BVA9503850 DOCKET NO. 93-10 889 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Entitlement to an increased evaluation for tendonitis of the left ankle, currently evaluated as 10 percent disabling. 2. Entitlement to an increased evaluation for strain of the medial head of the left gastrocnemius with tendonitis behind the left knee, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Ronald R. Bosch, Counsel INTRODUCTION The veteran served on active duty from February 1971 to December 1973. This appeal arose from a December 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. The RO denied entitlement to increased evaluations for the left knee and ankle disabilities at issue. In the representative’s VA Form 1-646, dated in May 1993, reference is made to a claim of entitlement to service connection for blackouts secondary to a service connected psychiatric disorder. The Board observes that the veteran is not service connected for a psychiatric disorder. Nevertheless, this issue is referred to the RO for appropriate action. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his left knee and ankle disabilities are more disabling than currently evaluated, thereby warranting entitlement to increased evaluations. He avers that due to constant pain, limited ability to walk, need of a cane, and use of medication, he should be granted higher evaluations. 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 increased evaluations for tendonitis of the left ankle and strain of the medial head of the left gastrocnemius with tendonitis behind the left knee. FINDINGS OF FACT 1. Tendonitis of the left ankle is productive of not more than moderate impairment. 2. Strain of the medial head of the left gastrocnemius with tendonitis behind the left knee is productive of not more than moderate impairment. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 10 percent for tendonitis of the left ankle have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.20, 4.40, 4.71a, Diagnostic Code 5271 (1994). 2. The criteria for an evaluation in excess of 10 percent for strain of the medial head of the left gastrocnemius with tendonitis behind the left knee have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.20, 4.40, 4.73, Diagnostic Code 5311. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially the Board finds that the veteran's claims are well grounded within the meaning of 38 U.S.C.A § 5107(a), in that he has presented claims which are plausible. The Board is satisfied that all relevant facts have been properly developed, and that no further assistance to the veteran is required in order to comply with 38 U.S.C.A. § 5107(a). In accordance with 38 C.F.R. §§ 4.1 and 4.2, and Schafrath v. Derwinski, 1 Vet.App. 589 (1991), the Board has reviewed the service medical records and all other evidence of record pertaining to the history of the veteran's tendonitis of the left ankle and the strain of the medial head of the left gastrocnemius with tendonitis behind the left knee. The Board has found nothing in the historical record which would lead to a conclusion that the current evidence of record is inadequate for rating purposes. Disability evaluations are based on the comparison of clinical findings to the relevant schedular criteria. 38 U.S.C.A. § 1155. In determining the rating warranted it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet.App. 55, 58 (1994). In this regard, the service medical records show that the veteran stepped on a nail and developed some swelling in his left ankle. In September 1980, a VA physician diagnosed chronic tendonitis in the left peroneal region, probably related to a patient described nail puncture. The RO granted entitlement to service connection for tendonitis of the left ankle and assigned a 10 percent evaluation in an October 1980 rating decision. That evaluation has remained in effect since. At a December 1984 VA orthopedic examination the veteran's reflexes were physiological and muscle function was present including the evertors of the left ankle or foot which had 10 degrees more eversion than on the right. Dorsiflexion was to 15 degrees and plantar flexion was to "150." There was a well healed 1 1/4 inch horizontal scar just above and behind the distal fibula. There was a full range of knee flexion and extension with no instability. The diagnostic impression was history of healed left heel infection, with subsequent tendonitis, and now a mild cyst or strain of medial head of left gastrocnemius with magnification. In a January 1985 rating decision the RO granted entitlement to service connection for strain of the medial head of the left gastrocnemius and assigned a noncompensable evaluation. This evaluation was increased to 10 percent following a July 1986 compensation examination which resulted in the diagnostic impression of a limp habit pattern with tendonitis behind the left knee. The examiner noted there could be mild internal derangement posteriorly in the left knee. This 10 percent evaluation has remained in effect ever since. At a June 1991 VA examination the veteran complained of intermittent pain and swelling primarily of the left ankle. He denied any swelling of the foot itself. Prolonged standing and walking, squatting or stooping, or going up and down steps were said to be painful in the left ankle as well as the left knee. On examination the appellant came into the room with a marked limp on the left while using a cane. He was able to walk with a slight limp on the left without using a cane. An examination of the left knee revealed 0 to 145 degrees of motion with pain on full flexion. There was some tenderness to palpation along the medial hamstring tendons posteriorly. No instability of the knee was demonstrated. Examination of the left ankle revealed 10 degrees of dorsiflexion and 35 degrees of plantar flexion. There was no swelling of the ankle, but there was some tenderness to palpation on the lateral malleolar area. There was a faint scar along the lateral border of the foot which the claimant stated represented where the incision and drainage procedure was previously performed. The appellant was able to do a satisfactory heel to toe walk with complaints of pain in the left foot and ankle. He performed a full squat and arose again. The appellant was able to walk on the inner and outer borders of both feet with complaints of pain in the left foot and ankle region. X-rays of the left knee and ankle disclosed no abnormalities. The diagnostic impressions were residual pain in the left foot and ankle as a result of a nail puncture wound, with infection of the left foot, postoperative; and left knee tendonitis. Associated with the claims file was a copy of an unfavorable October 1992 determination for Social Security Disability benefits. This determination was for the most part referable to unrelated disability; nonetheless, the report shows that the veteran had swelling of the knees and ankles and used a cane. The veteran provided testimony at an RO hearing held in November 1992. He described the disabling manifestations of his left ankle and left knee disorders, and how they had adversely affected him in his daily life situation. Reexamination was requested. The veteran is rated as 10 percent disabled for his tendonitis of the left ankle by analogy to moderate limitation of motion of the left ankle under diagnostic code 5271 of the VA Schedule for Rating Disabilities. 38 C.F.R. §§ 4.20, 4.71a. The next evaluation of 20 percent requires marked limited motion of the ankle. Considering the left ankle range of motion studies conducted by VA most recently, the Board finds that marked limitation of motion or marked impairment of the left ankle is not shown by the evidence of record. In this regard, 38 C.F.R. § 4.71 (1994) provides that the normal range of ankle dorsiflexion is from 0 to 20 degrees, and that the normal range of ankle plantar flexion is from 0 to 45 degrees. As the veteran shows dorsiflexion to 10 degrees and plantar flexion to 35 degrees, his current 10 percent evaluation for a moderate limitation of motion is appropriate. As to his strain of the medial head of the left gastrocnemius with tendonitis behind the left knee, the veteran is rated as 10 percent disabled by analogy to moderate impairment of the gastrocnemius muscle under diagnostic code 5311. 38 C.F.R. §§ 4.20, 4.73. The next evaluation of 20 percent requires moderately severe impairment of the gastrocnemius muscles. Such an impairment is not shown on examination. In this respect, there is no evidence that either the strength or endurance of the veteran’s gastrocnemius muscle is anything more than moderately disabling, particularly in view of his ability to flex the left knee to 145 degrees, (Normal knee flexion is to 125 degrees. See 38 C.F.R § 4.71.), and the fact that one of the functions of the gastrocnemius muscle is knee flexion. See 38 C.F.R. § 4.73, Diagnostic Code 5311. Accordingly, an increased evaluation is not warranted. In reaching this decision the Board observes that the veteran's complaints of increased left ankle and knee impairment have not been substantiated by VA examinations and treatment reports of record. The direct clinical inspections in addition to x-ray studies do not demonstrated anything more than a moderate impairment of either the left knee or ankle upon which to predicate increased evaluations with application of applicable criteria. The Board further notes that the 10 percent evaluations for the left knee and ankle take into consideration the veteran's disabling pain. Such pain is not shown to be of such an extent as to be productive of functional impairment warranting increased evaluations under the criteria of 38 C.F.R. § 4.40. No question has been presented as to which of two or more evaluations would more properly classify the severity of the veteran's left knee and ankle disorders. 38 C.F.R. § 4.7. The veteran's left knee and ankle disorders have not rendered his disability picture unusual or exceptional in nature and have not been shown to markedly interfere with his employment. They have not required frequent inpatient care as to render impractical the application of regular schedular standards. 38 C.F.R. § 3.321(b)(1). Finally, the Board observes that the VA compensation examination conducted in June 1991, was adequate for rating purposes in that the examination report completely describes the nature and extent of the veteran’s left knee and ankle disorders. Hence, another examination is not warranted. ORDER Entitlement to an increased evaluation for tendonitis of the left ankle is denied. Entitlement to an increased evaluation for strain of the medial head of the left gastrocnemius with tendonitis behind the left knee is denied. DEREK R. BROWN 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.