BVA9503696 DOCKET NO. 92-10 023 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Portland, Oregon THE ISSUE Entitlement to an increased evaluation for a left varicocele, status post varicocelectomy, chronic orchalgia, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Ronald R. Bosch, Counsel INTRODUCTION The veteran served on active duty from January 1954 to March 1956. This appeal arose from a September 1990 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon. The RO denied entitlement to an increased (compensable) evaluation for the veteran's genitourinary disability then classified as a left varicocele. The Board of Veterans' Appeals (Board) REMANDED this case to the RO for further development in December 1993. The Board instructed the RO to rule on whether the veteran was entitled to special monthly compensation for loss of use of a creative organ and if the decision was adverse to the veteran, he was to be advised of his appellate rights. In a July 1994 rating decision, the RO granted entitlement to an increased (compensable) evaluation of 10 percent for a left varicocele, status post varicocelectomy, chronic orchalgia; and denied entitlement to special monthly compensation for loss of use of a creative organ. The RO issued a supplemental statement of the case to the veteran in August 1994 encompassing the new issue of entitlement to special monthly compensation for loss of use of a creative organ. The RO advised him of his appellate rights but the veteran did not file a substantive appeal as to this issue. The veteran did not respond within 60 days as instructed to perfect his appeal as to the new issue. The Board has therefor limited its jurisdiction of the appellant's case to the issue reported on the title page. The representative has questioned the effective date of the RO grant of an increased (compensable) evaluation for the appellant's left varicocele. Instead of August 27, 1991, the date selected by the RO. the representative believes the date should have been effective retroactive to April and May 1989, when the veteran is believed to have made informal claims for increased compensation benefits. 38 C.F.R. § 3.155 (1994). As this issue have neither been prepared nor certified for appellate review, the Board is referring it to the RO for initial consideration. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his genitourinary disability is more disabling than currently evaluated, thereby warranting entitlement to an increased evaluation. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against a grant of an increased evaluation for a left varicocele, status post varicocelectomy, chronic orchalgia. FINDING OF FACT The veteran's left varicocele, status post varicocelectomy, with chronic orchalgia is productive of impairment compatible with tenderness and pain on objective demonstration. CONCLUSION OF LAW An evaluation in excess of 10 percent for left varicocele, status post varicocelectomy, chronic orchalgia, is not warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.20, 4.118, Diagnostic Codes 7803,7804, 7805 (1994). REASONS AND BASES FOR FINDING AND CONCLUSION Initially the Board finds that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a), in that it is at least plausible that his genitourinary disability has increased in severity. The Board is satisfied that as a result of the December 1993 remand of the case to the RO for further development, all relevant facts have been properly developed, and that no further assistance to the veteran is required in order to comply with 38 U.S.C.A. § 5107(a). In accordance with 38 C.F.R. §§ 4.1 and 4.2, and Schafrath v. Derwinski, 1 Vet.App. 589 (1991), the Board has reviewed the service medical records and all other evidence of record pertaining to the history of the veteran's genitourinary disability. The Board has found nothing in the historical record which would lead to a conclusion that the current evidence of record is inadequate for rating purposes. The service medical records show that when examined for separation from service in January 1956, the veteran was reported to have a left varicocele. The RO granted entitlement to service connection for a moderate left varicocele which was assigned a noncompensable evaluation when it issued a rating decision in November 1972. The veteran was hospitalized by VA during May and June 1986. He presented with a 20 year history of a left varicocele which was first noticed on a routine physical examination. Since then the appellant had noted the varicocele to become more tender and bothersome. He also believed it had been growing larger. On genitourinary examination was seen a left varicocele which did not increase with Valsalva or transluminate. A left varicocelectomy and left direct inguinal hernia repair were performed. The relevant discharge diagnosis was symptomatic left varicocele and left inguinal hernia. In an October 1986 letter, a VA physician noted that in May 1986 the veteran had undergone ligation of a left varicocele. His postoperative course was uneventful and he had recovered fully from the surgery. The appellant provided testimony at an RO hearing held in January 1992. The veteran testified that he continued to have pain and tenderness from the left varicocele. He described swelling following exertion of the left testicle which had caused him to lose some time from work, interfere with his sleep and cause fatigue preventing him from going to work. VA outpatient treatments reports on file dated during the 1980's and early 1990's show that in July 1992 the veteran was seen with complaints of a painful left varicocele which had been surgically repaired in 1986. A small left varicocele was noted on examination. There was a clinical assessment of orchalgia. An April 1994 VA genitourinary examination report shows the veteran was pertinently diagnosed with a left varicocele. The veteran's left varicocele is rated by analogy to a tender and painful scar under diagnostic code 7804 of the VA Schedule for Rating Disabilities. 10 percent is the only evaluation under this diagnostic code contemplating tenderness and pain on objective demonstration. A 10 percent evaluation may be assigned for scars that are poorly nourished with repeated ulceration under diagnostic code 7803. This is not shown to be the veteran's case. Other scars are rated on the basis of limitation of function of the anatomical part affected under diagnostic code 7805. The veteran is already compensated for his left varicocele with postoperative residuals of a previous varicocelectomy and orchalgia under diagnostic code 7804. There is no medical evidence of record to permit the Board to assign a higher evaluation for the veteran's genitourinary disability. The left varicocele disability has not been shown to be productive of any other relevant genitourinary impairment which would warrant a higher evaluation under diagnostic code 7512, as for chronic cystitis. In this regard the Board observes that moderately severe genitourinary impairment which would warrant an increased evaluation of 20 percent as for cystitis productive of diurnal and nocturnal frequency with pain and tenesmus is not shown by the medical evidence of record. No question has been presented as to which of two or more evaluations would more properly classify the severity of the veteran's genitourinary disability. 38 C.F.R. § 4.7. It has not rendered the veteran's disability picture unusual or exceptional in nature and has not markedly interfered with employment. It has not required frequent inpatient care as to render impractical the application of regular schedular standards, thereby precluding assignment of an increased evaluation on an extraschedular basis. 38 C.F.R. § 3.321(b)(1). The Board finds that the veteran's left varicocele, status post varicocelectomy with chronic orchalgia is properly evaluated as 10 percent disabling and the evidentiary record does not support a grant of an increased evaluation with application of pertinent governing criteria. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.20, 4.118, Diagnostic Codes 7803, 7804, 7805. ORDER Entitlement to an increased evaluation for a left varicocele, status post varicocelectomy, chronic orchalgia is denied. BRUCE KANNEE 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.