BVA9500890 DOCKET NO. 93-05 783 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Seattle, Washington THE ISSUES 1. Entitlement to service connection for a right eye disorder. 2. Entitlement to service connection for a back disorder. 3. Entitlement to service connection for a bilateral wrist disorder. 4. Entitlement to service connection for a right ankle disorder. 5. Entitlement to service connection for a right knee disorder. 6. Entitlement to an increased (compensable) evaluation for residuals of a left foot injury. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD James A. Frost, Associate Counsel INTRODUCTION The veteran served on active duty from November 1982 to January 1991. This appeal arises from rating decisions of June 1991 and May 1992 by the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. Jurisdiction over the veteran's claims has been transferred to the RO in San Diego, California. In his notice of disagreement, received at the RO in April 1992, the veteran asserted a claim of entitlement to service connection for a right knee disorder. The claim was denied by a rating decision in May 1992. He again raised the issue in his substantive appeal, received at the RO in July 1992. The United States Court of Veterans Appeals has held that the Board of Veterans' Appeals (the Board) must review all issues reasonably raised by a liberal reading of the substantive appeal. Myers v. Derwinski, 1 Vet.App. 127 (1991). The Board, therefore, finds that the issue of entitlement to service connection for a right knee disorder is in appellate status. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he continues to have pain in his right ankle and back since injuries in service. He further contends that he sustained injuries in service to his right eye, right knee and both wrists. Finally, he contends that his left foot, which was injured in service, is sore at times. 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 preponderance of the evidence is against the veteran's claims of entitlement to service connection for disorders of the right eye, wrists and right knee and to a compensable evaluation for residuals of a left foot injury and that the record supports an allowance of service connection for disorders of the back and right ankle. FINDINGS OF FACT 1. A laceration of the lid of the right eye in service was acute and transitory and resolved without producing chronic disability. 2. A claimed disorder of the wrists was not present in service, nor is it attributable to any incident or manifestation in service. 3. A right knee strain in service was acute and transitory and resolved without producing chronic disability. 4. A back disorder was present in service and has persisted since then. 5. A preexisting right ankle disorder was asymptomatic at service entrance and increased in severity during service beyond normal progression. 6. Residuals of a left foot injury are primarily manifested by occasional pain on use, which is productive of no more than slight impairment. CONCLUSIONS OF LAW 1. A right eye disorder was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.303(b) (1994). 2. A bilateral wrist disorder was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 5107. 3. A chronic right knee disorder was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303(b). 4. A back disorder was incurred in service. 38 U.S.C.A. §§ 1110, 1131, 5107. 5. A right ankle disorder was aggravated in service. 38 U.S.C.A. §§ 1153, 5107 (West 1991); 38 C.F.R. § 3.306(b) (1994). 6. The schedular and extraschedular criteria for a compensable evaluation for residuals of a left foot injury are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.71a and Code 5284 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, the Board notes that the veteran's claims are "well- grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented claims which are plausible. The Board is also satisfied that all relevant facts have been properly developed. No further assistance to the veteran is required to comply with the duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a). I. Right Eye Disorder Service medical records disclose that, in October 1988, while playing basketball, the veteran was accidentally elbowed in the right eye. On examination a small 1/2-centimeter laceration to the lid of the right eye was observed. There was edema of the upper and lower lids; there was no bleeding. Visual acuity of the right eye was 20/25. There was some redness of the right eye, which was a little watery. The assessment was laceration of the lid of the right eye. The right eyelid was sutured. The following week the sutures were removed. There was no redness, edema or drainage at the site of the sutures. However, there was some bright redness of the right eye, due to subconjunctival hemorrhage. The assessment was suture site healing properly. Subsequent service medical records are negative for any complaint, diagnosis or treatment of an eye injury or disease. At an examination for service separation in April 1990, the veteran's eyes were evaluated as normal and his vision was 20/20, bilaterally. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131. Where a condition is not noted to have been chronic in service, continuity of symptomatology after service is required to support a claim of entitlement to service connection. 38 C.F.R. § 3.303(b). In the veteran's case, although he suffered a laceration to the lid of the right eye in 1988, the record indicates that the injury was acute and transitory and resolved without producing any chronic impairment of vision or other functional limitation. The veteran has not presented any evidence that he currently has any residuals of the eyelid laceration. Accordingly, in the absence of a showing of continuity of symptomatology, service connection for a right eye disorder is not established. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(b). II. The Wrists At an examination for service separation in April 1990, the veteran complained that his wrists were sore and would crack and pop. Subsequent service medical records until his separation from service in January 1991 are, however, negative for any further complaint, diagnosis or treatment concerning the wrists. The veteran has not presented any evidence that he currently has a disorder of the wrists. Service connection for a bilateral wrist disorder is thus not established. 38 U.S.C.A. §§ 1110, 1131. III. Right Knee Service medical records disclose that, in December 1990, the veteran complained of a sharp pain in the right knee after he bumped it on a table. On examination, extension of the right knee was painful; there was tenderness over the lateral aspect of the right knee. The assessment was sprain/strain of the lateral collateral right knee. VA X-rays of the right knee in March 1991 were negative. At a VA examination in March 1991 the right knee was stable and essentially normal. As the record does not show that the veteran has any current disability of the right knee, service connection for such a disorder is not established. 38 U.S.C.A. §§ 1110, 1131. IV. The Back Service medical records disclose that, in March 1989 the veteran complained of back pain, with occasional tingling in his legs, for one week after lifting heavy radar equipment. Upon inhalation, he had sharp pain in his lower back. On examination by a nurse practitioner, his gait was guarded and halting; there was mild paraspinous muscle tenderness and tightness in the thoracolumbar area. Range of motion was good but full movement of the back was painful. Straight leg raising was positive. Knee jerks and Achilles reflexes were 1/4 and bilateral. X-rays were reviewed by a physician, who noted an irregularity at L1-2. The diagnosis was lumbosacral strain. A radiologist interpreted the X-rays as within normal limits and did not note any evidence of a fracture. The veteran was advised to rest in bed and take medication. At examination for service separation in April 1990 the veteran did not complain about his back. However, in December 1990 he did complain of low back pain off and on. On examination flexion of the lumbosacral spine was limited by comfort. X-rays showed an old fracture of L3. The assessment was low back pain. At a VA examination in March 1991, the veteran indicated that his complaint was about pain in the inner scapular area, which had become chronic. In service he had had an episode of lower back pain but lumbosacral films were negative. On examination range of motion of the dorsal spine was only 50 percent of normal; range of motion of the back was 70 percent of normal, but it was more muscular tightness than actual pain; straight leg raising was negative. Impressions included dorsal back pain and an episode of low back pain. As noted above, on VA examination, the veteran's back was symptomatic. There is no evidence of record that he sustained an intercurrent injury to the back after his separation from service. The Board finds that the evidence is in equipoise on the question of whether his current limitation of motion and discomfort of the back are related to the lifting injury in service. Resolving the doubt on that issue in the veteran's favor, service connection for a back disorder will be established. 38 U.S.C.A. §§ 1110, 1131, 5107. V. Right Ankle and Left Foot In a report of medical history for enlistment in March 1982, the veteran reported that six months earlier he had a severe sprain of his right ankle, without a fracture; he now had full use of the right ankle, including running and basketball. In November 1988 he complained of bilateral foot pain; he gave a history of a left foot fracture five years earlier. On examination his feet and arches had full range of motion; his gait was normal; the ankles were stable with no pain on palpation. The assessment was metatarsalgia with vague objective findings. Motrin and ice packs were prescribed. In April 1989 at an emergency room the veteran complained of right ankle pain. He was playing basketball and landed on another player. On examination the lateral right ankle was tender and swollen. X-rays of the right ankle and foot showed soft tissue swelling adjacent to the lateral malleolus and a small bony fragment distal to the medial malleolus, which might represent an avulsion fracture. A few days later, the veteran was ambulating on crutches. On examination the right ankle had minimal inflammation; the malleolus region was tender to palpation; range of motion was full. X-rays showed a questionable old avulsion fracture from seven years earlier. The assessment was mild right ankle sprain versus avulsion fracture. At the examination for service separation in April 1990 the veteran complained that his ankles were frequently sore and would crack and pop. In June 1990 he complained that he had turned his left ankle. On examination there was swelling of the anterior proximal left foot. X-rays showed a fracture of the navicular bone at the dorsal insertion. At an orthopedic consultation the veteran indicated that he had sprained his left foot/ankle several times a few years earlier. He was fully ambulatory, with full weight bearing without pain; the left ankle had full range of motion without pain or laxity. All bony structures of the left foot were nontender to palpation; there was no appreciable swelling. Sensory was intact in all distributions. X-rays showed a 5-millimeter avulsion of the navicular bone. The assessment was minor left ankle/foot sprain. In December 1990 the veteran complained of recurrent pain in the left ankle. On examination there was tenderness over the left lateral malleolus. The assessment was left ankle pain. VA X-rays of the feet in March 1991 were negative. X-rays of the right ankle showed a probable small avulsion fracture. At the VA examination in March 1991, the veteran complained of soreness of the left foot and pain in the right ankle. On examination he performed heel and toe walking with difficulty due to foot and ankle pain. The right ankle had full range of motion; drawer sign was negative. Impressions included a negative examination of the left foot and status post severe sprain of the right ankle. With reference to the right ankle, the record shows that, although the veteran sustained an injury prior to service, the right ankle was asymptomatic when he entered service in 1982. The severe ankle strain he suffered in 1989 constituted an increase in the severity of the preexisting right ankle condition. At the VA examination in 1991 right ankle pain was still imposing a functional limitation. Applicable law and regulations provide that, where a preservice disability undergoes an increase in severity during service, there is a presumption of aggravation which can only be rebutted by clear and unmistakable evidence (obvious or manifest) that the increase in severity was due to natural progression. In the absence of such evidence in this case, service connection for a right ankle disorder will be established. 38 U.S.C.A. § 1153, 38 C.F.R. § 3.306(b). With reference to the left foot, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Diagnostic Code 5284 provides a 10 percent evaluation for a moderate foot injury. A slight foot injury is noncompensable. As the veteran's left foot was asymptomatic at the VA examination in 1991, a compensable evaluation is not in order. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.71a, Code 5284. The veteran's left foot does not present an exceptional or unusual disability picture, with such related factors as frequent hospitalizations or marked interference with employment, so as to render impractical the application of regular schedular standards. An extraschedular evaluation is thus not in order. 38 C.F.R. § 3.321(b)(1). While the Board has considered the doctrine of affording the veteran the benefit of any existing doubt with regard to the issues on appeal for which the benefits sought were not granted, the record does not demonstrate an approximate balance of positive and negative evidence as to warrant resolution of this matter on that basis. 38 U.S.C.A. § 5107(b). ORDER Service connection for a right eye disorder is denied. Service connection for a bilateral wrist disorder is denied. Service connection for a right knee disorder is denied. An increased (compensable) evaluation for residuals of a left foot injury is denied. Service connection for a back disorder is granted. Service connection for a right ankle disorder is granted. 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.