Citation Nr: 0003893 Decision Date: 02/15/00 Archive Date: 02/23/00 DOCKET NO. 95-28 156 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUES 1. Entitlement to service connection for a skin disorder, claimed as due to herbicide exposure. 2. Entitlement to an increased evaluation for a right knee disorder, currently evaluated as 20 percent disabling. 3. Entitlement to a temporary 100 percent evaluation under the provisions of 38 C.F.R. § 4.30. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Phillip L. Krejci, Counsel INTRODUCTION The veteran had active service from January 1967 to March 1969. In April 1969, he claimed service connection for a bilateral knee disorder. An August 1969 rating decision granted service connection for postoperative derangement of the right knee, assigning a 10 percent evaluation, and denied service connection for internal derangement of the left knee. In November 1992, the veteran claimed an increased rating for the right knee disability, service connection for a left knee disorder secondary to the right knee disability, and service connection for a skin disorder secondary to Agent Orange exposure. An April 1993 rating decision denied an increased rating for the right knee disability, denied service connection for a left knee disorder, and denied service connection, on a direct basis, for a skin disorder. Adjudication of the herbicide exposure claim was deferred pending issuance of pertinent VA regulations. In August 1994, the veteran reported October 1989 right knee surgery, and claimed a temporary 100 percent evaluation for convalescence pursuant to 38 C.F.R. § 4.30. This appeal comes to the Board of Veterans' Appeals (Board) from an April 1995 rating decision by the Pittsburgh, Pennsylvania, Regional Office (RO) that denied, in addition to the benefit claimed, an increased rating for the right knee disability and service connection for a skin disorder secondary to herbicide exposure. In June 1996, the veteran reported February 1996 left knee surgery, claimed clear and unmistakable error in the August 1969 rating decision that had denied service connection for a left knee disorder, and claimed a temporary 100 percent evaluation for convalescence following the left knee surgery pursuant to 38 C.F.R. § 4.30. An August 1996 rating decision found clear and unmistakable error in the August 1969 rating decision, granted service connection for a left knee disorder, and also granted a temporary 100 percent evaluation for a period of convalescence following the February 1996 left knee surgery. However, in granting service connection for a left knee disorder, the rating decision characterized the grant as "traumatic arthritis, both knees (previously described as postoperative derangement, right knee)". (Emphasis added.) A single 10 percent evaluation was assigned from April 1969 for both knees, a 100 percent evaluation was assigned for convalescence from February 1996, and a single 10 percent evaluation was assigned from May 1996. A December 1996 hearing officer decision, following a May 1996 hearing, granted an increased rating, to 20 percent, for the right knee disability. The hearing officer decision also granted a separate 10 percent evaluation, from August 1994, for the left knee disorder. The December 1996 rating decision implementing the hearing officer decision characterized the veteran's service-connected knee disabilities as "postoperative derangement, right knee[,] with arthritic changes" and "post traumatic arthritis of the left knee". The Board suggests that the RO may wish to consider the application of the bilateral factor under the provisions of 38 C.F.R. § 4.26. That matter, however, is not before us at this time, and it does not appear that application of the bilateral factor would have a current impact upon the veteran's level of compensation. FINDINGS OF FACT 1. The claim for service connection for a skin disorder secondary to herbicide exposure is not plausible under the law, as it is not accompanied by adequate supporting medical evidence. 2. With regard to the claim for an increased rating for a right knee disorder, all available relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 3. The veteran's right knee disorder is manifested by complaints of aching, stiffness, and occasional swelling. Clinical findings show no atrophy, effusion, erythema, tenderness, or instability, but X-rays show degenerative joint disease, and range of motion was reported as 0 to 135 degrees. 4. On November 10, 1989, the veteran was hospitalized for arthroscopic surgery of the right knee; his doctor allowed him to return to work on February 1, 1990. CONCLUSIONS OF LAW 1. The claim for service connection for a skin disorder secondary to herbicide exposure is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The veteran's right knee disorder is not shown to be more than 20 percent disabling. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, to include §§ 4.7, 4.10, 4.40, 4.45, and 4.71a, Diagnostic Codes (DC) 5010, 5003, 5260 (1999). 3. Convalescence benefits are granted from November 10, 1989, through January 31, 1990. 38 C.F.R. § 4.30 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Evidence The veteran's service medical records include a January 1967 Report of Medical History wherein the veteran reported arthritis, right knee, at age 10 but no trouble since. The examiner noted no current disability. A September 1968 outpatient treatment record noted complaints of right knee pain, crepitus, and locking during preceding weeks. At an October 1968 orthopedic examination, there was marked crepitus, pain on motion, and a positive Apley grinding test, and X-rays showed an irregular surface of the medial condyle. The diagnosis was osteochondritis dissecans with early femoral-tibial arthritis. A January 1969 outpatient treatment record noted a torn right medial meniscus with effusion, locking, and a positive McMurray's sign. An August 1969 VA examination noted right knee surgery in service. The veteran was slightly unsteady when squatting, and complained of a pulling sensation in his knees. There was no swelling, tenderness, or deformity, but there was crepitus over the medial aspect of the right knee. Joint spaces of the knees appeared normal on X-rays, but there was early lipping of the intercondyloid eminences bilaterally and of the superior and posterior margins of the patella on the right. The radiologist concluded that the X-rays showed traumatic arthritis or degenerative joint disease in both knees. The examiner diagnosed postoperative internal derangement of the right knee and internal derangement of the left knee. At a July 1974 VA examination, the veteran complained of bilateral knee pain and stiffness that began spontaneously in 1968, followed by a medial meniscectomy of the right knee in January 1969. He had not had treatment for knee disorders since service. Recently, knee pain had increased and he had lost three to four weeks of work because of it. The examiner noted a limp. On examination of the right knee, a surgical scar was noted, all deep tendon reflexes and pulses were present, and flexion was to 125 degrees. The left knee was slightly tender, and all deep tendon reflexes and pulses were present, but flexion was only to 120 degrees. X-rays showed mild degenerative changes bilaterally, a small ossific loose body in the in the joint space below the right medial femoral condyle, and a large ossific loose body in the soft tissue superior to the left patella. The diagnosis was bilateral osteochondritis. Letters from Roger Ferguson, MD, PhD, to the Ohio Bureau of Workmen's Compensation noted that the veteran had twisted his right knee at work in October 1989. There was no significant ligamentous instability, effusion, or hemarthrosis, but there was tenderness over the medial joint line, pain on flexion and extension, and pain, but no click, on McMurray's maneuver. Magnetic resonance imaging showed a tear in the medial meniscus and degeneration of the lateral meniscus. The veteran was hospitalized on November 10, 1989, and underwent arthroscopy, which revealed grade 3 to 4 degenerative changes of the patellofemoral joint, fibrillation of the cartilage in the central portion of the patella, and loss of cartilage down to the bone in the trochlear area of the femur. The area was debrided to a stable rim of articular cartilage. There was a large, thickened, pathological, medial patella plica, that the surgeon felt was probably due to prior surgery, that also was excised. There were grade-2 changes of the articular surfaces of the medial femoral condyle and the tibial plateau. There was a tear of the medial meniscus that was debrided to a stable rim of tissue. The anterior cruciate ligament was intact, as was the lateral meniscus, but there were some grade-1 changes of the articular cartilage of the lateral compartment. A December 1989 letter from Doctor Ferguson noted that the arthroscopic incisions were well healed, but there was still 1+ effusion. The veteran was continuing with an intensive rehabilitation program and was making good progress. In a January 1990 letter, the doctor reported that the veteran was doing physical therapy on his own, and had made some progress, but needed a formal therapy program. He tentatively released him to return to work on February 1, 1990. In a November 1992 statement, the veteran contended that, while in Vietnam, he was in areas sprayed with Agent Orange and that, currently, he frequently had blister-like sores and rashes on his buttocks and in the groin area. He sought service connection for a skin disorder secondary to herbicide exposure, an increased rating for his right knee disability, and service connection for a left knee disorder secondary to the right knee disability. An April 1993 VA examination noted that the circumference of the veteran's knees was 17 inches on the right and 161/2 inches on the left. The right knee appeared slightly deformed. Range of motion was 0 to 120 degrees on the right, and 0 to 140 degrees on the left. The diagnosis was bilateral traumatic arthritis, worse on the right. At an August 1995 VA examination, the veteran complained of pain and swelling of the knees and occasional giving way. He also reported a rash of the groin and feet, previously diagnosed as dermatophytosis, and said that onychomycosis had also been diagnosed. Range of motion of the knees was 0 to 90 degrees with discomfort on the right, and 0 to 140 degrees with discomfort and crepitus on the left. Both knees measured 45 cm in circumference. He could stand on toes and heels, but could not squat due to pain and crepitus, and there was no quadriceps atrophy. The assessment was bilateral post-traumatic osteoarthropathy. In addition, there was a well-defined, erythematous, 3-by-4-cm patch over the left groin, compatible with dermatophytosis. Examination of the feet revealed onychomycosis and scaly, erythematous areas, also compatible with dermatophytosis. The assessment was dermatophytosis of the groin and feet, and onychomycosis. At a November 1995 examination by Tri-State Orthopaedics and Sports Medicine, the veteran complained of bilateral knee pain. The examiner noted the history of the 1989 right knee surgery and the finding of moderately-advanced arthritis. On examination of the knees, there was slight effusion bilaterally, a palpable loose body in the suprapatellar pouch on the left, and palpable osteophytes around the margins of the joint on the right. X-rays of the right knee showed moderately-advanced arthritis of the medial and patellofemoral compartments and a fairly large loose body in the posterolateral aspect that had not been seen previously. X-rays of the left knee confirmed the loose body palpated and the examiner reported that it was mobile and occasionally caused pain and locking. Arthroscopic surgery was recommended for both knees, to remove loose bodies and debride as necessary. The doctor opined that, since the veteran did not have a work injury until 1989, and since advanced arthritis was found during the 1989 right knee arthroscopy, the arthritis was attributable to the veteran's military service and not to the 1989 injury. Letters from Victor Thomas, MD, show that the veteran underwent left knee arthroscopy in February 1996. The surgery, during which a loose body was removed and a torn medial meniscus was repaired, revealed synovitis and degenerative changes. At a May 1996 hearing, the veteran offered no evidence in connection with the claim for service connection for a skin disorder secondary to herbicide exposure. Rather, all of his testimony related to his knee disorders. He said that he had had problems with swelling and stiffness in his right knee before the 1989 surgery. In 1989, at work, he had stepped up two or three feet with his right foot onto a railing, and heard and felt a popping sensation in his right knee. Currently, his right knee was stiff and sore in the morning and felt like there was gravel or sand in the joint. In addition, it made an audible sound on motion, and the hearing officer indicated that he could hear it. The veteran said that Doctor Thomas recently told him that X-rays showed loose bodies in the right knee, and recommended more arthroscopic surgery. At a July 1996 VA examination, the veteran reported pain and crepitus in both knees, right worse than left, and difficulty climbing stairs and with prolonged walking. He denied instability and also denied current problems with locking or catching. The examiner noted that the veteran walked with a normal gait, without evidence of a limp. An attempt to squat was limited by discomfort and a feeling that he might not be able to rise. On examination of the right knee, there was no effusion and no lateral joint line tenderness, but there was minimal medial joint line tenderness to palpation. Passive range of motion was 0 to 130 degrees, with crepitus of the patellofemoral joint. There was no evidence of atrophy, and strength was 5/5 in the quadriceps, gastrocnemius, anterior tibial, extensor hallucis longus, and extensor digitorum longus muscles. Lachman's and posterior drawer tests were negative, the knee was stable to varus and valgus stress, and there was otherwise no evidence of ligamentous instability. X-rays showed significant patellofemoral degenerative joint disease, significant osteophyte formation at the superior and inferior poles of the patella, and significant joint space narrowing. There were also some early Fairbank's changes, more in the medial compartment than in the lateral, with osteophyte formation consistent with degenerative joint disease. The diagnosis was tricompartmental degenerative joint disease of the right knee. At another VA examination, in June 1999, the veteran reported aching and stiffness of the right knee, and occasional swelling and tightness, aggravated by prolonged standing or walking. He said he had difficulty rising from a kneeling or squatting position and also had difficulty with more than three or four flights of stairs. He had changed his job in order to avoid stairs and ladders. He denied subluxation and asymmetric pain. The examiner noted that the veteran was able to walk to and from the examining room, distances of approximately 200 feet, without distress and without favoring either leg, and he also noted that his shoe wear was symmetric. On examination of the lower extremities, there was no effusion, erythema, or tenderness of the knees to palpation, and muscles were symmetric. Range of motion of the knees was from 0 to approximately 135 degrees, with crepitus, bilaterally. There was no anterior, posterior, lateral, or medial instability of either knee. X-rays were ordered. The diagnoses were marked osteoporosis, degenerative joint disease of the knees, and a small loose body in the posterior aspect of the right knee. Analysis Service connection for a skin disorder claimed to be due to herbicide exposure Service connection is granted for disability resulting from injury or disease incurred or aggravated in service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. However, a claimant seeking benefits under a law administered by the Secretary of Veterans Affairs has the burden to submit evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded; then, if that burden is met, the Secretary has the duty to assist the claimant in developing additional evidence pertaining to the claim. 38 U.S.C.A. § 5107; Murphy v. Derwinski, 1 Vet.App. 78, 81-82 (1990); Lathan v. Brown, 7 Vet.App. 359, 365 (1995). If that burden is not met, the statutory duty to assist pursuant to 38 U.S.C.A. § 5107(a) does not attach. See Morton v. West, 12 Vet.App. 477, 480-1 (1999), citing Grivois v. Brown, 6 Vet.App. 136, 139 (1994); Anderson v. Brown, 9 Vet.App. 542, 546 (1996). Indeed, if the claim is not well grounded, the Board is without jurisdiction to adjudicate it. Boeck v. Brown, 6 Vet.App. 14, 17 (1993). Further, the Court has made it clear that it is error for the Board to proceed to the merits of a claim that is not well grounded. Epps v. Brown, 9 Vet.App. 341, 344 (1996), aff'd sub nom. Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997), cert. denied sub nom. Epps v. West, 118 S. Ct. 2348 (1998). Thus, the threshold question in any case is whether the claimant has presented a well- grounded claim. A well-grounded claim is a plausible claim, one that is meritorious on its own or capable of substantiation; it need not be conclusive, but only possible, to satisfy the initial burden of 38 U.S.C.A. § 5107(a). Murphy, Lathan, supra. To present a well-grounded claim, the claimant must provide evidence; mere allegation is insufficient. Tirpak v. Derwinski, 2 Vet.App. 609, 611 (1992). Except for evidentiary assertions that are inherently incredible or beyond the competence of the person making them, the credibility of evidence is presumed for the limited purpose of determining whether a claim is well grounded. King v. Brown, 5 Vet.App. 19, 21 (1993). Competent lay evidence may suffice where the determinative issue is factual in nature, but medical evidence is required where the determinative issue involves medical etiology or diagnosis. Gregory v. Brown, 8 Vet.App. 563, 568 (1996). For a service connection claim to be well grounded, there must be medical evidence of current disability, lay or medical evidence of incurrence or aggravation of a disease or injury in service, and medical evidence of a nexus (i.e., a connection or link) between the incurrence events in service and the current disability. See Winters v. West , 12 Vet.App. 203, 207-209 (1999) (en banc); Epps, supra; Caluza v. Brown, 7 Vet.App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). The veteran contends that he has a skin disorder due to herbicide exposure in service. With regard to such claims, Congress has provided that, when a veteran who served in Vietnam between 9 January 1962 and 7 May 1975 develops one of the following disorders to a requisite degree, that disorder is considered to have been incurred in service: chloracne or another acneform disease consistent with chloracne, Hodgkin's disease or non-Hodgkin's lymphoma, respiratory cancers, multiple myeloma, porphyria cutanea tarda, and certain soft- tissue sarcomas. 38 U.S.C.A. §§ 1116(a)(1)(A), (a)(2). However, active service in Vietnam does not presume exposure to herbicide unless the veteran develops a listed disorder. McCartt v. West, 12 Vet.App. 164, 168 (1999); 38 C.F.R. § 3.307(a)(6)(iii). In addition, Congress has delegated to the Secretary the authority to add disorders to this list when sound medical and scientific evidence shows a positive association between such additional disorders and exposure to herbicides. 38 U.S.C.A. §§ 1116(a)(3), (a)(1)(B), (b)(1). VA has found positive associations between herbicide exposure and prostate cancer and peripheral neuropathy. 38 C.F.R. § 3.309(e). However, with regard to disorders added by the Secretary, Vietnam service between 9 January 1962 and 7 May 1975 creates only a rebuttable presumption of exposure to herbicides, and affirmative evidence that the veteran was not exposed to herbicides while stationed in Vietnam will rebut the presumption. 38 U.S.C.A. §§ 1116(a)(3); 38 C.F.R. § 3.309(e)(iii). Regulations further provide that chloracne or other acneform diseases consistent with chloracne, acute and subacute peripheral neuropathy, and porphyria cutanea tarda, must become manifest to the requisite degree within one year from the last possible date of exposure. 38 C.F.R. § 3.307(a)(6)(ii). In addition, acute and subacute peripheral neuropathy means transient peripheral neuropathy that appears within weeks or months of exposure to a herbicide agent and resolves within two years of the date of onset. See Note 2 to 38 C.F.R. § 3.309(e). In this case, the veteran has dermatologic disorders that have been diagnosed as dermatophytosis and onychomycosis. Neither of these disorders has been found by Congress or by VA to be associated with exposure to herbicide, and there is no medical evidence of record that either one equates to "another acneform disease consistent with chloracne". Thus, the veteran is not entitled to presumptive service connection for a skin disorder due to herbicide exposure in service. Nevertheless, since the regulations do not operate to exclude the traditional approach to service connection claims, service connection may be established, without the benefit of a legal presumption, by evidence that the veteran was exposed to herbicide in service, and medical evidence that he has a disorder etiologically related to herbicide exposure. 38 U.S.C.A. § 1110; Combee v. Brown, 34 F.3d 1039, 1043-5 (Fed. Cir. 1994); Ramey v. Brown, 9 Vet.App. 40, 44 (1996), aff'd sub nom. Ramey v. Gober, 120 F.3d 1239 (Fed. Cir. 1997); McCartt, supra; 38 C.F.R. § 3.303(d). However, save for the veteran's bare contention in his November 1992 statement that he was exposed to herbicide(s) in service, the credibility of which we presume for the limited purpose of determining whether the claim is well grounded even though his competence to make such a contention is subject to some question, there is no evidence in this record that he was so exposed. More important, there is no medical evidence in this record that the veteran has a disorder which is etiologically related to herbicide exposure. In sum, there is no medical evidence of record that the veteran has a disorder presumptively related to herbicide exposure and no medical evidence that dermatologic disorders with which he has been diagnosed are etiologically related to herbicide exposure. In the absence of such evidence, the claim is not well grounded and must be denied. Increased evaluation for right knee disorder An August 1969 rating decision granted serce connection for a right knee disorder, and assigned a 10 percent evaluation pursuant to DC 5257. In May 1995, the veteran expressed disagreement with an April rating decision which had denied an increased evaluation. A December 1996 rating decision increased the evaluation to 20 percent, pursuant to DC 5010- 5257. However, since a claimant is generally presumed to seek the maximum benefit allowed by law, an increased evaluation, assigned during the pendency of an appeal, that is less than the maximum evaluation available, does not resolve the appeal absent withdrawal thereof pursuant to 38 C.F.R. § 20.204. The claim remains in controversy. See Fenderson v. West, 12 Vet.App. 119, 126 (1999) citing AB v. Brown, 6 Vet.App. 35, 38 (1993). Therefore, although the evaluation of the veteran's right knee disorder was increased in December 1996, the veteran did not withdraw his appeal of the April 1995 denial of an increased evaluation, so it is presumed that he also disagrees with the 20 percent evaluation assigned by the hearing officer. If a veteran claims an increased evaluation based on increased disability of a service-connected disorder, such a claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a). See Jackson v. West, 12 Vet.App. 422, 428 (1999), citing Proscelle v. Derwinski, 2 Vet.App. 629 (1992). With such a claim, entitlement to compensation has already been established, so the present level of disability is of primary concern. Francisco v. Brown, 7 Vet.App. 55 (1994). The basis of disability evaluations is the ability of the body as a whole, or of a system or organ of the body, to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The VA Schedule for Rating Disabilities, Part 4 of title 38 of the Code of Federal Regulations, identifies various disabilities by separate diagnostic codes. 38 C.F.R. § 4.27. Within diagnostic codes, specific ratings are determined by the application of criteria that are based on the average impairment of earning capacity caused by the rated disability. 38 U.S.C.A. § 1155; 38 C.F.R. § 3.321(a). When there is a question as to which of two evaluations should be assigned, the higher evaluation is assigned if the disability picture more nearly approximates the criteria for that evaluation; otherwise, the lower evaluation is assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability is resolved in favor of the veteran. 38 C.F.R. § 4.3. Disability of the musculoskeletal system is primarily the inability to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. See DeLuca v. Brown, 8 Vet.App. 202 (1995). Functional loss, due to the absence of bones, muscles, or associated structures, or due to deformity, adhesions, defective innervation, or other pathology, or due to pain, supported by adequate pathology and evidenced by the visible behavior of the veteran while undertaking motion, must be considered. 38 C.F.R. § 4.40. As regards the joints, the factors of disability reside in reductions of their normal excursion or movement in different planes. In rating disability of the joints, consideration must be given to demonstrated range of motion, pain on motion, excess fatigability, weakened motion, lack of coordination, and swelling, deformity, and atrophy from disuse. 38 C.F.R. § 4.45. Here, the evidence shows that the veteran has traumatic arthritis of the right knee. With arthritis, painful motion is an important factor of disability and evidence thereof, e.g., facial expression, wincing, etc., with pressure, manipulation, or motion, as well as crepitus in joint structures, should be carefully noted. The law intends to recognize the residuals of healed injury, e.g., actually painful motion or unstable or malaligned joints, as entitled to at least the minimum compensable rating for the joint. Flexion elicits such manifestations and the joints involved should be tested for pain on active and passive motion, and on weight- and non-weight-bearing. 38 C.F.R. § 4.59. The diagnostic code for traumatic arthritis is DC 5010, which refers adjudicators to DC 5003 (degenerative arthritis). Degenerative arthritis, evidence of which must be established by X-ray, is rated on the basis of limitation of motion according to the appropriate diagnostic codes for the joint or joints involved. Turning now to the diagnostic codes for limitation of motion of the leg, we first recognize that the normal range of motion of the leg is from 0 to 140 degrees. 38 C.F.R. § 4.71, Plate II. The rating criteria for DC 5260 (limitation of flexion of the leg) begin with a noncompensable evaluation when flexion is limited to 60 degrees. The rating criteria for DC 5261 (limitation of extension of the leg) begin with a noncompensable evaluation when extension is limited to 5 degrees. At the June 1999 examination, the range of motion of the veteran's right leg was from 0 to 135 degrees. Thus, a compensable evaluation would not be warranted under the provisions of either DC 5260 or DC 5261. If limitation of motion is demonstrated, but not to a compensable degree, then a 10 percent evaluation is warranted pursuant to DC 5003 (degenerative arthritis) for each major joint or group of minor joints involved. If there is no limitation of motion, a single 20 percent evaluation is warranted if two or more major joints or two or more minor joint groups are involved and there are occasional exacerbations. If there is no limitation of motion, a single 10 percent evaluation is warranted if two or more major joints or two or more minor joint groups are involved and there are no exacerbations. The knee is a major joint. 38 C.F.R. § 4.45(f). At the June 1999 examination, flexion of the left knee was limited by 5 degrees so, although that limitation of motion is noncompensable and so slight that another examination the same day might show no limitation of motion, a 10 percent evaluation is warranted for degenerative arthritis of the right knee pursuant to DC 5003. We have considered the application of the DeLuca case and 38 C.F.R. §§ 4.40, 4.45, and 4.59. There is no evidence of weakened motion, lack of coordination, atrophy from disuse, or bony deformity. However, the veteran reported aggravation of his symptoms with prolonged standing or walking, which we view as evidence of excess fatigability. In addition, there is evidence of occasional swelling. However, even if flexion of the leg was limited to 30 degrees, instead of 135, by swelling or excess fatigability, an evaluation greater than 20 percent would not be warranted. The Board is of the view that, since only a 10 percent evaluation is warranted by examination findings, the veteran is adequately compensated, even for flare-ups or exacerbations of the right knee disability, by the 20 percent evaluation currently assigned. We have also considered evaluations under the provisions of other diagnostic codes. However, there is no evidence of recurrent subluxation or lateral instability, so DC 5257 is not applicable. The maximum evaluation under DC 5258 (dislocated cartilage with locking, pain, and effusion into the joint) is 20 percent, and the maximum evaluation under DC 5259 (symptomatic postoperative removal of cartilage) is 10 percent, so evaluation pursuant to either of those diagnostic codes would not result in an increase. The veteran has only one right knee disability, not more, so he could not be assigned a separate evaluation pursuant to one of the foregoing diagnostic codes, in addition to the one currently assigned, without violating the rule against pyramiding. See Esteban v. Brown, 6 Vet.App. 259 (1994); 38 C.F.R. § 4.14. The veteran has arthritis of the right knee that warrants only a 10 percent evaluation under the provisions of applicable diagnostic codes. Some activities exacerbate his disability, and he has some flare-ups of it, but there is no evidence that either the exacerbations or the flare-ups are so disabling as to warrant an evaluation greater than the 20 percent currently assigned. Temporary 100 percent evaluation under 38 C.F.R. § 4.30 A 100 percent evaluation is assigned, effective the date of hospital admission and continuing for one, two, or three months from the first day of the month following hospital discharge, when medical evidence shows that: the veteran underwent surgery necessitating at least one month of convalescence; or there are severe postoperative residuals, such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one or more major joints, a body cast, the necessity of home confinement, or the necessity of crutches or a wheel chair; or there is immobilization by cast, though no surgery, of one or more major joints. The 100 percent evaluation may be extended beyond three months and is followed by the schedular evaluation warranted by the evidence. 38 C.F.R. § 4.30. Here, the veteran has a lengthy history of osteochondritis dissecans and arthritis of the right knee. He was hospitalized on November 10, 1989, and underwent right knee surgery. Thereafter, he had intensive physical rehabilitation and was precluded, by direction of his doctor, from working until February 1, 1990. We find that he was entitled to a temporary total (100 percent) evaluation under the provisions of 38 C.F.R. § 4.30 for a period beginning with his hospitalization on November 10, 1989, and ending January 31, 1990, the day before he was allowed to return to work. In his December 1996 decision, the hearing officer held that convalescence benefits were precluded by the fact that the veteran did not claim an increased rating until November 1992. It is true that he did not claim an increased rating until 1992, and it is also true that he did not claim section 4.30 benefits for his 1989 surgery until August 1994, but the relationship between the dates of his claims and section 3.400 (a general regulation containing guidance on effective dates for a plethora of benefits), to which the December 1996 hearing officer decision alluded, is not entirely clear. The effective date for section 4.30 benefits, the date of admission to the hospital, is found in section 4.30, so there is no need, indeed, no authority, to resort to section 3.400. An ancient and accepted principle of statutory construction is that, when there is some conflict between a general law and a specific one, the specific law controls. See Zimick v. West, 11 Vet.App. 45 (1998), citing Busic v. United States, 446 U.S. 398, 100 S. Ct. 1747, 64 L. Ed. 2d 381 (1980). ORDER Entitlement to service connection for a skin disorder, claimed to be due to herbicide exposure, is denied. Entitlement to an increased evaluation for a right knee disorder, currently evaluated as 20 percent disabling, is denied. Entitlement to a temporary 100 percent evaluation, under the provisions of 38 C.F.R. § 4.30, is granted for the period from November 10, 1989, through January 31, 1990, subject to the statutes and regulations governing the payment of monetary benefits. ANDREW J. MULLEN Member, Board of Veterans' Appeals