BVA9506458 DOCKET NO. 90-06 314 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for a bilateral foot disorder to include an arch disorder and residuals of a foot injury. 2. Entitlement to service connection for a cardiovascular disorder. 3. Entitlement to service connection for a pulmonary disorder to include residuals of pneumonia. 4. Entitlement to service connection for a neck disorder. 5. Entitlement to an increased rating for migraine headaches, currently evaluated as 10 percent disabling. 6. Entitlement to an increased rating for postoperative lumbar disc disease, currently evaluated as 10 percent disabling. 7. Entitlement to an increased (compensable) disability evaluation for residuals of a fracture of the right wrist. 8. Entitlement to an increased (compensable) disability evaluation for bilateral hearing loss. 9. Entitlement to an increased (compensable) disability evaluation for duodenal ulcer disease. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD R. M. Yonemoto, Counsel INTRODUCTION The veteran had active service from August 1968 to August 1988. This case comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of March 1989 by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. In February 1991, the case was transferred to the St. Louis, Missouri, RO because the veteran resided in that jurisdiction. Following a January 1994 Remand, the RO increased the evaluation assigned for the veteran's lumbar disc disease from noncompensable to 10 percent. The veteran has continued to express dissatisfaction with the rating assigned; consequently, that claim remains before us. The case previously encompassed an issue of service connection for a disorder manifested by chest pain. Since the chest pain is claimed to be a symptom of a pulmonary or cardiovascular disorder, it would be redundant to address it separately. It will be addressed in the context of the cardiovascular and pulmonary claims. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he injured his feet in service and currently had residuals of the injury. It is maintained that while in service he had complaints of chest and neck pain; that he was found to have pneumonia and arthritis of the neck; and that he currently has a pulmonary disorder manifested by chest pain, residuals of the pneumonia, and a chronic neck disorder. It is asserted that chest pain is also a manifestation of cardiovascular disease, and that the veteran underwent a stress test in approximately 1993, but the results are not of record. It is further asserted that his migraine headaches, low back disorder, residuals of a fracture of the right wrist, bilateral hearing loss, and duodenal ulcers have become progressively worse. It is also argued that he has had continuing treatment for these disorders since his separation from service, that he is under constant suffering because of his service-connected disabilities, and that life for him is almost unbearable. Additionally, the veteran's representative argues that the increase in the disability evaluation for the service- connected low back disorder still does not adequately reflect the true degree of the low back impairment. DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), we have reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on a review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the claims for service connection for a bilateral foot disorder to include an arch disorder and residuals of a foot injury, a cardiovascular disorder and a pulmonary disorder to include residuals of pneumonia are not well grounded. It is also our decision that the preponderance of the evidence is against the claims for increased ratings for migraine headaches, residuals of a fracture of the right wrist, and bilateral hearing loss. It is our decision that the evidence supports the grant of service connection for arthritis of the cervical spine, a 20 percent rating for lumbar disc disease, and a 10 percent disability rating for duodenal ulcer disease. FINDINGS OF FACT 1. It is not shown that the veteran has a bilateral foot disorder; he did not report for a VA examination scheduled to determine if he does. 2. It is not shown that the veteran has a cardiovascular disorder. 3. It is not shown that the veteran has a pulmonary disorder or any residuals of pneumonia 4. The veteran has cervical spine arthritis which was first manifested in service. 5. The veteran's migraine headaches are manifested by complaints of frequent severe headaches; it is not shown that he has characteristic prostrating attacks averaging once a month over several months. 6. The veteran's lumbar disc disease is manifested by no more than moderate limitation of motion and complaints of pain, swelling, tenderness, and spasm; these symptoms reflect moderate, but not more than moderate lumbar disc disability. 7. The residuals of a fracture of the right wrist include subjective complaints of loss of strength, pain, discomfort and weak grip, but no limitation of wrist motion or other objective signs of impairment. 8. The veteran has level I hearing in each ear. 9. The veteran has recurring symptoms of mild duodenal ulcer disease about once or twice yearly. CONCLUSIONS OF LAW 1. The veteran's claim for service connection for a bilateral foot disorder to include an arch disorder and residuals of a foot injury is not well grounded. 38 U.S.C.A. §§ 1110, 1131, 5107(a) (West 1991); 38 C.F.R. §§ 3.303(b), 3.655 (1994). 2. The claim for service connection for a cardiovascular disorder is not well grounded. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(a) (West 1991); 38 C.F.R. §§ 3.303(b), 3.307, 3.309, (1994). 3. The claim for service connection for a pulmonary disorder, to include residuals of pneumonia is not well grounded. 38 U.S.C.A. §§ 1110, 1131, 5107(a) (West 1991); 38 C.F.R. § 3.303(b) (1994). 4. Arthritis of the cervical spine was incurred in peacetime service. 38 U.S.C.A. § 1131 (West 1991); 38 C.F.R. §§ 3.102, 3.303(b) (1994). 5. A disability rating in excess of 10 percent for migraine headaches is not warranted. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.41, Part 4, Code 8100 (1994). 6. A 20 percent disability rating for lumbar spine disc disease is warranted. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.102, 3.321(b)(1), 4.1, 4.2, 4.40, 4.41, Part 4, Code 5292 (1994). 7. A compensable disability evaluation for residuals of a fracture of the right wrist is not warranted. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.2, 4.31, 4.40, 4.41, Part 4, Code 5215 (1994). 8. A compensable disability evaluation for bilateral hearing loss is not warranted. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.85, Part 4, Code 6100 (1994). 9. A 10 percent disability rating for duodenal ulcer disease is warranted. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.102, 3.321(b)(1), 4.1, 4.2, Part 4, Code 7305 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, we find that the veteran's claims, except for those concerning service connection for a bilateral foot disorder and cardiovascular and pulmonary disorders, are well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, we find that those claims are plausible. We are also satisfied that all relevant facts have been properly developed to the extent possible and that there is no further "duty to assist" the veteran which is also mandated by § 5107(a). To establish service connection for a disability, the evidence must show that the disability was incurred in service, or if pre- existing, that it was aggravated therein. 38 U.S.C.A. §§ 1110, 1131 (West 1991). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1994). Chronic disorders, such as cardiovascular disease may be presumed to have been incurred in service if they are manifested to a compensable degree within one year following separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994). When a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 3.102 (1994). I. Entitlement to Service Connection for a Bilateral Foot Disorder to include an Arch Disorder and Residuals of a Foot Injury. In a medical history report of June 1978, the examiner reported that the veteran had a history of broken right foot. Examination revealed no musculoskeletal foot abnormality. The service medical records disclose that in July 1982 the veteran sprained an ankle while doing physical therapy. A history of twisted left ankle 4 to 5 times in one month was reported. He had always had bilateral "laxity or looseness" of the ankles and would quite often turn his feet with resulting sprain. Examination revealed mild left lateral malleolar swelling with anterolateral mortise tenderness. The veteran had symmetrical range of motion and had apparent collapse of metatarsal arch with callous formation over the second metatarsal heads. Strength was grossly within normal limits, bilaterally, with eversion being the weakest. He had excess lateral laxity. The assessment was chronic instability with decreased proprioceptive - status post sprain. In July 1983, it was noted that the veteran had a history of twisted left ankle. Examination showed no evidence of edema or tenderness of the left ankle. The assessments included sprained left ankle. The service medical records disclose that the veteran had problems including metatarsal head pain versus Morton's neuroma in September 1983. He had left foot pain especially with running. Examination revealed tenderness in the 4th metatarsal head and questionable Morton's neuroma. He was referred to podiatry. In a master problem list, it was noted that the veteran had an acute (temporary) problem of left foot pain - metatarsalgia in September 1983. The podiatry examination in October 1983 revealed neuroma but it was not symptomatic. Cavus architecture with pronation stance was reported. The diagnoses included sesamoiditis. In conjunction with an evaluation for low back problems in February 1984, he reported having numbness in both feet, all 5 toes. Examination was unremarkable. In June 1984, the veteran complained of pain in the feet of several years duration. There was no diagnosis referable to the foot. At a periodic service examination of the veteran in November 1984, the examiner commented that the veteran had a history of metatarsal arch collapse. In June 1985, the veteran complained of recurring multiple joint pain, including in the feet. The impressions included rule out rheumatoid arthritis. In March 1986, the veteran complained of bilateral foot pain of one month's duration. He added that his feet hurt all the time during the previous two years, and that the pain was in the arches and balls of the feet. No history of trauma was reported. Examination revealed high arches of the feet. The impressions included high arches and rule out arthritis. In early April 1986, the veteran again complained of foot pain. He added that arch supports were helping to relieve the back pain. A few days later, he still had foot pain. Dorsiflexion of both ankles was to 5 degrees. There was mild pes cavus of both feet. Gait was within normal limits. There was no evidence of edema. Motor function and neurological sensation were grossly intact. An assessment referable to the foot was not reported. In mid-April 1986, the veteran sought treatment for foot pain at a physical therapy clinic. He stated that the heel lift did not seem to be helping much. The assessments included foot pain. He was referred to a podiatry clinic. An April 1986 X-ray study disclosed no significant abnormality. At the clinic in May 1986, the veteran complained of pain in the plantar aspect of the feet, especially the metatarsal heads, heels and arches. Examination revealed high arches with slight contracted toes. Good range of ankle motion was observed. There was no detectable weakness in the muscles. The assessment was high arches with chronic strain. A periodic examination in May 1986 revealed that the veteran had normal feet. In a medical history report completed in connection with that examination, the veteran answered in the affirmative the question of whether he had ever had foot trouble. In June 1986, the veteran complained of tightness in the big toe. Pes cavus was noted. Examination of the right foot showed intact sensation and motor functioning. Deep tendon reflexes were symmetrical. The sole of the foot was erythematous and scaly. Cavus foot was noted. The assessment was first metatarsalgia. At an orthopedic clinic in July 1986, he reported that he still had pain in the first toe. Undated clinical records show that the veteran had numbness in the foot. In a medical history report completed in connection with his retirement examination in March 1988, the veteran reported he had foot trouble. He stated that he had foot pain and was wearing support for arches, and that he had some numbness in the feet. The retirement examination revealed normal feet. On a VA examination in November 1988, the veteran stated that he had injured his feet, that he had collapsed arches, and that he also twisted both ankles and currently had ankle problems. The veteran exhibited normal carriage, posture and gait. Examination revealed no limitation of motion of the ankle. Flat feet were not detected even though the veteran pointed to the anterior arches of his feet and stated that he had had special shoes made to relieve pain in his feet in service. Right ankle X-ray films as well as X-ray films of both feet showed no fracture or dislocation. The diagnoses included normal X-ray studies of the feet and right ankle, current complaint of some pain in both feet, and history indicating arch supports in the shoes to help with foot pain. In November 1989, the veteran appeared before a personal hearing on appeal at the RO. On that occasion, he testified that he had injured his foot in service and received treatment for the injury. He mentioned that since his service discharge he had had problems with his feet, and that he had not received any foot treatment within one year following his service discharge. He mentioned that his arches had collapsed while in service. On a private examination in August 1991, the veteran did not have ankle jerk on the left side. He experienced difficulty with toe walking. In a VA orthopedic examination report of February 1994, it was noted that the veteran had injured his foot in service; that he complained of pain in the metatarsal head, arch pain and heel pain, all intermittently, and complained of numbing sensation in the left lateral foot and distal toes; and that the problems occurred with prolonged standing or walking distances, all intermittently. There were no findings or diagnosis relating to the feet. A VA document in the claims folder discloses that an examination of the feet scheduled for March 1994 was canceled because the veteran failed to report. Regarding the claim for service connection for a bilateral foot disorder to include an arch disorder and residuals of a foot injury, the veteran argues that he injured his ankles and feet during service on several occasions, and currently had residuals of those injuries. His arguments and assertions are reflected in his contentions and testimony. The service medical records disclose that he had ankle sprain, broken right foot, callous formation of the feet, collapsed arches, and pain, "laxity or looseness," swelling, tenderness, chronic instability, sesamoiditis and numbness of the ankles. On a private examination in August 1991, the veteran did not have ankle jerk on the left side. He experienced difficulty with toe walking. On a VA orthopedic examination of his feet, it was noted that the veteran had injured his foot in service; that he complained of pain in the metatarsal head, arch and heel pain, all intermittently, and complained of numbing sensation in the left lateral foot and distal toes; and that his problems occurred with prolonged standing or walking distances, all intermittently. A foot disorder was not diagnosed. The examiner related that the veteran should not have been scheduled for an orthopedic examination, but should have had a podiatry examination. A podiatry examination was scheduled for March 1994, but the veteran failed to report for that examination. Under the provisions of 38 C.F.R. § 3.655 (1994), when a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim will be rated on the evidence of record. The threshold requirement to establish service connection for a disability is the current existence of that disability. It is not enough for the veteran to assert or testify that he has the disability for which he is seeking service connection. His assertions must be corroborated by medical evidence. The burden of establishing a well-grounded claim may not be met merely by presenting lay testimony, as lay persons are not competent to offer medical opinions. Hanna v. Brown, 6 Vet.App. 507, 510 (1994). As stated above, there is no medical diagnosis of a current foot disability. As the veteran has not met the threshold requirement of showing that the claimed disability exists, his claim for service connection for a bilateral foot disorder is not well grounded. II. Entitlement to Service Connection for a Cardiovascular Disorder. In a medical history report, completed in connection with his enlistment examination in April 1968, the veteran reported having had rheumatic fever. Examination revealed normal lungs and chest, and cardiovascular system. It was noted that he had rheumatic fever at age 11 without sequelae. The service medical records show that in January 1969 the veteran had flu-like syndrome. In April 1969, the veteran was noted to carry a diagnosis of rheumatic fever. In August 1969, he had aches all over, congestion, cramps in the legs and arms, earaches and headaches. A history of the symptoms for the previous two weeks was reported. It was noted that he had been previously treated for rheumatic fever. Examination revealed clear chest. The impressions included a disorder not pertinent herein. In April 1970, the veteran was on rheumatic prophylaxis medication and this was continuing in August 1970. A history of rheumatic fever was reported in September 1970. It was reported in November 1970 that the veteran's medical charts were reviewed regarding cardiac status secondary to rheumatic fever seven years before. The service medical records disclose that the veteran was on medication for rheumatic fever from September 1970 to January 1971. In March 1973, he reported having had a history of rheumatic fever when he was 11 years old. The veteran stated that he was hospitalized approximately one month and was on Penicillin for 4 to 5 years. It was noted that he was found to have a blowing apical systolic murmur, and that there was diffuse point of maximum impulse in the 5th and 6th intercostal space in the midclavicular line. Antibiotic prophylaxis was recommended. At the internal medicine clinic, the veteran's blood pressure reading was 110/70. Examination of his heart revealed normal rate and rhythm. Diffuse point of maximum impulse was in the 5th to 6th intercostal space in the midclavicular line. There was a flowing apical systolic murmur. The service medical records also reveal that in early March 1974 the veteran complained of nervousness and jitteriness. Examination revealed a Grade II/VI systolic murmur along the left sternal border without radiation. The blood pressure reading was 120/80. In mid-March 1974, he reported having some cold symptoms. The blood pressure reading was 120/80. The impression was a disorder not pertinent herein. In a medical history report of October 1976, the veteran reported having or having had pain or pressure in the chest. The examiner related that the veteran had off-and-on pain in the chest, and that the veteran smoked more than 40 cigarettes daily. In a respiratory history, dated in August 1977, it was mentioned that the veteran had chief complaints of mild pain and cough for seven days that was not improving. The blood pressure reading was 112/80. Examination revealed chest point tenderness. The assessments were disorders not pertinent herein. The service medical records show that in August 1977 the veteran reported that his chest hurt. A blood pressure reading of 152/96 was reported in February 1978. In May 1978, he complained of pain in the side of his chest of one-day duration. A periodic examination in June 1978 revealed a normal cardiovascular system. A blood pressure reading of 110/68 was reported. A chest X-ray film was negative. In a medical history report completed in connection with that examination, the veteran answered in the affirmative the question of whether he had or had had pain or pressure in the chest, and in the negative question of whether he had or had ever had heart trouble of high or low blood pressure. In early March 1979, the veteran had chest pain of two days' duration. The blood pressure reading was 122/76. A periodic service examination in March 1979 revealed no pertinent disorder. A chest X-ray film was negative. The blood pressure reading was within normal limits. In March 1979, the veteran again reported having mild chest pain. Examination was negative. In December 1979, he reported having soreness in the chest of 3 days' duration. The blood pressure reading was 106/80. In November 1980, he again complained of chest pain. Examination revealed clear chest. The blood pressure reading was 120/80. In March 1981 in an emergency room, the veteran complained of intermittent chest pain of 3 to 4 months' duration. An electrocardiogram revealed borderline inferior wall ST-T-wave changes. In March 1981, the veteran was referred for a cardiac evaluation. A history of pressure and heavy sensation in the left chest since December 1980 was reported. The sensation was described as a knot-like sensation that would last for several hours and knife- like pain lasting from 2 to 3 seconds. These sensations were not particularly related to activity, food ingestion, position or stress. They were relieved spontaneously. A past history was positive for rheumatic fever and treatment with Penicillin with a one-year stay at home. An intermittent heart murmur was heard at that time. He smoked approximately two packages of cigarettes per day. A history of hypertension or coronary artery disease was denied. On examination, his blood pressure was 124/84 in the right arm and the sitting position. Examination showed that the point of maximum impulse was normally located in the fourth interspace at the midclavicular line. The 1st and 2nd heart sounds were of normal intensity. There was no evidence of thrills, rubs, lifts, murmurs, gallops or clicks. An electrocardiogram revealed borderline nonspecific ST-T-wave changes. The chest X-ray study was within normal limits. The diagnoses were chest pain of noncardiac origin. In an April 1981, radiographic report shows no cardiovascular abnormality. In a medical history report completed in connection with a periodic examination in September 1982, the veteran answered in the affirmative the questions of whether he had or ever had shortness of breath, pain or pressure in the chest, palpitation or pounding heart, and heart trouble. The examiner reported that the veteran had shortness of breath and chest pain, and that a cardiac check was within normal limits. Examination revealed a normal cardiovascular system. The service medical records also disclose that in April 1983 the veteran had some pleuritic chest pain. Examination of the heart revealed regular rate and rhythm without murmurs or gallops. The blood pressure reading was 138/60. The impression was viral illness. In a radiographic report of July 1983, it was noted that chest X-ray films revealed no active cardiopulmonary disease. A chest X-ray film in April 1984 disclosed no evidence of acute disease. At an emergency clinic at a hospital in October 1984, the veteran complained of chest pain and pain in the left arm and shoulder with occasional numbness in the left arm. He denied difficulty breathing. He stated that the pain was a sharp stabbing sensation. His blood pressure reading was 118/74. There was no pain in the chest on palpation. Examination of the heart revealed regular rate and rhythm without murmurs or gallops. The assessment/diagnosis was a disorder not pertinent herein. A periodic service examination of the veteran in November 1984 showed a normal heart. A chest X-ray film was interpreted as normal. The blood pressure reading was 104/72. In a medical history report completed in connection with that examination, the veteran reported having or having had pain or pressure in the chest, palpitation or pounding heart, and heart trouble. The examiner commented that the veteran had pain in the chest occasionally along the left side and arm, and pounding of the heart occasionally and heart murmur which was not recorded on a previous physical examination. A chest X-ray in June 1985 disclosed no abnormalities of the heart and pulmonary vasculature. A report from Wood River Township Hospital, dated in July 1985, reveals that the veteran had no history of chest pain, that an examination disclosed normal sinus rhythm, and that the chest was clear but with tachycardia. An X-ray report shows that chest X-ray films revealed minimal left ventricular prominence. The impressions were disorders not pertinent herein. At the emergency room in October 1985, the veteran reported having 24 hours' pressure sensation to the chest. He also complained of severe weakening and dizziness associated with transient spells of shortness of breath and tightness of the chest. Examination revealed that the heart rhythm was regular without murmurs. Electrocardiogram disclosed nonspecific rhythm and biphasic waves in the interior leads, otherwise within normal limits. In a medical history report completed in connection with a periodic examination in May 1986, the veteran answered in the affirmative the questions of whether he had or had ever had shortness of breath, pain or pressure in the chest, palpation or pounding heart, and high or low blood pressure. A blood pressure reading of 110/72 was reported. Examination revealed normal heart. A chest X-ray film was within normal limits. The veteran reported that he experienced chest pain and pressure while running and flutter or butterfly feeling of the heart. In mid- March 1987, the veteran reported having chest pain and discomfort. A few days later, he complained of chest pain which radiated to the roof of his mouth. The service medical records disclose that in September 1987 the veteran complained of chest pain. He added that the chest hurt whenever he coughed. Examination revealed supple neck. Chest examination showed regular sinus rhythm. There was no pertinent impression. Retirement examination in March 1988 disclosed normal lungs, chest, and heart. The chest X-ray film was within normal limits. The blood pressure reading was 100/70. In a medical history report completed in connection with that examination, the veteran reported having had or had ever had pain or pressure in the chest and palpitation or pounding heart. He stated that he did not know if he had heart trouble. The veteran added that he had sharp/severe chest pains. The chest X-ray film showed a normal heart size. The impression included no active disease. An electrocardiogram disclosed sinus arrhythmia, and artifact leads I and III. On a VA examination in November 1988, the veteran complained of chest pain. He stated that he experienced episodic anterior chest pain described as usually sharp, very sudden onset and of almost paralyzing intensity radiating to the laryngeal area that lasted between seconds and minutes. Shortness of breath was not a prominent feature of the complaint by history. It was also reported that the electrocardiogram was within normal limits, and that he had had the problem for at least four years and could recall having episodes of such pain earlier in his life. Cardiovascular examination revealed normal rate and rhythm of the heart without murmur or gallop. There was no evidence of pallor, cyanosis, clubbing, or edema. The blood pressure reading was 100/65 in the right arm in the sitting position. The chest X-ray films revealed no significant abnormality. An electrocardiogram revealed normal sinus rhythm with nonspecific ST-T-abnormality and was interpreted as borderline. The diagnoses included episodic chest pain, not typical of angina pectoris by history, nonspecific ST-T abnormality by electrocardiogram, normal chest X-ray study. The veteran's testimony at a personal hearing on appeal at the RO in November 1989 was silent with respect to a cardiovascular disease. On a private examination in August 1991 at the St. Anthony's Medical Center, the veteran reported that he had a heart murmur. Examination revealed normal heart and rhythm. A radiographic report shows that chest X-ray films revealed normal cardiac structures. An electrocardiogram of the veteran in August 1991 disclosed normal sinus rhythm and nonspecific inferior T abnormalities. The results were interpreted as borderline. The veteran had a VA cardiovascular examination in August 1992. It was noted that he veteran did not have a previous cardiac disease history. It was further noted that he had a less than 10 year history of incidence of sharp chest pain unrelated to exertion. He was not on cardiac medication. The final impressions were mitral valve prolapse, doubt coronary artery disease. An electrocardiogram of the veteran in August 1992 revealed sinus bradycardia, otherwise normal. On a VA cardiovascular examination in February 1994, the veteran complained of occasional episodes of nonexertional chest pain, occurring sporadically about one per month that was associated with shortness of breath. He denied having orthopnea, paroxysmal nocturnal dyspnea or syncope, but complained of occasional palpitation. The veteran related that he had one episode of hemoptysis. It was noted that he had a history of a stress test and an electrocardiogram more than a year before, the results of which were not available. Examination revealed no cyanosis, clubbing, rash or carotid bruit. Heart examination revealed normal S-1 an S-2 without S-3 or S-4. There was S-2 splitting in the pulmonary area. No evidence of murmur, thrill, heave or rub was found. The blood pressure reading was 110/68. It was noted that an electrocardiogram revealed normal sinus rhythm, possibly left atrial enlargement, and no other abnormalities. The veteran declined to undergo a stress test and an echocardiogram. The diagnoses were that the veteran presented nonspecific chest pain and history of rheumatic fever, that the clinical findings did not disclose significant cardiovascular disease, and that the tests requested would greatly aid in enhancing the completion of the evaluation. A threshold requirement in establishing a well-grounded claim for service connection for a disability is that that disability must be shown to exist. 38 U.S.C.A. § 1110, 1131 (West 1991). Here, a review of the claims folder shows that the veteran exhibited abnormal cardiovascular symptoms and manifestations during service, but most of them were not confirmed by postservice examinations. It is significant that the chest X-ray films in July 1985 revealed left ventricular prominence, that an electrocardiogram disclosed nonspecific ST-T abnormality, and that an examiner in August 1992 had an impression of mitral valve prolapse. Nevertheless, there was no diagnosis of cardiovascular disease. Because of the above-mentioned evidence, we remanded the case for a special cardiovascular examination to determine whether or not the veteran had heart disease. The veteran had a special VA cardiovascular examination in February 1994. At the examination, it was noted that an electrocardiogram had revealed possibly left atrial enlargement, that he had undergone a stress test and electrocardiogram more than a year before, but that the reports disclosing their results were not available. The veteran was then scheduled for a stress test and an echocardiogram, but he declined to undergo a stress test and an echocardiogram. The examiner concluded that the clinical findings did not disclose any significant cardiovascular disease. He added that the requested diagnostic studies would have greatly aided in the determination of whether the veteran had heart disease. The record currently before us does not establish that the veteran has cardiovascular disease. Hence, the claim for service connection for cardiovascular disease is not well-grounded. Although there is a suggestion that further studies may disclose cardiovascular disease, the veteran has declined such studies. Accordingly, we must base our decision on the evidence before us. III. Entitlement to Service Connection for a Pulmonary Disorder to include Residuals of Pneumonia. Service medical records reveal that in February 1974 the veteran complained of back pain and cough. Examination revealed rhonchi in the left lung. A chest X-ray film showed a floor lobe infiltrate and a "single-coin lesion" in the parenchyma of the periphery of the left lung that overlaid the scapula but did not move with the rotation of the scapula. The impressions were pneumonia, probably viral; and rule out tuberculosis or histoplasmosis. In early March 1974, the veteran complained of nervousness and jitteriness. In mid-March 1974, he reported having some cold symptoms. Examination revealed that the chest and lungs appeared normal. The impression was viral upper respiratory infection. A chest X-ray study in January 1975 showed evidence of an old granulomatous disease. In a medical history report of October 1976, the veteran reported having or having had pain or pressure in the chest. The examiner related that the veteran had off-and-on pain in the chest, and that he smoked more than 40 cigarettes daily. In a respiratory history, dated in August 1977, the veteran had chief complaints of mild pain and cough for seven days that was not improving. Examination revealed chest point tenderness. Medication was prescribed. The assessments included bronchitis. The service medical records show that in August 1977 the veteran again reported that his chest hurt. In May 1978, he complained of pain in the side of his chest of one-day duration. A periodic examination in June 1978 revealed normal lungs and chest. A chest X-ray film was negative. In a medical history report completed in connection with that examination, the veteran answered in the affirmative the question of whether he had or had ever had pain or pressure in the chest. In March 1979, the veteran had chest pain of two days' duration. The periodic service examination in March 1979 revealed no pertinent disorder. A chest X-ray film was negative. In November 1980, he again complained of chest pain. Examination revealed a clear chest. In March 1981 in an emergency room, the veteran complained of intermittent chest pain of 3 to 4 months' duration. In March 1981, the veteran was referred for a cardiac evaluation. A history of pressure and heavy sensation in the left chest since December 1980 was reported. The sensation was described as a knot-like sensation that would last for several hours and knife- like pain lasting from 2 to 3 seconds. These sensations were not particularly related to activity, food ingestion, position or stress. They were relieved spontaneously. He smoked approximately two packages of cigarettes per day. He denied a history of chronic lung disease. On examination, the chest was symmetrical. There were mild wheezes in the right upper and mid lung fields on forced expiration. The chest X-ray study was within normal limits. The diagnoses were chest pain of noncardiac origin and mild obstructive pulmonary disease. In an April 1981 radiographic report, it was noted that the veteran had a 5 mm density in the lateral aspect of the left mid-chest that was probably a calcified granuloma, and that the X-ray study was otherwise negative. In a medical history report completed in connection with a periodic examination in September 1982, the veteran answered in the affirmative the questions of whether he had or ever had shortness of breath, and pain or pressure in the chest. The examiner reported that the veteran had shortness of breath and chest pain . The service medical records also disclose that in April 1983 the veteran had some pleuritic chest pain. Clear lungs in all fields were found. The impression was viral illness. In July 1983, the veteran complained of bruised rib while diving and hitting the edge of a pool. Examination of the chest showed tenderness in the left lateral chest wall. Lungs were clear to percussion and auscultation. The assessments included contusion of the right chest wall. In a radiographic report of July 1983, it was noted that chest X-ray films revealed no active cardiopulmonary disease without evidence of aspiration, pneumonitis or edema, and that there was a 4 mm calcified granuloma in the left lung periphery. A chest X-ray film in April 1984 disclosed an old granulomatous disease without evidence of acute disease. At an emergency clinic at a hospital in October 1984, the veteran complained of chest pain. He denied difficulty breathing. He stated that the pain was a sharp stabbing sensation. There was no pain in the chest on palpation. The lungs were clear. The assessment/diagnosis was costochondritis. A periodic service examination of the veteran in November 1984 showed normal lungs and chest. A chest X-ray film was normal. In a medical history report completed in connection with that examination, the veteran reported having or having had pain or pressure in the chest. The examiner commented that the veteran had pain in the chest occasionally along the left side and arm. It was further noted that the veteran had had pneumonia in January 1969 and May 1974. A service radiographic report of June 1985 shows that a chest X- ray study disclosed no abnormalities of pulmonary vasculature, and that there were old granulomatous changes seen but were unchanged in appearance from a prior study. A report from Wood River Township Hospital, dated in July 1985, reveals that the veteran denied a history of chest pain or respiratory distress, and that an examination disclosed a clear chest with tachycardia. A chest X-ray revealed minimal interstitial fibrosis with slight infiltration of the left lower lobe. The left hilum was slightly prominent. There were a few scattered old calcified granulomas. The impressions included minimal fibrotic changes of the left lung with possibly minimal infiltration with prominence of the left hilum and ruleout remote possibility of broncho-occlusive disease. Another X-ray revealed minimal fibrotic changes and blebs in the lung field with calcified left hilar nodes and peripheral parenchymal calcification most compatible with old granulomatous disease. At an emergency room in October 1985, the veteran reported having 24 hours' pressure sensation to the chest. He also complained of severe weakening and dizziness associated with transient spells of shortness of breath and tightness of the chest. Examination revealed that the lungs were clear to percussion and auscultation. In a medical history report completed in connection with a periodic examination in May 1986, the veteran answered in the affirmative the questions of whether he had or had ever had shortness of breath, and pain or pressure in the chest. Examination revealed normal lungs and chest. A chest X-ray film was within normal limits. The veteran reported that he experienced chest pain and pressure while running. In mid-March 1987, the veteran reported having chest congestion, pain and discomfort. A few days later, he complained of chest pain which radiated to the roof of his mouth. The service medical records disclose that in September 1987 the veteran complained of chest pain. He added that the chest hurt whenever he coughed. Chest examination showed scattered rhonchi cleared with coughing. There were no rales or wheezes. The impression was upper respiratory infection. Retirement examination in March 1988 revealed normal lungs and chest. The chest X-ray film was within normal limits. In a medical history report completed in connection with that examination, the veteran reported having or having had pain or pressure in the chest. He added that he had sharp/severe chest pains. The chest X-ray film showed a healed granuloma in the left midlung field, laterally. The lungs were otherwise clear. The impression was healed granulomatous disease without active disease. On a VA examination in November 1988, the veteran complained of chest pain. He stated that he experienced episodic anterior chest pain described as usually sharp, very sudden onset and of almost paralyzing intensity, radiating to the laryngeal area, and lasting between seconds and minutes. Shortness of breath was not a prominent feature of the complaint by history. Examination of the respiratory system disclosed clear chest to percussion and auscultation. The chest X-ray films revealed no significant abnormality. The diagnoses included episodic chest pain, not typical of angina pectoris by history; normal chest X-ray study; and no current complaint in regards to pneumonia. At a hearing on appeal at the RO in November 1989, the veteran testified that he had pneumonia during service, that he currently had residuals of the pneumonia to include chest pains and occasional breathing difficulty, and that because of the residuals he could not participate in any sports. The veteran stated that he had pneumonia in January 1989 and again in October 1989, and that he was currently receiving treatment for his pulmonary condition. He mentioned that he was not taking any medication for his pulmonary condition. The veteran felt that his chest pain was related to the pneumonia he had had in service. On a private examination in August 1991 at the St. Anthony's Medical Center, the veteran had clear lungs. A radiographic report shows that chest X-ray films revealed no infiltrative or consolidative process in either lung field, and that there was no evidence or congestion or effusion. The radiologist's impression was normal chest. On a VA cardiovascular examination in February 1994, the veteran complained of occasional episodes of nonexertional chest pain, occurring sporadically at about one per month that was associated with shortness of breath. He denied having orthopnea, paroxysmal nocturnal dyspnea or syncope. Examination of the lungs was normal on percussion. Normal breath sounds without wheezes or rales were heard. The diagnoses included that the veteran presented nonspecific chest pain. As was stated before, for a claim for service connection for a disability to be well grounded, the disability must be shown to exist. Initially, we observe that in service the veteran complained of chest pain and had pulmonary disorders including pneumonia, but that the clinical findings during his retirement examination in March 1988 reflected normal lungs and chest. While a chest X-ray study at that time showed a healed granuloma in the left midlung field, subsequent chest X-ray studies were within normal limits. VA chest X-ray films in November 1988 revealed no significant abnormality. A private radiographic report of August 1991 shows that the veteran did not have any infiltrative or consolidative process in either lung field, and that there was no evidence or congestion or effusion. Any radiographic findings of a lung abnormality in service have not been confirmed by postservice chest X-ray studies. There is no current diagnosis of a chronic respiratory disorder. The veteran has asserted that he has residuals of pneumonia, but there is no medical evidence disclosing such residuals since service. Without substantiating objective evidence, his lay assertions including those at the personal hearing in November 1989 have no merit. He is not competent to render an opinion that his complaints of chest pain are a residual of pneumonia. Hanna v. Brown, 6 Vet.App. 507(1994). As stated before, the threshold requirement to establish a well-grounded claim for service connection is the presence of the disability for which service connection is being sought. In the absence of medical evidence showing that the veteran currently has the claimed disability, we hold that his claim for service connection for a pulmonary disorder manifested by chest pain is not well grounded. IV. Entitlement to Service Connection for a Neck Disorder. The service medical records disclose that in May 1978 the veteran complained of pain in the side of his neck of one-day duration. In June 1985, he related that he had pain in the neck. Examination revealed a supple neck. In March 1986, he complained of neck pain of one month duration. He added that his neck would grind upon slight rotation and that he had had that symptom for two years. Examination revealed full range of neck motion with crepitation. The impressions included pain in the cervical spine. A radiographic report of March 1986 shows that the veteran had a history of intermittent pain for 2 years without history of trauma, and that the X-ray films revealed no significant abnormality. The service medical records disclose that the veteran had neck pain in early April 1986. X-ray films of the cervical spine were within normal limits. A few days later, he again complained of neck pain. A periodic examination in May 1986 revealed no muscular abnormality of the neck. In mid-July 1986 at an orthopedic clinic, he reported that he had increased neck pain. Examination revealed full range of motion of the neck. An X-ray film showed osteophytes of C3-4. The assessment was mild cervical spondylosis. A radiographic report of mid-July 1986 shows that an X-ray study of the veteran's cervical spine disclosed minimal early degenerative changes at C4-5 level, that there was a nuchal bone between the spinous processes of C2 and C3, without evidence of significant osteophyte formation in the region of the neural foramina; and that the intervertebral disc spaces were well maintained. The impression was minimal early degenerative change. A problem of degenerative joint disease of cervical spine was recorded in October 1986. In early December 1986, the veteran complained of neck pain. A day later, it was reported that the veteran had mild degenerative joint disease with nuchal bone below C2-C3 spaces. Examination revealed full range of neck motion without symptoms. Tenderness was elicited in the posterior soft tissues at C2, C3, C4 levels. Passive motion was within normal limits. Neurological function was also normal. The assessment was myofascial neck pain. At the orthopedic clinic a few days later, it was mentioned that he currently had cervical spondylosis. Examination revealed tenderness at C1, C3/4 spinal process. He was able to bend his chin to the chest. On a Master Problem List, it was noted that the veteran had degenerative joint disease and myofascial neck pain in early December 1986. An assessment of normal electromyogram findings at the cervical parapineal inconsistent with cervical radiculopathy was reported in January 1987. In April 1987, the veteran complained of pain in both shoulders and neck. A history of degenerative joint disease of the cervical spine was reported. Examination showed that the neck was supple. At a medial/surgical clinic in late April 1987, the veteran reported that his problems included neck aches. Clinical data included that he had spondylosis and osteophytes on cervical spine X-ray films, and that pain increased with pushups and running. Examination revealed C8 sensory loss. The impressions included cervical spondylosis with mild left C8 radiculopathy. The service medical records disclose that in December 1987 the veteran complained of pain in the shoulder/neck area. No history of trauma was reported. The impression was muscle spasm. At a physical therapy clinic in mid-December 1987, the veteran reported that he felt as though he had a bad stiff neck. Examination revealed grossly normal motor and neurological function. The assessment was left upper trapezius myalgia. In late December 1987, the veteran related that he had pain increasing but radiating down the right shoulder. It was noted that he had a permanent profile for a neck condition. Examination disclosed full range of neck motion; there was pain. The assessment was slowly resolving left upper trapezius myalgia. On the veteran's service retirement examination in March 1988 it was noted that he had suffered with severe neck pain since 1982. On a VA examination in November 1988, the veteran mentioned that he had been informed of having degenerative arthritis of his cervical spine. Examination revealed a normal neck. Limitation of neck motion was observed. He could not touch his chin to the chest. Other movements of the cervical spine were normal but with complaints of pain on lateral flexion. A cervical spine X-ray study showed reversal of the normal cervical lordosis and anatomical alignment without fracture. The diagnoses included episodic chest pain might be related to cervical spine abnormality, limited motion of the cervical spine - X-rays showing reversal of the normal curvature. At a hearing on appeal at the RO in November 1989, the veteran testified that he received treatment for a neck disability in service. He mentioned that the neck symptoms included pain and irritation, and that he was placed on permanent profile for the neck disability. A VA radiographic report of February 1994 shows that X-ray films disclosed normally aligned vertebral bodies with normal width of the interspaces, that there was no evidence of fracture, dislocation, or bone or joint pathology, and that the impression was normal cervical spine. On a VA orthopedic examination in February 1994, the veteran gave a history of neck pain, but reported having no neck pain currently. Examination of the neck revealed some limitation of motion. After reviewing the X-ray films reported above, the examiner noted that the veteran had early degenerative joint disease of the cervical spine. Service medical records disclose that the veteran had longstanding recurring complaints of neck pain. Several X-rays in service revealed arthritic changes in the cervical spine. On a VA examination in February 1994, the examiner found that the veteran had early degenerative arthritis of the cervical spine. The only logical conclusion based on the evidence is that the veteran has cervical arthritis which began in service. Consequently, service connection for arthritis of the cervical spine is warranted. V. Entitlement to an Increased Rating for Migraine Headaches. The veteran asserts that he is entitled to a disability rating higher than the 10 percent currently in effect for his service- connected migraine headaches. Under the provisions of Diagnostic Code 8100 of the Schedule for Rating Disabilities, a 10 percent evaluation is warranted for migraine with characteristic prostrating attacks averaging one in 2 months over the last several months. A 30 percent evaluation requires characteristic prostrating attacks occurring on an average of once a month over the last several months. 38 C.F.R. Part 4 Code 8100. We have reviewed the entire claims folder of the veteran which included his service medical records, VA examination reports and a hearing transcript. 38 C.F.R. §§ 4.1, 4.2, 4.41 (1994). The service medical records disclose that the veteran had headaches on several occasions. In the medical history completed in connection with the retirement examination in March 1988, the veteran reported having or having had frequent or severe headaches. On a VA examination in November 1988, the veteran complained that he experienced severe headaches almost daily and that he was currently receiving treatment for the headaches. He said that he took a drug called "Midrin" for headaches. Examination revealed no pertinent abnormalities. At a personal hearing in November 1989, the veteran testified that he felt the headaches were caused by any injury during basic training in 1968. He further related that he had received treatment for the headaches since 1970, and that the headaches continued to become progressively worse. The veteran added that he had severe headaches daily, and had learned to live with them, but that the headaches still bothered him extremely. The veteran described the pain as numbing, sometimes associated with slurred speech, blurred vision and blackout spells. He further stated that he experienced trouble sleeping because of the headaches, and that he was taking daily medication for the headaches. A careful review of the evidence in the claims folder discloses that the veteran reports having severe headaches daily. However, he has not described characteristic prostrating attacks occurring on an average of once a month over the last several months. Neither the clinical data nor his testimony at the November 1989 hearing demonstrates that the requisite schedular criteria for the next higher disability rating have been met. Consideration has also been given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, including § 4.40 (1994), whether or not they were raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet.App. 589, (1991). In particular, we find that the evidence discussed above does not suggest that the migraine headaches present such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards and to warrant an assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1) (1994). For example, the disability did not recently require frequent periods of hospitalization, nor does it present marked interference with employment that is not already been contemplated by the currently assigned evaluation. Consequently, a rating in excess of 10 percent for migraine headaches is not warranted. VI. Entitlement to an Increased Rating for Postoperative Lumbar Disc Disease. This disability has been rated, as strain, under Diagnostic Code 5295, which provides that a 20 percent evaluation is warranted where there is muscle spasm on extreme forward bending and unilateral loss of lateral spine motion in a standing position. Under Diagnostic Code 5292, slight limitation of motion of the lumbar segment of the spine warrants a 10 percent evaluation. A 20 percent evaluation requires moderate limitation of motion. A 40 percent evaluation requires severe limitation of motion. Intervertebral disc syndrome warrants a 10 percent rating when mild, a 20 percent rating when moderate with recurring attacks, and a 40 percent rating when severe, with recurring attacks with intermittent relief. Code 5293. The veteran's claims folder contains his service medical records, VA examination reports, private medical reports and the veteran's testimony 38 C.F.R §§ 4.1, 4.2, 4.41 (1994). A VA examination report of November 1988 shows no limitation of low back motion. The diagnoses included normal X-rays of the lumbosacral spine. A VA radiographic report of November 1988 reveals no skeletal abnormality of the lumbosacral spine. During a personal hearing conducted in the RO in November 1989, the veteran testified that he was given a profile in service because of his low back pain, that he was receiving physical therapy for the back condition, and that he experienced radiating low back pain down the left lower extremity and limitation of back motion. He added that he could not walk for more than 200 feet before he felt back discomfort, that climbing stairs was a problem for him, and that he occasionally had swelling, tenderness and muscle spasm. He said that he had muscle spasms about once a month and that the last episode lasted 4 days. On a VA orthopedic examination in February 1994, the veteran gave a history of a back injury in 1979. He complained of intermittent excruciating low back pain and left hip/lateral leg pain. He described the pain as sharp and stabbing. Range of low back motion was extension to 30 degrees, flexion to 90 degrees and lateral bending to 30 degrees. Motor and sensory function and reflexes were intact. It was noted that the X-rays showed early degenerative joint disease of the lumbar spine. The diagnoses included chronic low back pain without evidence of neurologic dysfunction. X-rays were interpreted as normal. Received for the record in March 1994 were copies of reports from St. Anthony's Medical Center, showing treatment of the veteran's low back in 1991. Also included were letters from G. J. Bailey, M.D., who gave a history of the veteran's low back pain and reported the results of an examination of the veteran's low back. In a letter of March 1994, S. R. Soerries, M.D., related that he had not actually seen the veteran in his office since July 1991, that the veteran had back pain with lumbosacral spine strain and herniated disc at L4-5, and that the veteran underwent a L4-5 diskectomy in August 1991. The veteran has degenerative disc disease of the lumbar spine, with arthritis. He underwent a L4-5 diskectomy. Since then, he has reported having back discomfort, swelling, tenderness and muscle spasm. He testified that he had muscle spasms about once a month. On a VA orthopedic examination in February 1994, his range of low back motion was extension to 30 degrees, flexion to 90 degrees and lateral bending to 30 degrees. These findings, reflect no more than slight limitation of lumbar motion. Hence, a rating in excess of 10 percent based on limitation of motion is not warranted. However, the veteran has had lumbar disc surgery with continuing complaints of discomfort, tenderness, spasm (occurring once a month). The picture presented is one of moderate disc disease with recurring attacks. Only intermittent relief is not demonstrated. Hence, a rating in excess of 20 percent is not warranted. We have also considered all other pertinent regulatory provisions, but found no basis for a rating in excess of 20 percent. In particular, factors, such as frequent hospitalization or marked interference with employment, which would warrant an extraschedular rating are not shown present. VII. Entitlement to an Increased (Compensable) Disability Evaluation for Residuals of a Fracture of the Right Wrist. This disability has been rated under Diagnostic Code 5215. Limitation of dorsiflexion of either wrist to less than 15 degrees or limitation of palmar flexion of either wrist to in line with the forearm warrants a 10 percent evaluation. 38 C.F.R. Part 4, Code 5215 (1994). Where the minimum schedular evaluation requires residuals and the schedule does not provide a noncompensable evaluation, a noncompensable evaluation will be assigned when the required residuals are not shown. 38 C.F.R. § 4.31 (1994). In evaluating the severity of the residuals of a fracture of the right wrist, we must look to the entire record. 38 C.F.R. §§ 4.1, 4.2, 4.41 (1994). The veteran's claims folders contain his service medical records, VA examination reports, private medical reports and the veteran's testimony. The service medical records reveal that the veteran sought treatment for a right wrist injury. At the VA examination in November 1988, a history of fracture of the veteran's right wrist was reported. The right wrist X-ray film revealed no fracture or dislocation. There diagnoses included normal X-ray of the right wrist with current complaint of some pain in the right wrist. During a personal hearing in November 1989, the veteran testified that he fractured his wrist when he fell down on concrete during service, and that he had severe wrist problems including loss of mobility and pain, and was given a profile. He said that he currently had loss of strength in the right wrist, that he could not do normal physical activities with the wrist, such as removing a tight lid off a jar, and that he had weak grip and difficulty shaking hands. The veteran further mentioned that his wrist would bother him during a change in the weather or temperature, that arthritis had set in, and that he wasn't receiving any treatment for the wrist condition. After carefully reviewing the medical evidence of record in conjunction with his contentions and testimony, we note that the veteran had only subjective complaints of right wrist pain on a VA examination in November 1988. The X-ray study at that time was within normal limits, even though he testified that he had arthritis. His testimony reflected other subjective complaints including weak grip, loss of strength and discomfort, but there was no objective evidence of limitation of right wrist motion. The complaints of functional loss due to pain are not supported by adequate pathology or shown visibly. Schafrath v. Derwinski, 1 Vet.App. 589 (1991). In view that the schedular criteria for a compensable disability evaluation have not been satisfied and in the absence of any medical showing of adequate pathology to account for subjective complaints of pain, we hold that a compensable evaluation for residuals of a fracture of the right wrist is not warranted. Additionally, the service-connected right wrist disorder does not warrant the assignment of a compensable rating on an extraschedular basis in accordance with 38 C.F.R. § 3.321(b)(1) (1994) since factors such as frequent periods of hospitalization or marked interference with employment which render impractical the application of the regular schedular standards have not been demonstrated. VIII. Entitlement to an Increased (Compensable) Disability Evaluation for Bilateral Hearing Loss. Evaluations of bilateral defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests together with the average hearing threshold level as measured by pure tone audiometry tests in the frequencies 1,000, 2,000, 3,000, and 4,000 cycles per second. To evaluate the degree of disability from bilateral service- connected defective hearing, the revised rating schedule establishes 11 auditory acuity levels, designated from level I for essentially normal acuity through level XI for profound deafness. 38 C.F.R. § 4.85 and Part 4, Codes 6100 to 6110. The veteran was accorded a VA audiometric examination, including pure tone air and bone conduction tests as well as speech audiometry, in December 1988. Pure tone air conduction tests revealed threshold levels of 15, 15, 35 and 55 decibels in the right ear and 15, 10, 30 and 40 decibels in the left at 1,000, 2,000, 3,000 and 4,000 hertz, respectively. The average threshold levels were 30 decibels in the right ear and 24 decibels in the left at those frequencies. Speech recognition ability was 100 percent correct and 94 percent correct, in the right and left ears, respectively. At a personal hearing on appeal at the RO in November 1989, the veteran related that he had hearing loss that affected his participation in school. He mentioned that he was handicapped because it was difficult for him to take notes during lectures and to listen in a group environment and comprehend conversation, that when he watched television or listened to the radio he had to turn the volume up considerably, and that on many occasions he could not hear the phone ring. Even though the veteran testified that his hearing loss impaired his daily activities, the results of the VA audiometric study are controlling in the determination of the assignment of a disability rating for service-connected bilateral hearing loss. Lendenmann v. Principi, 3 Vet.App. 345(1992). In the instant case, the audiometric findings reflect level I hearing in each ear. Under Diagnostic Code 6100, such impairment warrants a noncompensable rating. Additionally, the disability picture presented by the record is not unusual or exceptional. There is no evidence disclosing that the bilateral hearing loss has recently caused frequent periods of hospitalization or marked interference with employment. Hence, an extraschedular rating for the bilateral hearing loss is not warranted. IX. Entitlement to an Increased (Compensable) Disability Evaluation for Duodenal Ulcer Disease. This disability is evaluated under Diagnostic Code 7305 of the Schedule for Rating Disabilities. 38 C.F.R. Part 4 (1994). A 20 percent evaluation requires moderate duodenal ulcer with recurring episodes of severe symptoms two or three times a year averaging 10 days in duration or with continuous moderate manifestations. A 10 percent evaluation is warranted for mild duodenal ulcer with recurring symptoms once or twice yearly. Where the minimum schedular evaluation requires residuals and the schedule does not provide a noncompensable evaluation, a noncompensable evaluation will be assigned when the required residuals are not shown. 38 C.F.R. § 4.31 (1994). In evaluating the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. § § 4.1, 4.2 (1994). The veteran's claims folders contain his service medical records, VA examination reports, private medical reports and the veteran's testimony. A report from Wood River Township Hospital, dated in July 1985, reveals a principal diagnosis of duodenal ulcer. The veteran was admitted to the hospital with a history of abdominal pain, recurrent episode of nausea and vomiting with gastrointestinal bleeding. An upper gastrointestinal series showed duodenal ulcer disease, and duodenitis. The final diagnosis was duodenal ulcer disease. On a VA examination in November 1988, the veteran complained of some indigestion, stomach pain and lots of gas. A history of a "bleeding stomach ulcer" was reported. It was noted that he had hematemesis in 1985, and that he still took Maalox, but the symptoms had largely cleared. Examination of the digestive system was normal. The diagnoses included history of "bleeding stomach ulcer" in 1985 with hematemesis, currently on Maalox therapy, with normal upper gastrointestinal series in service according to the veteran. At a personal hearing in November 1989, the veteran testified that he experienced pain in the stomach and vomiting episodes to include throwing up of blood during service. He added that he still had stomach irritation, pain and nausea, that he regurgitated blood about once a month, and that he was on a diet to treat his stomach ulcer problems. The veteran also stated that he had not received any treatment for his ulcer problem since his separation from service, that he could not afford a private physician, and that basically he self-medicated himself for his gastrointestinal problem. The veteran has duodenal ulcer disease as established by upper gastrointestinal series. He testified that he had stomach irritation, pain and nausea, and that he regurgitates blood about once a month. Thus, the record reflects that the veteran has recurring symptoms of mild duodenal ulcer disease. Recurring episodes of severe symptoms two or three times a year averaging 10 days in duration or with continuous moderate manifestations are not shown either by the medical evidence of record or in the veteran's testimony at the November 1989 personal hearing. Under these circumstances, after resolving reasonable doubt in the veteran's favor, we are of the opinion that a 10 percent disability rating for duodenal ulcer disease is warranted but that a rating in excess of 10 percent is not. It has not been shown that the duodenal ulcer disease presents such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards and to warrant an extraschedular evaluation under 38 C.F.R. § 3.321 (1994). ORDER The claims for service connection for a bilateral foot disorder to include an arch disorder and residuals of a foot injury, a cardiovascular disorder, and a pulmonary disorder to include residuals of pneumonia are dismissed. Service connection for arthritis of the cervical spine is granted. A 20 percent disability rating for postoperative lumbar disc disease and a 10 percent disability rating for duodenal ulcer disease are granted, subject to the regulations controlling payment of monetary awards. A disability rating in excess of 10 percent for migraine headaches is denied. A compensable disability evaluation for residuals of a fracture of the right wrist is denied. A compensable disability evaluation for bilateral hearing loss is denied. GEORGE R. SENYK Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.