Citation Nr: 0004605 Decision Date: 02/23/00 Archive Date: 02/28/00 DOCKET NO. 97-24 724 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUES 1. Entitlement to service connection for a rupture of the right tympanic membrane. 2. Entitlement to a compensable disability rating for the residuals of a gunshot wound to the right inguinal region. REPRESENTATION Appellant represented by: John Stevens Berry, Attorney ATTORNEY FOR THE BOARD N. W. Fabian, Counsel INTRODUCTION The veteran had active duty from April 1959 to September 1966. These matters come to the Board of Veterans' Appeals (Board) from a September 1996 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In that rating decision the RO denied entitlement to service connection for a rupture of the right tympanic membrane, granted service connection for the residuals of a gunshot wound to the right inguinal area, and assigned a noncompensable rating for the service-connected disorder. The veteran perfected an appeal of that decision. This case was previously before the Board in November 1998, at which time issues no longer in appellate status were decided and the issues shown above were remanded to the RO for additional development. That development has been completed and the case returned to the Board for consideration of the veteran's appeal. FINDINGS OF FACT 1. The claim of entitlement to service connection for a rupture of the right tympanic membrane is not supported by medical evidence showing that the veteran currently has a ruptured right tympanic membrane that is related to an in- service disease or injury. 2. The residuals of a gunshot wound to the right inguinal area are manifested by a scar that is not poorly nourished or ulcerated, tender on objective demonstrative, or productive of any functional limitation. 3. A question of such medical complexity or controversy is not presented to warrant obtaining the opinion of an independent medical expert. CONCLUSIONS OF LAW 1. The claim of entitlement to service connection for a rupture of the right tympanic membrane is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 2. The criteria for a compensable disability rating for the residuals of a gunshot wound to the right inguinal region are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.31, 4.40, 4.56, 4.73, 4.118, Diagnostic Codes 5313- 5318, 7803-7805 (1999). 3. Obtaining an opinion from an independent medical expert is not warranted. 38 U.S.C.A. § 7109 (West 1991); 38 C.F.R. § 3.328 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background The veteran's service medical records show that on entry into service in April 1959 the examiner noted a dry, perforated right tympanic membrane. In addition, on November 16, 1963, he accidentally shot himself in the right groin with a .22 caliber pistol while target shooting. Examination revealed a small punctate wound in the mid-inguinal area on the right, with a hematoma in the surrounding subcutaneous tissue. His peripheral pulses were normal, and he denied any problems with urination. The bullet was palpable on rectal examination, and an X-ray study revealed a metallic density in the mid-lower pelvis, approximately three to four centimeters behind the symphysis pubis and anterior to the rectum, in the area of the prostate. The treating physician determined that the path of the bullet had lacerated the femoral vein, which was surgically repaired. The veteran was returned to full duty on December 4, 1963. With the exception of bilateral hearing loss, the service medical records make no further reference to any ear or inguinal abnormality. The veteran initially claimed entitlement to compensation benefits in November 1995. In conjunction with his claim he provided private medical treatment records showing that an examination in July 1989 revealed that the external ear drums and canals were normal, and no abnormalities were found in the abdomen or genital area. A VA medical examination in February 1996 revealed a surgical scar in the right inguinal region that was 12 centimeters in length and one centimeter in width. The examiner found no evidence of tissue loss, adhesions, or damage to tendons, bones, joints, or nerves. The examiner was unable to determine the specific muscle groups penetrated by the bullet. Strength in the affected area was normal, there was no pain on palpation of the area, and there was no evidence of muscle hernia. During the February 1996 medical examination the examiner found that the tympanic membranes in both ears were normal. The examiner provided a diagnosis of a history of possible rupture of the right tympanic membrane. In conjunction with the Board's November 1998 remand, in January 1999 the veteran was asked to provide the names and addresses of all medical providers who had treated him for a right tympanic membrane disorder or for any residuals of the in-service gunshot wound. Although he provided the names and addresses of his treating physicians, and those physicians provided evidence of treatment for a number of non-service connected disabilities, none of the evidence pertains to the issues on appeal. The veteran was provided additional VA examinations in March 1999. During the orthopedic examination he reported having pain in the right groin area following the injury, which the treating physicians attributed to the healing process. He also reported having right groin pain following his separation from service, but denied having received any medical treatment for the injury for at least the previous 20 years. The veteran stated that he continued to have intermittent pain in the groin area. He described the pain as sharp, but was unable to give any precipitating cause for the pain, other than moving a certain way. He stated that the pain occurred a couple of times a week, and that he had numbness in the groin area. On examination, he was able to ambulate without an antalgic gait. Strength in the right lower extremity, including hip flexion, was 5/5, and there was no evidence of muscle atrophy in either lower extremity. He did have dependent edema in the lower extremities, which his private treatment records show as a symptom of cardiovascular disease. There was a scar in the groin area that was 12 centimeters in length that was not painful to palpation. He had decreased sensation along the medial aspect of the scar, but no loss of sensation in the right lower extremity. The examiner stated that no pain or limitation of motion was found on examination, and accordingly, that no current pain or limitation of motion could be attributed to the gunshot wound. The examiner found that no pain was elicited on manipulation of the joint. The examiner also stated that the residuals of the gunshot wound did not cause any weakened movement, fatigability, or incoordination, although the veteran experienced weakened movement and fatigability as a result of his non-service connected cardiovascular and respiratory diseases. The examiner also found that there were no residuals of the in-service gunshot wound with the exception of occasional pain and numbness that did not interfere with the veteran's activities or result in any limitation of function. An examination of the ears in March 1999 resulted in the finding that the tympanic membranes in both ears were intact and not inflamed, and that there was no evidence of tympanic membrane perforation. During a March 1999 VA neurology examination the veteran denied having any pain or other problem related to the reported ruptured tympanic membrane. He stated that the bullet in the groin region was lodged near his prostate, and that he had had blood in his urine. He reported having been hospitalized for five to six months following the gunshot wound, but denied having any problems with his leg after he was discharged. He also reported having intermittent pain with urination, and an intermittent shooting pain into the right hip since the injury. The neurology examination revealed no abnormalities, and the examiner provided the opinion that the gunshot wound resulted in some urinary symptoms, but no neurological dysfunction. The examiner noted that the veteran reported having intermittent pain that did not interrupt or interfere with his life. The examiner also stated that the veteran had a ruptured tympanic membrane on the right, which was documented in his medical records, which resulted in hearing loss and tinnitus on the right. II. Service Connection for a Right Ruptured Tympanic Membrane The threshold question that must be resolved with regard to the claim is whether the veteran has presented evidence that the claim is well grounded. 38 U.S.C.A. § 5107(a); Epps v. Brown, 9 Vet. App. 341 (1996), aff'd, 126 F.3d 1464 (Fed. Cir. 1997), cert. denied, 118 S.Ct. 2348 (1998). A well grounded claim is a plausible claim, meaning a claim that appears to be meritorious on its own or capable of substantiation. Epps, 126 F.3d at 1468. An allegation of a disorder that is service connected is not sufficient; the veteran must submit evidence in support of the claim that would "justify a belief by a fair and impartial individual that the claim is plausible." Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). The quality and quantity of the evidence required to meet this statutory burden depends upon the issue presented by the claim. Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993). In order for a claim for service connection to be well grounded, there must be a medical diagnosis of a current disability, medical or lay evidence of the incurrence of a disease or injury in service, and medical evidence of a nexus between the in-service disease or injury and the current disability. Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). Alternatively, the second and third elements can be satisfied by evidence showing that a disorder was noted during service, evidence of post-service continuity of symptomatology, and medical or, in some circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. In addition, if the claim for service connection pertains to a disease rather than the residuals of an injury, a well-grounded claim can be established by evidence showing a chronic disease in service and present disability from that disease. See Savage v. Gober, 10 Vet. App. 488, 495-497 (1997); 38 C.F.R. § 3.303(b). A lay person is not competent to make a medical diagnosis or to relate a medical disorder to a specific cause. Therefore, if the determinant issue is one of medical etiology or a medical diagnosis, competent medical evidence is generally required to make the claim well grounded. See Grottveit, 5 Vet. App. at 93. A lay person is, however, competent to provide evidence of an observable condition during and following service. Savage, 10 Vet. App. at 496. If the claimed disability relates to an observable disorder, lay evidence may be sufficient to show the incurrence of a disease or injury in service and continuity of the disorder following service. Medical evidence is required, however, to show a relationship between the current medical diagnosis and the continuing symptomatology. See Clyburn v. West, 12 Vet. App. 296 (1999). In determining whether the claim is well grounded, the evidence is generally presumed to be credible. Robinette v. Brown, 8 Vet. App. 69 (1995). If the veteran fails to submit evidence showing that his claim is well grounded, VA is under no duty to assist him in any further development of the claim. See Morton v. West, 12 Vet. App. 477 (1999), en banc denied July 28, 1999. The Board notes that the veteran's representative asserts that additional VA examinations or an independent medical opinion should be obtained in order to determine whether the veteran has a current ear disorder that is related to service. 38 U.S.C.A. § 7109; 38 C.F.R. § 3.328. In the absence of a well-grounded claim, however, VA has no duty to assist the veteran in developing the evidence relevant to the claim. The Board finds, therefore, that additional development is not warranted. VA may, dependent on the facts of the case, have a duty to notify the veteran of the evidence needed to support his claim. 38 U.S.C.A. § 5103; see also Robinette v. Brown, 8 Vet. App. 69, 79 (1995). The veteran has not indicated the existence of any evidence that, if obtained, would make his claim well grounded. VA has no further obligation, therefore, to notify him of the evidence needed to support his claim. See McKnight v. Gober, 131 F.3d 1483, 1485 (Fed. Cir. 1997). The Board has reviewed the evidence of record and finds that the claim of entitlement to service connection for a rupture of the right tympanic membrane is not well grounded. In order to establish a well-grounded claim, the veteran must provide medical evidence showing that he currently has the claimed disability. Caluza, 7 Vet. App. at 506. Although the service medical records show that on entry into service in April 1959 he had a ruptured right ear drum, none of the medical evidence since then is probative of him having the claimed condition. VA examinations of the ears in February 1996 and March 1999 failed to disclose any clinical evidence of a ruptured tympanic membrane, and the private treatment records make no reference to such a disorder. The examiner in February 1996 provided a diagnosis of a history of a possible rupture of the right tympanic membrane. This evidence is not probative of a current medical diagnosis of disability because the clinical examination revealed no evidence of a ruptured right tympanic membrane, and the assessment was, therefore, based on the historical reference to a ruptured eardrum. "[T]here is no indication that the examiner, based on his medical expertise, found any disability relating back to service." Sanchez-Benitez v. West, No. 97-1948, slip op. at 5 (U.S. Vet. App. Dec. 29, 1999). During the March 1999 neurology examination the veteran reported having ruptured the right eardrum in the early 1960s. The examiner stated that the veteran had a ruptured right tympanic membrane, but the report of the examination does not indicate that the examiner physically examined the ears, although he did test the veteran's hearing. The examiner apparently based the finding on the veteran's report and the service medical records. Because the finding was based on a historical report and not on current clinical findings, it is not probative of whether the veteran currently has a ruptured right tympanic membrane. See LeShore v. Brown, 8 Vet. App. 406, 409 (1995) (evidence that is simply information recorded by a medical examiner, un- enhanced by any medical comment by that examiner, does not constitute competent medical evidence of a well-grounded claim). The neurologist found that the only residuals of the claimed ruptured tympanic membrane were tinnitus and hearing loss. Service connection for bilateral hearing loss and tinnitus has been previously established. In addition to the absence of proof of a present disability, the veteran has not submitted any evidence indicating that the ruptured right eardrum, which was noted on his entry into service in April 1959, was aggravated by service. If the claim is based on the aggravation of a pre-existing disease or injury during service, the second Caluza element is satisfied if the service medical records show treatment for the disease or injury during service. Maxson v. West, 12 Vet. App. 453 (1999). The veteran's service medical records do not reflect any complaints or clinical findings pertaining to the right tympanic membrane during service. In addition, he has not provided any evidence of complaints or clinical findings pertaining to a ruptured right tympanic membrane for the 30 years since his separation from service. Because the probative medical evidence does not show that the veteran currently has the claimed disability, or that the claimed disability was aggravated during service, the Board has determined that the claim of entitlement to service connection for a right tympanic membrane is not well grounded. See Brammer v. Derwinski, 3 Vet. App. 223 (1992) (the veteran is not entitled to a benefit simply because he had a disease or injury in service; in the absence of proof of a present disability his claim is not valid). III. Compensable Rating for Residuals of a Gunshot Wound A. Laws and Regulations Disability ratings are based on the average impairment of earning capacity resulting from disability. The percentage ratings for each diagnostic code, as set forth in the VA's Schedule for Rating Disabilities, codified in 38 C.F.R. Part 4, represent the average impairment of earning capacity resulting from disability. Generally, the degrees of disability specified are considered adequate to compensate for a loss of working time proportionate to the severity of the disability. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. If the minimum schedular evaluation requires residuals and the schedule does not provide a no-percent evaluation, a no- percent evaluation is assigned when the required residuals are not shown. 38 C.F.R. § 4.31. Diagnostic Code 7803 provides a 10 percent evaluation if a superficial scar is poorly nourished with repeated ulceration. Diagnostic Code 7804 provides a 10 percent evaluation for superficial scars that are tender and painful on objective demonstration. Diagnostic Code 7805 for other scars indicates that other scars are to be evaluated based on the limitation of function of the part affected. 38 C.F.R. § 4.118. Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40. Subsequent to the initiation of the veteran's appeal, the regulatory criteria for evaluating muscle injuries were revised effective July 3, 1997. Schedule for Rating Disabilities; Muscle Injuries, 62 Fed. Reg. 30235 (1997) (codified at 38 C.F.R. Part 4). If a change in the rating criteria occurs during the pendency of the veteran's appeal, he is entitled to the application of the rating criteria more favorable to him. Karnas v. Derwinski, 1 Vet. App. 308 (1991). The veteran was provided the revised regulations in an August 1999 supplemental statement of the case. The Board has reviewed the facts of the veteran's case in light of the original and revised regulations, and finds that no material change occurred in the rating criteria applicable to the veteran's claim. However, the Board has considered both the old and the new criteria. See Fischer v. West, 11 Vet. App. 121 (1998). Under the old regulation, the provisions of 38 C.F.R. § 4.55, provided: The following principles as to combination of ratings of muscle injuries in the same anatomical segment, or of muscle injuries affecting the movements of single joint, either alone or in combination or limitations of the arc of motion will govern the ratings: (a) Muscle injuries in the same anatomical region, i.e., (1) shoulder girdle and arm, (2) forearm and hand, (3) pelvic girdle and thigh, (4) leg and foot, will not be combined, but instead, the rating for the major group will be elevated from moderate to moderately severe, or from moderately severe to severe according to the severity of the aggregate impairment o function of the extremity. (b) Two or more severe muscle injuries affecting the motion (particularly strength of the motion) about a single joint may be combined but not in combination receive more than the rating for ankylosis of that joint at an "intermediate" angle, except that with severe injuries involving the shoulder girdle and arm, the combination may not exceed the rating for unfavorable ankylosis of the scapulohumeral joint. Claims of an unusually seer degree of disability involving the shoulder girdle and arm or the pelvic girdle and thigh muscles wherein the evaluation in criteria under this section appears inadequate may be submitted to the Director, Compensation and Pension Service, for consideration under § 3,321(b)(1) of this chapter. (c) With definite limitation of the arc of motion, the rating for injuries to muscles affecting motion within the remaining arc may be combined but not to exceed ankylosis at an "intermediate" angle. (d) With ankylosis of the shoulder, the intrinsic muscles of the shoulder girdle (Groups III or IV) are out of commission and carry no rating for injury however severe. The extrinsic muscles (Group I and II) which act on the shoulder as a whole may, if severely injured elevate the rating to ankylosis at an unfavorable angle. (e) With ankylosis of the knee, the hamstring muscles (Group XIII) may if severely injured, receive the rating for the moderately severe degree of disability as a maximum in combination, and corresponding values for less severe injuries, the major function of these muscles being hip function. (f) With disability such as flail joint, ankylosis, faulty union, limitation of motion, etc., muscle injuries affecting junction at a lower level may be separately rated and combined, always reserving the maximum amputation rating for the most severe injuries. (g) Muscle injury ratings will not be combined with peripheral nerve paralysis ratings for the same part, unless affecting entirely different functions. 38 C.F.R. § 4.55 (1996). The revised provisions of 38 C.F.R. § 4.55 are as follows: (a) A muscle injury rating will not be combined with a peripheral nerve paralysis rating of the same body part, unless the injuries affect entirely different functions. (b) For rating purposes, the skeletal muscles of the body are divided into 23 muscle groups in 5 anatomical regions: 6 muscle groups for the shoulder girdle and arm (diagnostic codes 5301 through 5306); 3 muscle groups for the forearm and hand (diagnostic codes 5307 through 5309); 3 muscle groups for the foot and leg (diagnostic codes 5310 through 5312); 6 muscle groups for the pelvic girdle and thigh (diagnostic codes 5313 through 5318); and 5 muscle groups for the torso and neck (diagnostic codes 5319 through 5323). (c) There will be no rating assigned for muscle groups which act upon an ankylosed joint, with the following exceptions: (1) In the case of an ankylosed knee, if muscle group XIII is disabled, it will be rated, but at the next lower level than that which would otherwise be assigned. (2) In the case of an ankylosed shoulder, if muscle groups I and II are severely disabled, the evaluation of the shoulder joint under diagnostic code 5200 will be elevated to the level for unfavorable ankylosis, if not already assigned, but the muscle groups themselves will not be rated. (d) The combined evaluation of muscle groups acting upon a single unankylosed joint must be lower than the evaluation for unfavorable ankylosis of that joint, except in the case of muscle groups I and II acting upon the shoulder. (e) For compensable muscle group injuries which are in the same anatomical region but do not act on the same joint, the evaluation for the most severely injured muscle group will be increased by one level and used as the combined evaluation for the affected muscle groups. (f) For muscle group injuries in different anatomical regions which do not act upon ankylosed joints, each muscle group injury shall be separately rated and the ratings combined under the provisions of Sec. 4.25. 38 C.F.R. § 4.55 (1999). The old provisions of 38 C.F.R. § 4.56 (1996), muscle injuries are considered slight if they involve simple muscle wounds without debridement, infection or the effects of lacerations. Treatment records typically show a wound of slight severity or relatively brief treatment and a return to duty, and healing with good functional results, and no consistent complaints of the cardinal symptoms of muscle injuries or painful residuals. The objective findings would include a minimal scar, little if any evidence of a fascial defect, atrophy, or impaired muscle tonus, and no significant impairment of function and no retained metallic fragments. Muscle injuries are considered moderately disabling under the old criteria contained in 38 C.F.R. 4.56, if they involve deep penetration by small shell fragments of relatively short track. The medical records would show hospitalization during service and records following service showing consistent complaint from the time of the first examination forward of one or more of the cardinal symptoms of muscle wounds particularly fatigue and fatigue pain after moderate use. Current objective findings would include scars indicative of a relatively short track of the missile through muscle tissue, signs of moderate loss of deep muscle fascia or substance, or impairment of muscle tonus, and of definite weakness or fatigue. A moderately severe muscle injury would result from a deep penetrating wound by a high velocity missile of small size or large missile of low velocity, with debridement, prolonged infection or sloughing of soft parts, and intermuscular cicatrization (scars extending into muscle tissue). The medical records would show hospitalization for a prolonged period during service for treatment of a severe wound with record s of consistent complaints of the cardinal symptoms of a muscle injury. The objective findings would include relatively large scars so situated as to indicate a track of the missile through important muscle groups. There would be indications of moderate loss of muscle substance or moderate loss of normal firm resistance compared with the sound side. There would also be evidence of marked or moderately severe muscle loss. Severe muscle injury was found where there was a through and through or deep penetrating wound due to high velocity missile, or large or multiple low velocity missiles, or explosive effect of high velocity missile, or shattering bone fracture with extensive debridement or prolonged infection and sloughing of soft parts, intermuscular binding and cicatrization. The history would be the same as for moderately severe injury, only in an aggravated form. The objective findings would include extensive ragged, depressed and adherent scars of skin so situated as to indicate wide damage to muscle groups in the track of the missile. X-ray may show minute multiple scattered foreign bodies indicating spread of intermuscular trauma and explosive effect of missile. Palpation shows moderate or extensive loss of deep fascia or of muscle substance. Soft or flabby muses in wound area. Muscles do not swell and harden normally in contraction. Tests of strength or endurance compared with the sound side or of coordinated movements show positive evidence of severe impairment of function. In electrical tests, reaction of degeneration is not present but a diminished excitability to faradic current compared with the sound side may be present. Visible or measured atrophy may or may not be present. Adaptive contraction of opposing group of muscles, if present, indicates severity. Adhesion of scar to one of the long bones, scapula, pelvic bones, scrum or vertebrae, with epithelial sealing over the bone without true skin covering, in an area where bone is normally protected by muscle, indicates the severe type. Atrophy of muscle groups not included in the track of the missile, particularly of the trapezius and serratus in wounds in the shoulder girdle (traumatic muscular dystrophy), and induration and atrophy of an entire muscle following simple piercing by a projectile (progressive sclerosing myositis), may be included in the severe group if there is sufficient evidence of severe disability. Under the new provisions of 38 C.F.R. § 4.56: The cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue- pain, impairment of coordination and uncertainty of movement. An open comminuted fracture with muscle or tendon damage will be rated as a severe injury of the muscle group involved unless, for locations such as in the wrist or over the tibia, evidence establishes that the muscle damage is minimal. A through-and-through injury with muscle damage shall be evaluated as no less than a moderate injury for each group of muscles damaged. For Diagnostic Codes 5301 through 5323, disabilities resulting from muscle injuries shall be classified as slight, moderate, moderately severe, or severe. 38 C.F.R. § 4.56. Disability is considered to be slight if the disability results from a simple wound without debridement or infection and shown by service medical records to be a superficial wound requiring brief treatment and return to duty and healing with good functional results, without any of the cardinal signs of muscle disability as shown above. The objective evidence of slight disability consists of a minimal scar, no evidence of fascial defect, atrophy, or impaired tonus, and no impairment of function or metallic fragments retained in muscle tissue. 38 C.F.R. § 4.56. Muscle disability is considered to be moderate if it was caused by a through and through or deep penetrating wound of short track from a single bullet or a small shell or shrapnel fragment, without the explosive effect of a high velocity missile, with the residuals of debridement or prolonged infection. Evidence of moderate disability consists of consistent complaints of one or more of the cardinal signs and symptoms of muscle disability as shown above, particularly lowered threshold of fatigue after average use, which affects the particular functions controlled by the injured muscles. The objective signs of moderate disability include small or linear entrance and (if present) exit scars, indicating a short track of the missile through muscle tissue, some loss of deep fascia or muscle substance, impairment of muscle tonus and loss of power, or a lowered threshold of fatigue when compared to the sound side. 38 C.F.R. § 4.56. Muscle disability is considered to be moderately severe if it results from a through and through or deep penetrating wound by a small high velocity missile or large low-velocity missile, with evidence of debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. Evidence of a moderately severe muscle injury includes service department record or other evidence showing hospitalization for a prolonged period for treatment of the wound, consistent complaints of the cardinal signs and symptoms of muscle disability as shown above and, if present, evidence of inability to keep up with work requirements. The objective evidence of a moderately severe muscle disability includes entrance and (if present) exit scars that indicate a track of the missile through one or more muscle groups, the loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with the sound side, and impairment of strength and endurance in comparison to the sound side. 38 C.F.R. § 4.56. Muscle disability is severe if it was caused by a through and through or deep penetrating wound due to a high-velocity missile or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding, and scarring. The evidence of severe muscle disability includes service department or other evidence showing hospitalization for a prolonged period for treatment of the wound, consistent complaints of the cardinal signs and symptoms of muscle disability as shown above, worse than those shown for moderately severe muscle injuries, and, if present, evidence of the inability to keep up with work requirements. 38 C.F.R. § 4.56. The objective findings of severe disability include ragged, depressed, and adherent scars indicating wide damage to the muscle groups in the missile's track, loss of deep fascia or muscle substance, soft flabby muscles in the wound area, muscle swelling and hardening abnormally in contraction, and severe impairment of strength, endurance, or coordinated movements in comparison to the sound side. Evidence of severe muscle disability also includes X-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and the explosive effect of the missile, adhesion of the scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle, diminished muscle excitability to pulsed electrical current in electro- diagnostic tests, visible or measurable atrophy, adaptive contraction of an opposing group of muscles, atrophy of muscle groups not in the track of the missile, or induration or atrophy of an entire muscle following simple piercing by a projectile. 38 C.F.R. § 4.56. The veteran has appealed the disability rating initially assigned with the grant of service connection in September 1996. Because he has appealed the initial rating, the Board must consider the applicability of staged ratings covering the time period in which his claim and appeal have been pending. Fenderson v. West, 12 Vet. App. 119 (1999). The evaluation of the level of disability is to be based on review of the entire evidence of record and the application of all pertinent regulations. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Once the evidence is assembled, the Secretary is responsible for determining whether the preponderance of the evidence is against the claim. If so, the claim is denied; if the evidence is in support of the claim or is in equal balance, the claim is allowed. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). B. Analysis The Board has reviewed the evidence of record and finds that a compensable disability rating for the residuals of a gunshot wound to the right inguinal region is not warranted. The disability is currently rated under Diagnostic Code 7805 as a scar. In accordance with the diagnostic codes pertaining to scars, a compensable rating requires evidence showing that the scar is poorly nourished with repeated ulceration, tender and painful on objective demonstration, or that the scar results in limitation of function of the part affected. VA examiners in February 1996 and March 1999 found that the scar was well healed, with no evidence of ulceration or tenderness on objective demonstration. Although there was reduced sensation in the area of the scar, the examiners also found that the scar resulted in no functional limitations in the affected area. Because the minimum schedular evaluation requires residuals and the required residuals are not shown, the Board finds that the criteria for a compensable disability rating for the surgical scar are not met. 38 C.F.R. § 4.31. The medical evidence indicates that the bullet penetrated the right inguinal area, and that it is lodged approximately three to four centimeters behind the symphysis pubis and anterior to the rectum, in the area of the prostate. It is reasonable to assume, therefore, that the bullet penetrated the muscles in the groin area. The examiner in February 1996 was unable to determine what muscles were penetrated by the bullet. In the November 1998 remand the Board requested an additional examination, in which the examiner was asked to determine what muscles had been penetrated. The Board notes that the Court of Appeals for Veterans Claims (Court) has held that the veteran is entitled to compliance with the Board's remand instructions as a matter of law. Stegall v. West, 11 Vet. App. 268 (1998). Although the RO provided the veteran neurology and orthopedic examinations, as requested in the remand, neither examiner specified the muscles penetrated by the gunshot. The examiners did, however, conduct thorough orthopedic and neurology examinations, and documented all of the functional limitations resulting from the gunshot wound. In light of the applicable rating criteria for muscle injuries, as explained below, the Board finds that the examiners' failure to document the specific muscle groups penetrated by the gunshot is not material to the disposition of the veteran's appeal, and that the RO and the VA medical center (MC) substantially complied with the remand instructions. See Dyment v. West, 13 Vet. App. 141 (1999). Diagnostic Codes 5313 through 5318 pertain to injuries to the muscle groups of the pelvic girdle and thigh. Diagnostic Code 5313 applies to injuries to muscle group XIII of the posterior thigh; Diagnostic Code 5314 applies to muscle group XIV of the anterior thigh; Diagnostic Code 5315 applies to muscle group XV of the mesial thigh; Diagnostic Code 5316 applies to muscle group XVI of the pelvic girdle controlling flexion of the hip; Diagnostic Code 5317 applies to muscle group XVII of the posterior pelvic girdle; and Diagnostic Code 5318 applies to muscle group XVIII of the pelvic girdle in the control of hip action. All of the diagnostic codes pertaining to the pelvic girdle and thigh indicate that in order for the muscle injury to be compensable, the injury must be at least moderate. A noncompensable (zero percent) rating applies for injuries to the relevant muscle groups if the injury is slight. 38 C.F.R. § 4.73. A muscle disability is considered to be moderate if it was caused by a through and through or deep penetrating wound with the residuals of debridement or prolonged infection. Evidence of moderate disability consists of consistent complaints of one or more of the cardinal signs and symptoms of muscle disability, including loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement that affects the particular functions controlled by the injured muscles. The objective signs of moderate disability include small or linear entrance and (if present) exit scars, some loss of deep fascia or muscle substance, impairment of muscle tonus and loss of power, or a lowered threshold of fatigue when compared to the sound side. 38 C.F.R. § 4.56. The medical evidence indicates that the in-service gunshot wound was penetrating and not a through and through wound. While the service medical records do show that the wound was debrided, the wound was not infected, and the veteran was returned to full duty less than three weeks after the injury without any additional medical procedures. The private treatment records provided by the veteran, which document his medical care back to 1989, are silent for any complaints of the cardinal signs and symptoms of muscle injury. The VA examiners in February 1996 and March 1999 found no evidence of tissue loss or adhesions, loss of muscle strength, or impairment of coordination. The orthopedic examiner in March 1999 found that the residuals of the gunshot wound did not result in any weakened movement, fatigability, or incoordination, and that there were no residuals of the injury, with the exception of reports of pain. The Board finds, therefore, that the criteria for a moderate muscle disability are not met, and that a compensable rating under any of the diagnostic codes pertaining to the pelvic girdle or thigh is not warranted under the old or new criteria. The evaluation of a musculoskeletal disability requires consideration of all of the functional limitations imposed by the disorder, including pain, weakness, limitation of motion, and lack of strength, speed, coordination or endurance. See Spurgeon v. Brown, 10 Vet. App. 194 (1997). The veteran reported having a sharp pain from the groin area into the right hip approximately twice a week. No pain was elicited on physical examination. As previously stated, the VA examiner in March 1999 provided the opinion that the gunshot wound did not result in any weakness, limitation of motion, or lack of strength, speed, coordination or endurance. The examiner also stated that although the veteran may experience occasional pain in the area, the pain did not interfere with his activities or limit his functioning in any way. The Board finds, therefore, that the reported symptom does not result in any functional limitation, and that a compensable rating based on the criteria shown in 38 C.F.R. § 4.40 is not warranted. During the March 1999 neurology examination the veteran also reported having had blood in his urine and intermittent pain with urination, and the examiner indicated that the gunshot wound had resulted in urinary tract problems. The examination report does not indicate that the examiner evaluated the urinary tract, nor did he provide any clinical findings indicative of a urinary tract disorder. The veteran's extensive private treatment records do not show that he has had any significant urinary tract symptoms or clinical findings for many years. His other disabilities, including severe chronic obstructive pulmonary disease with pulmonary hypertension; coronary artery disease, status post coronary artery bypass grafts, with congestive heart failure; and arthritis, are well documented. The statement made by the examiner appears, therefore, to have been based on the veteran's report of having had blood in his urine and pain with urination, and is not probative of the veteran having a urinary tract disorder that is related to the gunshot wound. See Grover v. West, 12 Vet. App. 109 (1999) (an opinion based on the veteran's reported history in diagnosing the residuals of an injury is not competent medical evidence). For the reasons shown above, the Board finds that the criteria for a compensable disability rating for the residuals of a gunshot wound to the right inguinal region have not been met at any point in time since the veteran initiated his claim. Fenderson, 12 Vet. App. at 119. The Board has determined, therefore, that the preponderance of the evidence is against the appeal to establish entitlement to a compensable rating for the disorder. ORDER The claim of entitlement to service connection for a rupture of the right tympanic membrane is denied. The appeal to establish entitlement to a compensable disability rating for the residuals of a gunshot wound to the right inguinal region is denied. Mark D. Hindin Member, Board of Veterans' Appeals