Citation Nr: 0005855 Decision Date: 03/03/00 Archive Date: 03/14/00 DOCKET NO. 98-18 961 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston- Salem, North Carolina THE ISSUES 1. Entitlement to compensation pursuant to 38 C.F.R. § 3.317 for chronic disability manifested by gynecological problems including dysmenorrhea, pelvic adhesions, endometriosis, menstrual problems, and the postoperative residuals of hysterectomy and salpingectomy, following service in the Southwest Asia theater of operations during the Persian Gulf War. 2. Entitlement to compensation pursuant to 38 C.F.R. § 3.317 for chronic disability manifested by shortness of breath following service in the Southwest Asia Theater of operations during the Persian Gulf War. 3. Entitlement to compensation pursuant to 38 C.F.R. § 3.317 for chronic disability from an undiagnosed illness manifested by symptoms of joint and muscle pain, severe sweats, body tightness, fatigue, and sleep impairment following service in the Southwest Asia theater of operations during the Persian Gulf War. 4. Entitlement to the assignment of a compensable disability evaluation for erosive enteritis. 5. Entitlement to the assignment of a higher rating for cold neurapraxia secondary to frostbite injury to the face, hands and feet, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: A.M. Hatley, Attorney at Law WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD A.D. Jackson, Counsel INTRODUCTION The veteran had active service with the United States Army from January 1981 to August 1992. She served in Southwest Asia from December 1990 to May 1991 in support of operation Desert Shield/Desert Storm. This matter came before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Winston-Salem, North Carolina, Regional Office (RO) of the Department of Veterans Affairs (VA). In a September 1999 letter, the Board informed the appellant that the substantive appeal received in November 1998 did not allege specific errors of law or fact with respect to the claims for increased ratings for erosive enteritis and cold neurapraxia secondary to frostbite injury to the face, hands and feet. The Board informed the appellant that pursuant to 38 C.F.R. § 20.203 she was given 60 days from the date of the letter to present a written argument or to request a hearing to present oral arguments in support of her appeal of those issues. The veteran and her attorney responded in statements received in November 1999. On further consideration, in light of the fact that the appellant noted in the VA Form 9 that she wished to appeal all issues listed on the statement of the case (SOC) and that she wanted a personal hearing (in which she later discussed the increased ratings issues) the Board shall accept jurisdiction over these issues. Further, in regard to the service-connected cold neurapraxia, this appeal is before the Board from the initial assignment of a disability evaluation for this disorder. The Board notes that the U.S. Court of Veterans Appeals (now the U.S. Court of Appeals for Veterans Claims, hereinafter the Court), in Fenderson v. West, 12 Vet. App. 119 (1999) held, in part, that the RO never issued a statement of the case concerning an appeal from the initial assignment of a disability evaluation, as the RO had characterized the issue in the statement of the case as one of entitlement to an increased evaluation. Fenderson involved a situation in which the Board had concluded that the appeal as to that issue was not properly before it, on the basis that a substantive appeal had not been filed. This case differs from Fenderson in that the appellant did file a timely substantive appeal concerning the initial rating to be assigned for the disability at issue. The Board observes that the Court, in Fenderson, did not specify a formulation of the issue that would be satisfactory, but only distinguished the situation of filing a notice of disagreement following the grant of service connection and the initial assignment of a disability evaluation from that of filing a notice of disagreement from the denial of a claim for increase. Moreover, the appellant in this case has clearly indicated that what he seeks is the assignment of a higher disability evaluation. Consequently, the Board sees no prejudice to the veteran in either the RO's characterization of the issue or in the Board's characterization of the issue as one of entitlement to the assignment of a higher disability evaluation. See Bernard v. Brown, 4 Vet. App. 384 (1883). Therefore, the Board will not remand this matter solely for a re-characterization of the issue in a new statement of the case. As explained below, the issue of entitlement to the assignment of a compensable disability evaluation for erosive enteritis will be remanded. FINDINGS OF FACT 1. The veteran's gynecological disorders have been variously diagnosed as dysmenorrhea, pelvic adhesions, endometriosis, and the postoperative residuals of hysterectomy and salpingectomy. 2. The veteran's gynecological disorders were not shown in service, and the record does not contain competent evidence of a nexus between a gynecological disorder and injury or disease during the veteran's active service. 3. The veteran's current symptom of shortness of breath has been variously diagnosed as rhinitis, rule out sinusitis, and probable mild bronchitis, rule out reactive airway disease; it has also been attributed to urticaria. 4. The record does not contain competent evidence of a nexus between a current respiratory disability and injury or disease during the veteran's active service. 5. The veteran's undiagnosed illness manifested by symptoms of joint and muscle pain, severe sweats, body tightness, fatigue, shortness of breath, and sleep impairment, has not been shown to have developed to a compensable degree. 6. The record does not contain competent medical diagnosis of a disability manifested by symptoms of joint and muscle pain, severe sweats, body tightness, fatigue, shortness of breath, and sleep impairment. 7. The residuals of cold neurapraxia secondary to frostbite injury to the face, hands and feet consist of subjective complaints of swelling and pain with objective evidence of hyperpigmentation of the face. CONCLUSIONS OF LAW 1. The appellant has not submitted evidence of a well- grounded claim for service connection for gynecological problems including dysmenorrhea, pelvic adhesions, endometriosis, menstrual problems, and the postoperative residuals of hysterectomy and salpingectomy claimed as a result of service during the Persian Gulf War. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. § 3.303 (1999); VAOPGCPREC 8-98. 2. The appellant has not submitted evidence of a well- grounded claim for service connection for a disability claimed as shortness of breath claimed as a result of service during the Persian Gulf War. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. § 3.303 (1999); VAOPGCPREC 8-98. 3. The appellant has not submitted evidence of a well- grounded claim for service connection for an illness manifested by symptoms of joint and muscle pain, severe sweats, body tightness, fatigue, shortness of breath, and sleep impairment claimed as a result of service during the Persian Gulf War. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. § 3.303 (1999); VAOPGCPREC 8-98. 4. The criteria for an increased evaluation in excess of 10 percent for cold neurapraxia secondary to frostbite injury to the face, hands and feet have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.104, Diagnostic Code 7122 (effective prior to January 12, and August 13, 1998); 38 C.F.R. §§ 4.7, 4.104; Diagnostic Code 7122; 62 Fed. Reg. 65207-65224 (Dec. 11, 1997) (effective January 12, 1998); 38 C.F.R. §§ 4.7, 4.104; Diagnostic Code 7122; 63 Fed. Reg. 37778-37779 (July 14, 1998) (effective August 13, 1998). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Gulf War Syndrome The veteran contends that she has numerous disabilities as the result of service. She asserts that these conditions have resulted from her service while stationed in the Persian Gulf in support of operation Desert Storm. She then states that she has had gynecological problems as well as symptoms of severe sweats, joint and muscle pain, body tightness, fatigue, shortness of breath, and sleep impairment, since returning from the Persian Gulf. Service connection may be established for a disability resulting from diseases or injuries which are clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (1999). For service members who served in the Southwest Asia theater of operations during the Persian Gulf War who exhibit objective indications of chronic disability manifested by one or more specific signs or symptoms, such disability may be service connected provided that it became manifest during active service in the Southwest Asia theater of operations or to a degree of 10 percent or more not later than December 31, 2001; and provided that the disability cannot be attributed to any known clinical diagnosis. 38 U.S.C.A. § 501(a) (West 1991); 38 C.F.R. § 3.317(a)(1) (1999). "Objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(2) (1999). Disabilities that have existed for 6 months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. The 6-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317(a)(3) (1999). Signs or symptoms which may be manifestations of undiagnosed illness include, but are not limited to, fatigue; signs or symptoms involving the skin; headache; muscle pain; joint pain; neurologic signs or symptoms; neuropsychological signs or symptoms; signs or symptoms involving the respiratory system (upper or lower); sleep disturbances; gastrointestinal signs or symptoms; cardiovascular signs or symptoms; abnormal weight loss; and menstrual disorders. 38 C.F.R. § 3.317(b) (1999). It should be noted that compensation shall not be paid under this section: if there is affirmative evidence that an undiagnosed illness was not incurred during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; or if there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between the veteran's most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or if there is affirmative evidence that the illness is the result of the veteran's own willful misconduct or the abuse of alcohol or drugs. 38 C.F.R. § 3.317(c) (1999). An opinion of the VA General Counsel, VAOPGCPREC 4-99 (5/3/99), noted that a well-grounded claim for compensation under 38 U.S.C.A. § 1117(a) and 38 C.F.R. § 3.317 for disability due to undiagnosed illness generally requires the submission of some evidence of: (1) active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; (2) the manifestation of one or more signs or symptoms of undiagnosed illness; (3) objective indications of chronic disability during the relevant period of service or to a degree of disability of 10 percent or more within the specified presumptive period; and (4) a nexus between the chronic disability and the undiagnosed illness. With respect to the second and fourth elements, evidence that the illness is 'undiagnosed' may consist of evidence that the illness cannot be attributed to any know diagnosis or, at minimum, evidence that the illness has not been attributed to a known diagnosis by physicians providing treatment or examination. The type of evidence necessary to establish a well-grounded claim as to each of those elements may depend upon the nature and circumstance of the particular claim. For purposes of the second and third elements, the manifestations of one or more signs or symptoms of undiagnosed illness or objective indications of chronic disability may be established by lay evidence if the claimed signs and symptoms, of the claimed indications, respectively, are of a type which would ordinarily be susceptible to identification by lay persons. If the claimed signs or symptoms of undiagnosed illness or the claimed indications of chronic disability are of a type, which would ordinarily require the exercise of medical expertise for their identification, then medical evidence would be required to establish a well-grounded claim. For the third element, a veteran's testimony may be considered sufficient evidence of objective indications of chronic disability, for purposes of a well-grounded claim, if the testimony relates to nonmedical indicators of disability within the veteran's competence and indicators are capable of verification from objective sources. Medical evidence would ordinarily be required to satisfy the fourth element, although lay evidence may be sufficient in cases where the nexus between the chronic disability and the undiagnosed illness is capable of lay observation. The veteran's DD-214 indicates that she was ordered to serve on active duty in support of Operation Desert Shield/ Desert Storm. She served in Southwest Asia. The record also shows that the veteran's claimed undiagnosed disabilities began within the time specified in the regulations. VA outpatient records show that she began to complain of general fatigue as early as 1995. VA records indicate that her complaints have continued and she has been receiving treatment since that time. However, in the instant case, the Board does not find that the veteran's claims for service connection for the various disabilities under 38 C.F.R. § 3.317 (1999) are well-grounded because her gynecological and pulmonary disabilities have been diagnosed and, moreover, her claimed remaining disabilities have not been shown to be 10 percent disabling. When a claim is not well grounded, VA does not have a statutory duty to assist a claimant in developing facts pertinent to the claim, but VA may be obligated under 38 U.S.C.A. § 5103(a) to advise a claimant of evidence needed to complete her application. This obligation depends on the particular facts of the case and the extent to which the Secretary has advised the claimant of the evidence necessary to be submitted with a VA benefits claim. Robinette v. Brown, 8 Vet. App. 65, 77-80 (1995). In this case the veteran reported that she received private treatment in 1991, however, as her claims are not well grounded the Board does not have a duty to assist in obtaining those records. Moreover, the RO fulfilled its obligation under section 5103(a) in a SOC that informed the veteran of the reasons her claims had been denied. Also, by this decision, the Board informs the appellant of the type of evidence needed to make her claims well grounded. Although the RO did not specifically state that it denied these claims on the basis that they were not well grounded, the Board concludes that this was not prejudicial to the veteran. See Edenfield v. Brown, 8 Vet. App. 384 (1995) (when the Board decision disallows a claim on the merits and the Court finds the claim to be not well grounded, the appropriate remedy is to affirm, rather than vacate, the Board's decision, on the basis of nonprejudicial error). A. Undiagnosed Illness While the veteran served in Southwest Asia and has complained of symptoms related to Persian Gulf in a timely manner, it is important to note that in the above referenced regulation one of the basic criteria for service connection is that the condition may not be attributed to any known cause. Review of the medical evidence of record shows that, in addition to the veteran's service medical records, private medical records and VA outpatient treatment records dated between 1995 and 1998, the veteran has had extensive evaluations by the VA in 1995 and 1997. Concerning the appellant's claim for disabilities manifested by shortness of breath and gynecological problems, the Board notes that the symptomatology of which the appellant has complained has not resulted in a disability which can be said to be "undiagnosed." To the contrary, treatment records reflect diagnoses that have not been related to service (as discussed below). Since there is, of record, medical evidence attributing the appellant's disabilities to clinically diagnosed disorders, the requirements for entitlement to service connection under 38 C.F.R. § 3.317 (1999) is rendered not plausible and may also be viewed as not well grounded. i. Gynecological Disorder In May 1995, the veteran underwent a Persian Gulf Registry examination. At this examination she failed to report any gynecological problems and she specifically indicated that her period was regular. VA outpatient records dated in July 1995, shows that the veteran complained of increased menstrual clotting and cramping. She was scheduled for additional testing and told to return in 1 year. Later that month, a letter was sent advising the veteran to return in 3 months due to inflammatory component of the pap test. VA outpatient records dated in March 1996 show that she complained of shorter menses and hot flashes. The cytopathology report of the vaginal-cervical area again showed an inflammatory alteration of cellular material. In June 1996, the veteran reported that her menses had worsened in that she experienced cramping, dizziness and pain for the previous three months. In October 1996, her complaints and symptoms of pain, chills and nausea with menses continued. The diagnosis included dysmenorrhea. A VA radiological study in November 1996 revealed a cystic left ovarian mass. Private records dated in April 1997 show that the veteran underwent laparoscopic study that revealed extensive pelvic adhesions (endometriosis). In August 1997, she underwent total abdominal hysterectomy with salpingo-oophorectomy and right salpingectomy. As the veteran's gynecological problems have been attributed to such disorders as endometriosis and dysmenorrhea, she is not entitled to service connection for a gynecological disorder as manifestations of an undiagnosed illness under 38 C.F.R. § 3.317 (1999). ii. Shortness of Breath The Persian Gulf Registry examination report dated in May 1995 shows that the veteran complained of body aches and nocturnal shortness of breath, mostly while sleeping. The next month she underwent laboratory analysis and other diagnostic testing that was considered normal. She underwent VA pulmonary testing in September 1995. The diagnoses included rhinitis, rule out sinusitis; probable mild bronchitis, and rule out reactive airway disease. In October 1997, the veteran underwent VA examination. The VA performed pulmonary testing, however, the results were within normal limits. In reporting the diagnostic assessment the examiner commented that the veteran had an urticaria type reaction to exposure to cold air associated with among other things, tightness of the chest. While these diagnoses are of an ill-defined disability, they are, nevertheless, diagnoses. As the veteran's shortness of breath has been attributed to rhinitis, mild bronchitis or urticaria, service connection may not be presumed under the referenced regulation applicable to service in the Persian Gulf and she is not entitled to service connection for shortness of breath as manifestations of an undiagnosed illness under 38 C.F.R. § 3.317 (1999). B. Development to 10 percent Another problem with the veteran's claim for service connection for Gulf War Syndrome, arises with the fact that her current disability has not developed to a compensable degree. It is also noted that besides the previously discussed disabilities the veteran has included in her claims symptoms of joint and muscle pain, severe sweats, body tightness, fatigue, shortness of breath, and sleep impairment. In light of the fact that this disability has not been definitively diagnosed the Board considered the reported complex of symptoms and determined that they more closely approximated those manifestations listed under Diagnostic Code 6354, Chronic Fatigue Syndrome. Diagnostic Code 6354 provides rating criteria for Chronic Fatigue Syndrome (CFS). 38 C.F.R. § 4.88(b) (1999). Under that code, a 10 percent rating is warranted for debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, or confusion), or a combination of other signs and symptoms which wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year, or symptoms controlled by continuous medication. A 20 percent rating is warranted for debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, or confusion), or a combination of other signs and symptoms which are nearly constant and restrict routine daily activities by less than 25 percent of the pre-illness level, or which wax and wane, resulting in periods of incapacitation of at least two but less than four weeks total duration per year. For the purpose of evaluating this disability, the condition will be considered incapacitating only while it requires bed rest and treatment by a physician. A review of the available records does not show that the veteran has been incapacitated by her chronic fatigue, as defined by regulation, or prescribed medication specifically for chronic fatigue. The Persian Gulf Registry examination report dated in May 1995 shows that the veteran reported that she suffered from body aches all over her body since 1991. This occurred every two-three months and she sometimes took Tylenol. The pain and stiffness would last from two-three days. She indicated that she was tired most of the time. She was also short of breath, mostly while sleeping. There were no reported abnormal physical findings reported. The diagnoses were history of shortness of breath, fatigue and body aches, and etiology undetermined. In October 1997, the veteran underwent VA examination of the joints. The veteran reported her history of a cold injury. She reported that she had an episode in October 1997 where she was exposed to the cold and her face, feet and hands became swollen. As the swelling subsided she developed tightness of the chest, shortness of breath and she also became extremely fatigued. Also while swollen she had problems with sweating. For the most part, the examination was negative except for hyperpigmentation of the face, swollen nasal passages, abdominal pain, gas and limitation of flexion and extension of the back. Although the examiner would not make a definitive diagnosis, he did relate that her symptoms seemed to be a generalized reaction to cold. It should be noted that the veteran is service connected for this disability. VA outpatient records dated between October and November 1998 show that she complained of rectal bleeding and abdominal pain. Sigmoidscopic study was performed however it was considered normal. In September and October 1996 as well as in April 1997, the veteran submitted lay statements of friends and fellow members of service, who in essence relate that they observed the veteran's reported symptoms both during and after service discharge. In October 1996 and October 1997, the veteran also submitted statements from a social worker who reported that she had been counseling the veteran since 1994 and also noticed the veteran's symptoms had increased. She also indicated that this has lead to increased anxiety and frustration for the veteran. Although it has been shown that the veteran has continued to complain of general fatigue, it has not been shown or contended by the veteran that her undiagnosed disability has been so debilitating as to result in periods of incapacitation. Further, it is not shown that medication is required to control her symptoms. The only medication that has been prescribed that can be remotely considered related to her complaints have been medication provided for her diagnosed disabilities. Consequently, considering the inservice history, the VA treatment records, and lay statements it is not found that the veteran meets the requirement for service connection for Persian Gulf War Syndrome. II. Direct Service connection While the veteran's contentions have primarily centered on her service in the Persian Gulf during Operation Desert Storm, service connection must also be considered on a direct basis, that is, it must also be determined if any of these conditions may be directly related to the veteran's periods of active duty. Combee v. Brown, 34 F.3rd 1039 (Fed. Cir. 1994). The threshold question to be answered is whether the appellant has presented evidence of a well-grounded claim; that is, one that is plausible. If she has not presented a well-grounded claim, her appeal must fail and there is no duty to assist her further in the development of her claim because such additional development would be futile. 38 U.S.C.A. § 5107 (West 1991), Murphy v. Derwinski, 1 Vet. App. 78 (1990). An appellant has the duty to submit evidence that a claim is well grounded. The evidence must justify a belief by a fair and impartial individual that the claim is plausible. 38 U.S.C.A. § 5107(a). In Tirpak v. Derwinski 2 Vet. App. 609 (1992), the Court, held that the appellant in that case had not presented a well-grounded claim as a matter of law. The Court pointed out that, unlike civil actions, the VA benefits system requires more than an allegation; the claimant must submit supporting evidence. Tirpak, 2 Vet. App. at 611. The evidentiary assertions by the appellant must be accepted as true for the purposes of determining whether a claim is well grounded, except where the evidentiary assertion is inherently incredible or beyond the competence of the person making the assertion. See King v. Brown, 5 Vet. App. 19 (1993). The three elements of a "well grounded" claim for service connection are: (1) evidence of a current disability as provided by a medical diagnosis; (2) evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, (3) a nexus, or link, between the in-service disease or injury and the current disability as provided by competent medical evidence. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996); see also 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303 (1999). A. Severe Sweats, Body Tightness, Fatigue, Sleep Impairment, Joint and Muscle Pain In regard to her claims of service connection for joint and muscle pain, severe sweats, body tightness, fatigue, shortness of breath, and sleep impairment, the veteran's problem with presenting well-grounded claims for these disabilities arises with the first element, which is evidence of current disability. The veteran has provided no medical evidence to show a current diagnosis of the claimed disabilities. Without proof of a current disability, there can be no valid claim. See, Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); and Rabideau v. Derwinski, 2 Vet. App. 141 (1992). A review of post service VA treatment and examination records dated as late as 1998 failed to document diagnoses regarding such disabilities. The examiners have listened to her complaints and symptoms regarding her disabilities, however there is not a diagnosed disability regarding either of the claimed disabilities. B. Gynecological Disorder and Shortness of Breath The first element of Caluza requires evidence of current disability as provided by a medical diagnosis. In regard to the remaining disabilities, as noted VA and private medical records include diagnoses of dysmenorrhea and endometriosis as well as rhinitis, rule out sinusitis, probable mild bronchitis, and rule out reactive airway disease. These diagnoses satisfy this requirement. Concerning the second element, evidence of inservice injury or disease, the veteran reported at her February 1999 personal hearing that she began to have menstrual problems beginning in 1980. She stated that she receive treatment for pelvic hemorrhaging. Her spouse also indicated that when he met her in 1990, she was having stomach and female problems. It should be noted that the veteran's service medical records do show treatment for gynecological problems. Moreover, the May 1995 Persian Gulf examination report shows that the veteran specifically stated that her period was regular. Regardless, for the purposes of determining a well-grounded claim, the veteran is competent to report her observable symptoms. In regard to the disability claimed as shortness of breath, a September 1980 inpatient treatment record cover sheet shows a diagnosis of acute respiratory disease. The veteran reported at her personal hearing that she felt that her shortness of breath began during the time she was in the Persian Gulf, especially when she was in the vicinity of burning oil wells. Although there is no evidence of treatment for respiratory problems during her period of service in the Persian Gulf, as pointed out above, for the purposes of determining a well-grounded claim, her statements may be satisfactory evidence of inservice injury. Nevertheless, the veteran's problem with these claims is that she has not provided any competent medical evidence showing that the current disabilities are related to disease or injury during service, as required by Caluza. The medical evidence of record does not include any competent medical statements or opinions concerning a nexus for either disability or any disease or injury during military service. The only evidence of record that suggests a causal relationship between the veteran's claimed disabilities and service are the statements of the veteran and her spouse. However, I find that their statements are not sufficient competent evidence to establish the etiology of her disabilities. As lay persons, they do not have the medical expertise to conclude such. Under these circumstances, it cannot be found that the statements of the veteran and her husband alone are competent to demonstrate the existence of the claimed disabilities or a relationship of these purported disabilities to her military service. See Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). III. Increased Rating The veteran's claim for an increased rating for her service-connected cold neurapraxia is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). When a claimant is awarded service connection for a disability and subsequently appeals the RO's initial assignment of a rating for that disability the claim continues to be well grounded as long as the rating schedule provides for a higher rating and the claim remains open. Shipwash v. Brown, 8 Vet. App. 218, 224 (1995). The Board is satisfied that all relevant facts have been properly developed. No further assistance to the veteran is required to comply with the duty to assist her mandated by 38 U.S.C.A. § 5107(a) (West 1991). The evaluation assigned for a service-connected disability is established by comparing the manifestations reflected by the recent medical findings with the criteria in the VA's SCHEDULE FOR RATING DISABILITIES (Schedule), codified in C.F.R. Part 4 (1999). VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. The Board has considered whether a "staged" rating is appropriate. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). The record, however, does not support assigning different percentage disability ratings during the period in question. The service medical records relate that in February 1986, the veteran reported a history of two episodes of frostbite. At that time she complained of redness and pain of her feet and hands. She underwent evaluation between April and June 1986, however, diagnostic studies were normal. She continued to complain of poor circulation in her hands and feet. She underwent diagnostic testing again in February 1987 and March 1988, however, there were no reported abnormalities related to the cold injury. In November 1991, she underwent evaluation for tingling in her extremities. It was noted that her extremities were cold to the touch but the color appeared normal. Based on in-service treatment and the VA examination, a February 1995 rating decision granted service connection for cold neurapraxia secondary to frostbite of hands, face and hands, and assigned a 10 percent evaluation under 38 C.F.R. § 4.114, Diagnostic Code 7307. During the pendency of the veteran's appeal, VA promulgated new regulations amending the rating criteria for cold injury residuals, effective January 12, 1998. "[W]here the law or regulation changes after a claim has been filed or reopened but before the administrative or judicial appeal process has been concluded, the version most favorable to [the veteran] . . . will apply unless Congress provided otherwise or permitted the Secretary of Veterans Affairs (Secretary) to do otherwise and the Secretary did so." Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). Under the rating criteria in effect prior to January 12, 1998 for evaluation of residuals of frozen feet, Diagnostic Code 7122 provides for a 10 percent disability evaluation for mild residuals of bilateral frozen feet or chilblains. The next higher evaluation of 30 percent requires bilateral persistent moderate swelling, tenderness, redness, etc. A 50 percent rating requires bilateral loss of toes, or parts, and persistent severe symptoms. 38 C.F.R. § 4.104 Diagnostic Code 7122 (effective prior to January 12, 1998). Under the rating criteria for evaluation of residuals of cold injuries, as modified effective in January 1998, when there are cold injury residuals with pain, numbness, cold sensitivity, or arthralgia, a 10 percent disability evaluation is warranted. When there are cold injury residuals with pain, numbness, cold sensitivity, or arthralgia plus tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, or X-ray abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis) of affected parts then a 20 percent disability evaluation is warranted. When there are cold injury residuals with pain, numbness, cold sensitivity, or arthralgia plus two or more of the following: tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, X-ray abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis) of affected parts then a 30 percent disability evaluation is warranted. 38 C.F.R. § 4.104 Diagnostic Code 7122 (effective January 12, 1998). Note 2 directs VA to evaluate each affected part separately and combine the ratings in accordance with 38 C.F.R. §§ 4.25 and 4.26. The rating criteria for residuals of cold injury were again amended, effective August 13, 1998, in order to incorporate additional comments VA had received on the proposed criteria. See 63 Fed. Reg. 37778 through 37779 (July 14, 1998). The additional amendment clarifies that disabilities that have been diagnosed as the residual effects of cold injury, such as Raynaud's phenomenon, muscle atrophy, etc., should be separately evaluated unless they are used to support an evaluation under Diagnostic Code 7122. Id. It was also noted that arthralgia is but one type of pain that will satisfy the evaluation criterion. 63 Fed. Reg. 37779 (July 14, 1998). It is noted that the veteran was not supplied with these amended regulations. However, a review of the changes effective August 13, 1998, reveals that the changes do not substantially affect the application of Diagnostic Code 7122 in this case. Therefore, there is no prejudice to the appellant by the Board's initial consideration of these revised regulatory criteria. Bernard v. Brown, 4 Vet. App. 384 (1993). A comprehensive review of the record demonstrates that prior to January 12, 1998, the veteran's service-connected neurapraxia was manifested by no more than mild symptoms and chilblains consistent with the 10 percent evaluation in effect at that time. At VA examination in January 1995, there was no reported evidence of cold injury residuals. At the May 1995 Persian Gulf Registry examination she reported that she suffered from body aches, fatigue and shortness of breath, however, there were no reported residuals related to her cold injury. At the October 1997 VA examination she reported that she had an episode of body aches, fatigue and shortness of breath earlier that month. She reported that if she was exposed to the snow for 40 minutes her hands, feet, and face would swell very rapidly. This was accompanied by burning sensation, joint pain, and cyanosis. Within five days of the onset of these symptoms she experienced fatigue, shortness of breath, tightness of the chest, sweating and impairment in sleep. Significantly, however, on examination there was no reported swelling of the extremities. The ranges of motion of the various joints that she reported she had problems during the cold were all normal. Still further, there were neurological abnormalities. There was hyperpigmentation of the face, and the veteran reported that this was residual from her last episode. Besides the hyperpigmentation of the face, the objective evidence failed to reflect findings meeting or more nearly approximating symptomatology consistent with persistent moderate swelling, tenderness, redness, etc., thereby warranting the assignment of a higher rating. If there were any separate co-existing symptoms of the separate extremities noted at that time this may not be considered when determining the issue of entitlement to an increased evaluation for residuals of a cold injury. Moreover, as noted, from January 12, 1998 the new criteria provide for the authorization for the assignment of a separate 10 percent evaluation for each part affected. However, in this case it appears that the only affected body part that can be considered is the veteran's face. Although the veteran has reported that various extremities have been swollen and discolored, the most recent examination only objectively shows that her face was hyperpigmented. Accordingly, there is no evidence that the veteran's disability warrants an increase under the new code as there is no evidence of evidence of arthralgia plus tissue loss, nail abnormalities, hyperhidrosis or associated X-ray abnormalities. IV. Extraschedular In Floyd v. Brown, 9 Vet. App. 88 (1996), the Court held that the Board does not have jurisdiction to assign an extraschedular rating under 38 C.F.R. § 3.321(b)(1) in the first instance. The Board is still obligated to seek out all issues that are reasonably raised from a liberal reading of documents or testimony of record and to identify all potential theories of entitlement to a benefit under the law and regulations. In Bagwell v. Brown, 9 Vet. App. 337 (1996), the Court clarified that it did not read the regulation as precluding the Board from affirming an RO conclusion that a claim does not meet the criteria for submission pursuant to 38 C.F.R. § 3.321(b)(1) or from reaching such a conclusion on its own. Moreover, the Court did not find the Board's denial of an extraschedular rating in the first instance prejudicial to the veteran, as the question of an extraschedular rating is a component of the appellant's claim and the appellant had full opportunity to present the increased-rating claim before the RO. Bagwell at 339. In this case, the evidence does not suggest that the veteran's disability produces such an exceptional or unusual disability picture as to render impractical the applicability of the regular schedular standard, thereby warranting the assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1) (1999). This case does not present factors such as frequent periods of hospitalization or marked interference with employment. In regards to industrial impairment, the veteran has offered very little concerning her employment and her service-connected disability. A VA outpatient report dated in July 1995 shows that she worked as a cashier. In statements received in October 1996, a person identified as her shift manager indicated that there were days when she would be in so much pain that it was difficult for her to work. Psychological therapy reports dated in June 1997 shows that the veteran had recently been employed by the U.S. Postal service. Further, she had been ill and required surgery (abdominal hysterectomy). The veteran expressed concern that her new supervisor would not be supportive. The Board notes that the veteran has disability from a number of disorders, including those that she has been denied service connection in this decision. Importantly, there is no evidence that the impairments resulting from her service- connected disability neurapraxia, when considered alone, warrants extra-schedular consideration. Further, she has not produced objective evidence that would indicate that her service-connected disability has interfered with her employment to such an extent that she is entitled to extraschedular consideration. Moreover, a review of the claims file does not show that her service-connected neurapraxia has resulted in hospitalization. Although the veteran reports that she has ongoing problems with her neurapraxia, the assigned disability evaluation is commensurate with her reported symptomatology and there are no reported symptoms that would warrant extraschedular consideration. Further, there were no other symptoms reported that could be considered disabling. Neither her statements nor the medical records indicate that the veteran's disability warrants the assignment of an extraschedular evaluation. ORDER Entitlement to service connection for gynecological problems including dysmenorrhea, pelvic adhesions, endometriosis, menstrual problems, and the postoperative residuals of hysterectomy and salpingectomy is denied. Entitlement to service connection for a disability claimed as shortness of breath is denied. Entitlement to service connection for a disability claimed as joint and muscle pain, severe sweats, body tightness, fatigue, and sleep impairment, is denied. Entitlement to the assignment of a higher rating for cold neurapraxia secondary to frostbite injury to the face, hands and feet, is denied. REMAND The veteran maintains that her service-connected enteritis is more disabling that the current disability evaluation reflects. The RO issued a SOC in March 1998. Unfortunately, the SOC did not contain laws and regulations that pertain to an increased rating for enteritis. Further, the RO rated the veteran under Diagnostic Code 7307. This code provides the rating criteria for evaluation of hypertrophic gastritis. It is noted that gastroenteritis can also be evaluated under Diagnostic Code 7325, which considers gastroenteritis. The RO should also consider reviewing this disability under Diagnostic Code 7325. Further, as noted above the veteran appealed the initial disability evaluation assigned when service connection was granted by the February 1995 rating decision. Consequently, the RO should re-phrase this issue in the supplemental statement of the case (SSOC) as indicated by the Court in Fenderson. Moreover, the veteran received a VA compensation examination in October 1997. VA outpatient records relate that in October 1997, the veteran complained of rectal bleeding and abdominal pain since her September 1997 hysterectomy. In October 1998 a flexible sigmoidoscopy was attempted, however, this was unsuccessful due to poor preparation by the veteran. On review of the record, it is not clear if her abdominal dysfunction is a result of her service connected enteritis or residuals of her hysterectomy. Further examination would be helpful in the determination of this case. The appellant is hereby notified that it is her responsibility to report for the examination and to cooperate in the development of the case, and that the consequences of failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158 and 3.655 (1999). Accordingly, this case is REMANDED for the following action: 1. The RO should schedule the veteran for a VA examination for the purpose of ascertaining the severity of her service- connected enteritis. The examiner is requested to report all symptomatology that can be attributed to the service- connected enteritis and provide a complete rationale for any opinion expressed. The veteran's claims folder should be made available to the examiner. 2. The veteran should be provided with the laws and regulations that pertain to an increased rating for gastroenteritis including Diagnostic Code 7325. 3. After the development requested above has been completed to the extent possible, the RO should again review the record. If any benefit sought on appeal, for which a NOD has been filed, remains denied, the appellant and representative should be furnished a SSOC - which should phrase the issue involving the service- connected enteritis in accordance with Fenderson -- and given the opportunity to respond thereto. Thereafter, the case should be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The appellant need take no action unless otherwise notified. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board 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. MARY GALLAGHER Member, Board of Veterans' Appeals