Citation Nr: 0000594 Decision Date: 01/07/00 Archive Date: 01/11/00 DOCKET NO. 94-00 300 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Washington, DC THE ISSUES 1. Entitlement to an increased rating for scars, residuals of shell fragment wounds of the right thigh with retained foreign bodies and painful dysesthesias, currently evaluated as 10 percent disabling. 2. Entitlement to an increased rating for scars, residuals of shell fragment wounds of the left thigh with retained foreign bodies and painful dysesthesias, currently evaluated as 10 percent disabling. 3. Entitlement to an increased rating for scars, residuals of shell fragment wounds of the left lower leg with retained foreign bodies and painful dysesthesias, currently evaluated as 10 percent disabling. 4. Entitlement to an increased rating for scars, residuals of shell fragment wounds of the right lower leg with retained foreign bodies and painful dysesthesias, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Jewish War Veterans of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD D. J. Drucker, Counsel INTRODUCTION The veteran had active military service from March 1968 to December 1970. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Washington, DC. In September 1995, the veteran was afforded a hearing before the undersigned Board member and, in March 1996, the Board remanded his claims for further evidentiary development. At his September 1995 Board hearing, the veteran raised issues of compensable ratings for face, chest and back wounds that were denied by the RO in a February 1999 determination. A notice of agreement and substantive appeal are not of record as to these matters. Further, regarding the veteran's claim of entitlement to the restoration of a compensable rating for post-traumatic stress disorder, the Board notes that in April 1997, the RO increased the veteran's disability evaluation to 100 percent, effective from December 1989. This represents a full grant of the benefits sought on appeal as to this matter and renders moot his informal claim for a total rating based upon unemployability due to service-connected disabilities, made at the September 1995 hearing. As such, the Board will confine its determination to the issues as set forth on the decision title page. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the claims on an appeal has been obtained by the RO. 2. Residual scars of shell fragment wounds of the right thigh with retained foreign bodies and painful dysesthesias are no more than mildly disabling and are shown to be well healed with painful dysesthesias over the scar areas, no limitation of motion and subjective complaints of pain. 3. Residual scars of shell fragment wounds of the left thigh with retained foreign bodies and painful dysesthesias are no more than mildly disabling and shown to be well healed with painful dysesthesias over the scar areas, no limitation of motion and subjective complaints of pain. 4. Residual scars of shell fragment wounds of the left lower leg with retained foreign bodies and painful dysesthesias are no more than mildly disabling and shown to be well healed with painful dysesthesias over the scar areas, no limitation of motion and subjective complaints of pain. 5. Residual scars of shell fragment wounds and scarring of the right lower leg with retained foreign bodies and painful dysesthesias are no more than mildly disabling and shown to be well healed with painful dysesthesias over the scar areas, no limitation of motion and subjective complaints of pain. CONCLUSIONS OF LAW 1. The schedular criteria for disability evaluations in excess of 10 percent for right and left thigh scars, residuals of shell fragment wounds with retained foreign bodies and painful dysesthesias have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1999); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.41, 4.45, 4.59, 4.118, 4.124, 4.124a, Diagnostic Code 7804-8726 (1999). 2. The schedular criteria for disability evaluations in excess of 10 percent for right and left lower leg scars, residuals of shell fragment wounds with retained foreign bodies and painful dysesthesias have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.41, 4.45, 4.59, 4.118, 4.124, 4.124a, Diagnostic Code 7804-8720. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran's claims for increased evaluations for right and left thigh and lower leg scars, residuals of shell fragment wounds with retained foreign bodies and painful dysesthesias, are plausible and capable of substantiation and, thus, well grounded within the meaning of 38 U.S.C.A. § 5107(a); see Proscelle v. Derwinski, 2 Vet. App. 629 (1992) (a claim of entitlement to an increased evaluation of a service-connected disability generally is a well-grounded claim). When a veteran submits a well-grounded claim, VA must assist him in developing facts pertinent to that claim. 38 U.S.C.A. § 5107(a). The Board is satisfied that all relevant evidence has been obtained regarding the veteran's claims and, to that end, remanded his case in March 1996 for further VA examination. The VA examination reports are associated with the claims folder and no further assistance to the veteran with respect to these claims is required to comply with 38 U.S.C.A. § 5107(a). In accordance with 38 C.F.R. §§ 4.1, 4.2, 4.41 and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed the evidence of record pertaining to the history of his service-connected left and right leg and thigh shell fragment wound scars and has found nothing in the historical record that would lead to a conclusion that the current evidence of record is inadequate for rating purposes. In addition, it is the judgment of the Board that this case presents no evidentiary considerations that would warrant an exposition of the remote clinical histories and findings pertaining to the disability at issue. When entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). I. Factual Background According to an April 1983 RO memorandum, the veteran has a reconstructed file and it is, therefore, exclusive of any service medical records. Existing documents include a November 1971 rating action in which the RO confirmed and continued 10 percent evaluations for the veteran's service- connected scars of shell fragment wounds of both thighs and lower legs, described as static. The RO reduced those evaluations to non-compensable in a September 1982 rating action. In its determination, the RO noted that a recent VA examination report showed the veteran had three small scars on his right thigh on the anterosuperior aspect with a 2-centimeter (cm.) scar on the anterolateral aspect. A 1-cm. scar was observed on the medial surface of the knee. The scars were all described as small, nonadherent and easily pliable. On the right lower leg, there was a 4-cm. scar and a 1-cm. scar on the medial surface of the right lower leg. There were no traumatic scars on the left thigh. Additionally, there was an area of dermasite where a split thickness graft was taken and the tissue was a little granular looking on the surface. On the left lower leg, there was a 5-cm. scar on the anterolateral aspect. The RO's decision also noted that x-rays showed some metallic fragments in the soft tissues in the thighs and legs with no bone involvement and a minimal amount of metal. A March 1983 VA radiographic report indicates that x-rays of the veteran's thighs showed no evidence of any soft tissue abnormality. Both lower extremities had evidence of metallic fragment in the mid portion of the right leg and the upper portion of the left leg with bone structures normally outlined. The RO received the veteran's claim for increased ratings in January 1991. When examined by VA in April 1991, the veteran, who was 41 years old, complained of leg scars and shrapnel in his body that set off metal detectors in government buildings. The examiner noted that the veteran sustained injuries from enemy fire in Vietnam in mid 1970. On examination, the veteran was observed to have well-healed scars in scattered areas on his legs, scalp and face. The veteran said there were too many small healed wounds to count and residual shrapnel in his body set off metal detectors. A diagram of the front of an anatomical figure indicates that the veteran had scars of healed wounds on his right thigh, lower leg and instep and his left lower leg and instep. The doctor said the scars were 1 millimeter (mm.) to 2.0 cm in diameter with most less than 5 mm. Diagnoses included healed scars on head and legs from gunshot wounds and fragmentation wounds. At his September 1995 Board hearing, the veteran testified to sustaining shell fragment wounds that caused scars to his lower lip, cheek and eyebrow. He described the eyebrow scar as painful and said his cheek scar occasionally got infected and required that he used hydrogen peroxide. He had retained foreign bodies in chest wounds near the left breast and bad scars on his upper thighs. The veteran had retained foreign bodies in his left lower leg that were painful and said his left foot turned in due to fragmentation and he was unable to walk more than three blocks without pain when he wore regular shoes. He described his pain as vibrating and noticeable. Further, the veteran reported right heel injury but said it did not cause trouble. Both ankles swelled and he had right arch pain. He did not have foot pain when he wore canvas shoes. The veteran noted that his left shoe wore differently than his right one but he rarely scraped his left foot along the ground. The veteran denied having calf or thigh muscle problems and said he had some left calf weakness and that his left calf was smaller than his right calf. If he sat incorrectly, his left leg went to sleep at about mid thigh. It was further noted that the veteran appeared to have less muscle mass in his left lower leg as compared to his right leg. The veteran, who was 46 years old and unemployed, underwent VA dermatologic and foot examinations in July 1996 and gave a history of a gunshot wound to the right thigh and multiple fragment wounds to both lower extremities while on active duty in the Republic of Vietnam. He said most of his pain was about his right heel and left foot. On examination, the veteran was observed to have a right antalgic gait. Range of motion of the hips, knees, ankles and subtalar joints was good. The veteran experienced pain about the right heel and subtalar movement and pains about the posterior right calf and ankle with forced dorsiflexion of the right foot. There was some local tenderness and decreased sensation about the right heel. The decreased sensation was about the medial aspect of the right heel and involved the right great toe. The veteran had a tender plantar callus on the fifth metatarsal head on the right. The clinical impression was multiple fragment wounds to both lower limbs, by history, as well as a gunshot wound to the right thigh with painful plantar callus and possible superficial nerve involvement about the right heel, secondary to multiple fragment wounds to the area. In May 1997, the veteran underwent VA dermatologic examination and told the examiner he developed acne vulgaris and jungle rot that affected his face, arms, shoulders, legs, abdomen, buttocks, thighs, calves, feet and hands and was not medically treated until he was evacuated to Japan. The veteran also reported being wounded with shrapnel in 1969 and 1970. Post service, he did not receive medical treatment. The veteran complained that, currently, his skin felt sweaty and his lesions hurt and gave him a low self-esteem. He described allergies to potatoes, tomatoes, bell peepers and modified food starch that caused headache, sweats and his hands to become edematous with pitting edema of his legs. His medical history included a 1967 knife wound during a riot in Los Angeles and, in February 1997, he underwent left shoulder surgery for torn ligaments. Findings on examination revealed that, on the skin on the veteran's back, there was a skin graft scar by rubbing the skin against the pavement, not during active service. There was also a large scar on his abdomen that was a Y-shape due to the knife wound he sustained during the riot in Los Angeles. On the veteran's right leg, there was a 4-cm long approximately 0.5-cm wide scar and, on his right thigh, there was a 1-cm x 0.7 hypopigmented atrophic scar from shrapnel wounds. Also on his thigh was a scar approximately 0.5 cm wide that was hypopigmented. On the right inner aspect of the right heel was an approximately 1.5 cm long atrophic scar from a shrapnel injury, according to the veteran. On the inner aspect of his left foot, there was an approximately 7 mm long x 1-mm wide scar and, on the left leg, there was a 1 x 1 cm. hypopigmented scar, from shrapnel. On the anterior aspect of the veteran's left leg were approximately 4 small, about 2 mm wide, oval hypopigmented scars from shrapnel. On the left thigh, there was about an 18 cm long x 4 cm wide barely noticeable, slightly hypopigmented draft donor site. Scars were also observed on the veteran's face. The clinical impression was history of shrapnel wounds in 1969 and 1970 with multiple scars affecting mainly the lower extremities with three small scars also present on the face and history of acne with no active acne lesions present and no evidence of fungus infection. According to a June 1997 VA Addendum, for orthopedic findings, the veteran's July 1996 x-rays were reviewed and the VA examiner noted small metallic fragments in the soft tissues about the anterior left tibia and the lateral right thigh, the medial left thigh and medial left femoral condyle. There were also small metallic fragments of the soft tissues about the posterior aspect of the right tibia and posterior right thigh. No fractures or dislocations were appreciated. The VA examiner concluded that no past orthopedic injuries were evident on current x-ray. The possible superficial nerve involvement about the medial aspect of the right heel previously noted, did not appear likely to be associated with previous injuries, as no metallic fragments were located in that vicinity. There was a small-healed scar in the area. The involvement would also be due to entrapment above that area. No direct causal relationship at the present time was evident. According to a May 1997 VA neurologic examination report, the veteran told the examiner that since being injured, he had general numbness and tingling that involved both legs in the thighs, below the knee and in the feet with pain and tingling centered around the multiple small shrapnel and gunshot wounds. He said that over time, some of the metal came to the surface and out of his skin, but much of it remained. Multiple small, depigmented areas in both eyes and particularly the right leg, below the knee were noted. On examination, deep tendon reflexes were normoactive and symmetrical. There was no weakness or atrophy in the legs. Sensation to cold and to vibratory sense was generally intact. Rubbing the skin over the areas of the scars generated dysesthesias. The clinical impression was intact motor reflex and sensory function with no clear sign of generalized or focal mononeuropathy and painful dysesthesias in the legs secondary to multiple small shrapnel and gunshot wounds. In February 1999, the RO assigned 10 percent disability evaluations to the veteran's right and left lower leg disorders, recharacterized as scars, residuals of shell fragment wounds with retained foreign bodies and painful dysesthesias under Diagnostic Codes 7804-8720. It also assigned 10 percent disability evaluations to his right and left thigh disorders, recharacterized as scars, residuals of shell fragment wounds with retained foreign bodies and painful dysesthesias under Diagnostic Codes 7804-8726. Analysis Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R. Part 4 (1999). The Board attempts to determine the extent to which the veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.10 (1999). Where there is a question as to which of two evaluations shall 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. During the pendency of the appeal, the rating criteria for muscle injuries were revised in July 1997. The RO did not specifically readjudicate the veteran's disabilities based on the revised criteria prior to the transfer of the claims file to the Board. However, as the schedular ratings applicable to his shell fragment wound disabilities did not change as a result of these revisions, the Board finds that no prejudice will result to the veteran by way of appellate review of the claims at this time. See Bernard v. Brown, 4 Vet. App. 384 (1993). The provisions of 38 C.F.R. § 4.56 (1999) define a slight (insignificant) disability of the muscles as a simple wound of the muscle without debridement, infection, or effects of laceration. Id. Findings usually include minimum scar, if any; evidence of fascia defect or of atrophy of or impaired tonus. Id. No significant impairment of function and no retained metallic fragments. Id. A moderate disability of the muscles is defined as a through and through or deep penetrating wound of a relatively short track by single bullet or small shell fragment. Id. Findings usually include relatively small entrance and exit scars, indicating a relatively short tract of the missile. Id. There are often signs of moderate loss of deep fascia or muscle substance or impairment of muscle tonus, with definite weakness or fatigue. A moderately severe disability of the muscles would be the consequence of a through and through or deep penetrating wound by a high velocity missile of small size or a large missile of low velocity. Id. Objective findings of such injury would include impairment of strength and endurance of the muscle group involved, moderate loss of deep fascia, or moderate loss of muscle substance. Id. A severe injury is one which would result from a deep penetrating wound due to a high velocity missile, or large or multiple low velocity missiles, or explosive effects of a high velocity missile, or shattering bone fracture with extensive debridement or prolonged infection and sloughing of soft parts. Id. Residual disability would include extensive, ragged depressed and adherent scars; x-ray findings of multiple scattered foreign bodies; loss of deep fascia or of muscle substance; atrophy; decreased strength and endurance and severe impairment of function of the affected muscle group. Id. Under 38 C.F.R. § 4.118, Diagnostic Code 7804, superficial and tender scars that are painful on objective demonstration warrant a 10 percent evaluation. Scars that are superficial, poorly nourished, and have repeated ulceration warrant a 10 percent evaluation pursuant to 38 C.F.R. § 4.118, Diagnostic Code 7803 (1999). Scars may also be evaluated based on the limitation of function of the part affected. 38 C.F.R. § 4.118, Diagnostic Code 7805 (1999). In cases of functional impairment, evaluations are to be based upon the lack of usefulness, and medical examiners must furnish, in addition to etiological, anatomical, pathological, laboratory and prognostic data required for ordinary medical classification, full description of the effects of the disability upon the person's ordinary activity. 38 C.F.R. § 4.10 (1999). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. 38 C.F.R. § 4.40. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. Id. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Id. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Id. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like. Pertinent regulations provide that neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum rating equal to severe, incomplete paralysis. 38 C.F.R. § 4.123 (1999). Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. 38 C.F.R. § 4.124. See nerve involved for diagnostic code number and rating. Id. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve. Id. That being stated, the Board acknowledges that the service- connected disabilities are left and right thigh and lower leg scars from shell fragment wounds with retained foreign bodies and painful dysesthesias. It is noted that the RO has assigned a 10 percent rating for the veteran's painful dysesthesias evaluated as mild neuralgia of the sciatic nerve (Diagnostic Code 7804-8720) and anterior crural nerve (femoral) (Diagnostic Code 7804-8726). Under 38 C.F.R. § 4.124a, Diagnostic Code 8720, neuralgia of the sciatic nerve is rated as paralysis of the sciatic nerve under Diagnostic Code 8520. Under Diagnostic Code 8520, a 10 percent evaluation is provided for mild incomplete paralysis of the sciatic nerve. Id. A 20 percent evaluation requires moderate incomplete paralysis. Id. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.123; Under 38 C.F.R. § 4.124a, Diagnostic Code 8726, neuralgia of the anterior crural nerve (femoral) is rated as paralysis of the quadriceps extensor muscles under Diagnostic Code 8526. Under Diagnostic Code 8526, a 10 percent evaluation is provided for mild incomplete paralysis of the anterior crural nerve. Id. A 20 percent evaluation requires moderate incomplete paralysis. Id. The question before the Board is whether the veteran's pain and impaired sensation satisfy the criteria for an increased evaluation-either under the diagnostic code for neuralgia of the sciatic nerve or anterior crural nerve (femoral), or under some other provision. As a proviso, the veteran should be aware that while coordination of rating with impairment of function is expected in all instances, 38 C.F.R. § 4.21 (1999), evaluation of the same disability under various diagnoses is a violation of the prohibition against pyramiding as set forth in 38 C.F.R. § 4.14 (1999). While the veteran's service medical records are not of record, he evidently sustained severe shell fragment wounds in service. VA x-rays taken in March 1983 and July 1996 reveal metallic fragments in the mid portion of the right leg and upper portion of the left leg without soft tissue abnormality. In April 1991, a VA examiner described the veteran's leg and thigh scars as well healed. When examined by VA in May 1997, findings included a 1-cm x 0.7-hypopigmented atrophic scar on his right thigh from shrapnel wounds and also a scar approximately 0.5 cm. wide that was hypopigmented. On his left thigh, there was an 18 cm long x 4 cm wide, barely noticeable, slightly hypopigmented draft donor site. On his right lower leg was a 4 cm x 0.5 cm wide scar and on the right inner aspect of the right heel was an approximately 1.5 cm long atrophic scar from a shrapnel wound according to the veteran. On the inner aspect of the left foot was an approximately 7 mm long x 1-mm wide scar also from shrapnel. Also, on the left leg there was a 1 x 1 cm hypopigmented scar from shrapnel and on the anterior aspect of the left leg were approximately 4 small, about 2 mm wide, oval hypopigmented scars from shrapnel The medical evidence since the veteran reopened his claim has not shown that the scars from the shell fragment wounds with retained bodies of the right and left thighs and lower legs are poorly nourished with repeated ulceration, or painful and tender on objective demonstration. 38 C.F.R. § 4.118, Diagnostic Codes 7803, 7804 (1999). In fact, the scars observed on VA examinations in April 1991, July 1996 and May 1997 were noted to be well healed. Accordingly, a separate compensable rating under the holding in Esteban v. Brown, 6 Vet. App. 259 (1994), is not warranted. The veteran testified in September 1995 that he had retained foreign bodies in his left leg that were painful, his left foot turned in due to fragmentation and walking more than three block in regular shoes was painful, although walking in canvas shoes was not painful. He described his pain as vibrating and noticeable. The veteran reported a right heel injury that was not troublesome and had left calf weakness. In July 1996, a VA examiner reported that the veteran had a right antalgic gait with good range of motion of the hips, knees, ankles and subtalar joints. In May 1997, the veteran told a VA neurologic examiner that he experienced general numbness and tingling in both legs in the thighs, below the knee and in the feet that was centered around the multiple small shrapnel and gunshot wounds. However, the VA physician found no weakness or atrophy in the veteran's legs, with generally intact sensation to cold and vibratory sense. Rubbing the skin over the areas of the veteran's scars generated dysesthesias. The impression was intact motor reflex and sensory function with no clear sign of generalized or focal moneuropahty and painful dysesthesias. Moreover, in June 1997, a VA examiner who reviewed the veteran's July 1996 x-rays concluded that there was no evidence of past orthopedic injuries on current x-ray. Possible superficial nerve involvement about the medial aspect of the right heel did not appear to be associated with previous injuries as there was no metallic fragments in that vicinity. Accordingly, after, reviewing the veteran's scars from shell fragment wounds with retained foreign bodies and painful dysesthesias, the Board concludes that the residuals are no more than mild in severity. Thus, a 10 percent evaluation, the current evaluation assigned is appropriate, for the right and left thigh and lower leg disabilities. As the residuals are not commensurate with moderate disability of his lower legs or thighs, criteria for a 20 percent evaluation, the next higher evaluation under Diagnostic Codes 8720 and 8726, respectively, have not been met or approximated. 38 U.S.C.A. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.2 4.7, 4.40, 4.41, 4.45, 4.59, 4.118, 4.124a, Diagnostic Codes 7804-8720 and 7804- 8726. However, where functional loss is alleged due to pain on motion, the provisions of 38 C.F.R. § 4.40 and 4.45 must also be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-208 (19950l. While the provisions of 38 C.F.R. § 4.40 do not require separate ratings based on pain, the Board is obligated to give reasons and bases pertaining to that regulation. Spurgeon v. Brown, 10 Vet. App. 194, 196 (1997). Within this context, a finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). A rating in excess of 10 percent under Diagnostic Code 7804- 8720 or 7804-8726 is not warranted under the holding of the U.S. Court of Appeals for Veterans Claims (known as the U.S. Court of Veterans Appeals prior to March 1, 1999) in DeLuca because, on examination by VA in May 1997, although there were subjective complaints of general numbness and tingling of both legs and thighs around the small shrapnel and gunshot wound scars, and rubbing the skin over the areas generated dysesthesias, the RO assigned a 10 percent rating under Diagnostic Codes 7804-8720 and 7804-8726. Further, there was no evidence of loss of range of motion, no orthopedic injury shown on x-ray and motor reflex and sensory function were intact. Nor is there medical evidence of muscle injury to warrant a higher rating. Too, the veteran's right heel complaints were considered unrelated to his service-connected disabilities. His scars have consistently been described as small and well healed. While the veteran subjectively complained of discomfort with movement, the pathology and objective observations of his behavior during the course of the most recent VA examinations do not satisfy the requirements for higher evaluations for his right and left leg and thigh scars with retained foreign bodies. After careful consideration of the evidence of record, the Board is of the opinion that the presently assigned evaluations appropriately reflect the current degree of functional impairment objectively demonstrated, due to the service- connected scars, residuals of shell fragment wounds, with retained foreign bodies and painful dysesthesias of the right and left thighs and lower legs. The evidence is not so evenly balanced that there is doubt as to any material issue. 38 U.S.C.A. § 5107(b). ORDER An increased rating is denied for scars, residuals of shell fragment wounds of the right thigh with retained foreign bodies and painful dysesthesias, currently evaluated as 10 percent disabling. An increased rating is denied for scars, residuals of shell fragment wounds of the left thigh with retained foreign bodies and painful dysesthesias, currently evaluated as 10 percent disabling. An increased rating is denied for scars, residuals of shell fragment wounds of the left lower leg with retained foreign bodies and painful dysesthesia, currently evaluated as 10 percent disabling. An increased rating is denied for scars, residuals of shell fragment wounds of the right lower leg with retained foreign bodies and painful dysesthesia, currently evaluated as 10 percent disabling. ROBERT E. SULLIVAN Member, Board of Veterans' Appeals