). The United States Court of Appeals for Veterans Claims (Court) has held that the duty to assist the appellant in obtaining and developing available facts and evidence to support his claim includes obtaining medical records to which he has referred and obtaining adequate VA examinations. The Court also stated that the Board must make a determination as to the adequacy of the record. Littke v. Derwinski, 1 Vet. App. 90 (1990). The veteran's service medical records include a notation on the report of his November 1969 separation examination that he had a small retinitis pigmentosa in the medial left eye. Records of VA treatment dated in August 1997 noted "chorioretinal atrophy c [with] pigment." A VA examination is needed in order to determine whether any disorders found in the veteran's left eye are related to the retinitis pigmentosa noted in service. Accordingly, this case is REMANDED for the following additional actions: 1. With any needed signed releases from the veteran, the RO should request up-to- date copies of any examination or treatment, VA or non-VA, that the veteran has received for a left eye disorder since October 1999. All records so received should be associated with the claims file. 2. The veteran should then be scheduled for a VA examination by a specialist in ophthalmology. The claims folder must be made available to and be reviewed by the examiner in conjunction with the examination. All special tests deemed necessary by the specialist should be completed. The specialist's report should describe in detail the veteran's current left eye symptoms, as well as pertinent clinical and laboratory findings and diagnoses of any left eye disorder found to be present. The specialist should also be requested to provide a medical opinion as to whether it is at least as likely as not that any left eye disorder found to be present is related to a left eye disorder noted during service. The opinion should be supported by reference to pertinent evidence in the claims file. 3. The RO should then review the file to ensure that the requested Remand actions have been satisfactorily completed, and should take any needed remedial action. 4. The RO should then review again the veteran's claim, considering all the evidence of record. If action taken remains adverse to the veteran, he and his accredited representative should be furnished with a supplemental statement of the case concerning the new evidence and they should be given an opportunity to respond. Thereafter, the case should be returned to the Board, if in order. The veteran need take no action until otherwise notified, but has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). By this REMAND, the Board intimates no opinion, either legal or factual, as to any final determination warranted in this case. The purpose of this REMAND is to obtain clarifying information and to provide the veteran with due process. This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44- 8.45 and 38.02-38.03. C. W. Symanski Member, Board of Veterans' Appeals