Citation Nr: 0005189 Decision Date: 02/28/00 Archive Date: 03/07/00 DOCKET NO. 98-10 074A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for hypertension. 2. Entitlement to service connection for headaches. 3. Entitlement to service connection for a skin condition, claimed as secondary to Agent Orange exposure. 4. Entitlement to a compensable disability rating for two- centimeter scar, residual of left jaw injury. 5. Entitlement to an initial disability rating higher than 10 percent for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD M. L. Kane, Associate Counsel INTRODUCTION The veteran had active military service from June 1965 to May 1968, with several years of inactive service thereafter. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 1997 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama, which denied service connection for hypertension, headaches, and a skin disorder; granted service connection for a scar on the left jaw, with assignment of a zero percent disability rating; and granted service connection for PTSD, with assignment of a 10 percent disability rating. By memorandum dated in October 1998, the Vice Chairman of the Board ruled favorably on the Board's own motion to advance this case on the docket because of administrative error that resulted in significant delay in docketing the appeal. See 38 C.F.R. § 20.900(c) (1999). In February 2000, the Board granted the veteran's motion to further advance his case due to financial hardship. In his substantive appeal, the veteran questioned why the RO had not considered his claim for service connection for hypertension as secondary to his service-connected PTSD. When he filed the claim for hypertension in 1997, he did not indicate that it was on a secondary basis, nor did he raise any such contentions during his VA examinations. The first indication that he wanted secondary service connection for hypertension was in the notice of disagreement prepared by his representative in 1998. This claim is not inextricably intertwined with the claim for direct service connection that is currently before the Board because a claim for secondary service connection is based on different laws and regulations than those applicable to direct service connection. See Parker v. Brown, 7 Vet. App. 116 (1994) (a claim is intertwined only if the RO would have to reexamine the merits of any denied claim which is pending on appeal before the Board under the pertinent law and regulations specifically applicable thereto). This issue has not been adjudicated by the RO, and it is therefore referred to the RO for appropriate action. FINDINGS OF FACT 1. There is no current diagnosis of an acneform disorder or of any chronic skin disorder. 2. The medical evidence shows that the veteran currently has essential hypertension and intermittent headaches. 3. There is no evidence showing the development of hypertension during active service or within the year after the veteran's separation from active service. 4. There is no medical evidence of a link between the veteran's current essential hypertension and headaches, or the claimed skin condition(s), and any disease or injury in service, including alleged Agent Orange exposure. 5. The scar on the veteran's left jaw is not disfiguring, tender, ulcerated, depressed, inflamed, or adherent. 6. The veteran's PTSD is manifested by disturbances of mood such as anxiety, nightmares, and sleep disturbance, resulting in no more than mild social and occupational impairment. CONCLUSIONS OF LAW 1. The claims for service connection for hypertension, headaches, and a skin condition, claimed as secondary to Agent Orange exposure, are not well grounded, and there is no statutory duty to assist the veteran in developing facts pertinent to these claims. 38 U.S.C.A. § 5107 (West 1991). 2. The claims for higher ratings for a two-centimeter scar, residual of left jaw injury, and PTSD are well grounded, and VA has satisfied its duty to assist the veteran in the development of these claims. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103 (1999). 3. The criteria for a compensable disability rating for the two-centimeter scar, residual of left jaw injury, are not met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, and 4.118, Diagnostic Code 7800 (1999). 4. The criteria for a disability rating higher than 10 percent for PTSD are not met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.125, 4.126, and 4.130, Diagnostic Code 9411 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board has reviewed all the evidence of record, which consists of the veteran's service medical records dating from 1965 to 1997 from both active and inactive service, reports of VA examinations conducted in 1997, a letter from Charles Cloutier, M.D., dated in 1997, and the veteran's contentions. The evidence pertinent to each issue is discussed below. A. Service connection claims Service connection means that the facts, shown by the evidence, establish that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated during service. 38 U.S.C.A. §§ 1110 and 1131 (West 1991); 38 C.F.R. § 3.303(a) (1999). It is the responsibility of a person seeking entitlement to service connection to present a well-grounded claim. 38 U.S.C.A. § 5107 (West 1991). Generally, a well-grounded claim is a "plausible claim, one which is meritorious on its own or capable of substantiation." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). In order to be well grounded, a claim for service connection must be accompanied by supporting evidence that the particular disease, injury, or disability was incurred in or aggravated by active service; mere allegations are insufficient. Tirpak v. Derwinski, 2 Vet. App. 609, 610-611 (1992); Murphy, 1 Vet. App. at 81. A claim for service connection requires three elements to be well grounded. It requires competent (medical) evidence of a current disability; competent (lay or medical) evidence of incurrence or aggravation of disease or injury in service; and competent (medical) evidence of a nexus between the in- service injury or disease and the current disability. Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997), cert. denied, sub nom. Epps v. West, 118 S.Ct. 2348 (1998); Caluza v. Brown, 7 Vet. App. 498, 506 (1995); aff'd 78 F.3d 604 (Fed.Cir. 1996) (table). Generally, the Board should consider only the evidence that is or may be favorable to the claim in deciding whether it is well grounded. See Arms v. West, 12 Vet. App. 188, 195 (1999) (noting that generally "only the evidence in support of the claim is to be considered and generally a presumption of credibility attaches to that evidence in order to decide whether or not any VA claimant has sustained the claimant's burden of submitting a well-grounded claim under section 5107(a)") (emphasis in original). The second and third Caluza elements can also be satisfied under 38 C.F.R. § 3.303(b) by (a) evidence that a condition was "noted" during service or during an applicable presumption period; (b) evidence showing post-service continuity of symptomatology; and (c) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Brewer v. West, 11 Vet. App. 228, 231 (1998); see also Savage v. Gober, 10 Vet. App. 488, 495-97 (1997). Alternatively, service connection may be established under 38 C.F.R. § 3.303(b) by evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease. Brewer, 11 Vet. App. at 231. 1. Hypertension Service connection may also be established for a current disability on the basis of a "presumption" under the law that certain chronic diseases manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C.A. §§ 1110, 1112, 1131 and 1137 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.303, 3.304, 3.307 and 3.309(a) (1999). Service connection for hypertension may be established based on a legal "presumption" by showing that it manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C.A. § 1112 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.307 and 3.309 (1999). The veteran is not entitled to presumptive service connection for hypertension. The medical evidence does not show that this condition was manifested within the first year after his separation from active service. The veteran does not contend that a diagnosis of hypertension was rendered within the first post-service year, and his service medical records indicate that this was first diagnosed in 1988, which was 20 years after his separation from active service. The veteran had inactive military service from approximately 1969 until 1998. The term "service-connected" means that a disability was incurred or aggravated in the line of duty during active military, naval, or air service. 38 U.S.C.A. § 101(16) (West 1991); 38 C.F.R. § 3.1(k) (1999). Active military, naval, or air service includes (1) active duty; (2) any period of active duty for training during which the appellant was disabled or died from a disease or injury incurred or aggravated in the line of duty; and (3) any period of inactive duty training during which the appellant was disabled or died from an injury incurred or aggravated in the line of duty. 38 U.S.C.A. § 101(24) (West 1991); 38 C.F.R. § 3.6(a) (1999). Therefore, an individual can be service-connected for an injury incurred during inactive service, but not for a disease. See VAOPGCPREC 86-90 (July 18, 1990); Brooks v. Brown, 5 Vet. App. 484, 485-486 (1993). The fact that the veteran was diagnosed with hypertension in 1988 while still in the Reserves does not mean that he is entitled to service connection for this condition. The medical evidence shows a current diagnosis of essential hypertension. The veteran's active service medical records do not show complaints of or treatment for elevated blood pressure readings. The veteran does not maintain that he was treated for hypertension during active service or that he had any elevated blood pressure readings during his period of active military service. Therefore, there is no evidence of a disease or injury during service, and the second element of a well-grounded claim for service connection has not been satisfied. Moreover, even if there were sufficient evidence of incurrence of a disease or injury during service, the veteran's claim would still not be well grounded. There is no medical evidence showing a nexus, or link, between the veteran's hypertension and an inservice disease or injury. The medical evidence indicates that the veteran was first diagnosed with hypertension in 1988. Therefore, the earliest possible diagnosis of hypertension was 20 years after his separation from active service. No medical professional has rendered an opinion that the post-service diagnosis of hypertension was related to the veteran's active service in any manner or that it began during service. The veteran has not alleged any continuity of symptomatology concerning elevated blood pressure readings since his active military service. However, any contentions as to continuity of symptomatology, standing alone, are not plausible in light of the absence of continuous symptomatology in the medical evidence of record that dates from 1965 until 1997. See McManaway v. West, 13 Vet. App. 60, 66-67 (1999). Of record are numerous Reports of Medical History completed while the veteran was on inactive service between 1969 and 1997. On each and every report prior to 1990, he denied having high blood pressure, and each examination report prior to that date reflected normal blood pressure readings. Moreover, there is no competent medical opinion of record associating hypertension diagnosed in 1988 with any prior symptoms the veteran may have experienced. Cf. Savage, 10 Vet. App. at 497. Therefore, this claim is not well grounded. 2. Headaches The medical evidence shows a current diagnosis of intermittent headaches, type uncertain. The veteran's active service medical records do not show complaints of or treatment for headaches. On the Report of Medical History completed in conjunction with his separation examination in 1968, he denied experiencing frequent or severe headaches. However, on his claim for compensation, the veteran alleged that his headaches began in 1968 or 1969. He has not, at any time, specifically stated that he experienced any headaches during service. In fact, he indicated at the 1997 VA examination that his headaches began in approximately 1987. Even if there were sufficient evidence of incurrence of a disease or injury during service, the veteran's claim would still not be well grounded. There is no medical evidence showing a nexus, or link, between the veteran's headaches and an inservice disease or injury. The medical evidence indicates that the veteran was first diagnosed with headaches in 1997, 29 years after his separation from active service. No medical professional has rendered an opinion that the post-service diagnosis of headaches was related to the veteran's active service in any manner or that these headaches began during service. It appears that the veteran was still in the Reserves when headaches were diagnosed in 1997. However, as indicated above, he is not entitled to service connection for this condition because an individual can be service-connected for an injury incurred during inactive service, but not for a disease. See VAOPGCPREC 86- 90 (July 18, 1990); Brooks v. Brown, 5 Vet. App. 484, 485-486 (1993). In the notice of disagreement prepared by the veteran's representative, it was argued that the veteran's headaches were due to the "wound" he had received during service, and it was necessary that an examination be conducted to "verify this fact." First, as indicated above, no medical professional has related the veteran's headaches to a disease or injury incurred during service, including the unspecified "wound." Second, as discussed in more detail below, it is the veteran's responsibility to submit a well-grounded claim, and VA has no duty to solicit opinions as to the etiology of his headaches unless he does so. The veteran has not alleged any continuity of symptomatology concerning his headaches since his active military service. He stated that his headaches began 19 years after his active service. However, any contentions as to continuity of symptomatology, standing alone, are not plausible in light of the absence of continuous symptomatology in the medical evidence of record that dates from 1965 until 1997. See McManaway v. West, 13 Vet. App. 60, 66-67 (1999). Of record are numerous Reports of Medical History completed while the veteran was on inactive service between 1969 and 1997. On each and every report, he denied ever experiencing frequent or severe headaches. Moreover, there is no competent medical opinion of record associating headaches diagnosed in 1997 with any prior symptoms the veteran may have experienced. Cf. Savage, 10 Vet. App. at 497. Therefore, this claim is not well grounded. 3. Skin condition As indicated above, service connection may be established for a current disability on the basis of a "presumption" under the law that certain chronic diseases manifesting themselves to a certain degree within a certain time after service must have had their onset in service. The laws and regulations pertaining to Agent Orange exposure provide for a presumption of service connection due to exposure to herbicide agents for veterans who have one of several diseases and served on active duty in Vietnam during the Vietnam Era. 38 U.S.C.A. § 1116 (West 1991 & Supp. 1999); 38 C.F.R. § 3.307(a)(6) (1999). A disease associated with exposure to certain herbicide agents listed in 38 C.F.R. § 3.309(e) will be considered to have been incurred in service under the circumstances outlined in that section, even though there is no evidence of such disease during the period of service. No other condition other than one listed in 38 C.F.R. § 3.309(e) will be considered chronic. 38 C.F.R. § 3.307(a) (1999). A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era, and has a disease listed at 38 C.F.R. § 3.309(e), shall be presumed to have been exposed during such service to an herbicide agent containing dioxin, such as Agent Orange, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iii) (1999). The Secretary of Veterans Affairs has formally stated that a presumption of service connection based on exposure to herbicides used in Vietnam was not warranted for "any other condition for which the Secretary has not specifically determined a presumption of service connection is warranted." See 59 Fed. Reg. 341 (January 4, 1994). Nonetheless, the United States Court of Appeals for the Federal Circuit has determined that the Veterans' Dioxin and Radiation Exposure Compensation Standards Act does not preclude a veteran from establishing direct service connection with proof of actual direct causation (proof that exposure during service caused the disease that appeared years later). See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The veteran feels that his current skin condition may be due to exposure to Agent Orange. Dr. Cloutier stated that the veteran had a "past history of dermatitis to his lower extremities when he was in the field and of course, we are worried about Agent Orange, etc." VA examination in 1997 showed one depigmented, macular, circular area above the veteran's left ankle and a slightly scaly area on his left hand. No diagnosis of a skin disorder was rendered. Despite the veteran's complaints, there must be a current, ascertainable medical disorder in order to warrant service connection. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. §§ 1110 and 1131 (West 1991); see Degmetich v. Brown, 104 F.3d 1328 (1997); (holding that Secretary's and Court's interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary and therefore the decision based on that interpretation must be affirmed); see also Caluza, 7 Vet. App. at 505; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (absent "proof of a present disability there can be no valid claim"). The medical evidence does not show a current diagnosis of a chronic skin disorder. Despite the findings upon VA examination in 1997, no diagnosis was rendered at that time. Dr. Cloutier merely related a past history of dermatitis, which is clearly not evidence of a current disability. The veteran did serve in the Republic of Vietnam. However, there is no competent medical evidence showing that he has any of the disorders specifically listed at 38 C.F.R. § 3.309(e). The only skin disorder entitled to the presumption of service incurrence due to Agent Orange exposure is chloracne or other acneform disease consistent with chloracne. The evidence does not show such a skin disorder; therefore, the veteran is not entitled to a presumption for the claimed disorder/symptoms as being etiologically related to exposure to herbicide agents used in Vietnam. See 38 C.F.R. § 3.307(a)(6)(iii) (1999); see also McCartt v. West, 12 Vet. App. 164, 168 (1999) (both service in the Republic of Vietnam and diagnosis of one of the listed diseases pursuant to 38 C.F.R. § 3.309(e) are required to establish entitlement to the presumption of exposure to herbicide agent in service). Even if the Board accepts the findings shown upon VA examination as sufficient evidence of a current disability, this claim would still not be well grounded because there is no medical evidence showing a nexus, or link, between the claimed skin condition and an inservice disease or injury. The veteran's service medical records are not entirely legible, but an entry in August 1966 appears to show a diagnosis of tinea pedis. This was clearly an acute and transitory condition because the veteran denied experiencing any skin diseases on the Report of Medical History completed in 1969 in connection with his enlistment into the Reserves. It was also noted in December 1971 that he had a rash in the groin area and on an examination report in 1972 that he had patches of hyperpigmented areas with irregular borders on the neck and shoulders that were probably tinea versicolor. Again, the veteran did not have a chronic skin disorder at that time. These were clearly acute and transitory conditions because (a) the veteran denied experiencing any skin diseases on every Report of Medical History completed between 1975 and 1995, and (b) all physical examinations after 1972 failed to show any evidence of a skin disorder. No medical professional has rendered an opinion that the claimed skin condition is related to the veteran's active service in any manner, including Agent Orange exposure, or that it began during service. The fact that the veteran may have had problems with his skin while a member of the Reserves does not mean that he is entitled to service connection for this condition. See VAOPGCPREC 86-90 (July 18, 1990); Brooks v. Brown, 5 Vet. App. 484, 485-486 (1993). Dr. Cloutier merely stated that he was "worried" about Agent Orange. Dr. Cloutier did not conclude that the veteran's skin disorder was related to prior Agent Orange exposure. This distinction is crucial. Dr. Cloutier's statement amounted to no opinion at all. When a medical professional is unable to provide a definite causal connection, the opinion on that issue constitutes "what may be characterized as 'non-evidence.'" Perman v. Brown, 5 Vet. App. 237, 241 (1993). In the notice of disagreement submitted by the veteran's representative, it was indicated that VA had to "prove" his skin condition was not caused by exposure to Agent Orange. That argument must fail, as it misstates the burden at this point in adjudication of a claim for service connection. It is the veteran's responsibility in the first instance to submit enough evidence to at least render his claim plausible. That has not been done in this instance. The veteran has alleged that he has continuously had skin rashes since his active military service. He is competent to report experiencing symptoms such as a skin rash, especially since such symptoms are readily observable. However, his contentions as to continuity of symptomatology, standing alone, are not plausible in light of the absence of continuous symptomatology in the medical evidence of record that dates from 1965 until 1997. See McManaway v. West, 13 Vet. App. 60, 66-67 (1999). Of record are numerous Reports of Medical History completed while the veteran was on inactive service between 1969 and 1997. On each and every report, he denied ever having any skin diseases. Moreover, there is no competent medical opinion of record to the effect that he currently has any diagnosed disorder(s) to account for his complaints or indicating that they result from exposure to Agent Orange. Cf. Savage, 10 Vet. App. at 497. Therefore, this claim is not well grounded. 4. Conclusion regarding service connection claims The only evidence linking the claimed conditions to the veteran's active military service consists of his current statements. Even accepting his statements as true, he cannot meet his initial burden under 38 U.S.C.A. § 5107(a) by simply presenting his own opinion. He does not have the medical expertise to render a probative opinion as to medical diagnosis or causation. See Edenfield v. Brown, 8 Vet. App. 384, 388 (1995); Robinette v. Brown, 8 Vet. App. 69, 74 (1995); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Until the veteran establishes a well-grounded claim, VA has no duty to assist him in developing facts pertinent to the claim, including providing him additional medical examinations at VA expense. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.326(a) (1999) (VA examination will be authorized where there is a well-grounded claim for compensation); see Morton v. West, 12 Vet. App. 477 (1999) (VA cannot assist a claimant in developing a claim that is not well grounded). When a claimant refers to a specific source of evidence that could make his claim plausible, VA has a duty to inform him of the necessity to submit that evidence to complete his application for benefits. See Epps v. Brown, 9 Vet. App. 341, 344-45 (1996), aff'd Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). In the February 2000 written brief to the Board, the veteran's representative argued that these claims had to be remanded to the RO in order to tell the veteran what he needed to submit to well ground these claims. However, VA has no outstanding duty in this case to inform the veteran of the necessity to submit certain evidence to complete his application for VA benefits, see 38 U.S.C.A. § 5103(a) (West 1991), because there is no indication of any medical records that might well ground any of these claims. The veteran has not alleged that any medical records exist that might contain medical opinions associating the claimed hypertension, headaches, and/or skin condition with his period of active service. The presentation of a well-grounded claim is a threshold issue. Therefore, since the veteran has failed to present competent medical evidence that his claims for service connection for hypertension, headaches, and a skin condition are plausible, the claims must be denied as not well grounded. Dean v. Brown, 8 Vet. App. 449 (1995); Boeck v. Brown, 6 Vet. App. 14, 17 (1993). There is no duty to assist further in the development of these claims, because such additional development would be futile. See Murphy, 1 Vet. App. 78. The Board notes that the veteran's representative requested in the February 2000 written brief that these claims be remanded so that the RO could consider entitlement to service connection under 38 C.F.R. § 1154(b). The provisions of 38 U.S.C. 1154(b) (West 1991) specifically allow combat veterans, in certain circumstances, to use lay evidence to establish service connection of a disease or injury. See, e.g., Jensen v. Brown, 19 F.3d 1413, 1416-17 (Fed. Cir. 1994); Chipego v. Brown, 4 Vet. App. 102, 105 (1993); Sheets v. Derwinski, 2 Vet. App. 512, 515 (1992); Smith (Morgan) v. Derwinski, 2 Vet. App. 137, 140 (1992). It is true that the veteran is a combat veteran. However, he has not, at any time, claimed that he has hypertension, headaches, and/or a skin condition as a result of injury sustained during combat. Furthermore, even in a claim for service connection based on incurrence during combat, there still must be medical evidence tending to show that a nexus, or link, between an inservice disease or injury and the claimed conditions is plausible. See Wade v. Brown, 11 Vet. App. 302, 304-5 (1998); Arms v. West, 12 Vet. App. 188 (1999); Kessel v. West, 13 Vet. App. 9 (1999). As discussed above, there is no such evidence in this case. No medical professional has indicated that there is a plausible relationship between the veteran's current hypertension and headaches, or the claimed skin disorder(s), and his active military service. It would be pointless to remand these claims for adjudication of an issue that the veteran has not claimed. Moreover, it is clear from the evidence that the claims are not well grounded even when considered under the provisions of 38 C.F.R. § 1154(b), so there is no way, as a matter of law, that the veteran could prevail. In such a situation, a remand for the RO to determine that the claims are not well grounded would simply serve to impose an unnecessary burden with no gain to the veteran. Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements in the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided); cf. Brady v. Brown, 4 Vet. App. 203, 207 (1993) (a remand is unnecessary even where there is error on the part of VA, where such error was not ultimately prejudicial to the veteran's claim). In this case, the lack of medical nexus evidence is clear, and it is not necessary to remand these claims merely so the RO can consider entitlement under the provisions of 38 C.F.R. § 1154(b). B. Claims for higher ratings The first responsibility of a claimant is to present a well- grounded claim. 38 U.S.C.A. § 5107(a) (West 1991). The veteran perfected his appeal as to the initial grants of service connection and original assignments of disability ratings for the scar on his left jaw and PTSD. Therefore, his claims continue to be well grounded as long as the rating schedule provides a higher rating for the service-connected condition. Shipwash v. Brown, 8 Vet. App. 218, 224 (1995). VA has a duty to assist the veteran in the development of facts pertinent to his claims. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103 (1999). The duty to assist includes, when appropriate, the duty to conduct a thorough and contemporaneous examination of the veteran. Green v. Derwinski, 1 Vet. App. 121 (1991). In addition, where the evidence of record does not reflect the current state of the veteran's disability, a VA examination must be conducted. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a well-grounded claim for an increase, but the medical evidence is not adequate for rating purposes, an examination will be authorized. 38 C.F.R. § 3.326(a) (1999). Reexamination will be requested whenever VA determines that there is a need to verify either the continued existence or the current severity of a disability. 38 C.F.R. § 3.327(a) (1999). Generally, reexaminations are required if it is likely that a disability has improved, if the evidence indicates that there has been a material change in a disability, or if the current rating may be incorrect. Id. In this case, the RO provided the veteran appropriate VA examinations. There is no evidence indicating that there has been a material change in the severity of either the veteran's left jaw scar or his PTSD since he was examined in 1997, and sufficient evidence is of record to rate the service-connected disabilities properly. There is no indication of private or VA treatment records that the RO failed to obtain, especially since the veteran has never alleged receiving psychiatric treatment or any treatment for the scar. Accordingly, no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). Murphy v. Derwinski, 1 Vet. App. 78 (1990); Littke v. Derwinski, 1 Vet. App. 90 (1990). The veteran has disagreed with the original disability ratings assigned for the left jaw scar and PTSD. There is a distinction between a claim based on disagreement with the original rating awarded and a claim for an increased rating. Fenderson v. West, 12 Vet. App. 119 (1999). The distinction may be important in determining the evidence that can be used to decide whether the original rating on appeal was erroneous and in determining whether the veteran has been provided an appropriate Statement of the Case (SOC). Id. at 126 and 132. With an initial rating, the RO can assign separate disability ratings for separate periods of time based on the facts found. Id. at 126. With an increased rating claim, "the present level of disability is of primary importance." Francisco v. Brown, 7 Vet. App. 55, 58 (1994). This distinction between disagreement with the original rating awarded and a claim for an increased rating is important in terms of VA adjudicative actions. Fenderson, 12 Vet. App. at 132. The SOC provided to the veteran identified the issues on appeal as increased evaluations for the service-connected left jaw scar and PTSD. However, the June 1997 rating decision that granted service connection for these conditions considered all the evidence of record in assigning the original disability ratings. The RO did not limit its consideration to only the recent medical evidence of record, and did not therefore violate the principle of Fenderson. The veteran has been provided appropriate notice of the pertinent laws and regulations and has had his claims of disagreement with the original ratings properly considered based on all the evidence of record. The RO complied with the substantive tenets of Fenderson in its adjudication of the veteran's claims, and it is unnecessary to remand these claims as his representative has requested. Disability ratings are intended to compensate reductions in earning capacity as a result of the specific disorder. The ratings are intended, as far as practicably can be determined, to compensate the average impairment of earning capacity resulting from such disorder in civilian occupations. 38 U.S.C.A. § 1155 (West 1991). Evaluation of a service-connected disorder requires a review of the veteran's entire medical history regarding that disorder. 38 C.F.R. §§ 4.1 and 4.2 (1999). Because this appeal is from the initial rating assigned to a disability upon awarding service connection, the entire body of evidence is for equal consideration. Consistent with the facts found, the rating may be higher or lower for segments of the time under review on appeal, i.e., the rating may be "staged." Fenderson v. West, 12 Vet. App. 119 (1999); cf. Francisco v. Brown, 7 Vet. App. 55, 58 (1994) (where an increased rating is at issue, the present level of the disability is the primary concern). Such staged ratings are not subject to the provisions of 38 C.F.R. § 3.105(e), which generally requires notice and a delay in implementation when there is proposed a reduction in evaluation that would result in reduction of compensation benefits being paid. Fenderson, 12 Vet. App. at 126. The Board will consider all evidence in determining the appropriate evaluation for the veteran's service-connected disabilities. It is also necessary to evaluate the disability from the point of view of the veteran working or seeking work, 38 C.F.R. § 4.2 (1999), and to resolve any reasonable doubt regarding the extent of the disability in the veteran's favor. 38 C.F.R. § 4.3 (1999). If there is a question as to which evaluation to apply to the veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1999). 1. Left jaw scar During service, the veteran incurred an open wound to the left cheek from grenade fragments. There was no artery or nerve involvement. The veteran is currently evaluated under Diagnostic Code 7800 as zero percent disabled (noncompensable) for the scar on his left jaw resulting from the inservice injury. Under Diagnostic Codes 7800 through 7805, scars are rated according to the location, type, and characteristics or, if none of the specific criteria apply, according to limitation of function of the affected part. Diagnostic Code 7800 provides compensation for the disfigurement resulting from scars on the head, face, or neck. The current zero percent rating requires a slight scar on the head, face, or neck. In order to warrant a 10 percent rating, the scar(s) on these locations would need to be moderate and disfiguring. A 30 percent disability rating requires scars that are severe, especially if producing a marked and unsightly deformity of the eyelids, lips, or auricles. A 50 percent disability rating requires complete or exceptionally repugnant deformity of one side of the face or marked or repugnant bilateral disfigurement. The service-connected scar on the veteran's left jaw is two centimeters, and the VA examiner indicated that it is not disfiguring. There is no medical evidence showing that the scar is in any way abnormal (i.e., tender, ulcerated, depressed, inflamed, or adherent). The veteran's only complaint is that the scar itches at times and that it is visible. Such complaints are of a slight nature. The scar is clearly barely visible, since (a) only one report of medical examination (1989) over the more than 20 years that the veteran was on inactive military service even mentioned the presence of a scar, and (b) it is only two centimeters. The Board has considered all other potentially applicable diagnostic codes. Diagnostic Codes 7801 and 7802 pertain to scars that result from burns; the veteran's scar resulted from an injury. Diagnostic Code 7803 provides a 10 percent disability rating for superficial scars that are poorly nourished with repeated ulceration. There is no medical evidence showing ulceration of the veteran's scar. Diagnostic Code 7804 provides a 10 percent disability rating for superficial scars that are tender and painful on objective demonstration. The veteran has denied experiencing any pain associated with the scar on his left jaw, and there is no objective evidence that would indicate such. Diagnostic Code 7805 provides for evaluation on the basis of limitation of function of the affected part. However, there is no medical evidence showing that the veteran has any limitation of function of the jaw as a result of the scar. The evidence simply does not show that the criteria for a compensable disability rating have been met. Despite the veteran's contentions, the objective medical evidence does not show any findings that would warrant a compensable disability rating. The Board has considered the requirement of 38 C.F.R. § 4.3 to resolve any reasonable doubt regarding the level of the veteran's disability in his favor. However, the objective medical evidence does not create a reasonable doubt regarding the level of his disability from the scar on his left jaw. The medical evidence does not show that he has any limitation of function. There is no objective evidence that the scar is tender, painful, or in any way abnormal. The veteran's complaints alone (i.e., occasional itching and visibility) are not enough to warrant a compensable disability rating according to the schedule. Despite his complaints, there is absolutely no evidence of impairment in earning capacity because of the scar. Accordingly, the Board finds that the preponderance of the evidence is against assignment of a compensable disability rating for the veteran's service-connected left jaw scar. The Board has considered all potentially applicable diagnostic codes as discussed above. 2. PTSD The veteran's service-connected PTSD is evaluated under Diagnostic Code 9411. The current 10 percent disability rating required: Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. A 30 percent disability rating is warranted for: Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, or recent events). The criteria for a 50 percent disability rating are: Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. The criteria for a 70 percent rating are: Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near- continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting; inability to establish and maintain effective relationships. And, the criteria for a 100 percent rating are: Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130 (1999). The medical evidence shows assignment of a GAF score of 80 upon VA examination in 1997. A GAF score of 71-80 contemplates that if symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). See DSM-IV (American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994)) at 44- 47. A GAF score is highly probative as it relates directly to the veteran's level of impairment of social and industrial adaptability, as contemplated by the rating criteria for mental disorders. See Massey v. Brown, 7 Vet. App. 204, 207 (1994). The veteran has not exhibited occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. In fact, he continues to work as a warden, and he has worked continuously in that position for more than 23 years. Therefore, he has a steady and consistent work history. He has not complained that psychiatric symptomatology has interfered with his occupational functioning in any manner, and he has referenced no period of inability to perform his occupational tasks. He has also not complained that psychiatric symptomatology has interfered with his social functioning in any manner. He has been married to his wife for more than 26 years. The veteran does complain of symptoms such as sleep disturbances, nightmares, and nervousness, especially around crowds of people. However, there is no evidence showing that he has experienced depression, suspiciousness, or panic attacks. There is no objective evidence of memory loss or any cognitive impairment. Although he may, according to his statements, experience chronic sleep impairment, the overall disability picture does not more nearly approximate the 30 percent criteria such as to warrant an increased rating. 38 C.F.R. § 4.7 (1999). As the veteran does not meet the criteria for a 30 percent evaluation, he certainly does not meet the criteria for a higher 50, 70, or 100 percent evaluation. The veteran's GAF score reflects minimal symptoms, and the VA examiner indicated that the PTSD is mild in severity. The veteran has denied more serious psychiatric symptoms such as delusions or hallucinations or suicidal or homicidal ideations. He is alert and oriented, and his speech is relevant and coherent. He has never contended an inability to function independently. He has never complained of impaired impulse control. He has never exhibited impaired judgment, thinking, or memory. He has never received outpatient or inpatient psychiatric treatment, and he does not take any psychiatric medications. The evidence does not show that the criteria for a disability rating higher than 10 percent have been met. The Board has considered the requirement of 38 C.F.R. § 4.3 to resolve any reasonable doubt regarding the level of the veteran's disability in his favor. However, the objective medical evidence does not create a reasonable doubt regarding the level of his disability. As indicated above, he experiences minimal psychiatric symptomatology (i.e., intermittent anxiety, nightmares, etc.`). Therefore, the preponderance of the evidence is against assignment of a disability rating higher than 10 percent for PTSD. ORDER Entitlement to service connection for hypertension, headaches, and a skin condition, claimed as secondary to Agent Orange exposure, is denied. Entitlement to a compensable disability rating for two- centimeter scar, residual of left jaw injury, is denied. Entitlement to an initial disability rating higher than 10 percent for post-traumatic stress disorder (PTSD), is denied. BETTINA S. CALLAWAY Member, Board of Veterans' Appeals