BVA9508399 DOCKET NO. 93-09 206 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for high cholesterol. 2. Entitlement to service connection for uvula palate enlargement with sleep apnea. 3. Entitlement to service connection for irregular heart beat, claimed as regular heart beat. 4. Entitlement to service connection for heart disease. 5. Entitlement to service connection for electrocardiogram abnormalities. 6. Entitlement to service connection for a deviated nasal septum. 7. Entitlement to an increased evaluation for chondromalacia of the right knee, currently evaluated as 20 percent disabling. 8. Entitlement to an increased evaluation for asthma with bronchitis, currently evaluated as 10 percent disabling. 8. Entitlement to an increased evaluation for anxiety disorder with features of post-traumatic stress disorder, currently evaluated as 10 percent disabling. 10. Entitlement to an increased (compensable) evaluation for bilateral hearing loss. 11. Entitlement to an increased (compensable) evaluation for serum hepatitis. 12. Entitlement to an increased (compensable) evaluation for postoperative basilar cell carcinoma at tip of nose. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD Ronald R. Bosch, Counsel INTRODUCTION The veteran had certified service from November 1966 to September 1970 and from November 1980 to February 1990. This appeal arose from a November 1990 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. The RO, in relevant part, granted entitlement to service connection for: chondromalacia of the right knee which was assigned a 10 percent evaluation; and for postoperative basilar cell carcinoma at tip of nose, serum hepatitis, and bronchitis which were assigned noncompensable evaluations each. The RO denied entitlement to service connection for asthma, anxiety and depression, uvula palate enlargement (sleep apnea), and cholesterol (high). In an August 1991 rating decision the RO, in pertinent part, granted entitlement to service connection for anxiety disorder and asthma which was associated with bronchitis and each was assigned a 10 percent evaluation; and affirmed the prior denial of entitlement to service connection for uvula palate enlargement, sleep apnea. The RO issued a rating decision in July 1992 granting an increased evaluation of 20 percent for chondromalacia of the right knee, denying entitlement to service connection for heart disease, abnormal electrocardiogram and deviated nasal septum, and affirming determinations previously entered. The case has been forwarded to the Board of Veterans' Appeals (Board) for appellate review. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that high cholesterol reported in service is reflective of chronic disease which should be service-connected. He avers that he was treated for uvula palate enlargement with sleep apnea while on active duty and continues to suffer from this disorder thereby warranting compensation benefits. The appellant argues that heart disease, electrocardiogram abnormalities and a "regular" heart beat are all indicative of chronic cardiovascular disease which should be service-connected. The veteran states that his deviated nasal septum which was diagnosed by VA in February 1991 is related to service thereby warranting entitlement to service connection. The appellant states that his right knee chondromalacia, asthma with bronchitis, anxiety disorder with features of post-traumatic stress disorder, bilateral hearing loss, serum hepatitis, and postoperative basilar cell carcinoma at the tip of his nose are more disabling than currently evaluated, thereby warranting entitlement to increased evaluations. 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 presented evidence of well grounded claims of entitlement to service connection for high cholesterol, uvula palate enlargement with sleep apnea, irregular heartbeat claimed as regular heartbeat, heart disease, electrocardiogram abnormalities, and deviated nasal septum; and that the preponderance of the evidence is against grants of entitlement to increased evaluations for chondromalacia of the right knee, asthma with bronchitis, anxiety disorder with post- traumatic stress disorder features, bilateral hearing loss, serum hepatitis, and postoperative basilar cell carcinoma at the tip of the nose. FINDINGS OF FACT 1. The claims for service connection for high cholesterol, uvula palate enlargement with sleep apnea, irregular heartbeat claimed as regular heartbeat, heart disease, electrocardiogram abnormalities, and deviated nasal septum are not supported by cognizable evidence showing that the claims are plausible. 2. Chondromalacia of the right knee is productive of not more than moderate recurrent subluxation or lateral instability. 3. Asthma with bronchitis is productive of not more than mild or moderate respiratory impairment. 4. Anxiety disorder with features of post-traumatic stress disorder is productive of not more than mild impairment. 5. The February 1991 VA audiology examination disclosed right pure tone thresholds of 15, 5, 10, and 25 decibels with an average of 14 decibels at 1000, 2000, 3000, and 4000 Hertz with speech recognition ability of 100 percent; and left pure tone thresholds of 5, 10, 5, and 15 decibels with an average of 9 decibels at 1000, 2000, 3000, and 4000 Hertz with speech recognition ability of 100 percent. 6. The February 1992 VA audiology examination disclosed right pure tone thresholds of 0, 5, 5, and 25 decibels with an average of 9 decibels at 1000, 2000, 3000, and 4000 Hertz with speech recognition of 100 percent; and left pure tone thresholds of 5, 0, 0, and 10 decibels with an average of 4 decibels at 1000, 2000, 3000, and 4000 Hertz with a speech recognition of 98 percent. 7. Serum hepatitis is healed and non symptomatic. 8. Postoperative basilar cell carcinoma at tip of nose is productive of slight, if any, exfoliation, exudation or itching. CONCLUSIONS OF LAW 1. The claims for service connection for high cholesterol, uvula palate enlargement with sleep apnea, irregular heartbeat claimed as regular heartbeat, heart disease, electrocardiogram abnormalities, and deviated nasal septum are not well grounded. 38 U.S.C.A. § 5107 (West 1991). 2. The criteria for an evaluation in excess of 20 percent for chondromalacia of the right knee have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3,321(b)(1), 4.7, 4.40, 4.71(a), Diagnostic Codes 5014, 5257, 5260, 5261(1994). 3. The criteria for an evaluation in excess of 10 percent for asthma with bronchitis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.97, Diagnostic Codes 6600-6602 (1994). 4. The criteria for an evaluation in excess of 10 percent for anxiety disorder with features of post-traumatic stress disorder have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.132, Diagnostic Codes 9400-9411 (1994). 5. The criteria for an increased (compensable) evaluation for bilateral hearing loss have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.85, Diagnostic Code 6100 (1994). 6. The criteria for an increased (compensable) evaluation for serum hepatitis have not been met. 38 U.S.C.A. §§ 1155. 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.114, Diagnostic Code 7345 (1994). 7. The criteria for an increased (compensable) evaluation for basilar cell carcinoma at tip of nose have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. 3.321(b)(1), 4.7, 4.118, Diagnostic Codes 7800, 7803, 7804, 7805, 7806 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS 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 service connection for high cholesterol, uvula palate enlargement with sleep apnea, irregular heartbeat claimed as regular heartbeat, heart disease, electrocardiogram abnormalities, and deviated nasal septum 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 (West 1991). 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 a veteran's claims not well grounded. The veteran seeks service connection for laboratory studies which have indicated that the cholesterol content of his blood is not within normal limits but has been classified or diagnosed as high. The Board does not dispute that cholesterol readings classified as high were reported in service and continue to be demonstrated post service. In this regard the Board notes that during service in April 1983 the veteran had a cholesterol reading of 256 milligrams per decaliter. In February 1988 it was 345 milligrams per decaliter. Cholesterol readings of 334 and 345 milligrams per decaliter were reported in April 1988. A cholesterol reading of 297 milligrams per decaliter was reported in November 1989. The April 1992 VA examination included a laboratory study showing a cholesterol reading of 314 milligrams per decaliter, and noted as high. While there is no dispute that the veteran has high cholesterol, the Board finds that no chronic acquired disorder or disability due to the high cholesterol count has been shown by the evidence of record. The veteran's high cholesterol count is merely a laboratory finding which has not been shown to reflect a chronic acquired disability for VA compensation purposes. As there is no ascertainable disability shown upon which to predicate a grant of entitlement to service connection, the Board has no alternative but to dismiss the appellant's claim for compensation benefits for a laboratory finding of high cholesterol. The service medical records show that during the latter part of the veteran's active service he was evaluated for what appeared to be uvula palate enlargement or obstructive sleep apnea based on his symptomatic complaints. However, such disorder was never definitively found to be present. The post service medical record shows that despite the veteran's subjectively furnished medical history of obstructive sleep apnea, VA determined in March 1992, after comprehensive diagnostic studies, that uvula palate enlargement consistent with obstructive sleep apnea was not present and not shown on examination. A VA physician specifically reported that the veteran does not have sleep apnea syndrome. As the veteran is not shown to have uvula palate enlargement consistent with obstructive sleep apnea, the Board must dismiss the claim for service connection. The veteran has claimed service connection for heart disease, irregular heartbeat, and electrocardiographic abnormalities on the basis that he has acquired cardiovascular disease. The service and post service medical record is nonsupportive in this regard. Briefly, the service medical records do show that the veteran was evaluated for chest pain in November 1980. Cardiovascular disease was not shown on the basis of diagnostic studies. An August 1987 electrocardiogram revealed sinus bradycardia. Such disorder has not been confirmed on the basis of later dated electrocardiographic reports post service. The February 1991 VA electrocardiogram revealed premature ectopic complexes but was otherwise considered to be normal. The February 1991 VA chest x-ray was interpreted as normal. There was no evidence of heart disease on a general medical examination. In February 1992 a VA physician reported that significant electrocardiographic abnormalities were seen and it was suggested that the veteran be referred for a cardiology examination. The February 1992 general medical examination report shows blood pressure was 130/85. Pulse was 72. Heart auscultation showed regular rhythm with no murmurs. S1 and S2 were normal and there were no S3 or S4. The electrocardiographic record disclosed normal sinus rhythm with occasional premature ectopic complexes and the report was considered to be otherwise normal. The chest x-ray was interpreted as normal. Heart disease and irregular heartbeat were not diagnosed. The premature ectopic complexes were not shown to be reflective of heart disease or any other chronic disorder. The medical evidence of record does not support the veteran's contention that he has a chronic disorder due to previously reported electrocardiographic abnormalities, irregular heartbeat claimed as regular heartbeat, or heart disease in general. As no chronic acquired cardiovascular disease is shown to be present, the Board must dismiss the appellant's claims for service connection. As to service connection for a deviated nasal septum, the Board observes that the service medical records contain no evidence of this disorder. A February 1991 VA otolaryngology examination report shows the septum was deviated slightly to the left. This disorder is not shown to have originated in service on the basis of the medical evidence of record to date. It was reported one year following service discharge. In the absence of competent medical evidence relating the post service reported deviated nasal septum to service, the Board has no alternative but to dismiss the claim for service connection. The Board recognizes that the veteran's claims have 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 veteran'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 herein. 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 (West 1991); McGinnis v. Brown, 4 Vet.App. 239 244 (1993). The Board also observes that the RO, in assuming that the veteran's claims were 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). The Board finds that the veteran's claims discussed below are well grounded within the meaning of 38 U.S.C.A. § 5107(a), in that it is at least plausible that the veteran's service- connected disabilities at issue have increased in severity, thereby warranting entitlement to grants of increased evaluations. The Board is satisfied that 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). In accordance with 38 C.F.R. §§ 4.1 and 4.2, and Schafrath v. Derwinski, 1 Vet.App. 589 (1991), the Board has reviewed the service medical records pertaining to the history of the veteran's chondromalacia of the right knee, asthma with bronchitis, anxiety disorder with features of post-traumatic stress disorder, bilateral hearing loss, serum hepatitis, and postoperative basilar cell carcinoma at the tip of nose. The Board has found nothing in the historical record which would lead to a conclusion that the current evidence of record is inadequate for rating purposes. II. Entitlement to an increased evaluation for chondromalacia of the right knee, currently evaluated as 20 percent disabling. The service medical records show that the veteran was hospitalized in 1979 after reporting a five year history of right knee pain. He underwent arthroscopy and was found to have chondromalacia. He received treatment for this disorder on occasion during the remaining years of service. The RO granted entitlement to service connection for chondromalacia of the right knee which was assigned a 10 percent evaluation when it issued a rating decision in November 1990. At a February 1991 VA orthopedic examination the veteran reported having injured his knee in service after a fall down a flight of stairs. He currently complained of intermittent anterior knee pain which was worse with exercise or going up or down stairs. He also complained of intermittent swelling. On examination was seen a healed medial surgical scar. There was positive retropatellar crepitus with range of motion. There was minimal medial joint line tenderness and a negative McMurray test. Range of motion was 0-125 degrees. There was no effusion. Significant quadriceps atrophy was present. X-rays of the right knee were negative except for what appeared to be a retained small round metal fragment overlying the patella which might be an artifact. The diagnostic impression was chondromalacia of the right knee, moderately symptomatic. At a March 1992 VA orthopedic examination the veteran complained of continuing pain and swelling in the right knee, particularly with respect to pain behind the right kneecap. He also felt "popping" in the right knee when he got up from a sitting position. There was swelling and giving way with activity. It was only partially relieved with Motrin. On examination was seen a 5 centimeter incision on the medial aspect of the right knee. The incision had spread slightly. The arthroscopic portals were well healed. Range of motion was from 15 degrees of flexion to 125 degrees of flexion. This meant that he had a 15 degree extension lag, and a 20 degree flexion lag. There was pain at the patellofemoral joint with active and passive flexion and extension. There was crepitus with terminal extension. A superior plica was palpated, and this was symptomatic. The medial and lateral joint lines were minimally tender. Anterior drawer and Lachman's test were negative. Quadriceps inhibition test; however, was positive. Quadriceps atrophy was mild with quad strength at 4/5. X-rays demonstrated no significant degenerative changes. The diagnosis was patellofemoral arthralgia, right knee, with post-traumatic chondromalacia patella and plica syndrome, moderately to severely symptomatic. The veteran's chondromalacia of the right knee is rated as 20 percent disabling under diagnostic code 5014 by analogy to osteomalacia. The Board is of the opinion that the right knee disability evaluation may also be considered under diagnostic code 5257 for recurrent subluxation or lateral instability of a knee. Under this code a 20 percent evaluation as assigned for moderate recurrent subluxation or lateral instability of a knee. The next higher evaluation of 30 percent requires severe recurrent subluxation or lateral instability of a knee. The Board is of the opinion that the veteran's right knee disability is productive of not more than moderate impairment. The record shows that despite previous surgery the veteran has continued to experience periodic disabling manifestations of his right knee disability including pain and swelling. Nonetheless, range of motion studies have not been demonstrative of increased impairment. In this regard, the Board observes that limitation of right leg flexion to 15 degrees which would warrant an increased evaluation of 30 percent has not been shown on examination. Limitation of leg extension to 20 degrees which would warrant a grant of an increased evaluation of 30 percent has not been shown on examination. The appellant has been able to obtain partial relief of his symptoms by use of over the counter medication. There is no evidence of a need for frequent outpatient treatment. No question has been presented as to which of two evaluations would more properly classify the severity of chondromalacia of the right knee. 38 C.F.R. § 4.7 (1994). The veteran's symptomatic pain is considered in his current 20 percent evaluation for his right knee disability thereby precluding a grant of an increased evaluation under the criteria of 38 C.F.R. § 4.40 (1994). Chondromalacia of the right knee has not rendered the veteran's disability picture unusual or exceptional in nature and has not markedly interfered with employment. It has not required frequent periods of 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) (1994). It is the judgment of the Board that the record does not support a grant of an increased evaluation for chondromalacia of the right knee. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.40, 4.71(a), Diagnostic Codes 5014, 5257, 5260, 5261(1994). III. Entitlement to an increased evaluation for asthma with bronchitis, currently evaluated as 10 percent disabling. A review of the service medical records discloses that the veteran was treated for occasional exacerbations of bronchitis manifested by breathing obstruction and wheezes. He was also evaluated for an allergic type asthma. The RO granted entitlement to service connection for bronchitis which was assigned a noncompensable evaluation when it issued a rating decision in November 1990. The claims file contains records of outpatient treatment of the claimant for bronchial asthma in 1990 and 1991. At a February 1991 VA general medical examination the veteran reported smoking one pack of cigarettes per day for the past 24 years. He reported having first experienced chest wheezes in February 1973 while in service. The appellant complained of occasional wheezing spells which were relieved by use of an inhaler. On examination the lungs were clear to auscultation. Chest expansion was adequate. The chest x-ray was interpreted as normal. Pulmonary function studies were interpreted as reflective of severe obstructive airways disease. The examiner diagnosed a history of episodic bronchial asthma. The RO granted entitlement to service connection for asthma which was associated with bronchitis and an increased (compensable) evaluation of 10 percent was assigned. At a February 1992 VA general medical examination the veteran reported having mild respiratory attacks with occasional shortness of breath. These attacks were quickly relieved by use of an inhaler and oral medication. The appellant complained of shortness of breath only on over exertion. On examination the lungs were clear to auscultation. The examiner diagnosed a history of asthma and noted that a person could suffer from asthma and his physical examination could be normal at any given time away from acute attacks. Pulmonary function tests were noted to reveal moderate obstructive lung disease. The veteran's asthma with bronchitis is rated as 10 percent disabling under diagnostic codes 6600 and 6602. A 10 percent evaluation may be assigned for moderate chronic bronchitis under diagnostic code 6600 productive of considerable night or morning cough, slight dyspnea on exercise, and scattered bilateral rales. The next higher evaluation of 30 percent may be assigned for moderately severe chronic bronchitis productive of persistent cough at intervals throughout the day, considerable expectoration, considerable dyspnea on exercise, rales throughout the chest, and beginning chronic airway obstruction. The Board's review of the medical evidence of record discloses that moderately severe chronic bronchitis is not shown. A 10 percent evaluation may be assigned for mild bronchial asthma productive of paroxysms of asthmatic type breathing (high pitched expiratory wheezing and dyspnea) occurring several times a year with no clinical findings between attacks. A 30 percent evaluation may be assigned for moderate bronchial asthma productive of rather frequent asthmatic attacks (separated by only 10-14 day intervals) with moderate dyspnea on exertion between attacks. The Board finds that moderate bronchial asthma is not shown by the medical evidence of record. The Board's analysis of the medical evidence of record does not permit a conclusion that the appellant's asthma with bronchitis warrants a grant of an increased evaluation. In this regard the Board notes that on VA examinations conducted in February 1991 and February 1992 there was no demonstrable evidence of respiratory impairment. The veteran described rather mild pulmonary symptomatology which he related was easily relieved with an inhaler and oral medication. The appellant has infrequently been treated on an outpatient basis for minor exacerbations of his respiratory disability which has not been shown to have increased in severity. The most recent pulmonary function studies have been reflective of moderate obstructive lung disease. No evidentiary basis has been presented upon which to warrant a grant of an increased evaluation for asthma with bronchitis under the criteria of 38 C.F.R. §§ 3.321(b)(1), 4.7. In the absence of a demonstration of increased respiratory impairment, the Board finds that the record does not support a grant of an increased evaluation for asthma with bronchitis. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.97, Diagnostic Codes 6600-6602 (1994). IV. Entitlement to an increased evaluation for anxiety disorder with features of post- traumatic stress disorder, currently evaluated as 10 percent disabling. The service medical records show that the veteran was treated for anxiety and depression during the later 1980's. At a February 1991 VA psychiatric examination the appellant related that he was under no stress at the moment. He worked around his home and enjoyed life. He and his wife were teaching their child at home, instead of sending him to school. He stated that in addition to his home teaching, he was heavily involved in Boy Scout activities. The veteran related that he had a recurrent dream stemming from his service in Vietnam. He awakened sweating and shaking. He had had the dream at least once every month. The veteran stated that he had always been "on guard" with people since his service in Vietnam. He had been able to let his guard down with his wife. On mental status examination the veteran's mood was euthymic. He was oriented for time, place, and person. He registered three items immediately and recalled one of the three items at three minutes. The veteran was able to give the names of three of the four most recent U.S. Presidents. He performed the first five calculations of serial 7's from 100 correctly and was able to correctly reverse the spelling of a word of five letters. The relevant diagnosis was anxiety disorder, not otherwise specified, with features of post-traumatic stress disorder, of mild to moderate severity. The examiner noted that the veteran's psychiatric symptoms failed to meet the criteria for making a diagnosis of post-traumatic stress disorder. The RO granted entitlement to service connection for anxiety disorder which was assigned a 10 percent evaluation when it issued a rating decision in August 1991. At a February 1992 VA psychiatric examination the veteran stated that his dreams of Vietnam were occurring about once per week. He stated that this represented a reduction in frequency. The appellant awakened from these dreams in a cold sweat. Dream content was usually the same. He stated that he continued to be "touchy" even while sleeping. By this he meant that he punched his wife in the middle of the night a couple of times and did not know that he was doing it. He was short tempered and would fly off the handle in response to minor provocation. The veteran and his wife had four adopted children. The had learned "what not to say to avoid setting him off." The appellant would become angry if they were impolite, but he did not physically chastise them. The veteran attended church and had managed to beat his fear of entering churches related to the explosion of a church witnessed in service. While he was not employed, he was pleasantly occupied with the education of his children, Boy Scout activities, and church activities. The appellant stated that he paid little attention to the war in the Persian Gulf. On mental status examination his mood was euthymic. He was oriented as to time, place, and person. He registered three items immediately and recalled all three items at three minutes. The appellant was able to give the names of three of the four most recent Presidents. He performed the first five calculations of serial 7's from 100 correctly. The claimant was able to correctly reverse the spelling of a word of five letters. The diagnostic impression was anxiety disorder, not otherwise specified, with features of post-traumatic stress disorder, of mild to moderate severity. The veteran's anxiety disorder with features of post-traumatic stress disorder is rated as 10 percent disabling under diagnostic codes 9400-9411 of the VA Schedule for Rating Disabilities. The 10 percent evaluation contemplates emotional tension or other evidence of anxiety productive of mild social and industrial impairment. The next higher evaluation of 30 percent requires definite impairment in the ability to establish or maintain effective and wholesome relationships with people. The psychoneurotic symptoms must result in such reduction in initiative, flexibility, efficiency, and reliability levels as to produce definite industrial impairment. In the case of Hood v. Brown, 4 Vet.App. 301 (1993), the United States Court of Veterans Appeals stated that the term "definite" in 38 C.F.R. § 4.132 was "qualitative" in character, and invited the Board to "construe" the term "definite" in a manner that would quantify the degree of impairment for purposes of meeting the statutory requirement that the Board articulate "reasons and bases" for its decision. 38 U.S.C.A. § 7104(d)(1) (West 1991). In a precedent opinion the General Counsel of VA concluded that "definite" is to be construed as representing a degree of social and industrial inadaptability that is "more than moderate but less than rather large." VA O.G.C. Prec. Op. 9-93, 59 Fed.Reg. 4753 (1994). The Board is bound by that interpretation of the term "definite." 38 U.S.C.A. § 7104(c) (West 1991). With these thoughts in mind the Board will now consider whether a higher evaluation is warranted for the appellant's psychiatric disability. The Board's evaluation of the evidentiary record discloses that although the appellant is not employed, his time is productively taken up with the education of his children, as well as Boy Scout and church activities. He does have some recurrent dreams referable to his Vietnam service and is known to react to minor provocation. Otherwise he has been noted by the VA examiner on two occasions to suffer from mild to moderate psychiatric impairment. The Board does not find that the veteran has definite social or industrial impairment. He is socially active with the Boy Scouts and his church. His current lack of gainful employment is not shown to be due to his psychiatric disability. The Board finds that no more than mild psychiatric impairment is shown by the evidence of record due to the appellant's psychiatric symptomatology. There exists no basis upon which to predicate a grant of an increased evaluation for the appellant's psychiatric disability under the criteria of 38 C.F.R. §§ 3.321(b)(1), 4.7. It is the judgment of the Board that the veteran's anxiety disorder with features of post-traumatic stress disorder has not increased in severity and that the record does not support a grant of an increased evaluation. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.132, Diagnostic Codes 9400-9411 (1994) V. Entitlement to an increased (compensable) evaluation for bilateral hearing loss. A review of the service medical records discloses that bilateral hearing loss was demonstrated on audiometric studies. The RO granted entitlement to service connection for deafness when it issued a rating decision in November 1990. A February 1991 VA audiology examination report shows right pure tone thresholds were 15, 5, 10, and 25 decibels with an average of 14 decibels at 1000, 2000, 3000, and 4000 Hertz with a speech recognition of 100 percent. Left pure tone thresholds were 5, 10, 5, and 15 decibels with an average of 9 decibels at 1000, 2000, 3000, and 4000 Hertz with a speech recognition of 100 percent. A February 1992 VA audiology examination report shows right pure tone thresholds were 0, 5, 5, and 25 decibels with an average of 9 decibels at 1000, 2000, 3000, and 4000 Hertz with a speech recognition of 100 percent. Left pure tone thresholds were 5, 0, 0, and 10 decibels with an average of 4 decibels at 1000, 2000, 3000, and 4000 Hertz with a speech recognition of 98 percent. While the appellant may feel that his bilateral hearing loss is more disabling than currently evaluated, the Board finds that two VA audiology examinations of record have been consistent in showing that his deafness is not sufficiently disabling as to permit a grant of an increased (compensable) evaluation with application of pertinent governing schedular criteria. The February 1991 VA audiology examination disclosed that right defective hearing was manifested by an average loss of 14 decibels with a speech recognition ability of 100 percent and left defective hearing was manifested by an average loss of 9 decibels with a speech recognition of 100 percent. The February 1992 VA audiology examination disclosed that right defective hearing was manifested by an average loss of 9 decibels with a speech recognition of 100 percent and left defective hearing was manifested by an average loss of 4 decibels with a speech recognition of 98 percent. These audiometric findings for both examinations result in numeric designations of I for each ear on Table VI of 38 C.F.R. § 4.85 of the VA Schedule for Rating Disabilities. The numeric designations of I for each ear equate to a noncompensable evaluation under diagnostic code 6100 on Table VII. There is no medical basis upon which to predicate a grant of an increased (compensable) evaluation for bilateral hearing loss under the criteria of 38 C.F.R. §§ 3.321(b)(1), 4.7. The Board finds that the record does not support a grant of an increased (compensable) evaluation for bilateral hearing loss. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.85, Diagnostic Code 6100 (1994). VI. Entitlement to an increased (compensable) evaluation for serum hepatitis. The service medical records show that the veteran required treatment for serum hepatitis. The RO granted entitlement to service connection for serum hepatitis which was assigned a noncompensable evaluation when it issued a rating decision in November 1990. The February 1991 VA general medical examination concluded in a relevant diagnosis of a history of viral hepatitis, probably type A, with no clinical recurrences. The February 1992 VA general medical examination concluded in a relevant diagnosis of a history of hepatitis, probably viral, type A or infectious, and not serum as claimed. The examiner later added viral hepatitis, B infection. VA laboratory studies dated in April 1992 show the veteran tested positive for hepatitis B core AB and hepatitis B surface AB. The veteran's hepatitis is evaluated as noncompensable under diagnostic code 7345 of the VA Schedule for Rating Disabilities. The noncompensable evaluation contemplates healed, non symptomatic infectious hepatitis. This is the veteran's case. The most recent VA clinical studies have demonstrated no clinical evidence of demonstrable liver damage with mild gastrointestinal disturbance which would warrant the next higher evaluation of 10 percent. In this regard, the Board observes that when examined by VA in February 1991, the veteran reported that since service he had been tested practically every year and his liver function tests had always been within normal limits. When examined by VA in February 1992 the veteran reported that at the time of his discharge from service he was reported as clinically cured of hepatitis. The examiner noted he had no current symptoms related to any kind of hepatic dysfunction. The Board finds that there exists no medical basis upon which to predicate a grant of an increased (compensable) evaluation under the criteria of 38 C.F.R. §§ 3.321(b)(1), 4.7. The Board concludes that in the absence of any disablement due to the service-connected serum hepatitis, there exists no basis upon which to predicate a grant of an increased (compensable) evaluation. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.114, Diagnostic Code 7345 (1994). VII. Entitlement to an increased (compensable) evaluation for postoperative basilar cell carcinoma. The service medical records show that in 1981 the veteran underwent surgery for removal of a basal cell carcinoma from the tip of his nose. The RO granted entitlement to service connection for basilar cell carcinoma at tip of nose which was assigned a noncompensable evaluation when it issued a rating decision in November 1990. The veteran failed to report for a VA dermatological examination of his nose in February 1991. At a February 1991 VA general medical examination the veteran reported a history of a 1979 excision of a basal cell carcinoma from the tip of his nose. He stated that for the last two years another black spot had been noticed on the tip of his nose and according to his statement it was getting darker and bigger. The examiner diagnosed history of basal cell carcinoma of the nose with possible recurrence. At a February 1992 VA general medical examination the veteran gave a history of removal of a basal cell carcinoma from the tip of his nose with no recurrence. A skin examination disclosed the presence of a small scar on the tip of the nose which was not disfiguring. The examiner diagnosed a history of a basal cell carcinoma, excised from the tip of the nose, without any recurrence. The examiner noted this was not a current problem. The RO has rated the appellant's basilar cell carcinoma at tip of nose under diagnostic code 7806 for eczema of the VA Schedule for Rating Disabilities, the Board is of the opinion that this disability may also be appropriately evaluated under diagnostic code 7800 pertaining to head, face, or neck scars. Nonetheless, the current noncompensable evaluation under diagnostic code 7806 contemplates slight, if any exfoliation, exudation or itching, if on a nonexposed surface. The next higher evaluation of 10 percent requires exfoliation , exudation or itching, if involving an exposed surface. The veteran's healed scar at the tip of the nose has not been productive of impairment contemplated in the 10 percent evaluation under diagnostic code 7806. The Board has also considered application of diagnostic codes 7803, 7804, and 7805. Under diagnostic code 7803 a 10 percent evaluation may be assigned for scars which are poorly nourished with repeated ulceration. This has not been shown in the case of the nose scar. A 10 percent evaluation may be assigned under diagnostic code 7804 for scarring which is tender and painful on objective demonstration. This has not been shown by the evidence of record. An evaluation may be predicated on the basis of limitation of function of the anatomical part affected under diagnostic code 7805. No limitation on function of the scar at the tip of the nose has been shown on examination. As was reported by VA in February 1992, the scar on the nose was not disfiguring. Under diagnostic code 7800, a noncompensable evaluation may be assigned for slightly disfiguring scars of the head, face, or neck. The next higher evaluation of 10 percent requires moderate disfigurement. As moderate disfigurement is not shown, there is no basis upon which to predicate a grant of an increased (compensable) evaluation. No medical basis has been presented upon which to predicate a grant of an increased evaluation for the basilar cell carcinoma at the tip of the nose under the criteria of 38 C.F.R. §§ 3.321(b)(1), 4.7. It is the judgment of the Board that the record does not support a grant of an increased (compensable) evaluation for postoperative basilar cell carcinoma at the tip of the nose. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.118, Diagnostic Codes 7800 7803, 7804, 7805, 7806 (1994). ORDER The claims for service connection for high cholesterol, uvula palate enlargement with sleep apnea, irregular heartbeat claimed as regular heartbeat, heart disease, electrocardiogram abnormalities, and deviated nasal septum are dismissed. Entitlement to an increased evaluation for chondromalacia of the right knee is denied. Entitlement to an increased evaluation for asthma with bronchitis is denied. Entitlement to an increased evaluation for anxiety disorder with features of post-traumatic stress disorder is denied. Entitlement to an increased (compensable) evaluation for bilateral hearing loss is denied. Entitlement to an increased (compensable) evaluation for serum hepatitis is denied. Entitlement to an increased (compensable) evaluation for basilar cell carcinoma is denied. 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.