BVA9501858 DOCKET NO. 93- 07 512 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for the residuals of an injury to the left little finger. 2. Entitlement to service connection for the residuals of an injury to the left ring finger. 3. Entitlement to service connection for the residuals of an injury to the left wrist. 4. Entitlement to service connection for an acquired psychiatric disorder, to include post traumatic disorder (PTSD). 5. Entitlement to a compensable evaluation for post-operative residuals of a left inguinal hernia. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD L. M. Barnard, Counsel INTRODUCTION The veteran served on active duty from January 1968 to January 1970. This appeal arises from an October 1991 rating decision of the Waco, Texas, Department of Veterans Affairs (VA), Regional Office (RO), which denied the benefits sought on appeal. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in essence, that service connection should be granted for the residuals of an injury to his left little and ring fingers and the left wrist. He avers that he injured this arm in service when he was thrown from a jeep, landing on the left upper extremity. He also asserts that he suffers from PTSD as a direct result of his service in Vietnam. He states that he was exposed to enemy fire and that he often retrieved the dead and the wounded. He states that he is jumpy, nervous, and has trouble sleeping. He also alleges that the noncompensable evaluation assigned to his hernia residuals does not accurately reflect the degree of severity of these residuals. Therefore, he believes that his claims should be granted. 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 evidence supports a finding of service connection for the residuals of an injury to the left little finger; the preponderance of the evidence is against entitlement to service connection for the residuals of an injury to the left ring finger and wrist, against service connection for PTSD, and against the assignment of a compensable evaluation for post-operative hernia residuals. FINDINGS OF FACT 1. The veteran suffers from chronic residuals of an injury to the left little finger that occurred in service. 2. The veteran does not suffer from residuals of an injury to the left ring finger that occurred in service. 3. The veteran does not suffer from residuals of an injury to the left wrist that occurred in service. 4. The veteran's diagnosed anxiety disorder was not present in service, and was not diagnosed until many years following his discharge. 5. PTSD has not been clinically identified by the medical evidence of record. 6. The veteran's service connected hernia is not recurrent in nature. CONCLUSIONS OF LAW 1. A disability of the left little finger was incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107(a) (West 1991). 2. A disability of the left ring finger was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107(a) (West 1991). 3. A disability of the left wrist was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107(a) (West 1991). 4. The veteran's anxiety disorder was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107(a) (West 1991). 5. PTSD was neither incurred in nor aggravated by service. 38 U.S.C.A. §§ 1110, 5107(a) (West 1991); 38 C.F.R. § 3.304(f) (1993). 6. The criteria for a compensable evaluation for post-operative hernia residuals have not been met. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38 C.F.R. § 3.321, Part 4, including §§ 4.1, 4.2, 4.7, 4.40, Code 7338 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claims are well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, we find that he has presented claims which are plausible. We are also satisfied that all relevant facts have been properly developed. The record is devoid of any indication that there are other records available which should be obtained. Therefore, no further development is required in order to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). Under the applicable criteria, service connection may be granted for a disability the result of disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 1991). I. Entitlement to service connection for the residuals of an injury to the left little finger. Our review of the service medical records indicated that the veteran's left little finger was normal upon entrance onto active duty in July 1968. In December 1969, he reported to sick call with a request that his left little finger be examined. He indicated that he had injured this finger approximately one month before. An x-ray done at the time of the injury was allegedly negative. Since this original injury, he suffered from continual swelling at the proximal interphalangeal (PIP) joint of the left little finger. He was referred for an orthopedic examination that same month. This examination revealed that the flexor and extensor tendons were intact. The PIP joint was slightly swollen and nontender. There was decreased range of motion in the flexor and extensor muscles. An x-ray revealed a questionable calcification around the PIP joint that could have represented old trauma. The separation examination performed in January 1970 noted no disability involving the left little finger. A VA outpatient treatment record from January 1970 noted his complaints that he had injured his left little finger about two months before. He stated that he was told by the doctors in service that there had been no fracture. The objective examination revealed that there was swelling of the PIP joint present, accompanied by an inability to fully extend the joint. There was pain on extension against resistance. An x-ray showed that there was flexion contracture of the left fifth finger at the PIP joint. The impression was possibility of a chip fracture at the distal end of the first phalanx of the left fifth finger. There was also soft tissue swelling present. The veteran's left little finger was examined by VA in July 1991. It was noted that he had been in a motor vehicle accident in January 1984 and that he had complaints of numbness in the left upper extremity ever since. The objective examination results indicated that there was flexion contracture in the PIP of the left fifth finger. Hypesthesia was present in the little finger and in the ulnar distribution of the left forearm. The diagnosis noted that he appeared to have tardy-ulnar nerve palsy. After a careful review of the evidence of record, it is the opinion of the undersigned that that evidence supports a grant of service connection for the residuals of an injury to the left little finger. The evidence includes the service medical records, which leave no doubt that the veteran did complain of injuring this finger in service. In fact, swelling and flexion contracture of the PIP joint were present. A VA outpatient treatment record from January 1970 noted his complaints of swelling. Again, the flexion contracture was noted, as well as soft tissue swelling. While the veteran did not seek treatment for swelling or pain after this point, it is noted that the July 1991 VA examination indicated that the flexion contracture of the PIP joint of the left little finger was still existent. This contracture, after consideration of all the evidence, appears to be a chronic residual caused by the in-service injury involving this joint experienced in 1969. Therefore, it is the conclusion of the undersigned that the veteran does suffer from a disability the result of an injury incurred in service. 38 U.S.C.A. § 1110 (West 1991). In conclusion, the undersigned finds that the evidence supports a finding of entitlement to service connection for the residuals of an injury to the left little finger. II. Entitlement to service connection for the residuals of an injury to the left ring finger and left wrist. A review of the service medical records, while noting an injury to the veteran's left little finger, make no reference to an injury involving the left ring finger or his left wrist. The separation examination conducted in January 1970 was silent as to any complaints concerning these joints. The objective examination found that the upper extremities were normal. Following his discharge, the veteran presented with complaints concerning his little finger. However, he made no mention of his left ring finger or wrist. A private outpatient treatment record from January 1984, revealed that the veteran was involved in a motor vehicle accident. His vehicle apparently collided with an 18-wheeler. He complained of swelling in the left elbow, numbness in the left hand, and stiffness on the left side of his neck. The physical examination noted there was swelling at the proximal side of the left elbow, as well as slight swelling of the left side of the neck. Pinprick and light touch sensation was decreased on the left side at the wrist. The impression was ulnar nerve contusion. In July 1991, the veteran was examined by VA. At that time, he stated that he had originally injured his left arm when he was thrown from a jeep he was riding in. He said that he wore a splint for one or two months. He then suffered an ulnar contusion following an accident in 1984. The objective examination found that he had diminished sensation in the little finger and in the ulnar half of the ring finger. Otherwise, there was good functioning of the left fingers and wrist. X-rays of the left wrist and elbow were negative. There appeared to be questionable slight thickening of the ulnar nerve about the elbow groove. It appeared that the veteran had tardy-ulnar nerve palsy, producing hypesthesia of the ulnar aspect of the left forearm, and hypesthesia of the little finger and half of the ring finger of the left hand. He had mild to moderate impairment of the left hand. After a careful review of the evidence of record, it is the conclusion of the undersigned that entitlement to service connection for the residuals of an injury to the left ring finger and left wrist is not warranted. Initially, it is noted that there is no evidence that the veteran ever injured these two areas while on active duty. While he injured his left little finger, there was absolutely no indication that the left ring finger and wrist were in any way involved. Moreover, the separation examination makes no reference to any complaints involving either the left ring finger or the wrist. While he complained immediately after discharge about his left little finger, he again offered no complaints about the ring finger or the wrist. In fact, no complaints about these areas were made until after the intercurrent injury involving his left upper extremity in 1984. Since this accident, he has complained of numbness in the left arm. However, there has been no objective evidence offered to suggest that these complaints are related to service, and not to this intercurrent injury. It has been noted that the veteran has alleged that he injured his left ring finger and wrist at the same time that he injured his little finger. Unfortunately, the objective evidence of record does not support this allegation. Rather, it clearly showed that only the little finger was injured in service. Therefore, it is the conclusion of the undersigned that the preponderance of the evidence is against the veteran's claims for entitlement to service connection for the residuals of an injury to the left ring finger and left wrist. III. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD. In order to establish entitlement to service connection for PTSD, there must be medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed inservice stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed inservice stressor. 38 C.F.R. § 3.304(f). The veteran's DD-214 indicated that he was an infantryman. He received the National Defense Service Medal, the Vietnam Service Medal and the Combat Infantryman Badge. There was no indication that he was wounded or that a Purple Heart Medal was awarded. A review of the veteran's service medical records indicated that he was psychiatrically normal during the entrance examination conducted in July 1968. There is no indication that he ever complained of or was treated for any psychiatric complaints during his tour of duty. The separation examination of January 1970 again noted that he was psychiatrically normal. In July 1991, the veteran submitted a statement wherein he alleged that, during his tour of duty in Vietnam, he was responsible for retrieving numerous wounded and dead soldiers. He commented that he experienced nightmares, and had sought treatment in 1971 or 1972 for his nerves. In July 1991, the veteran was examined by VA. This report noted that the veteran had received the Combat Infantryman Badge. He stated that had served as a member of a tank crew. His own unit took very light casualties, although the infantry unit of which they were in support received heavier casualties. He again stated that he helped with the evacuation of the dead and wounded. He also noted that a friend of his was killed when his tank was destroyed. It was commented that his descriptions of combat were vague and uncertain. He stated that he had been brought to the VA on one occasion, apparently in the 1970's, by his brother; he had apparently become dazed while driving his truck. He was seen on only one occasion and never sought further treatment. He was allegedly given some medication, which he said he only took for a week or two. His description of his symptoms was noted to be vague, almost evasive. He stated that he was jumpy, and had nightmares, whose content he could not remember. The mental status examination found him to be somewhat tense but cooperative. His answers to questions were relevant and he was able to organize his thoughts, although he volunteered no information. His speech displayed normal production and he was oriented. His thought content was not too remarkable, showing some anxiety and a preoccupation with his physical complaints. There was a slight sensitivity to sudden noises but he was not really hypervigilant. There was some sleep disturbance on occasion but he described no combat nightmares. He was irritable, but had no history of rage reactions, deep depressions with suicidal ideation or survival guilt, and provided no description of any dissociative phenomenon. The examiner stated that a diagnosis of PTSD could not be supported. The diagnosis was generalized, chronic mild anxiety reaction. After a careful review of the evidence of record, it is the conclusion of the undersigned that service connection for an acquired psychiatric disorder is not warranted. The record clearly indicates that the veteran did not suffer from any such disorder during service. The service medical records contain no complaints of or treatment for any type of psychiatric disorder. In fact, the January 1970 separation examination found him to be psychiatrically normal. The record contains no objective reference to a psychiatric disorder, namely anxiety reaction, until 1991, during the VA examination. The veteran had indicated that he had been brought to a VA hospital on one occasion after becoming "dazed" while driving his truck. He noted that he never went back for any follow-up treatment. No psychiatric diagnosis was referred to as having been made at that time. Significantly, there was no further attempt on the part of the veteran to obtain any type of treatment, which argues against the onset of a chronic psychiatric disorder. In any event, in order to establish entitlement to service connection for a neurosis, such as anxiety reaction, the evidence must establish that it had its onset during active duty. Such is not the case here. After carefully weighing the evidence, it is the conclusion of the undersigned that the preponderance of the evidence is against entitlement to service connection for anxiety reaction. The veteran has also asserted that he suffers from PTSD. However, the record does not support his contention. The DD-214 notes that he received a Combat Infantryman Badge, which is evidence of stressful duty. However, there has been no post- service, verified diagnosis of PTSD. The VA examination conducted in 1991 found none of the typical symptoms of PTSD. The examiner specifically noted that the evidence did not support a diagnosis of PTSD. Clearly, in the absence of a currently manifested PTSD, service connection for PTSD is not assignable. Therefore, the preponderance of the evidence is against the veteran's claim for entitlement to service connection for PTSD. IV. Entitlement to an increased evaluation for post-operative hernia residuals. Under the applicable criteria, disability evaluations are determined by the application of a schedule of ratings which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1993). When a question arises as to which of two evaluations shall be assigned, the higher evaluation will be assigned of 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). In determining the disability evaluation, the VA has a duty to acknowledge and consider all regulations which are potentially applicable based upon the assertions and issues raised in the record and to explain the reasons used to support the conclusion. Schafrath v. Derwinski, 1 Vet.App. 589 (1991). These regulations include, but are not limited to, 38 C.F.R. § 4.1, that requires that each disability be viewed in relation to its history and that there be an emphasis placed upon the limitation of activity imposed by the disabling condition, and 38 C.F.R. § 4.2 which requires that medical reports be interpreted in light of the whole recorded history, and that each disability must be considered from the point of view of the veteran working or seeking work. This evaluation includes functional disability due to pain under the provisions of 38 C.F.R. § 4.40. These requirements for the evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decision based upon a single, incomplete or inaccurate report and to enable VA to make a more precise evaluation of the disability level and any changes in the condition. According to Diagnostic Code 7338, an inguinal hernia which is small, reducible, or without true hernia protrusion is noncompensable. A noncompensable rating is applicable if the hernia has not been operated on but is remedial. A 10 percent rating is warranted for postoperative recurrent hernia which is readily reducible and well supported by a truss or belt. 38 C.F.R. Part 4, Code 7338. A review of the service medical records reveals that the veteran underwent a surgical repair of an inguinal hernia in February 1968. In August 1968, some weakness at the anterior abdominal site was present. In June 1969, the veteran complained of swelling at the site of the hernia repair. There was no evidence of defect or swelling upon objective examination. By September 1969, he was still complaining of discomfort at the site of the repair, and reported occasional pain upon heavy lifting. The examination revealed a scar that was not painful. No tissue defect could be felt. There was noted to be no evidence of a recurrence of the hernia. The veteran was examined by VA in July 1991. He complained of discomfort, but the objective examination found no evidence of a recurrence of his hernia. The diagnosis was history of a hernia repair in 1968. After carefully reviewing the evidence, it is the finding of the undersigned that a 10 percent disability evaluation for the residuals of a hernia repair is not warranted. The evidence of record, consisting of the July 1991 VA examination, clearly established that the veteran was not experiencing a recurrence of his hernia. While he noted some discomfort, no hernia was found by the examiner. There was also no indication that he wore a truss or a belt to support any hernia. Clearly, the criteria for a 10 percent disability evaluation, most notably a postoperative recurrent hernia, are not present in this case. Moreover, an extraschedular evaluation pursuant to 38 C.F.R. § 3.321 (1993), is not warranted. The disability in question has not resulted in frequent periods of hospitalizations, nor has it caused marked interference with employment. Therefore, the preponderance of the evidence is against the veteran's claim for a compensable evaluation for this disorder. ORDER Service connection for the residuals of an injury to the left little finger is granted. Service connection for the residuals of an injury to the left ring finger is denied. Service connection for the residuals of an injury to the left wrist is denied. Service connection for an acquired psychiatric disorder, to include PTSD, is denied. A compensable evaluation for postoperative residuals of a hernia repair is denied. C. P. RUSSELL Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.