Citation Nr: 0005095 Decision Date: 02/28/00 Archive Date: 03/07/00 DOCKET NO. 95-40 602 ) DATE ) ) On appeal from a decision certified by the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to service connection for post traumatic stress disorder (PTSD). 2. Entitlement to service connection for a back condition. 3. Entitlement to service connection for a right leg condition. 4. Entitlement to service connection for a right shoulder condition. 5. Entitlement to service connection for a bilateral foot condition. 6. Entitlement to service connection for a left wrist condition. 7. Entitlement to service connection for residuals of a nasal fracture. 8. Entitlement to service connection for residuals of removal of a neck cyst. 9. Entitlement to service connection for painful joints, other than a back condition, a right leg condition, a right shoulder condition, a bilateral foot condition, and a left wrist condition. 10. Entitlement to an initial compensable rating for bilateral hearing loss. 11. Entitlement to an initial disability rating in excess of 10 percent for tinnitus. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD L. McCain Parson, Associate Counsel INTRODUCTION The veteran had verified service from November 1988 to September 1993. The veteran served in the Southwest Asia Theater of operations in support of Operation Desert Shield/ Desert Storm from February 1991 to March 1991. His military occupational specialty was fighting vehicle infantryman. These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 1994 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California, which denied inter alia service connection for a back condition, a right leg condition, a right shoulder condition, a bilateral foot condition, a left wrist condition, residuals of a nasal fracture, residuals of removal of a neck cyst, and painful joints. The RO also granted service connection for bilateral hearing loss evaluated as non-compensable, tinnitus evaluated as 10 percent disabling, and residuals of an old inflammatory disease of the lung evaluated as non compensable. The veteran filed a notice of disagreement with respect to each of the above-noted issues contained in the June 1994 rating decision. See In re Fee Agreement of Cox, 10 Vet. App. 361, 374 (1997); Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). The RO furnished a statement of the case relative to each of the issues in response to the veteran's notice of disagreement. A timely substantive was filed, but the veteran did not perfect an appeal as to the issue of an initial compensable evaluation for residuals of an old inflammatory disease of the lung. See 38 U.S.C.A. § 7105(d)(3) (West 1991); 38 C.F.R. § 20.302(b) (1999). Therefore, Board's appellate consideration will be limited to the issues listed on the cover page of this decision. Additionally, the Board observes that a review of the evidence of record appears to have reasonably raised the issues of entitlement to service connection for a psychiatric disorder other than PTSD, to include a mixed dysthymic disorder and an anxiety disorder; and for tender scar as a residual of the status post perforated duodenal ulcer. Since these issues have not been developed for appellate review, they are referred to the RO for appropriate action. See Suttman v. Brown, 5 Vet. App. 127, 132 (1993). The issues of entitlement to service connection for a back condition, for a right leg condition, for a right shoulder condition, for a bilateral foot condition, for a left wrist condition, for residuals of a nasal fracture, for residuals of removal of a neck cyst, and for painful joints, are addressed in the remand section following the decisions on appeal. Effective March 1, 1999, the United States Court of Veterans Appeals changed its name to the United States Court of Appeals for Veterans Claims (hereinafter, "the Court"). FINDINGS OF FACT 1. The veteran does not have a current diagnosis of PTSD. 2. The evidence of record indicates that hearing acuity in the right ear is manifested by speech discrimination scores of 96-100 percent and average puretone decibel losses of 30-39. 3. The evidence of record indicates that hearing acuity in the left ear is manifested by speech discrimination scores of 96-98 percent and average puretone decibel losses of 40-53. 4. The veteran has Level I hearing in the right ear and Level I hearing in the left ear pursuant to Table VI. 5. The veteran's tinnitus is constant, bilaterally. CONCLUSIONS OF LAW 1. The claim of entitlement to service connection for PTSD is not well-grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The criteria for an initial compensable rating for bilateral hearing loss have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.85, Diagnostic Code (DC) 6100, Tables VI & VII (effective prior to June 10, 1999), as amended by 38 C.F.R. § 4.85, Tables VI & VII (effective from June 10, 1999). 3. The criteria for an initial disability rating in excess of 10 percent for tinnitus have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.87a, DC 6260 (effective prior to June 10, 1999) as amended by 38 C.F.R. § 4.87, DC 6260 (effective from June 10, 1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection The veteran claims that he developed PTSD from his service in the Persian Gulf. He served during the ground war phase of Operation Desert Storm from "about January to March 1991." He contends that he was fearful for his life, that he did not get to the front line while he was on Red-Con 1 status, that he thought some of his buddies had been killed, that terrorists were in his area and [the unit] was always on guard, and that a "toe-popper" went off and shredded a tent and a soldier's arm. He asserts that he is often depressed and disillusioned. He has a startle reflex and sleeps poorly. He thinks about Desert Storm and feels as though he is being watched. The veteran has asserted that his experiences while assigned in the Persian Gulf were not routine, that his experiences were outside the range of usual experience, and that it is VA's responsibility to confirm his stressors. Additionally, he asserts that the February 1995 psychiatric examination was inadequate because it did not apply the DSM-III criteria. A. Factual Background Service department records reflect that the veteran was awarded the Southwest Asia Service Medal with 1 Bronze Star and the Kuwait Liberation Medal. The veteran's military occupational specialty was fighting vehicle infantryman. Service medical records are limited to the period from July 1993 to September 1993. The August 1993 report of medical history completed by the veteran for separation reflects that he has been depressed and nervous about leaving the army and changing his lifestyle. The August 1993 separation examination reflects that the psychiatric evaluation was normal. An emergency room report from the Palm Drive Hospital dated in October 1993, for an unrelated condition, reflects that the veteran did not have a neuropsychiatric history. A December 1993 VA Social Work Service - Reports and Summaries reflects that the veteran had been referred from the North Bay Vet Center and that the county veterans officer suggested to the veteran that he might have PTSD and referred him to the North Bay Vet Center. The record also reflects that the veteran manifested some signs of PTSD, but it was not clear that those symptoms were related to traumatic events. He presented with symptoms of anxiety and depression. The social worker noted that all of those symptoms may be related to an adjustment disorder concerning his recent hospitalization, homelessness, and joblessness and that the symptoms seemed to be improving. The veteran was referred to the VA medical center for medical treatment. The February 1994 VA PTSD examination reflects that the veteran did not know if he had PTSD. When he was applying for VA benefits, the benefits counselor asked him if he had PTSD and showed him a list of PTSD symptoms. The veteran recognized some of the symptoms and the application was initiated. In brief, the examiner noted that the veteran had some unusual experiences in the Persian Gulf. He was not involved in any combat and never fired a round. He reported being awakened in the middle of the night after someone shouted "gas, gas". It turned out to be an exercise but it was unsettling. At another time, a soldier was stuffing a mine into his duffel bag. The mine exploded shredding the soldier's arm and tent. The veteran was not involved in the incident but it had everyone running around. Another unusual experience was hearing that there were terrorists nearby. His outfit was placed on 100 percent security and everyone was walking around waiting for something to happen even though they had no bullets, just bayonets. The veteran described that experience as "kind of hairy" and indicated that it had him on edge. The examiner noted that the veteran sometimes had thoughts about his unusual experiences in the Persian Gulf. He occasionally had dreams of being shot at or being in a setting where shooting was going on. He had no flashbacks. He had a feeling of detachment or estrangement from others, which is non-specific and not related particularly to his service experiences. His sleep was good. He had no problems with irritability or anger. Sometimes, he had a feeling that something bad was going to happen. Sudden unexpected noises sometimes made him edgy but he was able to recompose himself in a couple of minutes. The diagnosis reflects that no mental disorder was apparent. The VA mental disorders examination dated in May 1995 reflects that this examiner reviewed the claims file and the February 1994 VA psychiatric examination. The veteran had been seeing a counselor at the North Bay Veterans Center since February 1995 about his feelings of despair, hopelessness, and despondency. He was on no medications. The examiner noted that the veteran's account of his experiences conforms to those described in the February 1995 VA examination. The veteran saw no direct combat. He was on alert often for incoming missiles near them, some gas alerts, and some worry about terrorist attacks. He denied any particular nightmares or intrusive thoughts about those experiences. The Axis I diagnosis was dysthymic disorder with elements of an anxiety disorder. The examiner's discussion reflects that the veteran did not show evidence of PTSD. However, he showed evidence of a mixed dysthymic and anxiety disorder. The February 1999 VA authorized PTSD examination reflects that the claims file was reviewed prior to the examination and that the veteran had been hospitalized for chemical detoxification and psychological evaluation for manic- depressive disorder. The veteran is medicated with Paxil, risperidone, Trazodone, and lithium. Following the clinical examination, the Axis I diagnosis was recurrent major depressive episode, mild, and history of alcohol abuse that did not appear to meet the diagnostic criteria per DSM-IV for a diagnosis of PTSD. The examiner noted that while the veteran was involved in certain incidences that could lead to traumatic reactions, he did not directly experience any significant threats to his life. The examiner opined that at the time of the examination, the veteran did not experience significant enough re-experiencing phenomenon. He was not endorsing flashbacks. He had only periodic nightmares and periodic recollections that were not specifically related to his combat situation. He had experienced panic attacks in the past, although again, these were not directly related to war situations. B. Analysis In general, service connection may be granted for disability due to disease or injury incurred in or aggravated by service. See 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303(a) (1999). The Board notes that the requirements for service connection for PTSD under 38 C.F.R. § 3.304(f) were changed effective March 7, 1997. Where a 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 applies unless Congress provided otherwise or permitted the Secretary to do otherwise and the Secretary does so. See Marcoux v. Brown, 9 Vet. App. 289 (1996); Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991); see also VAOPGCPREC 11-97 (March 25, 1997). In the instant case, the Board observes that the veteran filed his initial claim for service connection for PTSD in September 1993. Thus, given the fact that this case is currently pending before the Board, and in light of the fact that the regulations regarding service connection for PTSD changed effective March 7, 1997, it is the Board's determination that the veteran's claim of entitlement to service connection for PTSD must be evaluated under both the old and new regulations in order to determine which version is most favorable to him. See Karnas v. Derwinski, supra. Prior to March 7, 1997, the requirements for service connection for PTSD under 38 C.F.R. § 3.304(f) included the following: (1) medical evidence establishing a clear diagnosis of the disorder; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. See 38 C.F.R. § 3.304(f) (1997). Effective March 7, 1997, the requirements for service connection for PTSD under 38 C.F.R. § 3.304(f) include the following: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a), (2) a link, established by medical evidence, between current symptoms and an in- service stressor, and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f) (1999). The Board notes that under 38 C.F.R. § 4.125(a), a diagnosis of a mental disorder, including PTSD, must conform to the criteria of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV). 38 C.F.R. § 4.125(1999). However, the threshold question to be answered is whether the veteran has presented evidence sufficient to justify a belief by a fair and impartial individual that his claim for service connection for PTSD is well-grounded; that is, a claim which is plausible and capable of substantiation. See 38 U.S.C.A. § 5107(a); Chelte v. Brown, 10 Vet. App. 268, 270 (1997) (citing Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990)). If the claim is not well-grounded claim, the appeal must fail. A well-grounded claim for service connection for PTSD requires (1) medical evidence of a current disability; (2) lay evidence (presumed to be credible for these purposes) of an in-service stressor; and (3) medical evidence of a nexus between service and the current PTSD disability. See Gaines v. West, 11 Vet. App. 353, 357 (1998) (citing Cohen v. Brown, 10 Vet. App. 128, 136-37 (1997), and Caluza v. Brown, 7 Vet. App. 489, 506 (1995)). The Board has considered the lay assertions of the veteran concerning the diagnosis, onset, and severity of the claimed PTSD. However, when the question involves one of medical diagnosis or causation, a lay person cannot provide probative evidence as to matters which require specialized medical knowledge acquired through experience, training, or education. Where the determinative issue involves medical causation or medical diagnoses, competent medical evidence to the effect that the claim is "plausible or possible" is required. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992); see also Brewer v. West, 11 Vet. App. 228, 234 (1998) (citing Grottveit v. Brown, 5 Vet. App. 91, 93 (1993)). In that regard, the service medical records are silent as to an evaluation or treatment for a psychiatric disorder, including PTSD. VA medical records to include the examinations dated in 1994, 1995, and 1999 reflect a history of his military experiences without yielding a current diagnosis of PTSD. Therefore, in the absence of a current disability, the veteran's claim for service connection for PTSD must be denied as not well grounded. See Brock v. Brown, 10 Vet.App. 155, 160 (1997) ("A service-connection claim . . . must be accompanied by evidence that establishes that the claimant currently has the claimed disability"); see also Degmetich v. Brown, 104 F.3d 1328, 1330-31 (Fed. Cir. 1997). Where, as in this appeal, the veteran has failed to present evidence of a well grounded claim, the VA is under no duty to assist the veteran in any further development of the claim. See 38 U.S.C.A. § 5107(a); Morton v. West, 12 Vet. App. 477 (1999) (VA cannot assist a claimant in developing a claim that is not well-grounded). Further, the veteran's burden to submit evidence sufficient to establish a well-grounded claim is the veteran's alone and is not relieved by the benefit of the doubt provision. See 38 U.S.C.A. § 5107(b); Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). By this decision, the Board is informing the veteran of the evidence that is lacking and that is necessary to make the claim well-grounded, namely medical evidence of a current diagnosis of PTSD, and medical evidence of a nexus between that diagnosis and his period of active duty service. The Board views its discussion as sufficient to inform the veteran of the elements necessary to complete his application for service connection for PTSD. See Robinette v. Brown, 8 Vet. App. 69, 78 (1995). II. Higher Disability Ratings As a preliminary matter, the Board finds that the veteran's claims are plausible and capable of substantiation and are thus well-grounded within the meaning of 38 U.S.C.A. § 5107(a). See Drosky v. Brown, 10 Vet. App. 251, 245 (1997). The Board is satisfied that all relevant facts have been properly developed. No further assistance to the veteran is required in order to comply with the duty to assist as mandated by 38 U.S.C.A. § 5107(a). In accordance with Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed the medical records and all other evidence of record pertaining to the history of the claims. Accordingly, the Board has found nothing in the historical record that would lead to a conclusion that the current evidence on file is inadequate for rating purposes. Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. See 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7 (1999). Any reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. See 38 C.F.R. § 4.3 (1999). At this juncture, the Board observes that this appeal arises from an original rating decision, dated in June 1994, following the award of service connection for bilateral hearing loss and tinnitus. In cases such as this, the Board must consider the applicability of a higher rating for the entire period in which the appeal has been pending. See Fenderson v. West, 12 Vet. App. 119 (1999). During the pendency of this appeal, the Board notes that by regulatory amendment effective June 10, 1999 changes were made to the Schedule for Rating Disabilities for diseases of the ear and other sense organs, as set forth in 38 C.F.R. §§ 4.85, 4.86, and 4.87 (1999). Where 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. See DeSousa v. Gober, 10 Vet. App. 461 (1997); Karnas, supra. A. Bilateral Hearing Loss Under the old criteria, evaluations of bilateral hearing loss range from non-compensable to 100 percent are based on organic impairment of hearing acuity as measured by the results of speech discrimination tests together with the average hearing threshold levels. Audiometric test results can be translated into a numeric designation ranging from Level I to Level XI to evaluate the degree of disability from the service-connected bilateral hearing loss. The Schedule for Rating Disabilities (hereinafter, "the rating schedule"), establishes eleven (11) auditory acuity levels, designated from Level I for essentially normal acuity through Level XI for profound deafness. In addition, the evaluations derived from the schedule contemplate proper allowance for improvement of hearing acuity by hearing aids. 38 C.F.R. §§ 4.85, 4.86, 4.87, Diagnostic Codes 6100 to 6110 (1998). Under the revised regulations in effect from June 10, 1999, an examination for hearing impairment must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. Examinations are to be conducted without the use of hearing aids. To evaluate the degree of disability from defective hearing, the rating schedule establishes 11 auditory acuity levels from Level I for essentially normal acuity through Level XI for profound deafness. These are assigned based on a combination of the percent of speech discrimination and the puretone threshold average, as contained in a series of tables within the regulations. The puretone threshold average is the sum of the puretone thresholds at 1000, 2000, 3000, and 4000 Hertz, divided by four. If impaired hearing is service-connected in only one ear, in order to determine the percentage evaluation from Table VII, the non-service-connected ear will be assigned a Roman Numeral designation for hearing impairment of I. 38 C.F.R. § 4.85 (1999). Also for consideration is the newly enacted 38 C.F.R. § 4.86, for exceptional patterns of hearing impairment. Thereunder, (a) when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Each ear will be evaluated separately; and (b) when the pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(a)-(b) (1999). Tables VI-VII are unchanged. Compare 38 C.F.R. § 4.86 (1999) with 38 C.F.R. § 4.87 (1998). The Board is therefore required to consider the appellant's claim in light of both the old and revised schedular rating criteria for hearing impairment and determine the extent to which each may be favorable to the appellant in this case. See Karnas v. Derwinski, supra. In this case, entitlement to service connection for bilateral hearing loss was granted in a June 1994 rating decision, and a non-compensable evaluation was assigned. This determination was based on the results of an audiometric test conducted in August 1993, for purposes of separation from service, the veteran's history of routine exposure to hazardous noise in-service, and the results of a February 1994 VA audiological examination. The results of the August 1993 audiometric testing reflect puretone thresholds, in decibels, of 15, 00, 10, 30, 35 for the right ear and 20, 10, 20, 50, 60 for the left ear at the 500, 1000, 2000, 3000, and 4000 Hertz frequencies. This report also indicates that the veteran required an audiological and otologic referral, and that he was routinely exposed to hazardous noise. A VA Summary Report of Examination for Organic Hearing Loss, dated in February 1994, reflects that the veteran was found to have decibel losses of 10, 20, 35, 55 in the right ear and 10, 25, 60, 65 in the left ear at the 1000, 2000, 3000, and 4000 Hertz frequencies. The puretone average was 30 in the right ear and 40 in the left ear. The speech recognition score was 96 percent in the right ear and 96 percent in the left ear. This report was prepared by the VA Chief of Audiology; and, over his signature, he entered a finding of bilateral hearing loss. A VA ear, nose, and throat (ENT) examination report, dated in February 1994, reflects a history significant for military noise exposure in the mechanized infantry. The examiner noted that on review of the veteran's August 1993 audiogram report, the veteran had significant hearing loss in the 3000 and 4000 range on the left and a milder loss in the 4000 range on the right. He elaborated that both of these findings were consistent with high frequency loss, or rather with noise exposure. The impression was of hearing loss consistent with military noise exposure. A Fee Basis audiology examination report, dated in February 1999, reflects that the veteran was found to have decibel losses of 15, 15, 20, 55, 65 in the right ear and 20, 15, 40, 70, 85 in the left ear at the 500, 1000, 2000, 3000, and 4000 Hertz frequencies. The puretone average was 39 for the right ear and 52.50 for the left ear. The speech recognition score was 100 percent in the right ear and 98 percent in the left ear. The Maryland NU-6 Word List was used. The examiner recommended that the veteran wear hearing aids in some circumstances, that he should study lip reading for future potential hearing loss progression, and the he should avoid loud noisy environments. The diagnoses included "sensorineural hearing loss with tinnitus - service- connected." In an April 1999 statement in support of his claim, the veteran reported that he was fitted with hearing aids. As previously noted, under the old and revised criteria, hearing impairment is evaluated based upon puretone thresholds average and speech discrimination. These values are then translated into a numeric designation in order to evaluate the degree of disability, and are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. 38 C.F.R. § 4.85, Table VI (1998 & 1999); see also Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Based on the audiometric results contained in the audiological examination reports of 1994 and 1999, the speech discrimination percentages of 96-100 compared with average puretone decibel losses between 30-39 are designated Level I; and speech discrimination percentages of 96-98 compared with average puretone decibel losses between 40-53 are designated Level I, for VA purposes. See 38 C.F.R. §§ 4.85, 4.87, Table VI (1998 & 1999). As a result, the provisions of the old and revised criteria would not result in a more favorable outcome of the veteran's claim. Since neither the VA nor Fee Basis examiners indicated that the veteran had language difficulties or inconsistent speech audiometry scores, the old provision of 38 C.F.R. § 4.85(c) (1998) is not for application. Further, the audiometric findings contained in the 1994 and 1999 reports do not reflect a puretone threshold of 55 decibels or more at each of the 1000 through 4000 Hertz level; nor do such findings reflect puretone thresholds of 30 decibels or less at 1000 Hertz, and puretone thresholds of 70 decibels or more at 2000 Hertz. As such, the newly enacted 38 C.F.R. § 4.86(a)-(b) (1999), for exceptional patterns of hearing impairment based only on the puretone threshold average, is likewise not for application in this case. The veteran has asserted on appeal that his bilateral hearing loss warrants a higher disability rating. After a review of all of the evidence of record, the Board acknowledges that the veteran's hearing acuity, in accordance with VA schedular standards, has undergone some change since the February 1994 VA authorized audiological examination, which reflected a Level I hearing acuity in the right ear and a Level I hearing acuity in the left ear to warrant a non-compensable disability rating. That notwithstanding, the results of the most recent Fee Basis audiological examination, which was performed in February 1999, reflects that the veteran's hearing acuity in the right ear is a Level I and a Level I in the left ear. Hearing loss classified at these Levels is evaluated as non-compensable under Table VII (38 C.F.R. § 4.85 (1999) and § 4.87, Diagnostic Code 6100 (1998)). In the absence of a greater level of hearing loss, a higher schedular evaluation for the veteran's service-connected bilateral hearing loss is not warranted. The appeal is denied. B. Tinnitus As discussed above, service connection for tinnitus was granted by a June 1994 rating decision, and a 10 percent disability rating was assigned pursuant to 38 C.F.R. § 4.87a, DC 6260 (effective prior to June 10, 1999). A 10 percent disability rating is warranted for tinnitus under the pre- June 10, 1999 schedular criteria if the record shows persistent tinnitus as a symptom of head injury, concussion, or acoustic trauma. See 38 C.F.R. § 4.87a, DC 6260 (1998). Under the revised criteria effective June 10, 1999, a 10 percent disability rating is warranted for recurrent tinnitus. See 38 C.F.R. § 4.87, DC 6260 (1999). The 10 percent rate is the maximum schedular rating assignable under DC 6260. This disability rating was based primarily on the reference audiogram conducted in August 1993, which reflects that the veteran was routinely exposed to hazardous noise without mention of tinnitus, and the report of VA examination dated in February 1994, which demonstrates that the veteran complained of constant bilateral tinnitus secondary to noise exposure. On Fee Basis audiological examination in February 1999, the veteran reported that the bilateral tinnitus, which was described as constant , started during military service and that he was exposed to gunfire on line and in tank activity. Generally, the claimant will be presumed to be seeking the maximum available benefit by law and regulation. See AB v. Brown, 6 Vet. App. 35, 38-39 (1993). As aptly noted above, the 10 percent disability rating for tinnitus is the maximum schedular rating assignable. See 38 C.F.R. § 4.87a, DC 6260 (1998) as amended by 38 C.F.R. § 4.87, DC 6260 (1999). Since the veteran has been awarded the maximum schedular rating for tinnitus, a higher schedular rating is not warranted. C. Other consideration In the unusual case where the schedular evaluations are found to be inadequate, an extraschedular evaluation may be assigned commensurate with the impairment in the average earning capacity due exclusively to the service-connected disability or disabilities. See 38 C.F.R. § 3.321(b)(1) (1999); Spurgeon v. Brown, 10 Vet. App. 194, 197 (1997). With respect to this claim, the Board observes that in light of Floyd v. Brown, 9 Vet. App. 88 (1996), 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, however, is still obligated to seek all issues that are reasonably raised from a liberal reading of documents or testimony of record and consider whether additional benefits are warranted under any of the provisions of Parts 3 and 4. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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 conclusion on its own. As to the disability picture presented in this case, the Board cannot conclude that the disability picture is so unusual or exceptional, with such related factors as frequent hospitalization or marked interference with employment, as to prevent the use of the regular rating criteria. The Board acknowledges the veteran's contentions that he has less than optimal hearing, that he was fitted with hearing aids in April 1999, and that he has tinnitus. The Board also takes note of the VA examinations of record which reflect noncompensable hearing loss with recommendations to use hearing aids in some circumstances and that he should study lip reading for future potential hearing loss progression. It is important to note that these factors are not so exceptional to preclude the use of the regular rating criteria. See Moyer v. Derwinski, 2 Vet. App. 289, 293 (1992); Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (noting that the disability evaluation itself is recognition that industrial capabilities are impaired). In sum, the rating schedule is shown to provide a fair and adequate basis for rendering a decision in this case. In the absence of an exceptional or unusual disability picture marked by frequent hospitalizations for the disabilities, the Board finds that the criteria for submission for assignment of an extraschedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not met. See Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). The Board finds that the preponderance of the evidence is against the claims for higher disability ratings for bilateral hearing loss and tinnitus. As the preponderance of the evidence is against these claims for higher disability ratings, the benefit of the doubt provisions are not for application. See 38 C.F.R. § 4.3. The appeal is denied. ORDER Service connection for PTSD is denied. Entitlement to an initial compensable rating for bilateral hearing loss is denied. Entitlement to an initial disability rating in excess of 10 percent for tinnitus is denied. REMAND There is some duty to advise the claimant of the elements necessary to complete his application for benefits under 38 U.S.C.A. §§ 5103(a), 5107(a) (1999), depending on the particular facts in each case. See Beausoleil v. Brown, 8 Vet. App. 459 (1996); Robinette v. Brown, 8 Vet. App. 69 (1995). The veteran served on active duty from November 1988 to September 1993. In March 1994, the RO submitted a VA Form 21-3101, Request for Information, to the National Personnel Records Center (NPRC) noting that the records received from the "SRMC" were incomplete and limited to treatment records and a separation examination dated for the period of July 1993 to September 1993. In August 1994, the NPRC responded to the RO's request for information noting that there was no entrance examination or additional service medical records on file but that the veteran had other service with the U.S. Army Reserves. In statements submitted in April 1995 and April 1999, the veteran reported his military assignments and points of treatment as early as 1990 for a back condition, a right leg condition, a right shoulder condition, a bilateral foot condition, a left wrist condition, a nasal fracture, a neck cyst, and painful joints. Specifically, he asserts receiving treatment for a nose fracture incurred coincident with an assault in 1990 while assigned with B Company, 1/15th infantry in Wurzburg, Germany. He also contends that he received treatment for his back and shoulder while assigned to A Company 2/16 and H.H.C. 2/16 Infantry between 1991 and 1993. Based on the veteran's contentions of treatment in-service and the potential existence of additional service medical records, the Board is of the opinion that additional action by the RO may be helpful in either obtaining putative service medical records held by the service department that are not currently of record or documented information that the reserve records cannot be obtained. See Bell v. Derwinski, 2 Vet. App. 611, 613 (1992) (a remand is required where records in control of VA could reasonably be expected to be a part of the record and could be determinative of the claim but were not considered). In any event, the VA has an obligation under 38 U.S.C.A. § 5103(a), to advise the veteran of the evidence necessary to complete his application for VA benefits based on service connection for a back condition, a right leg condition, a right shoulder condition, a bilateral foot condition, a left wrist condition, residuals of a nasal fracture, residuals of removal of a neck cyst, and painful joints. See Beausoleil and Robinette, both supra. In this case, the veteran is hereby notified that preliminary review indicates that the evidence necessary to complete these applications for service connection is competent medical evidence of currently diagnosed disabilities which can be related to his period of military service (or within the one-year statutory presumptive period). Once the development is completed, the record must again be reviewed to determine whether the claims are ultimately well-grounded. Accordingly, the veteran is advised that, unless the development directed herein coincidentally provides evidence on the theories of entitlement to service connection, he is still under an obligation to provide such evidence. See 38 U.S.C.A. § 5107. To ensure that VA has met its duty to assist under 38 C.F.R. §§ 5103 and 5107(a) and to give the veteran every consideration with respect to the present appeal, the case is REMANDED to the RO for the following actions: 1. The RO should confirm the veteran's mailing address and acquire the dates of his U.S. Army Reserve service. At the same time, the veteran should be informed by letter that it is his duty to keep VA abreast of any circumstances which may affect his appeal, including his change of address. 2. The RO should make another attempt to secure any available service medical records through official channels to include morning and sick reports for the veteran's period of active duty (November 1988 to September 1993) and army reserve service with the specific information provided by the veteran. See lay statements submitted by the veteran in April 1995 and April 1999. The RO is also directed to obtain any line of duty determinations conducted by the service department in 1990 regarding injuries as a result of an assault, if any. All outstanding VA outpatient treatment records should be obtained. These records should be associated with the claims file. If any request is not fulfilled, the responding agency/ service department must submit a written statement to that effect. 3. Upon completion of the above, the RO should review the claims file and ensure that all indicated actions have been completed, to the extent possible. Thereafter, the RO should make a specific determination, based upon the complete record, with respect to whether or not the veteran has presented well-grounded claims for entitlement to service connection for a back condition, a right leg condition, a right shoulder condition, a bilateral foot condition, a left wrist condition, residuals of a nasal fracture, residuals of removal of a neck cyst, and painful joints. Based on this determination, and if appropriate, see Morton v. West, 12 Vet. App. 477 (1999), the RO should accomplish any further indicated development. 4. If the determination remains adverse to the veteran, the RO should furnish the veteran and his representative a supplemental statement of the case for each adverse determination and provide them an opportunity to respond. The case should then be returned to the Board for further appellate consideration, if appropriate. The Board does not intimate any opinion, either factual or legal, as to the ultimate disposition of the claims. No action is required of the veteran unless he is notified by the RO. The veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the RO. See 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. Deborah W. Singleton Member, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 1991 & Supp. 1999), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1999).