BVA9504256 DOCKET NO. 92-03 614 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to a compensable evaluation for bilateral hearing loss. 2. Entitlement to an increased evaluation for tinnitus, currently evaluated as 10 percent disabling. 3. Entitlement to a compensable evaluation for postoperative residuals of removal of a ganglion cyst of the right wrist. 4. Entitlement to service connection for a left knee disorder. 5. Entitlement to an evaluation in excess of 10 percent for right foot metatarsalgia. 6. Entitlement to an evaluation in excess of 10 percent for postoperative residuals of removal of a ganglion cyst of the left wrist. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD T. S. Kelly, Associate Counsel INTRODUCTION The veteran had active military service from July 1977 to July 1990. While the Regional Office (RO) has developed the issues of entitlement to an earlier effective date for a 10 percent evaluation for right foot metatarsalgia and entitlement to an earlier effective date for a 10 percent evaluation for postoperative residuals of the removal of a ganglion cyst of the left wrist, these issues were not raised by the veteran, and as such are not properly before the Board of Veterans' Appeals (Board). The United States Court of Veterans Appeals (Court) has held that the Board must continue to review decisions that have resulted in a partial grant of benefits but have not resulted in a full grant of benefits. As the veteran's representatives have continued to argue the above two issues as increased evaluations, although their arguments relate to the assignment of a compensable evaluation which has already been assigned, the Board will address these issues as though they were requests for evaluations in excess of 10 percent. This case was before the Board in September 1992, at which time it was remanded to the RO on the issues of service connection for right ankle and right knee disorders. The RO granted those benefits on remand. Thus, those issues are no longer before us. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the symptomatology associated with his service-connected bilateral hearing loss is sufficient to warrant a compensable evaluation. He further contends that he has constant ringing in his ears and that an increased evaluation for tinnitus is warranted. He further maintains that the symptomatology associated with his left and right wrist disorders warrants increased ratings for the disorders. He also maintains that his current left knee disorder had its origin in service. The veteran further contends that an increased evaluation is warranted for his right foot metatarsalgia. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the veteran's claims for compensable evaluations for bilateral hearing loss and for postoperative residuals of removal of a ganglion cyst of the right wrist. It is further the decision of the Board that the preponderance of the evidence is against evaluations in excess of 10 percent for tinnitus and for postoperative residuals of removal of a ganglion cyst of the left wrist. It is also the decision of the Board that the evidence supports the grant of service connection for a left knee disorder. It is further the decision of the Board that the evidence supports the grant of a 20 percent disability evaluation for right foot metatarsalgia, but that the preponderance of the evidence is against an evaluation in excess of 20 percent for that disorder. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO insofar as possible. 2. The veteran has constant ringing in his ears; the ringing is not shown to have required hospitalization, to have caused marked interference with employ- ability, or to have involved any other such factors. 3. Dorsiflexion of the right wrist is not less than 15 degrees, nor is palmar flexion limited in line with forearm. 4. Ankylosis of the left wrist is not shown. 5. The veteran's right foot metatarsalgia produces moderately severe, but not severe foot disability. 6. The veteran's left knee chondromalacia had its onset during service. 7. The veteran has level I hearing in the right ear and level I hearing in the left ear. CONCLUSIONS OF LAW 1. An evaluation in excess of 10 percent for tinnitus is not warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.87a, Code 6260 (1994) 2. A compensable evaluation for postoperative residuals of removal of a ganglion cyst of the right wrist is not warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.31, 4.71a, Codes 5015, 5214, 5215, 7803, 7804, 7805 (1994). 3. A rating in excess of 10 percent for postoperative residuals of removal of a ganglion cyst of the left wrist is not warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.71a, Codes 5099, 5214, 5215, 7803, 7804, 7805 (1994). 4. A 20 percent evaluation for right foot metatarsalgia is warranted, but a rating in excess of 20 percent is not. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.71a, Codes 5283, 5284 (1994). 5. With reasonable doubt resolved in favor of the veteran, his left knee chondro- malacia was incurred in service. 38 U.S.C.A. §§ 1131, 5107 (West 1991); 38 C.F.R. §§ 3.102, 3.303(d) (1994). 6. A compensable evaluation for bilateral hearing loss is not warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1),4.7, 4.85, Codes 6100 through 6110 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran has submitted well-grounded claims. That is, he has submitted claims which are plausible and capable of substantiation. The Department of Veterans Affairs (VA), therefore has a duty to assist the veteran in the development of his claims. In this regard, we note that the Board remanded this case to the RO in September 1992 for additional development, to include a thorough search for the veteran's service records and for additional VA examinations. As the additional development has been accomplished, the duty to assist has been met. 38 U.S.C.A. § 5107 (West 1991). I. Increased Evaluations Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1994). Separate diagnostic codes identify the various disabilities. A. Bilateral Hearing Loss Evaluations of bilateral defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as noted by the results of controlled speech discrimination tests, together with the average hearing threshold levels as measured by pure tone audiometry tests in the frequencies of 1,000, 2,000, 3,000, and 4,000 cycles per second. To evaluate the degree of disability from bilateral service-connected defective hearing, the revised rating schedule establishes 11 auditory acuity levels, designated from level I for essentially normal acuity through XI for profound deafness. 38 C.F.R. § 4.85, Codes 6100 to 6110 (1994). Historically, the veteran sustained loss of hearing in both ears during service, and this loss of hearing has continued since his separation from service. VA audiological results recorded in January 1991 showed the veteran's' pure tone threshold average in the right ear to be 39 decibels for the pertinent four frequencies, with speech recognition ability of 96 percent correct. In the left ear, the pure tone threshold average was 43 decibels, with speech recognition ability of 96 percent correct. This equates to level I hearing in the right ear and level I hearing in the left ear. VA audiological results recorded in July 1993 showed the pure tone threshold average in the right ear to be 24 decibels, with speech recognition ability of 96 percent correct. In the left ear, the pure tone threshold average was 29 decibels, with speech recognition ability of 96 percent correct. This also equates to level I hearing in the right ear and level I hearing in the left ear. As the Court recognized in Lendenmann v. Principi, 3 Vet.App. 345 (1992), "[D]isability ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered." Here, such mechanical application establishes that a noncompensable rating is warranted under Diagnostic Code 6100. The veteran's testimony that his hearing loss bothers him is credible, but does not establish that the criteria for a higher rating are met. Consideration has also been given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the appellant, as required by Schafrath v. Derwinski, 1 Vet.App. 589 (1991). In particular, the evidence discussed above does not suggest that the veteran's bilateral hearing loss presents such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards so as to warrant the assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1) (1992). For example, the disability has not required frequent periods of hospitalization or markedly interfered with employment. B. Tinnitus The veteran is currently service connected for tinnitus, which has been assigned a 10 percent disability evaluation. Persistent tinnitus as a symptom of head injury, concussion, or acoustic trauma, warrants a 10 percent disability evaluation. 38 C.F.R. § 4.87a, Code 6260 (1994). As such, the veteran has attained the highest possible schedular disability evaluation. The only way that rating may be increased is on an extraschedular base. While the rating schedule will be used for evaluating the degree of disabilities in claims for disability compensation, in exceptional cases an extraschedular evaluation may be assigned commensurate with the average earning capacity impairment due exclusively to the service-connected disability. The governing norm in these exceptional cases is: A finding that 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 the regular schedular standards. 38 C.F.R. § 3.321(b)(1) (1994). A review of the file demonstrates that the veteran has not been hospitalized for his tinnitus, nor is it shown to have markedly interfered with his employment. While the veteran reported at the time of his July 1993 VA audiological evaluation that he had high ringing in his ears, which interfered with his hearing, such impairment is already contemplated in the schedular rating. As such, an extraschedular evaluation is not warranted. C. Postoperative Residuals of Removal of a Ganglion Cyst of the Right Wrist The veteran is currently service connected for postoperative residuals of removal of a ganglion cyst of the right wrist, which has been assigned a noncompensable disability evaluation. A 10 percent disability evaluation will be assigned for a superficial scar which is tender and painful on objective demonstration or that is poorly nourished with repeated ulceration. Scars are also rated on limitation of the function of the part affected. 38 C.F.R. § 4.118, Codes 7803, 7804, 7805 (1994). 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 compen- sable evaluation are not met. 38 C.F.R. § 4.31 (1994). Benign new bony growths are also rated on the basis of limitation of motion. 38 C.F.R. § 4.71a, Code 5015 (1994). A 10 percent disability evaluation is warranted where palmar flexion of the wrist is limited in line with forearm or where dorsiflexion is less than 15 degrees. An evaluation of 20 percent or more requires ankylosis of the wrist. 38 C.F.R. § 4.71a, Codes 5214, 5215. At the time of the January 1991 VA special orthopedic examination, the veteran reported having had bilateral ganglions of the wrists removed while in service. The veteran indicated that the wrists were occasionally aching, painful, tender, and sore. Examination of the wrist showed scars dorsally on both wrists. Excellent range of motion was reported, with no swelling or deformity being noted. Excellent grip and grasp were also noted. X-ray examination revealed no significant abnormality of the bone, joint, or adjacent tissue. At his June 1992 personal hearing, the veteran reported that his wrists often became sore to the point that he could almost not move them. He also indicated that he could not hang onto things. Transcript page 4 (T. 4). The veteran was afforded another VA examination in October 1992, at which time right wrist flexion was reported to 75 degrees and extension (dorsiflexion) was reported to 57 degrees. The examiner further noted that the ganglion had returned in the dorsum of the right wrist and that it had been injected with cortisone approximately one year ago and had come back. The examiner further reported that the right dorsal scar measured 3.5 inches and was not tender. A diagnosis of post excision dorsal ganglion right wrist with good result was rendered at that time. As evidenced above, the veteran's 3.5-centimeter scar was reported to be nontender. There were no findings made that the scar had repeated ulcerations or was poorly nourished, and there was no evidence of pain on objective demonstration. Range of motion of the wrist was reported as excellent at the time of the January 1991 VA examination, while the October 1992 VA examination noted flexion to 75 degrees with extension to 57 degrees. No other impairment of right wrist function was noted. Consequently, the clinical data do not support the veteran's testimony regarding the level of impairment caused by his right wrist ganglion. Where subjective complaints are inconsistent with objective clinical findings, the latter must have greater probative value on the claim. As such, the criteria for an increased evaluation have not been met or approximated. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.71a, Codes 5099, 5214, 5215, 7803, 7804, 7805 (1994). Consideration has also been given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the appellant, as required by Schafrath v. Derwinski, 1 Vet.App. 589 (1991). In particular, the evidence discussed above does not suggest that the postoperative residuals of removal of a ganglion cyst of the right wrist present such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards so as to warrant the assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1) (1994). For example, the disability has not required frequent periods of hospitalization or markedly interfered with employment. D. Postoperative Residuals of Removal of a Ganglion Cyst of the Left Wrist. The veteran is currently service connected for postoperative residuals of removal of a ganglion cyst of the left wrist, which has been assigned a 10 percent disability evaluation under 38 C.F.R. §§ 4.71a, 4.118, Codes 5099 and 7804 (1994). 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 are 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 diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20 (1994). A 10 percent disability evaluation will be assigned for a superficial scar which is tender and painful on objective demonstration or that is poorly nourished with repeated ulceration. Scars are also rated on limitation of the function of the part affected. 38 C.F.R. § 4.118, Codes 7803, 7804, 7805 (1994). A 10 percent disability evaluation is also warranted where palmar flexion of the wrist is limited in line with forearm or where dorsiflexion is less than 15 degrees. An evaluation of 20 percent or more requires ankylosis of the wrist. 38 C.F.R. § 4.71a, Codes 5214, 5215 (1994). At the time of the January 1991 VA special orthopedic examination, the veteran reported having had bilateral ganglions of the wrists removed while in service. The veteran indicated that the wrists were occasionally painful, tender, aching, and sore. Examination of the wrist showed scars dorsally on both wrists. Excellent range of motion was reported, with no swelling or deformity being reported. Excellent grip and grasp were also noted. X-ray examination revealed no significant abnormality of the bone, joint, or adjacent tissue. At his June 1992 personal hearing, the veteran reported that his wrists often became sore to the point that he could almost not move them. He also indicated that he could not hang onto things. (T. 4). He further reported that he had a cyst coming back on his left wrist. (T. 3). The veteran was afforded another VA examination in October 1992, at which time left wrist flexion was reported to 75 degrees and extension (dorsiflexion) was reported to 50 degrees. The examiner noted that the left dorsal scar measured 4.5 inches and was tender over the dorsum of the left wrist. A diagnosis of post excision dorsal ganglion left wrist, which remained tender, and a recurrence of the dorsal ganglion was rendered at that time. As evidenced above, the veteran's 4.5-centimeter scar was reported to be tender. Range of motion of the wrist was noted to be excellent at the time of the January 1991 VA examination, while the October 1992 VA examination noted flexion to 75 degrees with extension to 50 degrees. There was no ankylosis reported on either examination. The current 10 percent evaluation is based on the tender scar. An increased schedular evaluation may only be based upon limitation of range of motion. As was previously noted, flexion of the left wrist was to 75 degrees with extension to 50 degrees. There was no ankylosis reported on either examination. As such, the schedular criteria for an increased evaluation have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.71a, Codes 5099, 5214, 5215, 7803, 7804, 7805 (1994). Consideration has also been given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the appellant, as required by Schafrath v. Derwinski, 1 Vet.App. 589 (1991). In particular, the evidence discussed above does not suggest that the postoperative residuals of removal of a ganglion cyst of the left wrist present such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards so as to warrant the assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1) (1994). For example, the disability has not required frequent periods of hospitalization or appeared to have markedly interfered with employment. We have considered the veteran's testimony regarding the impairment resulting from his residuals of a right wrist ganglion cyst removal. However, that testimony does not establish that he has ankylosis of the wrist or that the factors needed to establish an extraschedular rating are present. E. Right Foot Metatarsalgia The veteran is service connected for right foot metatarsalgia, currently evaluated as 10 percent disabling. A 10 percent disability evaluation requires a moderate foot injury. A 20 percent disability evaluation is warranted for a moderately severe foot injury. A 30 percent disability evaluation is warranted for a severe foot injury. 38 C.F.R. § 4.71a, Code 5284 (1994). A 20 percent disability evaluation is also warranted for moderately severe malunion or nonunion of the tarsal or metatarsal bones. 38 C.F.R. § 4.71a, Code 5283 (1994). A review of the record demonstrates that the veteran was seen on several occasions for right foot pain while in service. At the time of separation, a diagnosis of arthralgia of the metatarsal joint of the right great toe was rendered. At the time of his January 1991 VA examination, the veteran reported having had right ankle and right foot sprains while in service. He further reported that he had occasional aches and soreness laterally around the ankle with heavy use as well as some second metatarsal pain. Examination of the right foot showed metatarsal tenderness over the 2nd "met" head with no other deformity. Right foot metatarsalgia was diagnosed. At his June 1992 personal hearing, the veteran testified that he had a loose bone in his foot which affected his walking and caused both his right foot and ankle to swell. Such testimony is credible and is considered in our discussion below. At his October 1992 VA examination, the veteran reported that his feet started bothering him when stationed at Fort Benjamin, Indiana, as a result of having had to stand for 12 hours or more during parades in 1982 and 1983. He further indicated that the basic trouble with his feet at the time of the examination was the 3rd metatarsal head in the right foot, which was painful. The veteran indicated that he was not receiving therapy for his right foot and that he worked as a truckdriver. He also indicated that he tried not to put pressure on the 3rd metatarsal head. Physical examination revealed no abnormal calluses on either foot. The 3rd metatarsal head on the right foot was reported to be tender. The veteran was found to walk to the outside of his shoe to protect the metatarsal head. The veteran further indicated that walking on the outside of the right foot aggravated the condition of his right ankle. The veteran was also noted to walk with a marked limp when walking on the right foot and could not go more than a few steps when attempting to walk on the right toes because of pain in the 3rd metatarsal head. The examiner further indicated that the veteran complained of pain in the 3rd metatarsal head when doing squats. A deformity of walking to the outside of the right foot was also noted. X-ray examination of the veteran's feet revealed a mild hallux valgus deformity of the 1st metatarsal, bilaterally, with no fracture, dislocation, or destructive bone changes. Right foot metatarsal phalangeal metatarsalgia was diagnosed. Overall, the evidence reflects a continuing worsening of the veteran's pain in the 3rd metatarsal head with a concomitant increase in functional impairment. While the January 1991 VA examination of the right foot showed metatarsal tenderness over the 2nd "met" head, with no other deformity, the October 1992 VA foot examination reported that the veteran walked with a marked limp when walking on the right foot and could not go more than a few steps when attempting to walk on the right toes because of pain in the third metatarsal head. A deformity of walking to the outside of the right foot was also noted at that time. Such findings reflect moderately severe foot disability. The degree of impairment warrants a 20 percent rating under Code 5284. Severe foot disability is not shown as the veteran continues to work as a truckdriver and is able to walk distances, albeit with a limp, when not placing weight on his right toes. The criteria for an evaluation under 38 C.F.R. § 4.71a, Code 5283, have also not been met as malunion or nonunion of the metatarsal bones has not been shown. Consequently, a schedular rating in excess of 20 percent is not warranted. Consideration has also been given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the appellant, as required by Schafrath v. Derwinski, 1 Vet.App. 589 (1991). In particular, the evidence discussed above does not suggest that the veteran's right foot metatarsalgia presents such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards so as to warrant the assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1) (1994). For example, the disability has not required frequent periods of hospi- talization and has not markedly interfered with employment. II. Service Connection for a Left Knee Disorder Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of a preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C.A. § 1131 (West 1991). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1994). It is the defined and consistently applied policy of the VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. It is not a means of reconciling actual conflict or a contradiction in the evidence; the claimant is required to submit evidence sufficient to justify a belief in a fair and impartial mind that the claim is well grounded. Mere suspicion or doubt as to the truth of any statements submitted, as distinguished from impeachment or contradiction by evidence or known facts, is not justifiable basis for denying the application of the reasonable doubt doctrine if the entire, complete record otherwise warrants invoking this doctrine. The reasonable doubt doctrine is also applicable even in the absence of official records, particularly if the basic incident allegedly arose under combat, or similarly strenuous conditions, and is consistent with the probable results of such known hardships. 38 C.F.R. § 3.102 (1994). A review of the file demonstrates that the veteran injured his left knee while playing football in July 1991. An August 1, 1989, service medical record noted that the veteran sustained an acute injury to the knee while running. An unremarkable history was reported at that time. Physical examination revealed equilateral varus/valgus laxity without pain on the right, with varus stress in the left knee. Range of motion was reported to be normal, with drawer, McMurray, and Lachmann's signs being negative. No crepitus, redness, swelling, bruising, or tenderness was noted. The veteran was again seen on August 8, 1989, for complaints of pain in his left knee. He reported that he had had pain on the side of the knee for the last seven days and further indicated that when he turned left his knee pulled. He also reported that his knee hurt a lot when he walked up stairs. Physical examination revealed range of motion to be from 0 to 135 degrees. Tenderness was noted in the area of the fibular head and lateral collateral ligament. A diagnosis of a lateral collateral ligament sprain was rendered at that time. No further complaints of knee pain were noted while the veteran was in service. At the time of the veteran's May 1990 service separation examination, normal findings were reported for the veteran's lower extremities. No complaints of knee pain were noted on the veteran's May 1990 service separation report of medical history. At the time of his January 1991 VA examination, the veteran reported having had bilateral knee pain from overuse in the service. Examination of the knees showed a little bit of patellofemoral pain and occasional cracking and popping of the knees. The veteran's knees were noted to be stable with full range of motion, and no effusion or joint line pain was present. X-rays of the veteran's knees showed no significant abnormality of the bone joints, or adjacent tissues. A "bilateral knee condition" was diagnosed. At his June 1992 personal hearing, the veteran testified that when he was discharged, the doctor giving him the physical indicated that he would probably have to have surgery on his knees within the next five years (T. 10). He further indicated that the doctor told him that his knee joints were so loose that he was surprised that they had not popped out already. (T. 10). At his October 1992 VA examination, all of the veteran's joints were noted to be hyperelastic. The veteran reported that both knees ached. Crepitus, clicking, and cracking in both knees were also reported. The veteran further indicated that while his knees did not lock, they did pop. He further reported that he could feel them sort of clunk over the margin of the articular surface in the femur and that they would occasionally swell. The veteran stated that his knees hurt medial to the patella[r] and superior to the patella[r] and that one could feel by pressing down the upper border of the patella[r] that it caught as it moved over the surface of the femur. Physical examination revealed that both knee joints were lax. Both knees were noted to have crepitus. Flexion was noted to 136 degrees, while extension was to zero degrees. X-ray examination of both knees revealed no fracture or dislocation or significant bone pathology. There was also no evidence of soft tissue or joint calcification. Chondromalacia of both knees with audible and palpable cracking was diagnosed. While normal findings of the lower extremities were noted at the time of the veteran's service separation examination, the diagnosis of a lateral collateral ligament strain in August 1989, in conjunction with the diagnoses of bilateral knee condition and bilateral chondromalacia at the January 1991 and October 1992 VA examinations, respectively, and the testimony of the veteran at his June 1992 personal hearing, demonstrate that a bilateral knee disorder now diagnosed as chondromalacia was first noted in service and has persisted to the present. Consequently, service connection for left knee chondromalacia is warranted. ORDER A compensable evaluation for bilateral hearing loss is denied. An evaluation in excess of 10 percent for tinnitus is denied. A compensable evaluation for postoperative residuals of removal of a ganglion cyst of the right wrist is denied. Service connection for left knee chondromalacia is granted. A 20 percent evaluation for right foot metatarsalgia is granted, subject to the laws and regulations governing the award of monetary benefits. An evaluation in excess of 10 percent for postoperative residuals of removal of a ganglion cyst of the left wrist is denied. GEORGE R. SENYK Member, Board of Veterans' Appeals (CONTINUED ON NEXT PAGE) 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.