BVA9501574 DOCKET NO. 92-18 626 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to an increased schedular disability rating for the post-operative residuals of a left knee disorder, currently rated as 20 percent disabling. 2. Entitlement to an increased schedular disability rating for service-connected hypertension, currently evaluated as 10 percent disabling. 3. Entitlement to an increased schedular disability rating for a lumbosacral spine disorder, currently rated as 10 percent disabling. 4. Entitlement to an increased schedular disability rating for bilateral plantar fasciitis, currently rated as 10 percent disabling. 5. Entitlement to an increased schedular disability rating for spondylosis of the cervical spine, currently rated as 10 percent disabling. 6. Entitlement to an increased (compensable) schedular disability rating for the post-operative residuals of a right thumb disorder. 7. Entitlement to an increased (compensable) schedular disability rating for the post-operative residuals of a left thumb disorder. 8. Entitlement to an increased (compensable) schedular disability rating for the post-excision residuals of benign lesions on the neck and right side of the back. 9. Entitlement to an increased (compensable) schedular disability rating for chronic pain syndrome of the right scapula. 10. Entitlement to an increased (compensable) schedular disability rating for hemorrhoids. 11. Entitlement to service connection for chronic sinusitis. 12. Entitlement to service connection for a chronic groin rash. 13. Entitlement to service connection for a kidney condition. 14. Entitlement to service connection for a gall bladder condition. 15. Entitlement to service connection for chronic left epididymitis. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD L. L. Gann, Associate Counsel INTRODUCTION The veteran had active service from September 1970 to May 1991. This appeal arises from rating decisions dated in October and November 1991 of the Montgomery, Alabama, Regional Office (RO). In April 1994, the Board of Veterans' Appeals (Board) remanded the claim for additional evidentiary development. The claims folder was returned and docketed at the Board in December 1994, and is now ready for appellate review and consideration. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the schedular disability evaluations in effect for service-connected disorders of the left knee, lumbosacral and cervical spine, left and right thumbs, and the right scapula, as well as for service-connected hypertension, benign lesions of the neck and back, hemorrhoids and bilateral plantar fasciitis warrant increases in order to more appropriately compensate his current level of physical impairment. He also claims that service connection should be established for a chronic groin rash, kidney and gallbladder conditions, left epididymitis, and for chronic sinusitis, as these disorders also arose during service. 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 increased schedular disability ratings are not warranted for the veteran's service-connected left knee disorder, hypertension, bilateral plantar fasciitis, cervical spondylosis, the post-excision residuals of a benign lesion on the neck, chronic pain syndrome of the right scapula, and hemorrhoids. We conclude, however, that a 20 percent schedular rating is warranted for his service-connected lumbosacral spine disorder, that a 10 percent schedular rating is warranted for bilateral degenerative arthritis of the thumbs, and that a 10 percent schedular disability rating is warranted for his service- connected post-excision residuals of a benign lesion on the right back. Based upon our review of the record, we find that the preponderance of the evidence is against a grant of service connection for chronic sinusitis. We also conclude that the veteran's claims for service connection for a groin rash, kidney condition, gall bladder condition and left epididymitis are not well-grounded. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. In October and November 1991, the veteran was granted service connection for multiple disabilities, to include a left knee disorder; hypertension; a lumbosacral spine disorder; bilateral plantar fasciitis; chronic pain syndrome of the right scapula; post-excision lesions of the neck and back; right and left thumb conditions; and hemorrhoids. In August 1994, he was also granted service connection for spondylosis of the cervical spine. 3. His service-connected post-operative residuals of a left knee disorder are evaluated as 20 percent disabling. This condition is currently manifested by pain and swelling of the joint, exacerbated by stooping, climbing stairs or squatting. The veteran also experiences periodic laxity and subluxation. Range of motion is 120 degrees, with some crepitus. 4. The veteran's service-connected hypertension is rated at 10 percent. The most recent Department of Veterans Affairs (VA) examination dated in June 1994 found blood pressure readings of 150/96, 140/90, 160/100, and 130/80. The veteran is currently using medication to control his hypertension. 5. His lumbosacral spine disorder, currently rated as 10 percent disabling, is manifested by pain which radiates into the left leg and down to the foot. The most recent VA examination found 80 degrees of flexion and 35 degrees of extension, with no spasm or tenderness. Electromagnetic (EMG) studies found the presence of left S1 radiculopathy. 6. Bilateral plantar fasciitis is currently evaluated at a disability rating of 10 percent. Symptomatology associated with this condition includes tenderness upon palpation over the calcaneal insertion of the plantar fascia bilaterally, with subjective complaints of pain upon weight bearing. The most recent x-ray views of the feet revealed no abnormalities. 7. X-rays made in June 1994 reveal the presence of moderate spondylosis in the cervical spine. He has 55 degrees of right lateral rotation, 75 degrees of left lateral rotation, 60 degrees of flexion and 35 degrees of extension, with increased pain on the right at extremes of motion. 8. The veteran's bilateral thumb disorders are each rated as noncompensably disabling. No limitation of function was found during the most recent VA examination. Moderate degenerative changes were noted, however, on x-ray. 9. The veteran previously had benign skin lesions removed from his neck and right back. Upon examination in 1993, the biopsy site located on his right back was tender upon objective demonstration. There were no complaints or findings associated with the biopsy site on the neck. 10. The veteran complains of intermittent flare ups of pain in the area of the right scapula. The most recent VA examination found no tenderness located in the right scapula region, and the veteran had full range of motion in his shoulders. 11. The most recent VA examination found no evidence of hemorrhoids, and no complaints associated with this condition. 12. The veteran was treated for recurrent episodes of upper respiratory infections, sore throats, acute tonsillitis, and nasal congestion during service. A May 1988 in-service x-ray found his sinuses to be normal. At separation, the veteran did not give a history of sinusitis, and no symptomatology was noted in his separation examination. 13. There are no records demonstrating treatment for a sinus condition since service separation. The most recent VA examination noted a history of chronic sinusitis and headaches, and gave a diagnosis of chronic sinusitis, but the examiner made no objective findings with regard to the presence or absence of symptomatology. 14. The most recent VA examination found no evidence of a groin rash, a kidney condition, a gall bladder condition, or chronic left epididymitis, nor is there any record that the veteran has been treated for these conditions since service. CONCLUSIONS OF LAW 1. A schedular rating in excess of 20 percent is not warranted for the service-connected post-operative residuals of a left knee disorder. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.7, Part 4, Diagnostic Code 5010-5257 (1994). 2. A schedular rating in excess of 10 percent is not warranted for service-connected hypertension. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 7101 (1994). 3. A schedular rating of 20 percent is warranted for a service- connected lumbosacral spine disorder. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.7, Part 4, Diagnostic Code 5293 (1994). 4. A schedular rating in excess of 10 percent is not warranted for service-connected bilateral plantar fasciitis. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 5310 (1994). 5. A schedular rating in excess of 10 percent is not warranted for service-connected spondylosis of the cervical spine. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Codes 5003, 5290 (1994). 6. A 10 percent schedular rating is warranted for bilateral degenerative arthritis of the thumbs. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Codes 5010-5003, 5224 (1994). 7. A compensable schedular rating is not warranted for the service-connected post-excision residuals of a benign lesion on the neck. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 7819-7805 (1994). 8. A 10 percent schedular rating is warranted for the service- connected post-excision residuals of a benign lesion on the right side of the back. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 7819-7804 (1994). 9. A compensable schedular rating is not warranted for service- connected chronic pain syndrome of the right scapula. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Codes 5203, 5301, 5302 (1994). 10. A compensable schedular rating is not warranted for service- connected hemorrhoids. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 7336 (1994). 11. Chronic sinusitis was not incurred in service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.303(b), 3.303(d) (1994). 12. The claim for service connection for a chronic rash of the groin is not well-grounded. 38 U.S.C.A. § 5107(a) (1994). 13. The claim for service connection for a kidney condition is not well-grounded. 38 U.S.C.A. § 5107(a) (1994). 14. The claim for service connection for a gallbladder condition is not well-grounded. 38 U.S.C.A. § 5107(a) (1994). 15. The claim for service connection for left epididymitis is not well-grounded. 38 U.S.C.A. § 5107(a) (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Claims for Increased Schedular Ratings The Board notes that the veteran's claims are well grounded within the meaning of 38 U.S.C.A. § 5107 (West 1991). A well grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). We are also satisfied that all relevant facts have been properly developed so that further assistance to the veteran is not required. A. Left Knee Disorder In October 1991, the RO granted service connection for "S/P open medial meniscectomy, left, with moderate degenerative joint disease," and assigned a 10 percent schedular disability rating pursuant to Diagnostic Code 5257, effective from June 1, 1991. The veteran appealed the disability assigned by the RO. In an August 1994 rating action, the RO retroactively increased this 10 percent rating to 20 percent. The veteran, however, continues to appeal. The veteran's left knee disability is evaluated pursuant to 38 C.F.R. Part 4, Diagnostic Code 5257 (1994), which states that slight, moderate, or severe impairment of knee functioning, with subluxation or instability, will be rated as 10 percent, 20 percent, or 30 percent disabling, respectively. Where there is a question as to which of two evaluations shall be applied, 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 (1994). Service medical records demonstrate that the veteran originally injured his left knee in 1974, and thereafter suffered problems with the joint. He underwent an open medial meniscectomy in 1977. He reinjured the knee joint again in August 1980 as a result of a motorcycle accident. X-rays taken in September 1990 found significant osteoarthritic changes with mild to moderate joint space narrowing of all compartments in the left knee joint. In October 1990, he underwent an arthrotomy for removal of exostoses. In June 1994, the veteran underwent a general and orthopedic VA examination. He described chronic pain with recurrent episodes of swelling and instability, particularly after prolonged periods of weight bearing, squatting, stooping or climbing stairs. Physical examination revealed a satisfactory gait pattern. The veteran exhibited a range of motion from 0 to 120 degrees, with some crepitus and degenerative enlargement of the joint noted by the VA orthopedist. There was no tenderness to palpation, but there was an anterior drawer sign, a pivot shift sign, and a 2+ Lachman. The diagnosis was chronic anterior cruciate ligament insufficiency and degenerative arthritis, as residuals of the left knee injury and post-operative meniscectomy. Based upon this evidence, we conclude that a rating in excess of 20 percent is not currently warranted for the veteran's service- connected left knee disorder. During his recent examination, he exhibited a full range of motion and a satisfactory gait pattern, and was able to squat approximately half way and rise again, as well as walk heel and toe, without difficulty. Although examination revealed the presence of anterior cruciate ligament insufficiency, the veteran noted that he experienced "episodes" of knee instability. There is no evidence that this instability or subluxation is constant or continuous in nature, or that his left knee impairment currently results in a "severe" impairment of functioning. In light of his symptoms of crepitus, pain upon extended motion or weight bearing, and swelling, however, we find that the veteran's left knee disorder constitutes more than a mild disability. Thus a 20 percent schedular, reflective of a moderate degree of impairment, is warranted. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.7, Part 4, Diagnostic Code 5257 (1994). B. Hypertension The RO originally granted service connection for "Hypertension" in the October 1991 rating action, and assigned a 10 percent schedular rating pursuant to Diagnostic Code 7101, effective from June 1, 1991. This rating was confirmed in August 1994. Hypertension is evaluated pursuant to 38 C.F.R. Part 4, Diagnostic Code 7101 (1994). Where diastolic pressure is predominately 100 or more, or where continuous medication to control hypertension is used for control of hypertension with a history of diastolic pressure predominately 100 or more, a 10 percent rating will be assigned. A 20 percent rating will be granted where diastolic pressure is predominately 110 or more, with definite symptoms. In cases where diastolic pressure is predominately 120 or more, with moderate symptoms, or is 130 or more with severe symptoms, 40 and 60 percent ratings will be warranted respectively. Essential hypertension was initially diagnosed during service, at which time the veteran had consistent blood pressure readings in the range of 90. It was noted, however, that the veteran required the constant use of hypertensive medications to control his condition. A post-service treatment record dated in May 1991 found blood pressure reading of 159/96. During the June 1994 VA examination, his sitting blood pressure was 150/96 and his recumbent pressure was 140/90. After exercise, his sitting blood pressure reading was 160/100, and two minutes after exercise, the reading was 130/80. The examiner noted that the veteran had been treated with hypertensive medication for approximately 15 years. Upon review of the record, we find no basis upon which to award an increased schedular rating. The veteran's diastolic blood pressure readings have consistently been measured between 90 and 100 since service, with only one reading actually measuring 100 or more. Moreover, the most recent VA examination found no definite symptoms associated with this condition. His heart demonstrated a normal sinus rhythm, with no murmurs or enlargement. He also exhibited no circulatory difficulties, with all peripheral pulses palpable. It is clear that the veteran requires the use of medication in order to control his hypertension, thus warranting a minimum rating of 10 percent. The evidence does not, however, present a consistent current picture, or history, of diastolic readings in excess of 100. Thus a schedular disability rating in excess of 10 percent for service-connected hypertension is not warranted. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 7101 (1994). C. Lumbosacral Spine Disorder The RO originally granted service connection for "Posterior herniation at L4-5, lumbar spine" in a November 1991 rating decision. A 10 percent schedular evaluation was assigned pursuant to Diagnostic Code 5293, effective from June 1, 1991. In August 1994, the RO retroactively granted a 20 percent disability rating for this condition, and confirmed this evaluation in October 1994. Intervertebral disc syndrome which results in a pronounced disability, 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, and little intermittent relief, will be granted a schedular rating of 60 percent. In cases of severe symptomatology, with recurring attacks and little intermittent relief, a 40 percent schedular evaluation will be awarded. Moderate symptoms associated with recurrent attacks will warrant a 20 percent disability rating. Postoperative or cured intervertebral disc syndrome will be awarded a noncompensable rating. 38 C.F.R. Part 4, Diagnostic Code 5293 (1994). Where there is a question as to which of two evaluations shall be applied, 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 (1994). The veteran contends that his low back condition was incurred in service when he slipped down several steps at a Marine Recruiting Center shortly before service separation. Although he did not fall, he alleges that he sustained some type of traumatic injury to his back. An October 1991 magnetic resonance imaging (MRI) revealed a posterior herniation of disc material at the L4-5, which lateralized towards the left neural foramen, causing mild to moderate encroachment. No herniated nucleus pulposus was seen, although the L5-S1 disc was diminished in height. All remaining lumbar discs were normal. The veteran complained of recurrent back discomfort, with pain radiating into the left leg and foot, which is aggravated by increased levels of physical activity such as bending or lifting. An electrodiagnostic study (EMG) produced findings indicative of left S1 radiculopathy. Upon orthopedic examination, the veteran was able to stand erect, and no spasm or tenderness was noted. He exhibited 80 degrees of flexion and 35 degrees of extension. A neurological examination found some diminished vibratory sensation in the toes, but other sensory modalities were intact. Romberg was normal, and the veteran exhibited normal gait and was able to heel and toe walk without difficulty. Straight leg raising was negative bilaterally, and there was minimal spine pain and no low back pain upon palpation. The neurologist could find no evidence of left S1 radiculopathy in the motor and sensory findings. X-rays found mild intervertebral disc space narrowing at the L5-S1. After review of the entire record, we conclude that an increased disability rating is warranted for the veteran's service- connected lumbosacral spine disorder. Although the RO apparently awarded a 10 percent disability rating for this condition, based upon periodic flare-ups of back pain and stiffness, we note that his condition apparently includes neural involvement. Although the VA neurologist could find no sensory or motor findings consistent with radiculopathy, this examination did not rule out the existence of neural involvement, particularly in light of the accompanying EMG findings indicative of left S1 radiculopathy, and the veteran's complaints of pain radiating from his low back into his left leg and foot. Moreover, according to the VA orthopedic examiner, the veteran suffers from symptoms of low back pain on a "recurrent" basis. We believe that in light of the relative frequency of "attacks" as well as possible neural involvement, the veteran's service- connected low back disorder more nearly approximates the criteria for a moderate disability. Therefore, a 20 percent schedular disability rating is warranted. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.7, Part 4, Diagnostic Code 5293 (1994). D. Bilateral Plantar Fasciitis Service connection for "Bilateral plantar fasciitis" was granted by the RO in the October 1991 rating decision, and a noncompensable schedular disability rating was assigned pursuant to Diagnostic Code 5310, effective from June 1, 1991. This rating was retroactively increased to 10 percent by the RO in the August 1994 rating action. This disability has been evaluated using the criteria outlined at 38 C.F.R. Part 4, Diagnostic Code 5310 (1994), which addresses the impairment and limitation of function in the intrinsic muscles of the foot, including the plantar and dorsal structures (Group X). With regard to impairment in the plantar structures, a slight disability will be awarded a noncompensable schedular rating. Moderate impairment will warrant a 10 percent schedular evaluation. In cases of moderately severe or severe impairment, a 20 percent or 30 percent disability rating will be respectively granted. Factors to be considered in determining the level of impairment include the type of underlying injury, the history of the disability, and objective medical findings upon examination or treatment. In 1988, during service, the veteran complained of pain in the right mid-heel area, which was diagnosed as right calcaneal fasciitis. No bony abnormalities were found upon x-ray. He was subsequently treated for left heel pain, which had been present for approximately one year. The diagnosis was plantar fasciitis, and the veteran was prescribed an orthotic device for his shoe. In June 1994, he complained of bilateral tenderness in his feet, particularly in the area of the heel pads, with increased pain upon weight bearing and upon first arising in the morning. The examining VA physician found objective signs of tenderness to palpation over the calcaneal insertions of the plantar fascia bilaterally. The veteran was able to walk heel and toe, and could squat approximately "one-half way down" and arise. X-rays found no significant abnormalities. Based upon this evidence, we find that the veteran's service- connected bilateral plantar fasciitis results in a moderate impairment of functioning, thus warranting a 10 percent schedular disability rating. Although the objective medical evidence suggests that his bilateral fascial defects are only slight, we note that his service records are significant for treatment, and that he suffers from chronic symptoms of tenderness and discomfort in his feet, particularly after moderate use. Despite the absence of bony abnormalities or specific muscular injury, we conclude that the veteran's functional symptomatology is indicative of a moderate disability. We find no basis, however, for granting a rating in excess of 10 percent. While the veteran does experienced recurrent discomfort in his feet, he is able to walk, bend, squat, and move without notable difficulty. Although we acknowledge that his bilateral foot condition does result in pain and tenderness, these manifestations do not demonstrate that he suffers from substantial loss of muscle tissue or strength in his feet so as more nearly approximate a moderately severe disability. We conclude, therefore, that a rating in excess of 10 percent for bilateral plantar fasciitis is not warranted. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 5310 (1994). E. Spondylosis of the Cervical Spine The RO granted service connection for "Spondylosis, cervical spine" in the August 1994 rating decision, and assigned a 10 percent schedular disability rating pursuant to Diagnostic Code 5003, effective from June 1, 1991. Degenerative arthritis or spondylosis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate Diagnostic Code for the joint involved. When, however, the limitation of motion of the specific joint involved is noncompensable under the appropriate diagnostic code, a rating of 10 percent will be applied where x-ray evidence demonstrates involvement of two or more major or minor joints. In cases of involvement of two or more major and minor joints, with occasional incapacitating exacerbations, a 20 percent evaluation will be assigned. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. Part 4, Diagnostic Code 5003 (1994). Inasmuch as the veteran's cervical spondylosis was rated pursuant to Diagnostic Code 5003, the RO apparently did not find compensable limitation of motion pursuant to Diagnostic Code 5290, the appropriate rating code for determining limitation of motion of the cervical spine. Findings indicative of slight limitation of motion will be granted a 10 percent schedular disability rating, while moderate or severe limitation of cervical spine motion will be awarded 20 percent or 30 percent schedular evaluations, respectively. 38 C.F.R. Part 4, Diagnostic Code 5290 (1994). If motion in the cervical spine is within normal limits, a noncompensable schedular rating will be granted. 38 C.F.R. § 4.31 (1994). The June 1994 VA orthopedic examination noted a history of intermittent left neck pain. Right lateral rotation was 55 degrees, while left lateral rotation was 75 degrees. The veteran exhibited increased pain on the right on the extremes of motion. He had 60 degrees of flexion and 35 degrees of extension, with no tenderness to palpation over the pericervical region. An x-ray revealed the presence of moderate spondylosis, with no acute fracture and normal prevertebral soft tissues. The measurements for lateral rotation appear to be within normal limits. Nevertheless, the levels of flexion and extension do demonstrate some slight limitation of motion. Moreover, the VA examiner's made objective findings of pain upon extremes of motion. Thus we believe that the veteran does suffer from slight impairment of motion in his cervical spine, which would more appropriately be rated pursuant to Diagnostic Code 5290. We do not find, however, that this change in rating codes materially alters the veteran's current schedular evaluation of 10 percent. The evidence presented does not demonstrate that the veteran's cervical spine impairment is moderate or severe in degree. His symptoms are intermittent in nature, and the most recent VA examination results do not indicate that the limitation of motion is more than slight in degree. Thus we conclude that a 10 percent schedular rating is appropriate for the veteran's service-connected cervical spondylosis. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 5290 (1994). F. Post-operative Residuals of Right and Left Thumb Disorders In October 1991, the RO granted service connection for "S/P open reduction and internal fixation of avulsion fracture of distal phalanx, right thumb (major)" and for "S/P repair of acute rupture of ulna collateral ligament and metacarpophalangeal joint, left thumb," each of which was assigned a noncompensable disability evaluation pursuant to Diagnostic Code 5224, effective from June 1, 1991. The RO confirmed these noncompensable ratings in August 1994. The veteran's post-operative residual bilateral thumb disorders are rated according to the criteria set forth at 38 C.F.R. Part 4, Diagnostic Code 5224 (1994), which more specifically addresses symptoms associated with ankylosis of the thumb, but is also applied to general service-connected disabilities of the thumbs. Where the thumb joint is ankylosed or immobile, and the consolidation of the joint is in a favorable position, a 10 percent rating will be awarded. Where the position is unfavorable, a 20 percent rating will be warranted. Degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic code for the joint involved. When, however, the limitation of motion of the specific joint involved is noncompensable under the appropriate diagnostic code, a rating of 10 percent will be applied where x-ray evidence demonstrates involvement of two or more major or minor joints. In cases of involvement of two or more major and minor joints, with occasional incapacitating exacerbations, a 20 percent evaluation will be assigned. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. Part 4, Diagnostic Code 5010-5003 (1994). In every instance where the minimum schedular evaluation requires residuals, and the schedule does not provide a no-percent evaluation, a noncompensable evaluation will be assigned when the required residuals are not shown. 38 C.F.R. § 4.31 (1994). According to service medical records dated in August 1980, the veteran was involved in a motorcycle accident, and subsequently complained of pain in both thumbs. Shortly thereafter, he underwent repair of an acute rupture of the ulna collateral ligament and metacarpophalangeal joint of the left thumb, and an open reduction and internal fixation of an avulsion fracture of the distal phalanx of the right thumb. X-rays taken in December 1990 noted that interphalangeal joint spaces in both thumbs were normal. At the time of his June 1994 VA examination, the veteran complained of occasional "feelings of weakness" in the hands, but otherwise noted no functional limitations. It was found that he is right handed, and feeds, grooms and writes with his right hand. Examination revealed that he could make a good fist in both hands, and could oppose the thumbs to the remaining fingertips satisfactorily. He displayed 5/5 grip strength bilaterally, and his post-operative scars were found to be well- healed. No neurological abnormalities were noted upon examination. X-rays found the presence of moderate degenerative changes in the thumbs, with no other abnormalities seen. We first note that neither of the veteran's thumbs are ankylosed in either a favorable or unfavorable position. Moreover, the most recent VA examination found no functional limitation whatsoever in either thumb joint. The veteran was able to form a good grip with each hand, could oppose the other fingers with his thumbs, and had normal grip strength. His only subjective complaint was of occasional weakness in both hands. Inasmuch as the evidence does not demonstrate the presence of any impaired function or limitation of motion, we find no basis upon which to award a compensable rating for the veteran's service-connected right or left thumb conditions pursuant to 38 C.F.R. § 4.31, Part 4, Diagnostic Code 5224 (1994). X-rays made during the most recent VA examination also found, however, the presence of moderate degenerative changes in both of the interphalangeal joints in the veteran's thumbs, indicative of arthritis. Based upon this finding of arthritic changes in 2 or more minor joints, we believe that the more appropriate rating code for the veteran's bilateral thumb disorders would be 38 C.F.R. Part 4, Diagnostic Code 5010-5003 (1994) which would address the degenerative arthritis which has arisen as a result of trauma to the joints during service. Moreover, pursuant to the criteria outlined by this Diagnostic Code, the veteran would be eligible for a 10 percent schedular disability rating to reflect the degenerative changes found in his thumbs. We do note, however, that there is no basis upon which to award a rating in excess of 10 percent. Inasmuch as the VA examination found only the presence of arthritis, with no objective evidence of "occasional exacerbations" associated therewith, a 20 percent evaluation is not warranted. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Codes 5010-5003 (1994). G. Residuals of Benign Lesions on the Neck and Back The RO granted service connection for "S/P excision benign skin lesions, neck and right side of back" in October 1991, and a noncompensable schedular rating was assigned pursuant to Diagnostic Code 7819, effective from June 1, 1991. This rating was maintained by the RO in August 1994. Benign skin growths are rated according to the considerations set forth in 38 C.F.R. Part 4, Diagnostic Code 7819 (1994), which states that such growths are to be rated commensurate with eczema, dependent upon the location, extent, or repugnance of the manifestations, or rated as scars or disfigurement resulting therefrom. Scars which are not disfiguring, poorly nourished and ulcerating, or tender and painful, will be rated according to the limitation of function resulting therefrom. 38 C.F.R. Part 4, Diagnostic Code 7805 (1994). Scars which are tender and painful on objective demonstration will be granted a 10 percent schedular evaluation. 38 C.F.R. Part 4, Diagnostic Code 7804 (1994). In February 1990, during service, the veteran underwent excision of a benign skin lesion located on his neck. He underwent excision of a similar lesion located on the right side of his back in May 1991, shortly before his separation from service. During the course of his June 1991 VA examination, he complained of continued tenderness and discomfort associated with the residual scar located on his right back. The examining physician made objective findings confirming the tenderness of this residual scar. The veteran raised no complaints concerning the residual scar located on his neck, and the examiner found no manifestations associated with this post-excision scar. Although these post-excision scars have heretofore been considered as a single disability for rating purposes, these conditions may be rated separately where the symptomatology associated with each is separate and distinct, with no "overlapping." See Esteban v. Brown, 6 Vet.App. 259, 261-62 (1994). We believe that this case presents such a situation. With regard to the veteran's post-excision benign lesion on the neck, we find no evidence which supports a compensable disability rating, inasmuch as the most recent examination found no residuals , nor has the veteran complained of any pertinent symptomatology. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 7819-7805 (1994). We note, however, that the veteran has complained of tenderness associated with his post- excision benign lesion of the right back, and this tenderness was confirmed by objective medical evidence. We find, therefore, that a 10 percent schedular disability evaluation is warranted for this post-excision residual. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 7819-7804 (1994). H. Chronic Pain Syndrome of the Right Scapula Service connection was granted in October 1991 for "Chronic pain syndrome, right inferior aspect of scapula (major)," which was assigned a noncompensable schedular rating pursuant to Diagnostic Code 5203, effective from June 1, 1991. This evaluation was maintained by the RO in an August 1994 rating action. Impairment involving the malunion of the scapula will warrant a 10 percent schedular rating. In those cases involving nonunion of the scapula without loose movement, a 10 percent schedular evaluation will also be warranted. Where the nonunion results in loose movement, or in cases of total dislocation of the scapula, the veteran will be granted a 20 percent schedular rating. 38 C.F.R. Part 4, Diagnostic Code 5203 (1994). Where there is slight impairment in the extrinsic muscles of the shoulder girdle (Muscle Groups I and/or II) of the major arm, a noncompensable disability rating will be awarded. Moderate impairment of functioning in either of these two muscle groups will be granted a 20 percent disability evaluation. Moderately severe or severe disabilities in the shoulder muscles of the major arm will be assigned a 30 percent or 40 percent schedular ratings, respectively. 38 C.F.R. Part 4, Diagnostic Codes 5301, 5302 (1994). In 1979, during service, the veteran complained of pain upon movement and tenderness in the area of his right axilla and scapula. He attributed this discomfort to possible muscle or underlying tissue inflammation caused after doing a "pull-up" on a chinning bar. Examination found that the right shoulder was tender upon palpation. The probable diagnosis was a soft tissue inflammation. Thereafter, he periodically continued to complain of right shoulder discomfort. In August 1990, an examiner diagnosed this condition as a chronic musculoskeletal pain syndrome of the right inferior aspect of the scapula. No additional treatment for, or symptoms of this condition are noted again in the record until the 1994 VA examination report. At that time, he noted a history of intermittent right scapula pain for approximately 20 years, with the severity of his symptoms dependent upon his level of physical activity. At the time of examination, however, he was asymptomatic. Examination found no tenderness over the right scapula region, and the veteran exhibited full range of motion in his shoulders. We first note that the nature of the veteran's complaints, as well as the history of the underlying trauma which first resulted in his right scapula condition, indicate that this disorder is more closely associated with impairment of muscular functioning, rather than a bony or skeletal abnormality. Therefore, we believe that the veteran's current disability would be more appropriately and comprehensively evaluated pursuant to those Diagnostic Codes which address the impairment of extrinsic muscle functioning in the right shoulder girdle. See 38 C.F.R. Part 4, Diagnostic Code 5201, 5202 (1994). Regardless of this change in rating criteria, however, we conclude that a compensable schedular disability rating is not warranted for the veteran's chronic pain syndrome of the right scapula. There has been no evidence of muscle loss, atrophy, or incapacitation indicative of a severe injury, and the absence of evidence showing consistent treatment both during and after service does not reveal that this condition is moderately severe in nature. Despite the veteran's history of recurrent flare-ups of pain and discomfort during service, the post-service record contains no evidence of treatment for any periodic exacerbations, consistent with a moderate disability. Moreover, the most recent VA examination found only a history of this disorder, with no symptoms or manifestations present at the time of examination. Without additional evidence demonstrating the precipitating factors for exacerbation of this condition, as well as information concerning the frequency of these exacerbations, we do not conclude that the veteran's muscular impairment resulting from his right scapula condition is more than slight. Therefore, a compensable schedular disability rating is not currently warranted for the veteran's service-connected chronic pain syndrome of the right scapula. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.56, Part 4, Diagnostic Codes 5201, 5202 (1994). I. Hemorrhoids The veteran was granted service connection for "Hemorrhoids, by history" in the RO's October 1991 rating, and a noncompensable disability rating was assigned pursuant to Diagnostic Code 7336, effective from June 1, 1991. This rating was confirmed in August 1994. Pursuant to 38 C.F.R. Part 4, Diagnostic Code 7336 (1994), mild or moderate hemorrhoids will be rated as noncompensably disabling, while large or thrombotic, irreducible hemorrhoids, with excessive redundant tissue, consistent with frequent recurrences, will be awarded a 10 percent disability rating. External or internal hemorrhoids, with persistent bleeding and secondary anemia or fissures, will be granted a schedular disability rating of 20 percent. In July 1986, during active service, the veteran complained of occasional rectal bleeding. Examination in January 1987 revealed a bleeding internal hemorrhoid, for which he underwent conservative treatment. Subsequent service medical records do not indicate any recurrence of this condition. In his substantive appeal, however, the veteran contends that he continues to suffer from a large hemorrhoid that causes frequent problems. Nevertheless, in the June 1994 VA examination, the veteran made no complaints whatsoever concerning symptoms or manifestations attributable to hemorrhoids. Moreover, a rectal examination found no palpable masses consistent with an active hemorrhoid condition. Inasmuch as no other medical evidence has been submitted which supports the veteran's contention that his condition is active, resulting in large, thrombotic, recurrent hemorrhoids, we find no basis upon which to award a compensable schedular disability rating. Thus entitlement to an increased evaluation is not warranted. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 7336 (1994). II. Claims for Service Connection A. Chronic Sinusitis The Board notes that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107 (West 1991). A well grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). We are also satisfied that all relevant facts have been properly developed so that further assistance to the veteran is not required. Service connection may be established for disability resulting from personal injury or disease incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). In the absence of chronicity at onset, a grant of service connection requires evidence of continuity of symptomatology demonstrating that a current disability was incurred in service. 38 C.F.R. § 3.303(b) (1994). Regulations also provide that service connection may be established where all the evidence of record, including that pertinent to service, demonstrates that the veteran's current disability was incurred in service. 38 C.F.R. § 3.303(d) (1994). The veteran contends that he suffers from chronic sinusitis which was incurred in service. Service medical records indicate that in September and October 1977, he was treated for symptoms of nasal congestion and a nonproductive cough. These manifestations were associated with a "cold." He was thereafter treated for sinus congestion in September 1981. Then, in April 1986, the veteran began seeking recurrent treatment for chronic sore throats and upper respiratory problems. This condition was initially diagnosed as acute tonsillitis, due in part to the presence of enlarged tonsils and a severe sore throat. From February to October 1987, he was again treated for a productive cough, sinus congestion, and nasal drainage. Then from April through June 1988, he again consulted physicians for complaints of a severe sore throat and upper respiratory symptoms. An x-ray made in May 1988 found his sinuses to be well-aerated and well- developed, with no evidence of mucous membrane thickening, air fluid level or bony erosion. Thereafter, in June 1988, the veteran was found to have "strep throat." He was again treated in December 1988 for an upper respiratory infection, and in January 1990 for nasal congestion and a productive cough. At service separation, however, the veteran noted a history of nose and throat problems, but denied a history of "chronic sinusitis." No abnormalities were noted in the separation examination. Further complaints or treatment associated with a sinus or respiratory condition are not shown until the VA examination of June 1994, when the veteran noted a history of chronic sinusitis, with congestion and drainage. The examining physician stated that the veteran "has frequent sinus drainage and his sinuses stop up and he has frequent sore throats." No other findings were made. The diagnosis was chronic sinusitis, as well as chronic headaches associated with chronic sinusitis. Upon review of the record, however, we cannot conclude that the veteran currently suffers a condition which first arose in service. We first note that despite his numerous records of treatment during service, chronic sinusitis was never diagnosed. His symptoms of sore throat, upper respiratory difficulties, sinus congestion and nonproductive cough were attributed to conditions such as acute tonsillitis, strep throat and upper respiratory infections, but not to a sinus condition. In mid- 1988, when he repeatedly suffered from upper respiratory problems, chronic sore throat, and even strep throat, an x-ray found his sinuses to be absolutely normal. Moreover, at service separation, the veteran noted no symptoms associated with chronic sinusitis, and specifically denied ever having this condition in the past. Even if we were to find that some of the veteran's in-service symptomatology was definitively related to a sinus problem, the post-service evidence does not indicate that such manifestations have been chronic or continuous since service. No medical evidence noting the presence of a sinus condition is found until the 1994 VA examination report, more than three years after service separation. Furthermore, the VA examiner noted with specificity the subjective complaints given by the veteran. His ultimate diagnosis, however, appears to be based upon this stated history. He included no objective findings concerning the status of the nose, sinuses, mouth and throat, which would support his impressions. We do note, however, that he found the veteran's ears to be normal, with no redness or discharge, and found his breathing to be normal and uncongested. "Sinusitis" was also noted by the VA neurological examiner, but the veteran referred to this as part of his "past medical history." Thus the totality of the evidence contained in the 1994 report does not indicate that the veteran actually suffered from an active sinus condition at the time of his VA examination, and the diagnosis of chronic sinusitis by the VA examiner appears to have been based solely upon the subjective history given by the veteran. Inasmuch as the record contains no medical evidence which supports the veteran's subjective contentions, the examiner's findings may be accorded little weight. See Swann v. Brown, 5 Vet.App. 229 (1993). We find that the absence of in-service records finding the presence of a sinus condition, the veteran's own indication at service separation that he had never suffered from chronic sinusitis, and the absence of treatment or other medical evidence for three years after service, all outweigh the questionable finding of the VA examiner, and the unsupported allegations of the veteran. Accordingly, service connection for chronic sinusitis is denied. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303(b), (d) (1994). B. Groin Rash, Kidney Condition, Gall Bladder Condition, and Left Epididymitis In order for the Board to consider the appellant's claim, the appellant must submit evidence of that the claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). A well-grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). A well-grounded claim also requires more than just mere allegations that the veteran's service, or an incident which occurred therein, resulted in illness, injury, or death. The appellant must submit supporting evidence that would justify the belief that the claim is plausible. See Tirpak v. Derwinski, 2 Vet.App. 609 (1992); Grivois v. Brown, 6 Vet.App. 136 (1994). The veteran contends that he incurred a chronic groin rash and chronic left epididymitis in service. He also contends that he currently suffers from kidney and gall bladder conditions which are attributable to his service-connected hypertension. We note, however, that the record is devoid of medical evidence which demonstrates that he currently suffers from any of these disorders, or has suffered any symptoms or manifestations consistent with these conditions since service separation. Service medical records demonstrate no treatment for, or complaints of a groin rash. Moreover, the record contains no treatment records or other medical evidence demonstrating that the veteran has experienced this skin condition since service. In the most recent VA examination, the veteran noted a history of a chronic groin rash, with red skin patches and itching. The presence of this condition was not found, however, upon examination, and the diagnosis was a history of candidiasis of the genitals, inactive. Inasmuch as the evidence does not show either treatment for a skin condition in service, or any current disability which is attributable to service, the veteran's claim for service connection for a groin rash is not well-grounded. See Rabideau v. Derwinski, 2 Vet.App. 141 (1992). With regard to chronic left epididymitis, service medical records are again devoid of treatment for this condition. Furthermore, the 1994 VA examination found complaints of right epididymitis, but no symptomatology or findings consistent with left epididymitis. Even if, however, the veteran is confused as to whether he is claiming right or left epididymitis, there is no record of these disorders in service, nor is there any post- treatment medical evidence linking the veteran's current complaints to any incident in service. Thus a claim for either left or right epididymitis is not well-grounded. See Montgomery v. Brown, 4 Vet.App. 343 (1993). Although the veteran stated in his substantive appeal that he suffers from kidney and gall bladder problems associated with his service-connected hypertension, we note that there is no record either during service, or subsequent to service separation, which demonstrates that such conditions have ever become manifest. In fact, during the course of the June 1994 VA examination, the veteran made no complaints whatsoever with regard to kidney or gall bladder disorders. He specifically stated that he had no digestive complaints, and no abnormalities of the endocrine system were found. Inasmuch as the veteran has not presented any medical evidence which supports that he currently suffers from kidney and gall bladder conditions attributable to service, or another service-connected condition, we find that these claims are not well-grounded. See Rabideau v. Derwinski, 2 Vet.App. at 144. In two recent decisions, Grottveit v. Brown, 5 Vet.App. 91 (1993), and Grivois v. Brown, 6 Vet.App. 136 (1994), the United States Court of Veterans Appeals (Court) has held that claims for service connection denied on the merits by the Board and, preceding the Board's decisions, by the Regional Office, were not well-grounded, and that "the [Board] and the Regional Office erred in not so deciding the claim." Grottveit, 5 Vet.App. at 92. The governing law, 38 U.S.C.A. § 5107(a) (West 1991), [R]eflects a policy that implausible claims should not consume the limited resources of the VA and force into even greater backlog and delay those claims which -- as well- grounded -- require adjudication. . . . Attentiveness to this threshold issue is, by law, not only for the Board but for the initial adjudicators, for it is their duty to avoid adjudicating implausible claims at the expense of delaying well-grounded ones. Grivois, 6 Vet.App. at 139. The Court expressed its concern that a decision on the merits, if deemed final, could constitute an unwarranted impediment to the appellant should he or she seek to reopen the claim because new and material evidence would be required to reopen. The Court deemed it appropriate, where the Board denied on the merits a claim that was not well-grounded, to "recognize the nullity of the prior decisions and allow appellant to begin, if he can, on a clean slate." Grottveit, 5 Vet.App. at 93; Grivois, 6 Vet.App. at 140. In both cases, the Court vacated the Board's decision and remanded with instructions to vacate the decisions of the RO. Id.; Grivois, 6 Vet.App. at 141. In view of the clear direction given by the Court, it is imperative that finality in accordance with 38 C.F.R. § 3.104 (1994), not attach to the rating decisions of October 15, 1991, and August 16, 1994, as regards these claims. ORDER Entitlement to a schedular rating in excess of 20 percent for the post-operative residuals of a left knee disorder is denied. Entitlement to a schedular rating in excess of 10 percent for hypertension is denied. Entitlement to a schedular rating of 20 percent for a lumbosacral spine condition is granted, subject to the regulations controlling the payment of benefits. Entitlement to a schedular rating in excess of 10 percent for bilateral plantar fasciitis is denied. Entitlement to a schedular rating in excess of 10 percent for cervical spondylosis is denied. Entitlement to a 10 percent schedular rating for bilateral degenerative arthritis of the thumbs is granted, subject to the regulations controlling the payment of benefits. Entitlement to a compensable schedular rating for the residuals of a post-excision benign lesion on the neck is denied. Entitlement to 10 percent schedular rating for the residuals of a post-excision benign lesion on the right back is granted, subject to the regulations controlling the payment of benefits. Entitlement to a compensable schedular rating for chronic pain syndrome of the right scapula is denied. Entitlement to a compensable schedular rating for hemorrhoids is denied. Entitlement to service connection for chronic sinusitis is denied. Well-grounded claims for service connection for a groin rash, kidney and gall bladder conditions, and for left epididymitis having not been submitted, these claims are dismissed, and the rating decisions of October 15, 1991, and August 16, 1994, are vacated insofar as entitlement to service connection for these disabilities was denied. (CONTINUED ON NEXT PAGE) JACK W. BLASINGAME 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.