BVA9505704 DOCKET NO. 91-21 781 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUES 1. Entitlement to service connection for diverticulitis. 2. Entitlement to service connection for spastic colitis. 3. Entitlement to service connection for lumbosacral strain with arthritis. 4. Entitlement to service connection for shortening of the right leg. 5. Entitlement to service connection for residuals of a fracture of the coccyx. 6. Entitlement to service connection for disorders of the right hip, knee, and ankle. 7. Entitlement to service connection for varicosities of the left lower extremity with claimed vascular stress. 8. Entitlement to service connection for edema. 9. Entitlement to service connection for sinusitis with a cyst. 10. Entitlement to service connection for tonsillitis. 11. Entitlement to service connection for an umbilical disorder. 12. Entitlement to service connection for spina bifida occulta. 13. Entitlement to service connection for otitis media. 14. Entitlement to service connection for tight heel cords. 15. Entitlement to service connection for a left knee disorder. 16. Entitlement to service connection for a left ankle disorder. 17. Entitlement to service connection for structural stress. 18. Entitlement to an increased evaluation for a scar, pilonidal cyst, currently evaluated as 10 percent disabling. 19. Entitlement to an increased evaluation for bilateral pes planus with pes cavus deformity, currently evaluated as 10 percent disabling. 20. Entitlement to an increased (compensable) evaluation for hemorrhoids. 21. Entitlement to an effective date, prior to July 25, 1989, for a grant of a 10 percent evaluation for a scar, pilonidal cyst. 22. Entitlement to an effective date, prior to July 25, 1989, for a grant of an increased (compensable) evaluation of 10 percent for bilateral pes planus with pes cavus deformity. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD Ronald R. Bosch, Counsel INTRODUCTION The veteran served on active duty from April 1951 to April 1955. This appeal arose from an October 1989 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia. The RO denied entitlement to increased (compensable) evaluations for hemorrhoids, recurrent pilonidal cyst, and pes planus. The above determination was affirmed by the RO in July, August, and September 1990. In a rating decision issued in February 1991, the RO granted increased (compensable) evaluations of 10 percent respectively for a pilonidal cyst scar and the service-connected foot disability reclassified as bilateral pes planus with pes cavus deformity effective July 25, 1989; and denied entitlement to service connection for diverticulitis, spastic colitis, and lumbosacral strain secondary to the service-connected disabilities. The Board of Veterans' Appeals (Board) REMANDED the case to the RO for further development in December 1991. In a March 1992 rating decision, the RO affirmed the determinations previously entered; denied entitlement to service connection for tonsillitis, sinusitis with a cyst, edema, otitis media, an umbilical disorder, scar of the spine, arthritis of the spine with loss of motion and stress, vascular stress, shortening of the right leg, a right hip disorder, a right knee disorder, a right ankle disorder, fracture of the coccyx, and tight heel cords; and denied entitlement to an effective date, prior to July 25, 1989, for grants of increased evaluations for a pilonidal cyst scar and bilateral pes planus with pes cavus deformity. The RO affirmed the prior denials of entitlement to increased evaluations for service-connected disabilities and denied entitlement to service connection for structural stress and disorders of the left knee and ankle when it issued a rating decision in September 1992. The RO affirmed the prior denials of entitlement to service connection for shortening of the right leg, back disorder, and an increased evaluation for pes planus with pes cavus deformity when it issued a rating decision in January 1993. The case has been returned to the Board for final appellate review. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he has diverticulitis, spastic colitis, lumbosacral strain with arthritis, shortening of the right leg, residuals of a fracture of the coccyx, a right hip disorder, bilateral knee disorders, bilateral ankle disorders, varicosities of the left lower extremity with claimed vascular stress, edema, sinusitis with a cyst, tonsillitis, an umbilical disorder, spina bifida occulta, otitis media, tight heel cords, and structural stress either directly as the result of his active service or secondary to surgery in service for a pilonidal cyst or surgery for his hemorrhoids. He argues that the medical evidence of record shows a correlation between most of his disabilities and the surgeries he underwent in service for disabilities for which service connection was ultimately granted. The veteran avers that his pilonidal cyst scar, bilateral pes planus with pes cavus deformity, and hemorrhoids are more disabling than currently evaluated, thereby warranting entitlement to increased evaluations. The claimant argues that his pilonidal cyst scar and bilateral pes planus with pes cavus deformity were already compensably disabling for many years well in advance of July 25, 1989, when the RO made the grants of 10 percent evaluations effective. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the veteran has not submitted evidence of well grounded claims for service connection for diverticulitis, spastic colitis, lumbosacral strain with arthritis, shortening of the right leg, residuals of a fracture of the coccyx, a right hip disorder, bilateral knee disorders, bilateral ankle disorders, varicosities of the left lower extremity with claimed vascular stress, edema, sinusitis with a cyst, tonsillitis, umbilical disorder, otitis media, tight heel cords, and structural stress; that the record supports a grant of an increased evaluation of 30 percent for bilateral pes planus with pes cavus deformity, and a grant of an effective date retroactive to December 15, 1988 for assignment of an increased (compensable) evaluation of 10 percent for bilateral pes planus with pes cavus deformity; and that the preponderance of the evidence is against grants of service connection for spina bifida occulta, increased evaluations for a pilonidal cyst scar and hemorrhoids, and an effective date, prior to July 25, 1989, for assignment of an increased (compensable) evaluation of 10 percent for a pilonidal cyst scar. FINDINGS OF FACT 1. The claims for service connection for diverticulitis, spastic colitis, lumbosacral strain with arthritis, shortening of the right leg, residuals of a fracture of the coccyx, a right hip disorder, bilateral knee disorder, bilateral ankle disorder, varicosities of the left lower extremity with claimed vascular stress, edema, sinusitis with a cyst, tonsillitis, an umbilical disorder, otitis media, tight heel cords, and structural stress are not supported by cognizable evidence showing that the claims are plausible or capable or substantiation. 2. Spina bifida occulta is not recognized as a disability under the law. 3. The pilonidal cyst scar is productive of impairment compatible with not more than poor nourishment, repeated ulceration, tenderness and pain on objective demonstration, and no limitation on function of the anatomical part affected. 4. Bilateral pes planus with pes cavus deformity is productive of not more than severe impairment. 5. Hemorrhoids are not more than mildly or moderately disabling. 6. The veteran filed a claim for increased evaluations for his service-connected disabilities on September 14, 1989. 7. VA outpatient treatment reports show the veteran was found to have pes cavus of the feet with possible neuroma at the second interspace on December 15, 1988. 8. VA outpatient treatment reports show that it was not until July 25, 1989, that the veteran was seen with complaints and findings of symptomatology related to his pilonidal cyst scarring. CONCLUSIONS OF LAW 1. The claims for service connection for diverticulitis, spastic colitis, lumbosacral strain with arthritis, shortening of the right leg, residuals of a fracture of the coccyx, a right hip disorder, bilateral knee disorder, bilateral ankle disorder, varicosities of the left lower extremity with claimed vascular stress, edema, sinusitis with a cyst, tonsillitis, an umbilical disorder, otitis media, tight heel cords, and structural stress are not well grounded. 38 U.S.C.A. § 5107 (West 1991). 2. Spina bifida occulta was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303(c) (1994). 3. An evaluation in excess of 10 percent for a scar, pilonidal cyst, is not warranted. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.40, 4.118, Diagnostic Codes 7803, 7804, 7805. 4. The criteria for an increased evaluation of 30 percent for bilateral pes cavus with pes cavus deformity have been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.71(a), Diagnostic Codes 5276-5278. 5. The criteria for an increased (compensable) evaluation for hemorrhoids have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.114, Diagnostic Code 7336. 6. The requirements for an effective date, prior to July 25, 1989, for a grant of an increased (compensable) evaluation of 10 percent for a scar, pilonidal cyst, have not been met. 38 U.S.C.A. §§ 1155, 5107, 5110(b)(2); 38 C.F.R. §§ 3.321(b)(1), 3.400, 4.7, 4.31, 4.118, Diagnostic Codes 7803, 7804, 7805. 7. The requirements for an effective date, retroactive to December 15, 1988, for a grant of an increased (compensable) evaluation of 10 percent for bilateral pes planus with pes cavus deformity have been met. 38 U.S.C.A. §§ 1155, 5107, 5110(b)(2); 38 C.F.R. §§ 3.321(b)(1), 3.400, 4.7, 4.71(a), Diagnostic Codes 5276, 5278. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Entitlement to service connection for diverticulitis, spastic colitis, lumbosacral strain with arthritis, shortening of the right leg, residuals of a fracture of the coccyx, a right hip disorder, a bilateral knee disorder, a bilateral ankle disorder, varicosities of the left lower extremity with claimed vascular stress, edema, tonsillitis, an umbilical disorder, otitis media, tight heel cords, and structural stress. Section 5107 of Title 38, United States Code unequivocally places an initial burden upon the claimant to produce evidence that his claims are well grounded; that is, that the claims are plausible. Grivois v. Brown, 6 Vet.App. 136, 139 (1994); Grottveit v. Brown, 5 Vet.App. 91, 92 (1993). Because the veteran has failed to meet this burden, the Board finds that his claims for diverticulitis, spastic colitis, lumbosacral strain with arthritis, shortening of the right leg, residuals of a fracture of the coccyx, a right hip disorder, a bilateral knee disorder, a bilateral ankle disorder, varicosities of the left lower extremity with claimed vascular stress, edema, sinusitis with a cyst, tonsillitis, an umbilical disorder, otitis media, tight heel cords, and structural stress are not well grounded and should be dismissed. Service connection may be granted for any disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5107. Service connection may be granted for any disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Where the determinative issues involve causation or a medical diagnosis, competent medical evidence to the effect that the claims are possible or plausible is required. Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). The claimant does not meet this burden by merely presenting his lay opinion because he is not a medical health professional and does not constitute competent medical authority. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Consequently, his lay assertions cannot constitute cognizable evidence, and as cognizable evidence is necessary for well grounded claims, Tirpak v. Derwinski, 2 Vet.App. 609, 611 (1992), the absence of cognizable evidence renders the veteran's claims not well grounded. The veteran has endeavored to persuade the Board in hearing testimony, statements on appeal, and with excerpts from medical texts that he has numerous disorders either directly related to service or secondary to service surgery for his pilonidal cyst scar and hemorrhoids. He has directed the Board's attention to VA as well as non-VA medical documentation of record in support of his claims for service connection for his many disabilities either on a direct or secondary basis. The Board's evaluation of the evidentiary record does not permit a conclusion that the veteran has any of the multiple disorders he claims either on the basis of his active service or as secondary to surgery in service for his service-connected pilonidal cyst scar and hemorrhoids. Despite the veteran's efforts, the Board has found no competent medical evidence of record relating any of the numerous disorders which are the subjects of this part of the veteran's appeal to his service or to his service-connected disabilities on any basis including surgery performing during service forty years previously. In the following paragraphs the Board will give a summary of the pertinent medical evidence of record and explain why the veteran has not submitted evidence of well grounded claims for multiple disorders either on a direct or secondary basis, and why such claims must be dismissed. The Board observes that the service medical records contain no evidence or findings of diverticulitis, spastic colitis, lumbosacral strain with arthritis, shortening of the right leg, residuals of a fracture of the coccyx, a right hip disorder, a bilateral knee disorder, a bilateral ankle disorder, varicosities of the left lower extremity with claimed vascular stress, tight heel cords, and structural stress. In January 1953 the veteran reported with complaints of symptomatology including rhinorrhea, cough, sputum, post-nasal drip, dysphagia, and fever. He reported a long history of frontal sinusitis. He was examined and diagnosed with acute pharyngo-tonsillitis. His symptoms resolved and there was no further mention of tonsillitis in the service medical records including the report of examination for separation from service. Sinusitis was not found on examination. The post service medical evidence of record is negative for any findings of tonsillitis. Sinusitis with a cyst reported initially in 1989 cannot be related to service on any basis as the service medical records are negative for any finding of sinusitis other than on the basis of history as noted above. A February 1952 clinical note shows that drainage from the umbilicus had ceased. There were no symptoms referable to balanitis and healing there was complete. In June 1952 it was reported that there had been no drainage from the veteran's umbilicus for the past four months. His only complaint was of a vague sensation of nausea of one month's duration. His appetite was fair. There had been no weight loss. The abdomen was perfectly soft without spasm, tenderness or masses. The umbilicus was clean. The appellant was advised to return if his symptom of nausea had not disappeared. In June 1952 the veteran was seen with complaints of epigastric pain and requested to be relieved of kitchen police duties. There was no umbilical pain, drainage or soreness. A clinical examination of the umbilicus was negative for any abnormalities. The diagnostic impression was no evidence of umbilical infection. An April 1953 clinical note shows the examiner could feel no umbilical mass. In October 1953 there was a furuncle on the umbilicus. The March 1955 separation examination report was negative for any umbilicus abnormality. A review of the post service medical evidence, VA and non-VA, discloses that it is negative for a demonstration of a chronic acquired disorder of the umbilicus. In October 1953 the veteran was treated for edema of the little finger of the left hand. There were no further references to edema of the little finger in service. The post service evidence of record shows the veteran has no chronic acquired disorder of his little finger manifested by edema. While edema has been reported, such edema has been associated with clinical situations unrelated to service or to service connected disabilities. The claimant was treated for mild external otitis of the left ear in December 1954. There are no further references to this disorder in the service medical records including the separation examination report. The post service medical evidence of record is negative for external otitis. The March 1955 report of examination for separation from active service notes a 6 inch surgical scar in the coccygeal region. The was also noted a history of pilonidal cystectomy in 1948, 1949, and 1951. When examined by VA in March 1968 the veteran reported complaints of bilateral knee pain on occasion and swelling. An orthopedic disorder of the knees was not found. The 1968 VA examination is negative for any findings of the multiple disorders at issue. A VA hospital summary pertaining to an admission of the veteran in February and March 1984 show a discharge diagnosis of lower gastrointestinal bleeding, cause not determined; probable colonic diverticulosis or telangiectasis. A September 1989 VA hospital summary report includes discharge diagnoses of diverticular disease of the colon, myochronic spastic colitis, and chronic low back pain syndrome. Spastic colitis, and dependent edema syndrome were included as discharge diagnoses when the veteran was hospitalized by VA in March 1990. A May 1990 VA podiatry treatment report shows the veteran complained of symptomatology including left ankle pain. A September 1990 VA outpatient treatment report noted scarring in the sacrococcygeal area. A March 1991 VA consultation report noted low back pain probably secondary to pilonidal cyst. An April 1991 VA radiographic study of the left knee disclosed degenerative changes. An October 1991 private medical statement shows the veteran sustained a fracture of the coccyx. Correspondence pertaining to its treatment dated in November 1991 is on file. Correspondence and diagnostic reports from non-VA health care professionals dated in 1991 show the veteran was reported to have degenerative disc disease of the lumbar spine, degenerative arthritis of multiple joints including the lumbar spine, and spinal stenosis to account for bilateral leg pain. A January 1992 VA outpatient treatment report shows that during the previous December the veteran was found to have a 2 centimeter leg length discrepancy. A November 1992 VA examination concluded in a finding of no evidence of leg length discrepancy. The Board's analysis of the evidence of record does not permit the conclusion that the multiple disorders for which compensation benefits are claimed are related to service or to service- connected disabilities. As the Board noted earlier in its discussion of the service medical records, edema, tonsillitis, otitis media, and an umbilical disorder were disorders which were treated and resolved without any residual disability. The post service medical record is negative for any of these disorders. Shortening of the right leg has not been shown to exist. Chronic disorders of the right hip, knees, and ankles were not shown in service and clinical evidence suggesting or noting the presence of disorders in these anatomic areas was initially reported many years after service with no competent medical evidence relating any such disorders to service-connected disabilities. A chronic acquired disorder manifested by structural stress is not shown by the evidence of record. Varicosities of the left leg were not shown in service but first reported in 1989, many years after service. A chronic disorder manifested by tight heel cords was not shown in service nor is one demonstrated by the evidence of record. The multiple disorders discussed in this part of the adjudication of the veteran's appeal were shown in service and resolved without residuals disability, were not shown in service but initially reported many years thereafter, or are not shown by the evidence of record. The Board finds that there is no competent medical evidence of record to show that the veteran has any of the multiple disabilities related to service or secondary to his service-connected disabilities. The veteran's claims are not well grounded and are accordingly dismissed. The Board recognizes that this part of the veteran's appeal has been disposed of in a manner different from that utilized by the RO. The Board therefore considered whether the claimant has been given adequate notice to respond, and if not, whether he has been prejudiced thereby. Bernard v. Brown, 4 Vet.App. 384 (1993). In light of the implausibility of the appellant's claims and his failure to meet his initial burden in the adjudication process, the Board concludes that he has not been prejudiced by the decision. In this regard, the Board points out that by the action of dismissing his claims, the Board has not burdened the veteran with a prior final adjudication on the merits. Thus, if he is able to submit well grounded claims in the future, he will not be faced with the higher hurdle of providing new and material evidence to reopen his claims after a prior final adjudication. 38 U.S.C.A. §§ 5108, 7104, 7105; McGinnis v. Brown, 4 Vet.App. 239, 244 (1993). The Board also observes that the RO, in assuming that the veteran's claims are well grounded, accorded him greater consideration than his claims in fact warranted under the circumstances. Bernard. To remand the case to the RO for consideration of the issue of whether the appellant's claims are well grounded would be pointless and, in light of the law cited above, would not result in a determination favorable to him. VA O.G.C. Prec. Op. 16-92, 57 Fed.Reg. 49,747 (1992). II. Entitlement to service connection for spina bifida occulta. With respect to the claim of entitlement to service connection for spina bifida occulta, the Board does not need to reach the question whether or not this claim is well grounded because the law concerning awards of service connection for spina bifida occulta per se is dispositive. In this regard, 38 C.F.R. § 3.303(c) provides that spina bifida occulta is not a disease or injury within the meaning of applicable legislation governing the awards of compensation benefits. As such, regardless of the character or quality of any evidence which the veteran could submit, spina bifida occulta cannot be recognized as a disability under the terms of the VA Schedule for Rating Disabilities. See Sabonis v. Brown, 6 Vet.App. 426, 430 (1994). Cf. also Beno v. Principi, 3 Vet.App. 439, 441 (1992). Spina bifida was reported on the basis of x-ray when the veteran was hospitalized by VA in September 1989, and has repeatedly been noted in later dated medical documentation on file. This disorder, not having been recognized as a chronic disorder for VA compensation purposes, permits no determination other than no basis exists upon which to warrant a grant of entitlement to service connection for spina bifida occulta. 38 U.S.C.A. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303(c). As to the remaining issues of entitlement to service connection for sinusitis with a cyst, increased evaluations for the service- connected disabilities and earlier effective dates for grants of increased (compensable) evaluations for the pilonidal cyst scar and bilateral pes planus with pes cavus deformity, the Board finds that the veteran's claims are well grounded within the meaning of 38 U.S.C.A. § 5107(a), in that he has presented claims which are plausible. More specifically, it is at least plausible that his service-connected disabilities have increased in severity and that his pilonidal cyst scar and bilateral pes planus with pes cavus deformity were compensably disabling at an earlier date than that assigned by the RO. The Board is satisfied that as a result of the December 1991 remand of the case to the RO for further development, all relevant facts have been properly developed, and that no further assistance to the veteran is required in order to comply with 38 U.S.C.A. § 5107(a). The Board's adjudication of the remaining issues for appellate review encompassing service connection for sinusitis with a cyst, increased evaluations for the service-connected disabilities and earlier effective dates for grants of increased (compensable) evaluations for the pilonidal cyst scar and bilateral pes planus with pes cavus deformity has included consideration of the testimony provided by the veteran at hearings held at the RO and before the Board as was the case in the adjudication of the issues discussed earlier, and his many written statements of record and medical excerpts from non-VA publications submitted in support of the appellant's claims, also considered in the adjudication of issues discussed earlier. III. Entitlement to an increased evaluation for a scar, pilonidal cyst, currently evaluated as 10 percent disabling. The service medical records show that the veteran was hospitalized in October 1951 for treatment for hemorrhoids. There was a history of his having undergone surgery on two prior occasions in 1947 and 1948 for a pilonidal cyst. Three weeks previously it had begun to drain. The cyst was excised in late November. At a March 1968 VA examination the veteran was noted to have had a pilonidal cyst operation in service. Currently he had a 5 inch scar. There was a recurrent or persisting sinus at the lower end of the incision from which the examiner extracted 10 or 12 hairs. The examiner noted that surgery was indicated. The examination diagnosis was pilonidal cyst, recurrent or persistent. The RO granted entitlement to service connection for a recurrent pilonidal cyst which was assigned a noncompensable evaluation when it issued a rating decision in April 1968. A VA outpatient treatment report dated in July 1989 shows the veteran had had recurring intermittent pain on either side of the coccyx, sometimes radiating to the buttock area. There was no swelling, mass or drainage. On examination was seen a well healed pilonidal surgical scar. There was no visible external sinus opening, no palpable mass, nodules, either externally or manually felt. The relevant clinical assessment was no recurrent pilonidal cyst. A September 1990 VA outpatient treatment report shows the veteran gave a history of previous surgery for a pilonidal cyst. He reported having noticed the week before a ridge at the operative site and denied any pain. On examination was seen a a non-raised scar about 2.5 centimeters long at the middle of the perineum anterior to the anus. There was an elongated induration felt during palpation. It was not a blood vessel and was nontender. The clinical assessment was scar tissue at the perineum with no fibroid bulging. A January 1991 VA examination report shows the veteran reported that since previous surgery for a pilonidal cyst he had had intermittent drainage. The last drainage was two months previously. On examination was seen a scar at the mid sacral area. The scar was tender, but not depressed or atrophic. The diagnosis was recurrent pilonidal cyst, inactive at this time. An August 1991 VA medical certificate shows an examination revealed a crack at the distal end of the sacra-coccygeal area. Old healed scarring was seen. There was no discharge. At a February 1992 VA examination the veteran complained of pain in the lower back and the sacral area which he attributed to pilonidal cysts and a fracture of the coccyx. On examination was seen a scar over the sacral area measuring 9 centimeters by 0.2 centimeters. It was tender on palpation. It was not depressed, adherent, or atrophic. The examination diagnosis was status post pilonidal cyst with tender superficial scar. The veteran's pilonidal cyst scar is rated as 10 percent disabling under diagnostic code 7804 of the VA Schedule for Rating Disabilities. The 10 percent evaluation is predicated upon tenderness and pain on objective demonstration. This is consistent with the medical evidence of record. VA formal examinations and outpatient treatment reports of record have shown that the veteran has residual tender scarring related to previous pilonidal cyst surgery. The 10 percent evaluation under diagnostic code 7804 is the highest evaluation under that code. No more than a 10 percent evaluation may be assigned under diagnostic code 7803 for scarring which is poorly nourished with repeated ulceration. Other scars are rated on the basis of limitation of function of the part affected under diagnostic code 7805. Despite the veteran's complaints of an increased level of impairment of his pilonidal cyst scar than is recognized in the current 10 percent evaluation, the Board finds no substantiating medical documentation of record. There has been no evidence of drainage on examination and there has been no recent surgery. Healed tender scarring with pain is contemplated in the current 10 percent evaluation and no basis has been presented upon which to warrant a grant of an increased evaluation. No question has been presented as to which of two or more evaluations would more properly classify the severity of the pilonidal cyst scar. 38 C.F.R. § 4.7. The pain experienced by the veteran is contemplated in his 10 percent evaluation thereby precluding a grant of an increased evaluation for functionally disabling pain under 38 C.F.R. § 4.40. The pilonidal cyst scar has not rendered the veteran's disability picture unusual or exceptional in nature. It has not markedly interfered with his employment. It has not required frequent inpatient care as to render impractical the application of regular schedular standards, thereby precluding a grant of an increased evaluation on an extraschedular basis. 38 C.F.R. § 3.321(b)(1). It is the judgment of the Board that the veteran is properly rated at 10 percent for his pilonidal cyst scar and an increased evaluation is not warranted. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.40, 4.118, Diagnostic Codes 7803, 7804, 7805. IV. Entitlement to an increased evaluation for bilateral pes planus with pes cavus deformity, currently evaluated as 10 percent disabling. The service medical records show that the veteran reported with complaints of pain in his right foot in January 1953. A physical examination disclosed a collapse of the right arch. Radiographic studies were interpreted as negative. He was furnished with arch supports. There were no further references to disability of the feet. At a March 1968 VA examination the claimant reported that he had flat feet in service and that the third toe of the right foot had become numb. He stated that it was still numb. On examination was seen moderate relaxation of the longitudinal arches of both feet. The examiner diagnosed flat feet with numbness of the right toe by history. The RO granted entitlement to service connection for pes planus which was assigned a noncompensable evaluation when it issued a rating decision in April 1968. VA outpatient treatment reports show the veteran was noted to have pes cavus of the feet with a neuroma at the second interspace on December 15, 1988. A January 1991 VA podiatry clinic report shows the veteran complained of pain in his feet laterally to the ankles. He had been taking Tylenol and Darvocet for pain. The pain was constant and radiated to his knees, hips, and low back. He had pain sitting, standing, and walking. On palpation of the feet there was marked pain elicited about the left medial longitudinal arch area site and left ankle. Deep tendon reflexes were equal and plus 1/4 bilaterally. Sensorium, pinprick, proprioception, light touch, and vibratory were equal. The nails appeared to be dystrophic and mildly discolored bilaterally. There was lateral deviation of the first metatarsal segment with hypertrophied first metatarsal head left and right with cystic erosion developing about the first metatarsal head of the right foot. The clinical assessments included functional pes cavus, pronation syndrome, xeroses, developing degenerative joint disease, hallux valgus with bunion formation, retrocalcaneal spur, and hammertoes. Similar findings were reported when the veteran was seen on an outpatient basis by VA in February 1991. A January 1992 VA outpatient report shows the veteran was evaluated for ambulatory dysfunction secondary to disorders including pes cavus. At a February 1992 VA examination a clinical inspection of the right foot disclosed mild bulging of the medial border and mild depression of the transverse and longitudinal arches. There was mild hallux valgus on the right and a callous over the medial aspect of the right metatarsophalangeal joint. The left foot showed mild medial bulging of the medial border of the foot. There was mild depression of the longitudinal transverse arches. There was no hallux valgus or clawing of the toes. There were no callosities of the left foot. X-rays of the feet were noted to show pes cavus bilaterally. There were also seen bilateral calcaneal spurs, hammertoes and right hallux valgus. The examination diagnoses were pes cavus bilateral with calcaneal spurs, hammertoes and right hallux valgus. At a November 1992 VA examination upon non-weight bearing the veteran displayed a pes cavus-type foot as well as an equinal type condition (gastrocnemius); however, upon weight-bearing, he appeared to be excessively pronating (more than 4 degrees-5 degrees) at mid stance phase gait of cycle. He also displayed only heel off during the gait phase cycle. The examiner noted that the excessive pronation was attributed to both the subtalar joint as well as the midtarsal joints pronating. The pronation was allowing the veteran's heel to make ground contact when the knee was flexed during the gait phase of the cycle. The right foot appeared to abduct more than the left foot. The veteran displayed a lateral deviation of the first metatarsal segment with hypertrophied first metatarsal head. The right foot tended to be greater than the left foot. The examination diagnoses were bilateral gastrocnemius equinus; functional pes cavus foot; hallux-abducto valgus deformity, right greater than left; and retro-calcaneal spur, bilaterally. The examiner noted that in his opinion there appeared to be a functional rather than anatomical shortage due to the veteran's accommodation of his combined deformities. At a November 1992 VA examination the feet showed normal foot arches with the veteran sitting and this was maintained with weight bearing. There was a bunion on the right foot. X-rays of both feet confirmed the presence of a bunion deformity on the right foot. The x-rays included weight bearing without any evidence of a cavus foot. A September 1993 VA podiatry clinic report shows the veteran had a Morton neuroma on the right foot. The current 10 percent evaluation for the veteran's bilateral pes planus with pes cavus deformity is predicated on application of diagnostic code 5278 of the VA Schedule for Rating Disabilities. The 10 percent evaluation contemplates bilateral acquired clawfoot with the great toe dorsiflexed, some limitation of dorsiflexion at the ankle, and definite tenderness under the metatarsal heads. The next higher evaluation of 30 percent requires all toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads. The VA examination reports and outpatient treatment records do not specifically record these requisite diagnostic criteria for a grant of a 30 percent evaluation; however, the Board is of the opinion that the diagnostic criteria under code 5276 for bilateral acquired flat foot are more applicable. A 30 percent evaluation is assignable for severe acquired flatfoot with objective evidence of marked deformity (pronation, abduction, etc.,), pain on manipulation and use accentuated, indication of swelling on use, or characteristic callosities. The evidentiary record shows that the veteran's service-connected bilateral foot disability has been productive of a level of impairment which more closely approximates the severity contemplated for severe bilateral flat feet under diagnostic code 5276. 38 C.F.R. § 4.7. Were the veteran rated as 10 percent disabled under diagnostic code 5276, it would be on the basis of not more than moderate impairment. The record shows that the veteran has been seen on an outpatient basis repeatedly for bilateral foot pain. VA examinations have disclosed a variety of bilateral foot disorders and complications showing the veteran has required physiatric attention to correct ambulatory difficulties. This has involved use of special shoes with modifications. It has been shown that the veteran excessively pronates and has had hammertoes, bunions, spurring, pes cavus deformity, hallux- abducto valgus deformity, chronic pain, etc. The complicated clinical picture of his bilateral foot disability in the Board's opinion warrants a finding of severe bilateral foot impairment with application of the pertinent governing schedular criteria to the medical evidence of record. The Board does not find that pronounced bilateral acquired flatfoot which would warrant assignment of a 50 percent evaluation under diagnostic code 5276 is present. For the 50 percent evaluation it is required that there be marked pronation, extreme tenderness of the plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation which is not improved by orthopedic shoes or appliances. As the above requisite diagnostic criteria have not been shown by the evidence of record, the Board finds that a 50 percent evaluation is not warranted. It is the determination of the Board that no basis has been presented to warrant a grant of an increased evaluation on the basis of disabling pain under 38 C.F.R. § 4.40 as such pain is considered in the granted 30 percent evaluation. An increased evaluation on an extraschedular basis under 38 C.F.R. § 3.321(b)(1) is similarly not warranted. The Board concludes that the record supports a grant of an increased evaluation of 30 percent for bilateral pes planus with pes cavus deformity. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.40, 4.71(a), Diagnostic Codes 5276-5278. V. Entitlement to an increased (compensable) evaluation for hemorrhoids. The service medical records show that the veteran required treatment for hemorrhoids in October 1951. The RO granted entitlement to service connection for hemorrhoids which were assigned a noncompensable evaluation when it issued a rating decision in July 1967. At a March 1968 VA examination of the rectum there was a 3 o'clock and 6 o'clock rather marked congestion of the veins which could bleed easily. The veteran stated he had bleeding recently. The examiner diagnosed mild hemorrhoids. At a January 1991 VA examination the veteran reported that he had begun to have trouble with hemorrhoids in 1951. A hemorrhoidectomy was performed in 1971. He complained of pain with each bowel movement. He stated that he bled intermittently and alleged anal stricture. On examination was seen a hemorrhoidal tag at 9 o'clock and at 4 o'clock. There was no evidence of anal stricture, fistula or fissure. There was no evidence of prolapse. Hemoccult was negative. The diagnostic impression was internal hemorrhoids. At a February 1992 VA examination the rectal area was noted to reveal small internal hemorrhoids at 6, 9, and 12 o'clock. The hemoccult test for blood was normal. The examination diagnosis was internal hemorrhoids at 6, 9, and 12 o'clock. When seen in March 1992 on an outpatient basis by VA, the veteran reported that he had had a hemorrhoidectomy in the past. He reported having been examined for hemorrhoids one week previously by VA. The veteran's hemorrhoids are evaluated as noncompensable under diagnostic code 7336. The noncompensable evaluation is predicated on mild or moderate external or internal hemorrhoids. The Board is of the opinion that the veteran is properly rated. The next higher evaluation of 10 percent requires medical examination demonstration of large or thrombotic, irreducible hemorrhoids with excessive redundant tissue evidencing frequent recurrences. The VA formal examination reports and outpatient treatment records discussed above do not show the requisite criteria are present for a grant of an increased (compensable) evaluation. As was noted by a VA examiner previously, the veteran's hemorrhoids were classified as mild in nature. This classification is consistent with the current noncompensable evaluation. The Board finds no basis upon which to predicate assignment of an increased (compensable) evaluation with application of the criteria of 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.40. In the absence of a demonstration of compensable disablement, it is the judgment of the Board that the record does not support a grant of an increased (compensable) evaluation for hemorrhoids. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.40, 4.114, Diagnostic Code 7336. VI. Entitlement to an effective date, prior to July 25, 1989, for a grant of an increased (compensable) evaluation of 10 percent for a pilonidal cyst scar. The veteran filed a claim for an increased (compensable) evaluation for his pilonidal cyst scar on September 14, 1989. As the Board noted earlier, the RO granted entitlement to an increased (compensable) evaluation of 10 percent for a pilonidal cyst scar effective July 25, 1989, when it issued a rating decision in February 1991. It has been the contention of the veteran the his pilonidal cyst scar was disabling to a compensable degree well in advance of July 25, 1989. The Board observes that the effective date of increased compensation shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year from such date. 38 U.S.C.A. § 5110(b)(2). The Board's analysis of the evidentiary record does not permit a conclusion that the veteran's pilonidal cyst scar was productive of compensable disablement prior to July 25, 1989. It was not until September 14, 1989, that the veteran filed a claim for increased compensation benefits. Entitlement to an increased (compensable) evaluation for the pilonidal cyst scar would have been warranted retroactive to September 1988 if compensable disablement had been demonstrated then. This is not the veteran's case. The VA outpatient treatment reports dated in 1988 do not show that the veteran's reported for treatment of increasing symptomatology associated with his pilonidal cyst scar. It was not until July 25, 1989, that he reported with complaints of increasing, recurrent intermittent pain which had been said to be of five years duration. The veteran did not report for treatment until July 25, 1989. Subsequent examinations then revealed tenderness of the scarring from previous pilonidal cyst surgery, thereby providing the basis upon which to predicate a grant of an increased (compensable) evaluation for tender and painful scarring under diagnostic code 7804. A grant of an earlier effective date, prior to July 25, 1989, is therefore not warranted. 38 U.S.C.A. §§ 1155, 5107, 5110(b)(2); 38 C.F.R. §§ 3.321(b)(1), 3.400, 4.7, 4.40, 4.118, Diagnostic Codes 7803, 7804, 7805. VII. Entitlement to an effective date, prior to July 25, 1989, for a grant of an increased (compensable) evaluation of 10 percent for bilateral pes planus with pes cavus deformity. As the Board noted above, the veteran filed a claim for increased compensation benefits for his service-connected disabilities on September 15, 1989. Depending on supportive medical documentation, a grant of an increased (compensable) evaluation could be made effective one year prior to the date of his filing a claim for increased compensation benefits. 38 U.S.C.A. § 5110(b)(2). The RO issued a rating decision in February 1991 selecting July 25, 1989, as the effective date for a grant of an increased (compensable) evaluation of 10 percent for the veteran's bilateral foot disability. The Board disagrees with the effective date. In this regard the Board observes that VA outpatient treatment reports show the veteran was seen on September 15, 1988, at which time he was noted to have a pes cavus foot disorder with possible neuroma at the second interspace. There were also elongated nails on ten toes for which he went debridement. The later dated medical evidence of record shows that pes cavus deformity was again diagnosed and ultimately associated with the veteran's service-connected bilateral pes planus. The veteran also had problems with his nails as part of a constellation of other foot problems as has been shown on VA formal examinations and in VA outpatient treatment reports. The appellant's compensable foot problems or initial signs of pathological worsening were first shown on September 15, 1988. It is the determination of the Board that an effective date, retroactive to September 15, 1988, for a grant of an increased (compensable) evaluation of 10 percent for bilateral pes planus with pes cavus deformity is warranted. 38 U.S.C.A. §§ 1155, 5107, 5110(b)(2); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.40, 4.114, Diagnostic Codes 5276-5278. ORDER The claims for service connection for diverticulitis, spastic colitis, lumbosacral strain with arthritis, shortening of the right leg, residuals of a fracture of the coccyx, a right hip disorder, bilateral knee disorder, bilateral ankle disorder, varicosities of the left lower extremity with claimed vascular stress, edema, sinusitis with a cyst, tonsillitis, an umbilical disorder, otitis media, tight heel cords, and structural stress are dismissed. Entitlement to service connection for spina bifida occulta is denied. Entitlement to an increased evaluation for a scar, pilonidal cyst, is denied. Entitlement to an increased evaluation of 30 percent for bilateral pes planus with pes cavus deformity is granted, subject to pertinent criteria applicable to the payment of monetary awards. Entitlement to an increased (compensable) evaluation for hemorrhoids is denied. Entitlement to an effective date, prior to July 25, 1989, for a grant of an increased (compensable) evaluation of 10 percent for a pilonidal cyst scar is denied. Entitlement to an increased (compensable) evaluation of 10 percent, prior to July 25, 1989, and retroactive to December 15, 1988, is granted, subject to pertinent criteria applicable to the payment of monetary awards. ALBERT D. TUTERA 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.