Citation Nr: 0003354 Decision Date: 02/09/00 Archive Date: 02/15/00 DOCKET NO. 94-13 103 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Seattle, Washington THE ISSUES 1. Entitlement to an initial disability evaluation in excess of 10 percent for sinusitis. 2. Entitlement to an initial compensable disability evaluation for allergic rhinitis. 3. Entitlement to an initial disability evaluation in excess of 10 percent for Achilles tendinitis/plantar fasciitis of the left foot. 4. Entitlement to an initial disability evaluation in excess of 10 percent for Achilles tendinitis/plantar fasciitis of the right foot. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant INTRODUCTION The veteran retired from active duty in July 1990 after completing more than 20 years of active military service. The veteran brought a timely appeal to the Board of Veterans' Appeals (the Board) from February 1991 and February 1993 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. The Board in April 1996 remanded the case for further development. The record shows that in May 1999 correspondence to the RO the veteran stated in effect that he was satisfied with the rating for arteriosclerotic heart disease with hypertension. This issue was before the Board in April 1996 and he was subsequently asked to clarify his intentions regarding the issues on appeal. The RO issued a supplemental statement of the case in June 1999 that advised the veteran that this issue was no longer on appeal. The veteran or his representative has not advised the Board of any intention to continue the appeal on this issue and the issue is considered withdrawn. 38 C.F.R. § 20.204. At the time of the April 1996 Board remand, the Achilles tendinitis/plantar fasciitis of the right foot was rated noncompensable. A RO Decision Review Officer (DRO) in June 1999 granted a 10 percent rating for the right foot from August 1990. The DRO also assigned a 10 percent rating for sinusitis under Diagnostic Code 6510 and a separate noncompensable rating for allergic rhinitis under Diagnostic Code 6522, each from August 1990. At the time of the April 1996 Board remand, a single 10 percent rating was assigned for allergic rhinitis with sinusitis/hay fever under Diagnostic Code 6501. The revised rating scheme for the sinus disability is at issue. FINDINGS OF FACT 1. Sinusitis symptoms are occasional and not shown to be incapacitating; there are intermittent symptoms of headache, sinus pain and occasional purulence annually. 2. Allergic rhinitis is currently manifested by no obstruction of breathing space on both sides and no polyps. 3. The disability of the left foot is principally manifested by pain and tenderness and slight or minimal limitation of motion of the ankles due to pain from Achilles tendinitis/plantar fasciitis. 4. The disability of the right foot is principally manifested pain and tenderness and slight or minimal limitation of motion of the ankles due to pain from Achilles tendinitis/plantar fasciitis, pain and tenderness. 5. The Achilles tendinitis/plantar fasciitis of the feet or the sinusitis/allergic rhinitis has not rendered the veteran's disability picture unusual or exceptional in nature, markedly interfered with employment, or required frequent inpatient care as to render impractical the application of regular schedular standards. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for sinusitis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3,321(b)(1), 4.1, 4.7, 4.14, 4.96, 4.97, and Diagnostic Codes 6501, 6510 in effect on October 7, 1996 and as amended. 2. The criteria for an initial compensable rating for allergic rhinitis from October 7, 1996 have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3,321(b)(1), 4.1, 4.7, 4.96, 4.97 (1999), Diagnostic Code 6522 effective October 7, 1996. 3. The criteria for a disability evaluation in excess of 10 percent for Achilles tendinitis/plantar fasciitis of the left foot have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.2, 4.7, 4.14, 4.20, 4,21, 4.71a, Diagnostic Codes 5003, 5024 (1999). 4. The criteria for a disability evaluation in excess of 10 percent for Achilles tendinitis/plantar fasciitis of the right foot have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.2, 4.7, 4.14, 4.20, 4,21, 4.71a, Diagnostic Codes 5003, 5024 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Criteria The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. 38 C.F.R. § 4.1 Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Both the use of manifestations not resulting from service- connected disease or injury in establishing the service- connected evaluation, and the evaluation of the same manifestation under different diagnoses are to be avoided. 38 C.F.R. § 4.14. Although a review of the recorded history of a disability is necessary in order to make an accurate evaluation, see 38 C.F.R. §§ 4.2, 4.41 (1999), the regulations do not give past medical reports precedence over current findings where such current findings are adequate and relevant to the rating issue. See Francisco v. Brown, 7 Vet. App. 55 (1994); Powell v. West, 13 Vet. App. 31 (1999). When a claimant is awarded service connection for a disability and subsequently appeals the RO's initial assignment of a rating for that disability, the claim continues to be well-grounded as long as the rating schedule provides for a higher rating and the claim remains open. Shipwash v. Brown, 8 Vet. App. 218, 224 (1995); see also Procelle v. Derwinski, 2 Vet. App. 629 (1992). When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic disease and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. Sinusitis (pansinusitis, ethmoid, frontal, maxillary, sphenoid, Diagnostic Codes 6510 through 6514):) is now rated under a general rating formula that provides a 50 percent rating following radical surgery with chronic osteomyelitis, or near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. A 30 percent rating is provided for three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. One or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting may be rated 10 percent. Detected by X-ray only sinusitis is rated 0 percent. Note: An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. 38 C.F.R. § 4.97, effective October 7, 1996. Prior to October 7, 1996, sinusitis (pansinusitis, ethmoid, frontal, maxillary, sphenoid, Diagnostic Codes 6510 through 6514) was rated under a rating formula that provided a 50 percent rating postoperative, following radical operation, with chronic osteomyelitis requiring repeated curettage, or severe symptoms after repeated operations. A 30 percent rating was provided where severe, with frequently incapacitating recurrences, severe and frequent headaches, purulent discharge or crusting reflecting purulence. A 10 percent rating was provided where moderate with discharge or crusting or scabbing, infrequent headaches. With X-ray manifestations only or symptoms mild or occasional a 0 percent rating was provided. A 30 percent rating is provided for allergic or vasomotor rhinitis with polyps. Without polyps, but with greater than 50-percent obstruction of nasal passages on both sides or complete obstruction on one side a 10 percent rating is provided. Diagnostic Code 6522, effective October 7, 1996. Prior to October 7, 1996, a 50 percent rating was provided for chronic atrophic rhinitis with massive crusting and marked ozena, with anosmia. A 30 percent rating was provided with moderate crusting and ozena, atrophic changes. A 10 percent rating was provided with definite atrophy of intranasal structure, and moderate secretion. Diagnostic Code 6501. Ratings under diagnostic codes 6600 to 6818, inclusive, and 6821 will not be combined with each other. Where there is lung or pleural involvement, ratings under diagnostic codes 6819 and 6820 will not be combined with each other or with diagnostic codes 6600 to 6818 inclusive and 6821. A single rating will be assigned under the diagnostic code which reflects the predominant disability picture with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. However, in cases protected by the provisions of Pub. L. 90-493, the graduated ratings of 50 and 30 percent for inactive tuberculosis will not be elevated. 38 C.F.R. § 4.96(a), in effect prior to October 7, 1996. Ratings under diagnostic codes 6600 through 6818 and 6822 through 6847 will not be combined with each other. Where there is lung or pleural involvement, ratings under diagnostic codes 6819 and 6820 will not be combined with each other or with diagnostic codes 6600 through 6817 or 6822 through 6847. A single rating will be assigned under the diagnostic code which reflects the predominant disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. However, in cases protected by the provisions of Pub. L. 90- 493, the graduated ratings of 50 and 30 percent for inactive tuberculosis will not be elevated. 38 C.F.R. § 4.96(a), effective October 7, 1996. A 40 percent rating is provided for impairment of the tibia and fibula, nonunion, with loose motion, requiring brace. Malunion with marked knee or ankle disability shall be rated 30 percent, with moderate knee or ankle disability, 20 percent, and with slight knee or ankle disability, 10 percent. Diagnostic Code 5262. Ankylosis of the ankle in plantar flexion at more than 40°, or in dorsiflexion at more than 10° or with abduction, adduction, inversion or eversion deformity shall be rated 40 percent. In plantar flexion, between 30° and 40°, or in dorsiflexion, between 0° and 10°, a 30 percent rating may be assigned. Ankylosis in plantar flexion, less than 30° shall be rated 20 percent. Diagnostic Code 5270. Marked limited motion of the ankle shall be rated 20 percent, and moderate limitation of motion shall be rated 10 percent. Diagnostic Code 5271. Ankylosis of the subastragalar or tarsal joint in poor weight-bearing position shall be rated 20 percent, and in good weight-bearing position, 10 percent. Diagnostic Code 5272. Malunion of the os calcis or astragalus with marked deformity shall be rated 20 percent, and with moderate deformity, 10 percent. Diagnostic Code 5273. Astragalectomy shall be rated 20 percent. Diagnostic Code 5274. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. Plates I and II provide a standardized description of ankylosis and joint motion measurement. Joint motion for the ankle from the anatomical position of 0 degrees: plantar flexion 45 degrees, dorsiflexion 20 degrees. 38 C.F.R. § 4.71, Plate II. The United States Court of Appeals for Veterans Claims (Court) has held that diagnostic codes predicated on limitation of motion do not prohibit consideration of a higher rating based on functional loss due to pain or due to flare-ups under 38 C.F.R. §§ 4.40, 4.45, 4.59. Johnson v. Brown, 9 Vet. App. 7 (1997) and DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. 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 it may be due to pain, supported by adequate pathology and evidenced by the 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. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like. 38 C.F.R. § 4.40. As regards the joints the factors of disability reside in reductions of their normal excursion of movements in different planes. Inquiry will be directed to these considerations: (a) Less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.). (b) More movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.). (c) Weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.). (d) Excess fatigability. (e) Incoordination, impaired ability to execute skilled movements smoothly. (f) Pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing are related considerations. For the purpose of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints; multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities, the interphalangeal, metatarsal and tarsal joints of the lower extremities, the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae, are considered groups of minor joints, ratable on a parity with major joints. The lumbosacral articulation and both sacroiliac joints are considered to be a group of minor joints, ratable on disturbance of lumbar spine functions. 38 C.F.R. § 4.45. With any form of arthritis, painful motion is an important factor of disability. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. The joints should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of the opposite undamaged joint. 38 C.F.R. § 4.59. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. Arthritis, degenerative (hypertrophic or osteoarthritis): 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 (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be 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. In the absence of limitation of motion, rate as below: With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations, 20 percent. With X- ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, 10 percent. Note (1): The 20 percent and 10 percent ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion. Note (2): The 20 percent and 10 percent ratings based on X-ray findings, above, will not be utilized in rating conditions listed under diagnostic codes 5013 to 5024, inclusive. Diagnostic Code 5003. The following diseases listed under diagnostic codes 5013 through 5024, respectively, Osteoporosis, with joint manifestations; Osteomalacia; Bones, new growths of, benign, Osteitis deformans, Gout, Hydrarthrosis, intermittent, Bursitis, Synovitis, Myositis, Periostitis, Myositis ossificans and Tenosynovitis will be rated on limitation of motion of affected parts, as arthritis, degenerative, except gout which will be rated under diagnostic code 5002. Flatfoot, acquired: Pronounced, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances, bilateral shall be rated 50 percent and if unilateral 30 percent. Severe, with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities, bilateral shall be rated 30 percent and if unilateral 20 percent. Moderate pes planus with weight- bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral shall be rated 10 percent. Mild pes planus, symptoms relieved by built-up shoe or arch support shall be rated 0 percent. Diagnostic Code 5276. Claw foot (pes cavus), acquired and manifested by marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, marked varus deformity if bilateral may be rated 50 percent and if unilateral 30 percent. With all toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads, if bilateral may be rated 30 percent and if unilateral 20 percent. Where the great toe is dorsiflexed, some limitation of dorsiflexion at ankle, definite tenderness under metatarsal heads if bilateral or unilateral a 10 rating may be assigned. Slight disability may be rated 0 percent. Diagnostic Code 5278. Hallux valgus, unilateral, operated with resection of metatarsal head or where severe, if equivalent to amputation of great toe, shall be rated 10 percent. Diagnostic Code 5280. The rating schedule provides the following ratings for other foot injuries: severe 30 percent, moderately severe 20 percent, moderate 10 percent. Note: With actual loss of use of the foot, rate 40 percent. Diagnostic Code 5284. In exceptional cases where the schedular evaluations are found to be inadequate, an extraschedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities may be approved provided the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of regular schedular standards. 38 C.F.R. § 3.321(b)(1). When, after consideration of all the evidence and material of record in an appropriate case before VA, there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the veteran. 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. When a claimant is awarded service connection for a disability and subsequently appeals the RO's initial assignment of a rating for that disability, the claim continues to be well grounded as long as the rating schedule provides for a higher rating and the claim remains open. Shipwash v. Brown, 8 Vet. App. 218, 224 (1995). In Fenderson v. West, 12 Vet. App. 119 (1999), it was held that a claim such as the veteran's is properly framed as an appeal from the original rating, rather than a claim for increase, but that in either case the veteran is presumed to be seeking the maximum benefit allowed by law or regulations. In Fenderson it was held that evidence to be considered in the appeal of an initial assignment of a rating disability was not limited to that reflecting the then current severity of the disorder and that in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period, classified as "staged ratings". Analysis As a preliminary matter, the Board finds that all relevant facts have been properly developed to the extent possible and that no further duty to assist exists with respect to the veteran's well grounded claim for increased compensation for the right ankle disability. The RO conscientiously developed the record to address the concerns mentioned in the Board remand. The RO contacted the veteran regarding sources of medical treatment and the medical examinations addressed the pertinent evaluative criteria. Since the Board remand, the holding in Stegall v. West, 11 Vet. App. 268 (1998), requires that the Board ensure compliance with the terms of a remand unless such failure to comply is shown to have not prejudiced the appellant. The Board sought to have a record that would support an informed determination and asked the RO to request additional medical evidence from the veteran and obtain a VA examination. The RO was conscientious in developing the record and the Board is satisfied that all relevant facts have been developed to the extent possible and that no further duty to assist exists with respect to the claim. The veteran was provided VA examinations that are probative of the level of impairment and the disabilities were rated in accordance with the examination findings. Therefore, the Board does not find any potential prejudice to the veteran in the evaluation of the disability by the RO after the Board remand development was completed as the rating appears to reflect consideration of the applicable criteria based upon the examination findings. The medical examination records include sufficient detail regarding the disability to apply current rating criteria and are considered the best evidence for an informed determination of the veteran's current impairment from the disabilities at issue. Further, there has not been reported any other comprehensive evaluation or treatment since the VA examination reports obtained on remand. Robinette v. Brown, 8 Vet. App. 69 (1995). The examinations appeared comprehensive and as to the musculoskeletal disorder appeared to consider of the holding in DeLuca v. Brown, 8 Vet. App. 202, 206 (1995) as the Board requested. Regarding the claim for an increased evaluation for a sinus disability, the Board observes that the RO has had the opportunity to consider the claim under the published changes to the rating schedule for respiratory disorders, effective October 7, 1996. 61 Fed. Reg. 46720-46731 (Sept. 5, 1996). Since the regulatory change occurred during the appeal prior to a final Board decision on the issue, the version most favorable to the appellant will apply as it has not been otherwise provided. Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). The revised rating criteria for sinusitis and rhinitis contained substantive changes and a current medical evaluation was completed. The veteran elaborated upon his symptoms at the RO hearing. The veteran's sinus disability is rated currently in accordance with the general rating formula for sinusitis at 38 C.F.R. § 4.97, applicable to Diagnostic Codes 6510-6514, which assesses basically evidence of pain, headache, purulence and postoperative symptoms as primary rating criteria for the incremental ratings from 0 to 50 percent. The veteran has been provided the essential rating criteria. The Board finds the selected rating scheme appropriate for the veteran's disability in view of the diagnosis and symptomatology. 38 C.F.R. §§ 4.20, 4.21. Regarding the evaluation for the veteran's sinusitis, the Board observes that the RO has assigned a 10 percent evaluation based upon the relevant rating criteria as applied to recent examination which, in essence, reported sinus symptoms complained of with minimal objective findings. Applying this information to the rating schedule criteria leads the Board to conclude that a higher evaluation is not warranted. The nature of the symptoms, overall, appear to reflect no more than is contemplated in the corresponding 10 percent evaluation. The rating scheme appropriate here does not require a mechanical application of the schedular criteria. However, applying the rating schedule liberally results in a 10 percent evaluation with the new criteria appearing somewhat more beneficial to the veteran. However, for the 30 percent rating, both sets of criteria would not appear to support the claim. The evidence of probative value in view of the detailed description of pertinent evaluative criteria, viewed objectively, clearly preponderates against the claim for increase. It supports a conclusion that the veteran's disorder does more nearly approximate the criteria for a 10 percent rating. The record shows little ongoing treatment between VA examinations in 1992 and 1998 that viewed liberally do not show clinical symptoms characteristic of more appreciable disability. The 1990 VA examination was reportedly negative for active pathology with boggy turbinates the objective finding. The service medical records showed an immunotherapy program beginning in 1975 after the veteran was evaluated for a reportedly lifelong history of pertinent symptoms. The service medical records thereafter show allergic rhinitis predominating sinusitis in the diagnostic impressions. Also the 1980 radiology finding of maxillary and ethmoid sinusitis was not shown on a more recent x-ray in 1989. The history of sinus disorder of the 1990 separation examination was elaborated upon as a reference to seasonal allergies and sinusitis with colds and allergies for which the veteran used medication intermittently. The RO granted 10 percent for allergic rhinitis since it was diagnosed on VA examinations in 1990 and 1992 and this coincided with the predominant diagnostic impression in the service medical records. The infectious symptoms noted by a VA examiner in February 1992 were not reported by a VA specialist examination a month later. That examination found no polyps or purulence or continuation of the hemorrhage changes noted a month earlier. Nor were any appreciable symptoms found on reexamination in late 1992. The Board notes that a 30 percent rating for sinusitis was provided where severe, with frequently incapacitating recurrences, severe and frequent headaches, purulent discharge or crusting reflecting purulence. The findings on several VA examinations, the service medical records and post service military reports in 1992 did not appear to more nearly approximate this level of impairment in view of the objective findings on the several examinations collectively. A 10 percent rating was provided where moderate with discharge or crusting or scabbing and infrequent headaches. A noncompensable rating was provided for X-ray manifestations only or symptoms mild or occasional. A 30 percent rating for chronic atrophic rhinitis was provided with moderate crusting and ozena, atrophic changes. A 10 percent rating was provided with definite atrophy of intranasal structure, and moderate secretion. The service records, VA and military records did not report findings approximating the 30 percent criteria for either rating scheme and overall did not show symptoms of sinusitis more nearly approximating the compensable criteria. Thus, the 10 percent evaluation for rhinitis in the period prior to the October 1996 effective date for the changed criteria appears appropriate. 38 C.F.R. § 4.21. Since late 1996, there have been infrequent references to sinus complaints. The military records show an assessment of allergic rhinitis in 1995 with no clinical findings. A Lakewood Clinic record in late 1995 noted no symptom findings for the nose or throat. The 1998 VA examination found no radiological evidence of sinusitis and the clinical examiner noted mild seasonal symptoms of headache and sinus congestion and an annual sinus infection requiring medication. Other than some bifrontal sinus tenderness and mild nasal mucosa congestion the examination was pertinently unremarkable including sinus radiology. A 30 percent rating is now provided for three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. One or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non- incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting may be rated 10 percent. The 10 percent rating for sinusitis appears to be a more accurate reflection of the disability manifested by little appreciable objective evidence of disability. The level of disability does appear to have been accounted for in the current evaluation, particularly in view of the objective symptoms shown in light of the history reported to the examiner. As for the veteran's allergic rhinitis, the rating schedule provisions in effect prior to October 7, 1996 and currently did not appear to preclude separate evaluations for coexisting sinusitis and rhinitis, although it would be essential to avoid pyramiding. 38 C.F.R. §§ 4.14, 4.96. Currently there are neither polyps nor obstruction from allergic rhinitis to allow for a compensable evaluation under the current criteria. As noted previously the 10 percent evaluation for rhinitis prior to October 7, 1996 was more nearly approximated by the objective findings of several examiners. The Board has not overlooked the veteran's testimony and history given to examiner's regarding the effects of seasonal changes. The adjudication principles established in Ardison v. Brown, 6 Vet. App. 405, 407-08 (1994) required an examination during the active stage, if prone to exacerbations at certain times, so as not to frustrate appellate review. The Board finds the facts of this case more clearly fall with the holding in Voerth v. West, 13 Vet. App. 117, 122-23 (1999) that limited the application of Ardison and do not require further examination. As in Voerth, the veteran has not stated that the worsened condition impaired his earning capacity, which is a primary component in the disability rating. Further, the veteran stated he would be required to take medication with the more severe symptoms that occurred about one time a year. From this the Board concludes that the increased symptoms are more likely of short duration rather than weeks or months and therefore he would be less impaired than a person who experienced more appreciable symptoms over a longer period of time. Another examination would not be required in such circumstances. Id. at 123. For the foregoing reasons, the Board concludes that the evidentiary record does not support entitlement to an evaluation in excess of 10 percent for sinus disability at any time or a compensable evaluation for allergic rhinitis currently with application of all pertinent governing criteria. In this case, the Board finds the current and previous schedular provisions preponderate against higher ratings. The rating scheme for allergic rhinitis could not be applied earlier than its effective date. The 10 percent rating initially assigned under chronic rhinitis criteria was the correct rating scheme at the time since chronic sinusitis was not reported on contemporaneous examination. The veteran's disability of the feet is rated currently by analogy in accordance with the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5024, which assess basically evidence of limitation of motion under Diagnostic Code 5003 criteria as the primary rating criteria for incremental ratings. The veteran has been provided the essential rating criteria. The Board finds the rating scheme appropriate for the veteran's disability in view of the diagnosis for the symptomatology. Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992); 38 C.F.R. §§ 4.20, 4.21 (1999). The Board observes that the RO has assigned a 10 percent evaluation for each foot based upon the recent VA examination which did report no or minimally limited range of motion, as the range of motion for each ankle recorded showed only slight disparity from the normal range of motion contemplated in the standardized description of ankle motion in the rating schedule. The examiner indicated that the limitation was from pain from plantar fasciitis and Achilles tendinitis. The RO had a medical evaluation that allows the Board to discuss the provisions of 38 C.F.R. §§ 4.40, 4.45 and 4.59, and comment on the extent of functional loss as discussed in DeLuca, supra, that functional loss due to pain will be rated at the same level as the functional loss where motion is impeded. Thus limitation of motion is not the sole prerequisite finding. There are the veteran's reports of difficulty in extended walking or standing for several hours on account of his disability. From the history of complaints in service beginning in the mid 1980's the disability predominated in the left foot but the VA examinations in late 1990, and in 1992 did not report objective limitation of function to coincide with the veteran's pain complaints and his testimony of limited activity on account of his disability. In fact the VA examiner in late 1992 noted no visible deformity and normal function and motion for the right foot, which was the focus of the veteran's complaint at the time. VA examiners had previously found no deformity, swelling, erythema or functional limitation. Applying this information to the rating schedular criteria leads the Board to conclude that an initial evaluation of 10 percent is warranted for each foot. The symptoms, overall, do not appear more than a percentage evaluation of 10 percent would contemplate. The rating scheme does not require a mechanical application of the schedular criteria, but applying the rating schedule liberally results in a 10 percent evaluation recognizing a symptomatic plantar fasciitis and Achilles tendinitis characterized by complaints of pain primarily and some functional limitation, but with a paucity of objectively confirmed disabling residuals. The recent examination findings, viewed with those previously of record, clearly support a conclusion that the veteran's disorder though productive of disability, is characterized by minimal appreciable objective findings. Thus, the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint would clearly be appropriate in the veteran's case and allow for a 10 percent rating under Diagnostic Code 5024 applying § 4.59, as the minimum compensable evaluation for the joint is 10 percent in view of the interplay of §§ 4.40 and 4.59. The recent VA examination and those earlier appear to have clearly addressed the veteran's complaints and reported objective manifestations likely related to the disability. In view of the foregoing, the Board concludes that the evidence is in favor of a 10 percent rating for each foot based upon the slight limitation of ankle motion linked to the service connected disability for the entire period of this appeal. 38 C.F.R. § 4.7. Clearly the objectively confirmed manifestations that would not support a higher evaluation under any rating scheme applicable to the disability. The pain, tenderness and minimal limitation of motion appear properly compensated with the 10 percent rating. The Board must point out that the symptoms have been adequately supported according to the VA examiner in 1998. However appreciable disability in the workplace is not reported and the exertional stress he has been able to withstand with walking and standing are noted. The examiners have not found a neurologic component of the disability. The provisions of 38 C.F.R. §§ 4.40 and 4.45, as they relate to pain and factors other than limitation of motion as described on VA examinations, appear to support no more than a 10 percent rating. The Board must point out that the VA examinations are consistent in the minimum appreciable objective findings and the disability appears to have been repeatedly characterized by a paucity of objective findings. The appreciable manifestations that are principally pain complaints and slight or minimal limitation of motion for the ankle appear to place the preponderance of the evidence against the claim for a rating in excess of 10 percent, when the relevant findings are reviewed, and the disability assessed in light of the level of impairment overall. Although the veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim for an initial evaluation greater than 10 percent. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The RO provided the veteran the extraschedular rating criteria in a recent supplemental statement of the case. Generally, the degrees of disability specified under the rating schedule are considered adequate to compensate for considerable loss of working time from exacerbation or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. The Board would agree that the exceptional or unusual disability picture mentioned in the regulation would reasonably contemplate factors other than marked interference with employment or frequent periods of hospitalization. Johnston v. Brown, 10 Vet. App. 80, 86 (1997). However, such factors would be apparent from the record and necessarily relate to the service-connected disability. See, for example, Smallwood v. Brown, 10 Vet. App. 97 (1997) and Spurgeon v. Brown, 10 Vet. App. 194, 197 (1997). Nor does there appear to be probative evidence that any nonservice- connected disorders affect the veteran's sinus or foot ankle disability in such a manner to render impractical the application of the regular schedular standards. See for example Johnston, 10 Vet App. at 86-89. The regulation provides for an extraschedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities. The pertinent part of the regulation, though somewhat ambiguously worded, appears to contemplate an individual rather than a collective disability assessment. Further, the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation is to be avoided. 38 C.F.R. § 4.14. This admonition could be read to apply to an extraschedular service-connected evaluation. However, in the case at hand, there is evidence showing monitoring, but nothing probative to support a finding that the veteran has such an unusual or exceptional disability picture as a result of the service-connected sinus disability or the disability of the feet. The veteran has reported work and the recent examination reports have not mentioned any appreciable interference with work. The Board must point out that the veteran has not offered evidence to support how there is established an exceptional or unusual disability picture as a result of either disability. The Board does not find any extraneous circumstances that could be considered exceptional or unusual such as were present in Fisher v. Principi, 4 Vet. App. 57, 60 (1993) to warrant a different result in view of the veteran's work history and treatment for his service-connected sinus disability or disability of the feet as reflected in the record. See also Fleshman v. Brown, 9 Vet. App. 548, 552-53 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). The Board notes that although the decision herein included consideration of the holding in Fenderson, the veteran has not been prejudiced by such discussion in view of the decision on the merits. See for example Bernard v. Brown, 4 Vet. App. 384, 392-394 (1993). The Board has determined that the veteran's sinus disability or the disability of the feet does not warrant consideration of staged ratings in view of facts specific to each disability. ORDER An initial disability evaluation in excess of 10 percent for sinusitis is denied. An initial compensable disability evaluation for allergic rhinitis is denied. An initial disability evaluation in excess of 10 percent for Achilles tendinitis/plantar fasciitis of the left foot is denied. An initial disability evaluation in excess of 10 percent for Achilles tendinitis/plantar fasciitis of the right foot is denied. Mark J. Swiatek Acting Member, Board of Veterans' Appeals