Citation Nr: 0002112 Decision Date: 01/27/00 Archive Date: 02/02/00 DOCKET NO. 97-12 830 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Fort Harrison, Montana THE ISSUES 1. Entitlement to service connection for lumbar spine disorder, a left hip disorder, and a right knee disorder, on a direct and secondary basis. 2. Entitlement to service connection for sinusitis. 3. Entitlement to an effective date prior to December 26, 1995, for the grant of a 60 percent rating for a left total knee replacement. 4. Entitlement to a compensable rating for hearing loss. 5. Entitlement to an increased evaluation in excess of 60 percent for a left total knee replacement. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD James J. Dunphy, Counsel INTRODUCTION The veteran served on active duty from December 1970 to January 1971, and from April 1974 to August 1978. The veteran has forwarded a number of overlapping claims and appeals. A review of the claims folder shows that not all of these issues have been developed for appellate review. A brief synopsis of this development, with conclusions as to which issues are presently before the Board, follows. The veteran has contended that an increased rating for the service connected left knee disorder is appropriate. Initially, a 30 percent rating was in effect, based on a reduction from the 100 percent rating following left total knee replacement. A rating in excess of 30 percent was denied in a March 1996 rating action. The veteran submitted a timely Notice of Disagreement (NOD) in October 1996. In a March 1997 rating action, the evaluation for the left knee was increased from 30 to 60 percent, effective March 1, 1997. The veteran voiced disagreement with the effective date of this rating, and a statement of the case (SOC) was issued in May 1997, which granted entitlement to an early effective date to December 26, 1995. The veteran nonetheless filed a timely appeal. The veteran presented testimony at a formal hearing in July 1997, at which time one of the issues was the effective date for entitlement to an increased rating for the left knee disorder. The Board notes that the veteran did not submit a claim for a rating in excess of 60 percent, but limited his claim to the effective date of the increase. Accordingly, the issue of the effective date of the 60 percent rating for a left knee disorder is properly before the Board. However, because a timely NOD associated with the increased rating issue has been received the Board finds that additional development in this regard is warranted. The issue of entitlement to an increased rating in excess of 60 percent for a total left knee replacement is addressed in the remand portion of the decision. In that March 1996 rating action, the RO also denied service connection for osteoarthritis of the lumbar spine, the left shoulder, the hands, and the right knee, both on a direct basis and secondary to the service connected left knee disorder. In October 1996, the veteran submitted an NOD for "osteoarthritis, especially in lumbosacral spine." A SOC was issued in March 1997, and a supplemental statement of the case (SSOC) was issued in May 1997 on the issues noted in the March 1996 rating action. The substantive appeal on these issues was received in March 1997. At the July 1997 hearing, the veteran withdrew the issues of entitlement to service connection for a left shoulder disorder and a disorder of the hands. In March 1998, the veteran submitted a claim for service connection for a lumbar disorder on a direct basis. An SOC on this claim was issued in November 1998. The RO annotated a November 1998 letter from the veteran to the extent that the claim for service connection for a back disorder was on appeal. The Board notes that the original March 1996 rating action considered the issue of service connection for arthritis of multiple joints on both a direct and secondary basis, and the veteran was furnished with appropriate laws and regulations and reasons and bases with regard to these claims. The veteran has not withdrawn his claim for service connection for these disorders. Therefore, notwithstanding the fact that the veteran limited his claim in March 1998 to only the back disorder on a direct basis, the Board will consider the issue of service connection for osteoarthritis of the lumbar spine and the right knee on a direct basis and a secondary basis. The veteran submitted a claim for an increased rating for hearing loss and for service connection for a stomach disorder in October 1996. In March 1997, these claims were denied by the RO. The veteran submitted a timely NOD in March 1997, and a SOC was issued in May 1997. The veteran provided a substantive appeal in June 1997, along with testimony at the July 1997 hearing. Subsequent to the hearing, the hearing officer granted service connection for the stomach disorder and assigned a 10 percent rating. An increased rating for hearing loss was again denied. The veteran has not voiced disagreement with the rating for the stomach disorder; accordingly, the Board finds that this issue has not been developed for appellate review. In April 1997, the veteran claimed that his service connected disabilities prevented him from all forms of substantially gainful employment. He submitted a formal claim for a total rating in May 1997, and his claim was denied in a January 1998 rating action. No NOD was forthcoming from this rating action. In the absence of an NOD, the Board finds that a total rating, due to unemployability, is not for Board consideration. In March 1997, the veteran contended that service connection for a left hip disorder on a secondary basis was warranted. The RO denied this claim in a January 1998 rating action, and, as a timely NOD and substantive appeal was forthcoming, the Board concludes that this issue is before the Board for review. Finally, in March 1998, the veteran submitted a claim for service connection for sinusitis. This claim was denied by the RO in November 1998, and appropriate development, to include a timely NOD, SOC and substantive appeal took place. Accordingly, this claim is likewise before the Board for review. After the preceding review, the Board concludes that the issues noted on the title page have been developed for appellate review and are properly before the Board. FINDINGS OF FACT 1. The medical evidence does not suggest a nexus between any current lumbar spine disorder, left hip disorder, and right knee disorder and any incidents of service, nor does it establish an etiological relationship between the aforementioned disorders and the service-connected left knee disorder. 2. The veteran has not provided medical evidence indicating a nexus between his sinusitis and incidents of service. 3. Regarding the left knee, from December 1993 to December 26, 1995, flexion was not limited to 15 degrees, nor was extension limited to 20 degrees, and there was no more than moderate recurrent subluxation and lateral instability. It is not factually ascertainable that the veteran's left knee disability increased in severity to warrant a rating to 60 percent prior to December 26, 1995. 4. The veteran's average puretone threshold level is 36 on the right and 37 on the left with speech discrimination to 96 on the right and 94 on the left. The veteran has Level I hearing, bilaterally. CONCLUSIONS OF LAW 1. The veteran's lumbar spine disorder, right knee disorder, and left hip disorder are neither related to service, nor proximately due to or the result of a disorder of service origin. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.310 (1999). 2. The claim of entitlement to service connection for sinusitis is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.159(a) (1999). 3. Entitlement to an effective date prior to December 26, 1995, for the grant of a 60 percent rating for a left total knee replacement is not warranted. 38 U.S.C.A. §§ 5107, 5110 (West 1991); 38 C.F.R. § 3.400(o), (r) (1999). 4. The criteria for a compensable rating for hearing loss are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.85, Diagnostic Code 6100 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Entitlement to service connection for a lumbar spine disorder, a right knee disorder, and a left hip disorder Law and Regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptoms after service is required for service connection. 38 C.F.R § 3.303(b) (1999). As in any service connection claim, the threshold question that must be resolved is whether the veteran's claim of entitlement to service connection is well grounded; that is, whether it is plausible, meritorious on its own, or otherwise capable of substantiation. See Chelte v. Brown, 10 Vet. App. 268, 270 (1997) (citing 38 U.S.C.A. § 5107(a) and Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990)). If the claim is not well grounded, the appeal fails and there is no further duty to assist in developing the facts pertinent to the claim. See Anderson v. Brown, 9 Vet. App. 542, 546 (1996); see also Epps v. Gober, 126 F.3d 1464, 1468-69 (Fed. Cir. 1997). In order for a claim to be well grounded, there must be competent evidence of a current disability (a medical diagnosis); evidence of incurrence or aggravation of a disease or injury in service (lay or medical evidence); and evidence of a nexus between the inservice disease or injury and the current disability (medical evidence). See Caluza v. Brown, 7 Vet. App. 498, 506 (1995). Where the determinant issue involves a question of a medical diagnosis or causation, competent medical evidence is necessary to establish a well-grounded claim. See Epps, supra (citing Caluza, supra, and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993)). Lay assertion of medical causation or a medical diagnosis cannot constitute evidence to render a claim well grounded. Grottveit, supra; Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Service connection on a secondary basis is warranted when it is demonstrated that a disorder is proximately due to or the result of a disorder of service origin. 38 C.F.R. § 3.310. Additionally, when aggravation of a veteran's non-service- connected condition is proximately due to or the result of a service-connected condition, the veteran shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). When a well grounded claim has been submitted and when all of the evidence is assembled, VA is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Facts and Analysis Initially, for the lumbar spine, right knee and left hip, the Board notes that the veteran's claims are well grounded. By this, the Board means that the claims are plausible. The Board further concludes that the VA has met its statutory duty to assist the veteran in the development of those claims. 38 U.S.C.A. § 5107. The Board notes that the veteran was scheduled for an examination of the joints and the spine in August 1998. However, the veteran failed to report for examination. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (The duty to assist is not always a one-way street. If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence). When a veteran fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. 38 C.F.R. § 3.655(b) (1999). Hence, the Board is limited to considering the evidence of record. At the outset, it is noted that on a direct basis, service connection for a lumbar disorder, left hip disorder, and right knee disorder cannot be established. In this case, there is no evidence of a lumbar disorder, left hip disorder, or a right knee disorder during the veteran's brief period of active duty and osteoarthritis of the lumbar spine or right knee were not shown until many years after service. Additionally, while these disorders are currently shown, as noted by Dr. W.'s June 1997 statement, the veteran has not provided any medical evidence demonstrating a nexus between these conditions and incidents of service. As the veteran is not a medical professional, any statements in that regard, to include his testimony at the July 1997 hearing, unsupported by medical evidence, cannot render the claim plausible. See Grottveit and Espiritu. Thus, service connection on a direct basis is not warranted. Nevertheless, the veteran also alleges that his low back, left hip, and right knee disorders became manifest as secondary to his service-connected left knee disorder. In this regard it is noted that service connection is in effect for a total left knee replacement. The veteran now contends that he has an abnormal gait as a result of the service- connected disability of the left knee, which has resulted in the disorders at issue. In support of this claim, the Board notes the findings on a VA compensation examination of the joints in July 1988 in which the examiner stated that the veteran would have incurred right knee problems even if his left knee was okay. The examiner added because of the left knee difficulty, the right knee symptoms appeared earlier than they would have otherwise and were more bothersome than they would have been if the left knee was okay. The findings on VA examination in December 1996 are also noted. At that time, the veteran reported some discomfort in his right knee due to an abnormal gait, but denied any pain in the left hip. The examiner noted an abnormal gait secondary to left knee instability, and also noted that the veteran had a flat footed gait of the left foot. It was concluded that these conditions were probably going to create problems with the hip at some other point in time, in addition to the right knee stress that would probably occur. Also of record is a statement from A. M. W., M.D., dated in June 1997. Dr. W. concluded that on a more probable basis that the veteran's remote trauma with subsequent multiple surgeries and eventual left total knee arthroplasty put greater stress on the contralateral right knee as well as his low back to accommodate for a chronic painful gait. Dr. W. further concluded that the veteran had lumbar disc disease and mild right knee arthritis, and that these conditions may have been contributed to by the chronic left knee condition. The veteran, in his July 1997 hearing, also provided testimony arguing that there was a relationship between the service-connected left knee disorder and the disorders at issue. Balanced against these conclusions are the findings of B. M. I., M.D., who conducted a compensation examination for the VA in May 1997. The impression after examination included minimal left hip pain, of questionable etiology and right knee pain, probably related to biceps tendonitis. Dr. I. found that the veteran's complaints of pain in the left hip were not substantiated by any physical findings, as X-ray films were normal, and the veteran retained normal range of motion. Biomechanicially, it would be difficult to relate an etiology for the left hip pain based on the left knee problem. This conclusion was made based on a six month history given by the veteran of left hip pain, during a time when the left knee had been non painful. The veteran also gave a 20-year history of right knee pain, and stated that the amount of the right knee pain has not been changed after the left total knee replacement. Therefore, Dr. I. did not think that the source of the veteran's right knee discomfort had any relationship to the problems that he had experienced in the left knee. In particular, the veteran did not have any evidence of regeneration, instability, loss of motion, or other factors such as synovitis that were apparent on examination and that might indicate any long term over use or abuse of the right knee. Finally, Dr. I. noted that the veteran mentioned low back problems as being flared by his problems with the left knee. However, he found that because the left knee was functioning non painfully and serviceably, it would be difficult to see how any problem in the low back could be affected by the veteran's successful left knee replacement procedure. Here, although the evidence indicates that a lumbar disorder, a right knee disorder, and a left hip disorder are currently present, for service connection to be granted on a secondary basis, it must be shown that there is an etiological relationship between these disorders and the service- connected left knee disorder. In resolving this issue, the Board notes the conclusions reached by Dr. I. in May 1997. At that time, Dr. I. found it difficult to relate any left hip pain to the left knee disorder, particularly when the left hip pain arose at a time that the left knee was not painful. Such a statement must carry more probative weight than the conclusions reached in December 1996 VA examination, which were tentative in nature and made reference to possible future conditions. Regarding the right knee, the findings on examinations in 1988, 1997, and 1996 are once again acknowledged. However, Dr. I., after reviewing the veteran's medical history, also made reference to specific findings, such as the lack of regeneration, instability, or synovitis in concluding that the right knee disorder was not caused by the left knee disorder. Thus the Board must give Dr. I.'s statement, couched in a definite manner and supported by medical evidence, greater probative weight that conclusions reached by the VA examiner in 1988 and Dr. W. in June 1997. Also, Dr. W. could only conclude that the left knee disorder may have contributed to the right knee condition, not that there was positively the required etiological relationship. Moreover, the conclusions reached after the December 1996 VA compensation examination only address possible future conditions, and only suggests a conclusion that there is a present etiological relationship. Finally, regarding the low back, the Board notes that Dr. I. concluded that, as the left knee was functionally serviceably, it would be difficult to see how any problem in the low back could be affected by the successful left knee procedure. Again, this must be granted greater probative weight than the tentative conclusion reached by Dr. W. in June 1997. In view of the foregoing, the Board concludes that the preponderance of the evidence is against a conclusion that there is an etiological relationship between a lumbar spine disorder, a right knee disorder, or a left hip disorder and service and the veteran's service-connected left knee disorder, and the evidence is not in equipoise. Therefore, the claims are denied. Gilbert, 1 Vet. App. 49; 38 C.F.R. § 3.310. Entitlement to service connection for sinusitis Regarding sinusitis, the evidence shows that the veteran's claim is not well grounded. A review of the veteran's outpatient treatment records shows that when he was treated at a VA facility in February 1996, the veteran reported chest congestion and coughing, and was to have a sinus drainage. The diagnostic impression was bronchitis. In January 1997, he reported a terrible sinus infection on the right side. He was very tender over the right maxillary sinus, and the diagnostic impression was acute right maxillary sinusitis. The Board therefore concludes that there is medical evidence of a current sinus condition. However, as noted above, the presence of a current disorder is not sufficient to render a claim well grounded. Evidence of the presence of the disorder in service, along with medical evidence of a nexus between the current disorder and the incidents of service must also be presented. A review of the veteran's service medical records indicates that the veteran complained in service in July 1976 of sinus pain. However, even though no sinusitis was shown on examination, for the purposes of determining if the veteran's claim for service connection is well grounded, the Board will accept these complaints as a manifestation of sinusitis in service. Despite the foregoing, the veteran must still provide medical evidence establishing a nexus between the current symptomatology and the incidents of service. It is on this basis that the veteran's claim fails, and must be denied. The evidence shows that no sinusitis was reported on the veteran's examination in June 1978, shortly before discharge, and, when the veteran was examined by the service department in May 1979, subsequent to the second period of service, clinical evaluation of the nose and sinuses was normal. At that time, the veteran did not report any ear, nose or throat problems. In addition, recent reports of treatment for sinusitis do not in any way address the issue of etiology. Therefore, the Board is left with the veteran's contentions, to include his hearing testimony, unsupported by medical evidence, that the current sinusitis is related to service. As the veteran is not a medical professional, his statements, standing alone, cannot render the claim well grounded. See Grottveit and Espiritu. In the absence of a well-grounded claim, the veteran's appeal must be denied. Entitlement to an earlier effective date for the grant of a 60 percent rating for a left total knee replacement The veteran contends that the effective date should be January 5, 1992, the date the veteran began the regimen of treatment for the left knee disorder that eventually led to the total knee replacement. A review of the veteran's claims folder indicates that he submitted a claim for a rating in excess of 20 percent for a left knee disorder in December 1993. In an October 1995 rating action, the claim was denied, and the 20 percent rating continued. In a November 1995 letter from his representative, the veteran indicated that he was to enter a VA hospital for a left total knee replacement. The records show that he was admitted to a VA facility in December 1995, and that during this period of hospitalization, he underwent a total knee replacement. Accordingly, in a March 1996 rating action, he was awarded a 100 percent rating for the left total knee replacement, and this evaluation remained in place until March 1997. This rating was schedular in nature, under Diagnostic Code 5055, and was not a temporary total rating based on convalescence or hospitalization. In March 1997, the rating for the left knee disorder was to be reduced to 30 percent. In a March 1997 rating action, the evaluation for the left knee total replacement was increased to 60 percent, effective in March 1997. Hence, the veteran's rating for the left knee disorder was at 60 percent or higher from December 16, 1995. The current rating is based on the provisions of Diagnostic Code 5055, which refers to a total knee replacement. Prior to the December 1995 hospitalization, the veteran was rated under the provisions of Diagnostic Code 5257. The veteran claims that the effective date of the current rating should be in January 1992, when he began treatment. However, there is no basis for extending the current rating, which is based on a left total knee replacement, earlier that the date of the actual total knee replacement. Hence, an effective date earlier than December 26, 1995, for the 60 percent rating under Diagnostic Code 5055 is not appropriate. In spite of the foregoing, the Board finds that the November 1995 letter from the veteran's representative, received shortly after the denial of an increased rating, may be considered an NOD from the October 1995 rating. As such, the Board will consider if an increased rating under the provisions of appropriate Diagnostic Codes would have been appropriate for the period from December 1993, when he submitted his claim, to December 26, 1995, when he entered the hospital for a left total knee replacement. Within that period, the veteran was examined for compensation purposes for the VA in January 1995. At that time, range of motion of the knees was normal. For a rating in excess of 20 percent for the left knee to be appropriate, flexion must be limited to 15 degrees, with extension limited to 20 degrees. 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5261. Here, the requisite criteria are not met. Also, examination of the left knee revealed no effusion, with only moderate subpatellar crepitation during extension. There was only slight to moderate laxity of the medial collateral ligament and anterior cruciate ligament of the left knee. The Board notes that a 30 percent rating would be predicated on severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The findings on examination do not support such a conclusion. Moreover, clinical findings on outpatient treatment also fail to show that entitlement to an increased evaluation was warranted. Accordingly, the medical evidence associated with the veteran's left knee disorder does not support a rating in excess of 20 percent for the period from when he submitted a claim in December 1993 to when he entered the hospital in December 1995. Given the foregoing, the evidence shows that entitlement to an effective date prior to December 26, 1995, is not warranted. VA law and regulation provides that the effective date for an increased rating shall be the date of receipt of the claim or the date entitlement arose, whichever is later, except as is provided in 3.400(o)(2) (1999). 38 C.F.R. § 3.400(o)(1). Pursuant to 3.400(o)(2), the effective date for disability compensation shall be the earliest date as of which is factually ascertainable that an increase in disability had occurred if the claim was received within one year from such date, otherwise the date of receipt of the claim. The effective date for a grant based on a reopened claim or on new and material evidence is the date of receipt of claim or date entitlement arose, whichever is later. 38 C.F.R. § 3.400(r). Here, as demonstrated above, it was not factually ascertainable that an increase in disability occurred prior to December 26, 1995. Again, for the reasons discussed above, the medical evidence associated with the veteran's left knee disorder does not support a rating in excess of 20 percent for the period from when he submitted a claim in December 1993 to when he entered the hospital in December 1995. Since the increase in disability was not factually ascertainable prior to December 26, 1995, the Board finds that the effective date of December 26, 1995, is the earliest date allowable by law and that entitlement to an earlier effective date is not warranted. Harper v. Brown, 10 Vet. App. 125, 126 (1997). Accordingly, the Board finds that there is no legal basis on which an effective date earlier than December 26, 1995, can be assigned. Shields v. Brown, 8 Vet. App. 346, 351 (1995); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Entitlement to an increased rating for hearing loss Initially, the Board finds that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a). See Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). By this finding, the Board means that the veteran has presented a claim which is not implausible when the contentions and the evidence of record are viewed in the light most favorable to the claim. The Board is also satisfied that all relevant facts have been properly and sufficiently developed. Under the laws administered by the VA, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Where entitlement to compensation has already been established and an increase in the disability evaluation is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Evaluations of bilateral defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests together with the average hearing threshold level as measured by pure tone audiometry tests in the frequencies 1,000, 2,000, 3,000 and 4,000 cycles per second. To evaluate the degree of disability from defective hearing, the revised rating schedule establishes eleven auditory acuity levels from level I for essentially normal acuity through level XI for profound deafness. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. § 4.85 and Part 4, Codes 6100 to 6110. The provisions of 38 C.F.R. § 4.86 were recently revised. Under the new provisions, when the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Each ear will be evaluated separately. Where the puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. On the authorized VA audiological evaluation in December 1996, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 15 60 95 LEFT 10 10 70 90 Thresholds averaged 45 decibels in the right ear and 45 decibels in the left ear. Speech audiometry revealed speech recognition ability of 94 percent in the right ear and of 94 percent in the left ear. The veteran underwent a private audiometric examination in December 1997. At that time, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 20 50 85 LEFT 25 20 65 90 Thresholds averaged 43 decibels in the right ear and 50 decibels in the left ear. Speech audiometry revealed speech recognition ability of 100 percent in the right ear and of 92 percent in the left ear. The veteran underwent an additional VA compensation examination in August 1998. At that time, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 10 50 80 LEFT 5 5 60 80 Thresholds averaged 36 decibels in the right ear and 37 decibels in the left ear. Speech audiometry revealed speech recognition ability of 96 percent in the right ear and of 94 percent in the left ear. Utilizing first the provisions of Table VI, under all three audiometric evaluations, the veteran's hearing acuity would be considered Level I in the right ear, and Level I in the left ear. Under the provisions of 38 C.F.R. § 4.85, Code 6100, the veteran's hearing acuity would be rated as zero percent disability, and hence these provisions do not establish a basis for an increased rating. As noted, the Board must also consider the criteria in Table VIA. Under this table, the veteran's hearing acuity would be rated as Level II in each ear on the 1996 VA compensation examination, as Level II in the right ear and Level III in the left ear on the private medical evaluation, and as Level I in each ear on the most recent VA compensation examination. While the levels may be higher than under Table VII, the provisions of Diagnostic Code 6100 do not support a compensable rating. As the criteria for a compensable rating under either set of criteria are not met, an increased rating for hearing loss is not appropriate, and the veteran's appeal must be denied. In reaching the above decision, the Board has given due consideration to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Board finds that these provisions do not support the grant of an increased rating for the disorder at question. ORDER Service connection for a lumbar spine disorder, left hip disorder, or a right knee disorder, on either a direct or secondary basis, is denied. Service connection for sinusitis is denied. Entitlement to an effective date prior to December 26, 1995, for the grant of a 60 percent rating for a left total knee replacement, is denied. An increased rating for bilateral hearing loss is denied. REMAND In March 1996, the RO denied entitlement to an increased rating in excess of 60 percent for a total left knee replacement. In October 1996, the veteran disagreed with that evaluation. Given the foregoing, the Board finds that the veteran has filed timely notice of disagreement with the March 1996 rating determination. Because the veteran has submitted communication which is construed as a timely NOD with the RO determination dated in March 1996, see 38 U.S.C.A. § 7105 (West 1991); 38 C.F.R. § 20.201 (1999), the Board finds that a statement of the case with respect to the claim should be issued. See 38 C.F.R. §§ 19.9, 20.200, 20.201 (1999); see also Garlejo v. Brown, 10 Vet. App. 229 (1997). In order to extend to the veteran every equitable consideration and to ensure that his due process rights are fulfilled, this case is REMANDED for the following: Regarding entitlement to an increased rating in excess of 60 percent for a total left knee replacement, the RO should review all the relevant evidence submitted and, if appropriate, accomplish any additional development deemed necessary. Thereafter, the RO should readjudicate the claim. If the claims remain in a denied status, the RO should issue a statement of the case to the veteran and his representative and advise them of the applicable time in which a substantive appeal may be filed. Thereafter, if an appeal has been perfected, the case should be returned to the Board. The case should then be returned to the Board, if in order, after compliance with customary appellate procedures. No action is required of the veteran until he is so informed. The Board intimates no opinion as to the final outcome of this case, pending completion of the requested development. The veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board or by the Court for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1998) (Historical and Statutory Notes). In addition, VBA's ADJUDICATION PROCEDURE MANUAL, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21- 1, Part IV, paras. 8.44-8.45 and 38.02-38.03. C. Crawford Acting Member, Board of Veterans' Appeals