Citation Nr: 0002526 Decision Date: 02/01/00 Archive Date: 02/10/00 DOCKET NO. 98-21 090 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a psychiatric disorder, to include depression. 2. Entitlement to an increased disability evaluation for right oophorectomy, currently evaluated as 0 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD C. Trueba-Sessing, Associate Counsel INTRODUCTION The case comes before the Board of Veterans' Appeals (Board) on appeal from an October 1998 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri, which denied the benefits sought on appeal. The veteran served on active service from October 1990 to October 1992. Additionally, the Board notes that in June 1998 and November 1998 VA forms 21-4138 (Statement in Support of Claim), the veteran indicated she was seeking an increased of her special monthly compensation for the anatomical loss of a creative organ and that she wished to reopen her claim of service connection for a bilateral knee disorder. However, as the only issues currently before the Board are those set forth on the title page of this decision, these matters are referred to the RO for appropriate action. FINDINGS OF FACT 1. In an October 1995 rating decision, the veteran was denied service connection for a psychiatric disorder, characterized as depression and stress. 2. In a January 1997 rating decision, the RO declined to reopened the veteran's claim of service connection for a psychiatric disorder; this decision is final. 3. The evidence associated with the claims folder since the January 1997 rating decision, when considered alone or in conjunction with all of the evidence of record, is so significant that it must be considered in order to fairly decide the merits of the veteran's claim. 4. There is no medical evidence that establishes a causal nexus between the veteran's in-service psychiatric symptomatology/diagnoses and her current psychiatric disorder. 5. The veteran's claim of service connection for a psychiatric disorder, to include depression, is not well grounded. 6. All relevant evidence necessary for an equitable disposition of the issue of entitlement to an increased disability evaluation for right oophorectomy has been obtained by the RO. 7. The veteran underwent a right oophorectomy in May 1991 during her active service. 8. The residuals of the veteran's right ovary removal include subjective complaints of pelvic pain, difficulty lifting on the right side, and painful intercourse. Objective findings include tenderness to palpation of the right adnexal area and possible adhesiolysis. The medical evidence of record indicates that her current disability is neither characterized by the complete removal of both ovaries, nor by symptoms that require continuous treatment. CONCLUSIONS OF LAW 1. The January 1997 rating decision is final. 38 U.S.C.A. § 7105 (West 1991); 38 C.F.R. §§ 3.160(d), 20.302, 20.1103 (1999). 2. The veteran has submitted new and material evidence to reopen the claim of entitlement to service connection for a psychiatric disorder, to include depression, and the claim is reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1999). 3. The claim of entitlement to service connection for a psychiatric disorder, to include depression, is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 4. The criteria for a compensable evaluation for right oophorectomy have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1-4.14, 4.27, 4.116, Diagnostic Codes 7615, 7699-7619 (1999); Butts v. Brown, 5 Vet. App. 532 (1993) REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a psychiatric disorder, to include depression. The law grants a period of 1 year from the date of the notice of the result of the initial determination for the filing of a notice of disagreement; otherwise, that decision becomes final and is not subject to revision in the absence of new and material evidence or clear and unmistakable error. See 38 U.S.C.A. § 7105 (West 1991); 38 C.F.R. §§ 3.104, 3.105(a) (1999). However, if new and material evidence is presented or secured with respect to a claim which has been disallowed, the claim will be reopened and reviewed. See 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1999). In this case, in an October 1995 rating decision, the veteran was denied service connection for a psychiatric disorder, including depression and stress, on the grounds that the evidence did not show her in-service symptoms were chronic, and had been continuous since her discharge to the date of claim. The veteran was provided notice of this determination by VA letter dated that same month. However, the veteran did not timely appealed the October 1995 rating decision. Subsequently, in a January 1997 rating decision, the RO declined to reopened the veteran's claim of service connection for a psychiatric disorder. Again, she was provided notice of the determination by VA letters dated within a month of the January 1997 rating decision. However, the veteran did not submit a timely appeal with respect to this rating decision either. As such, the January 1997 rating decision is final as outlined in 38 U.S.C.A. § 7105 (West 1991), and consequently, the veteran's claim may only be reopened if new and material evidence is submitted. See 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a) (1999). Consideration of whether new and material evidence has been submitted is required before the merits of the claim can be considered. Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). New evidence will be presumed credible solely for the purpose of determining whether the claim has been reopened. Justus v. Principi, 3 Vet. App. 510, 513 (1992). In the recent case of Winters v. West, 12 Vet. App. 203 (1999) (en banc), the United States Court of Appeals for Veterans Claims (the Court), citing Elkins v. West 12 Vet. App. 209 (1999) (en banc), held that the two-step process set out in Manio v. Derwinski, 1 Vet. App. 140, 145 (1991), for reopening claims became a three-step process under the Federal Circuit's holding in Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998): the Secretary must first determine whether new and material evidence has been presented under 38 C.F.R. § 3.156(a); second, if new and material evidence has been presented, immediately upon reopening the Secretary must determine whether, based upon all the evidence and presuming its credibility, the claim as reopened is well grounded pursuant to 38 U.S.C. § 5107(a); and third, if the claim is well grounded, the Secretary may evaluate the merits after ensuring the duty to assist under 38 U.S.C. § 5107(b) has been fulfilled. In this case, since the January 1997 final adjudication, the additional evidence in the file which is related to this issue includes medical records from the Metropolitan St. Louis Psychiatric Center dated October 1996, which show the veteran was hospitalized with suicidal ideation and depression. Upon admission, she reported depression for the prior several months, several prior hospitalizations, and recurrent episodes of depression since she was 19 years old. On examination, the diagnoses were major recurrent depression without psychotic features, and rule out personality disorder, not otherwise specified. Medical records from the St. Louis VA Medical Center (VAMC), John Cochran Division, dated July 1997 indicate the veteran was hospitalized for left flank pain. Upon evaluation, it was noted she had a long-standing history of depression, chemical dependency and personality disorder. A review of her clinical files showed she had been scheduled several times with psychiatry and other providers, but that she had missed multiple appointments. Her discharge diagnoses included acute pyelonephritis, vaginal bacterial vaginosis, pelvic fluid collection, status post hysterectomy, history of chemical dependency and history of depression/personality disorder. In addition, medical records from the Christian Hospital Northeast-Northwest dated September 1997 show the veteran was admitted to the psychiatric unit as a voluntary patient with diagnoses of major depression and alcohol abuse, and probable borderline personality disorder. Furthermore, medical records from the St. Louis VAMC, Jefferson Barracks Division, dated from April 1998 to May 1998 note she was hospitalized with depressed mood following an altercation with her oldest son; her diagnosis was recurrent major depression. Lastly, medical records from the St. Mary's Hospital dated October 1998 note the veteran was brought to the Emergency Room (ER) after taking eight tablets of Trazodone, 150 milligrams, over two hours. She reported she was upset with her boyfriend and decided to take the overdose, but that she did not have the intention of killing herself. Her diagnosis was drug overdose; and suicide gesture, but no suicide ideation. After a review of the record, the Board finds that the evidence, as set forth above, is sufficient to reopen the claim in this case. As noted above, the veteran was initially denied service connection in October 1995 on the basis that she had not shown a continuity of the symptoms noted during her service after her discharge. Specifically, the RO noted that the veteran's service medical records failed to substantiate her claim that she suffered from a chronic psychiatric disorder during her service, and deemed her in-service symptoms as acute and transitory. In this regard, the Board finds that, since the January 1997 rating decision, the veteran has submitted extensive medical evidence showing that she has continued to receive treatment for her psychiatric symptomatology, including depressed mood and suicide gesture/attempts, since her discharge from service in October 1992 to the present. In particular, the Board notes that the July 1997 medical records from the St. Louis VAMC, John Cochran Division, reveal the veteran's clinical files reflected she had been scheduled in the past for consultations with the psychiatric unit and other providers. Furthermore, the additional evidence submitted shows her current diagnoses include major depression, probable borderline personality disorder, and adjustment disorder. The Board notes that in-service diagnoses included depression and adjustment disorder. Thus, the Board finds that the evidence submitted, as noted above, tend to show a continuity of the veteran's in-service psychiatric symptomatology since her discharge to the present. As noted in Hodge, "the ability of the Board to render a fair, or apparently fair, decision may depend on the veteran's ability to ensure the Board has all potentially relevant evidence before it," and the Federal Circuit stated further, that some new evidence may "contribute to a more complete picture of the circumstances surrounding the origin of the veteran's injury or disability, even where it will not eventually convince the Board to alter its rating decision." Hodge, 155 F.3d at 1363. Therefore, the Board finds that the evidence submitted since the last prior final decision in January 1997 satisfies this requirement. Based on the foregoing, the Board finds that some of the recently submitted evidence warrants a reopening of the veteran's claim in that such evidence was not previously submitted to agency decisionmakers, bears directly and substantially upon the specific matter under consideration, is neither cumulative nor redundant, and by itself or in connection with evidence previously assembled is so significant that it must be considered to decide fairly the merits of the claim. The Board finds that such evidence contributes to a complete evidentiary record for the evaluation of the veteran's claim. As such, this evidence is "new and material" as contemplated by law, and thus, provides a basis to reopen the veteran's claim of service connection for a psychiatric disorder, to include depression. See 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156. Having reopened the veteran's claim of service connection for a psychiatric disorder, the Board turns to the "well grounded" analysis required by Winters, Elkins and Hodge. In this regard, the veteran must satisfy three elements for her claim for service connection to be well grounded. First, there must be competent evidence of a current disability. Second, there must be medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury. Lastly, there must be medical evidence of a nexus or relationship between the in-service injury or disease and the current disability. See Epps v. Brown, 9 Vet. App. 341 (1996). In the alternative, the chronicity provisions of 38 C.F.R. § 3.303(b) are applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service, or during an applicable presumption period, and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under the Court's case law, lay observation is competent. If the chronicity provision is not applicable, a claim may still be well grounded on the basis of 38 C.F.R. § 3.303(b) if the condition is observed during service or during any applicable presumption period, if continuity of symptomatology is demonstrated thereafter, and if competent evidence relates the present condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488, 498 (1997). Thus, the claimant is required to establish a nexus between the claimed disability and his/her active military service, even if a continuity of symptomatology has been established under 38 C.F.R. § 3.303(b). See Clyburn v. West, 12 Vet. App. 296 (1999) (distinguishing the factual circumstances in Falzone v. Brown, 8 Vet. App. 398 (1995), and Hampton v. Gober, 10 Vet. App. 481 (1997)). In determining whether a claim is well grounded, the truthfulness of the evidence is presumed. See Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995); King v. Brown, 5 Vet. App. 19, 21 (1993). Upon a de novo review of the veteran's claim, the Board finds that the veteran's service medical records show that she was treated in several occasions during her active service for psychiatric symptomatology and was variously diagnosed with depression, borderline/paranoid personality, and adjustment disorder with depressed mood. In addition, as noted above, the evidence submitted since the January 1997 rating decision, shows that she has continued to receive treatment for psychiatric symptomatology, including depressed mood and suicide gesture/attempts, since her discharge from service in October 1992 to the present. Moreover, her current diagnoses include major depression, probable borderline personality disorder, and adjustment disorder, which include two out of the three psychiatric diagnoses she received during her active service. Lastly, the Board notes that the veteran has reported she currently has the same psychiatric symptoms she experienced in service including depressed mood, stress, and excessive worrying. However, the Board also finds that the evidence, as set forth above, does not provide sufficient evidence to establish a claim that is plausible or capable of substantiation. Specifically, the present record does not include medical evidence showing that the veteran's present psychiatric disorder is related to her in-service symptomatology, or is otherwise related to her service. Specifically, the veteran has failed to satisfy an essential element necessary to well ground her claim, which is the existence of a nexus between the currently claimed psychiatric disorder and her period of service. A well-grounded claim must be supported by evidence, not merely allegations. See Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). In addition, although the evidence arguably shows a continuity of symptomatology since service, she has not provided medical evidence of a nexus between her claimed psychiatric disorder and either those symptoms or her military service. See Savage, supra; Clyburn, supra. Thus, in the absence of competent medical evidence to support the claim of service connection for a psychiatric disorder, to include depression, the Board can only conclude that the veteran has not presented evidence sufficient to justify a belief by a fair and impartial individual that her claim is well grounded, and thus, the claim must be denied. 38 U.S.C.A. § 5107 (West 1991). In arriving at this conclusion, the Board took into consideration the various statements from the veteran and her representative tending to link her current psychiatric disorder to her service. While the Board does not doubt the sincerity of these statements, the medical evidence of record does not support such a conclusion. In addition, where, as in this case, the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. Brown, 7 Vet. App. 134, 137 (1994); Espiritu v. Derwinski, 2 Vet. App. 292, 294-95 (1991). Further, since the record does not reflect that the veteran or her representative possess the medical training and expertise necessary to render an opinion as to etiology or the existence of a disability, these lay statements alone cannot serve as a sufficient predicate upon which to find the veteran's claim for service connection to be well grounded. See Heuer v. Brown, 7 Vet. App. 379, 384 (1995) (citing Grottveit v. Brown, 5 Vet. App. 91, 93 (1993)). As a final consideration, the Board notes that as the veteran has failed to meet her initial burden of submitting evidence which would well ground her claim of service connection, the VA is under no duty to assist the veteran in developing the facts pertinent to the claim. See Epps v. Gober, 126 F. 3d 1464, 1468 (1997). Giving the benefit of the doubt to a claimant does not relieve the claimant of carrying the burden of establishing a "well grounded" claim, and thus, there is nothing in the text of section 5107 to suggest that the VA has a duty to assist the claimant until he or she meets his or her burden of establishing a "well grounded" claim. See 38 U.S.C.A. § 5107(a) (West 1991); see also Epps, supra. The Board notes that in February 1997 and November 1998 VA Forms 21-4138 (Statement in Support of Claim), and in a December 1996 RO letter, there is mention of treatment records from the Depaul Health Center, a health care provider located at 1225 Graham Road, the St. Vincent Hospital, and Dr. Robert Poetz. In this regard, the Board observes that the medical records from these health care providers/institutions have not been submitted by the veteran, and suggest to the veteran to submit such private records as they may assist her in well grounding his claim for service connection. See 38 U.S.C.A. § 5103 (West 1991); see generally McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997). The Board views its discussion as sufficient to inform the veteran of the elements necessary to present a well-grounded claim of service connection, and the reasons for which her claims failed. See Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995). II. Increased disability evaluation for right oophorectomy. As a preliminary matter, the Board finds that the veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). See Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). That is, the Board finds that the veteran has presented a claim which is not implausible when her contentions and the evidence of record are viewed in the light most favorable to that claim. The Board is also satisfied that all relevant facts have been properly and sufficiently developed. Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Where an increase in an existing disability rating based on established entitlement to compensation is at issue, the present level of disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In this case, in an October 1995 rating decision, the RO awarded the veteran service connection for right oophorectomy (with hysterectomy prior to service), effective May 15, 1995, and assigned a noncompensable disability evaluation under 38 C.F.R. § 4.116, Diagnostic Code (DC) 7619. In addition, in a June 1997 rating decision, the RO determined the veteran was entitled to special monthly compensation effective May 15, 1995 under 38 U.S.C.A. § 1114, subsection (k), and under 38 C.F.R. § 3.350(a) on account of the anatomical loss of a creative organ. Subsequently, in a July 1997 rating decision, the RO confirmed and continued the noncompensable disability evaluation assigned the veteran's disability at issue in this case. With respect to the applicable law, under Diagnostic Code 7619, the removal of an ovary warrants a 100 percent disability evaluation for a three-month period after removal. See 38 C.F.R. § 4.116, Diagnostic Codes 7619. Thereafter, a 30 percent evaluation is warranted for complete removal of both ovaries; and a noncompensable evaluation is warranted for the removal of one ovary, with or without partial removal of the other. See id. With respect to the evidence of record, the veteran's service medical records show she underwent a right oophorectomy in May 1991 during her active service. In this regard, the law is clear that compensation shall not be paid to any person for any period of time for which such person is receiving active service pay. See 38 U.S.C.A. § 5304(c) (1999); VAOPGCPREC 9-98. Thus, as the veteran was in active service at the time of her May 1991 right oophorectomy, and as she was not discharged from active service until October 1992 which is more than three months after her right oophorectomy, the veteran is not entitled to received a 100 percent disability evaluation for the three-month period following the removal of her right ovary. See 38 C.F.R. § 4.116, Diagnostic Code 7619. In addition, the evidence includes a March 1997 VA examination report which notes the veteran complained of chronic right lower abdominal quadrant pain for the prior 1 to 2 years, and reported a history of hysterectomy in 1985 and oophorectomy in 1991. Upon examination, she had normal external genitalia and vagina without drainage, although pain was elicited on palpation of the right adnexal area and abdomen. The diagnoses were: possible right adnexal mass; check pelvic ultrasound to visualize which ovary was extracted and to rule out an adnexal mass; and menopause. A July 1997 hospitalization summary from the St. Louis VAMC, John Cochran Division, note the veteran was hospitalized with complaints of left flank pain reportedly progressive in intensity with movement, and with questionable blood with urination. In addition, the hospitalization summary notes that an echography was performed on the veteran in March 1997, which showed a 1.5 centimeter cyst lesion in her left ovary and some moderate free fluid in the peritoneal cul-de- sac. Furthermore, upon CT scan examination, there was evidence of fluid in the pelvis, a questionable left ovarian mass versus enlargement, and some fluid around the right kidney consistent with pyelonephritis. A repeat CT scan conducted in July 1997 was significant for no fluid collection or abscess in either kidney although there was some evidence of an old chronic pyelonephritis in the right kidney. Further, the fluid that was initially noted in the pelvis had almost completely resolved on repeat CT scan and there were no masses or other abnormalities noted in the pelvic region. Therefore, it was felt that the abdominal pain was most likely related to an acute pyelonephritis. A gynecology consultation conducted was also notable for a finding that pelvic inflammatory disease was unlikely, and it was noted that the veteran did not have any vaginal or pelvic complaints prior to or during the hospitalization. Her discharge diagnoses included, but were not limited to, acute pyelonephritis, vaginal bacterial vaginosis, and pelvic fluid collection/status post hysterectomy. Lastly, a September 1998 VA examination report indicates the veteran had complaints of sharp pain with numbness and tingling in the right pelvic area since her May 1991 right oophorectomy. She also reported painful intercourse and an inability to lift items on the right side. The veteran's physical examination revealed she had bilateral inguinal lymph enlargement with an otherwise normal external pelvic exam. Her right ovary was not present, and her left ovary was slightly nodular with a 4 to 5 centimeter scar along the anterior lower pelvis. The diagnoses were status post right oophorectomy for probable ruptured ovarian cyst and an otherwise unremarkable examination. The examiner reported that the veteran continued to experience moderate to severe right lower pelvic pain which increased with activity and which was consistent with possible adhesiolysis. The Board notes, however, that the findings include no objective evidence of pain related to the veteran's service-connected right oophorectomy. After a review of the evidence of record, the Board finds the evidence shows the veteran's left ovary is still present, and thus, her current disability is not characterized by the complete removal of both ovaries. As such, the preponderance of the evidence is against an award of an increased disability evaluation in excess of 0 percent for the veteran's right oophorectomy, under 38 C.F.R. § 4.116, Diagnostic Code 7619 (1999). However, upon further consideration of the veteran's symptomatology, including the above discussed diagnoses of right adnexal mass and possible adhesiolysis, the Board will consider evaluation, by analogy, of the veteran's disability under Diagnostic Code 7699-7615, in addition to evaluating the veteran's disability under Diagnostic Code 7619. See 38 C.F.R. § 4.116, Diagnostic Code 7615 (1999); Butts v. Brown, 5 Vet. App. 532 (1993) (implicitly holding that the BVA's selection of a Diagnostic Code may not be set aside as "arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law," if relevant data is examined and a reasonable basis exists for its selection) (Citations omitted). In this regard, where the particular disability for which the veteran has been service connected is not listed, it may be rated by analogy to a closely related disease in which not only the functions affected, but also the anatomical location and symptomatology are closely analogous. See 38 C.F.R. §§ 4.20, 4.27. See also Lendenmann v. Principi, 3 Vet. App. 345, 349- 350 (1992); Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). The Board acknowledges the veteran's complaints of right pelvic pain, painful intercourse and difficulty lifting on the right side. However, there has only been one finding of tenderness in the right adnexal area, and there is no objective evidence of record that the other symptoms of which the veteran's complains are related to the service-connected disability at issue. Although the Board notes a diagnosis of possible adhesiolysis, there no actual final diagnosis of such related to the service-connected disability at issue. Further, repeat CT scan has revealed no relevant abnormality related to the veteran's right oophorectomy. However, even assuming that the veteran's pelvic pain and the other reported symptoms are related to the right oophorectomy, there is no evidence of record that any of the reported symptoms require continuous treatment. Specifically, the Board observes that, other than the veteran's July 1997 hospitalization at the St. Louis VAMC, John Cochran Division, the present record is devoid of evidence showing continuous treatment for the veteran's symptoms. Further, this hospitalization is notable in that the veteran's abdominal pain was thought to be the result of a nonservice-connected disorder, and for the fact that none of the symptoms were reported to be related to the veteran's service-connected right oophorectomy. Based on the foregoing, the Board finds that the preponderance of the evidence is against an award of a disability evaluation in excess of 0 percent for the veteran's right oophorectomy, under 38 C.F.R. § 4.116, Diagnostic Code 7699-7615 (1999). Furthermore, the Board finds that increased ratings on an extraschedular basis is not warranted. The Code of Federal Regulations, at 38 C.F.R. § 3.321(b) (1998), provides that, in "exceptional case[s], where the schedular evaluations are found to be inadequate, . . . an extra-schedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities . . ." may be granted. Generally speaking, for a specific case to be deemed "exceptional," it should present "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) (1999). The veteran's symptomatology related to her right oophorectomy does not constitute an "exceptional case" as to allow for the assignment of extraschedular ratings. Indeed, the record does not show either that the veteran's disability subject her to frequent periods of hospitalization or that it interferes with her employment to an extent greater than that which is contemplated by the assigned ratings, as deemed appropriate by the Board. As is apparent from the foregoing discussion, it cannot be said that the schedular rating criteria are inadequate in this instance. ORDER New and material evidence having been submitted, the claim for service connection for a psychiatric disorder, to include depression, is reopened; the appeal is granted to this extent only. Evidence of a well-grounded claim not having been submitted, service connection for a psychiatric disorder, to include depression, is denied. A compensable evaluation for right oophorectomy is denied. S. L. KENNEDY Member, Board of Veterans' Appeals