Citation Nr: 0000010 Decision Date: 01/03/00 Archive Date: 12/28/01 DOCKET NO. 96-47 245 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for chronic disability manifested by nosebleeds. 2. Entitlement to service connection for defective vision. 3. Entitlement to service connection for residuals of a laceration on the left hand. 4. Entitlement to service connection for a growth or lump in the groin. 5. Entitlement to service connection for a disability manifested by left upper abdominal pain. 6. Entitlement to service connection for residuals of laceration of the right thigh. 7. Entitlement to service connection for a disorder manifested by chest pain. 8. Entitlement to service connection for hives. 9. Entitlement to service connection for a skin condition. 10. Entitlement to service connection for a disorder manifested by left ear pain. 11. Entitlement to service connection for disability manifested by back and neck pain. 12. Entitlement to service connection for bronchitis. 13. Entitlement to service connection for seasonal allergies. 14. Entitlement to service connection for hypertension. 15. Entitlement to an increased (compensable) evaluation for residuals of a nose fracture, on appeal from the initial grant of service connection. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Bernard Gallagher, Counsel INTRODUCTION The appellant had active service from July 1973 to July 1993. This appeal comes before the Board of Veterans' Appeals (the Board) on appeal as a result of rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. A rating decision in July 1994 granted service connection for residuals of a fracture to the nose evaluated as noncompensable from August 1993. This rating decision also denied entitlement to service connection for all of the disabilities currently on appeal. A rating decision in August 1998 granted service connection for tinnitus, residuals of a laceration scar on the right second finger, residuals of laceration scar of the left knee, and hemorrhoids and continued the denial of service connection for all of the disabilities on appeal. FINDINGS OF FACT 1. There is no competent medical evidence that the appellant has chronic disability causing his nosebleeds or that the nosebleeds themselves represent any pathology. 2. The veteran's myopia or defective vision is congenital or developmental in nature. 3. There is no competent medical evidence demonstrating residuals of laceration of the left hand. 4. There is no competent medical evidence linking the right inguinal lymphadenopathy to service. 5. An abdominal disorder manifested by pain and diarrhea had its onset during service. 6. There is no competent medical evidence of the current existence of residuals of a right thigh injury. 7. There is no competent evidence of chronic disability producing hives. 8. There is no competent medical evidence of a current chronic skin disorder. 9. There is no competent medical evidence of a chronic disorder manifested by left ear pain. 10. There is no competent evidence of record to demonstrate the current existence of back or neck disorders. 11. There is no competent medical evidence of record demonstrating the current existence of bronchitis. 12. The veteran's seasonal allergies subside on the absence or removal of the allergen and have not been demonstrated by competent medical evidence to have resulted in any residuals. 14. There is no competent medical evidence demonstrating the current existence of hypertension. 15. The veteran's nose fracture has not resulted in interference of breathing space or any obstruction of the nasal passage at any time since August 1, 1993. CONCLUSIONS OF LAW 1. The claims for service connection for nosebleeds, defective vision, residuals of laceration of the left hand, a growth or lump in the groin, lacerations of the right thigh, a disorder manifested by chest pain, hives, a skin disorder, a disorder manifested by left ear pain, back and neck disorders, bronchitis, seasonal allergies, and hypertension are not well grounded and there is no further duty to assist the appellant in developing facts pertinent to these claim. 38 U.S.C.A. § 5107(a) (West 1991). 2. An abdominal disorder was incurred in service. 38 U.S.C.A. § § 1110, 1131, 5107. 3. The appellant's residuals of a nose fracture do not warrant an increased (compensable) evaluation pursuant to the schedular criteria at any time since August 1, 1993. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, Diagnostic Code 6502. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Factual Background The service medical records disclose that in August 1974 the veteran was seen in the optometry clinic. The diagnosis was simple myopia, bilateral. In October 1974, it was reported that he had had epistaxis for one year and this occurred 3-4 times a month. His nose had not bled for a long time. He had bright red blood. He denied use of nasal spray or oral medications. He also complained of pain in the right upper quadrant for the past month. This had no relationship to exercise, meals, or the time of day. He denied trauma to the right side. The pain lasted 3 to 4 minutes then disappeared spontaneously. His blood pressure at that time was 108/76. Examination of the nose showed pink mucosa bilaterally. In November 1974, it was reported he had no further problems with epistaxis. The assessment was epistaxis, etiology unknown, probably dry mucosa and right upper quadrant pain, etiology unknown. In July 1976, the veteran was seen with complaints that he was dizzy for six months. He had woken up vomiting. On examination of the abdomen, there was increased bowel sounds and mild diffuse tenderness. A clinical impression was gastroenteritis. He was seen again for recurrent epistaxis. His blood pressure was 120/90. The assessment was recurrent epistaxis and orthostatic symptoms possibly related to the epistaxis. In September 1978, the veteran was seen for a dressing change in the left midfinger. It was healing well with no sign of infection. Also in 1978, he was treated for laceration of the upper back. In May 1979, he was seen with a pustule or lump in the groin. On examination, he had 2 to 3 small carbuncles in the pubic hair and groin area. In March 1980, he was seen with a complaint of pain in the upper abdomen and chest. He had been seen in the emergency room last night but at this time he felt better. Mylanta was prescribed. In October 1980, he was seen with the complaint of a lump in his groin area of four days duration. A small scrotal abscess was noted. In February 1981, he was seen with complaints of mid-sternal chest pain. A history of chest pain on numerous occasions was reported. On examination, there was no chest wall tenderness. An electrocardiogram was normal. In June 1981, the veteran was treated for a 4 centimeter laceration of the right thigh. He received 8 stitches. The sutures were removed the following month. In June 1984, he was seen with complaints of blisters all over his body of three days' duration with itching. The examiner noted multiple welts on the skin and trunk and the extremities. In July 1984, he was seen with a complaint of rash in his groin area for two days with itching in the groin. The examiner noted no rash or lice and no erythema. The assessment was questionable insect bites. In October 1985, the veteran was seen with the complaint that he had pain in the right groin of one-week duration. He also complained of right buttock numbness. He denied trauma. His blood pressure was 128/90. On examination, there were no masses, tenderness, hernias or swelling noted. It was reported the abdominal wall pain was now gone. In November 1985, he was seen with a complaint of a sore in the left groin, which began last night. The examiner observed redness and drainage (white pus). The site was lanced. Blood pressure at that time was 110/86. In December 1985, he was seen with a complaint of irritation to the chest of two days' duration. He denied any rash. He complained of slight abdominal discomfort. On examination there was no rash. His blood pressure was 122/84. Dry skin was noted. In December 1985 the veteran complained of abdominal pain and diarrhea of four days' duration. Examination was within normal limits. In April 1986, he was seen with the complaint of pain in the left ear. There was minimal erythematous externa of the ear canal. The assessment was external otitis of the left ear. In June 1986 the veteran was treated for an upper respiratory infection manifested by a sore throat and a painful jaw. In October 1987 he underwent X-rays of the nasal bones as a result of injury to the nose. The radiological impression was left nasal bone and inferior nasal spine fractures. He also reported that he had fallen last night and his neck was now hurting. An X-ray of the cervical spine was normal. In March and April 1987 the veteran underwent regular blood pressure checks for several days. The recorded diastolic pressures were intermittently elevated. Later in April 1987, diastolic pressures were 80, 90 and 82. The assessment was borderline hypertension. In June 1987, he was seen with the complaint of sharp retrosternal pain. An electrocardiogram was normal. The assessment was musculoskeletal chest pain versus esophageal spasm. In September 1987, his blood pressure was "ok". He was to be followed up in a year. In March 1988, the veteran reported a history of frequent nosebleeds. The assessment was upper respiratory infection. In April 1989, he complained of itching over the whole body and chest pain. The assessment was jock itch and nonspecific pruritus. In April 1989, he was treated for chest wall pain. An electrocardiogram was normal. In May 1989, he complained of a lump on the right leg and a lump on the left testicle. Two lumps were noted on the right thigh. The assessment was folliculitis. In June 1990, he was treated for allergic rhinitis. In July 1991, the veteran was seen for eye irritation from possible dust or pollen. He requested Visine eye drops. He denied eye injury, infection or chronic eye disorder. He denied a history of allergies. The assessment following examination was minor eye irritation. In July 1991, he was seen with the complaint of back and neck pain after a motor vehicle accident. The back pain was in the lower lumbar region and high thoracic region between the scapulas. The neck pain was described as more of an ache without radiation. The assessment was status post motor vehicle accident. In December 1991 the veteran complained of an injury three weeks ago to the left hand involving the first metacarpophalangeal joint. He reported he had hyperextension and immediate swelling that had since resolved. He denied numbness or weakness. The assessment was resolving minor sprain on the first left metacarpophalangeal joint. In January 1992, the veteran was treated for complaints of sore throat, chest congestion and productive cough of 2 to 3 days' duration. The symptoms had progressively worsened since the onset. He denied headaches, sinus pain, ear pain, shortness of breath or chest pain. In April 1992, the veteran was seen with recurrent episodes of substernal pain lasting 2 to 3 minutes. The pain was not always effort related. Examination was within normal limits. The assessment was chest pain, most likely noncardiac. An upper gastrointestinal X-ray series and a cardiac stress test were advised. A cardiovascular stress test performed in May 1992 was negative with no electrocardiographic changes or symptoms indicating angina. Gastroscopy showed an inflammatory edematous pyloric stenosis and red edema in the duodenum with no evidence of an ulcer. The conclusion was signs of gastritis in the pyloric antrum and small inflammatory edematous pyloric stenosis but no ulcer (usually called B gastritis and caused by Helicobacter Pyloria). In May 1992, the veteran complained of hay fever, nasal congestion, watering eyes, and nonproductive cough for the past 48 hours. He stated that these symptoms occurred since the change of seasons and never had happened before. The examination was normal and the assessment was allergic rhinitis. In July 1992, history of "GERD" (gastroesophageal reflux disease) was recorded. In September 1992, he was seen with a two-week history of right groin and right testicle pain. The assessment was right inguinal strain. Also in September 1992, a history of chest pain, undiagnosed apparently, and associated with the rib cage or sternum, was recorded on the veteran's dental history. A similar history was recorded on dental history in May 1993. The veteran underwent his retirement examination in November 1992. On the report of medical history, he complained of sinusitis, hay fever, pain or pressure in the chest, and piles or rectal disease. The examiner reported that the veteran had worn glasses since childhood. He noted the veteran had sinusitis secondary to allergic rhinitis in May 1992 which was treated with nasal sprain and antibiotics and the veteran made a full recovery. He also noted that the veteran complained of pain in the chest in March 1992, which was due to gastroenteritis. He was treated with medications and made a full recovery. During an electrocardiogram in November 1992, the veteran's blood pressure was 124/88. An electrocardiogram disclosed bradycardia. A chest x-ray disclosed that the right heart border was not well defined, possibly the result of a middle lobe infiltrate or atelectasis. On the physical examination in November 1992 clinical evaluations were normal, including the respiratory and cardiovascular systems. Examination of the abdomen and viscera showed no pertinent abnormality. Service hospital outpatient records dated in April 1994 disclosed the veteran had been experiencing abdominal cramping associated with diarrhea. He also complained of pains in the chest area. He denied dyspnea or a history of recent trauma. The assessment was gastroenteritis, muscle strain, medial nerve neuropathy. In November 1994, he was seen with the complaint of recurring pruritus of the suprapubic region. The pertinent assessment was urticaria. In January 1995, he was seen with the complaint of persistent pruritus over the groin and scrotum. It was reported this was a chronic condition. A pertinent assessment was pruritus (rule out mycotic etiology). The veteran underwent a VA general medical examination in August 1995. He complained of nosebleeds and reported that he had not had a nosebleed in the last 3 or 4 months. Over the last 10 years he noticed that he had nosebleeds that started at any time, approximately one time a month. The nosebleeds would stop after 5 or 10 minutes of direct pressure but he reported there seemed to be no exacerbating factors that he could identify. He had not been worked up for this and was not sure of why he had nosebleeds. He also complained of a visual problem, and that he wore glasses as long as he could remember and throughout his military career. However, the examiner reported that his last examination report revealed his visual acuity was actually getting better. He had no other visual complaints. He also reported that he had a scar on the left thigh. He reported no decreased range of motion or tenderness associated with this scar but he was concerned about its cosmetic appearance. He reported he had lumps in his groin and this seemed to come and go. It could be on the left side as well as on the right. He complained of a diffuse type of cramping abdominal pain that did not seem to localize to any area. It had no affect on his bowel movements and the bowel movements had no effect on the pain. He reported a fair amount of diarrhea with no constipation. He stated there was no relationship to food or laxness to the abdominal pain and no exacerbating or relieving factors. He denied fever or chills associated with this abdominal pain and he noted no melenic stools. The veteran complained of one episode of hives 10 years ago and indicated no episode since then. He also had a chronic skin condition in the groin that had been treated with Nizoral cream. He reported this condition itched and also came and went and was right in the pubic inguinal area and he reported that with treatment of Nizoral and Cruex, this sometimes helped. He reported it did not bother him at this time. He also complained of pain in the left ear and residual tinnitus. He reported about 10 years before leaving the service he noted sharp pains in his ear. He spent time on the flight line and he thinks that maybe some of the tinnitus and sharp pain in the ears could be a result of this. He also reported several episodes of hypertension. While in service he was checked several times and this had not been recurrent and his blood pressure is normal now. He reported that he had chronic sinus congestion and nosebleeds since he fell downstairs in 1986 and fractured his nose. He also reported chronic nasal stuffiness and rhinitis secondary to this. He thinks the problem with some of his bronchitis and allergies were related to this. He reported that his bronchitis and allergies seemed to fluctuate from year to year. Last year he spent the whole summer with nasal congestion, sinus-type symptoms. Relatively this year. He also reported headaches, neck pain and back pain which was occasional. He reported that the headaches seemed to be in the frontal distribution of his head and he noticed that the neck pain sometimes appeared to be after working long hours or keeping his head in a certain position for long periods of time. The back pain was exacerbated by lifting and sudden jerky motions. He had no known allergies and was on no medications at this time. The ear, nose and throat examination was unremarkable. The tympanic membranes were normal bilaterally. The neck was supple with no vein distention lymphadenopathy. The lungs were clear to auscultation bilaterally. The cardiovascular evaluation revealed a regular rate and rhythm without murmur, gallop or rubs. The abdominal examination revealed normal abdominal bowel sounds that were soft and nontender. There was no hepatosplenomegaly or masses. The extremities revealed no clubbing, cyanosis or edema. The musculoskeletal evaluation revealed that all joints had full range of motion without tenderness, warmth, effusion or crepitus. The peripheral pulses were two plus and symmetric. The neurological evaluation revealed no focal deficits. The veteran did have a right inguinal lymphadenopathy which was not tender. There was no skin rash noted. He was able to flex his back fully and had a negative straight-leg raising examination. The skin examination revealed a linear scar on the left thigh. Otherwise it was normal. The areas were nontender. Clinical impressions were: History of nosebleeds, none for the last 3 or 4 months; history of fracture to the nasal area with persistent rhinitis, seasonal allergies and congestion. The examiner indicated that it was unknown but doubtful that this was related to the previous nose fracture; scars on left thigh, left knee and right second finger; history of hypertension but none evident today; low back and neck pain with no evidence of this today; shotty right inguinal lymphadenopathy; history of inguinal skin rash; history of bronchitis and seasonal allergies with no evidence of these today; history of hives; history of pain in the left ear and tinnitus; abdominalgia with diarrhea. The veteran received an audio-ear examination in August 1995. He complained of episodic otalgia that happened every several months. He also complained of episodic tinnitus that was unrelated to the otalgia. He denied a history of ear infection, trauma, or surgery. He also complained of recurrent epistaxis. He had never required nasal packing or medical attention for a nose-bleed. On examination, the tympanic membranes were normal and the canals clear. of the nose with nasal telescope revealed pink, moist, mucosa. The septum was midline with mild hypertrophy and inferior turbinates. There were no polyps or pus or mucosal lesions. There were no spurs noted. The clinical impression was history of tinnitus otalgia with normal ear examination. On a VA visual examination in August 1995 both eyes were corrected to 20/20. There was no diplopia or visual field deficit. A VA audiometric examination disclosed complaints of tinnitus and aural pain, bilaterally. He denied middle ear pathology, vertigo and hearing loss. On spirometry testing the examiner reported the veteran had poor performance. The flow/volume loop suggested variable intrathoracic obstruction. Legal Analysis Entitlement to service connection for a particular disability requires evidence of the existence of a current disability and evidence that the disability resulted from disease or injury incurred in or aggravated during service. 38 U.S.C.A. §§ 101(16), 1110, 1113 (West 1991). In making a claim for service connection for a disorder, the claimant has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). The United States Court of Appeals for Veterans Claims (Court) has defined the term "well-grounded claim" as a "plausible claim, one which is meritorious on its own or capable of substantiation." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The Court has further noted that "[a]lthough the claim need not be conclusive, the statute provides that it must be accompanied by evidence." Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992); 38 U.S.C.A. § 5107(a) (West 1991). Moreover, the Court has stated that "[t]he quality and quantity of the evidence required to meet this statutory burden . . . will depend upon the issue presented by the claim." Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993). Where the issue in a case is factual, competent lay evidence may suffice; however, "where the determination involves medical causation or a medical diagnosis, competent medical evidence to the effect that the claim is 'plausible' or 'possible' is required." Id. at 93. Service connection means that the facts, shown by 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, 1131 (West 1991); 38 C.F.R. § 3.303(a) (1998). With chronic disease shown as such in service or within the presumptive period so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b) (1998). 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. This third element may be established by the use of statutory presumptions. Caluza v. Brown, 7 Vet. App. 498, 506 (1995). Truthfulness of the evidence is presumed in determining whether a claim is well-grounded. Id. at 504. When a disorder had its onset is a medical question involving medical evidence for its resolution, and therefore "competent medical evidence to the effect that the claim is 'plausible' or 'possible' is required" to establish a well-grounded claim for service connection on a direct basis. Grottveit, 5 Vet. App. at 93. Nosebleeds The service medical records disclose that the veteran had recurrent nosebleeds, and he reportedly has continued to experience them intermittently since service. However, the medical evidence does not reflect the existence of chronic disability manifested by epistaxis. Instead, it appears from the medical evidence that they have been associated with, for example, dry mucosa and upper respiratory infection. That is, they are symptomatic of acute and transitory disorders unrelated to service. Accordingly, this claim is not well grounded and is denied. Defective vision The service medical records disclose that the veteran had bilateral myopia. Myopia is considered a congenital or developmental disorder. In July 1991, he was treated for a minor eye irritation, but no residuals of the irritation have been medically demonstrated. On the retirement examination, the examiner reported that the veteran had worn eyeglasses since he was a child and no acquired eye disorder was noted. In addition, on a VA eye examination in August 1995, his vision was corrected to 20/20. Again, no acquired eye disorder was noted. [N]early all astigmatism is congenital (where heredity is the only known factor), it may also occur as a residual of trauma and scarring of the cornea, or even from the weight of the upper eyelid resting upon the eyeball." Browder v. Brown, 5 Vet. App. 268, 272 (1993). Myopia is "nearsightedness." Parker v. Derwinski, 1 Vet. App. 522, 523 (1991). The Board notes that refractive error of the eyes is not a disease or injury within the meaning of applicable legislation pertaining to entitlement to service connection. 38 C.F.R. §§ 3.303(c), 4.9 (1998); Parker v. Derwinski, 1 Vet. App. 522, 523. In view of the absence of any evidence of residuals of inservice trauma superimposed on the veteran's myopia, his claim is not plausible. Laceration of the left hand. During service, the veteran was treated for laceration to the left mid-finger in 1978 and for minor sprain of the left first metacarpophalangeal joint in 1991. However, no residuals of injury to the left hand were noted either on the service retirement examination or on the VA examination in August 1995. Therefore, based on the absence of competent evidence of a current disability, this claim is denied. Residuals of laceration of the right thigh. Service medical records show that the veteran received stitches for a 4 centimeter laceration of the thigh in 1981. However, no residuals of the laceration were shown at service separation or on the subsequent VA examination. On the latter occasion, he reported various scars, and these were apparently documented. However, these scars were neither claimed to be present on the right thigh nor shown on the right thigh. Accordingly, there is no competent evidence of any residuals of the right thigh injury. Therefore, this claim is not well grounded and is denied. Disorder manifested by chest pain. During service the veteran was seen on several occasions with complaints of chest pain. Apart from the occasion in March 1992, when the chest pain was attributed to gastrointestinal disorder (this matter will be addressed subsequently in the Board decision), the etiology of the pain was not determined medically. Possible etiologies included esophageal spasm and musculoskeletal pain. Cardiac pain was ruled out. The post- service record includes medical evidence of the likely existence of a number of disorders which arguably could account for the veteran's chest pain, but, significantly, there is no medical opinion linking the chest pain to any chronic disability, respiratory, musculoskeletal or otherwise. In the absence of competent evidence of chronic disability producing chest pain, this claim is not well grounded. A groin growth or lump, hives, and a skin condition. Hives or urticaria are defined as an eruption of itching wheals, usually of systemic origin, which may be due to a state of hypersensitivity to food or drugs, foci of infection, physical agents (heat, cold, light, friction), or psychic stimuli. Stedman's Medical Dictionary, 26th ed., 1995, at 1895. Pruritus is defined as itching. Stedman's Medical Dictionary, 26th ed., 1995, at 1449. A lymphadenopathy is defined as any disease process affection a lymph node or lymph nodes. Stedman's Medical Dictionary, 26th ed., 1995, at 1002. Because of the similarity of these claims, the Board will address these issues together. The service medical records do, in fact, reflect disorders such as a lump in the groin area, scrotal abscess, pruritus, folliculitis, urticaria and hives. However, when the veteran was examined for service separation, neither a lump or growth in the groin area nor any skin disorder was noted. The postservice medical record discloses that he had further episodes of pruritus and urticaria, but as noted above, these are simply descriptions of symptoms often of allergic etiology. Of themselves, do not represent a chronic disease entity. The post service medical evidence does not reflect the existence of a chronic skin disorder, including hives. When the veteran underwent VA examination in August 1995, skin rash was diagnosed by history alone. Based on the absence of a chronic current disability producing hives or of a chronic skin disorder, these claims are not well grounded. With respect to the claim involving growth or lump in the groin area, the post service medical evidence does not reflect that the veteran has any residuals of the various groin problems he had in service. Apparently, these were acute and transitory disorders that resolved prior to service separation. The post service medical evidence does reflect the existence of right inguinal lymphadenopathy. However, there is no evidence of any disease process effecting a lymph node during service and there is no competent evidence of record linking the lymphadenopathy to service or to any of the groin problems treated during service. Therefore, this claim also is not well grounded. Disorder manifested by left ear pain. The service medical records disclose one episode of a left ear pain. However, a left ear disorder was not manifested on the retirement examination. Although he claimed aural pain on the VA audiometry examination in August 1995, a left ear disorder manifested by pain was not noted. Because of the absence of competent evidence of a chronic left ear disability manifested by pain in service or after service, this claim is not well grounded. Disability manifested by back and neck pain. The service medical records do disclose that the veteran sustained a laceration of the right upper back in 1978, a fall affecting his neck in 1987, and had complaints of neck and lower back pain following a motor accident in 1991. On the retirement examination, however, chronic disability causing back and neck pain was not shown medically. This was also the case when he underwent VA examination in August 1995. At that time, he claimed recurrent back and neck pain, but, significantly, there is no post service medical evidence of the existence of chronic disability causing back and neck pain. Based on the absence of any current evidence of any such chronic disability, this claim is not well grounded. Bronchitis During service the veteran was seen with respiratory complaints, including bronchitis. However, on the retirement examination the evaluation of the respiratory system was normal. On the VA examination in August 1995, the lungs were clear on examination and the diagnosis was history of bronchitis with no evidence of the disorder today. Therefore, because of the absence of competent medical evidence of a current disability, this claim is not well grounded. Seasonal allergies Diseases of an allergic etiology may not be disposed of routinely for compensation purposes as constitutional or developmental abnormalities. 38 C.F.R. § 3.380 (19998). Service connection must be determined on the evidence as to existence of the allergy prior to enlistment and, if so existent, a comparative study must be made of its severity at enlistment and subsequently. Increase in the degree of disability during service may not be disposed of routinely as natural progress nor as due to the inherent nature of the disease. However, seasonal and other acute allergic manifestations subsiding on the absence of or removal of the allergen are generally to be regarded as acute diseases, healing without residuals (emphasis added). The determination as to service incurrence or aggravation must be made on the whole evidentiary showing. The service medical records disclose that in July 1991, the veteran denied a history of allergies. However, when examined in November 1992, he complained of hay fever and sinusitis and it was reported that in May 1992 he had been treated for sinusitis secondary to rhinitis and had a full recovery. No symptoms of allergies were noted on this examination. On the VA examination in August 1995, he reported that he had had problems with nasal stuffiness, rhinitis and allergies in service. The ear, nose, and throat examination was normal, however, and the examiner diagnosed history of seasonal allergies with no evidence at this time. As indicated above, seasonal and other acute allergic manifestations subsiding on the absence of or removal of the allergen are generally to be regarded as acute diseases, healing without residuals. Therefore, in the absence of demonstrated residuals, this claim is denied as not well grounded. Hypertension "Hypertension" is defined as follows: "(H)igh arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 . . . systolic and 90 . . . diastolic to as high as 200 . . . systolic and 110 . . . diastolic." DORLAND'S Illustrated Medical Dictionary, 801 (28th ed., 1994). Borderline hypertension is by consensus, that blood pressure zone between highest acceptable "normal" blood pressure and hypertensive blood pressure. The Framingham Heart Study defines this as pressures between 140 and 160 mm Hg systolic and 90 and 95 mm Hg diastolic. Stedman's Medical Dictionary, 26th ed., 1995, at 831. The service medical records disclose that the veteran had mild intermittently elevated blood pressure readings. However, he did not have consistently elevated blood pressure readings in service, and was not diagnosed with hypertension. Moreover, he has presented no post-service evidence of hypertension. On the VA examination in August 1995, the diagnosis was history of hypertension but none evident today. Therefore, based on the absence of current evidence of hypertension, this claim is not well grounded. Abdominal disability. The service medical records disclose that the veteran was seen on several occasions with complaints of abdominal pain. In addition, after complaints of abdominal pain in 1992, diagnostic tests disclosed the existence of gastritis and an inflamed pyloric stenosis. Following service he was seen with complaints of abdominal cramps and diarrhea at a military facility, and when he underwent VA examination in August 1995, the diagnosis was abdominalgia with diarrhea. In view of the medical evidence which is consistent with the existence of chronic abdominal disorder manifested by symptoms including pain and diarrhea both during and after service, the Board finds that service connection is warranted for this condition. Increased (compensable) rating for residuals of a nose fracture. The first responsibility of a claimant is to present a well- grounded claim. 38 U.S.C.A. § 5107(a) (West 1991). A claim for an increased disability rating is well grounded if the claimant alleges that a service-connected condition has worsened. Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). In this case, the veteran has complained of increased disability as a result of his nose fracture, and therefore he has satisfied the initial burden of presenting a well-grounded claim. VA has a duty to assist the veteran in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103 (1998). 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). In this case the RO provided the veteran a VA examination. There is no indication of additional medical records that the VA failed to obtain. Therefore, VA has satisfied its duty to assist the veteran mandated by 38 U.S.C.A. § 5107. Disability evaluations are determined by the application of a schedule of ratings which is based on the average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R., Part 4. Separate diagnostic codes identify the various disabilities. 38 C.F.R. § 4.1 requires that each disability be viewed in relation to its history and that there be emphasis upon the limitation of activity imposed by the disabling condition. 38 C.F.R. § 4.2 requires that medical reports be interpreted in light of the whole recorded history, and that each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.7 provides that, where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. These requirements for evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decisions based on a single, incomplete or inaccurate report and to enable VA to make a more precise evaluation of the level of the disability and of any changes in the condition. Schafrath v. Derwinski, 1 Vet.App. 589 (1991). Moreover, VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record and to explain the reasons and bases for its conclusion. After the veteran disagreed with the original disability rating assigned for his service-connected residuals of a nose fracture, the RO issued a Statement of the Case (SOC) in that essentially addressed the issue as entitlement service connection for residuals of a nose fracture, although the rating criteria for an increased rating in effect at that time were supplied. The Court recently held that 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 Board has decided this claim consistent with the holding in Fenderson. The veteran's residuals of a fractured nose have been evaluated by analogy to deviation of the nasal septum, as contemplated in 38 C.F.R. § 4.97, Diagnostic Code (DC) 6502, and this is the diagnostic code assigned by the RO. Initially, the Board notes that recent changes have amended the VA Rating Schedule, 38 C.F.R. Part 4, specifically the rating criteria for deviation of the nasal septum. The revised rating criteria requires that a 10 percent evaluation will be assigned where there is 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. 38 C.F.R. § 4.97, DC 6502 (effective October 7, 1996 (as printed in the Federal Register: September 5, 1996)). The Court of Veterans Appeals has held that where a law or regulation changes after a claim has been filed or reopened but before the administrative or judicial process has been concluded, the version most favorable to the appellant generally applies. Karnas v. Derwinski, 1 Vet. App. 308, 312-313 (1991). Accordingly, the veteran's residuals of a fractured nose will be evaluated under both the old and revised versions of 38 C.F.R. 4.97. Under the old criteria of DC 6502, deflection of the nasal septum, traumatic only, with marked interference with breathing space, warranted an evaluation of 10 percent. In this case, there is no objective evidence of marked interference with breathing space. The VA examination report in August 1995 indicated that the veteran's nose was essentially normal, with the septum in midline and with mild hypertrophy and no evidence of a spur. Accordingly, a compensable evaluation is not warranted under DC 6502, as in effect prior to October 7, 1996. In addition, it is apparent that 50 percent obstruction of the nasal passage has not been demonstrated and that therefore the veteran is not entitled to a 10 percent rating under the new criteria. ORDER Service connection for nosebleeds, defective vision, residuals of laceration of the left hand, a growth or lump in the groin, laceration of the right thigh, a disorder manifested by chest pain, hives, a skin disorder, a disorder manifested by left ear pain, disorder manifested by back and neck pain, bronchitis, seasonal allergies, and hypertension is denied. Service connection for an abdominal disorder is granted. An increased (compensable) rating for residuals of a nose fracture at any time since August 1, 1993 is denied. NANCY I. PHILLIPS Member, Board of Veterans' Appeals