BVA9501252 DOCKET NO. 93-09 433 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUES 1. Entitlement to service connection for bursitis and impingement syndrome of the right shoulder. 2. Entitlement to service connection for arthritis of the neck and degenerative disc disease at C5-6 and C6-7. 3. Entitlement to service connection for degenerative arthritis of the hands. 4. Entitlement to service connection for bronchitis. 5. Entitlement to service connection for emphysema. 6. Entitlement to an increased (compensable) evaluation for hearing loss of the left ear. 7. Entitlement to an increased (compensable) evaluation for lacerations of the frontal area and chin. 8. Entitlement to an increased (compensable) evaluation for an appendectomy scar. 9. Entitlement to an increased (compensable) evaluation for a herniorrhaphy scar. 10. Entitlement to a compensable evaluation in accordance with the provisions of 38 C.F.R. § 3.324 (1993). REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD C.M. Flatley, Counsel INTRODUCTION The veteran had active service from December 1942 to December 1945 and from August 1950 to May 1967. Throughout the course of the veteran's appeal, he has claimed entitlement to service connection for residuals of Agent Orange exposure, to include urticaria, memory loss, bronchitis, emphysema, and chronic obstructive pulmonary disease. By a December 1992 rating decision, entitlement to service connection for urticaria as secondary to exposure to Agent Orange was denied; the veteran made no further reference to the claimed disorder. Entitlement to service connection for urticaria was previously denied by a May 1949 rating decision. Entitlement to service connection for a skull fracture and a concussion and head injury with associated memory loss was also denied by the December 1992 rating decision. However, the veteran's claim for service connection for memory loss as a residuals of exposure to Agent Orange was deferred. In his February 1993 substantive appeal, the veteran again noted disabilities as claimed as a result of exposure to Agent Orange. This matter is not currently developed for appellate consideration and is not inextricably intertwined with the issues before the Board. Accordingly, it is referred to the regional office (RO) for appropriate action. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that bursitis and impingement of the right shoulder, arthritis and degenerative disc disease of the neck, and arthritis of the hands were incurred during service, including as a result of his involvement in a motor vehicle accident. He emphasizes that arthritis was present in service. He further argues that his bronchitis and emphysema may be due to bronchitis in service or to smoking in service. It is also maintained that compensable ratings are warranted for the veteran's service-connected disabilities or, in the alternative, that a 10 percent rating is warranted under 38 C.F.R. § 3.324. DECISION OF THE BOARD The Board of Veterans' Appeals (Board), in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the veteran's claim for service connection for bursitis and impingement syndrome of the right shoulder, arthritis of the neck and degenerative disc disease at C5-6 and C6-7, degenerative arthritis disease of the hands, bronchitis, and emphysema; the preponderance of the evidence is also against the claims for increased evaluations for hearing loss of the left ear, lacerations of the frontal area and chin, an appendectomy scar, and a herniorrhaphy scar, and a compensable evaluation in accordance with the provisions of 38 C.F.R. § 3.324. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. Complaints of right shoulder pain were noted in service, with complete resolution of symptomatology; impingement of the right shoulder was first shown many years after separation from service and is not related to any incident of service. 3. Arthritis of the neck and degenerative disc disease at C5-6 and C6-7 were not shown in service; the disorders were first manifested many years after separation from service and are not related to any incident of service. 4. Degenerative arthritis of the hands was not shown in service; the disorder was first manifested many years after separation from service and is not related to any incident of service. 5. The veteran experienced acute and transitory bronchitis in service, with complete resolution of symptomatology; the bronchitis and emphysema currently demonstrated first became manifest many years after separation from service and are not related to any incident of service. 6. Audiometry findings include average puretone threshold levels of 22 in the right ear and 51 in the left ear, with speech recognition of 96 percent in the right ear and 100 percent in the left ear; puretone averages of 21 in the right ear and 18 in the left ear with speech discrimination of 96 percent in the right ear and 88 percent in the left ear are also recorded. The latter findings establish level I hearing in the right ear and level II hearing in the left ear. 7. The veteran's lacerations of the frontal area and chin are not disfiguring and do not result in any tenderness, ulceration, or limitation of function. 8. The veteran's appendectomy and herniorrhaphy scars are well healed and do not result in any tenderness, ulceration, or limitation of function. 9. Interference with normal employability as a result of the veteran's service-connected disabilities is not shown. CONCLUSIONS OF LAW 1. Bursitis and impingement syndrome of the right shoulder were not incurred in or aggravated by the veteran's period of active service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.303 (1993). 2. Arthritis of the neck and degenerative disc disease at C5-6 and C6-7 were not incurred in or aggravated by the veteran's period of active service; in-service incurrence may not be presumed. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1993). 3. Degenerative arthritis of the hands was not incurred in or aggravated by the veteran's period of active service; in-service incurrence may not be presumed. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1993). 4. Bronchitis and emphysema were not incurred in or aggravated by the veteran's period of active service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.303 (1993). 5. The schedular criteria for a compensable evaluation for hearing loss of the left ear have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, § 4.85, Table VI, and Diagnostic Codes 6100, 6101 (1993). 6. The schedular criteria for a compensable evaluation for lacerations of the frontal area and chin have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, § 4.118, Diagnostic Codes 7800, 7803, 7804, 7805 (1993). 7. The schedular criteria for a compensable evaluation for an appendectomy scar and a herniorrhaphy scar have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, § 4.118, Diagnostic Codes 7803, 7804, 7805 (1993). 8. A compensable evaluation in accordance with the provisions of 38 C.F.R. § 3.324 is not warranted. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. § 3.324 and Part 4 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Review of the record indicates that the veteran has submitted a well-grounded claim with regard to each issue on appeal. 38 U.S.C.A. § 5107(a). The Department of Veterans Affairs (VA) therefore has a duty to assist the veteran in the development of facts pertinent to his claims. 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet.App. 78, 81-82 (1990). In this regard, the veteran's service medical records have been obtained and VA clinical data and post-service private records have been associated with his claims folder. Upon review of the clinical data of record, as well as the veteran's complaints on appeal, and absence thereof, the Board concludes that the veteran has been adequately assisted in the development of his case and that the evidence currently of record provides an adequate basis upon which to address the merits of his claims. I. Bursitis And Impingement Syndrome Of The Right Shoulder. Service medical records associated with the veteran's first period of active service show no pertinent complaint, treatment, finding or diagnosis of a right shoulder disability. On examination in December 1945 for separation from service, no abnormalities of the musculoskeletal system were found. On examination in August 1950 for entrance into the veteran's second period of active service, no pertinent abnormalities were noted. In September 1956, the veteran sought treatment for complaints of bursitis of the right shoulder. Exercises and follow-up evaluation were advised. A sick call treatment record dated in January 1957 notes the veteran's complaints of mild pain in the right shoulder. It was noted that the veteran had experienced a similar pain several months earlier, which had been treated with a Cortisone injection. On examination, a full range of motion of the right shoulder was found, with no tenderness or pain. A grating sensation was noted over the deltoid area of the arms. The diagnostic impression was possible calcium deposits. Reports of examination for re-enlistment in February 1957 and February 1963 reflect no pertinent abnormalities. On examination for retirement and for transfer to the Reserves in March and May 1967, respectively, and on examination in April 1971, evaluation of the upper extremities revealed normal findings. The postservice evidence includes U.S. Air Force Hospital outpatient reports, which reflect a complaint of right shoulder pain in January 1992. No pertinent finding or diagnosis was made. On VA examination in February 1992, the veteran reported that the had experienced shoulder bursitis while in service, with intermittent shoulder "problems" since that time, currently occurring nearly weekly. On VA examination in March 1992, the veteran complained of acute pain in the right shoulder occurring every week, reportedly related to in-service treatment of severe bursitis which involved over-extension of the right arm and shoulder. No pertinent findings were made at that time. On examination in May 1992, examination of the right shoulder revealed supraspinatus and infraspinatus atrophy. Range of motion revealed positive impingement at 50 degrees of abduction; abduction caused tenderness in the subacromial region. It was noted that an x-ray study conducted in February 1992 revealed supraspinatus calcifications at the tendinous insertion. The diagnoses included impingement of the right shoulder. Pertinent law and regulations in this case provide that entitlement to service connection may be allowed for a disability which is incurred in or aggravated by the veteran's period of active service. 38 U.S.C.A. §§ 1110, 1131. Determinations of service connection are based on a review of the entire evidence of record. 38 C.F.R. § 3.303. In this case, the veteran stresses that he received treatment in service for bursitis of the right shoulder. Although the service medical records reflect the veteran's complaints to this effect, the disorder was not definitively demonstrated in service; organic pathology of the right shoulder was also not otherwise established. At most, as shown above, the presence of calcium deposits was suspected. Throughout the remainder of the veteran's period of service, no further reference was made to a shoulder disorder, and routine examinations repeatedly revealed normal findings. In-service clinical data, therefore, indicate that the veteran's right shoulder symptomatology fully resolved prior to separation from service. Complete resolution of any in- service symptomatology is also indicated by the absence of any pertinent post-service complaint or finding for many years after separation from service. It is recognized that current clinical data contain a diagnosis of impingement of the right shoulder. There is no evidence, however, of a relationship between the veteran's acute and transitory symptomatology in service and impingement of the right shoulder demonstrated more than 20 years after separation therefrom. As evidence of a chronic right shoulder disability is not shown in service and there is no indication that the veteran currently has a right shoulder disability of in-service onset, his claim must be denied. II. Arthritis Of The Neck And Degenerative Disc Disease At C5-6 And C6-7. Service medical records associated with the veteran's first period of active service show no complaint, treatment, finding, or diagnosis of arthritis of the neck or degenerative disc disease of the cervical spine, including at C5-6 and C6-7. On examination in December 1945 for separation from service, no abnormalities of the musculoskeletal system were found. On examination in August 1950 for entrance into the veteran's second period of active service, no pertinent abnormalities were noted. In pertinent part, service medical records associated with the veteran's second period of active service show that in September 1957 the veteran sought treatment for "clicking in the neck" followed by sharp pain in the right neck and upper back; it was noted that he had no history of recent injury. Limited motion of the neck to the right was found. Muscle spasm of the right posterior cervical muscles was noted. The diagnostic impression was possible arthritis with muscle spasm and possible disc clicking with irritation. An X-ray study was recommended. On evaluation the following day, it was noted that an X-ray study revealed loss of normal cervical lordosis, with otherwise normal findings. Complaints of pain in the upper thoracic spine on movement of the neck, with no pain in the neck, were noted. Full range of motion of the neck, with no spasm, was found. The diagnostic impression was possible fibrositis syndrome; it was noted that pain was located in the area of developmental wedging of the vertebra. In this regard, it should be pointed out that developmental defects are not considered diseases or injuries within the meaning of VA law and regulations applicable in the veteran's case. 38 C.F.R. § 3.303(c). A report of examination for re-enlistment in February 1963 reflects no pertinent abnormalities. On examination for retirement and for transfer to the Reserves in March and May 1967, respectively, and on examination in April 1971, evaluation of the neck and musculoskeletal system revealed normal findings. The postservice records include VA outpatient reports dated in 1990 and U.S. Air Force Hospital records dated in 1991, which reflect pertinent complaints and a diagnostic assessment of osteoarthritis. On VA examination in February 1992, the veteran reported that he initially noticed neck pain three years after his involvement in an in-service automobile accident in 1950. His pain was reportedly present in the upper thoracic and lower cervical region and occurred approximately once per week. Flexion of the cervical spine was to 50 degrees, with extension to 45 degrees, rotation to 45 degrees, bilaterally, and lateral bending to 20 degrees, bilaterally, with no evidence of pain on motion. An X- ray study of the cervical spine revealed degenerative disc disease at C5-6 and C6-7. The diagnoses included degenerative disc disease at C5-6 and C6-7, compatible with age and usual anatomic distribution. The presence of osteoarthritis was also noted thereafter, including on VA outpatient evaluation in May 1992. Initially, it should be pointed out that in addition to establishing direct in-service incurrence of arthritis, service connection may also be established if the disorder becomes manifest to a compensable degree within one year after separation from service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. As indicated above, however, the veteran's osteoarthritis of the cervical spine was not shown in service or for many years thereafter. Although the veteran seeks to relate his disorder with trauma sustained in service, his allegation is not supported by clinical data recorded contemporaneous with the alleged trauma. Service medical records for many years after the veteran's in-service motor vehicle accident are negative for any indication of arthritis or disc disease of the cervical spine, with normal findings in this respect demonstrated on examination. After service, the disorder was not shown for many years, and an etiologic relationship between the veteran's complaints in service and the osteoarthritis demonstrated many years later has not been established. Further, degenerative disc disease of the cervical spine was also not shown in service or for many years thereafter. The veteran has argued that arthritis was shown in service. In response, the Board stresses that, although "possible arthritis" was noted in service, the disorder was not confirmed on any X-ray study. The veteran's symptomatology was found to be attributable to other causes and, as noted above, fully resolved prior to his service separation. With respect to both the veteran's osteoarthritis and his degenerative disc disease of the cervical spine, a relationship to an incident of service has also not been established. Further, the most recent VA examiner concluded that the finding was compatible with the veteran's age. In light of the evidence of record, therefore, the Board must deny the veteran's claim. III. Degenerative Arthritis Of The Hands. Service medical records associated with the veteran's first period of active service reflect no evidence of degenerative arthritis of the hands. On examination in December 1945 for separation from service, no abnormalities of the musculoskeletal system were found. During the veteran's second period of active service, clinical data recorded in an entry in December 1950 reflects that the veteran sustained a lacerating injury to the hands as a result of his involvement in an automobile accident. No nerve or artery involvement was present. Examination of the extremities was negative, with the exception of a small laceration on the ulnar side of the wrist. Reports of examinations for re-enlistment in February 1957 and February 1963 reflect no pertinent abnormalities. Examinations for retirement and for transfer to the Reserves in March and May 1967, respectively, and an examination in April 1971, revealed normal findings with respect to the upper extremities and musculoskeletal system. On VA examination in February 1992, the veteran complained of a gradual 10- to 20-year progression of stiffness and pain in his hands. On examination, a full functional range of motion of the hands was found, with ankylosis of the distal interphalangeal joints in a flexed, functional position. Radial deviation at the distal interphalangeal joints of the little fingers was noted. An X-ray study revealed osteoarthritis, symmetrically, of the distal interphalangeal joints in the hands. The diagnoses included osteoarthritis of the hands. The record fails to establish the presence of osteoarthritis of the hands in service or to a compensable degree within one year after separation therefrom. The disorder was initially demonstrated on VA examination February 1992, and there is no evidence to associate the finding with the veteran's period of service. Although it is recognized that he sustained trauma to the hands in service, the record fails to establish that the trauma was extensive, as claimed by the veteran. More importantly, evidence of degenerative arthritis during service and for many years thereafter is absent. Further, clinical data are silent as to a relationship between the any trauma experienced by the veteran in service and the osteoarthritis initially shown fairly recently. Overall, as the veteran's arthritis of the hands was not shown in service or to a compensable degree within one year after separation from service, and a relationship between his disorder and service is not demonstrated, the Board has no foundation upon which to allow the veteran's claim. IV. Bronchitis and Emphysema. Service medical records show that in November 1944 the veteran sought treatment for a two-day history of tightness in the chest; wheezes at both lung bases were present on examination. An X-ray study of the chest revealed a slight increase in the vascular markings and was otherwise within normal limits. A diagnosis of acute, catarrhal bronchitis, moderately severe, was made. On examination in December 1945, for separation from service, an X- ray study of the chest revealed no abnormalities; examination of the lungs revealed normal findings. Medical records associated with the veteran's second period of active service reflect no pertinent abnormalities on examination in August 1950 for service entrance. An entry dated in January 1955 documents radiographic findings of a moderate increase in bronchovascular shadows at the right base; both hilar shadows were prominent. The diagnosis was acute bronchitis. Thereafter, reference to or evidence of bronchitis in service is absent. Reports of routine examinations noted negative findings on X-ray study of the chest. Normal findings were also made on subsequent clinical and radiographic examinations of the chest, including on examination for retirement and for transfer to the Reserves in March and May 1967, respectively. Subsequent to service, the presence of pulmonary impairment was initially recorded in a 1990 VA outpatient report, which reflects a finding of decreased breath sounds, left more than right, and a diagnosis of chronic obstructive pulmonary disease. Outpatient entries from VA and from a U.S. Air Force Hospital dated from 1990 to 1992 reflect continued complaints referable to the veteran's pulmonary impairment, with follow-up and routine care on a regular basis and with diagnoses of bronchospasm, emphysema, and chronic obstructive pulmonary disease. On VA examination in February 1992, the veteran reported that he had experienced bronchitis every fall over a period of "many years." It was noted that a diagnosis of emphysema had been made five years before; the veteran's lung disease had reportedly increased in severity since that time. It was reported that he had stopped smoking in 1969 after smoking for more than 20 years. Pulmonary function studies conducted in March 1992 revealed moderate restrictive disease, with significant response to bronchodilator or increased effort. Private hospital records dated in September 1992 reflect continued symptomatology associated with the veteran's lung disorder. Review of the record shows that the veteran experienced bronchitis on two occasions in service. Both episodes were described as acute, and the evidence establishes that they resolved uneventfully; continued or residual impairment associated with bronchitis is absent in each instance. Viewed in its entirety, pertinent clinical data reflect that on each occurrence the veteran's bronchitis resolved completely. The acute and transitory nature of bronchitis is further highlighted by the absence of any reference to the disorder until more than 20 years after the veteran's period of active service. Although claimed by the veteran, there is no evidence of a relationship between the acute episodes of bronchitis in service and the bronchitis currently demonstrated. Overall, in light of the absence, until recently, of any indication of the disorder subsequent to the occurrences in service, and the failure to relate the veteran's current bronchitis to the symptomatology experienced in service, the Board has no foundation upon which to allow the veteran's claim in this regard. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. The veteran asserts that bronchitis which he experienced in service has grown progressively worse and has led to the onset of emphysema. He also argues that his pulmonary disabilities may be due to smoking in service. In response, it is initially pointed out that emphysema was not shown in service, and first became manifest many years after separation therefrom. Evidence of a relationship between the veteran's emphysema and service is absent. There is no medical evidence reflecting that his current pulmonary disabilities are causally related to any incident of his service. As to the veteran's assertion as to the onset of emphysema, it is stressed that clinical data fail to establish a relationship between the bronchitis experienced by the veteran in service and his current pulmonary pathology. Evidence of continued pulmonary impairment in service and subsequent thereto is absent. Clearly, a relationship between the acute episodes of bronchitis and the development of emphysema is not demonstrated by the evidence of record. The veteran's claim, therefore, must be denied. Id. V. Hearing Loss Of The Left Ear. Service medical records show that in November 1944 the veteran sought treatment for pain and impaired hearing in the left ear subsequent to exposure to a sudden blast from a loud speaker. Evaluation led to a diagnosis of acute, suppurative otitis media, left, moderately severe. The veteran's auditory acuity was 12/15 on the left. On examination in December 1945 for separation from the veteran's first period of active service, hearing was 15/15. Remaining service medical records show, in pertinent part, that defective hearing was noted on examination for retirement and for transfer to the Reserves in March and May 1967, respectively. Post-service, clinical data include reports of VA outpatient treatment, including in August 1990, when decreased hearing, left more than right, was noted. Entitlement to service connection for hearing loss in the left ear was allowed by a May 1992 rating decision, and a noncompensable evaluation was assigned. On VA audiology examination in March 1992, the average puretone threshold for the frequencies of 1,000, 2,000, 3,000, and 4,000 Hertz was 22 in the right ear and 51 in the left ear. Speech recognition was 96 percent in the right ear and 100 percent in the left ear. In accordance with VA standards, results of the audiology examination reflect level I hearing bilaterally. 38 C.F.R. Part 4, § 4.87, Table VI. On VA audiology evaluation in May 1992, puretone averages of 21 in the right ear and 18 in the left ear were recorded; the veteran's speech discrimination was 96 percent in the right ear and 88 percent in the left ear. The diagnosis was bilateral sensorineural high frequency hearing loss, left more than right. The values recorded equate to level I hearing in the right ear and level II hearing in the left ear. Id. Initially, it is pointed out that disability ratings are based, as far as practicable, upon the average impairment of earning capacity attributable to specific injuries. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. With regard to the veteran's claim of increased compensation for left ear hearing loss, it is noted that evaluations of defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests together with the average threshold level as measured by pure tone and audiometry tests in the frequencies of 1,000, 2,000, 3,000, and 4,000 Hertz. 38 C.F.R. Part 4, § 4.85, Diagnostic Codes 6100 to 6110 (1993). To evaluate the degree of disability from defective hearing, the Rating Schedule establishes auditory acuity levels from I to XI. Id. In this case, service connection is in effect for hearing loss in the left ear only. In situations in which service connection has been granted for defective hearing in one ear, a maximum 10 percent evaluation is assignable when hearing in the service-connected ear is at level X or XI. Id. Service- connected hearing loss in one ear and total deafness in the other ear also warrants the assignment of a compensable evaluation. 38 U.S.C.A. § 1160(a)(3). In this case, results of a recent audiology examination reveal level I hearing in the right ear and level II hearing in the left ear. In accordance with the Rating Schedule, therefore, the veteran's hearing loss in the left ear does not, given the level of hearing acuity in the right ear, warrant the assignment of a compensable evaluation in the absence of bilateral deafness. 38 C.F.R. Part 4, § 4.85, Table VII, Diagnostic Code 6100. In accordance with applicable schedular criteria, therefore, the Board concludes that the noncompensable evaluation in effect for the veteran's left ear hearing loss is appropriate. 38 U.S.C.A. §§ 1155, 1160(a)(3); 38 C.F.R. Part 4, § 4.1, 4.85, Tables VI, VII. VI. Lacerations Of The Frontal Area And Chin. In pertinent part, service medical records show that in December 1950, during his second period of active service, the veteran sustained a lacerating wound of the "front area down into the left eyebrow." A small laceration on the right side of the chin was also present. It was noted that the veteran's cranial nerves were intact and that no sensory or motor involvement was present. The wounds were sutured and, as noted at hospital discharge, healed satisfactorily. The discharge diagnoses included lacerated wound of the face. On examination in February 1957 for re-enlistment, a 1/4-inch scar over the left eyebrow was recorded; essentially similar findings were noted on examination in February 1963. On examination in May 1966, a 1 1/2-inch scar on the left temple and a 1-inch scar on the right cheek were noted. Essentially similar findings were made on examination for retirement and for transfer to the Reserves in March and May 1967, respectively. No associated abnormalities were noted. Post-service evidence referable to the veteran's laceration scars on the frontal area and chin is limited to results of a VA examination conducted in February 1992, which notes no complaint or residual associated with the veteran's scars from his 1950 motor vehicle accident. Pertinent schedular criteria provide that a noncompensable evaluation is assigned for slight and a 10 percent evaluation is assigned for moderate disfiguring scars of the head, face, or neck. 38 C.F.R. Part 4, § 4.118, Diagnostic Code 7800. Superficial, poorly nourished scars, with repeated ulceration, or superficial scars which are tender and painful on objective demonstration also warrant the assignment of 10 percent evaluations. 38 C.F.R. Part 4, § 4.118, Diagnostic Codes 7803, 7804, respectively. Scars may also be rated on limitation of function of the affected part. 38 C.F.R. Part 4, § 4.118, Diagnostic Code 7805. At most, the record reflects that the veteran has noted that a scar is present as a result of his motor vehicle accident. Since treatment of his in-service injuries, there has been no indication of continued impairment attributable to residual scars, including as a result of pain or tenderness; disfigurement has been neither claimed nor established. On the veteran's recent VA examination, it was noted that no complaint or residual was made with respect to the aforementioned scars. In this case, review of the record in its entirety fails to establish that the veteran's laceration scars on the frontal area and chin are productive of compensable disability in accordance with schedular criteria. No abnormalities associated with the laceration scars were shown subsequent to their occurrence in service. Thereafter, clinical data, recorded on individual examination and in VA outpatient reports, do not indicate that impairment associated with the scars is present to the extent required for the assignment of a compensable rating. Moderate disfigurement or tenderness of the scars, for example, is not established. The recent VA examiner noted the absence of pertinent complaints or residuals. Overall, the Board concludes that a compensable evaluation for the veteran's scars of the frontal area and chin may not be assigned. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4, §§ 4.1, 4.118, Diagnostic Codes 7800, 7803, 7804, 7805. VII. Appendectomy and Herniorrhaphy Scars. With regard to the veteran's appendectomy scar, service medical records show that in April 1944 a diagnosis of acute appendicitis was made and an appendectomy was performed using a McBurney's incision. On examination in November 1944, examination of the skin revealed negative findings. On examination in December 1945 for separation from service, a 3-inch McBurney's scar was noted on examination of the skin. Service medical records also show that the veteran was hospitalized in January and February 1945 for treatment of a right inguinal hernia. Repair of the hernia was accomplished. On examination approximately four weeks after the herniorrhaphy, the scar was noted to be well healed and non-tender. The discharge diagnosis was indirect right inguinal hernia, incomplete, reducible, incurred in April 1944 upon straining when lifting a generator. On examination in December 1945 for separation from service, examination of the veteran's skin revealed a 6-inch hernia scar. Service medical records also include results of an examination conducted in August 1949, which revealed normal findings on examination of the skin. Entitlement to service connection for a herniorrhaphy scar on the right and for an appendectomy scar was allowed by a May 1949 rating decision, and noncompensable evaluations were assigned; the evaluations have remained at a noncompensable level since that time. On examination in August 1950 for service entrance, no significant abnormalities were noted on examination of the veteran's skin, including on evaluation for scars. On examination in February 1957 for re-enlistment, a 4-inch scar in the right lower quadrant was found. Essentially similar findings were noted on examination in February 1963. A 2-inch scar was noted on the right side of the pubic area and a 2-inch scar in the right lower quadrant were noted on examination in May 1966 and on examination for retirement and for transfer to the Reserves in March and May 1967, respectively. No notations were made at that time as to symptomatology associated therewith. Subsequent to service, reference to the veteran's appendectomy and herniorrhaphy scars is limited. As indicated above, post- service clinical data are comprised essentially of recent outpatient reports which document a variety of complaints. Complaints regarding symptomatology associated with the veteran's surgical scars, however, are not recorded. On general physical examinations conducted in response to other symptomatology, there is no indication the scars are symptomatic. Although noted in a report of a VA outpatient evaluation in August 1990, for example, no complaint or pathology associated with the scars is shown. With regard to the veteran's herniorrhaphy scar, it is stressed that in-service findings indicate that it was well healed and non-tender. In addition, on VA examination conducted in February 1992, the examiner commented that no complaint or residual associated with scars from the veteran's 1950 motor vehicle accident was noted. It is recognized that the examiner appeared to limit findings to the veteran's scars associated with a motor vehicle accident. The examiner's comments, however, are consistent with the remainder of the record, which reflects no pertinent complaints made by the veteran with regard to the surgical scars and absence of positive findings in the record as a whole. Repeated ulceration, tenderness, or limitation of function of the affected part, for example, are clearly not shown. 38 C.F.R. § 4.118, Diagnostic Codes 7803, 7804, 7805. In this light, the examination of the veteran's appendectomy and herniorrhaphy scars appears to have been routinely initiated by the RO due to their service-connected status rather than complaints by the veteran relative thereto. Overall, the Board concludes that the clinical picture as to the veteran's appendectomy and herniorrhaphy scars does not reflect the presence of compensable disability in accordance with the applicable law and regulatory and schedular criteria outlined above. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.118, Diagnostic Codes 7803, 7804, 7805. VIII. A Compensable Evaluation In Accordance With The Provisions Of 38 C.F.R. § 3.324. The provisions of 38 C.F.R. § 3.324 state that when a veteran is suffering from two or more permanent service-connected disabilities of such character as to clearly interfere with normal employability, though none of the disabilities may be of compensable degree in accordance with the VA's Schedule For Rating Disabilities, a 10 percent rating may nonetheless be applied. A report of the veteran's March 1992 VA examination reflects that subsequent to the veteran's separation from service in 1967, he was employed as a building superintendent from 1972 until his retirement in 1982. As reflected above, there is no indication, upon review of the veteran's history, that his service-connected disabilities have, currently or by history, been productive of impairment which would interfere with normal employability. It is noted by history that the veteran retired in 1982, and prior thereto the record is silent as to any impairment associated with his service-connected appendectomy and herniorrhaphy scars. Currently, the evidence of record fails to establish impairment as a result of the veteran's current service-connected disabilities, including impairment to an extent which would interfere with employment. Pertinent complaints or the need for regular treatment associated with the veteran's service-connected disorders is in large part absent. Overall, the record indicates that the veteran's service-connected disorders are productive of minimal, if any, impairment, and includes no evidence of any appreciable impact on the veteran's ability to function generally. As such, the Board concludes that a 10 percent rating in accordance with the provisions of 38 C.F.R. § 3.324 is not warranted. IX. Additional Consideration. The Board has also considered all pertinent provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the veteran. In this respect, the Board has considered whether extraschedular ratings are in order under 38 C.F.R. § 3.321 (1993). Upon review of the record, however, as discussed above, the Board concludes that the disability picture presented by the service-connected disabilities is not so unusual or exceptional that use of the regular rating criteria is precluded. Consequently, extraschedular ratings are not warranted. Further, the Board notes that the provisions of 38 U.S.C.A. § 5107(b) and 38 C.F.R. § 4.7 (1993) are not for application in this case, as the evidence is not evenly balanced and the veteran's disability picture does not more nearly approximate the schedular criteria for the next higher evaluation. ORDER Entitlement to service connection for bursitis and impingement syndrome of the right shoulder, arthritis of the neck and degenerative disc disease at C5-6 and C6-7, degenerative arthritis of the hands, bronchitis, and emphysema is denied. Entitlement to increased (compensable) evaluations for hearing loss of the left ear, lacerations of the frontal area and chin, an appendectomy scar, and a herniorrhaphy scar is denied. Entitlement to a compensable evaluation in accordance with the provisions of 38 C.F.R. § 3.324 is denied. V. L. JORDAN 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.