BVA9502564 DOCKET NO. 93-04 402 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUES Entitlement to service connection for a pterygium of the right eye. Entitlement to increased (compensable) evaluations for degenerative joint disease of the right knee with chondromalacia, degenerative joint disease of the left hip, and a pterygium of the left eye. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD Richard V. Chamberlain, Counsel INTRODUCTION The veteran had active service from March 1969 to March 1991. This appeal comes to the Board of Veterans' Appeals (Board) from a July 1991 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona. As clarified in subsequent records, including statements by the veteran and his representative, the issues for Board review are entitlement to service connection for a right eye pterygium, and entitlement to increased (compensable) ratings for a right knee disability, left hip disability, and a left eye pterygium. The Board notes that the appeal initially included an issue of entitlement to an increased (compensable) rating for a right shoulder disability. The RO hearing officer subsequently assigned a 10 percent rating for that disorder, which was the full benefit requested by the veteran. That issue is no longer on appeal. The Board also notes that the July 1991 RO decision denied service connection for a left knee disability, and the veteran did not appeal that determination. He has since submitted a February 1992 VA X-ray report (from within the year after service) which notes, in part, mild degenerative changes of the left knee. This may represent an inferred application to reopen the previously denied claim for service connection for a left knee disability. See EF. v. Derwinski, 1 Vet.App. 324 (1991). This matter, which has not been developed for Board review, is referred to the RO for appropriate action. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that a beginning pterygium of the right eye was first found at the examination for his retirement from service, and he requests service connection for this disorder. He requests compensable ratings for service-connected disabilities of the right knee and left hip. He contends that he has functional limitation of the right knee due to pain. He also requests a compensable rating for his service-connected pterygium of the left eye. His representative, in a statement dated in February 1993, requested a remand of this case in order to have the veteran undergo additional VA medical examinations. 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, and for the following reasons and bases, it is the decision of the Board that the evidence supports service connection for a right eye pterygium (or pinguecula) and supports an increased rating (to 10 percent) for a disability of the right knee. It is also the decision of the Board that the preponderance of the evidence is against the claims for increased (compensable) ratings for degenerative joint disease of the left hip and a pterygium of the left eye. FINDINGS OF FACT 1. A right eye pterygium (or pinguecula) began during active service. 2. Arthritis and chondromalacia of the right knee is manifested primarily by episodic pain with minimal limitation of motion. 3. Arthritis of the left hip is manifested by X-ray evidence without any limitation of motion or other functional impairment. 4. A left eye pterygium does not cause loss of vision. CONCLUSIONS OF LAW 1. A right eye pterygium (or pinguecula) was incurred in active service. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 1991); 38 C.F.R. § 3.303 (1993). 2. The criteria for a 10 percent rating for degenerative joint disease of the right knee with chondromalacia are met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.71a, Code 5003 (1993). 3. The criteria for a compensable rating for degenerative joint disease of the left hip are not met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.31, 4.71a, Code 5003 (1993). 4. The criteria for a compensable rating for a pterygium of the left eye are not met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.75, 4.84a, Codes 6034, 6079 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background The veteran had active service from March 1969 to March 1991. The 1969-1991 service medical records show that for most of the veteran's service he was noted to have refractive error of vision for which he was prescribed glasses with corrective lenses. A small, asymptomatic pterygium of the left eye was noted in December 1978, and this was periodically noted throughout the remainder of service. It was generally referred to as a left eye pterygium, but occasionally as a left eye pinguecula. Numerous eye examinations showed no similar problem in the right eye. The August 1990 service retirement examination noted refractive error, with distant and near vision corrected with lenses to 20/25 in both eyes. Clinical examination of the eyes (item 24 on the examination form) showed a pterygium of the "left" eye; although when summarizing all examination defects (item 74 on the form) the examiner referred to a "right" eye pterygium. The service medical records show intermittent right knee symptoms, with assessments which included chondromalacia and degenerative joint disease (arthritis). Right knee X-rays in July 1990 were reportedly compatible with the veteran's age, showing minor degenerative changes; the lower extremities were normal at the August 1990 retirement examination; and in September 1990 there were right knee symptoms assessed as minimal degenerative joint disease. During service the veteran also had intermittent left hip complaints, with assessment which included tendinitis and arthritis. X-rays of the left hip in February 1990 were reportedly compatible with the veteran's age, showing minimal degenerative changes; and the problem was not noted at the August 1990 retirement examination. The veteran retired from service in March 1991. His initial VA compensation claim, received by the VA in April 1991, referred to a left eye pterygium but not a right eye pterygium. The veteran underwent a VA examination in May 1991. He complained of right knee pain. He stated that the right knee was painful when running or going up and down stairs. He stated that the right knee made a "crunching sound," and at times he would have occasional aching in the knee. He stated that a pterygium of the left eye was found in service, and was growing, and that he believed he was also getting one on the right eye. He stated that the pterygium seemed to bother his left eye vision. He complained of occasional hip pain that began in service. On examination, a pterygium was noted on the left eye, and an early pterygium was noted on the right eye. There was no limitation of motion of the lower extremities. The impressions included pterygium on the left, early pterygium on the right. Service department medical records show the veteran received outpatient treatment, as a military retiree, for various ailments from September 1991 to March 1992. In September 1991 he was treated for right leg pain, from the posterior thigh to the knee, following a July 1991 water-skiing accident. The impression was muscle strain of the posterior thigh. Subsequent records, dated to 1992, show periodic treatment for this leg/thigh injury; there were also isolated complaints of right knee pain. The records do not refer to left hip or any eye problems. In December 1991, the veteran underwent a VA eye examination. He gave a history of a bump on his left eye about 5 to 10 years previously, and that he had worn glasses since the age of 18. The visual acuity of both eyes was 20/20 minus 1. The right eye had a pinguecula nasally but no corneal vessels. The left eye had a 2-millimeter pterygium. The ocular media were clear. Nerve heads had good color and distinct edges. There was no visible retinopathy. The impression was pterygium on the left eye. VA records show that the veteran received outpatient treatment for various disorders in 1991 and 1992. In November 1991 he complained of right knee pain. An orthopedic consultation in February 1992 noted the veteran's complaints of occasional right knee pain, usually after running. There was no effusion of the right knee, which was stable. He had good quadriceps muscle strength. Range of motion was from 0 to 120 degrees. The assessment was patellofemoral pain. X-rays showed mild lateral tracking of the right patella when compared with the left. The veteran testified at a hearing at the RO in June 1992. He stated that he began wearing glasses in service and at the time of his medical examination for retirement from service, a pterygium or pinguecula of the right eye was suspected, but not recorded by the physician. He complained of pain of the right knee with certain activities, such as when climbing up and down a hill or stairs. He said that he had no significant problems with the arthritis of the left hip. He also requested a compensable evaluation for the pterygium of the left eye. A September 1992 RO rating decision shows that service connection is in effect for degenerative joint disease of the right shoulder, rated 10 percent; chondromalacia and degenerative joint disease of the right knee, rated zero percent; degenerative joint disease of the left hip, rated zero percent; metatarsalgia with calcaneal spurs of the feet and status post removal of neurofibroma on the right foot, rated zero percent; pterygium of the left eye, rated zero percent; allergic rhinitis, rated zero percent; hemorrhoids, rated zero percent; and keratoses and solar elastosis of the face and trunk, rated zero percent. The combined rating for the service-connected disabilities is 10 percent. II. Legal Analysis The veteran's claims are well-grounded, meaning they are plausible. 38 U.S.C.A. § 5107(a) (West 1991). The veteran's representative requests a remand of this case for additional VA medical examinations, but in the judgment of the Board all relevant evidence has been developed, particularly when taking into account the hearing testimony and medical records submitted since the last VA compensation examination. Consequently, there is no further VA duty to assist the veteran with the instant claims, which have been decided based on the evidence of record. Id. A. Service Connection for Pterygium of the Right Eye In order to establish service connection for a disability, the evidence must show the presence of it and that it resulted from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. The veteran's service medical records primarily refer to a left eye pterygium (at times labeled as a similar condition, pinguecula), which is now service connected. He says that an early right eye pterygium (or pinguecula) was detected by the doctor at his 1990 service retirement examination, but perhaps not recorded. The veteran's assertions appear credible on this point and are somewhat corroborated by the 1990 retirement examination which noted a left eye pterygium on clinical examination, but referred to the problem as involving the right eye when summarizing defects. This, of course, may have been a simple mistake by the examiner when recording his findings. An early pterygium of the right eye was noted at the initial VA examination in May 1991, less than two months after the veteran's March 1991 retirement from service. The doctor did not comment on the likely date of onset of the condition, but the finding so soon after service is consistent with the veteran's account of the condition being detected near the end of his service. The December 1991 VA eye examination found a right eye pinguecula, but it appears that the doctor was describing the same eye lesion, whether categorized as a pterygium or the kindred condition of a pinguecula. The Board finds that the evidence is evenly divided on whether the right eye pterygium (or pinguecula) was incurred in service; the benefit of the doubt is given to the veteran on this point, and service connection is warranted. 38 U.S.C.A. § 5107(b). B. Increased (Compensable) Rating for Degenerative Joint Disease of the Right Knee With Chondromalacia Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When the limitation of motion of the specific joint or joints involved is not compensable under the appropriate diagnostic codes, an evaluation of 10 percent is applied for each major joint or group of minor joints affected by limitation of motion. These 10 percent evaluations are combined, not added, under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Code 5003. Active duty service medical records, including X-rays, show minimal right knee arthritis and chondromalacia. The evidence since service indicates that the veteran complains of occasional right knee pain. The report of his VA orthopedic consultation in February 1992 indicates the presence of some limitation of motion of the right knee. (Motion of 0 degrees-120 degrees is lightly less than the norm. 38 C.F.R. § 4.71, Plate II.) While the limitation of motion of the right knee at that time was not severe enough to warrant a compensable rating under Diagnostic Codes 5260 or 5261, it does warrant a compensable rating under Diagnostic Code 5003 based on degenerative arthritis of the right knee with at least some limitation of motion, particularly when the effects of pain on functional impairment are considered. 38 C.F.R. § 4.59. A rating in excess of 10 percent for degenerative arthritis of the right knee, however, is not warranted. The evidence supports granting a 10 percent rating for the right knee disorder, and no more. C. Increased (Compensable) Evaluation for Degenerative Joint Disease of the Left Hip The report of the veteran's VA examination in May 1991 indicates that he had no limitation of motion of his left lower extremity and the veteran testified to the effect that he had no significant problems with the degenerative joint disease of his left hip. While an X-ray of the veteran's left hip shortly prior to his discharge from service showed the presence of minimal degenerative changes, the evidence indicates no significant problems associated with the degenerative joint disease of the left hip. Since the evidence does not indicate the presence of any limitation of motion of the left hip due to the arthritis in that joint, a compensable rating is not warranted for this disorder under Diagnostic Code 5251, 5252, or 5253, pertaining to limitation of motion. Nor is a compensable rating warranted based on noncompensable limitation of motion of this joint under Diagnostic Code 5003 because the evidence does not indicate that the veteran has any limitation of motion of this joint. In accordance with 38 C.F.R. § 4.31, the current zero percent rating is proper. The evidence is not in relative equipoise concerning the claim for a compensable rating for the degenerative joint disease of the left hip. Thus, the veteran is not entitled to favorable resolution of this claim based on reasonable doubt. The preponderance of the evidence is against the claim and it must be denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). D. Increased (Compensable) Evaluation for Pterygium of the Left Eye A pterygium is evaluated on the basis of any resulting loss of vision. 38 C.F.R. § 4.84a, Code 6034. The best distant vision obtainable after best correction by glasses will be the basis for rating loss of visual acuity. 38 C.F.R. § 4.75. Corrected visual acuity of 20/40 or better warrants a noncompensable evaluation. 38 C.F.R. § 4.84a, Code 6079. The evidence indicates that the veteran has a pterygium on the left eye, but it does not result in loss of vision. The report of his VA eye examination in December 1991 shows corrected visual acuity of the left eye of 20/20 minus 1. Thus, the evidence indicates that the current zero percent rating for this disorder is proper. The Board finds that the evidence is not in relative equipoise concerning the claim for a compensable rating for this disorder. Hence, the veteran is not entitled to favorable resolution of this claim based on reasonable doubt. The preponderance of the evidence is against the claim and it must be denied. 38 U.S.C.A. § 5107(b); Gilbert, supra. ORDER Service connection for a pterygium (or pinguecula) of the right eye is granted. An increased rating, to 10 percent, for a right knee disability is granted. Increased (compensable) evaluations for degenerative joint disease of the left hip and a pterygium of the left eye are denied. L. W. TOBIN 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.