BVA9500718 DOCKET NO. 93-07 660 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to service connection for peripheral vascular disease. 2. Entitlement to service connection for varicose veins with thrombophlebitis. 3. Entitlement to a disability evaluation in excess of 10 percent for residuals of fracture of the left pelvis. 4. Entitlement to a disability evaluation in excess of 10 percent for left sciatic nerve disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Christopher B. Moran, Counsel INTRODUCTION The veteran served on active duty from January 1943 to February 1945. Since it appears from the veteran's statement in support of claim received in March 1991 that he may be raising the issue of entitlement to a total disability rating based on individual unemployability for the first time, such matter is referred to the Department of Veterans Affairs (VA) Regional Office (RO) for appropriate action, as it is not inextricably intertwined with the certified issues on appeal. A VA hospital summary reflecting a period of hospitalization in June 1994 was received at the Board of Veterans' Appeals (Board) in October 1994 without waiver of initial consideration by the RO. The hospital record primarily refers to a continuation of findings previously considered by the RO and is without any relevant or material bearing on the outcome of the issues currently on appeal. Therefore, there is no need to remand this case to the RO for initial consideration of the recently received VA hospital summary. 38 C.F.R. §§ 19.37(b), 20.1304(c)(1993). CONTENTIONS OF APPELLANT ON APPEAL It is contended by the veteran, in essence, that he developed peripheral vascular disease with varicose veins and thrombophlebitis at the time he injured his left sciatic nerve and fractured his left pelvis during active duty when a large rock rolled down upon him, pinning him to the edge of a foxhole. In the alternative, it is essentially argued that the veteran's peripheral vascular disease with varicose veins and thrombophlebitis developed over the post-service years secondary to service-connected residuals of fracture of the left pelvis and/or incomplete paralysis of the left sciatic nerve. Additionally, the veteran maintains that he is receiving VA outpatient treatment for symptoms and impairment associated with his service- connected residuals of fracture of the left pelvis and incomplete paralysis of the left sciatic nerve and that this supports the assignment of increased evaluations for each of the service-connected disorders at issue. DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), following review and consideration of all evidence and material in the veteran's claims file and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the claims for service connection for peripheral vascular disease with varicose veins and thrombophlebitis and for increased evaluations for the residuals of fracture of the left pelvis and left sciatic nerve disorder. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. Service connection has been established for residuals of a fracture of the left pelvis, incomplete paralysis of the left sciatic nerve, and residuals of hemorrhoidectomy. 3. Peripheral vascular disease and thrombophlebitis and varicose veins were not present during active duty, or initially manifested until approximately 20 years following separation from active duty, and are without any etiologic link to service demonstrated. 4. The clinical evidence does not suggest, nor does any physician state, that an etiologic relationship exists between peripheral vascular disease, thrombophlebitis or varicose veins and a service-connected disorder. 5. The veteran's incomplete paralysis of the sciatic nerve has remained static for many years and is productive of no more than mild incomplete paralysis. 6. The veteran's residuals of a fracture of the left pelvis have remained static for many years and are primarily manifested by complaints of pain, X-ray evidence of left hemipelvis deformity due to old fracture through the inferior and superior rami with good healing, and does not involve more than slight hip disability. CONCLUSIONS OF LAW 1. Peripheral vascular disease, thrombophlebitis, and varicose veins were not incurred in or aggravated by wartime service, nor may arteriosclerosis be presumed to have been incurred therein. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1154(b), 5107 (West 1991); 38 C.F.R. §§ 3.303(d), 3.307, 3.309 (1993). 2. Peripheral vascular disease, thrombophlebitis, and varicose veins are not proximately due to or the result of a service-connected disease or injury. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. § 3.310(a) (1993). 3. The criteria for the assignment of a disability evaluation greater than 10 percent for residuals of fracture of the left pelvis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 3.321, Part 4, §§ 4.1, 4.7, 4.40, 4.59, 4.71a (Plate II), Diagnostic Codes 5010, 5252, 5253, 5255 (1993). 4. The criteria for the assignment of a disability evaluation greater that 10 percent for left sciatic nerve disorder have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 3.321, Part 4, §§ 4.1, 4.7, 4.40, Diagnostic Code 8520 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Assist Upon a review of the record, the Board concludes that the veteran's claims are plausible and well grounded within the meaning of the statute and judicial construction. 38 U.S.C.A. § 5107(a)(West 1991); Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). The VA, therefore, has a duty to assist the veteran in the development of facts pertinent to his claims. In this regard, we note that the veteran's service medical records, post- service VA and private treatment records, and a transcript of testimony given by the veteran at the RO before a hearing officer in December 1992 have been included in the veteran's claims file and provide a sufficient basis for determining the merits of the issues on appeal. Moreover, there is no indication that there are additional records which the VA has not attempted to obtain and, accordingly, no further assistance to the veteran is required to comply with the duty to assist as mandated by 38 U.S.C.A. § 5107(a) (West 1991). II. Pertinent Law and Regulations Service connection may be established for a disability resulting from personal injury suffered or disease contracted in line of duty or for aggravation of preexisting injury suffered or disease contracted in line of duty. 38 U.S.C.A. § 1110 (West 1991). We note that regulations also provide that service connection may be granted for any disability 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) (1993). If the disorder is arteriosclerosis, service connection may be granted if it becomes manifest to a compensable degree within one year following separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1993). Disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310(a) (1993). In accordance with the provisions of 38 U.S.C.A. § 1154(b) (West 1991), for any veteran who engaged in combat with the enemy on active service with a military, naval, or air organization of the United States during a period of war, campaign or expedition, the VA shall accept as sufficient proof of service connection of any disease or injury alleged to have been incurred in or aggravated by such service, satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such service incurrence or aggravation in such service, and to that end, shall resolve every reasonable doubt in favor of the veteran. Service connection for such injury or disease may be rebutted by clear and convincing evidence to the contrary. The reasons for granting or denying service connection in each case shall be recorded in full. When all the evidence is assembled, the Secretary is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event or whether the preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet.App. 49 (1990). III. Peripheral Vascular Disease, Thrombophlebitis, and Varicose Veins The veteran primarily argues that he developed peripheral vascular disease, varicose veins, and thrombophlebitis at the time he had a fracture of the left pelvis and left sciatic nerve injury, for which service connection has been established, due to injury incurred during enemy action in Kiska, Alaska, in 1943. In the alternative, he essentially believes that the disorders are a consequence of service-connected residuals of fracture of the left pelvis and left sciatic nerve injury. A comprehensive review of the veteran's service medical records, including those medical records regarding treatment for injuries sustained on Kiska Island in Alaska during 1943, noted as partial paralysis of peroneal and posterior tibial divisions of sciatic nerves, left, secondary to simple fracture of pelvis without artery involvement, is entirely silent for any pertinent finding regarding peripheral vascular disease, arteriosclerosis, thrombophlebitis, or varicose veins. A Certificate of Disability for Discharge for separation from active duty is also silent for any pertinent finding. Initial post-service reports of VA examinations dated in February 1950 and May 1950 are silent for any findings pertaining to peripheral vascular disease, thrombophlebitis, or varicose veins. Following a period of hospitalization by the VA between September 1951 and November 1951, the status of service-connected disabilities was reported as fracture, old, left pelvis, with moderate deformity-not found, and paralysis of nerve, partial peroneal, tibial division of sciatic nerve left, post-traumatic, mild, not found. There was no mention of any finding of peripheral vascular disease, arteriosclerosis, thrombophlebitis, or varicose veins. Initial post-service records of treatment, including hospital records from St. Rita's Hospital reflecting treatment beginning in 1961, and September 1975, are nonrevealing until approximately December 1970, when the veteran was treated for multiple injuries, including fracture of the left tibia and fibula. In September 1971, he was treated for acute chronic phlebitis of the left leg. In January 1973, he was seen for a varicose ulcer of the left leg requiring radical stripping of the varicose veins of left leg. In October 1973, he was seen for a chronic ulcer of the left ankle due to deep thrombophlebitis of the left leg requiring debridement of stasis ulcer of the left leg ankle area. In November 1974, he was treated for recurrent varicose dermatitis and cellulitis of the left ankle area. In September 1975, the veteran was hospitalized for complaints of acute cellulitis of the left lower leg. A history showed an automobile accident with acute cellulitis and ulcer formation. The veteran indicated that he had been relatively asympto- matic until five years earlier, at which time he had an automobile accident which left him with cellulitis and discomfort of his left leg. He ultimately had skin grafts and was treated for left leg cellulitis. At the time of hospitalization, he had acute cellulitis of the entire left lower extremity below the knee. There was pitting edema with ankle swelling and foot swelling. There was discoloration of the skin over the dorsum of the foot. On hospital examination, the veteran was in acute distress because of pain, discomfort, redness, and swelling of the left lower leg associated with acute cellulitis with excoriation of the skin over the foot. On a report of examination dated in December 1975, it was noted as history that the veteran supposedly had partial paralysis of the sciatic nerve. He also had a fracture of the tibia and fibula. He stated that his back and right leg hurt "quite a bit." It was indicated that he was in an automobile accident in 1970 in which the injuries occurred. He stated that he had no ulcer on the leg at the time of the examination, although he had had one for a long time after the injury. He noted that phlebitis developed following the fracture and that he still had pain and wore an elastic wrapper. Examination of the left leg showed a generalized violaceous hue very dark in color, but with excellent pulse in the dorsalis pedis and posterior tibial. There was edema of the left leg, one plus. There was "brawn" induration noted. There was a scar in the lateral left leg. The veteran did not have footdrop on either side, but on the left leg the dorsiflexion was limited. He dorsiflexed to neutral position, but no further. Plantar flexion was 0 to 10 degrees, inversion was from 0 to 30 degrees, and eversion was from 0 to 3 degrees. There was a limp on walking. Left knee had limited motion. Flexion was from 0 to 120 degrees. The right knee, foot, and ankle had full range of motion. There was some atrophy of the left quadriceps, measuring 1 inch less than the right. No ulcer was seen. No anesthesia in the left lower leg was noted. Diagnoses included residuals of fracture of the left leg and chronic phlebitis of the left leg. VA and private hospital records dated from approximately March 1991 through June 1994 reflect findings and treatment regarding peripheral vascular disease, bilateral, with occlusive disease of both femoral arteries. In approximately July 1991, the veteran reported as history that he was crushed in a foxhole during World War II and suffered bilateral crushing injuries to both legs and pelvis and that he had suffered claudication since then. An examination of the left leg was noted to reveal discoloration from the midcalf to the toes and venous ulcer scar and multiple scars from the original crushing. An examination of the right leg revealed slightly pale color from the knee to the toes and multiple scars. At a hearing before a hearing officer at the RO in December 1992, the veteran essentially argued that he experienced symptoms of initial peripheral vascular disease beginning at the time of the original injury during active duty. A comprehensive review and analysis of the total record clearly demonstrate that peripheral vascular disease due to arteriosclerosis, thrombophlebitis, or varicose veins was not present during active duty or noted at the time of separation. As it stands, the evidence of record first reflects the presence of peripheral vascular disease, thrombophlebitis, and varicose veins more than 20 years following separation from active duty and does not show any etiologic link to active duty, especially in light of intervening post-service injuries. Importantly, we note that the veteran's recently reported history of onset of peripheral vascular symptoms since crushing injuries in service is unsupported by the overall evidence of record. Accordingly, any medical indication or opinion in the record relating peripheral vascular changes to service is based upon the veteran's claimed medical history, which is clearly unsupported by the evidence of record and, therefore, such opinion is not probative or material to the central issue. See Elkins v. Brown, 5 Vet.App. 474 (1993). Moreover, we note that the evidence does not suggest, nor does any physician state, that an etiologic relationship exists between the veteran's peripheral vascular disease, thrombophlebitis, or varicose veins and any service-connected disability. The veteran is not competent to make any such diagnosis. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Overall, the veteran's self-reported history and arguments raised on appeal comprise the only association between his peripheral vascular disease, thrombophlebitis, and varicose veins and his active duty or a service-connected disorder. However, his arguments are substantially outweighed by the lack of supporting clinical evidence both in service and post service. Therefore, the preponderance of the evidence is negative and does not support a grant of service connection for peripheral vascular disease, thrombophlebitis, or varicose veins. IV. Increased Evaluations Disability ratings are based, as far as practicable, on the average impairment of earning capacity resulting from disability. 38 U.S.C.A. § 1155 (West 1991). The average impairment as set forth in the VA's Schedule for Rating Disabilities, codified at 38 C.F.R. Part 4, includes diagnostic codes which represent particular disabilities. Generally, the degrees of disability specified are considered adequate to compensate for a considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1 (1993). Functional loss due to pain must be supported by adequate pathology and evidenced by visible behavior, and painful motion must be supported by joint or periarticular pathology. See 38 C.F.R. §§ 4.40, 4.59 (1993). When all the evidence is assembled, the VA is responsible for determining whether the evidence supports a claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet.App. 49 (1990). V. Residuals of Fracture of the Left Pelvis and Left Sciatic Nerve Disorder It is contended by the veteran, in essence, that the manifestations and symptoms associated with service-connected residuals of a left pelvis fracture and service-connected incomplete paralysis of the left sciatic nerve are productive of impairment warranting the assignment of disability evaluations greater than those currently assigned. He contends that his claim is supported by recent VA clinical records reflecting treatment for increased lower extremity symptoms. A historical review of the record shows that service connection was established for the service-connected disorders at issue, based upon service medical records showing treatment for injuries sustained on Kiska Island in Alaska during 1943, noted as partial paralysis of peroneal and posterior tibial divisions of sciatic nerves, left, secondary to simple fracture of pelvis. Also suspected was chronic lumbago. Following the establishment of service connection for paralysis of nerve, partial, peroneal and tibial divisions of sciatic nerve, left, post-traumatic, evaluated at 20 percent, and for chronic lumbago at a noncompensable rate based upon incurrence in service, a rating determination by the RO dated in June 1950 reduced the 20 percent in effect for paralysis of nerve, partial, peroneal and tibial division of sciatic nerve, left, post-traumatic, mild, from 20 percent to 10 percent, in accordance with 38 C.F.R. Part 4, Diagnostic Code 8520, and increased the remaining service-connected disorder characterized then as old fracture, left pelvis, with deformity, moderate, residuals (formerly diagnosed as lumbago) from a noncompensable rating to 10 percent, in accordance with 38 C.F.R. Part 4, Diagnostic Code 5010, based upon the evidence of record. Such evaluations have remained in effect to the present. On file at the time of the June 1950 rating determination was a report of a VA special orthopedic examination dated in February 1950. The veteran stated that with excessive work, he experienced an aching in his back and left hip. At times, he had sudden numbness of his left hip and dislocation of the left hip. He stated that, on several occasions, a doctor was called and pulled on his left hip, with relief. There was no snapping sensation. The leg was straight. The examiner indicated that it did not sound from the description as though the left hip was dislocated. After the pulling of the leg, the veteran stated that he felt better. The veteran's other complaints included numbness around his hip region and abdomen in a girdle fashion. It was noted as history that he had an injury in combat in August 1943 when he was pinned in a foxhole by a large rock. He was aboard a hospital ship, and a cast was applied to his trunk and entire left leg and the upper part of his right leg. He remained in the cast for approximately six weeks. His total hospitalization was approximately eight months. He stated that he had a footdrop of the left foot after his injury. He noted that he worked in a shop as of the time of the examination and occasionally had to take off because of aching in his back. On physical examination, the veteran was described as a well-developed individual. There was no indication that he was in any acute distress. The spine was straight. There was a 2 1/2-inch increase in length of the lumbar spine on flexion. Lateroflexion and extension were normal. There was no area of tenderness. There was no muscle spasm. The gluteal fold was in the midline and perpendicular. The iliac crests were level. The muscular development of both thigh and calf regions were equal, bilaterally. There was a full range of motion of the hip joints, the knee joints, and the ankle joints. Dorsiflexion and plantar flexion of the left foot and the right foot were normal. There was no crepitation on motion of any joints. No deformity was demonstrated. Tests for sacroiliac pathology were negative. The neurological examination was entirely negative. An X-ray study of the bony pelvis showed a deformity of the ischium on the left side, which was thought to be due to residuals of an old fracture. The lumbar spine appeared essentially negative. There was no evidence of a fracture at that time. Diagnoses were negative orthopedic examination and no neurological disability found. On a report of a VA special orthopedic examination dated in May 1950, the veteran reported pain in the lower back. He noted an onset of pain in August 1943 while in the service in the Aleutian Islands. At that time, he suffered an injury to his back when a large boulder fell on him. He underwent a period of significant hospitalization. It was also noted that in February 1950 he had been examined with X-ray at a VA facility. The veteran stated that he felt that his back condition had not improved and, if anything, had become worse in the preceding 18 months. He stated that he had had pain in his back on bending and stooping. He also noted that his left foot and leg became stiff and painful after use. On examination, the veteran was described as well developed; and there was no indication that he was in any acute distress. There was no visible or palpable difference between the two lower extremities. Circumferences of the midthigh and the midcalf levels were almost identical on both extremities. The veteran complained of numbness to the pricking test over the entire surface of the left thigh, leg, and foot, with no difference in the amount of sensation between the lateral anterior or posterior surface. The knee jerks and Achilles jerks were equal on both sides. There was no evidence of footdrop on the left side at the time of the examination. The tips and heels of both shoes were worn almost identically. There was no difference at all between the left and right shoes. Moreover, there were no visible or palpable abnormalities of the lower spine or pelvis. Movements of the back were described as normal in extent and appeared to be painless. Some pain was claimed on pressure over the lumbar vertebrae. Pain was also claimed on pressure over the sacroiliac crest. An X-ray study of the lumbosacral spine and pelvis, including both hip joints, showed marked lordosis at the lumbosacral joint; but, otherwise, the area was not remarkable. The sacroiliac joints did not appear remarkable. There was a deformity of the left hemipelvis due to old fracture through the inferior and superior rami with good healing, but resultant deformity was noted in the area. Diagnosis was old fracture of left pelvis with deformity. The veteran underwent a period of hospitalization by the VA from September to November 1951 for primary complaints of dorsal and lumbar backache radiating into the hips with numbness of the left thigh. He reported as history that a rock rolled down the side of a mountain in 1943 while he was in the service and pinned him in a foxhole, thereby sustaining permanent low back and left leg injuries manifested by low back pain and numbness of the left leg. While the back pain cleared up, the numbness remained. From about 1944 to 1946, he was free of back pain; and it was after discharge from the service that he began having recurrence. He also had had radiation of pain in both hips, but never down either leg. The footdrop cleared up on the left side, but he stated there was still slight impairment of dorsiflexion to the foot. The left leg was constantly numb, more or less. On admission physical examination, he was described as a well-developed individual. He was not noted to be in any acute distress. Slight paravertebral muscle spasm was present in the lumbar area with slight tenderness over the lower lumbar vertebrae. There was hypesthesia over the entire left lower leg and the left thigh except for an area posteriorly along the entire length of the thigh which presented normal sensation. While hospitalized, an orthopedic consultation was obtained; and a diagnosis of "monoplegia, left lower extremity, mild to moderate, post-traumatic, due directly to overwork of weakened muscles" was noted. A neurological consultation revealed that a suspected herniated nucleus pulposus was not confirmed. Surgery was not indicated at that time. It was recommended that the veteran be placed in a plaster body jacket for approximately three weeks to see if he could obtain relief of back pain. He was given a three-week furlough home. While at home, the veteran showed considerable improvement in the soreness in his back, and the pain in his legs disappeared. The numbness in the left lower extremity became better than it was at the time of discharge from the service. He had discovered that he could do considerable work providing that he kept his back straight at all times. On readmission to the hospital, his cast was removed; and he noted that he had some soreness in the lower portion of the lumbar region. A physical examination revealed the paravertebral muscles to be nonspastic. The curvature of the spinal column was normal; however, forward bending was limited during which time there was minimal reversal of the lumbar lordotic curve. There was no soreness in the lower back. The sciatic nerve was not tender to palpation. There was some weakness in the left lower extremity which had been recorded during previous hospitalization. The tendon reflexes were equal and active, bilaterally. Plantar stimulation was flexor, bilaterally. Abdominal reflexes were normal. Sensory examination was difficult to evaluate, as there was diminished appreciation over the left portion of the abdomen and the entire left lower extremity. The sensory defect was noted as not entirely substantiated by temperature tests. However, the veteran was discharged in November 1951 with instructions to return to his work. The cast had been removed and would not be reapplied. It was explained to the veteran that the brace was not in order at that time and that he should return to work and perform his duties without bending his back. It was indicated that, until it was felt that the VA medical service was satisfied that definite neurological findings existed, the veteran should not be considered a neurological problem, but he should return to the hospital regarding his condition and admitted to the orthopedic service. The status of the veteran's service-connected disabilities was listed as fracture, old, pelvis, with moderate deformity, not found, and paralysis of nerve, partial peroneal tibial division of sciatic nerve, left, post-traumatic, mild, not found. It was also indicated that a herniated nucleus pulposus was not found. An unappealed RO rating determination dated in February 1952 denied service connection for herniated nucleus pulposus, because it was not shown at that time. Private medical records dating between approximately July 1961 and September 1975 show that, in June 1963, the veteran was seen for protruded intervertebral disc, right, with laminectomy and removal of disc at that time. In October 1966, he was seen for recurrent backache. A myelogram was undertaken. In December 1970, he was seen for injuries apparently sustained in an automobile accident, including fracture of the left tibia and fibula. He noted at that time that he had been essentially asymptomatic until the automobile accident which left him with cellulitis and discomfort in the left leg. During that time, between 1970 and 1975, he was also treated for acute chronic phlebitis of the left leg with deep thrombophlebitis of the left leg and stasis ulcers of the left ankle and recurrent varicose dermatitis. On a report of a VA examination dated in December 1975, the veteran complained of left leg and back problems. It was noted as history that the veteran had sustained supposedly a partial paralysis of the sciatic nerve. He also had a fracture of the tibia and fibula. He stated that his back and right leg hurt. He was in an automobile accident in 1970 in which he noted that his injuries had occurred. He stated that he had no ulcer on the leg at the time of the examination, although he had had one for a long time after the injury. He also had phlebitis following the fracture and still had pain and wore an elastic wrapper. On examination of the left leg, generalized violaceous hue, very dark in color, was noted, but with excellent pulse in the dorsalis pedis and posterior tibial. There was edema of the left leg, one plus. There was "brawn" induration noted. There was a scar on the lateral left leg. The veteran did not have footdrop on either side, but on the left leg dorsiflexion was limited. He dorsiflexed to neutral position, but no further. Plantar flexion was from 0 to 10 degrees, with inversion from 0 to 3 degrees and eversion from 0 to 3 degrees. He walked with a limp. The left knee had limited motion. Flexion was from 0 to 120 degrees. The right knee, foot, and ankle had full range of motion. There was some atrophy of the left quadriceps, measuring 1 inch less than the right. No ulcer was seen on the leg. No anesthesia was found in the left lower leg. An X-ray of the left tibia and fibula revealed an old, well-healed fracture. The tibial fracture had very little angulation and only minimal anterior displacement of the distal fragment. The fibular fracture was displaced medially in the distal fragment. Both were well healed. An X-ray of the lumbosacral spine was interpreted as revealing probably minimal narrowing of the L4-L5 interspace. It was also noted incidentally that some minimal sclerosis of the left sacroiliac joint was present. The remaining medical records primarily consist of VA and private medical records reflecting treatment, including surgery, for symptoms primarily attributed to nonservice-connected bilateral peripheral vascular disease, as noted on an outpatient clinical report dated May 28, 1991, and not showing any pertinent findings regarding any service-connected residuals of fracture of the left pelvis or incomplete paralysis of the left sciatic nerve, including on physical examinations undertaken while hospitalized by the VA in January 1992, and in June 1994. At a hearing at the RO in November 1992, the veteran noted that he last complained of back and hip problems to the VA in approximately 1948 or 1950, when he was hospitalized for several months. He noted that, following that period of hospitaliza- tion, he reinjured his back at work while bending a rod which snapped while he was pushing down to bend it. He required back surgery in 1962. He indicated that he was reoperated on after that for calcium overgrowth. He noted that, at that time, he could not bend over even to tie his own shoes. He still had problems bending over after the second operation. He noted that his wife had been helping him put his shoes and stockings on for the preceding 40 to 45 years, off and on, and that he had trouble lifting his leg through the hip area. On a neurologic examination undertaken during hospitalization by the VA in June 1994, motor testing on the left lower extremity was reported as 5/5 with no deficits. Babinski was negative. Motor on the right side was also incidentally noted as 4/5. No other pertinent findings were noted. The veteran continued to undergo treatment primarily for other than service-connected disorders. With respect to the veteran's claim for entitlement to an increased evaluation for residuals of fracture of the left pelvis, we note that the provisions of 38 C.F.R. Part 4, Diagnostic Code 5010, rate traumatic arthritis as degenerative arthritis, Diagnostic Code 5003, on the basis of limitation of motion of the affected parts. The provisions of 38 C.F.R. Part 4, Diagnostic Code 5251, provide a sole evaluation of 10 percent where limitation of extension of the thigh is to 5 degrees. In accordance with the provisions of 38 C.F.R. Part 4, Diagnostic Code 5252, a 10 percent evaluation is provided where flexion of the thigh is limited to 45 degrees. Flexion limited to 30 degrees warrants the assignment of a 20 percent evaluation. In accordance with the provisions of 38 C.F.R. Part 4, Diagnostic Code 5253, a 10 percent evaluation is warranted where limitation of rotation is present so that one cannot toe out more than 15 degrees with the affected leg. A 10 percent evaluation is also provided where limitation of adduction is such that one cannot cross the legs. A 20 percent evaluation is provided where limitation of the thigh in abduction where motion is lost beyond 10 degrees. Under the provisions of 38 C.F.R. Part 4, Diagnostic Code 5255 for impairment of femur, a 10 percent evaluation is warranted where there is malunion with slight knee or hip disability. Where there is malunion with moderate knee or hip disability, a 20 percent evaluation is provided. 38 C.F.R. § 4.71a (Plate II) provides a standard description of joint motion measurement. A comprehensive analysis of the record in this case, including numerous private and VA clinical data received into the record dating between approximately 1961 and June 1994 does not demonstrate other than that the veteran's service-connected residuals of fracture of the left pelvis has remained stable and static over the post- service years. Such is illustrated by the fact that the added evidence primarily refers to findings and treatment regarding intervening nonservice-connected peripheral vascular disorders of the lower extremities and herniated disc, postoperative, or residuals of fracture of the left tibia and fibula for which service connection has not been adjudicated. Importantly, such evidence is without findings demonstrating impairment greater than that reflected on the VA examinations in 1950 and supportive of the assignment of the 10 percent evaluation that has continued to the present. We note that a VA examination in December 1975 was silent for any significant findings pertaining to service-connected residuals of fracture of the left pelvis, although findings pertaining to intervening disorders of the left lower extremity were reported. Overall, the Board concludes that the symptomatology attributed to the veteran's residuals of a left pelvis fracture is productive of no more than that required for the 10 percent evaluation, especially in view of the lack of supporting evidence demonstrating greater hip impairment. As it stands, the veteran's residuals of a fracture of the left pelvis have remained static and are primarily manifested by complaints of pain, X-ray evidence of left hemipelvis deformity due to old fracture through the inferior and superior rami with good healing, and no more than slight hip disability. While the veteran claims increased symptoms associated with service- connected residuals of left pelvis fracture, the medical evidence submitted in support thereof shows otherwise. Accordingly, the Board concludes that the current 10 percent evaluation is appropriate. The absence of any regular treatment over the post- service years further illustrates the lack of significant impairment. In making this decision, we have considered the provisions of 38 C.F.R. §§ 4.40 and 4.59, as well as the veteran's arguments and testimony on appeal; however, the 10 percent evaluation assigned for residuals of fracture of the left pelvis contemplates the current level of associated symptoms. With respect to the veteran's service-connected incomplete paralysis of the sciatic nerve, we note that, in accordance with the provisions of 38 C.F.R. Part 4, Diagnostic Code 8520, for paralysis of the sciatic nerve, a 10 percent evaluation is warranted where there is mild incomplete paralysis. For moderate incomplete paralysis, a 20 percent evaluation is warranted. 38 C.F.R. Part 4, Diagnostic Code 8520. Similarly, a comprehensive analysis of the record in this case, including numerous private and VA clinical data dating between approximately 1961 and June 1994, does not demonstrate other than that the veteran's service- connected incomplete paralysis of the sciatic nerve has remained stable and static over the post- service years. The evidence received in support of the veteran's current claim filed in March 1991 primarily consists of VA and private medical records referring to treatment for other than service-connected disorders, including nonservice-connected peripheral vascular disease and herniated disc, postoperative, and residuals of fracture of the left tibia and fibula. However, such evidence is without any objectively demonstrated findings of more than mild incomplete paralysis that would warrant the assignment of a higher evaluation under the diagnostic code cited above. There were no findings or complaints pertaining to service-connected residuals of sciatic nerve injury. The absence of any treatment over the past years further illustrates the lack of any significant disability. Upon a review of the record, we find that the record clearly demonstrates that the current 10 percent evaluation contemplates the current level of symptoms. VI. Other Considerations Consideration has been given to the potential application of various provisions of 38 C.F.R. Parts 3 and 4 with regard to the veteran's claim for increased evaluations for residuals of fracture of the left pelvis and incomplete paralysis of the left sciatic nerve, whether or not they were raised by the veteran. We find that neither service- connected disorder meets or more nearly approximates the criteria for the next higher evaluation under the above-noted respective code provisions. Therefore, the current evaluations remain in effect. 38 C.F.R. § 4.7. We also note that the evidence discussed herein does not show that the veteran has service-connected impairment with respect to the disorders at issue of such exceptional or unusual disability picture as to render impractical the application of the regular schedular standards. Therefore, the assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1) (1993) is not warranted. ORDER Service connection for peripheral vascular disease, thrombophlebitis, and varicose veins is denied. An increased evaluation for residuals of fracture of the left pelvis is denied. An increased evaluation for left sciatic nerve disorder is denied. WILLIAM J. REDDY 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 institute 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.