Citation Nr: 0006240 Decision Date: 03/08/00 Archive Date: 03/17/00 DOCKET NO. 98-10 490A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to an evaluation in excess of 10 percent for a fungus infection of the feet. 2. Entitlement to an evaluation in excess of 10 percent for plantar keratosis of the left foot. 3. Entitlement to a compensable evaluation for the residuals of a hemorrhoidectomy. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J. L. Prichard, Counsel INTRODUCTION The veteran had active service from June 1946 to May 1949. This matter comes before the Board of Veterans' Appeals (Board) on appeal of rating decisions of the Los Angeles, California, regional office (RO) of the Department of Veterans Affairs (VA). FINDINGS OF FACT 1. The veteran's fungus of the feet is productive of exfoliation and itching, without constant itching, extensive lesions, or marked disfigurement. 2. The veteran's plantar keratosis is productive of some tenderness, without objective evidence of disfigurement or limitation of function of the feet. 3. The residuals of the veteran's hemorrhoidectomy are productive of no more than mild to moderate symptomatology. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 10 percent for a fungus infection of the feet have not been demonstrated. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.118, Codes 7806, 7813 (1999). 2. The criteria for an evaluation in excess of 10 percent for plantar keratosis of the left foot have not been demonstrated. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.118, Codes 7803, 7804, 7819 (1999). 3. The criteria for a compensable evaluation for the residuals of a hemorrhoidectomy have not been demonstrated. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.114, Code 7336 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran contends that the evaluations currently assigned to his service connected disabilities are inadequate to reflect their current level of severity. Initially, the Board finds that the veteran's claims are "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a); that is, plausible claims have been presented. Murphy v. Derwinski, 1 Vet. App. 78 (1990). An allegation of increased disability is sufficient to establish a well- grounded claim seeking an increased rating. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The Board is also satisfied that all relevant facts have been properly developed to their full extent and that the VA has met its duty to assist. White v. Derwinski, 1 Vet. App. 519 (1991); Godwin v. Derwinski, 1 Vet. App. 419 (1991). The evaluation of service-connected disabilities is based on the average impairment of earning capacity they produce, as determined by considering current symptomatology in the light of appropriate rating criteria. 38 U.S.C.A. § 1155. Consideration is given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they are raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In addition, the entire history of the veteran's disability is also considered. Consideration must be given to the ability of the veteran to function under the ordinary conditions of daily life. 38 C.F.R. § 4.10. If there is a question as to which of two evaluations should apply, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). I. Foot Fungus and Plantar Wart The veteran argues that his disabilities have become worse. He states that his feet itch all of the time, and that he has cracking between his toes. He says that the plantar keratosis of the left foot requires surgery. A review of the record indicates that entitlement to service connection for a fungus infection of the feet and a plantar wart was established in a September 1971 rating decision. A zero percent evaluation was assigned for each of these disabilities. These evaluations remained in effect until a 10 percent rating was assigned for each of them in an August 1994 Board decision. An August 1994 rating decision implemented the decision of the Board. The 10 percent evaluations remain in effect for both the veteran's service connected fungus of the feet, and his service connected plantar keratosis. The veteran's fungal infection of the feet is evaluated under the rating code for dermatophytosis. This disability is evaluated under the rating code for eczema. 38 C.F.R. § 4.118, Code 7813. Eczema with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or that is exceptionally repugnant is evaluated as 50 percent disabling. When there is exudation or itching constant, extensive lesions, or marked disfigurement, a 30 percent evaluation is merited. For exfoliation, exudation or itching, if involving an exposed surface or extensive area, a 10 percent rating is warranted. A zero percent rating is assigned for slight, if any, exfoliation, exudation or itching, if on a nonexposed surface or small area. 38 C.F.R. § 4.118, Code 7806. The veteran's plantar keratosis is evaluated under the rating code for benign new growths of the skin. Benign growths of the skin are rated as for scars and disfigurement. 38 C.F.R. § 4.118, Code 7819. Scars that are superficial, poorly nourished, with repeated ulceration are evaluated as 10 percent disabling. 38 C.F.R. § 4.118, Code 7803. Scars that are superficial, tender, and painful on objective demonstration also merit a 10 percent evaluation. 38 C.F.R. § 4.118, Code 7804. VA hospital records dated from September 1996 to November 1996 show that the veteran was admitted for treatment of his blindness. The physical examination was positive for athlete's foot, which was treated with medicated creams. The discharge diagnoses included tinea pedis. October 1996 records from this hospitalization show that the veteran presented with a painful lesion of the left second metatarsal. On examination, there was hyperkeratosis under the second metatarsal head of the left foot, which was described as a nucleated lesion. There was also hyperkeratosis of the planter surface of the lateral fifth metatarsal. The assessments included nucleated intractable plantar keratosis of the second metatarsal head, and reduce calluses of intractable plantar keratosis. VA hospital records from May 1997 to July 1997 show that the veteran was treated for chronic obstructive pulmonary disease, and prostate disease. On examination, the veteran had onychomycosis of his nails. There was macerated interdigital space between the second, third, and fourth spaces bilaterally. He also had diffuse calluses on the plantar aspect of the left fifth metatarsal base and styloid process area on the foot, which were reduced that same day. The veteran was afforded a VA fee basis examination in October 1998. He gave a history of developing fungus infections of the feet in 1947, and a wart on his left foot in 1946. He said the wart could be provoked by stepping on something. He noted that the foot itching occurred daily, particularly on the left. He said that he tended to walk on the sides of his feet. The veteran stated that he treated his fungus with a cream. On examination, there was no generalized skin disease. There was a fungus infection of the right toenails, primarily the first, second, and fifth. For the left foot, there was insensation of the first and fifth toenails. A left plantar wart was noted. The veteran could walk unassisted. The Board finds that the criteria for an evaluation greater than 10 percent for the veteran's fungus infection of the feet is not shown by the evidence. Tinea pedis was noted and treated during a hospitalization in 1996, and onychomycosis of the nails with maceration of some of the interdigital spaces of the feet was noted in 1997. The October 1998 examination was positive primarily for a fungus infection of the feet. There is no evidence of the extensive lesions, marked disfigurement, exudation, or the constant itching required in order to receive a 30 percent evaluation. The veteran's symptomatology does not more nearly resemble that of the next highest evaluation. Therefore, entitlement to an increased evaluation for fungus infection of the feet is not warranted. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.118, Codes 7806, 7813. The Board also finds that the criteria for an evaluation greater than 10 percent for the veteran's plantar keratosis of the left foot have not been met. The evidence shows that his plantar wart is productive of pain when he steps on an object, and that reduction of the calluses associated with the wart is required on a periodic basis. However, the Board notes that the veteran is already in receipt of the highest evaluation possible under the rating codes for superficial scars that are poorly nourished, or for scars that are tender and painful on objective demonstration. 38 C.F.R. § 4.118, Codes 7803, 7804. An increased evaluation under the rating code for limitation of function of the part affected has been considered, but no limitation has been noted. The October 1998 examination states that the veteran walks without assistance. 38 C.F.R. § 4.118, Code 7805. Finally, the rating code for disfiguring scars has been considered, but this is intended for scars of the face, head, and neck. Even if it were to be applied, the wart has not been shown to be severely disfiguring. 38 C.F.R. § 4.118, Code 7800. Therefore, as the veteran is currently in receipt of the highest evaluation available under the rating codes currently in effect, and as there are no more rating codes under which the veteran's disability can properly be evaluated, entitlement to an increased evaluation is not warranted. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.118, Codes 7803, 7804, 7819. II. Hemorrhoids The veteran contends that he is entitled to a compensable evaluation for his service connected residuals of a hemorrhoidectomy. He states that he has weekly bleeding, and that additional surgery has been recommended. Entitlement to service connection for the residuals of hemorrhoids was established in a June 1953 rating decision. A zero percent evaluation was assigned for this disability. This evaluation currently remains in effect. External or internal hemorrhoids with persistent bleeding and with secondary anemia, or with fissures are evaluated as 20 percent disabling. Hemorrhoids that are large, thrombotic, irreducible, with excessive redundant tissue evidencing frequent recurrences are evaluated as 10 percent disabling. Mild or moderate hemorrhoids are evaluated as zero percent disabling. 38 C.F.R. § 4.114, Code 7336. VA hospital records from March 1997 show that the veteran had a history of hemorrhoid surgery in 1990. On examination, the veteran had normal sphincter tone. No hemorrhoids were noted. The veteran was afforded a VA fee basis examination in October 1998. He said that he developed hemorrhoids in 1947. The veteran reported undergoing six or seven hemorrhoid surgeries, with the most recent in 1992. He noted anal and rectal itching daily, and said his anus or rectum bleed once a week. His discomfort was relieved by sitz baths. He did not use hemorrhoid cream. The veteran reported being constipated, and said that he had a discharge from his anus. On rectal examination, there were no obvious hemorrhoids. There appeared to be a transverse small raphe or tag in the central anal area. There were no obvious internal hemorrhoids. There was a slightly yellowish discharge of the superior aspect of the perianal area. Above and to the left of this and just below the left sacral area, there appeared to be a fistula approximately three or four millimeters in diameter. The diagnoses included hemorrhoidectomy. It was recommended that the veteran undergo a sigmoidoscope or colonoscope to determine the source of his weekly bleeding. The Board finds that the veteran is not entitled to a compensable evaluation for the residuals of his hemorrhoidectomy. The October 1998 examination was negative for hemorrhoids. Although the veteran reported weekly bleeding, the examiner did not attribute this to hemorrhoids. There is no evidence of the large, thrombotic, or irreducible hemorrhoids with excessive tissue or with frequent recurrences required in order to receive a 10 percent evaluation. Therefore, as the criteria for an increased evaluation have not been demonstrated, entitlement to a higher evaluation is not warranted. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.114, Code 7336. ORDER Entitlement to an evaluation in excess of 10 percent for a fungus infection of the feet is denied. Entitlement to an evaluation in excess of 10 percent for plantar keratosis of the left foot is denied. Entitlement to a compensable evaluation for the residuals of a hemorrhoidectomy is denied. WAYNE M. BRAEUER Member, Board of Veterans' Appeals