BVA9501707 DOCKET NO. 92-14 029 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUE Entitlement to special monthly pension by reason of the need for aid and attendance of another person or at the housebound rate. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD J. Sherman, Counsel INTRODUCTION The veteran had active military service during World War II. This case was remanded by the Board of Veterans' Appeals (Board) to the New Orleans, Louisiana, regional office (RO) in November 1993 for additional development on a claim of entitlement to special monthly pension, denied by the RO in a rating decision of May 1992. Following additional development and subsequent rating again denying entitlement to special monthly pension in June 1994, the case is again before the Board on appeal. The veteran contends that the RO erred in its application of the combined ratings table (38 C.F.R. § 4.25) and that his combined rating should be 100 percent. That issue is not inextricably intertwined with the issue before the Board, and it is referred to the RO for appropriate action. In this regard, we note that entitlement to special monthly pension at the housebound rate requires, in part, a single 100 percent disability. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends, in essence, that he is entitled to special monthly pension by reason of being in need of aid and attendance of another person or at the housebound rate. 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 claim for special monthly compensation by reason of the need for aid and attendance or at the housebound rate. FINDINGS OF FACT 1. All relevant evidence necessary to an equitable decision has been obtained by the RO. 2. The veteran has vision in the right eye corrected to 20/50 and in the left eye corrected to 20/30; he is not a patient in a nursing home as a result of mental or physical incapacity. 3. The veteran is able to dress and undress himself and to keep himself ordinarily clean and presentable; needs no special orthopedic or prosthetic appliances; is able to feed himself and attend to the wants of nature; and does not require assistance on a regular basis to protect himself from hazards or dangers incident to his daily environment. He is not bedridden. 4. No single disability of the veteran is 100 percent permanently disabling. CONCLUSION OF LAW The veteran is not entitled to special monthly pension by reason of requiring regular aid and attendance, nor is he entitled to special monthly pension at the housebound rate. 38 U.S.C.A. §§ 1521(a), (d) and (e), 1502(b) and (c), 5107(a) (West 1991); 38 C.F.R. §§ 3.351(b) and (d), 3.352(a), Part 4, to include §§ 4.7, 4.40, 4.45, 4.59, and diagnostic codes 5276, 5293, 7305, 7101, 6204, 5003-5201, 5003-5215, 5003-5257, 7913, 6028-6079, 6510, 5003-5223, 6699-6600, 9399-9310, and 8299-8205. (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran satisfied the threshold requirement of submitting a well-grounded claim within the meaning of 38 U.S.C.A. § 5107(a) in that he submitted a claim which is plausible. All relevant evidence has been properly developed by the RO, and no further assistance is required to comply with the duty of the Department of Veterans Affairs (VA) to assist the claimant in developing facts pertinent to his claim. Id. A veteran of a war who is permanently and totally disabled from non-service connected disabilities not the result of his or her own willful misconduct may be entitled to payment of pension. 38 U.S.C.A. § 1521(a) (West 1991). A veteran receiving such a pension may be entitled to special monthly pension if the veteran requires regular aid and attendance or if the veteran has one disability rated as permanent and total and additional disabilities independently ratable at 60 percent disabling or more or the veteran is permanently housebound by reason of disabilities. 38 U.S.C.A. § 1521(d) and (e) (West 1991). A claimant who is helpless or so nearly helpless as to require the regular aid and attendance of another person will be determined to be in need of aid and attendance. The criteria for assessing the need for aid and attendance require that the person be blind or so nearly blind as to have corrected visual acuity of 5/200 or less in both eyes or concentric contraction of the visual field to 5 degrees or less, or that the person be a patient in a nursing home because of physical or mental incapacity, or that a factual need for aid and attendance be demonstrated under specific criteria set out in regulations. 38 U.S.C.A. § 1502(b) (West 1991); 38 C.F.R. § 3.351(b) (1993). In order to determine that a factual need for aid and attendance is supportable, the following factors must be considered: inability of a claimant to dress or undress himself or to keep himself ordinarily clean and presentable; frequent need of adjustment of special orthopedic or prosthetic appliances; inability to feed himself through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity which requires care or assistance on a regular basis to protect the claimant from the hazards incident to his daily environment. A claimant who is bedridden as a result of a condition that requires remaining in bed, as opposed to a condition for which bed rest is prescribed or undertaken voluntarily, may be determined to need aid and attendance. 38 C.F.R. § 3.352(a) (1993). A veteran who is not in need of regular aid and attendance may be entitled to special monthly pension at the housebound rate if the veteran has a single permanent disability rated at 100 percent and additional disability or disabilities independently ratable at 60 percent or more or if the veteran is permanently housebound. "Permanently housebound" means that the veteran must be substantially confined to the house, ward, or immediate premises due to a disability or disabilities which are reasonably certain to remain throughout the veteran's lifetime. 38 U.S.C.A. §§ 1502(c), 1521(e) (West 1991); 38 C.F.R. § 3.351(d) The veteran had a hemilaminectomy and discectomy at the L-5, S-1 interspace in September 1971 at the VA hospital in Shreveport, Louisiana. The veteran filed an application for pension in October 1971. A VA examination was provided, and diagnoses were postoperative status herniated nucleus pulposus, L-5, S-1 interspace, with residual radiculitis and muscle spasm; pes planus, first degree, no disability; chronic gastritis, symptoms minimal; and intermittent headache, etiology undetermined, apparently not disabling. The veteran's back condition was rated 40 percent disabling under diagnostic code 5293. The veteran was awarded pension on an extraschedular basis. In 1980, the veteran filed a claim for aid and attendance or housebound benefits, citing treatment at the Shreveport VA medical center and by A.E. Dean, Jr., M.D., and W.W. Fox, M.D. An outpatient report from the Shreveport VA outpatient clinic dated August 1973 noted that the veteran had been in an automobile accident and complained of pain in the neck radiating down the shoulder. There was no decrease in strength, reflexes were symmetrical, sensation was intact, and there was no cervical tenderness. The veteran provided a statement from Dr. Dean dated in January 1980 indicating that the veteran is doing well, but will continue to have pains or aches in his neck and occasional stiffness. The doctor expressed the opinion that most of the veteran's disability is due to degenerative changes and is only minimal. It is noted that Drs. Dean and Fox are associated with the same medical practice. Entitlement to aid and attendance or housebound benefits was denied in a rating decision of August 1980. Pain and stiffness in the cervical spine was rated as zero percent disabling under diagnostic code 5290. The veteran appealed to the Board, and entitlement to special monthly pension was denied by decision of March 1981. Pension benefits were terminated in 1981 due to excessive income. They were reinstated effective November 1991. General medical and aid and attendance examinations were accorded the veteran in April 1992. An electrocardiogram revealed a normal sinus rhythm with first degree AV block. The ECG was otherwise normal. A chest x-ray revealed cardiac size at the upper limits of normal with a left ventricular configuration and normal pulmonary vascular markings. Bilateral knee x-rays reflected mild degenerative changes in the knee joints, most marked on the right, with some peripheral lipping of the tibial plateau and opposing distal femoral condyles. The spinal x-ray showed degenerative changes about the L5-S1 with considerable loss of interspace and eburnation of the articular cortices, with vertebral bodies and interspace otherwise normal. The veteran's complaints on the general medical examination were noted to be some weakness, dizziness, sinus trouble, and high blood pressure. The diagnoses were arterial hypertension, treated; heart condition examined for and not found; postoperative status removal of a ruptured intervertebral disc in 1971, lumbar spine; and bilateral arthritis of the knee confirmed by x-ray. On the report of the aid and attendance examination, it was noted that the veteran had no functional restrictions of the upper extremities. He was able to feed himself, fasten clothing, bathe, shave, and tend to the needs of nature. No functional restrictions were noted with the lower extremities, and there were no deficits of weight bearing, balance, or propulsion. There was no significant limitation noted of the lumbar, thoracic, or cervical spine. The veteran was noted to be able to carry on a normal existence, with no problem with significant dizziness, loss of memory, or poor balance. The veteran was noted to live alone and to be able to leave home and carry on normal activities. He could walk without the assistance of another person or mechanical aids. An additional diagnosis of arthritis of the spine, confirmed by x-ray, was added to those listed on the general medical examination report. A rating decision was issued in May 1992 assigning a disability rating of 40 percent for hemilaminectomy, discectomy L5-S1 under diagnostic code 5293; zero percent for pes planus under diagnostic code 5276; zero percent for duodenal ulcer under diagnostic code 7305; 10 percent for hypertension, heart condition under diagnostic code 7101; 10 percent for arthritis of both knees under diagnostic code 5003; and zero percent for pain and stiffness of the cervical spine under diagnostic code 5290. Entitlement to special monthly pension was denied. The veteran notified the RO of his disagreement with the rating decision and advised that he had received additional treatment at the Shreveport VA medical center. The Board remanded the appeal to the RO, asking that the treatment records to which the veteran referred be obtained and that additional examinations be accorded the veteran. Progress notes covering the period January 1990 through January 1994, and a hospital summary for February 1993 were obtained from Shreveport VA medical center. The hospital summary covers a 10- day hospitalization following an episode of syncope and vomiting. On examination, the veteran was noted to be in no acute distress. The neck was supple with no adenopathy, no thyromegaly, and no bruits. The lungs had faint basilar crackles. The heart had a regular rate and rhythm with no murmurs. The abdomen was obese and nontender. Bowel sounds were present. The prostate was enlarged. On admission, the diagnoses were aspiration pneumonia, probable viral syndrome, and hypertension. During his hospitalization, the veteran broke out in an erythematous, multiple pustular rash on the right buccal area consistent with zoster. On discharge, the diagnoses were aspiration pneumonia, hypertension, and herpes zoster. The outpatient progress notes reflect appointments for chronic sinusitis, hypertension, complaints of dizziness, degenerative joint disease, removal of a hypertrophic skin tag, hypo/hyperglycemia, musculoskeletal strain, and ophthalmology clinic. In January 1990, blood pressure readings of 151/84 and 151/81 were noted. In August 1990, blood pressure readings of 144/93, 140/94, and 143/82 were noted. In November 1990, blood pressure readings of 159/81 and 141/80 were recorded. In February 1991, blood pressure readings were 158/94 and 152/83 on one occasion and 143/89 and 109/91 on another. In July 1991, blood pressure was recorded as 136/76 and 160/88. In November 1991, blood pressure readings of 169/98, 155/86, 165/94, 156/94, and 146/92 were recorded. In August 1993, blood pressure readings of 169/97, 168/100, and 164/93 were noted. An undated progress note reflects a blood pressure reading of 160/95, and hypertension is noted to be uncontrolled secondary to noncompliance with medications. In November 1993, hypertension was noted to be well controlled, and a reading of 138/68 was recorded. It was noted that the veteran was on medication for hypertension. In July 1991, the veteran was evaluated for complaints of dizziness on coming in from outside. A questionable history of hypo/hyperglycemia controlled by diet and of peptic ulcer disease was recorded. The impressions were benign positional vertigo, mild NC/NC anemia, and elevated glucose. In November 1991, the veteran was seen with complaints of headache and dizziness and an impression of benign vertigo, positional vs. labyrinthitis, was recorded. Notes reflect that the veteran had a 3 cm by 4 cm skin tag removed from his right upper thigh in December 1993, and the wound healed well. The veteran was diagnosed with cataracts in March 1993 and advised to follow up in two years. VA examinations were accorded the veteran in March 1994. On examination for joint problems, the veteran was observed to walk slowly and carefully but with normal gait and arm swing. He was able to walk briefly on heels and toes but could not squat down and stand up. The shoulder girdle was symmetrical, with no acromioclavicular separation or tenderness, swelling, or deformity. Bilaterally, the range of motion of the shoulders was: flexion 160 degrees, extension to zero, internal rotation 80, external rotation 90, abduction 150. Wrists were equal with no specific swelling or deformity. The right wrist had radial deviation of 15 degrees, ulnar deviation of 35 degrees, palmar flexion of 80 degrees, and dorsiflexion of 70 degrees. On the left, radial deviation was 20 degrees, ulnar deviation 45 degrees, palmar flexion 80 degrees, and dorsiflexion 70 degrees. Full range of motion for the fingers was noted, although slight fusiform swelling of the small joints of the thumb and fingers was noted. The right knee was moderately swollen. There was no subluxation, lateral instability, or loose motion of either knee. Moderate thoracolumbar scoliosis and moderate flattening in the lumbar area were noted. Forward flexion was 60 degrees, extension was 20 degrees, left lateral flexion was 30 degrees, right lateral flexion was 25 degrees, rotation to the left was 35 degrees, and to the right was 30 degrees. The diagnoses were degenerative arthritis of both shoulders, right wrist, both hands and both knees, and status postoperative lumbar laminectomy with residual scoliosis and evidence of degenerative arthritis and degenerative disc disease of the lumbar spine. On general medical examination, it was noted that there was no evidence of any skin lesions and there were no enlarged lymph nodes. There was no tenderness over the paranasal sinuses and no evidence of any swelling. Vision in the right eye was 20/200, corrected to 20/50, and in the left eye was 20/70, corrected to 20/30. Field of vision was normal. The heart was not clinically enlarged, rhythm was regular, and no murmurs were heard. No abnormalities were noted with respect to the respiratory system. The diagnoses were sinus condition confirmed by records of treatment for acute sinusitis and chronic paranasal sinusitis; arterial hypertension, treated; and slight anemia, unchanged since 1992. On the aid and attendance examination report, the veteran was noted not to require an attendant, not to be hospitalized, and not to be blind. It was reported that he could feed himself, fasten clothing, bathe, shave and attend to the needs of nature. It was reported that the veteran was able to leave his home at will, to walk one-half to one block without significant problems, and to drive an automobile. He was able to take care of usual household chores without significant problems. He used no mechanical aids. On the heart examination report, the veteran's blood pressure seated was recorded as 188/96. Recumbent blood pressure was 190/102, and standing blood pressure was 192/100. An electrocardiogram was normal. A chest x-ray revealed a tortuous aorta with calcification and chronic obstructive pulmonary disease. On neurological examination, Romberg test was negative and cerebellar function tests were normal. Forward and lateral bending of the low back did not appear to be restricted. A full range of motion in the upper extremities was noted. Deep tendon reflexes were hypoactive and equal bilaterally in upper and lower extremities.. Babinski and Hoffman signs were absent, and cranial nerve function was normal. All neurological examinations were noted to be negative. The examining physician noted that the veteran did not bring up dizziness or forgetfulness. When questioned, the veteran reported that he had had a problem four or five years previously with dizziness and had no present complaints of memory loss. The evidence adduced at his VA examination for aid and attendance in March 1994 indicates that the veteran lives alone at home, so he is clearly not a patient in a nursing home because of mental or physical incapacity. He is clearly not blind, his visual acuity being corrected to 20/50 in the right eye and 20/30 in the left eye. With respect to the criteria to be considered in determining whether there is a factual basis establishing a need for aid and attendance apart from the criteria of blindness or residence in a nursing home, the examining physician noted that the veteran was able to feed himself, fasten clothing, bathe, shave, and attend to the needs of nature. No amputations were noted. The neurological examination was reported as essentially negative. The veteran denied present specific complaints about memory difficulty and dizziness. Thus, he is able to protect himself against the hazards of daily living. There is no basis for finding the veteran to be in need of regular aid and attendance. He is not blind or in a nursing home. He meets none of the criteria for a determination of need for aid and attendance on a factual basis. There are likewise specific criteria for application to determine whether pension at the housebound rate is payable. The primary criterion is that the veteran have a single permanent disability ratable as 100 percent disabling. In making this determination, each disability of the veteran has been considered. When there is a question as to which of two evaluations are to be applied, the higher evaluation is to 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 (1993). Although the veteran has a number of disabilities for which he is rated, he does not meet the criterion of having a single permanent disability rated as 100 percent disabling, as will be explained below. Regulations define disabilities of the musculoskeletal system as "primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance." 38 C.F.R. § 4.40 (1993). Disabilities of the joints consist of reductions in the normal excursion of movements in different plants. Consideration is to be given to whether there is less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse, instability of station, or interference with standing, sitting, or weight bearing. For rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints. The cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae are considered groups of minor joints, ratable on a parity with major joints. The lumbosacral articulation and both sacroiliac joints are considered to be a group of minor joints, ratable on disturbance of lumbar spine functions. 38 C.F.R. § 4.45 (1993). With any form of arthritis, painful motion is an important factor in determining disability. 38 C.F.R. § 4.59 (1993). The veteran has been rated 40 percent disabled for status postoperative hemilaminectomy, discectomy L-5, S-1, with degenerative disc disease, under diagnostic code 5293. A 40 percent rating is for application in severe cases of intervertebral disc syndrome characterized by recurring attacks and intermittent relief. As noted above, the veteran's neurological examination was essentially negative. The diagnosis was "[h]istory of lumbar disc surgery, remote, with continuing chronic back pain, but no objective neurological signs." The only higher rating that might be assigned under that diagnostic code would be a 60 percent disability rating for pronounced intervertebral disc syndrome with persistent symptoms compatible with sciatic neuropathy with characteristic pain and demonstrable muscle spasm, absent ankle jerk, or other neurological findings appropriate to the site of the diseased disc, with little intermittent relief. The disability attributable to the postoperative hemilaminectomy therefore merits a rating no higher than 40 percent under diagnostic code 5293. He has no significant neurological findings. Unfavorable ankylosis of the lumbar spine, which would entitle him to a 50 percent rating under diagnostic code 5289, has also not been established. Rather, motion is clearly present in the veteran's spine. The veteran in this case has a 10 percent disability rating for cataracts under diagnostic code 6028-6079, with visual acuity in the right eye of 20/50 and in the left eye of 20/30. In order to merit a 20 percent disability rating for cataracts, his visual acuity in one eye would have to be 20/70, with vision in the other eye of 20/50, or vision of 20/100 and 20/50, or vision of 20/200 and 20/40, or vision of 15/200 and 20/40. The veteran's corrected visual acuity merits no more than a 10 percent disability rating under diagnostic code 6028-6079. He is not blind, nor is his corrected visual acuity 5/200 or less. The veteran has been assigned a rating of 10 percent for peptic ulcer disease under diagnostic code 7305. A rating of 10 percent is for application in cases of mild duodenal ulcer with recurring symptoms once or twice yearly. In order to merit a rating of 20 percent, there would have to be recurring episodes of severe symptoms two or three times a year averaging 10 days in duration, or there would have to be continuous moderate manifestation. A 40 percent evaluation requires a moderately severe duodenal ulcer with less than severe symptoms, but with impairment of health manifested by anemia and weight loss or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year. A 60 percent evaluation requires a severe duodenal ulcer with pain which is only partially relieved by standard ulcer therapy, periodic vomiting, recurrent hematemesis or melena, and manifestations of anemia and weight loss productive of definite impairment of health. The veteran has current complaints of heartburn occasionally, with no evidence of active ulcer. The veteran's history of peptic ulcer disease merits no more than a 10 percent disability rating under diagnostic code 7305, because he does not have an active ulcer, and his only complaint is occasional heartburn. There is no evidence that he suffers severe symptoms averaging 10 days in duration two or three times a year, let alone that he suffers symptoms severe enough to merit a 40 or 60 percent evaluation. The veteran has a rating of 10 percent for hypertension under diagnostic code 7101. His arterial hypertension is noted on VA examination to be treated, and blood pressure readings have all reflected diastolic pressure below 110. A rating of 10 percent is for application when diastolic pressure is predominantly 100 or more. A minimum ten percent evaluation is also assignable where continuous medication is shown necessary for control of hypertension with a history of diastolic blood pressure predominantly 100 or more. A rating of 20 percent requires diastolic readings that are predominantly more than 110 with definite symptoms. The veteran does not have diastolic blood pressure readings of 110 or more and his hypertension merits no more than a 10 percent disability rating under diagnostic code 7101. The veteran has a rating of 10 percent for labyrinthitis under diagnostic code 6204. A 10 percent disability rating for labyrinthitis reflects moderate disability characterized by tinnitus and occasional dizziness. The veteran has complained occasionally of dizziness, and a history of occasional tinnitus was noted on the February 1993 hospital summary. In order to apply a 30 percent disability rating for labyrinthitis, the veteran would have to have severe labyrinthitis characterized by tinnitus, dizziness, and occasional staggering. The veteran's labyrinthitis merits no more than a 10 percent disability rating under diagnostic code 6204. His condition is clearly not severe. He reports his dizziness and tinnitus to be intermittent, and occasional staggering attributable to labyrinthitis has not been demonstrated. The veteran has a rating of 10 percent for arthritis of the right shoulder with limitation of motion under diagnostic code 5003- 5201. His range of mobility for both shoulders was described on VA examination in March 1994 to be flexion to 160 degrees, extension to zero degrees, internal rotation to 80 degrees, external rotation to 80 degrees, and abduction to 150 degrees. Under diagnostic code 5201, limitation of motion of the arm to shoulder level (abduction and flexion limited to 90 degrees) is required for a 20 percent disability evaluation. Degenerative arthritis established by x-ray is to be rated on the basis of limitation of motion under the appropriate diagnostic code. 38 C.F.R., Part 4, Diagnostic Code 5003 (1993). When limitation of motion for the joint or joints involved is noncompensable under the appropriate diagnostic codes, as the limitation of motion for this veteran's shoulders is, a rating of 10 percent is for application for each major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. The veteran does exhibit limitation of motion which would be noncompensable under diagnostic code 5201, and the disability merits no more than a 10 percent evaluation under diagnostic code 5003. Likewise, the left shoulder merits the same disability rating, since the limitation of motion is the same as the right. The veteran is currently rated 10 percent disabled for each wrist under diagnostic code 5003-5215, for degenerative arthritis with limitation of motion. The arthritis of the right wrist is characterized by radial deviation of 15 degrees, ulnar deviation of 35 degrees, palmar flexion of 80 degrees, and dorsiflexion of 70 degrees. Limitation of motion of the wrist merits at most a 10 percent disability rating under diagnostic code 5215, and that requires either limitation of dorsiflexion to less than 15 degrees or palmar flexion limited in line with the forearm. The veteran does not exhibit such limitation of motion. Since there is some slight limitation of motion of the right wrist, and it is a major joint under the rating schedule, a rating of 10 percent is to be applied even though the criteria for a compensable rating are not met. The left wrist exhibited no limitation of motion of VA examination, and no diagnosis of arthritis was made. Nonetheless, the RO assigned a disability rating of 10 percent for the left wrist. There being no limitation of motion of the left wrist and no diagnosis of arthritis, a higher rating than 10 percent would not be appropriate. The veteran has a disability rating of zero percent for degenerative arthritis of each hand under diagnostic code 5003- 5223. His arthritis is characterized by slight fusiform swelling of the small joints of the thumbs and fingers of both hands with no limitation of motion. In evaluating disabilities of the musculoskeletal system, functional loss must be considered under 38 C.F.R. § 4.40. Although the veteran did not demonstrate any limitation of motion on examination, his small joints of his fingers and thumbs were swollen. Swelling is one of the factors which may provide objective evidence of limitation of motion under diagnostic code 5003. In order to recognize the limitation evidenced by the swelling of the small joints of both hands, an evaluation of 10 percent for each hand is warranted under diagnostic code 5003. The RO has assigned a disability rating of 10 percent for degenerative arthritis of each knee with limitation of motion under diagnostic code 5003-5257. On VA examination in March 1994, the veteran's right knee was 5/8 inches greater in circumference than the left and was described by the doctor as being slightly swollen with perhaps a small amount of fluid. There was no deformity, subluxation, lateral instability, or loose motion of either knee. The range of motion for the right knee was: flexion to 115 degrees, extension to within five degrees of zero. The range of motion of the left knee was: flexion to 125 degrees, extension to zero. If the rating were made on the basis of limitation of flexion and extension of the leg under diagnostic codes 5260 (flexion) and 5261 (extension), the limitation would be noncompensable under each code. In order for a compensable rating to be applied under code 5260, flexion would have to be limited to 45 degrees. In order for a compensable rating to be applied under code 5261, extension would have to be limited to 10 degrees. There being no basis for assigning a compensable rating but demonstrated slight limitation of motion of major joints, a rating of 10 percent for each knee is appropriate under diagnostic code 5003-5257. The veteran has a rating of 10 percent for non-insulin dependent diabetes mellitus, hypoglycemia under diagnostic code 7913. The veteran's treatment notes reflect a history of hypo/hyperglycemia controlled by diet and include a urinalysis on hospitalization in 1993 showing 2+ glucose, trace ketones, 2+ blood, three to four white cells, and 15 to 19 red cells. A subsequent urinalysis was within normal limits. Under the rating code, a rating of 10 percent is for application in a mild case of diabetes mellitus controlled by restricted diet without insulin that does not impair health or vigor or limit activity. In order to merit a 20 percent evaluation, the diabetes would have to require moderate insulin or oral hypoglycemic agent dosage and a restricted diet. As there is no requirement for medication to control diabetes mellitus for the veteran, a rating of no more than 10 percent is merited under diagnostic code 7913. The veteran is rated 10 percent disabled for sinusitis under diagnostic code 6510. A 10 percent evaluation is warranted for moderate chronic sinusitis manifested by a discharge, crusting, or scabbing and infrequent headaches. A 30 percent evaluation requires severe chronic sinusitis manifested by frequently incapacitating recurrences, severe and frequent headaches, and a purulent discharge or crusting reflecting purulence. 38 C.F.R. Part 4, Code 6510 (1993). The veteran's medical treatment records show no active pathology for his chronic sinusitis. The veteran reported on his medical examination that his nose is stopped up in the mornings, and he has pain in the face and head, which is relieved by use of Tylenol. He occasionally uses a spray to promote sinus drainage. There is no evidence of frequent incapacitating occurrences to warrant a 30 percent disability evaluation, and a 10 percent evaluation is warranted under diagnostic code 6510. The veteran has been assigned a zero percent evaluation for aspiration pneumonia under diagnostic code 6699-6600. Aspiration pneumonia has been rated by the RO as analogous to bronchitis. A noncompensable evaluation is warranted for mild chronic bronchitis manifested by slight cough, no dyspnea, and few rales. A 10 percent evaluation requires moderate chronic bronchitis manifested by considerable night or morning coughing, slight dyspnea on exercise, and scattered bilateral rales. 38 C.F.R. Part 4, Code 6600 (1993). The veteran was hospitalized with a diagnosis of aspiration pneumonia in February 1993. His lungs had faint basilar crackles. He was treated with antibiotics and discharged to home in stable condition. On VA examination in March 1994, the veteran's respiratory movements were normal, lungs were resonant to percussion, breath sounds were well-heard on auscultation, and no rales were heard. There is no evidence to support a compensable rating for aspiration pneumonia under diagnostic code 6699-6600. The RO assigned a noncompensable rating for pes planus under diagnostic code 5276. A noncompensable evaluation is warranted for mild unilateral or bilateral acquired flatfoot (pes planus) with symptoms which are relieved by built-up shoes or arch supports. A 10 percent evaluation is warranted for moderate unilateral or bilateral acquired pes planus where the weight- bearing lines are over or medial to the great toes and there is inward bowing of the tendo achillis and pain on manipulation and use of the feel. 38 C.F.R. Part 4, Code 5276 (1993). The veteran does not have any current complaints, findings, or diagnoses of pes planus, and no more than a zero percent evaluation is warranted. The veteran has a noncompensable rating for history of memory loss under diagnostic code 9399-9310. A noncompensable evaluation is warranted for dementia due to unknown cause with no impairment of social and industrial adaptability. A 10 percent evaluation requires slight impairment of social and industrial adaptability. 38 C.F.R. Part 4, Code 9310 (1993). On VA examination in March 1994, the veteran reported that he has no current problems with memory loss. With no impairment, no more than a zero percent evaluation is warranted. The veteran likewise has a zero percent disability rating for herpes zoster under diagnostic code 8299-8205. When the veteran was hospitalized in February 1993, he developed an erythematous, multiple pustular rash on the right buccal area extending from the right neck to the right clavicular area. He was treated with Acyclovir and improved. There was no evidence of skin lesions on VA examination in March 1994, and the neurological examination was essentially negative. There being no current symptomatology referable to herpes zoster, a noncompensable rating is warranted. The veteran simply does not have a single disability rated as 100 percent disabling. Further discussion of the additional factors that must be present in order to qualify for pension at the housebound rate would be pointless, because the primary criterion has not been met. A combined rating of 100 percent would not change the result in this case, since the necessary predicate is a single disability rating of 100 percent. ORDER The appellant's claim of entitlement to special monthly pension by reason of the need for aid and attendance of another person or at the housebound rate is denied. I. S. SHERMAN 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.