Citation Nr: 0112553 Decision Date: 05/02/01 Archive Date: 05/09/01 DOCKET NO. 94-06 374 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office in Newark, New Jersey THE ISSUES 1. Entitlement to service connection for a low back disorder on a direct basis or, alternatively, as due to an undiagnosed illness. 2. Entitlement to service connection for a right ankle disorder on a direct basis or, alternatively, as due to an undiagnosed illness. 3. Entitlement to service connection for a rash on the legs on a direct basis or, alternatively, as due to an undiagnosed illness. 4. Entitlement to service connection for a left foot disorder on a direct basis or, alternatively, as due to an undiagnosed illness. 5. Entitlement to service connection for healed laceration of the right middle finger on a direct basis or, alternatively, as due to an undiagnosed illness. 6. Entitlement to service connection for scrotal tongue on a direct basis or, alternatively, as due to an undiagnosed illness. 7. Entitlement to service connection for residuals of smoke inhalation on a direct basis or, alternatively, as due to an undiagnosed illness. 8. Entitlement to service connection for residuals of a blood infection on a direct basis or, alternatively, as due to an undiagnosed illness. 9. Entitlement to service connection for subcutaneous nodule of the right costal margin on a direct basis or, alternatively, as due to an undiagnosed illness. 10. Entitlement to service connection for hearing loss on a direct basis or, alternatively, as due to an undiagnosed illness. 11. Entitlement to an increased (compensable) evaluation for a scar of the right shoulder, on appeal from the initial grant of service connection. 12. Entitlement to an evaluation in excess of 10 percent for folliculitis, on appeal from the initial grant of service connection. REPRESENTATION Appellant represented by: New Jersey Department of Military and Veterans' Affairs WITNESS AT HEARINGS ON APPEAL The veteran ATTORNEY FOR THE BOARD Suzie S. Gaston, Counsel INTRODUCTION The record indicates that the veteran had active military service from June 1988 to June 1992; he served in the Southwest Asia theater of operations during the Persian Gulf War from August 1990 to March 1991. He has been represented throughout his appeal by the New Jersey Department of Military and Veterans' Affairs. This matter came before the Board of Veterans' Appeals (hereinafter Board) on appeal from a January 1993 rating decision by the Newark, New Jersey, Regional Office (RO), which granted service connection for scar of the right shoulder and folliculitis, both evaluated as noncompensably disabling; however, the RO denied the veteran's claims for service connection for mechanical low back pain, a right ankle disorder, rash on the legs, hearing loss, healed laceration of the right middle finger, a left foot disorder, residuals of smoke inhalation, residuals of blood infection, scrotal tongue, and subcutaneous nodule of the right costal margin. A notice of disagreement (NOD) with this determination was received in July 1993. A statement of the case (SOC) with respect to the claims of service connection for a back disorder, a right ankle, rash on the legs, and hearing loss was issued in July 1993. A substantive appeal (VA Form 9), addressing the issues of entitlement to service connection for a back disorder, a left foot disorder, rash on the legs, and scrotal tongue, as well as increased ratings for a scar of the right shoulder and folliculitis, was received in October 1993. The veteran appeared and offered testimony at a hearing before a Hearing Officer at the RO in June 1994. A transcript of the hearing is of record, containing testimony on the issues of service connection for knee and cervical spine disorders. A VA compensation examination was performed in July 1994. Thereafter, a Hearing Officer's Decision was entered in September 1994, which assigned a 10 percent disability rating for folliculitis; however, the Hearing Officer confirmed the previous denial of the veteran's claims of service connection for a low back disorder, a left foot disorder, hearing loss, and an increased rating for a scar of the right shoulder. A rating action later in September 1994 implemented the hearing officer's decision and assigned a 10 percent rating for folliculitis. A supplemental statement of the case (SSOC) was issued in October 1994. A VA compensation examination was performed in March 1995. Thereafter, a rating action of April 1995 confirmed the previous denial of the claim for service connection for a low back disorder. An NOD as to that rating action was received in August 1995, and an SOC was issued in September 1995. An SSOC, addressing all the claims adjudicated and denied by the RO in January 1993, was issued in June 1996. In June 1996, the veteran appeared and offered testimony at a Travel Board hearing before a Member of the Board, sitting at Newark, New Jersey. A transcript of that hearing is also of record. This transcript is construed as a substantive appeal with regard to the new issues considered in the June 1996 supplemental statement of the case. The appeal was received at the Board later in June 1996. Upon reviewing the evidentiary record, the Board requested an opinion from a medical expert with the Veterans Health Administration (VHA). The opinion of the VHA physician was received in March 1997. Subsequently, a copy of the opinion was sent to the veteran's representative for review and response. The representative was afforded sixty days in which to submit any additional evidence or argument. No response was received within the given period of time. In July 1997, the Board remanded the case to the RO for further development. A VA compensation examination was conducted in September 1997. Additional medical records were received in February, March, and November 1998. By a rating action in June 2000, the RO confirmed the previous denial of the veteran's claims for service connection for a low back disorder, a right ankle disorder, a rash on the legs, a left foot disorder, healed laceration of the right middle finger, scrotal tongue, residuals of smoke inhalation, blood infection, subcutaneous nodule of the right costal margin, and hearing loss, all on direct basis and as due to an undiagnosed illness; the RO also confirmed the ratings assigned for a scar of the right shoulder and folliculitis. SSOCs were issued in June and September 2000. The appeal was received back at the Board in January 2001. In AB v. Brown, 6 Vet.App. 35 (1993), the United States Court of Appeals for Veterans Claims held that, on a claim for an original or increased rating, the claimant will generally be presumed to be seeking the maximum benefit allowed by law. Accordingly, the Board must conclude that, even though an increase from zero percent to 10 percent was granted by the RO during the pendency of this appeal, the claim for an increased rating for folliculitis remains in appellate status. By rating actions in June and October 2000, the RO denied service connection for a heart condition. The veteran was notified of that determination and of his appellate rights by letters dated in June and October 2000, respectively. However, the veteran did not file an NOD as to either of those determinations. Thus, the issue of entitlement to service connection for a heart condition is not in proper appellate status and will not be addressed herein. 38 U.S.C.A. § 7105 (West 1991). FINDINGS OF FACT 1. All relevant available evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The veteran served in the Southwest Asia Theater of operations during the Persian Gulf War. 3. The service medical records contain no reference to a left foot disorder, residuals of smoke inhalation, residuals of a blood infection, or subcutaneous nodule of the right costal margin. 4. In service, the veteran received clinical attention and treatment for mechanical low back pain, right ankle pain, a rash on the left leg, and "some" hearing loss. 5. Episodes of low back pain and low back strain during service were acute and transitory, and resolved without residual chronic disability. 6. The veteran's complaints of low back pain have been attributed to a clinical diagnosis of myofascial pain syndrome, and it is not shown to be related to military service. 7. There is no objective medical evidence which tends to show the veteran currently suffers from a right ankle disorder, to include as a manifestation of an undiagnosed illness. 8. There is no competent evidence of a current disability manifested by a rash on the legs, to include a competent medical nexus between the signs and symptoms of this claimed disability and an undiagnosed illness. 9. No medical evidence has been submitted indicating that the veteran currently has a left foot disorder, to include a competent medical nexus between the signs and symptoms of this claimed disability and an undiagnosed illness. 10. The service medical records reflect that the veteran suffered a laceration of the right middle finger prior to service entry. 11. The pre-existing right middle finger laceration is not shown by competent medical evidence to have increased in severity during the veteran's period of active service. 12. The veteran's current disability involving the tongue has been diagnosed as a scrotal tongue, which is a congenital or developmental defect and, as such, is not a disease or injury within the meaning of applicable law. 13. The current medical evidence does not show the presence of an undiagnosed illness involving the tongue. 14. There is no competent medical evidence showing that the veteran has any chronic disability, or any objective signs or symptoms of a chronic disability from an undiagnosed illness, as a residual of smoke inhalation in service. 15. There is no competent evidence of a current disability manifested by a blood infection, to include as a manifestation of an undiagnosed illness. 16. The medical evidence of record demonstrates that the veteran's subcutaneous nodule of the right costal margin had its onset during active service. 17. VA audiologic findings in August 1992 reflect that the auditory thresholds in the frequencies of 500, 1000, 2000, 3000, and 4000 Hertz were all less than 26 decibels, and that the speech recognition scores using the Maryland CNC Test were 94 percent in right ear and 96 in the left ear. 18. A hearing loss disability as defined by 38 C.F.R. § 3.385 has not been shown. 19. The veteran's folliculitis is not shown to manifest or be productive of exudation or itching constant, extensive lesions, or marked disfigurement. 20. The veteran's folliculitis is not shown to produce scarring which is poorly nourished with repeated ulcerations, or painful and tender on objective demonstration, or causes any functional limitation. 21. The veteran's scar on the right shoulder is currently manifested by a .5x7cm linear scar that is essentially asymptomatic, without residual deficits. CONCLUSIONS OF LAW 1. A chronic low back disorder was not incurred in or aggravated by the veteran's military service, nor may his complaints of low back pain be presumed to be related to his service in the Persian Gulf. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991 & Supp. 2000); Pub. L. No. 106-475, § 4, 114 Stat. 2096, 2097-99 (2000) (to be codified as amended at 38 U.S.C.A. §§ 5103A(f), 5107); 38 C.F.R. §§ 3.303, 3.317 (2000). 2. A right ankle condition, a rash on the left leg, and a left foot condition were not incurred in or aggravated by the veteran's military service, nor may they be presumed to be related to his service in the Persian Gulf. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991 & Supp. 2000), Pub. L. No. 106-475, § 4, 114 Stat. 2096, 2097-99 (2000) (to be codified as amended at 38 U.S.C.A. §§ 5103A(f), 5107); 38 C.F.R. §§ 3.303, 3.317 (2000). 3. A healed laceration of the right middle finger, which preexisted active service, was not aggravated therein and is not due to an undiagnosed illness. 38 U.S.C.A. §§ 1110, 1111, 1117, 1131, 1153 (West 1991 & Supp. 2000); 38 C.F.R. §§ 3.303, 3.306, 3.317 (2000); Pub. L. No. 106-475, § 4,114 Stat. 2096, 2098-99 (2000) (to be codified as amended at 38 U.S.C.A. § 5107). 4. The veteran's claim of entitlement to service connection for scrotal tongue is denied, as it is not a disease or injury for which service connection can be granted. 38 C.F.R. § 3.303 (c) (2000). 5. Residuals of smoke inhalation and a blood infection, including as due to an undiagnosed illness, were not incurred in or aggravated in service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5107 (West 1991 & Supp. 2000); 38 C.F.R. §§ 3.303, 3.317 (2000); Pub. L. No. 106-475, § 4,114 Stat. 2096, 2098- 99 (2000) (to be codified as amended at 38 U.S.C.A. § 5107). 6. Giving the benefit of the doubt to the veteran, a subcutaneous nodule of the right costal margin was incurred during active military service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991 & Supp. 2000); 38 C.F.R. §§ 3.102, 3.303 (2000); Pub. L. No. 106-475, § 4,114 Stat. 2096, 2098-99 (2000) (to be codified as amended at 38 U.S.C.A. § 5107). 7. Bilateral hearing loss was not incurred or aggravated in service, nor may it be presumed to be related to his service in the Persian Gulf. 38 U.S.C.A. §§ 1110, 1117, 1131, 5107 (West 1991 & Supp. 2000); 38 C.F.R. §§ 3.303, 3.385 (2000); Pub. L. No. 106-475, § 4,114 Stat. 2096, 2098-99 (2000) (to be codified as amended at 38 U.S.C.A. § 5107). 8. The criteria for an evaluation in excess of 10 percent for folliculitis have not been met at any time since the initial grant of service connection. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.10, Part 4, Diagnostic Codes 7899 and 7806 (2000). 9. The criteria for a compensable rating for a scar of the right shoulder, from the date of the veteran's separation from active service, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 4.118, Diagnostic Codes 7803, 7804, 7805 (2000). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual background The records show that the veteran entered active duty in June 1988. An enlistment examination, conducted in February 1988, reported a history of a laceration of the right middle finger and a finding of swollen right middle finger; otherwise, the enlistment examination was unremarkable. An audiometric evaluation revealed pure tone thresholds of 0, 0, 0, 5, 10, and 0 decibels in the right ear and 0, 0, 0, 5, 10, and 0 decibels in the left ear at the 500, 1000, 2000, 3000, 4000, and 6000 Hertz levels, respectively. The veteran was seen in August 1988 for complaints of rash on his feet; the assessment was tinea pedis. The service medical records indicate that the veteran was seen in December 1988 for complaints of low back pain with radiation to the upper back when trying to bend forward; the assessment was low back pain vs. mild cold congestion. The veteran was next seen in August 1989, at which time he complained of a rash on his legs and hips. The assessment was heat rash and probable cellulitis of the left leg. In February 1990, he was seen for complaints of right ankle pain; he reported twisting the right leg while playing football. The clinical assessment was "rule out" inversion injury to ankle; an ace wrap was placed on the ankle. In March 1990, an X-ray of the right ankle was reported to be within normal limits; the diagnosis was second degree ankle sprain, "rule out" ligament tear, avulsion fracture. He was next seen in May 1990 complaining of bumps under his chin after shaving; no pertinent diagnosis was reported. A note dated in June 1991 disclosed that the veteran was exposed to a large amount of smoke in the oil fields from February 24, 1991, to February 28, 1991; it was also reported that the smoke from those fields was known to be high in sulfur. When seen in July 1991, the veteran reported a three-year history of low back pain, without lower extremity radiation and without history of trauma. He complained of occasional difficulty straightening, due to increased pain. The impression was of back strain. Subsequently, in August 1991, the veteran was seen for complaints of back pain; he indicated that he had had low back pain for two-and-one-half years; the diagnosis was mechanical low back pain, and he was referred to physical therapy. He was again seen in September 1991 and November 1991, for complaints of low back pain. On the occasion of his separation examination in April 1992, it was noted that the veteran had mechanical low back pain, bilateral high frequency hearing loss with tinnitus, and geographic tongue; it was also noted that he had a 3cm scar on the right deltoid. The veteran was afforded VA compensation examinations in August 1992. A general medical examination was unremarkable, except for a subcutaneous nodule under the right costal margin, which was described as a probable fibroma. The veteran was also accorded an orthopedic examination, at which time he reported suffering a low back injury in December 1988, which was diagnosed as mechanical low back pain; he indicated that he was treated with physical therapy. The veteran also reported that he twisted his right ankle during service; he was given a diagnosis of "sprain," with no treatment. He stated that he injured his right middle finger prior to entering military service, with a laceration being sutured. He also indicated that he injured his left ankle, and not his foot, but he never received any treatment. Following an evaluation, the examiner reported findings of: mechanical low back pain by history, examination and X-rays were negative; sprain of the left ankle, healed without any complications or sequelae; and healed laceration on dorsum of the right middle finger. The veteran was also accorded a dermatology examination in August 1992, which showed scattered folliculitis of the upper trunk, extremities, and beard area. It was further noted that the veteran's tongue had multiple furrows, but no lesions. The pertinent diagnoses were folliculitis, scar of the right shoulder, and scrotal tongue. During an audiological examination, it was noted that the veteran was a radio operator for four years, and was exposed to loud static through the headphones during that time. An audiometric evaluation revealed pure tone thresholds of 10, 10, 10, 15, and 25 decibels in the right ear and 5, 10, 10, 20, and 25 decibels in the left ear at the 500, 1000, 2000, 3000, and 4000 Hertz levels, respectively; speech recognition was 94 percent in the right ear and 96 percent in the left ear. The examiner reported that hearing sensitivity was within normal limits, bilaterally; speech recognition was good and impedance was normal. At the time of his personal hearing in June 1994, the veteran reported that he injured his lower back while lifting some boxes in the supply warehouse in service; he stated that he received treatment which included exercises, heat, and medication. The veteran related that, despite the treatment which received, his back did not improve. He further reported that he suffered a lot of pain, and was unable to function properly. He also indicated that he had problems with radiation of pain in the legs, mainly the left leg. He testified that he noticed swelling in the left foot after prolonged standing. The veteran also testified that he currently had a hearing problem as a result of his service; he indicated that he was a radio operator during Desert Storm, which required long hours of radio watch. Submitted at the hearing was a private treatment report from the Rutgers University Veterans Readjustment counseling program, dated in June 1994, indicating that the veteran began receiving treatment in March 1994 for anger management. Among the diagnoses were back pain, and unidentified growth of torso. Also submitted at the hearing was the report of a Magnetic Resonance Imaging (MRI) of the lumbar spine, conducted in May 1994, which revealed findings of congenitally diminutive cervical spinal canal, with acquired changes including disc bulging and posterior element spondylosis, causing spinal stenosis; no evidence of disc herniation was noted. Also submitted at the hearing was the report of a private evaluation conducted by Dr. Paul V. Campana in May 1994, who reported that the veteran had been under his care since November 1, 1993, for injuries sustained while employed as a "radio man" in the Marine Corps back in 1990. Dr. Campana reported that X-rays were negative for any fracture, dislocation, or gross osseous pathology. Following an evaluation of the back, the pertinent diagnoses were chronic lumbalgia, left lumbosacral radicular syndrome, chronic cervicalgia, multiple disc bulges in the lumbar spine, and congenital lumbar spinal stenosis. Dr. Campana stated that, taking into consideration the history, the MRI results, the subjective complaints, and the objective findings, it was his opinion that the veteran's injuries were a direct result of the duties he performed in service and were permanent in nature. On the occasion of a VA compensation examination in July 1994, the veteran reported experiencing discomfort in the lumbar spine; on occasion, he had some radiation of discomfort down the posterior lateral aspect of his left leg to the region of his ankle. The veteran indicated that his back pain was aggravated by physical activity. On examination, there was normal lumbar lordosis. There was no significant paraspinal muscle spasm noted at that time, nor was there any spinous process tenderness noted. There were 3+ reflexes at both the patella and the Achilles region. Sensation in the lower extremities was intact. Muscle strength in the lower extremities was 5/5. There was no weakness of the extensor hallucis longus. On straight leg raising, he was able to go to 85 degrees bilaterally, and was limited at that point by hamstring and gastrocnemius tightness, but not by any radiation of pain down the legs. There was no complaint of pain in the back. The pertinent diagnosis was intermittent lumbosacral strain syndrome with an occasional left leg distribution of pain; no evidence of radiculopathy was noted. MRI study revealed minimal bulge at L3-4, but no evidence of cord or root compression. The veteran was afforded another VA compensation examination in March 1995, at which time he reiterated the history of injuring his back while lifting boxes during service; he was treated with physical therapy and medication. The veteran indicated that he continued to experience back discomfort after service. He stated, however, that he did not seek any medical attention following service. Following an evaluation of the back, and review of the claims file, including a report of the MRI conducted in May 1994, the examiner reported that the mechanical low back pain was related to a congenital spinal stenosis rather than a specific service- connected injury. At the time of his hearing in June 1996, the veteran indicated that he was a radio operator in a tracked vehicle that called in air strikes, which were then carried out by jets and helicopters. The veteran related that he injured his back while pulling some big boxes of paperwork in service; he indicated that he was diagnosed with a low back disability, for which he received physical therapy. He indicated that he continued to have pain in his lower back, which was aggravated by prolonged sitting and standing; he also reported radiation of pain into his left leg. He testified that he injured his right ankle while playing football in the Marine Corps; he stated that he was unable to walk for months. The veteran also testified that, although he had the split in his tongue prior to service, it became worse in service. The veteran further testified that his tracked vehicle was very close to the fires during Desert Storm; he stated that sometimes it became so dark that he could not see his hand in front of him. He reported that, while he had a gas mask, he did not always wear it; as a result, he often inhaled smoke into his lungs. He said he was constantly tired. The veteran further asserted that no doctors had told him that he had a blood infection; however, he was treated with chemicals in service and he was given botulism shots. He reported that he was told that he had a little hearing loss prior to discharge. The veteran further reported that, although he noticed a lump on the right costal margin prior to getting out of military service, he did not wish to complain and have his discharge delayed; he wanted to get to his father, who was gravely ill. In January 1997, the Board requested an opinion from a VA orthopedist. That physician was asked to review the veteran's claims folder and furnish an opinion as to the following questions: a. Did the veteran have a low back disorder while on active duty? If so, what is the diagnosis? b. Does the veteran currently have a low back disorder? If so, what is the diagnosis? If the veteran has a low back disorder now, is it related to service or any in-service disease or injury? In a March 1997 report, a VHA physician, in response to the foregoing questions, noted that the records do support that the veteran had a low back disorder while in service; he stated that it was most likely a lumbar strain or mechanical low back pain, which did not appear to be a radiculopathy. The physician observed that, at the time of discharge from service, the back pain had apparently resolved and the veteran was able to be employed in various jobs without limitation due to his prior back pain. The physician also noted that the veteran currently complained of low back pain which did not seem to be radicular in nature. The physician further noted that the findings of the veteran's recent MRI did reveal congenital stenosis as well as bulging disks; he stated, however, that fifty percent of adult males without any symptoms of back pain will have those findings on an MRI evaluation. He also stated that the findings of congenital narrowing were not related to his service duties, and may or may not contribute to his current complaints of low back pain. The physician explained that the veteran's complaints were not limited to his back and legs, but were more generalized pain problems and were exacerbated with changes in the weather and especially with cold weather. The physician noted that the above symptoms were consistent with a myofascial pain syndrome, which was unlikely to be related to the veteran's prior lumbar strain while in service. The physician stated that it was his belief that the veteran's current complaints of low back pain represent low back strain and were likely part of a more generalized myofascial pain syndrome, not related to the prior service-related mechanical low back pain. He also stated that the lumbar stenosis noted on the MRI might contribute to the above, but, given the radicular findings, it was probably a secondary contributor. Received in September 1997 was a VA hospital summary, which showed that the veteran was admitted in March 1996 for evaluation and treatment of symptoms associated with a psychiatric disorder. A physical evaluation was positive for low back pain and bilateral tinea pedis. During his period of hospitalization, the veteran received physical rehabilitation for his lower back pain. It was noted that he presented physical limitations secondary to his lower back pain. The veteran was accorded a VA compensation examination in September 1997, at which time he gave a positive history of exposure to oil smoke. He stated that he was definitely enveloped in the oil smoke, but he also gave a positive history of using a mask. The veteran also gave a positive history of having been told to put on protective gear at least one time during his duty because of exposure to either chemical or biological warfare. He was unsure, but he thought that he was around tanks that were exposed to uranium weapons. The veteran denied any pulmonary symptoms. He complained of multiple aches, fatigue, and tiredness. He also complained of low back pain, particularly in his buttocks, with radiation down his legs; he stated that it started in service, but the radiating pain exacerbated since he was in a car accident in May 1997. The veteran complained of pain in his left foot and his ankle. He also reported having a fever in the Philippines, and said he had experienced no recurrence of any fever or blood infection. On examination, the veteran had an erect carriage, with normal posture and gait. On the left shoulder, he had a 5 x 1-cm fairly thick scar which looked like a keloid that was secondary to an accident in service. He had folliculitis in his beard under his chin; folliculitis barbae. He also had nonspecific and very discreet papules over his body, but not concentrated in any particular area. He had a very small, well-healed laceration without any restriction of movement over his right ring finger on the ventral side; it did not restrict any kind of movement. His lungs were clear to auscultation and percussion. He had no problems with his lungs currently. There was no muscle atrophy noted in any limbs, upper or lower. There was full range of motion in both ankles; no pain or disability was noted. Only on palpation of the foot and the left proximal metacarpal was there some pain just on palpating. The veteran indicated that he had increased pain in the left foot with prolonged standing; he had good pulses. On examination of the lumbar spine, he had full range of motion; it appeared he had a straight back and lordotic curvature of the back. His straight leg raising on the right and left was 0 to 80 degrees without any pain. A neurological examination was grossly within normal limits. No pertinent diagnoses were noted. The veteran was also afforded a special skin examination in September 1997, at which time he complained of folliculitis since returning from the Gulf; he indicated that he had had no treatment for that condition. He stated that he broke out with small little bumps on his thighs and chest periodically, which were asymptomatic, non-pruritic, and non-painful. A scar on the right arm was secondary to laceration, and was mildly pruritic. On examination, there were minute follicular erythematous papules and small pustules, few in number, located on the thighs and upper back. The right arm and shoulder area scar was a .5x7cm linear scar, nontender and non-deforming. The diagnoses were minimal folliculitis at this time; and scar on the right arm, non-deforming, with no limitation of function. Received in February 1998 were medical records from the Social Security Administration, dated from March to April 1996, which reflect clinical evaluation and treatment for a psychiatric disorder. These records also indicate that the veteran was treated for complaints of low back pain. In May 1996, he was diagnosed with low back pain. Additional VA treatment records dated from December 1996 to November 1997 were subsequently received in March 1998, which show that the veteran continued to receive clinical attention and treatment for several disabilities, including a psychiatric disorder, a cardiovascular disorder, and a back disorder. A radiology report dated in June 1997 indicates that the veteran was involved in an automobile accident in May 1997, and he had mild swelling, numbness, and pain in the right lateral mid back to buttocks. A CT scan of the back was negative for herniated disk, but several fractures were noted. Received in November 1998 was a VA hospital summary dated in October 1997, showing that the veteran was hospitalized and treated for a psychiatric disorder. Subsequently received in October 1999 were additional VA hospital reports dated from December 1996 to April 1997 which reflect treatment for a cardiovascular disease not currently at issue. These records do not reflect any complaints, diagnoses, or treatment of the disorders currently on appeal. II. Legal analysis -- Service connection Service connection connotes many factors, but basically it means that the facts, as shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131, 1153 (West 1991 & Supp. 2000); 38 C.F.R. § 3.303(a)(2000). Such a determination requires a finding of a current disability which is related to an injury or disease incurred in service. Watson v. Brown, 4 Vet.App. 309, 310 (1993); Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d)(2000). Alternatively, under 38 C.F.R. § 3.303(b), service connection may be awarded for a "chronic" disorder where: (1) a chronic disease manifests itself and is identified as such in service (or within the presumption period under 38 C.F.R. § 3.307) and the veteran currently has the same condition; (2) a disease manifests itself during service (or during the presumption period) but is not identified until later, there is a showing of continuity of symptomatology after discharge, and the medical evidence relates the symptomatology to the veteran's present condition. Rose v. West, 11 Vet.App. 169 (1998); Savage v. Gober, 10 Vet.App. 488, 495-98 (1997). A veteran who served during a period of war or during peacetime service after December 31, 1946, is afforded a presumption of sound condition upon entry into service, except for any defects noted at the time of examination for entry into service; that presumption can be overcome only by clear and unmistakable evidence that a disability existed prior to service. 38 U.S.C.A. § 1111; see Doran v. Brown, 6 Vet. App. 283 (1994); Laposky v. Brown, 4 Vet. App. 331 (1993). Further, a preexisting injury or disease is considered to have been aggravated by service if there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a). However, intermittent or temporary flare- ups during service of a preexisting injury or disease do not constitute aggravation. Rather, the underlying condition must have worsened. Hunt v. Derwinski, 1 Vet.App. 292, 297 (1991). In addition, 38 U.S.C.A. § 1117 provides for additional compensation for Persian Gulf veterans suffering from a chronic disability resulting from an undiagnosed illness that became manifest during active duty in the Southwest Asia theater of operations or became manifest to a compensable degree within the prescribed presumptive period. 38 U.S.C.A. § 1117 (West Supp. 2000). Regulations clarify that a veteran of the Persian Gulf war must exhibit objective indications of a chronic disability resulting from an undiagnosed illness or combination of illnesses manifested by one or more signs or symptoms. 38 C.F.R. § 3.317(a)(1). "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). A disability is considered "chronic" if it has existed for six months or more or if the disability exhibits intermittent episodes of improvement and worsening over a six-month period. 38 C.F.R. § 3.317(a)(3). Signs or symptoms which may be manifestations of an undiagnosed illness include, but are not limited to: fatigue, signs or symptoms involving skin, headache, muscle pain, joint pain, neurologic signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the upper or lower respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. 38 U.S.C.A. § 3.317(b). It is emphasized that the disability must not be attributed to any known clinical diagnosis by history, physical examination, or laboratory test. 38 C.F.R. § 3.317(a)(1)(i) and (ii). Finally, the claimed chronic disability must have been manifest during active service in the Southwest Asia theater of operations or manifest to a compensable degree by December 31, 2001. 38 C.F.R. § 3.317(a)(1)(i) and (ii); 62 Fed. Reg. 23138, 23139 (1997) (interim amendment, now codified at 38 C.F.R. § 3.317(a)(1)(i)). We will digress for a moment to note that, until very recently, the RO and the Board were required by law to assess every claim, before completing our adjudication as to the its merits under substantive law, to determine whether it was well grounded, pursuant to 38 U.S.C.A. § 5107(a) (West 1991). However, the United States Congress has recently passed, and the President signed into law, legislation repealing the requirement that a claim must be well-grounded. See Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, § 4, 114, Stat. 2096, 2097-98 (2000). That statute, enacted on November 9, 2000, contains a number of new provisions pertaining to claims development procedures, including assistance to be provided to claimants by the RO, notification as to evidentiary requirements, and the obtaining of medical examinations and opinions to attempt to establish service connection. We have carefully reviewed the veteran's claims file, to ascertain whether remand to the RO is necessary in order to assure compliance with the new legislation. Based upon the extensive development of the record, the Board concludes that all reasonable efforts have been made to compile a complete record for our decision, including the development undertaken pursuant to our July 1997 Remand, and that the veteran has had adequate notice of the evidence needed to substantiate his claims. Throughout the lengthy passage of this case, the veteran has received numerous notices and statements of the case, advising him of the evidence necessary in his claims. He has availed himself of hearings before both a Hearing Officer and a Member of the Board, and has been apprised of a VHA medical opinion. Accordingly, we find that VA has satisfied its duty to assist the appellant in apprising him as to the evidence needed, and in obtaining evidence pertaining to his claim, under both former law and the new VCAA. 38 U.S.C.A. § 5107(a) (West 1991); Pub. L. No. 106-475, § 3(a), 114 Stat. 2096, 2096-98 (2000) (to be codified as amended at 38 U.S.C. §§ 5103 and 5103A). The Board therefore finds that no useful purpose would be served in remanding this matter for yet more development. Such a remand would result in unnecessarily imposing additional burdens on VA, with no benefit flowing to the appellant. The Court of Appeals for Veterans Claims has held that such remands are to be avoided. See Winters v. West, 12 Vet.App. 203 (1999) (en banc), vacated on other grounds sub nom. Winters v. Gober, 219 F.3d 1375 (Fed. Cir. 2000); Soyini v. Derwinski, 1 Vet.App. 540, 546 (1991); Sabonis v. Brown, 6 Vet.App. 426, 430 (1994). Under both pre- and post-VCAA law, where there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b) (West 1991); Pub. L. No. 106-475, § 4, 114 Stat. 2096, 2099 (2000) (to be codified as amended at 38 U.S.C.A. § 5107(b)); 38 C.F.R. § 3.102 (2000). A. Service connection for a low back disorder The Board notes that the service medical records reflect that the veteran was treated twice during service for complaints of low back pain; he was diagnosed with mechanical low back pain, and was treated with physical therapy. However, the veteran's symptoms appeared to have resolved without any residual disability; the separation examination of April 1992 reported a normal musculoskeletal system. Moreover, VA examination in August 1992 was negative for a chronic back disorder, and X-ray study of the back was normal. The pertinent diagnosis was mechanical low back pain, by history. Therefore, the Board must categorize any low back disorder in service as acute and transitory in the absence of clinical data documenting chronic residuals. Post-service medical records reflect complaints of low back pain, and the veteran has been diagnosed with congenital spinal stenosis. While the veteran has submitted a private medical statement that attributes the current back disorder to service, the doctor's statement is based mainly on history provided by the veteran. Significantly, following a recent VA examination in March 1995, the examiner commented that the mechanical low back pain is related to the veteran's congenital spinal stenosis rather than any service-connected injury. Moreover, the opinion of the VHA physician reflects that the findings of congenital narrowing, which were demonstrated on an MRI, were not related to the veteran's service. The physician specifically reported that the veteran's current complaints were consistent with a myofascial pain syndrome, which was unlikely to be related to the veteran's prior lumbar strain while in service. The physician stated that it was his belief that the veteran's current complaints of low back pain represent low back strain and was likely part of a more generalized myofascial pain syndrome and that it was not related to the prior service- related mechanical low back pain. Under these circumstances, the Board finds that the weight of the evidence shows that the veteran's current back disorder is not attributable to service or any incident thereof. Consequently, the veteran's claim of entitlement to service connection for a low back disorder must be denied. To the extent that the veteran's complaints of low back pain have been attributed to a clinical diagnosis, i.e., myofascial pain syndrome, the provisions of 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317 would not be applicable to this claim. Based upon the absence of evidence of a low back disorder resulting from an undiagnosed illness, the criteria for establishing entitlement to service connection for a low back disorder under 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317 have not been met. In reaching this decision, the Board has considered the doctrine of granting the benefit of the doubt to the veteran, but we do not find the evidence is approximately balanced such as to warrant its application. 38 U.S.C.A. § 5107(b). B. Service connection for a right ankle disorder and a rash on the legs As indicated above, an award of service connection requires that the facts, as shown by the evidence, establish that a particular injury or disease resulting in disability was incurred during service, or was due to an incident of same. Such a determination requires a finding of a current disability which is related to an injury or disease incurred in service. Rabideau v. Derwinski, supra. In this regard, we note that, while the service medical records indicate that the veteran was diagnosed with ankle sprain, the separation examination in April 1992 was negative for any complaints or findings of a right ankle disorder. Further, a right ankle disorder has not been established by medical evidence as existing currently. Therefore, without competent medical evidence showing that the veteran currently has a right ankle disorder noted in service, service connection for a right ankle disorder is not warranted. Moreover, the medical records do not otherwise document complaints associated with the right ankle that defy diagnosis. Under these circumstances, service connection for a right ankle disorder due to a claimed undiagnosed illness is not warranted under 38 C.F.R. § 3.317. With respect to the claim for a rash on the legs, we note that the service medical records reveal that the veteran was seen on one occasion for complaints of a rash on his legs and hips; at that time, he was diagnosed with prickly heat rash and probable cellulitis of the left leg. However, there was no evidence of a rash on the legs on the April 1992 separation examination, and there was no evidence of a rash on the legs at the time of the August 1992 VA examination. The most recent VA examination conducted in September 1997 was also negative for any rash on the legs, other than folliculitis for which service connection has already been granted. Therefore, without competent medical evidence showing that the veteran currently has a right ankle disorder noted in service, service connection for a right ankle disorder is not warranted. Rabideau. Moreover, the medical records do not otherwise suggest complaints of a rash that defy diagnosis. Under these circumstances, service connection for rash on the legs due to a claimed undiagnosed illness is not warranted under 38 C.F.R. § 3.317. C. Service connection for healed laceration of the right middle finger As noted above, a pre-existing disease or injury will be considered to have been aggravated by military service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C.A. § 1153 (West 1991); 38 C.F.R. § 3.306(a) (1996). See Green v. Derwinski, 1 Vet.App. 320, 322-23 (1991). Moreover, in the case of wartime service, clear and unmistakable evidence is required to rebut the presumption of aggravation when the preservice disability underwent an increase in severity during service. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(b). Temporary or intermittent flare-ups of a pre-existing injury or disease are not sufficient to be considered "aggravation in service" unless the underlying condition as contrasted to symptoms, is worsened. See Browder v. Brown, 5 Vet. App. 268, 271-72 (1993) (citing Hensley v. Brown, 5 Vet.App. 155 (1993)). As noted above, a laceration of the right middle finger was noted at the time of the veteran's enlistment examination in February 1988. Therefore, the veteran's medical history provides clear and unmistakable evidence that this disability existed prior to entry into military service. However, service medical records do not reflect any treatment for the right middle finger during the veteran's period of active service. The discharge examination was also negative for any complaints or findings regarding the right middle finger. Evidence in the claims file also contains no medical opinion that the laceration of the right middle finger was chronically worsened or aggravated during the veteran's period of service. On VA examination in August 1992, the examiner reported findings of a healed laceration on dorsum of the right middle finger at the proximal interphalangeal joint which does not interfere with function. Temporary flare-ups will not be considered to be an increase in severity. Hunt v. Derwinski, 1 Vet.App. 292, 295 (1991), and aggravation may not be conceded where the disability underwent no increase in severity during service. 38 C.F.R. § 3.306(b). The determination as to whether a preexisting disability was aggravated by service is a question of fact. Doran v. Brown, 6 Vet.App. 283, 286 (1994). Here, there is no medical evidence to support a finding that the laceration of the right middle finger was chronically worsened or aggravated during service. In view of the foregoing, the Board finds that the evidence of record simply does not establish that the underlying right middle finger disorder increased in severity during service. In the absence of medical evidence showing aggravation of the veteran's disorder during service, service connection for a healed laceration of the right middle finger by aggravation is not warranted. Application of the benefit-of-the-doubt doctrine has been considered with respect to this claim, but the Board finds that there is no approximate balance of negative and positive evidence such as to warrant its application. To the extent that the veteran's complaints of a laceration on his right middle finger have been attributed to a clinical diagnosis, i.e., healed laceration of the right middle finger, the provisions of 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317 would not be applicable to this claim. Based on the absence of evidence of a healed laceration of the right middle finger resulting from an undiagnosed illness, the criteria for establishing entitlement to service connection for a low back disorder under 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317 have not been met. D. Service connection for a left foot disorder, residuals of smoke inhalation, and residuals of a blood infection After careful review of the evidentiary record, the Board notes that the service medical records are completely silent with respect to any complaints, findings, or diagnoses of a left foot disorder, residuals of smoke inhalation, or residuals of a blood infection. Significantly, the separation examination of April 1992 did not report any complaints or findings of any of the above disorders. Further, the post-service medical records do not demonstrate any complaints or diagnoses of either a left foot disorder, residuals of smoke inhalation, or residuals of blood infection. During the August 1992 VA examination, clinical evaluation of the respiratory system and both feet was reported to be normal; a CBC (complete blood count)was essentially normal. Similar findings were reported on the most recent VA examination in September 1997. In fact, despite the veteran's contentions and testimony that he inhaled smoke while performing active duty during Desert Storm, was treated with chemicals and experienced left foot pain while in service, the claims file does not contain any clinical evidence of smoke inhalation, blood infection, or a left foot disorder. Therefore, without competent medical evidence showing that the veteran currently has a left foot disorder, residuals of smoke inhalation, and a blood disorder, service connection for those disorders is not warranted. Because the regulations define an undiagnosed illness essentially as one as to which objective indications of a chronic disability cannot be attributed to any known clinical diagnosis, and there is no evidence of the current disabilities claimed, the Board need not reach the issue of whether they have existed for six months or more, or whether they are manifestations of an undiagnosed illness. 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317. E. Service connection for scrotal tongue Under applicable criteria, congenital or developmental defects are not diseases or injuries within the meaning of applicable legislation. 38 C.F.R. § 3.303(c) (2000); Beno v. Principi, 3 Vet.App. 439 (1992). With regard to the claim for service connection for scrotal tongue, the evidence indicates that the veteran has a congenital disorder of the tongue. This is not subject to service connection, as congenital or developmental defects are not subject to service connection. 38 C.F.R. § 3.303(c). He has submitted no evidence of aggravation, or of additional disability superimposed upon the congenital condition. Therefore, insofar as the veteran's scrotal tongue has been reported to be a congenital or developmental defect, service connection cannot be granted for this disability. In addition, the Board finds that the reported symptomatology concerning the veteran's tongue has been associated with a known diagnosis, scrotal tongue, and, therefore, do not meet the requirements of a chronic disability of unknown diagnosis. 38 C.F.R. § 3.317(a) (2000). F. Service connection for subcutaneous nodule of the right costal margin The law provides that a veteran is presumed to be in sound condition on entrance into service, except for defects noted when examined and accepted for service. Clear and unmistakable evidence that the disability manifested in service existed before service will rebut the presumption. 38 U.S.C.A. § 1111 (West 1991). The veteran is presumed to be in sound condition as no defects were noted on the service entrance examination in June 1988. The service medical records, including the separation examination in April 1992, were silent with respect to any complaints, treatment for, or diagnosis of a subcutaneous nodule of the right costal margin. However, on VA examination in August 1992, only two months following the veteran's discharge from active service, the examiner reported a small, firm, subcutaneous nodule about 3/4 cm. in diameter, palpable under the right costal margin, reported to have been present for the past one-and-a-half years. The evidence in support of the veteran's claim as to this disorder includes the following: the absence of noted pertinent physical defects on the entrance examination, the diagnosis of the disorder only two months after the veteran's discharge from service, and the absence of any intercurrent causation. Although this evidence is not clearly preponderant in the veteran's favor, it appears to be in approximate balance, creating a reasonable doubt. Resolving reasonable doubt in favor of the veteran, the Board finds that a subcutaneous nodule of the right costal margin was incurred in service. 38 U.S.C.A. §§ 1131, 5107(b) (West 1991); 38 C.F.R. § 3.102 (2000). G. Service connection for hearing loss For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz (Hz) is 40 dB or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hz are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2000). After reviewing the evidence of record, the Board concludes that the preponderance of the evidence is against service connection for bilateral hearing loss. While the service separation examination, dated in April 1992, showed bilateral hearing loss, VA audiological evaluation following service does not establish the presence of a hearing loss disability as defined by 38 C.F.R. § 3.385. We note that, on the most recent audiologic testing in August 1992, the auditory threshold in the frequencies 500, 1000, 2000, 3000 and 4000 Hertz were all less than 26 decibels, and speech recognition scores using the Maryland CNC Test were 94 in the right ear and 96 in the left ear. Thus, for purposes of VA compensation benefits, the record does not indicate that the veteran has a current hearing loss in either the right or the left ear. A current disability must be shown in order to establish service connection. Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992). The appellant testified at his hearing in June 1996 that he developed a hearing loss as a result of his military duty, and a hearing loss was noted even before he was discharged from service. Generally, statements prepared by lay persons ostensibly untrained in medicine cannot constitute competent medical evidence to establish service connection. A layperson can certainly provide an eyewitness account of a veteran's visible symptoms. Layno v. Brown, 5 Vet.App. 465, 469 (1994). However, the capability of a witness to offer such evidence is different from the capability of a witness to offer evidence that requires medical knowledge. For the most part, a witness qualified as an expert by knowledge, skill, experience, training, or education must provide medical testimony. Espiritu v. Derwinski, 2 Vet.App. 492, 494-95 (1992). The record does not indicate that the veteran has the requisite medical expertise to render a medical opinion. Thus, his testimony alone cannot make up for the lack of medical evidence showing a current hearing loss. Accordingly, in view of the above, the Board concludes that entitlement to service connection for bilateral hearing loss is not warranted. Because the regulations define an undiagnosed illness essentially as one where objective indications of a chronic disability cannot be attributed to any known clinical diagnosis, and there is no evidence of current hearing loss, the Board need not reach the issue of whether hearing loss existed for six months or more, or whether a bilateral hearing loss is a manifestation of an undiagnosed illness. 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317. III. Legal analysis -- Increased rating Disability evaluations are determined by comparing a veteran's present symptomatology with criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. § Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the veteran. 38 C.F.R. § 4.3. The veteran's entire history is reviewed when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet.App. 589, 592 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet.App. 55, 58 (1994). However, where the question for consideration is propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of "staged rating" is required. See Fenderson v. West, 12 Vet. App. 119 (1999). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. See 38 U.S.C.A. § 5107(a); 38 C.F.R. § 3.102; and Gilbert v. Derwinski, 1Vet. App. 49, 55 (1990). A. Increased rating for folliculitis The veteran's folliculitis is rated 10 percent disabling by analogy to Diagnostic Code (DC) 7806 (eczema). DC 7806 provides for a noncompensable evaluation if there is slight exfoliation, exudation or itching, if on a nonexposed surface or a small area. A 10 percent evaluation is assigned if there is exfoliation, exudation, or itching, involving an exposed surface or an extensive area. A 30 percent evaluation is warranted if there is constant itching or exudation, or extensive lesions, or marked disfigurement. And, a 50 percent disability evaluation is warranted for eczema with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or exceptionally repugnant. After careful review of the evidentiary record, the Board finds that none of the VA examinations of record describes the veteran's symptomatology with the findings or terminology required for a 30 percent rating. There is no medical evidence of record showing constant exudation or itching, extensive lesions, or marked disfigurement. In fact, on the occasion of his most recent VA examination in September 1997, it was noted that the veteran had minute follicular erythematous papules and small pustules, few in number, on the thighs and upper back; it was also noted that they were asymptomatic, non-pruritic, and non painful. In the Board's judgment, a 10 percent rating more appropriately accounts for the symptomatology described by the veteran and observed by the VA examiner. Further, no physician who has examined the veteran has described his skin condition as amounting to marked disfigurement. Based upon the foregoing, the Board finds that the current 10 percent evaluation is appropriate, and that the criteria for a higher evaluation are not met. In the absence of medical evidence demonstrating that the veteran's folliculitis results in constant exudation or itching, extensive lesions, or marked disfigurement, only the 10 percent rating criteria area are met. Furthermore, because the 10 percent evaluation adequately compensates the veteran for the greatest degree of disability shown since his discharge from service, there currently is no basis for consideration of "staged rating." Applying the Diagnostic Codes for scars and disfigurement appropriate to the veteran's skin disorder, the Board notes that DC 7800 applies to disfiguring scars of the head, face, or neck. Although the veteran has folliculitis in his beard, it has not been described as disfiguring. Diagnostic Codes 7803 and 7804 are not applicable, because they only provide for a 10 percent evaluation and the Board notes that the veteran's skin condition has not been shown to manifest scars characterized as poorly nourished, with repeated ulceration, or tender and painful on objective demonstration. Also, since the veteran's skin disorder has not been contended or shown to cause any functional limitation, a higher evaluation under Diagnostic Code 7805 is not warranted. B. Compensable evaluation for scar of right shoulder According to the applicable criteria, a 10 percent evaluation is warranted for scarring where the scars are "superficial, tender and painful on objective demonstration." 38 C.F.R. § 4.118, DC 7804 (2000). Alternatively, scars can be rated based on limitation of function of the part affected. 38 C.F.R. § 4.118, DC 7805 (2000). In every instance where the VA Schedule for Rating Disabilities 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 (2000). After a contemporaneous review of the evidence of record, the Board finds that an increased (compensable) disability rating for a scar of the right shoulder is not warranted. As previously noted, a 10 percent disability evaluation would require the scar to be tender and painful on objective demonstration, or, alternatively, there would need to be a loss of function of the affected part. Such symptomatology has not been demonstrated in the instant case. Of significance is the fact that the appellant has sought no medical treatment for his scar since his discharge from military service, and also the fact that the VA examiner, in September 1997, described the scar on the right shoulder as nontender and nondeforming, with no limitation of function. Clearly, the objective examination does not support a finding of entitlement to an increased (compensable) disability rating. Additionally, there is no evidence that the veteran suffers from a superficial scar that is tender and painful on objective demonstration. 38 C.F.R. Part 4, DC 7804. In the absence of any evidence that the scar of the right shoulder has ever been manifested by the symptomatology necessary for a compensable evaluation under Diagnostic Codes 7803, 7804, or 7805; the Board must conclude that a compensable evaluation is not warranted for any period since the effective date of the grant of service connection. Fenderson, supra. Moreover, application of the extraschedular provisions is also not warranted in this case. 38 C.F.R. § 3.321(b) (2000). There is no objective evidence, nor has it been contended, that this service-connected disability presents such an exceptional or unusual disability picture, with such factors as marked interference with employment or frequent periods of hospitalization, as to render impractical the application of the regular schedular standards. Hence, referral by the RO to the Chief Benefits Director of VA's Compensation and Pension Service, under the above-cited regulation, was not required. See Bagwell v. Brown, 9 Vet.App. 337 (1996). ORDER Service connection for a low back disorder is denied. Service connection for a right ankle disorder is denied. Service connection for a rash on the left leg is denied. Service connection for a left foot disorder is denied. Service connection for a healed laceration of the right middle finger is denied. Service connection for scrotal tongue is denied. Service connection for residuals of smoke inhalation is denied. Service connection for residuals of blood infection is denied. Service connection for subcutaneous nodule under the right costal margin is granted. Service connection for hearing loss is denied. An evaluation in excess of 10 percent for folliculitis is denied. An increased (compensable) rating for a scar of the right shoulder is denied. ANDREW J. MULLEN Member, Board of Veterans' Appeals