Citation Nr: 0005667 Decision Date: 03/02/00 Archive Date: 03/14/00 DOCKET NO. 94-27 581 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUES 1. Entitlement to service connection for the residuals of a compression fracture of the thoracic spine. 2. Entitlement to service connection for a lung disability. 3. Entitlement to service connection for a left knee disability. 4. Entitlement to service connection for a left hip disability. 5. Entitlement to service connection for the residuals of a left ankle stab wound. 6. Entitlement to service connection for chronic ear aches. 7. Entitlement to service connection for the residuals of a sprain of the left hand index finger. 8. Entitlement to service connection for a right hand disability. 9. Entitlement to service connection for the residuals of an insect bite. 10. Entitlement to an increased rating for degenerative disc disease of the lumbosacral spine, currently evaluated as 20 percent disabling. 11. Entitlement to an increased (compensable) rating for a chronic fungus infection of both feet. 12. Entitlement to an increased (compensable) rating for degenerative arthritis of the right knee. 13. Entitlement to an increased (compensable) rating for arterial hypertension. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Michael E. Kilcoyne, Counsel INTRODUCTION The veteran retired from active military service in July 1993, after serving more than 21 years. A perfected appeal to the Board of Veterans' Appeals (Board) of a particular decision entered by a Department of Veterans Affairs (VA) regional office (RO) consists of a notice of disagreement in writing received within one year of the decision being appealed and, after a statement of the case has been furnished, a substantive appeal received within 60 days of the issuance of the statement of the case or within the remainder of the one-year period following notification of the decision being appealed. The present case arises from a March 1994 rating action, with which the veteran expressed disagreement in April 1994. A statement of the case was issued in May 1994, and the appeal was perfected by the submission of a VA Form 9 (Appeal to Board of Veterans' Appeals), which was received at the RO in July 1994. In December 1998, the veteran appeared at a Travel Board hearing conducted by the undersigned Member of the Board, at the RO in St. Petersburg, FL. Unfortunately, the tape on which that hearing was recorded was damaged, and it was not possible to obtain a transcript of it. In view of that, the veteran was advised of this fact in a letter addressed to him in March 1999, and was asked to inform the Board whether he desired to appear at another Travel Board hearing, or whether he wished to forego a second hearing and have the Board consider his case on the current record. The veteran was also informed that, if he did not respond to the above letter within 30 days, it would be assumed he wished to attend another hearing before a Member of the Board at the RO, and that arrangements would be made to accomplish that in due course. Since no response was received from the veteran, his claim was remanded to the St. Petersburg RO, from which the appeal had originated, in order to have the veteran scheduled for another hearing. In June 1999, the veteran advised the St. Petersburg RO that he had moved to Indiana, and requested that his hearing be moved to Indianapolis, IN. Shortly thereafter, the veteran's claims file was transferred to the RO in Indianapolis, and, in a letter to the veteran from that RO dated in July 1999, the veteran was advised that a Board Member had previously visited that RO to conduct hearings in March 1999, and that no further hearings were scheduled at that location for the remainder of 1999. The veteran was also advised that the proposed schedule for hearings by Board Members at that RO, for the year 2000, had not yet been published. Accordingly, the veteran was informed that if he decided he still wanted to have a hearing before a Board Member, his claims might be subject to considerable delay. The veteran was asked whether he still desired to appear at a hearing before a Member of the Board at the RO, or whether he would prefer other hearing options. These options included attending a hearing before a hearing officer at the RO, attending a hearing before a Board Member in Washington, DC, attending a hearing at the Louisville, KY, RO with a Board Member via teleconference, or attending a hearing at the Chicago, IL, RO with a Board Member via teleconference. In August 1999, the veteran advised that he desired to appear at a hearing before a hearing officer at the local VARO. Pursuant to the veteran's instructions, he was scheduled to appear at a hearing at the RO in November 1999. The record reflects, however, that he did not appear for that hearing, and, the following day, the RO advised the veteran that his claims file was being forwarded to the Board in Washington, DC, for appellate review. To date, the record does not reflect that the veteran has offered any explanation for his failure to report for the November 1999 hearing, or that he desires to have any further hearings scheduled. Accordingly, the Board will proceed to address the veteran's claims based upon the current record. FINDINGS OF FACT 1. The veteran's assertion that he has disabilities affecting the thoracic spine, the lungs, the left ankle, the left index finger, and the right hand, which are related to service, is not supported by medical evidence that would render the claims for service connection for those disabilities plausible under the law. 2. The veteran's assertion that he has disabilities that are the residuals of insect bites or manifested by ear aches, which are related to service, is not supported by medical evidence that would render the claims for service connection for those disabilities plausible under the law. 3. The veteran had a permanent duty profile limiting his activity during the last three years of his military service, due, in part, to left knee and left hip complaints. 4. Post-service records dated within a year of the veteran's retirement from service include diagnoses of left knee chondromalacia and left knee arthritis, together with complaints of left hip discomfort. 5. The veteran's chronic, bilateral fungus foot infection is on a nonexposed surface or small area and is not shown to be productive of more than slight, if any, exfoliation, exudation, or itching. 6. The veteran's arterial hypertension is not shown to be productive of a history of diastolic pressure predominantly 100 or more, or a systolic pressure of predominantly 160 or more. CONCLUSIONS OF LAW 1. The veteran has not submitted a well-grounded claim for service connection for the residuals of a compression fracture of the thoracic spine. 38 U.S.C.A. § 5107 (West 1991). 2. The veteran has not submitted a well-grounded claim for service connection for a lung disability. 38 U.S.C.A. § 5107 (West 1991). 3. The veteran has not submitted a well-grounded claim for service connection for the residuals of a left ankle stab wound. 38 U.S.C.A. § 5107 (West 1991). 4. The veteran has not submitted a well-grounded claim for service connection for chronic ear aches. 38 U.S.C.A. § 5107 (West 1991). 5. The veteran has not submitted a well-grounded claim for service connection for the residuals of a sprain of the left hand index finger. 38 U.S.C.A. § 5107 (West 1991). 6. The veteran has not submitted a well-grounded claim for service connection for a right hand disability. 38 U.S.C.A. § 5107 (West 1991). 7. The veteran has not submitted a well-grounded claim for service connection for the residuals of an insect bite. 38 U.S.C.A. § 5107 (West 1991). 8. The veteran has submitted a well-grounded claim for service connection for a left knee disability. 38 U.S.C.A. § 5107(a) (West 1991). 9. The veteran has submitted a well-grounded claim for service connection for a left hip disability. 38 U.S.C.A. § 5107(a) (West 1991). 10. The criteria for a compensable evaluation for a chronic fungus infection of both feet are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2. 4.7, 4.31, Diagnostic Code 7806 (1999). 11. The criteria for a compensable evaluation for arterial hypertension are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2. 4.7, 4.31, Diagnostic Code 7101 (as in effect prior to and since January 1998). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection The threshold question to be answered regarding these claims is whether they are well grounded. 38 U.S.C.A. § 5107 (West 1991); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). If they are not, they must fail and there is no further duty to assist in their development. 38 U.S.C.A. § 5107; Murphy v. Derwinski, 1 Vet.App. 78 (1990). This requirement has been reaffirmed by the United States Court of Appeals for the Federal Circuit, in its decision in Epps v. Gober, 126 F.3d 1464, 1469 (Fed. Cir. 1997), cert. denied, 118 S. Ct. 2348 (1998). That decision upheld the earlier decision of the United States Court of Appeals for Veterans Claims (formerly known as the United States Court of Veterans Appeals) which made clear that it would be error for the Board to proceed to the merits of a claim which is not well grounded. Epps v. Brown, 9 Vet.App. 341 (1996). See Morton v. West, 12 Vet.App. 477, 480 (1999) (noting that the Federal Circuit, in Epps v. Gober, supra, "rejected the appellant's argument that the Secretary's duty to assist is not conditional upon the submission of a well-grounded claim"). The Court of Appeals for Veterans Claims has also held that, in order to establish that a claim for service connection is well-grounded, there must be competent evidence of: (1) a current disability (a medical diagnosis); (2) the incurrence or aggravation of a disease or injury in service (lay or medical evidence); and (3) a nexus (that is, a link or a connection) between the in-service injury or aggravation and the current disability. Competent medical evidence is required to satisfy this third prong. Caluza v. Brown, 7 Vet.App. 498 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). See Elkins v. West, 12 Vet.App. 209 (1999) (en banc). "Although the claim need not be conclusive, the statute [38 U.S.C.A. § 5107] provides that [the claim] must be accompanied by evidence" in order to be considered well grounded. Tirpak v. Derwinski, 2 Vet.App. 609, 611 (1992). In a claim of service connection, this generally means that evidence must be presented which in some fashion links the current disability to a period of military service or to an already service-connected disability. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1996); Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992); Montgomery v. Brown, 4 Vet.App. 343 (1993). Evidence submitted in support of the claim is presumed to be true for purposes of determining whether it is well grounded. King v. Brown, 5 Vet.App. 19, 21 (1993). Lay assertions of medical diagnosis or causation, however, do not constitute competent evidence sufficient to render a claim well grounded. Grottveit v. Brown, 5 Vet.App. 91, 93 (1992); Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992). Under applicable criteria, service connection may be granted for disability resulting from disease or injury which was incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1999). Service connection for arthritis may be presumed if it became manifest to a degree of 10 percent disabling during the veteran's first year after separation from service. 38 U.S.C.A. § 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). A. Thoracic Spine, Left Ankle, Chronic Ear Aches, Left Index Finger, Right Hand, Insect Bite A review of the veteran's service medical records reflects that, in 1977, he was treated for back pain, and a muscle spasm was noted at the area of T-10 to L-1 (from the tenth thoracic vertebra to the first lumbar vertabra). Thereafter, however, there are no records relating to the thoracic spine until January 1987, when X-rays of the back were taken in connection with complaints of low back pain. In pertinent part, those X-rays revealed "minimal wedging of T-11 and T- 12," as well as minimal reduction in height of the posterior aspect of the T-11 disc space. In connection with low back complaints in 1993, additional X-rays were taken in February of that year. They revealed, in pertinent part, that the T- 12 vertebra appeared somewhat wedged anteriorly, which was considered to be consistent with an old minimal compression fracture. Subsequently, no specific findings regarding the veteran's thoracic spine were recorded in the report of the examination conducted in connection with his retirement from active service in June 1993. In September 1993, the veteran was examined for VA purposes. The report from this examination did not include any findings regarding a disability of the thoracic spine. Similarly, when he was again examined by VA in February 1994, the report from that examination revealed no findings regarding a disability of the thoracic spine, and none of the post- service outpatient treatment records obtained in connection with the veteran's claim (dated in 1993 and 1994) has revealed the presence of any thoracic spine disability. As to the veteran's claim concerning the residuals of insect bites, his service medical records reflect that, in 1983, he was seen by medical personnel after having been bitten by a "bug." At that time, he was evidently provided medication, and referred for a consultation with a dermatologist. Subsequently dated records, however, do not reflect any follow-up in that regard. Ten years later, in January 1993, the veteran was seen again by medical personnel following his report of having an insect bite on his right lower extremity. The presence of cellulitis was noted about the site; on the next day, it was described as resolving. Thereafter, no further pertinent findings were recorded in the service medical records, and, when he was examined for VA purposes in September 1993 and February 1994, there were no findings entered into the record regarding any residuals of insect bites. Similarly, the post-service outpatient treatment records associated with the file do not reflect any complaints or diagnoses related to insect bites. With respect to the veteran's claim for service connection for a left index finger disability, a review of his service medical records reflects that, in 1987, he received treatment to his left index finger after striking it with a hammer. X- rays, however, revealed no evidence of a fracture or dislocation, and the diagnostic assessment was of a first- digit contusion. Following service, none of the outpatient treatment records, dated in 1993 and 1994, reflects the presence of any left index finger impairment, and there was no left finger disability noted when the veteran was examined for VA purposes in September 1993 and February 1994. As to the veteran's claim regarding a left ankle impairment, service medical records, dated in 1989, reflect that he was treated for a left ankle sprain. There was no indication, however, of any stab wound to that joint. Similarly, when he was examined for VA purposes in 1993 and 1994, there were no findings regarding the residuals of any left ankle stab wound. Moreover, there were no findings or complaints regarding the residuals of a left ankle stab wound noted in the post-service outpatient treatment records associated with the claims file. With respect to a right hand disability, the service medical records reflect that, in July 1990, the veteran was seen for right hand pain at the fourth digit, which occurred after he removed a splinter from that location. Examination revealed that the veteran had a swollen knuckle, and, on the following day, medical personnel removed an additional foreign body from that area. Subsequently dated service medical records show no further pertinent complaints, and none were noted upon VA examinations in September 1993 and February 1994. Post service outpatient treatment records, dated in 1993 and 1994, also fail to show the presence of any disability of the right hand. Regarding the veteran's claim for service connection for chronic ear aches, a review of his service medical records fails to show any records in which he was diagnosed to have a disability manifested by chronic ear aches. Similarly, no such disability was diagnosed when the veteran was examined following service in 1993 or 1994, or in any post-service outpatient treatment records. Under the circumstances described above, the Board must respectfully conclude that the veteran has failed to satisfy the threshold requirement for submitting well-grounded claims for service connection for the residuals of a compression fracture of the thoracic spine, the residuals of a left ankle stab wound, chronic ear aches, the residuals of a sprain of the left hand index finger, a right hand disability, and/or the residuals of an insect bite, as set out in the judicial precedent in Caluza, supra, and as imposed by 38 U.S.C.A. § 5107(a), because he has failed to present any medical evidence reflecting the current presence of any of these claimed disabilities. In view of this, there is no duty to assist the veteran further in the development of the claims, and the Board does not have jurisdiction to adjudicate them. Boeck v. Brown, 6 Vet.App. 14 (1993), Grivois v. Brown, 6 Vet.App. 136 (1994). As claims that are not well grounded do not present a question of fact or law over which the Board has jurisdiction, the claims for service connection for the residuals of a compression fracture of the thoracic spine, the residuals of a left ankle stab wound, chronic ear aches, the residuals of a sprain of the left hand index finger, a right hand disability, and the residuals of an insect bite, must be denied. B. Lungs Regarding the veteran's claim for service connection for a lung disability, a review of his service medical records discloses that, in X-rays taken in November 1988, he was considered to have a normal chest. The lungs were reportedly well inflated and free of acute or active chronic inflammatory process or tumor. Similarly, additional chest X-rays taken in May 1993, shortly before the veteran's retirement, revealed what was described as a normal chest. The reports of VA examinations, in September 1993 and February 1994, also fail to show any findings related to disability of the lungs. Indeed, in the February 1994 examination report, it was specifically noted that there were no pulmonary symptoms. The only post-service treatment record reflecting that there may be some lung impairment present is a March 1994 outpatient treatment record, on which it was noted that there was an abnormal sound heard emanating from the veteran's right middle lung. The diagnostic impression was "rule out" pneumonia. Significantly, however, there was no indication in that record that the finding was considered in any way to be related to the veteran's service. Thus, while it may well be that the veteran has, as he contends, a blemish on his lung that arose from pneumonia he had in service, there is no medical evidence indicating that this causes any impairment. Since the record is devoid of any diagnosis of a chronic lung impairment in service, and there is no medical opinion linking, to service, the abnormal lung sound heard upon examination after service, it is the Board's view that the veteran has failed to satisfy the threshold requirement for submitting a well-grounded claim for service connection for a lung disability, as required by Caluza, supra, and as imposed by 38 U.S.C.A. § 5107(a). Under these circumstances, there is no duty to assist the veteran further in the development of his claim, and the Board does not have jurisdiction to adjudicate it. Boeck and Grivois, supra. As claims that are not well grounded do not present a question of fact or law over which the Board has jurisdiction, the claim for service connection for a lung disability must be denied. C. Left Knee Regarding the veteran's left knee, his service medical records reflect that, in 1981, he apparently was seen for complaints of left sided knee pain. X-rays taken at that time, however, revealed that there was no significant abnormality. Records dated in 1986 again show that the veteran was seen for left knee pain. Examination revealed that there was no edema or ecchymosis. There was, however, slight tenderness with palpation to the posterior knee. The final clinical assessment was left knee pain of questionable etiology. A report dated in 1988 revealed that the veteran described experiencing occasional left knee pain, and records dated in June 1990 reflect that the veteran was given a permanent duty profile whereby he had permission to limit his running to a distance not to exceed 2 miles, and to run at his own pace, in part, because of left knee pain. Following service, the veteran underwent an examination for VA purposes in September 1993. The report from this examination revealed that there was no swelling of the knees, and that range of motion of the knees was considered normal. Although X-rays of the left knee were interpreted as normal, the diagnosis entered on the report was "Chondromalacia, both knees." Outpatient treatment records, dated in December 1993, reflect that the veteran was seen for complaints of left knee pain, and that he gave a history of pain with locking of the knee. Examination revealed the presence of swelling, and it was suspected that the veteran had degenerative joint disease. Outpatient treatment records dated two days later again show that the veteran was considered to have degenerative joint disease of the left knee. In February 1994, the veteran underwent another VA examination. In the report thereof, it was noted that the veteran advised that his left knee began bothering him in the late 1980's, although there was no specific injury. It was also recorded that he had arthroscopic surgery on that knee in January 1994, after he developed severe pain, locking, and swelling in December 1993. The surgery reportedly included debridement of the medial and lateral meniscus, and of the femoral condyles. The veteran also reported that a medial and lateral meniscus tear was found. At the time of the VA examination, the knee was still swollen and painful, as well as productive of a 15-degree loss of flexion. The diagnosis was "Post op status, post traumatic arthritis, left knee." Since the evidence in this case shows that the veteran had sufficient left knee complaints in service to require a permanent profile limiting his running during his last three years of service, and because there are post-service records dated within a year of the veteran's retirement from service that show a diagnosis of left knee chondromalacia and left knee arthritis, the Board finds that the veteran's claim for service connection for a current left knee disability is well grounded. D. Left Hip As to the veteran's claim concerning his left hip, a review of his service medical records shows that, in December 1987, he was seen for follow-up in regards to what was described as bilateral hip degenerative joint disease. This record also indicates that X-rays had been interpreted as showing bilateral degenerative joint disease. Unfortunately, the evidence does not include any records that show the original treatment from which this December 1987 treatment was a follow-up, nor does the record contain the actual report of the X-rays which presumably provided the basis for concluding that degenerative joint disease was present in the hips. In 1989, however, the veteran was again seen for complaints of left hip pain, for which he was provided medication. A follow-up record, dated in January 1990, noted that the veteran had been asymptomatic since using the medication, but, in June 1990, he was given permanent limited duty profile, whereby he was to run at his own pace, not to exceed 2 miles, in part, because of his left hip pain. The report of the examination conducted in connection with the veteran's service retirement, in 1993, contains a notation regarding the 1987 finding of degenerative joint disease of both hips, but does not include any current findings in that regard. In connection with the veteran's current claim, he was examined for VA purposes in September 1993. The report from that examination reveals that the veteran complained that cold weather would give his left hip "trouble." At that time, however, the veteran had a normal range of motion of his hips, although it was noted that he had trouble going from a sitting to a lying position and from a lying to a sitting position. X-rays of the left hip were interpreted as "essentially normal," although the examination report itself reflects that the veteran was diagnosed to have "probably degenerative joint disease, left hip." Upon VA examination in February 1994, there were no findings made with respect to that specific joint, other than to note that pain complaints in the area were attributed to radiculopathy from the veteran's degenerative disc disease in his lumbosacral spine. Since the evidence in this case shows that the veteran was diagnosed to have degenerative joint disease of the left hip in service, he had sufficient in-service left hip complaints to require a permanent profile limiting his running during the last three years of his service, and there are post- service records reflecting current discomfort in the left hip, the Board finds that the veteran's claim for service connection for a left hip disability is well grounded. II. Increased Ratings The law provides that claims for increased ratings are, in general, well grounded within the meaning of 38 U.S.C.A. § 5107, since an assertion by a claimant that a condition has worsened is sufficient to state a plausible, well-grounded claim. See Jackson v. West, 12 Vet.App. 422, 428 (1999), citing Proscelle v. Derwinski, 2 Vet.App. 629, 632 (1992). The veteran has asserted that the service-connected disabilities in issue are worse than currently evaluated by the RO, and he has, therefore, stated well-grounded claims. With that initial burden having been satisfied, VA has a duty to assist the veteran in the development of facts pertaining to his claims. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1996). The Court has held that the duty to assist includes obtaining available records which are relevant to the claimant's appeal, and that this duty is neither optional nor discretionary. Littke v. Derwinski, 1 Vet.App. 90 (1990). In this regard, the RO has obtained the reports of VA examinations of the veteran, as well as outpatient treatment records. With respect to the evaluation of the veteran's fungus infection and arterial hypertension, the veteran has not indicated that any further relevant records are available. Therefore, we conclude that the duty to assist with respect to these claims has been satisfied. Disability evaluations are determined by the application of a schedule of ratings which is based on the average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. 38 C.F.R. § 4.1 requires that each disability be viewed in relation to its history and that there be emphasis upon the limitation of activity imposed by the disabling condition. 38 C.F.R. § 4.2 requires that medical reports be interpreted in light of the entire recorded history, and that each disability must be considered from the point of view of the veteran's working or seeking work. 38 C.F.R. § 4.7 provides that, where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. At the same time, in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. The requirements for evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decisions based upon a single, incomplete, or inaccurate report and to enable VA to make a more precise evaluation of the level of the disability and of any changes in the condition. Schafrath v. Derwinski, 1 Vet.App. 589 (1991). Moreover, VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. A. Fungus Infection A review of the record reflects that, while in service, the veteran was treated at various times for crusty, scaly lesions between his toes, and a foot fungus. His retirement examination in June 1993, however, showed that the skin was normal upon clinical evaluation. In August 1993, the veteran submitted an application for VA benefits, based in part upon his skin condition, and, in September 1993, he underwent a VA medical examination. The report from this examination noted that there were several small crusted areas at the base of the veteran's toes and the dorsum of his feet, bilaterally. There were, however, no blisters noted at the time, and the diagnosis was fungus infection, skin of both feet, around the toes. In February 1994, the veteran underwent another VA examination, at which time he indicated that his fungus infection was "in good shape today." Physical inspection revealed that no evidence of fungal infection was noted. The diagnosis was history of fungus, toenails, bilateral. In the March 1994 rating action currently on appeal, the veteran was awarded service connection for his bilateral foot fungus infection, and was assigned a noncompensable evaluation. Thereafter, post-service outpatient treatment records were associated with the claims file, dated in 1993 and 1994. They fail to show any treatment for the veteran's skin condition. The veteran's foot fungus has been evaluated under the provisions of 38 C.F.R. § 4.118, Diagnostic Code 7805, for eczema. Under this code, a noncompensable evaluation is assigned with slight, if any, exfoliation, exudation, or itching, if on a nonexposed surface or small area. A 10 percent evaluation is assigned with exfoliation, exudation, or itching, if involving an exposed surface or extensive area. In this case, the veteran's skin condition affects a small non-exposed area, his feet. While, in September 1993, small crusted areas at the base of the veteran's toes and dorsum of his feet were noted, the most current evidence shows that the condition was asymptomatic. Clearly, this evidence does not show more than slight, if any, exfoliation, exudation, or itching, on a nonexposed surface or small area. In view of this evidence, the criteria for a compensable evaluation for the veteran's chronic fungus infection of both feet are not met. B. Arterial Hypertension A review of the service medical records discloses occasions when the veteran's blood pressure was noted to be elevated. In particular, records dated in January 1993 reflect that it was 140/90. When recorded February 1993, the veteran's blood pressure levels were 140/92, 138/65, 161/93, and 152/85. In March 1993 records, the veteran's blood pressure was recorded at 134/90, and, when his blood pressure was recorded in April 1993, it was 155/94. In June 1993 treatment records, his blood pressure was variously recorded at 138/84, 163/99, 166/99, 160/100, and 147/103. When examined in connection with his retirement from active service, the veteran's blood pressure was 157/108. In connection with the veteran's current claim for benefits, he underwent VA examination in September 1993. At that time, his sitting blood pressure was 158/98, his recumbent blood pressure was 136/88, and his standing blood pressure was 148/100. Sitting after exercise, his blood pressure was 166/100, and, two minutes after exercise, the recording was 148/104. The diagnosis was mild arterial hypertension. He was examined again for VA purposes in February 1994. At that time, his sitting blood pressure level was 136/96, recumbent blood pressure level was 128/78, and blood pressure while standing was 144/90. Thereafter, outpatient treatment records, dated between December 1993 and April 1994, were associated with the claims file. These show that, in December 1993, the veteran's blood pressure was 169/110. In March 1994, he was apparently provided medication to control his blood pressure, and its level that month was recorded as 158/86 and 154/89. April 1994 records reflect that the veteran's blood pressure level was 146/92 in mid month, and 146/80 later in the month. Based upon the foregoing record, the veteran was awarded service connection for arterial hypertension, and assigned a noncompensable rating. The veteran's arterial hypertension has been evaluated under the provisions of 38 C.F.R. § 4.104, Diagnostic Code 7101. Under this code as in effect when the veteran initiated his claim in 1993, a 10 percent rating was assigned when the diastolic pressure was predominantly 100 or more. In addition, when continuous medication was shown necessary for control of hypertension with a history of diastolic blood pressure predominantly 100 or more, a minimum rating of 10 percent was to be assigned. A 20 percent rating was assigned when diastolic pressure was predominantly 110 or more with definite symptoms. During the pendency of the veteran's appeal, the criteria for evaluating diseases of the arteries and veins were revised. These changes became effective in January 1998. 62 Fed. Reg. 65,219 (December 11, 1997). Under these new criteria, a 10 percent rating under Diagnostic Code 7101 is assigned when diastolic pressure is predominantly 100 or more; or systolic pressure predominantly 160 or more, or as the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent rating is assigned with diastolic pressure predominantly 110 or more, or with systolic pressure predominantly 200 or more. The U.S. Court of Appeals for Veterans Claims has held that, where laws or regulations change after a claim has been filed or reopened and before the administrative or judicial process has been concluded, the version most favorable to the appellant will apply unless Congress provided otherwise or has permitted the Secretary of Veterans Affairs to do otherwise and the Secretary has done so. Karnas v. Derwinski, 1 Vet.App. 308, 312-313 (1991). See also Baker v. West, 11 Vet.App. 163, 168 (1998). As indicated above, the rating schedule amendments were not in effect at the time the RO issued its decision assigning a noncompensable evaluation for the veteran's hypertension and, therefore, would not have been applied by the RO in making its determination. In view of that, the Board must consider whether or not the veteran would be prejudiced if we were to proceed with appellate consideration of the claim without first giving the RO the opportunity to consider the new regulations. In this regard, the Board notes that the criteria for assigning a 10 percent evaluation for hypertension in effect prior to, and since January 1998, are nearly identical. In order to establish entitlement to a compensable evaluation, both versions require that diastolic pressure be predominantly 100 or more, or that there be a history of diastolic pressure predominantly 100 or more which requires continuous medication for control. The only difference is that, under the more recent version, a 10 percent rating may also be assigned when systolic pressure is predominantly 160 or more. Although it is the usual practice of the Board to remand a claim to the RO for initial consideration of new regulations promulgated during the pendency of an appeal, in this case, since application of the only difference between these regulations requires but a simple listing of the systolic pressure levels to determine whether most are 160 or more, a different result could not be obtained by having the RO accomplish this in the first instance. Therefore, the veteran would not be prejudiced by the Board proceeding to the merits of the claim, and a remand would only result in needless delay and impose further burdens on the RO, with no benefit flowing to the veteran. The Court has held that such remands are to be avoided. See Winters v. West, 12 Vet.App. 203 (1999) (en banc); Soyini v. Derwinski, 1 Vet.App. 540, 546 (1991); Sabonis v. Brown, 6 Vet.App. 426, 430 (1994). As can be seen from the foregoing, of the 22 blood pressure levels measured between January 1993 and December 1993 (prior to the veteran beginning his use of medication), there were only seven instances when the diastolic level was 100 or more. (Records dated after the apparent initiation of the use of medication show that the veteran's diastolic level was always below 100.) Similarly, there were only six instances when the systolic level was 160 or more. Since the evidence does not show a history of diastolic pressure predominantly 100 or more, or a systolic pressure of predominantly 160 or more, the criteria for a compensable evaluation for the veteran's arterial hypertension are not met. ORDER To the extent the Board has determined that the veteran's claim for service connection for a left knee disability is well grounded, thereby giving rise to a duty to assist in its development, the appeal is granted. To the extent the Board has determined that the veteran's claim for service connection for a left hip disability is well grounded, thereby giving rise to a duty to assist in its development, the appeal is granted. Service connection for the residuals of a compression fracture of the thoracic spine is denied. Service connection for a lung disability is denied. Service connection for the residuals of a left ankle stab wound is denied. Service connection for chronic ear aches is denied. Service connection for the residuals of a sprain of the left hand index finger is denied. Service connection for a right hand disability is denied. Service connection for the residuals of an insect bite is denied. Entitlement to an increased (compensable) rating for a chronic fungus infection of both feet is denied. Entitlement to an increased (compensable) rating for arterial hypertension is denied. REMAND Having concluded that the veteran's claim for service connection for a left knee disability is well grounded, the Board is of the opinion that additional development is necessary prior to entering a final determination regarding a decision on the underlying merits of the claim. As indicated above, while the evidence shows that the veteran's activities in service were limited due, in part, to left knee complaints, there were essentially no abnormal left knee findings recorded following the 1993 VA examination which would otherwise account for the diagnosis of left knee chondromalacia at that time. We observe that X-rays of the knee taken in September 1993 were specifically interpreted as normal. Then, when he was examined only a few months later, it was noted that the veteran had undergone surgery the month before, and he was diagnosed to have post-traumatic arthritis of the knee. The records of that surgery have not been associated with the claims file, and, in view of the essentially normal findings noted only a few months earlier, it is unclear whether the trauma with which this arthritis is associated was a post- service trauma, or was a trauma to which the knee was exposed during the veteran's military career. In order to base our decision on a complete record, it will be necessary to return the case to the RO to attempt to obtain the records of the veteran's post-service left knee surgery, as well as to have the knee examined and a medical opinion obtained regarding the nature and etiology of any current left knee impairment. Regarding disability affecting the veteran's left hip, there is clearly a conflict in the medical evidence regarding the presence and nature of such a disability. While service medical records reflect a diagnosis of degenerative joint disease, purportedly based on X-ray findings, and the veteran's activities were limited during service based in part on left hip pain, the post-service X-ray reports show that this joint was considered essentially normal, and no left hip impairment was noted when the veteran was last examined for VA purposes in February 1994. In view of this, a current examination of the veteran's hip, together with an opinion regarding the etiology of any current impairment, is necessary before a final decision on this matter can be made. Regarding the veteran's claim for increased ratings for his low back and right knee disabilities, since the veteran has essentially contended that this impairments are worse that currently evaluated by the RO, he has stated well-grounded claims. See Proscelle, supra. In this regard, however, it must be observed as an initial matter that, owing to delays associated with the veteran's requests for Travel Board hearings, the unfortunate damage to the tape recording of the 1998 Board hearing that prevented a transcription of it, and the veteran's move from the geographic jurisdiction of the RO in which he initiated his claim, the most recent medical records associated with the claims file are now more than five years old. Similarly, the most recent VA examination is nearly six years old. In view of this stale evidence, an attempt to obtain more current records concerning these disabilities and a more contemporary examination of the veteran would be useful in adjudicating his claims. Furthermore, the VA examination reports of record all pre- date the decision entered by the United States Court of Appeals for Veterans Claims (previously known as the U.S. Court of Veterans Appeals) in DeLuca v. Brown, 8 Vet.App. 202 (1995). In DeLuca, the Court stressed that, in evaluating disability in a joint or joints, VA has a duty to determine whether the joint in question exhibits weakened movement, excess fatigability, or incoordination, and whether pain could significantly limit functional ability during flare-ups or when the joint is used repeatedly over a period of time. The Court indicated that these determinations should be made by an examiner and should be portrayed by the examiner in terms of the additional loss in range of motion due to these factors (i.e., in addition to any actual loss in range of motion noted upon clinical evaluation). See Deluca, supra, at 206. In another decision, the Court has reemphasized its DeLuca holding: Under 38 C.F.R. § 4.40 (1996), the Board is required to consider the impact of pain in making its rating determination. Schafrath v. Derwinski, 1 Vet.App. 589, 593 (1991). The Board is required to provide a statement of its reasons and bases with respect to that aspect of the determination as well. Ibid (citing Gilbert, 1 Vet.App. at 58). Although section 4.40 does not require a separate rating for pain, it does promulgate guidance for determining ratings under other diagnostic codes assessing musculoskeletal function. See generally 38 C.F.R. § 4.71(a) (1996). The fact that a specific rating for pain is not required by section 4.40 does not relieve the BVA from its obligation to provide a statement of reasons or bases pertaining to that regulation. See DeLuca v. Brown, 8 Vet.App. 202, 207 (1995). Spurgeon v. Brown, 10 Vet.App. 194, 196 (1997). Since the examination reports currently of record do not address the considerations discussed by the Court in the DeLuca decision, it will be necessary to have the veteran examined under the guidelines set out in that decision, before the Board enters its determination on the matter. For the reasons set forth above, this case is being remanded to the RO for the following action: 1. The RO should ask the veteran to identify those locations at which he has received any treatment for his low back, his knees, and his left hip since his discharge from service in 1993. Upon receipt of the veteran's reply, together with any appropriate authorization, the RO should attempt to obtain, and associate with the claims file, copies of any records the veteran has identified, which are not currently part of the record on appeal. In particular, any records related to surgery apparently performed on the veteran's left knee in January 1994 should also be obtained. 2. The veteran should then be scheduled for an examination to evaluate the nature and extent of his low back disability, his left hip disability, and any disability affecting his knees. All indicated tests, and any consultations deemed necessary, should be accomplished. In addition, all examination reports should fully set forth the current complaints, pertinent clinical findings, and diagnoses affecting each of the identified joints. With respect to the veteran's low back and right knee, the extent of any functional loss present in those areas due to weakened movement, excess fatigability, incoordination, or pain on use should be noted. The examiner should also state whether any pain claimed by the veteran is supported by adequate pathology and is evidenced by his visible behavior. Any additional impairment on use should be described in terms of the degree of additional range-of-motion loss, as per the DeLuca precedent, supra, and specific findings should be made regarding range of motion of the lumbar spine and right knee, to include the extent to which that motion deviates from normal. The level of pain on motion should also be described. All opinions expressed should be supported by reference to pertinent evidence. With regard to the veteran's left knee and left hip, the examiner should identify each left knee and left hip disability currently present and then render an opinion as to whether it is at least as likely as not that any such left hip and left knee disability originated during the veteran's service. A complete rationale for any opinion expressed, with reference to supporting records, should be provided. Before evaluating the veteran, the examiner should review the claims folder, and a notation to the effect that this review of the record was accomplished should be included as part of any examination report. 3. Upon completion of the above, the RO should review the evidence, and ensure that all of the foregoing development actions have been conducted and completed in full. If any development is incomplete (for example, if any requested opinions are not provided), appropriate corrective action should be taken. 4. Upon completion of the foregoing development of the record requested by the Board, and any other development as may be deemed appropriate by the RO, the RO should enter its determination regarding the veteran's claim for increased ratings for his low back and right knee disabilities, and for entitlement to service connection for a left knee and left hip disability. If the decision results in an increased rating, and/or a grant of service connection, the veteran should be asked whether that satisfies his appeal. If he replies in the negative, or not at all, or if his claims continue to be denied, he should be furnished a supplemental statement of the case concerning all evidence added to the record since the last supplemental statement of the case in 1995, and which includes and addresses the provisions of 38 C.F.R. §§ 4.40, 4.45 as may be appropriate. The veteran should then be given an opportunity to respond, and the case returned to the Board for further appellate consideration, if otherwise in order. Although no further action is required of the veteran until he receives further notice, he has the right to submit additional evidence and argument on the matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet.App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44- 8.45 and 38.02-38.03. ANDREW J. MULLEN Member, Board of Veterans' Appeals