BVA9504643 DOCKET NO. 93-06 509 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for a skin disorder. 2. Entitlement to service connection for lumbosacral strain. 3. Entitlement to service connection for chondromalacia of the left knee. 4. Entitlement to service connection for chondromalacia of the right knee as being proximately due to or the result of a service-connected disability. 5. Entitlement to service connection for bilateral ankle pain as being proximately due to or the result of a service-connected disability. 6. Entitlement to service connection for bilateral hip pain as being proximately due to or the result of a service-connected disability. 7. Entitlement to an increased rating for bilateral pes planus with plantar calluses, currently evaluated as 30 percent disabling. 8. Entitlement to restoration of a 10 percent rating for sarcoidosis. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD John R. Pagano, Counsel INTRODUCTION The veteran had active military service from June 1972 to June 1974. This matter arises from various rating decisions rendered since March 1992 by the St. Petersburg, Florida, Regional Office (RO). Therein, an increased rating for pes planus was denied, the existing 10 percent rating for sarcoidosis was reduced to no percent, and service connection was denied for the remaining disabilities at issue. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the Department of Veterans Affairs (VA) erred in denying him the benefits sought on appeal. He asserts that his bilateral pes planus has increased in severity, and has given rise to disabilities of the ankles, hips, knees, and lower back. He further asserts that his sarcoidosis has not improved. To the contrary, he argues that the latter disability has given rise to a skin disorder. 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 upon its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that: (1) the preponderance of the evidence is against the claims for service connection for lumbosacral strain, a skin disorder, and chondromalacia of the left knee; (2) the claims for service connection for bilateral ankle pain, bilateral hip pain, and chondromalacia of the right knee are not well grounded; (3) the preponderance of the evidence is against the claim for an increased rating for bilateral pes planus; and (4) the prior 10 percent disability evaluation for sarcoidosis should be restored. FINDINGS OF FACT 1. No competent evidence has been presented which would tend to relate disorders of the ankles, hips, or right knee, to either the veteran's military service or any of his service-connected disabilities. 2. All relevant evidence necessary for an equitable disposition of the veteran's appeal regarding bilateral pes planus, sarcoidosis, chondromalacia of the left knee, lumbosacral strain, and a skin disorder has been obtained by the RO. 3. A chronic skin disability is not currently demonstrated. 4. Muscle strain resulting in low back pain during service was acute in nature, and is unrelated to the chronic lumbosacral strain currently diagnosed; nor is chronic lumbosacral strain causally related to the veteran's service-connected bilateral pes planus, or any other service-connected disability. 5. Left knee pain experienced by the veteran during service was acute in nature, and unrelated to his currently diagnosed chondromalacia of that joint; nor is left knee chondromalacia causally related to bilateral pes planus, or any other service- connected disability. 6. Symptomatology currently associated with bilateral pes planus includes tender calluses at the heels and balls of the feet, along with bilateral pes planovalgus deformities; this represents no more than severe impairment. 7. Sustained improvement in the veteran's sarcoidosis has not been clinically demonstrated. CONCLUSIONS OF LAW 1. The claims of entitlement to service connection for disabilities of the ankles, hips, and right knee are not well grounded. 38 U.S.C.A. §§ 1110, 5107(a) (West 1991); 38 C.F.R. § 3.310 (1994). 2. Chondromalacia of the left knee, chronic lumbosacral strain, and a chronic skin disorder were not incurred in or aggravated by military service, and are not proximately due to, or the result of, any of the veteran's service-connected disabilities. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.310 (1994). 3. Bilateral pes planus is not more than 30 percent disabling under the applicable schedular criteria. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.40, 4.41, and 4.71a, Diagnostic Code (DC) 5276 (1994). 4. The criteria for the restoration of a 10 percent disability rating for sarcoidosis are met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.344, 4.7, 4.20, and 4.97, DC 6603 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Preliminary Observations One claiming entitlement to VA benefits has the burden of submitting evidence sufficient to justify a belief that a given claim is well grounded. See 38 U.S.C.A. § 5107(a). "[T]he [VA] benefits system requires more than just an allegation;" a claimant must submit supporting evidence sufficient to justify a belief by a fair and impartial individual that a given claim is plausible. See Tirpak v. Derwinski, 2 Vet.App. 609, 611 (1992). The first question thus presented is whether the appellant has met this burden with regard to the various aspects of his appeal. The veteran's claims regarding lumbosacral strain, a left knee disability, a skin disability, pes planus and sarcoidosis meet the threshold requirements cited above. They are supported by evidence which might lead to a favorable conclusion. As such, VA has the duty to assist the veteran in their development. With regard to these questions, the Board is satisfied that all relevant facts have been properly developed and that VA has complied with its duty as mandated by 38 U.S.C.A. § 5107(a). The same cannot be said for the veteran's claims regarding service connection for disabilities of the ankles, hips, and right knee. The veteran has contended that these disorders were incurred secondary to his service-connected bilateral pes planus. See 38 C.F.R. § 3.310(a) (1994). However, unlike his other claims, the clinical evidence submitted fails to indicate that any such relationship exists. To the contrary, the VA physician who examined the veteran in January 1992 indicated that, in his opinion, the foregoing conditions may have been exacerbated by the veteran's pes planus, but "are not caused by them." Exacerbation, in this regard, is not a legal basis for a grant of service connection. See 38 U.S.C.A. § 1110; Leopoldo v. Brown, 4 Vet.App. 216, 218-219 (1993). In effect, only the veteran's statements would tend to relate disabilities of the ankles, hips, and right knee to military service. Because the veteran is a layman, his assumptions regarding the relationship between various disorders (i.e., questions of medical causation), by themselves, do not constitute evidence sufficient to render a claim well grounded. See Espiritu v. Derwinski, 2 Vet.App. 492, 494-495 (1992). Since the evidence which the veteran has submitted in conjunction with his claims in no way corroborates his allegations, he has not met the burden imposed by 38 U.S.C.A. § 5107(a). See Grottveit v. Brown, 5 Vet.App. 91, 93 (1993). The absence of competent medical evidence in support of these claims, therefore, is fatal to these aspects of the veteran's appeal. It is important to note further, however, that because the veteran did not meet the burden of submitting evidence sufficient to establish "well-grounded" claims with regard to bilateral ankle, bilateral hip and right knee disabilities, the RO was without statutory authority to carry these claims to full adjudication. See 38 U.S.C.A. § 5107(a). The RO should, therefore, vacate those portions of the rating decision that formally denied service connection for these disabilities so that the veteran is in a position to begin, if he can, on a clean slate. See Grottveit, 5 Vet.App. at 93. II. Entitlement to Service Connection for Lumbosacral Strain and Disabilities of the Skin and Left Knee The veteran's complaints, along with clinical findings recorded in his service medical records, reflect symptomatology associated with his skin, left knee, and low back. As such, his claims with regard to each will be dealt with in tandem. The veteran has contended that current disabilities of the low back, left knee, and skin developed secondary to his service- connected disabilities; the Board notes, however, that symptomatology associated with the left knee, low back, and skin was noted during military service. As such, the question of service connection on a direct basis is reasonably raised by the record. See Myers v. Derwinski, 1 Vet.App. 127, 129 (1991). Parenthetically, this is in contrast to disorders of the ankles, hips, and right knee; these were not noted in service, and the veteran has not claimed as much. Service medical records reflect various physical complaints by the veteran during active duty. In August 1972, he complained of left knee pain. Upon physical examination, no tenderness or edema was noted. The veteran was treated conservatively, and his left knee remained symptom-free during the remainder of military service. Similarly, the veteran complained of low back pain during May 1973. Localized tenderness over the lower back was observed. Acute muscle strain was diagnosed, and bed rest and muscle relaxants were prescribed. This disorder apparently resolved without further sequelae since the veteran had no further complaints regarding his low back during service. In March 1974, the veteran complained of a rash on his neck and upper torso, diagnosed as bacterial in nature. Disinfectant soap was prescribed. This condition also apparently resolved because the veteran had no further complaints either prior to, or during, his discharge examination conducted in June 1974, and no abnormality of the skin was observed during that time. The veteran underwent a VA general medical examination in December 1974. During the examination, he registered no complaints regarding his left knee, his skin, or his low back. His musculoskeletal system was observed by the examiner to be normal, except for calluses on both feet. A spina bifida occulta at L2 was noted by X-ray as an incidental matter. The veteran was hospitalized at a VA medical facility in February 1975. A mild congenital ptosis of the left eyelid was treated and corrected; otherwise, the skin was free of abnormality, save for the reappearance of the large plantar warts observed during service. The record is silent as to any further complaints or findings regarding the veteran's low back, skin, or left knee until January 1992. During a consultation at a VA medical center, a cystic lesion of the left lateral canthus was diagnosed. A history of a congenital ptosis of the left eye also was noted. The cyst was removed in June 1992. Nothing in the record would tend to relate the cyst to the bacterial infection experienced by the veteran during service or to a service-connected disability. The veteran also underwent a VA general medical examination in January 1992. Although he alluded to a history of tinea versicolor, no such disorder was evident to the examiner. On orthopedic examination conducted the same date, moderate patellofemoral crepitus was present during movements of the left knee which the examiner believed to be indicative of chondromalacia. Although range of motion of the low back was less than normal, X-rays of that spinal segment, and of the knees, were within normal limits. The examiner diagnosed, inter alia, chronic lumbosacral strain, and bilateral chondromalacia of the patellas. Service connection may be granted for disability resulting from disease or injury incurred in, or aggravated by, active military service. 38 U.S.C.A. § 1110. In addition, service connection may be granted for disability which is the proximate result of a service-connected disability. 38 C.F.R. § 3.310(a). The question presented is whether the veteran's low back, left knee, or skin abnormalities may be attributed either to military service or to a service-connected disability. Regarding direct service connection, the record does not demonstrate a chronic left knee, skin, or low back disorder during service. Findings during service regarding the skin, left knee, and low back were indicative of acute symptomatology which resolved without sequelae prior to the veteran's discharge. Moreover, it was not until many years following service that the veteran complained of symptoms associated with his left knee, skin, and low back. Given the acute nature of symptomatology during service, along with the absence of evidence of continuity of symptomatology subsequent to service, the Board finds no reasonable basis upon which to predicate a grant of service connection for any of the disabilities claimed on a direct basis. See 38 C.F.R. § 3.303(b). The question remains whether disabilities of the low back, left knee, or skin may be attributed to any of the veteran's service- connected disabilities. The veteran has submitted no clinical evidence that would support such a relationship. Moreover, the physician who conducted the January 1992 orthopedic examination specifically ruled out an etiological relationship between the veteran's service-connected bilateral pes planus and back and knee disorders. Finally, the Board notes that no chronic skin disability was observed during the January 1992 general medical examination. Absent clinical evidence of an etiological relationship between the veteran's service-connected disabilities and the disorders claimed, service connection on a secondary basis is not warranted. See 38 C.F.R. § 3.310. III. Entitlement to an Increased Rating for Bilateral Pes Planus The veteran was seen on a number of occasions while on active duty for chronic calluses of the feet. During a VA examination conducted shortly after the veteran's military discharge, it was noted that he walked on the lateral aspect of both feet as a result of painful plantar calluses. The examiner diagnosed second degree pes planus with marked pronation which, in his opinion, contributed to the plantar calluses. Various records of the veteran's VA and private medical treatment since then reflect periodic trimming of his plantar callosities. During a VA physical examination conducted in January 1992, pes planus with calluses at the heel and plantar calluses on the ball of each foot were observed; these were quite tender. The examiner also noted planovalgus deformities of both feet. However, no additional abnormalities of the feet were observed. Disability evaluations are based upon a comparison of clinical findings with the applicable schedular criteria. 38 U.S.C.A. § 1155. Bilateral flat feet with evidence of marked deformity on pronation with characteristic callosities are indicative of severe impairment, and are to be rated at 30 percent under VA's Schedule for Rating Disabilities, 38 C.F.R. § 4.71a, DC 5276 (1994). To warrant the next higher evaluation, i.e., 50 percent, there must be marked inward displacement and severe spasm of the tendo achillis on manipulation that is not improved by orthopedic shoes or appliances. Neither the history of the veteran's pes planus, nor current clinical findings, reflect such symptomatology. See 38 C.F.R. § 4.41; Schafrath v. Derwinski, 1 Vet.App. 589, 595-596 (1991). The Board finds, therefore, that this disability does not more nearly approximate the level of impairment required for the next higher disability evaluation. See 38 C.F.R. § 4.7. Ancillary to the foregoing is the question of whether the veteran's bilateral pes planus with associated callosities is a disability exceptional enough in nature to qualify for an extra- schedular evaluation under the provisions of 38 C.F.R. § 3.321(b)(1) (1994). The governing norm is whether a given service-connected disability presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization so as to render impractical the application of the regular standards. Id. The record does not indicate that pes planus has required frequent hospitalization or, for that matter, more than regular topical treatment of attendant callosities. Nor has any evidence been introduced to indicate that this disability has compromised the veteran's employment, to include significant time lost from work. As such, the rating schedule is adequate to evaluate the veteran's service-connected disabilities, and the provisions of 38 C.F.R. § 3.321(b)(1) are not for application. IV. Entitlement to Restoration of a 10 Percent Rating for Sarcoidosis The Board notes that although the veteran initially applied for an increased rating for sarcoidosis, his substantive appeal filed in December 1992 was limited to the "[p]ropriety of reduction of service-connected sarcoidosis from 10% to 0%." His representative likewise limited his allegations in a March 1993 statement. Accordingly, the Board will confine its review of this issue to the parameters stated on the cover page of this decision. See Peyton v. Derwinski, 1 Vet.App. 282, 286 (1991). The RO granted the veteran service connection for sarcoidosis by rating decision dated in December 1975. That grant was based upon VA X-ray findings which indicated bilateral paratracheal, parabronchial, and bronchopulmonary adenopathy with involvement of azygos nodes and interstitial infiltrate. Hilar adenopathy was confirmed by chest tomography. Pulmonary function testing revealed mild restrictive lung disease. A transbronchial lung biopsy was performed which demonstrated noncaseating granuloma, consistent with sarcoidosis. Based upon those findings, a 30 percent disability evaluation was assigned. A review examination was conducted in December 1983. Both chest X-rays and pulmonary function testing were within normal limits; however, diffusing lung capacity was decreased, consistent with a diagnosis of sarcoidosis. The veteran indicated that he was not taking any medications for that disorder. Based upon those findings, in April 1984, the RO reduced the then existing 30 percent disability evaluation to 10 percent pursuant to the provisions of 38 C.F.R. § 4.97, DC 6603 (1984). The veteran did not appeal that decision. The veteran's sarcoidosis was most recently evaluated clinically during a VA examination conducted in January 1992. The veteran again indicated that he was not taking any medications for this disability. The examiner observed that the veteran's lungs were clear to auscultation and percussion. However, it does not appear that either X-ray studies or pulmonary function testing was conducted. Based upon that examination, in June l992, the RO reduced the 10 percent disability evaluation then in effect to zero percent, effective October l992. Rating agencies will handle cases so as to produce the greatest degree of stability of disability evaluations consistent with the laws and regulations governing disability compensation. 38 C.F.R. § 3.344(a) (1994). In effect, ratings are not to be reduced except in those instances where all of the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated, to include the question of whether the evidence makes it reasonably certain that the improvement will be maintained under the "ordinary conditions of life." Id. This is required in those cases where ratings have continued for long periods at the same level (five years or more). See 38 C.F.R. § 3.344(c) (1994). The Board finds no evidence of such improvement in this case and no finding to that effect in the RO's reduction decision. Indeed, the reduction in the veteran's disability evaluation appears to have been based upon a single VA examination. That examination was limited to the physical observations of the examining physician. Neither X-ray studies nor pulmonary function testing was conducted. The results of such testing had been the basis for the disability evaluation previously in effect. Absent additional testing, it appears that an inadequate examination was the basis for the reduction at issue. See 38 C.F.R. § 4.2 (1994). Under the circumstances, the Board finds that the reduction was void ab initio as not in accordance with law, requiring retroactive reinstatement of the veteran's l0 percent rating to October l, l992, the effective date of the reduction. See generally, Brown v. Brown, 5 Vet.App. 413 (1993). ORDER The claims of entitlement to service connection for right knee, bilateral ankle, and bilateral hip disorders are dismissed. Service connection for lumbosacral strain, for a left knee disorder, and for a skin disorder is denied. An increased rating for bilateral pes planus is denied. A 10 percent disability evaluation for sarcoidosis is restored, effective October 1, 1992, subject to the laws and regulations governing payment of monetary benefits. JACQUELINE E. MONROE 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.