BVA9506275 DOCKET NO. 91-50 546 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for bilateral pes planus. 2. Entitlement to service connection for a dog bite scar on the thigh. 3. Entitlement to service connection for residuals of a thoracic spine injury. 4. Entitlement to service connection for residuals of a lumbar spine injury. 5. Entitlement to service connection for residuals of a fractured scapula. 6. Entitlement to service connection for hypertension. 7. Entitlement to an increased rating for residuals of a right knee injury, currently evaluated 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD William Harryman, Counsel INTRODUCTION The veteran had active service from March 1954 to February 1957. This case came before the Board of Veterans’ Appeals (Board) on appeal from a decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri, in July 1991 which denied service connection for the first six disorders listed above. That rating decision granted service connection for the right knee disability, and assigned a 10 percent rating; the veteran disagreed with the denials of service connection and with the assigned right knee evaluation. This case was remanded in December 1992 to develop the record further, and has now been returned to the Board for final appellate review. The Board notes that in a memorandum by the veteran’s representative in April 1991, two issues which had previously been appealed, relating to residuals of shell fragment wounds to the tailbone and legs, were withdrawn. In addition, at his personal hearing in September 1993, the veteran withdrew his appeal of claims relating to the rating assigned for a right hand disability and to the effective date for the grant of service connection for his right knee disability. CONTENTIONS OF APPELLANT ON APPEAL It is contended by and on behalf of the veteran that he was first noted to have pes planus during service and that he received treatment therefor during service. He asserts that, also during service, he was bitten on the thigh by a dog and that he still has a scar from that bite. In his substantive appeal, the veteran maintained that it was his right thigh that was bitten. In addition, he claims that he sustained injuries to his thoracic and lumbar spine and to his scapula during service, and that he had back surgery during service because of the injury. The veteran also contends that he had elevated blood pressure readings during service, and that he was first treated for hypertension within the first year after his separation from service. He asserts that, therefore, service connection should be granted for those disorders. He also contends that he has constant pain in his right knee and frequent effusions, and has to wear a brace on the knee. The veteran believes, therefore, that a much higher rating for that disability is warranted. The veteran’s representative also argues that additional consideration should be given to the veteran’s statements and testimony and to the post-service medical evidence, since it appears that some of his service medical records were lost in the 1973 National Personnel Records Center fire. 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’s claim regarding a dog bite scar is not well grounded, and that service connection for residuals of thoracic and lumbar spine and scapula injuries and for hypertension is not established. It is also the Board’s decision that service connection is established for pes planus and that an increased rating to 20 percent disabling for residuals of a right knee injury is warranted. FINDINGS OF FACT 1. Bilateral pes planus was first noted during service, and has been noted to be present by a recent VA examiner. 2. The veteran has no current disability attributable to an in-service dog bite of the thigh. 3. The veteran is not shown to have any current thoracic spine disability which is reasonably related to any injury he sustained to his back in service. 4. The veteran is not shown to have any current lumbar spine disability which is reasonably related to any injury he sustained to his back in service. 5. The record does not show that the veteran has any current residuals of a scapular injury in service. 6. Hypertension was not present during service or to a compensable degree within one year thereafter; nor is his current hypertension shown to be related to service. 7. Postoperative residuals of a right knee injury are manifested by constant pain, frequent effusions, and limitation of flexion to 45 degrees, and have required steroid injection and occasional needle aspiration. CONCLUSIONS OF LAW 1. Bilateral pes planus was incurred during active service. 38 U.S.C.A. §§ 1110, 1111, 1131, 5107 (West 1991); 38 C.F.R. § 3.303 (1994). 2. The claim for service connection for a dog bite scar of the thigh is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 3. Residuals of a thoracic spine injury were not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.303 (1994). 4. Residuals of a lumbar spine injury were not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.303 (1994). 5. Residuals of a scapular injury were not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.303 (1994). 6. Hypertension was not incurred in or aggravated by service, and may not be presumed to have been incurred therein. 38 U.S.C.A. §§ 1101, 1110, 1111, 1112, 1131, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1994). 7. Residuals of a right knee injury are 20 percent disabling, and no more, according to the schedular and extraschedular criteria. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.1, 4.7, 4.10, 4.40, 4.45, 4.59, and Part 4, Code 5260 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS At the outset, except as noted below concerning the issue relating to service connection for a dog bite scar, the Board finds that the veteran has met his burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claims are well grounded; that is, the claims are not implausible. See Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). Additionally, there is no indication that there are additional, pertinent records which have not been obtained. Accordingly, there is no further duty to assist the veteran in developing the claims, as mandated by 38 U.S.C.A. § 5107(a). Factual background The service medical records show that at the time of the veteran’s enlistment examination no pertinent abnormalities were noted and the veteran reported no pertinent medical history. In March 1954, approximately 9 days after he entered service, he sustained a bruise to his back at the level of T-12 when some chairs he was lifting fell on him. The examiner reported that he complained of pain over the superior medial angle of the scapula (side not noted), with a possible fracture. No X-rays were apparently taken. An outpatient note dated in March 1955 indicates that the veteran had fallen on his left shoulder three weeks previously, and had continued to have pain on movement of the shoulder. He also stated that he fell on his right knee, and had had pain on movement of the knee, with incomplete extension on several occasions. On examination, there was light tenderness over the supraspinatus muscle and the acromioclavicular joint, but there was no evidence of ligamentous damage. Full range of motion of the shoulder was possible, with no evidence of joint symptoms. Examination of the knee revealed that no fluid was present, and there was no evidence of ligamentous damage. Nor were there any markedly tender areas. The examiner diagnosed bruises of the right knee and left shoulder. The service medical records also reflect an April 1954 outpatient visit for a complaint of backache of two weeks’ duration. The examiner noted that the veteran had a moderate amount of muscle spasm, but no limitation of motion. A finding of "poker spine" was noted. An outpatient record dated in February 1955 indicates that the veteran had ruptured the semilunar cartilage of his right knee. Three prior right knee injuries were reported, with one occasion of questionable locking. A moderate effusion was noted, but there was no sign of ligamentous damage. The service medical records show that in April 1955 the veteran was bitten by a dog on the left thigh. The wound was cleansed, but no additional treatment was apparently necessary. The service records make no mention of any residuals of the bite, of any complaints referable to this area, or of any left thigh scar. A July 1955 record notes a diagnosis of flat feet, which hurt the veteran when standing. The following month it was noted that he was then wearing arch supports, but that his feet still hurt and he needed additional orthotics. In May 1956 the veteran was hit in the ribs and complained of pain in the left anterior rib cage since the incident. X-ray was negative for fracture or dislocation. A note dated the following month indicates that he had a strain of the intercostal muscles of the chest wall. In September 1956, the veteran was hospitalized for treatment of a pilonidal cyst. During that hospitalization his blood pressure was reported to be 150/80 on one occasion and 170/90 on another. Several other diastolic blood pressure readings of 90 or 92 were recorded during this hospitalization, while a number of other readings were entirely within normal limits. The report of the veteran’s separation examination in December 1956 contains no notations of any pertinent abnormalities, and the veteran did not refer to any pertinent problems, other than that he indicated a history of high blood pressure. His blood pressure at that time was noted to be 146/76. Cardiovascular examination was normal. The veteran has submitted a copy of letter he wrote to his sister in October 1956. In the letter he stated that he had been hospitalized and had had X-rays and a spinal tap, and surgery on his back. He indicated that he had previously not had any feeling in his right leg, but that it was much improved. Private medical records dated from 1978 reflect apparent treatment for high blood pressure (as do later records). Blood pressure readings from 1978 to 1980 were noted to be between 136 and 166 (systolic) and ranging from 80 to 108 (diastolic). Notations state "continue meds," although it is not entirely clear whether the medications were for treatment of hypertension. An August 1979 record indicates complaints of back pain and muscle spasms. Rest and muscle relaxants were prescribed. The veteran was hospitalized at a private facility in September 1980 after falling 4-5 feet from a truck and injuring his back. He stated that, although he was able to walk around and drove home, his back later "stiffened up." On examination, there was reported pain in the lower thoracic-lumbar area, but no neurological deficit was noted. X-rays of the thoracic and lumbar spine revealed no fracture. A contusion of the back was diagnosed. A February 1989 private outpatient note reflects complaints by the veteran that he had been having problems with upper and lower extremity weakness, primarily in his hands and thigh muscles. He was hospitalized in March 1989 for evaluation of the symptoms. No definite etiology was determined. A private myelogram was performed in conjunction with the above evaluation in August 1989. That study revealed evidence of a prior total laminectomy and posterior fusion at the L4 and L5 levels. There was retrolisthesis of L3 posteriorly on L4, and an associated mild bulge involving the L3-4 disc. There was also retrolisthesis of L2 on L3, with an associated mild, diffuse bulge; narrowing of the central canal at L2-3; and a mild, diffuse bulge at L1-2. The radiologist’s impressions included lumbar spondylosis. Letters from private physicians in 1989 concerning the evaluation for the muscular weakness experienced by the veteran do not otherwise refer to any back injury the veteran may have sustained during service. A VA physical therapy note dated in April 1991 indicates that range of motion of the right knee was from 33 to 110 degrees, with extension requiring active assistance. (The neuromuscular disorder was later diagnosed as chronic inflammatory demyelinating polyneuritis/polyneuropathy.) All motions were painful. Passive straight leg raising produced pain in the legs and low back at about 40 degrees. The lumbar paraspinal muscles were very tight, and any forward or back bending caused pain. Decreased lumbar lordosis was noted, and the veteran was wearing a back brace which he felt was helpful. Other notes from that time period also reflect spasm and pain on palpation of the paraspinal muscles and 40 degrees of back flexion, with decreased lumbar spine contribution. A VA compensation examination was conducted in May 1991 in conjunction with the veteran’s current claim for VA benefits. At that time he complained of low back pain, right knee pain, left shoulder pain, numbness in his feet and legs, and inability to walk more than 50 feet without falling. He also stated that he had been bitten on the left thigh by a dog in 1954 or 1955, and that he had occasional thigh and groin pain associated with the bite. Examination of that area revealed no evidence whatsoever of scarring or muscle disruption. The veteran also reported that his scapula and thoracic spine had been fractured in 1954 when metal chairs had fallen on him. On examination, there was mild bilateral thoracic paraspinal muscle spasm, but no offset of the spinous processes. Recent X-rays revealed degenerative osteoarthritis of the thoracic spine, but no vertebral compression deformities suggestive of old vertebral fracture. In addition, the veteran stated that his lumbar spine had been fractured in 1956 when he had fallen off a trailer. Treatment had included a spinal fusion. He complained of chronic lumbar spine pain which occasionally radiated into his posterior thighs and feet. Recent X-rays reportedly were suggestive of a posterior fusion from L4 to S1. On examination, flexion and extension were noted to be minimal. Just a trace of lateral bending was possible. The veteran had pain on all motions, primarily paraspinous muscle pain from the lumbar spine into the sacroiliac joints. The lower extremities were symmetrically hyporeflexic. Foot strength was reduced, as was lower extremity sensation, but thigh strength was grossly normal. At the time of the May 1991 VA compensation examination by two examiners, the veteran also complained of bilateral flat feet, which "developed in the service." On examination, there was severe bilateral pes planus. The veteran had pain along the tarsonavicular joints of both feet, as well as pain with subtalar motion. The posterior tibial tendons were intact, but likely attenuated. Both ankles displayed full range of motion. The veteran also reported having torn the semilunar cartilage in his right knee during service, diagnosed by arthrogram. He reported persistent popping and giving way of the knee, as well as daily effusions. Although he had been offered arthroscopic surgery, the veteran had declined. Range of motion of the right knee was reported as normal, 0 to 130 degrees. There was some medial joint line tenderness, as well as crepitus on McMurray’s testing. A trace amount of effusion was noted. The diagnoses listed by the examiner included: (1) left thigh dog bite, although no significant residual disability was found, (2) fracture of the thoracic spine and scapula, with degenerative thoracic spinal osteoarthritis, but no evidence of vertebral fracture, (3) fracture of the lumbar spine, with definitive degenerative osteoarthritis, with postoperative residuals of spinal fusion, (4) bilateral pes planus, with possible attenuation or rupture of the posterior tibial tendons, and (5) probable medial meniscus tear of the right knee, with associated degenerative osteoarthritis. During the May 1991 examination, one examiner noted the veteran’s history of having been bitten on the left thigh by a German shepherd in 1954 or 1955. That examiner reported the veteran’s statement that he had occasional thigh pain and groin pain "associated with this," but the veteran did not note any specific weakness. The examiner indicated that examination of that thigh revealed no evidence of scarring whatsoever, or any significant residual disability associated with the left thigh dog bite. The other examiner stated that the veteran indicated he was, in fact, bitten on the inner right upper thigh. On examination, there were some slight scars on the inner surface of his right thigh. That examiner’s diagnoses included asymptomatic dog bites to the right thigh. The latter examiner also reported blood pressure readings which varied from 150 to 160 systolic and from 96 to 110 diastolic. Cardiovascular examination was otherwise reportedly normal. The examiner listed a diagnosis of hypertension. Lay statements submitted in May 1991 by a friend of the veteran and by the veteran’s brother attest to his having been treated for hypertension in 1957 by a private physician who had since died and whose records were no longer available. Subsequent 1991 VA outpatient records reflect continued back pain and spasm. They also show that, because of his neuromuscular disorder, the veteran used a wheelchair much of the time. A note dated in October 1991 indicates that the veteran had flexion contractures of both knees, and was able to ambulate only six feet without resting. A September 1991 letter from a private podiatrist states that he had examined the veteran, who had bilateral pes planus and would benefit from orthotics. In April 1992, the veteran was seen in the VA outpatient clinic complaining of a two week history of increasing right knee pain. He denied any recent trauma to the knee, but stated that, due to his muscular disorder, he would fall occasionally. Examination revealed a healing abrasion laterally. There was some medial and anterior tenderness, but the examination was otherwise negative. X-rays were interpreted as being negative for fracture or degenerative joint disease, but showed a probable small effusion. The examiner’s diagnosis was probable medial sprain of the right knee. A June 1992 VA outpatient record notes complaints of continued right knee pain, two months after re-injuring the knee. He reported swelling, stiffness, popping, and giving way, but denied any locking. On examination of the right knee, there was a moderate effusion, medial and lateral joint line tenderness, and patellofemoral pain, but no medial or lateral laxity or Lachman’s sign. X-ray of the right knee revealed minimal joint space narrowing. The knee effusion was aspirated, and the knee was injected with steroids. The veteran was hospitalized at a VA facility in November 1992 and in December 1992, each time for treatment of an acute myocardial infarction. The summary of each hospitalization notes a history of hypertension, but does not indicate that he was taking any antihypertensive medications. VA outpatient records dated from December 1992 to September 1993 reflect visits for complaints of chronic right knee pain. In December 1992, range of motion of the knee was noted to be 0 to 90 degrees, with pain to palpation, but no instability. The examiner’s impression was of a probable meniscal tear, possible anterior cruciate ligament rupture, and possible loose body. During an orthopedic clinic visit in May 1993, the veteran reported a 1 year history of right knee pain and swelling and of low back pain. On examination, lower extremity sensation and motor strength were normal. There was a mild effusion in the right knee joint, and range of motion of the knee was reported as 30 to 120 degrees. There was no ligamentous instability. The veteran was given instruction to continue low back pain exercises. Magnetic resonance imaging of the right knee in January 1993 showed only a mild effusion. No other abnormalities were found. A February 1993 statement by a private physician indicates that he saw the veteran on hospital admission in September 1980, that his blood pressure was then 180/104, and that he was treated with antihypertensive medication. A letter from another private physician, dated in February 1993, states that the veteran was a patient of his father from March 1957 through December 1973, and that during that time he was treated for hypertension and various other conditions. The veteran was hospitalized at a VA facility in August 1993 for treatment of his neuromuscular disorder. No pertinent abnormal clinical findings were noted on the hospital summary. The summary does state, however, that the veteran’s blood pressure was generally stable during the hospitalization. A personal hearing was held at the RO in September 1993. The veteran testified that he had no trouble with his feet until during service in 1955 and that he had had persistent and increasing foot pain due to that disorder since then. He also stated that the left thigh dog bite was documented in the service medical records and that he now had a scar from that bite. He indicated that the scar was not noted on his separation examination, but that the service examiner did not look for the scar. The veteran also testified that, following the in-service injury to his back in the area of T12, he was hospitalized in France for approximately 16 days, during which he underwent surgery on his back. He stated that doctors at that time told him that he definitely had a fracture of the scapula or spine. The veteran indicated at the hearing that he wore a brace spanning his thoracic and lumbar spine, that recent X-rays had been inconclusive and that he was scheduled for an MRI or a CAT scan of his back later in September 1993. He further stated that he had constant pain in his right knee, and had twice had fluid drained from the knee. The veteran testified that he had to wear a plastic brace on the knee. In addition, he reported that he was first treated for hypertension within the first year after his separation from service. He also testified that no records of this treatment had been found. VA outpatient records dated in November 1993 show that the veteran was seen complaining of constant low back pain, even at night. He reported little relief from use of his back brace. On examination, the pain was localized to the L3-4 level. Straight leg raise testing on each side was positive for severe low back pain on the right. A bone scan revealed increased uptake at L4. The examiner’s diagnosis was degenerative joint disease of the spine. A December 1993 note reflects that a lumbar epidural steroid injection was performed for the veteran’s continued severe low back pain. A January 1994 report states that the veteran had experienced relief from his back pain, but that his right knee continued to be painful. He indicated that he had difficulty rising from a chair and could not flex his leg past 45 degrees while standing. The veteran also reported occasional paresthesias over the knee laterally. The examiner noted pain on palpation of the joint line. Analysis Concerning the veteran’s contention that additional consideration should be given to the available evidence because of the possibility of missing service medical records, the Board finds that, despite his contention, the veteran’s service medical records do appear complete. It should be pointed out that it cannot be presumed that, simply because this may be a fire- related case , records which might substantiate the veteran’s claims are missing. The service records contained in the claims file reflect considerable medical treatment throughout his period of service and contain the report of his separation examination. The Board finds, therefore, that no piece of evidence warrants extra consideration in this regard. Pes Planus Service connection connotes many factors, but basically it means that the facts, as shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces or, if pre-existing such service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131. Such a determination requires a finding of a current disability which is related to an injury or disease incurred in service. Watson v. Brown, 4 Vet.App. 309, 314 (1993); Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992). Each disabling condition shown by a veteran’s service records, or for which he seeks service connection, must be considered on the basis of the places, types and circumstances of his service as shown by service records, the official history of each organization in which he served, his medical records and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154 (West 1991). Satisfactory lay or other evidence that injury or disease was incurred or aggravated in combat will be accepted as sufficient proof of service connection if the evidence is consistent with the circumstances, conditions or hardships of such service, even though there is no official record of such incurrence or aggravation during active service. 38 C.F.R. § 3.304 (1993). For a showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Additionally, regulations 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). Every veteran shall be presumed to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by service. 38 U.S.C.A. § 1111. Initially, the Board notes that pes planus was not noted on the report of the veteran’s enlistment examination. Therefore, as to this disorder, he is presumed to have been in sound condition at that time. 38 U.S.C.A. § 1111. In addition, the record contains no clear and unmistakable evidence that the pes planus pre- existed service. The service medical records clearly document the presence of symptomatic pes planus requiring the use of arch supports, which were provided during service. Although those records do not use the term "chronic" to describe the disorder, the Board recognizes that pes planus is not the type of disorder which, once present, ever returns to normal. The Board also notes the veteran’s credible hearing testimony in this regard. Therefore, since the May 1991 VA examiner also noted the presence of bilateral pes planus, the Board finds that service connection for bilateral pes planus is established. Dog bite scar of the thigh As a preliminary matter, the Board must determine whether the veteran has submitted evidence of well-grounded claims. His appeal as to those which are not must fail, and VA is not obligated to assist him in the development of those claims. 38 U.S.C.A. § 5107(a). Evidentiary assertions by the appellant must be accepted as true for the 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). For the reasons set forth below, the Board finds that the veteran has not met his burden of submitting evidence to support a belief that his claim for service connection for a left thigh dog bite scar is well grounded. See 38 U.S.C.A. § 5107(a); Grottveit v. Brown, 5 Vet.App. 91 (1993); Tirpak v. Derwinski, 2 Vet.App. 609 (1992); Murphy v. Derwinski, 1 Vet.App. 78 (1990). The VA benefits system requires more than just an allegation; a claimant must submit supporting evidence. Furthermore, the evidence must justify a belief by a fair and impartial individual that the claim is plausible. The quality and quantity of the evidence required to meet this burden of necessity will depend upon the issue presented by the claim. Where the issue is factual in nature, e.g., whether an incident or injury occurred in service, competent lay testimony, including a veteran’s solitary testimony, may constitute sufficient evidence to establish the claim as well grounded. However, where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence to the effect that the claim is plausible or possible is required. A threshold requirement for establishing service connection for a claimed disability is that it must be shown that such disability exists. Here, the service medical records document that the veteran was bitten by a dog on his left thigh in April 1955. The wound was cleansed, but the remainder of the service medical records, including the report of the veteran’s separation examination, reflect no complaints or abnormal clinical findings related to that bite. The only subsequent reference was recorded in May 1955, and was to the effect that a check with security personnel revealed that there had been no cases of rabies in the geographic area where the veteran had been bitten by the dog. On his substantive appeal, dated in September 1991, the veteran indicated that he was bitten on the right thigh by a dog in service, not the left thigh. At his personal hearing in September 1993, the veteran’s representative inquired of the veteran whether he had ever had any other injury to the left thigh, other than the dog bite, and the veteran indicated that he had not. Noting that the scar was on the inner aspect of the right thigh, the hearing officer asked the veteran whether, at the time of his separation examination, the examiner had observed the scar or questioned him about it; the veteran responded that he didn’t think so. While there appears to be some confusion as to which thigh was actually bitten, the service medical records clearly indicate that it was the left thigh. The clinical evidence, however, fails to reveal any current residual scarring or other impairment related to the left thigh bite. Where the claimed disorder is not currently demonstrated, the claim is not well grounded. See Grivois v. Brown, 6 Vet.App. 136 (1994); Rabideau v. Derwinski, 2 Vet.App. 141 (1992). In the absence of any corroborating evidence, and in the face of contrary, contemporaneous documentary medical evidence, the Board finds the veteran’s own statements, even under oath, that it was, in fact, his right thigh which was bitten not to be persuasive. After more than 30 years since the veteran’s separation from service, and without any clinical documentation of their presence at any time during that period, there is no basis to attribute the origin of the right thigh scars, noted on examination in May 1991, to service. It is apparent that the examiner's notation of the right thigh scarring as scarring due to "remote dog bites to the right thigh" was solely the result of the veteran's report that he had been bitten there, and was not based on an objective assessment of its origin. In any event, the scarring on the right thigh was described as slight and asymptomatic, and no current disability attributable to it was found. Where there is no evidence, other than the veteran’s own unsupported assertions, that the claimed injury occurred, the claim is, likewise, not well grounded. It is the Board’s conclusion, therefore, that the veteran has not submitted evidence of a well grounded claim for service connection for a dog bite scar of the thigh, and that the claim should be dismissed. Thoracic spine injury and residuals of a fractured scapula The service medical records reflect that the veteran sustained a bruise over the area of his twelfth thoracic vertebra and pain over his scapula, with a possible fracture. However, those records do not document the existence of a vertebral fracture or a scapula fracture, and no clinical record since service makes reference to any evidence of a thoracic vertebral fracture or scapular fracture. The report of the veteran’s separation examination notes no abnormal clinical findings or complaints relative to the back or scapula. The post-service medical records do not note any complaints referable to the thoracic spine until 1980, when the veteran injured his back falling from a truck. X-rays at that time did not reveal any thoracic spine fracture. The post-service medical records are silent regarding residuals of a scapula fracture during service. Although the May 1991 VA examiner listed a diagnosis of fracture of the thoracic spine and scapula, with thoracic spinal arthritis, it is clear that that diagnosis was made solely on the veteran’s report, since the clinical record simply does not corroborate that such fractures ever occurred. Even though the veteran did sustain an injury to his upper back during service, the clinical record does not establish that any thoracic spinal arthritis he may now have is in any way related to that injury. Moreover, thoracic spinal arthritis was not diagnosed or otherwise shown by the record until many years after service, and there is no clinical evidence that his current arthritis is in any way related to service. Although the veteran testified at his hearing that he was to have an MRI or a CAT scan of his back within a few weeks to better delineate his back problems, the record provides no indication that such an examination was undertaken. In addition, although he testified that he was hospitalized in France for treatment of the injury he sustained to the area of T12, that the injury definitely resulted in a fracture to his spine or scapula, and that he underwent surgery on his back, the service medical records reflect that the injury occurred only 9 days after his entry onto active duty, not in France. Nor do the service medical records document any back surgery. Accordingly, the Board finds the veteran’s testimony regarding his claimed back disability to be of limited probative value. The Board recognizes that the presence of and symptoms due to the veteran’s neuromuscular disorder, which was first shown many years after service, may disguise other back symptoms and the etiology for them. However, service connection may not be predicated on mere supposition. In this case, although the veteran did sustain an in-service upper back injury, there simply is no clinical or other credible evidence that any upper back symptoms or clinical findings he may now have are in any way related to that in-service injury or otherwise to service. Therefore, service connection for residuals of a thoracic spine injury and for residuals of a scapular fracture is not established. 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(a); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). In this case, the Board finds that the preponderance of the evidence is against the veteran’s claims for service connection for residuals of thoracic spine and scapular injuries. Lumbar spine injury The service medical records, including the report of the veteran’s separation examination, are completely negative for any evidence of complaints or abnormal clinical findings regarding his lumbar spine. The Board notes that the service medical records do show that the veteran was hospitalized in September 1956 and underwent surgery for treatment for a pilonidal sinus and cyst, an ailment totally unrelated to the lumbar spine, but anatomically located at the lower end of the spine. It may be, given the veteran's statements about back surgery, that he mistook that surgery for spinal surgery. There simply is no evidence of any back surgery during service. The post-service clinical evidence does not reflect any back problems until 1979, when a private medical record notes complaints of back pain and spasms. The affected segment of the back is not mentioned, however. Moreover, the veteran sustained a clear intercurrent contusion to his lower thoracic-lumbar area in a fall in 1980. A 1989 myelogram revealed evidence of a prior L4-5 laminectomy and fusion. The only evidence supportive of this claim, other than the veteran’s current assertions and testimony, is a copy of a letter purportedly written by the veteran to his sister in 1956, while he was hospitalized following surgery on his lower back. As noted above, his hearing testimony is somewhat limited in probative value in view of its inconsistencies with the documentary evidence compiled contemporaneously with service. Likewise, the probative value of the letter is lessened by the total lack of any clinical evidence that the veteran had spinal surgery during service. Also, the Board notes the 1991 VA examiner’s clinical impressions that the veteran had sustained a fracture of his lumbar spine in 1956, had undergone a spinal fusion, and now had "definitive degenerative osteoarthritis of the lumbar spine associated with the fusion with chronic low back pain." It is clear that the historical aspect of that impression was based entirely on the veteran’s medical history as reported by him. However, since that clinical impression was based on erroneous medical information, it carries no probative weight. Reonal v. Brown, 5 Vet.App. 458, 460-61 (1993). The Board has considered all the above evidence. Although some weight is to be given to the 1956 letter, the Board believes that if the veteran had undergone major back surgery during service, that would have been something he or the examiner would have mentioned during his separation examination. However, the veteran specifically indicated at that time that he had no history of any back problems, and the examiner noted no back complaints or abnormal clinical findings regarding the back. The Board finds that this very strong negative evidence outweighs the positive effect of the letter. The fact that the 1989 myelogram demonstrated evidence of a prior laminectomy does not, in itself, lead to the conclusion that the surgery was performed in service more than 30 years earlier. Such evidence must be considered in view of the entire record. Since the record does not otherwise show that a laminectomy (or any other back surgery) was done in service, the Board finds the 1989 X-ray evidence not particularly probative regarding the issue of the service incurrence of residuals of a lumbar spine injury, particularly in view of the documented history of back injury after service, and thus we find it to be outweighed by the strong negative evidence. Therefore, in light of the absence of credible evidence of any lumbar back injury during service and the lack of any evidence of lumbar spinal complaints until many years after service, the Board concludes that service connection for residuals of such an injury is not established. The Board finds that the preponderance of the evidence is against the veteran’s claim for service connection for residuals of a lumbar spine injury. Hypertension Service connection may be accomplished by affirmatively showing inception or aggravation during service or through the application of statutory presumptions. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1993). If hypertension is demonstrated to a compensable degree within one year after separation from service, service connection for that disorder is to be presumed. Although the service medical records document a number of elevated blood pressure during his 1956 hospitalization for treatment for a pilonidal cyst, the service records do not reflect that the veteran was diagnosed as having hypertension. Further, no high blood pressure or hypertension was noted or diagnosed during the remainder of his period of service. The reading reported at the time of the veteran’s separation examination was 146/76; no diagnosis of hypertension was assigned, even though the veteran listed a history of high blood pressure at the time of the separation examination. Cardiovascular examination was normal. Private medical records dated from 1978 reflect apparent treatment for high blood pressure. Lay statements by a friend of the veteran and by his brother attest to his having been treated for high blood pressure beginning in 1957. Also of record is the 1993 letter from a private physician indicating that his father, a physician, had treated the veteran for hypertension and various other conditions from March 1957 to December 1973. In addition, the veteran testified that he was treated for high blood pressure during the first year after his separation. There is no evidence which shows that hypertension was present during service or that his current hypertension resulted from any incident of service. The Board recognizes that the above evidence might be sufficient to establish that the veteran was treated for high blood pressure beginning in 1957, within one year after service. However, the law requires that, to establish service connection on a presumptive basis, the hypertension must have been present to a compensable degree during that first post- service year. A compensable evaluation for hypertension requires that the diastolic pressures be predominantly 100 or greater, or that continuous medication be necessary for control of hypertension with a history of diastolic blood pressure readings predominantly 100 or greater. 38 C.F.R. Part 4, Code 7101 (1994). For purposes of analysis only, the Board will assume that the veteran was indeed treated for high blood pressure during the first year after his separation from service. However, there is no evidence in the record of any blood pressure readings during that period. More importantly, there are no readings demonstrating that the veteran’s diastolic pressure was predominantly 100 or greater; nor does the evidence indicate that medication was necessary for the control of hypertension with a history or diastolic readings predominantly 100 or greater. Although the evidence does indicate at least two readings of 104 and 108 in 1978 and 1980, it would be purely speculative to conclude, based on that evidence, that his diastolic pressure was predominantly 100 or greater prior to February 1958, especially in light of the fact that no such readings were noted during service or on the separation examination. At best, the record indicates that the veteran was treated for high blood pressure between 1957 and the 1970's. The nature of that treatment or of any clinical manifestations present during the period is not known, since there are no clinical records of this treatment. Thus, from the available evidence, the Board is unable to find that hypertension was shown to a degree warranting a compensable evaluation during the first post-service year. Moreover, in view of the gap in time between the several elevated blood pressure readings inservice during hospitalization and the first documented pattern of hypertensive readings in the 1970's, the Board is unable to find that hypertension had its onset in service. We would point out that despite the several mildly elevated blood pressure readings inservice, no diagnosis of hypertension was recorded. In addition, blood pressure was normal at separation. In weighing the evidence for and against the claim for service connection for hypertension, the Board finds that the evidence against the claim outweighs that which is favorable. We conclude that the criteria for establishing service connection for hypertension on either a direct service incurrence basis or a presumptive basis are not met. Accordingly, service connection for hypertension is not established. Right knee disability In general, disability evaluations are assigned by applying a schedule of ratings which represent, as far as can practicably be determined, the average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Such evaluations involve consideration of the level of impairment of the veteran’s ability to engage in ordinary activities, to include employment, as well as an assessment of the effect of pain on those activities. 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59. Where there is a question as to which of two evaluations should be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1993). Although regulations require that, in evaluating a given disability, that disability be viewed in relation to its whole recorded history, 38 C.F.R. §§ 4.1, 4.2, the present level of disability is of primary concern. Francisco v. Brown, No. 93-76, slip op. at 5 (U.S. Vet. App. Sept. 27, 1994). In evaluating the veteran’s claim, all regulations which are potentially applicable through assertions and issues raised in the record have been considered, as required by Schafrath v. Derwinski, 1 Vet.App. 589 (1991). A number of diagnostic codes are potentially applicable in this case. For dislocation of the semilunar cartilage, with frequent episodes of "locking," pain, and effusion into the joint, a 20 percent evaluation is warranted. Code 5258. A 20 percent evaluation may be assigned for limitation of flexion of the leg to 30 degrees. Limitation to 45 degrees warrants a 10 percent rating. A noncompensable evaluation is to be assigned for limitation of flexion to 60 degrees or more. Code 5260. For limitation of extension to 15 degrees, a 20 percent rating is appropriate. Limitation to 10 degrees warrants a 10 percent evaluation. A noncompensable rating is to be assigned where the limitation of extension is to 5 degrees or less. Code 5261. Other impairment of the knee, with recurrent subluxation or lateral instability, warrants a 20 percent rating if the impairment is moderate and a 10 percent evaluation if the impairment is slight. Code 5257. Although examiners in service and also in more recent years have indicated their impression that there was some cartilage damage in the veteran’s right knee, magnetic resonance imaging in January 1993 definitively showed no abnormalities, other than a mild effusion. Therefore, rating the disability under Code 5258, which specifically requires dislocated cartilage, would not be appropriate. No examiner has noted that there is any limitation of extension of the right knee. Accordingly, under Code 5261, a compensable rating would not be warranted. Similarly, since neither any examiner nor even the veteran has reported limitation of flexion to more than 45 degrees, a schedular rating of more than 10 percent is not warranted under Code 5260. Moreover, examiners have consistently indicated the absence of any ligamentous instability or any recurrent subluxation of the right knee. Therefore, the criteria for a higher rating under Code 5257 are not met. Accordingly, a rating greater than the currently assigned 10 percent for the right knee disability on a schedular basis is not warranted at this time. However, the Board recognizes that the severe nature of the veteran’s non-service-connected neuromuscular disorder, which has rendered him unable to take more than a few steps on account of generalized weakness, makes it difficult to assess the precise functional impairment due solely to his service-connected knee disability. In addition, in view of the veteran’s reports and testimony that he, nevertheless, has constant right knee pain, and considering the fact that examiners have confirmed the reported pain and tenderness, as well as the frequent right knee effusions, and also considering that treatment for the knee has included needle aspirations and even steroid injection in June 1992, the Board concludes that, in this case, the evaluations provided by the rating schedule do not adequately describe the veteran’s average earning capacity impairment due to the service- connected disorder. In light of this analysis and resolving all doubt in the veteran’s favor, the Board believes that the degree of right knee impairment currently present warrants an extraschedular rating of 10 percent, but no more than 10 percent, in addition to the currently assigned 10 percent schedular evaluation, to total 20 percent for the veteran’s right knee disability. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.321. ORDER Service connection for bilateral pes planus is granted. The appeal relating to service connection for a dog bite scar of the thigh is dismissed. Service connection for residuals of thoracic and lumbar spine injuries, for residuals of a scapular fracture, and for hypertension is denied. An increased rating to 20 percent is granted for the postoperative residuals of a right knee injury, subject to the law and regulations governing the award of monetary benefits. D. C. SPICKLER 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 LEFTS: 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. A 1973 fire at the National Personnel Records Center in St. Louis, Missouri service personnel. Some of the veteran’s service medical records appear scorche proximity to the fire.