Citation Nr: 0528500 Decision Date: 10/24/05 Archive Date: 01/12/06 Citation Nr: 0528500 Decision Date: 10/24/05 Archive Date: 11/01/05 DOCKET NO. 00-03 309 ) DATE OCT 24 2005 ) RECONSIDERATION ) ) On appeal from the Department of Veterans Affairs Regional Office in Baltimore, Maryland THE ISSUE Entitlement to an initial compensable evaluation for bilateral pes planus. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD M. Tenner, Counsel INTRODUCTION The veteran served on active duty from February 1951 to January 1953. This case comes before the Board of Veterans' Appeals (Board) on appeal from an April 1999 rating decision by the Baltimore, Maryland, Regional Office (RO), which, in part, assigned a noncompensable evaluation for bilateral pes planus. As the veteran has perfected an appeal as to the initial rating assigned for the service-connected bilateral pes planus, the Board has characterized the issue in accordance with the decision in Fenderson v. West, 12 Vet. App. 119, 126 (1999) (appeals from original awards are not to be construed as claims for increased ratings), which requires consideration of the evidence since the effective date of the grant of service connection. In April 2001, the Board remanded said appellate issue to the RO for additional evidentiary development. In that remand, the Board directed the RO to adjudicate the issues of entitlement to secondary service connection for certain additional disabilities of the feet. After a subsequent May 2002 rating decision denied secondary service connection for Morton's neuroma and calcaneal spurs of the feet, appellant was properly informed of his appellate rights by letter dated the following month, including the necessity to inform the RO in writing if he disagreed with that adverse rating decision and of the one-year time period in which to file an appeal. However, appellant did not express timely disagreement with that rating decision. Subsequently, in a November 13, 2002 decision, the Board, in part, denied a compensable rating for bilateral pes planus. In January 2003, appellant filed a motion for reconsideration of that November 13, 2002 Board decision insofar as it denied a compensable rating for bilateral pes planus. In September 2003, a Deputy Vice Chairman of the Board, by direction of the Chairman, under the authority granted in 38 U.S.C.A. § 7103 (West 2002), ordered Reconsideration of that November 13, 2002 Board decision as to the instant issue. See 38 C.F.R. §§ 20.904(a), 20.1000 (2004). As pointed out in that Order for Reconsideration, the November 13, 2002 Board decision as it concerns the instant issue, would be replaced by a decision, once promulgated, by a reconsideration panel of the Board. In February 2004, a reconsideration panel of the Board remanded the matter to the RO for additional development. In December 2004, following substantial completion of the requested development, the RO issued a Supplemental Statement Of the Case in which it continued the denial of the veteran's claim. In May 2004 and January 2005, the veteran submitted additional evidence directly to the Board, accompanied by a waiver of initial RO review of such evidence. Finally, in September 2005, the Board granted a motion to allow the veteran to submit additional evidence directly to the Board. See generally, 38 C.F.R. § 20.1304 (2004). The matter has also been advanced on the Board's docket. FINDINGS OF FACT 1. Bilateral pes planus is characterized by subjective evidence of pain on use, with objective evidence of flat feet upon weight bearing, valgus heels, plantar fasciitis, and abnormal pronation. 2. Symptoms more nearly approximate severe bilateral impairment. CONCLUSION OF LAW With resolution of reasonable doubt in the appellant's favor, the criteria for an initial 30 percent rating for bilateral pes planus, and not in excess thereof, have been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 4.7, 4.71a, Diagnostic Code 5276 (2004). REASONS AND BASES FOR FINDING AND CONCLUSION I. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2005); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2004). In these matters, VA has substantially complied with the duty to assist and the duty to notify provisions of the VCAA. A VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits. Additionally, a VCAA notice letter consistent with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) must: (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; (3) inform the claimant about the information and evidence the claimant is expected to provide; and (4) request or tell the claimant to provide any evidence in the claimant's possession that pertains to the claim. In the present case, by way of a February 2004 letter, pursuant to the VCAA, the RO advised the appellant of the types of evidence that he needed to send to VA in order to substantiate the claim, as well as the types of evidence VA would assist in obtaining. Specifically, he was advised to identify evidence showing that bilateral pes planus had increased in severity. In addition, the veteran was informed of the responsibility to identify, or to submit evidence directly to VA. Furthermore, the RO specifically requested that the veteran provide it with or identify any other additional evidence that could help substantiate the claim, including complete authorizations to obtain VA and private medical evidence. Finally, the letter advised the veteran of the evidence it had received in connection with the claim. For the above reasons, the Board finds that the RO's notice substantially complied with the specificity requirements of Quartuccio v. Principi, 16 Vet. App. 183 (2002) (identifying evidence to substantiate the claim and the relative duties of VA and the claimant to obtain evidence); Charles v. Principi, 16 Vet. App. 370 (2002) (identifying the document that satisfies VCAA notice). While the notice provided to the veteran was not given prior to the first AOJ adjudication of the claim, the notice was provided by the AOJ prior to the transfer and certification of the veteran's case to the Board, and the content of the notice fully complied with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). Based on the above, the Board concludes that the defect in the timing of the VCAA notice is harmless error. See generally, Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). See also Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements in the law does not dictate an unquestioning blind adherence in the face of overwhelming evidence in support of the result of a particular case, such adherence will result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). The Board also finds that all necessary development has been accomplished. The veteran identified treatment for pes planus through the VA medical center. The RO has obtained the veteran's VA outpatient treatment records. Additionally, the record reflects that the veteran received private medical treatment for his bilateral foot condition from F. N., M.D. Those treatment records are associated with the veteran's claims folder. Moreover, the veteran was afforded VA examinations as noted below. Significantly, neither the veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. Hence, no further notice or assistance to the veteran is required to fulfill VA's duty to assist him in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Accordingly, appellate review may proceed without prejudice to the veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). II. Background The veteran's service enlistment examination did not include any complaints or clinical findings of a foot disorder. During his service discharge examination in January 1953, he was diagnosed with bilateral second-degree pes planus. In a September 1953 unappealed rating decision, the RO denied the veteran's initial claim for service connection for pes planus. In a January 1999 Board decision, the Board found that new and material evidence had been received, reopened the claim, and granted entitlement to service connection for pes planus. In March 1999, the veteran underwent a VA examination. Therein, he complained of pain and weakness in both feet. He reported that he could not walk any great distances and the feet were occasionally stiff and fatigued. There were arch supports in both shoes. A physical examination revealed obvious loss of arch in both feet. There was no limitation of motion of the toes or the ankles. There were no calluses in either plantar aspect of the feet. There was pain upon manipulation of the calcaneal region of both feet. X-rays revealed bilateral flat feet and calcaneal spurs. In April 1999, the RO effectuated the Board's grant of service connection for bilateral pes planus. A noncompensable (0 percent) evaluation was assigned, effective September 9, 1996, the date the RO received the reopened claim. A July 1999 VA outpatient treatment records note reported the veteran's complaints of pain along the plantar fascia bilaterally, and under the right heal. Upon physical examination, his medial longitudinal arch and transverse metatarsal arch were flattened, particularly during weight bearing. He was prescribed combined arch supports and metatarsal pad insoles, and ibuprofen. A July 1999 treatment record from F. N., M.D., noted that the veteran was seen with complaints of chronic flat feet. The veteran stated that his feet hurt when walking. He further stated that he did not wear any special inserts in his shoes, but used store-bought arch supports. He reported no surgery on his feet. Examination revealed second-degree pes planus that was flexible. There was good range of motion in the feet and ankles. Neurovascular status was intact. There was no evidence of worsening foot pronation or insufficiency of posterior tibial tendon. The diagnosis was symptomatic Grade II pes planus. A September 1999 progress note from F. N., M.D. noted that the veteran's bilateral foot condition warranted a 15 percent permanent partial rating according to the AMA Guides to Evaluation of Permanent Impairment, Fourth Edition. A November 1999 VA outpatient treatment record noted that since the veteran was fitted with orthotics, he had less foot pain. An April 2000 note reported the veteran's complaints of increased right foot pain along the plantar fascia on the medial band in the arch area. He was assessed with pes planus and neuritis and prescribed naprosyn. A May 2000 follow-up note indicated that the veteran was doing better and receiving good pain relief with naprosyn. A June 2000 note indicated that the veteran had a hammertoe of the 5th right toe. In July 2000, two hyperkeratotic lesions were debrided. A February 2001 treatment note indicated that the veteran had neuroma of the left foot and a hammertoe at the fifth left toe. An April 2001 podiatry follow-up note indicated that the veteran continued to have pain in his right heel, but his left foot was doing well. The assessment was plantar fasciitis. The veteran underwent a VA examination in July 2001. Upon examination, the veteran's plantar arch sagged and flattened out bilaterally with lateral deviation of the heel cord. The veteran had marked atrophy of the heel pad bilaterally and fatty tissue atrophy of the forefoot bilaterally; however, on non-weightbearing, there was excellent arch and no evidence of flat feet. Marked internal tibial torsion was noted bilaterally. There was no callosity of any part of the plantar aspect of the foot. No static deformity was noted. There was no evidence of a tight heel cord. There was no tenderness along the medial/longitudinal arch, the mid tarsal joint, or the spring ligament on either side. X-rays, taken both weightbearing and non-weightbearing, showed no sagging of the mid tarsal joint or subluxation of the Shopart's joint. Diagnoses included dynamic pes planus, developmental, and bilateral internal tibial torsion, moderately severe, developmental, contributing in part to pes planus. The examiner stated that there were very few clinical symptoms upon examination of the veteran. A July 2001 VA operative/procedure note indicates that the veteran underwent a release of the nerve on the medial side of the right heel and a release of right plantar fascia. Post-operative diagnoses included neuritis and plantar fasciitis. During VA treatment in November 2003, the veteran complained of continuing pain in the heals, right worse than left. Objectively, the veteran had signs of bilateral plantar fasciitis. There was significant pes planus noted with his heel being in valgus and both feet abducted. Pes planus was most evident upon weight bearing. There appeared to be a collapse of the medial arch. In a February 2004 letter, the veteran's VA podiatrist noted that the veteran had current pain due to plantar fasciitis as well as developing neuroma. The examiner noted that pes planus was a true medical condition and at increased activity levels the symptoms would become more evident. She opined that the veteran had started to experience significant symptoms due to an increased activity level. The veteran underwent another VA examination in June 2004. Therein, the veteran complained of weakness in the feet and constant pain, that was aggravated by activity. He reported that he could not walk more than 15 minutes without taking a break. Upon physical examination, there was a pes planovalgus deformity bilaterally. There was no edema, calluses, hammertoes, or claw toes. He did have an equines deformity, due to tight Achilles tendons. On gait examination, he had an abnormal pronation with extensor substitution. He had about 5 degrees of valgus that was flexible. X-rays were non-weight-bearing and revealed some degenerative changes in the talonavicular joint that were consistent with a flat foot deformity. The veteran was diagnosed with plantar fasciitis. The examiner noted that pes planus could predispose one to plantar fasciitis. She opined that it was at least as likely as not that the present foot condition was in some way related to service. III. Analysis 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. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. The veteran's entire history is reviewed when making disability evaluations. See generally 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (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, as here, the question for consideration is the 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, 12 Vet. App. at 126. The RO has rated the veteran's service-connected bilateral pes planus as noncompensably disabling pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5276. Diagnostic Code 5276 contemplates a disability manifested by acquired flatfoot. Pursuant to such Diagnostic Code, a 10 percent evaluation is warranted for moderate bilateral acquired flatfoot (pes planus) where the weight-bearing lines are over or medial to the great toes and there is inward bowing of the tendo achillis and pain on manipulation and use of the feet. A 30 percent evaluation is warranted for severe bilateral acquired flatfoot manifested by marked deformity (pronation, abduction, etc.), accentuated pain on manipulation and use of the feet, indications of swelling on use of the feet, and characteristic callosities. A 50 percent rating is warranted for pronounced bilateral acquired flatfoot manifested by marked pronation, extreme tenderness of the plantar surfaces of the feet, and marked inward displacement and severe spasm of the tendo achillis on manipulation which is not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276. In reviewing this matter, the Board initially notes that in addition to pes planus, the veteran has been diagnosed with other foot symptomatology, to include calcaneal spurs, Morton's neuroma, and plantar fasciitis. The Board notes that the issues of secondary service connection for calcaneal spurs and Morton's neuroma were previously denied by the RO in an unappealed rating decision. With respect to plantar fasciitis, the VA examiner in June 2004 opined that the veteran's plantar fasciitis symptoms were related to his service-connected pes planus disability. Plantar fasciitis is defined as inflammation involving the plantar fascia especially in the area of its attachment to the calcaneus and causing pain under the heel in walking and running. Hoag v. Brown, 4 Vet. App. 209, 211 (1993). Considering the VA examiner's opinion, and affording the veteran the benefit of the doubt, the Board will consider the veteran's plantar fasciitis symptoms as a component of his service-connected pes planus. The veteran's bilateral foot disability is manifested by subjective evidence of pain on use, with objective evidence of flat feet upon weight bearing, valgus heels, plantar fasciitis, and abnormal pronation. The record reflects that since the effective date for the grant of service connection symptoms attributable to the condition have not been relieved by the use of orthotics or arch supports. Affording the veteran the benefit of the doubt, the Board finds that an initial 30 percent evaluation for the disability is warranted. In making this determination, the Board acknowledges that the bilateral foot disability has not been objectively shown to result in limitation of motion of the joint, swelling or characteristic callosities. As such, not all of the criteria for a 30 percent evaluation were demonstrated. Nevertheless, foot specialists have noted that the veteran had "significant symptoms" associated with his pes planus. Moreover, the rating criteria are not premised upon the fact that all cases will show all of the findings expected. 38 C.F.R. § 4.21. The Board further recognizes that the VA examiner in July 2001 questioned the etiology of the bilateral foot disability and did not attribute any current symptomatology to his pes planus. Such an opinion, although certainly pertinent, is not conclusive as to the rating to be assigned. VA's rating schedule lists very specific symptoms associated with a severe pes planus disability, and the veteran has some of those symptoms. Moreover, as noted above, the Board affords greater probative weight to the June 2004 VA examination results that noted that the veteran had significant pes planus symptoms as well as associated plantar fasciitis symptomatology. In reaching this conclusion, the Board has considered whether an evaluation greater than 30 percent is warranted. The Board finds, however, that the bilateral foot symptomatology more closely approximates the schedular criteria for a 30 percent rating for severe bilateral pes planus than those for a higher evaluation. In this regard the Board notes that neither the VA or private outpatient treatment records nor the VA examination reports show that the veteran's pes planus is manifested by symptomatology such as marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement or severe spasm of the tendo achillis on manipulation. As such, an evaluation greater than 30 percent is not warranted. Finally, the Board finds that there is no showing that the veteran's bilateral foot disability has reflected so exceptional or so unusual a disability picture as to warrant the assignment of any higher evaluation on an extra-schedular basis. In this regard, the Board notes that the disability has not objectively been shown to markedly interfere with employment (i.e., beyond that contemplated in the assigned rating), to warrant frequent periods of hospitalization, or to otherwise render impractical the application of the regular schedular standards. Put another way, the 30 percent rating assigned herein adequately compensates the veteran for the severity of his bilateral pes planus disability. Hence, the criteria for invoking the procedures set forth in 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). ORDER An initial rating of 30 percent, but not greater, for bilateral pes planus is granted, subject to the law and regulations governing the payment of monetary benefits. LAWRENCE M. SULLIVAN DEREK R. BROWN Veterans Law Judge Veterans Law Judge Board of Veterans' Appeals Board of Veterans' Appeals __________________________________________ MICHAEL D. LYON Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs Citation Nr: 0216312 Decision Date: 11/13/02 Archive Date: 11/25/02 DOCKET NO. 00-03 309 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Baltimore, Maryland THE ISSUES 1. Entitlement to ratings for sinusitis in excess of 10 percent for the period from September 9, 1996 through July 24, 2001; and in excess of 30 percent for the period from July 25, 2001 through October 5, 2001. 2. Entitlement to a compensable rating for bilateral pes planus. (The issue of entitlement to a rating for sinusitis in excess of 30 percent for the period from October 6, 2001 will be the subject of a later decision.) REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Kathleen Reardon Fletcher, Counsel INTRODUCTION The veteran served on active duty from February 1951 to January 1953. These matters come before the Board of Veterans' Appeals (Board) on appeal from an April 1999 rating decision by the Baltimore, Maryland RO that granted service connection for sinusitis, evaluated as 10 percent disabling from September 9, 1996, and bilateral pes planus, evaluated as noncompensable from September 9, 1996. In April 2001, the Board remanded the matters on appeal to the RO for additional development. By rating decision dated in November 2001, the RO granted an increased, 30 percent, rating for sinusitis, effective July 25, 2001. Thereafter, the veteran continued his appeal. Both a July 2001 VA examination report and a September 2002 statement from the veteran's representative raise the issues of entitlement to service connection for a left ear infection and mastoiditis, both secondary to the veteran's service- connected sinusitis. Since these issues have not been developed for appellate review, they are referred to the RO for appropriate action. The Board is undertaking additional development with respect to the issue of entitlement to a rating for sinusitis in excess of 30 percent for the period from October 6, 2001, pursuant to authority granted by 67 Fed. Reg. 3,099, 3,104 (Jan. 23, 2002) (to be codified at 38 C.F.R. § 19.9(a)(2)). When development is completed with respect to that claim, the Board will then provide notice of the development as required by Rule of Practice 903. (67 Fed. Reg. 3,099, 3,105 (Jan. 23, 2002) (to be codified at 38 C.F.R. § 20.903.) After giving the notice and reviewing the veteran's response, the Board will prepare a separate decision addressing that issue. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's claims has been obtained by the RO. 2. For the period from September 9, 1996 through October 6, 1996, the veteran's service-connected sinusitis was productive of no more than moderate sinusitis with discharge or crusting or scabbing and infrequent headaches. 3. For the period from September 9, 1996 through October 6, 1996, the veteran's service-connected sinusitis was productive of no more than one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non- incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. 4. For the period from October 7, 1996 through July 24, 2001, the veteran's service-connected sinusitis was productive of no more than three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. 5. For the period from July 25, 2001 through October 5, 2001, the veteran's service-connected sinusitis was productive of no more than severe sinusitis with frequent incapacitating recurrences, severe and frequent headaches, and purulent discharge or crusting reflecting purulence. 6. For the period from July 25, 2001 through October 5, 2001, the veteran's service-connected sinusitis was productive of no more than three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. 7. Since September 9, 1996, the veteran's pes planus has been manifested by complaints of bilateral foot pain and use of arch supports. There has been no showing of inward bowing of the tendo achillis, or weight-bearing line over or medial to the great toe. Those manifestations are consistent with not more than mild pes planus. CONCLUSIONS OF LAW 1. The criteria for a rating for sinusitis in excess of 10 percent for the period from September 9, 1996 through October 6, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 2002); 38 C.F.R. § 4.97, Diagnostic Code 6513 (1996); 38 C.F.R. § 4.97, Diagnostic Code6513 (2001). 2. The criteria for a 30 percent rating from sinusitis for the period from October 7, 1996 through July 24, 2001 have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 2002); 38 C.F.R. §4.132, Diagnostic Code 9411 (1996); 338 C.F.R. § 4.97, Diagnostic Code 6513 (1996); 38 C.F.R. § 4.97, Diagnostic Code 6513 (2001). 3. The criteria for a rating for sinusitis in excess of 30 percent for the period from September 9, 1996 through October 5, 1996 have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 2002); 38 C.F.R. § 4.97, Diagnostic Code 6513 (1996); 38 C.F.R. § 4.97, Diagnostic Code 6513 (2001). 4. The criteria for a compensable rating for the veteran's service-connected pes planus have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 2002); 38 C.F.R. § 4.71a, Diagnostic Code 5276 (2001). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, the Board notes that during the pendency of this claim, the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000), was signed into law. The Board will assume, for the purposes of this decision, that the liberalizing provisions of the VCAA are applicable to the present appeal. In addition, regulations implementing the VCAA (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West Supp. 2002)), were published at 66 Fed. Reg. 45,620, 45,630-32 (August 29, 2001)(to be codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326). The Board notes that in this case, the requirements of the new law have essentially been satisfied. As evidenced by the December 1999 statement of the case and the December 2001 supplemental statement of the case, the veteran has been given notice of the pertinent laws and regulations governing his claims and the reasons for the denial of his claims. Hence, he has been provided notice of the information and evidence necessary to substantiate the claims and has been afforded ample opportunity to submit such information and evidence. The RO has made reasonable and appropriate efforts to notify the veteran whether he or the VA would be responsible for obtaining relevant evidence. For example, in a letter to the veteran dated in May 2001, he was notified that to save time, he should obtain any private medical records. However, the VA could obtain such records if he submitted the complete name and addresses of the examiners and included authorization for the VA to obtain the requested materials. The VA on its own has obtained relevant VA records from the Martinsburg VA Medical Center. See Quartuccio v. Principi, 16 Vet. App. 183 (2002) (addressing the duties imposed by 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159). It appears that all existing, pertinent evidence identified by the veteran as relative to this claim, including VA and private treatment records, has been obtained and associated with the claims files. In fact, the veteran indicated in a statement received by the RO in June 2001 that copies of his private treatment records had already been submitted and that he was currently receiving treatment at the VA Medical Center in Martinsburg; the Board notes that this evidence is of record. Moreover, the veteran has undergone several VA examinations in connection with the claims, and there is no indication that there is additional, pertinent evidence outstanding that is necessary for a fair adjudication of the claims. Under these circumstances, the Board finds that the claims are ready to be considered on the merits. I. Factual Background In September 1996, the veteran submitted a claim, in pertinent part, to reopen his previously denied claims for service connection for pes planus and pharyngitis. The veteran testified during a June 1997 personal hearing that his doctor wanted him to buy special arch supports for his shoes. In a July 1997 letter, Dr. James M. Chicklo noted that he had seen the veteran off and on since 1990 for throat complaints and head congestion. Diagnoses included upper respiratory infection and sinusitis. In a July 1997 statement, Dr. Mathew McIntosh stated that the veteran was diagnosed with second degree pes planus in the fall of 1995. In a July 1997 letter, Dr. Charles Sanicola stated that he had seen the veteran on various occasions over the past few years for complaints of bilateral foot pain. Diagnoses included pes planus. By decision dated in January 1999, the Board granted service connection for pes planus based on evidence of pes planus at separation from service and a current diagnosis of pes planus linked to the veteran's military service. The Board also found that, as new and material evidence had been submitted, the veteran's claim for service connection for acute pharyngitis was reopened; the issue was then remanded for further development. A March 1999 VA special sinus examination report notes the veteran's complaints of suffering from a head cold and a sore throat, lasting one month, about six times a year. He reported that six weeks ago he was treated with Amoxicillin, Flonase and Tylenol. Examination revealed no nasal obstruction; the veteran was able to breathe freely through his nose. The veteran's sinuses were draining freely; there was some phlegm and yellowish discharge in the nose. X-rays revealed left frontal and right maxillary sinusitis. The veteran complained of tenderness in the whole frontal area, and periodic headaches. He indicated that these symptoms improved with antibiotic treatment. Diagnosis was sinusitis. A March 1999 VA special feet examination report notes the veteran's complaints of stiffness, pain, weakness and fatigability in both feet. The veteran stated that he was unable to walk long distances due to pain in both lower extremities and feet. He was able to walk a mile and climb two flights of stairs. Examination of the feet revealed no evidence of ischemia. The veteran was able to walk on his toes and heels without difficulty. Posture and gait was normal. Manipulation of the tarsal metatarsal and metatarsal phalangeal joints was not painful; however, the veteran had pain in manipulation of the calcaneal region in both feet. There was obvious loss of arch in both feet, and the veteran used arch supports in both shoes. There was no evidence of loss of range of motion in the toes. There was no evidence of calluses in the plantar aspect of either foot. X-rays of the feet revealed bilateral pes planus and early calcaneal spurs. Diagnoses included bilateral pes planus and bilateral calcaneal spurs. A March 1999 VA operative/procedure note indicates that the veteran underwent excision of a neuroma of the second intermetatarsal space of the left foot. An April 1999 rating decision effectuated the Board's January 1999 award of service connection for pes planus. The RO assigned a noncompensable evaluation, effective September 9, 1996. The April 1999 rating decision also granted service connection for sinusitis (previously characterized as pharyngitis) based on evidence of symptoms that were present since service. The RO assigned a 10 percent evaluation for sinusitis, effective September 9, 1996. The veteran appealed the ratings assigned by this decision. A July 1999 VA orthopedic clinic report notes the veteran's complaints of pain along the plantar fascia bilaterally, on the dorsum of the foot and under the right heel. The veteran also complained of pain in his left Achilles tendon after walking any great distance and numbness in the left middle toe. Examination revealed bilateral pes planus. Upon walking, the veteran tended to pronate his feet. The medial longitudinal arch was flattened, particularly during weight bearing. Physical therapy and new arch supports were recommended. A July 1999 treatment record from Frank G. Nisenfeld, M.D., notes that the veteran was seen with complaints of chronic flat feet. The veteran stated that his feet hurt when walking. He further stated that he did not wear any special inserts in his shoes, but rather store-bought arch supports. He reported no surgery on his feet. Examination revealed second degree pes planus that was flexible. There was good range of motion in the feet and ankles. Neurovascular status was intact. There was no evidence of worsening foot pronation or insufficiency of posterior tibial tendon. Diagnosis was symptomatic Grade II pes planus. Dr. Nisenfeld stated that the veteran would benefits from either a custom molded last shoe or permanent arch supports, but did not feel that the veteran needed surgery. A November 1999 VA orthopedic clinic report notes that the veteran's foot pain had improved since being fitted for new orthotics in October. Examination revealed bilateral pes planus, some tenderness on the mid-foot at the top of the medial arch, and signs of Morton's neuroma. Assessment included bilateral pes planus, mild degenerative arthritis of the left mid-foot, and Morton's neuroma between the second and third toe. A December 1999 VA ENT progress note indicates that a CT scan revealed chronic frontal ethmoidal maxillary sinusitis.. There was a longstanding thickening of the mucosa of the left side of sinuses. Diagnosis was left chronic pansinusitis, suspected allergic rhinitis. The examiner noted that antibiotics had been prescribed in September 1999, but no more were prescribed at that time. Instead, nasal spray and an antihistamine were prescribed. A February 2000 VA treatment record notes that the veteran was seen with complaints of nosebleed and a mild sore throat. The veteran reported that these were early symptoms of his chronic sinusitis. Examination revealed a clear nose and no sinus tenderness. Assessment was presumed recurrent sinusitis. Augmentin was prescribed for seven days. VA podiatric treatment records note that the veteran was seen in from March to June 2000 with complaints of bilateral foot pain, especially in the right heel. Assessment included pes planus, metatarsalgia, neuritis and plantar fasciitis. A June 2000 VA treatment record notes the veteran's complaints of drainage with congestion and pressure. Assessment included acute, chronic sinusitis. Bactrim was prescribed. A July 2000 VA prosthetics/orthotics lab note indicates that the veteran received custom arch supports. An August 2000 VA physical therapy consultation note indicates that the veteran was referred by his podiatrist for treatment of plantar fasciitis, right more than left. The veteran stated that it was difficult to walk without pain. Pain was located in the left toes and arch and in the right heel and arch. The veteran had received two Cortisone shots that were effective for only one week each time. He was wearing inserts in both shoes that provided a minimal decrease in discomfort when walking. Examination revealed point tenderness in the aforementioned areas. There was no numbness. Sensation and reflexes were intact. Range of motion and strength was within normal limits bilaterally. Gait was slightly antalgic in appearance. Assessment was plantar fasciitis. Treatment records note that the veteran continued to receive physical therapy, to include whirlpool baths and stretching exercises, through October 2000. An August 2000 VA emergency room note indicates that the veteran was seen with complaints of a stuffy nose, problems breathing and pain around the left eye and left ear. Examination revealed narrowing in both nostrils, a swollen and tender left submandibular gland, and some congestion in the left ear and left nostril. Assessment included sinusitis; Augmentin was prescribed. A September 2000 VA treatment record notes the veteran's complaints of nasal discharge in the mornings, which was sometimes yellowish in color. He said that he sneezed a lot, the discharge went down his throat and he got a sore throat. Examination revealed mild deviation of the nasal septum, pallor and edema of the mucosa present, but nasal respiration was still free. No polyps were seen. Hypertrophy of inferior turbinate was present. Diagnoses included right maxillary, left frontal and ethmoidal sinusitis by past sinus x-rays. An antibiotic was prescribed. An October 4, 2000 VA ENT progress note reports the veteran's history of sinusitis, which was treated with antibiotics. CT scan revealed great improvement of the sinuses, with very little residual, thickening of the mucosa only. The examiner advised the veteran that surgery was not recommended unless there was recurrent sinusitis requiring antibiotics 5 or 6 times a year. An October 23, 2000 VA treatment record notes the veteran's complaints of nasal congestion and greenish phlegm. Examination revealed no sinus tenderness. The pharynx was inflamed and the left nasal turbinate was pale and swollen. Assessment was upper respiratory infection versus acute sinusitis. Cipro was prescribed. On November 3, 2000, the veteran called the VA clinic with complaints of persistent sinus symptoms, including green drainage, green phlegm and pressure in his head. The veteran indicated that he had just finished his antibiotics the day before. The veteran was advised to continue nasal drops and stream inhalation, and to call back if his symptoms were still present in a couple of days. A November 8, 2000 VA treatment record notes the veteran's history of chronic sinusitis. Examination revealed no sinus tenderness. The nasal turbinates were pale and edematous. Assessment was chronic and recurrent sinusitis. The examiner stated that she was going to "try Bactroban mixed with NS locally in [the] nose." A November 22, 2000 VA ENT progress note indicates that the veteran was seen with complaints of excessive sneezing and nasal discharge. Examination showed inflammation of the mucosa on both sides with yellowish mucus on the right side. No polyps were seen. Diagnosis was recurrent sinusitis. The examiner planned to control the veteran's symptoms with medications. A December 2000 VA podiatry progress note indicates that the veteran's right heel was better, but he was still having a lot of pain in his left foot. Examination of the left foot revealed no redness or swelling, but there was radiating pain with pressure in the second intermetatarsal space. Assessment was hammertoe syndrome with hyperkeratosis and neuroma of the second intermetatarsal space of the left foot. A January 3, 2001 VA treatment record notes that the veteran was seen with complaints of nasal congestion and greenish phlegm for four days. Examination revealed mild tenderness in the left maxillary sinus. The nasal turbinates were congested. Assessment was sinusitis. Zithromax was prescribed. A January 17, 2001 ENT progress note indicates that the veteran had acute exacerbation of chronic sinusitis. A CT scan was taken and the examiner noted that the sinuses appeared quite clear. A February 2001 VA podiatry follow-up note indicates that the veteran was seen with complaints of pain in his left foot. Assessment was neuroma of the left foot and hammertoe. A March 2001 VA operative/procedure note indicates that the veteran underwent excision of a neuroma of the second intermetatarsal space of the left foot. Postoperative diagnosis was neuroma, second metatarsal space, left foot. An April 2001 podiatry follow-up note indicates that the veteran continued to have pain in his right heel, but his left foot was doing well. Assessment was plantar fasciitis. An April 2001 VA treatment record notes that the veteran was seen with complaints of nasal congestion and cough with yellow sputum for one day. The veteran stated that he could hardly breathe. Examination revealed no sinus tenderness. Assessment was mild exacerbation of sinusitis. Biaxin was prescribed. A May 2001 VA ENT progress note indicates that the veteran returned for a follow-up visit with complaints of recurrent rhinitis, pharyngitis and bronchitis. The veteran complained of sneezing attacks and itching in the nose. Examination revealed inflammation of the nasal mucosa with yellowish- green secretion. The pharynx showed moderate inflammation. Diagnoses included upper and lower respiratory infection, nasal allergy and past history of sinusitis. Ceftin and Medrol were prescribed. A May 2001 VA podiatry progress report notes the veteran's complaints of pain in the right heel. Assessment was right plantar fasciitis with possible neuritis. A July 25, 2001 VA nose, sinus, larynx and pharynx examination report notes that the examiner reviewed the veteran's claims file. The veteran complained of a headache in the frontal and maxillary area during the examination. He indicated that he had these headaches whenever he suffered from sinusitis, which was more than six times a year. He further indicated that these episodes required antibiotics for two weeks at a time. No incapacitating episodes of sinusitis requiring bed rest were reported. The examiner noted that the veteran did not undergo any surgeries on his sinuses, but he did undergo septoplasty in the 1970's, and left mastoidectomy and tympanoplasty in the 1990's. Examination revealed muco-purulent nasal discharge and small crusts due to drying up of these secretions on both sides of the nose. Tenderness was noted over the left maxillary and left frontal areas. Partial nasal obstruction of about 50 percent was noted in each nostril. The veteran had no dyspnea at rest or exertion. Speech was normal. There was no stenosis of the larynx and no facial disfigurement. The examiner stated that the veteran did not have chronic osteomyelitis requiring periodic curettage currently, but noted that the a left mastoidectomy was done in the 1990's for chronic osteomyelitis of the left mastoid bone. X-rays revealed bilateral chronic maxillary sinusitis. Diagnosis was recurrent, acute, left frontal, left ethmoid and bilateral maxillary sinusitis. The examiner stated that the veteran's sinusitis was characterized by more than six non- incapacitating episodes per year. These episodes were characterized by headache, pain, and purulent discharge from the sinus and crusting. A July 2001 VA feet examination report notes that the examiner reviewed the veteran's claims files. Upon examination, the veteran was in no acute distress. On standing, the veteran's plantar arch sagged and flattened out bilaterally with lateral deviation of the heel cord. The veteran had marked atrophy of the heel pad bilaterally and fatty tissue atrophy of the forefoot bilaterally; however, on non-weightbearing, there was excellent arch and no evidence of flat feet. Marked internal tibial torsion was noted bilaterally. There was no callosity of any part of the plantar aspect of the foot. No static deformity was noted. There was no evidence of a tight heel cord. There was no tenderness along the medial/longitudinal arch, the mid tarsal joint, or the spring ligament on either side. X-rays, taken both weightbearing and non-weightbearing, showed no sagging of the mid tarsal joint or subluxation of the Shopart's joint. Diagnoses included dynamic pes planus, developmental, and bilateral internal tibial torsion, moderately severe, developmental, contributing in part to pes planus. The examiner stated that there were very few clinical symptoms upon examination of the veteran. The examiner further stated that the recently diagnosed Morton's neuroma and calcaneal spur were unrelated to his pes planus. Furthermore, the veteran's recent foot surgery was not necessitated by his pes planus. The examiner also stated that the veteran did not exhibit any weakened movement, excess fatigability, or incoordination attributable to his service-connected pes planus. He stated that the veteran's "symptoms attributable to dynamic pes planus are not disabling . . . ." A July 2001 VA operative/procedure note indicates that the veteran underwent a release of the nerve on the medial side of the right heel and a release of right plantar fascia. Post-operative diagnoses included neuritis and plantar fasciitis. By rating decision dated in November 2001, the RO granted an increased, 30 percent, rating for sinusitis, effective July 25, 2001. Thereafter, the veteran continued his appeal. The evidence of record also includes a list of medications, including antibiotics, prescribed to the veteran from 1996 to 2000. II. Analysis In general, disability evaluations are assigned by applying a schedule of ratings that represent, as far as can practically be determined, the average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 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. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. In addition, VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The veteran's entire history is reviewed when making disability evaluations. Id.; 38 C.F.R. § 4.1 In Fenderson v. West, 12 Vet. App. 119, 126 (1999), the United States Court of Appeals for Veterans Claims (Court) noted an important distinction between an appeal involving the veteran's disagreement with the initial rating assigned at the time a disability is service connected. 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 after a grant of service connection, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of "staged rating" is required. See Fenderson, 12 Vet. App. at 126. A. Sinusitis On October 7, 1996, the regulations pertaining to diseases of the nose and throat were revised. Under the regulations in effect prior to October 7, 1996, Diagnostic Code 6513 and other codes pertaining to sinusitis provide for a noncompensable rating when there are x-ray manifestations only of sinusitis, and the symptoms are mild or occasional. Moderate sinusitis with discharge or crusting or scabbing and infrequent headaches warrants a 10 percent evaluation. Severe sinusitis with frequent incapacitating recurrences, severe and frequent headaches, purulent discharge or crusting reflecting purulence warrants a 30 percent evaluation. Postoperative sinusitis, following radical operation, with chronic osteomyelitis requiring repeated curettage, or severe symptoms after repeated operations warrants a 50 percent evaluation. 38 C.F.R. § 4.97, Diagnostic Code 6513 (1996). On October 7, 1996, the rating criteria for respiratory disorders were revised. The revised rating criteria provides that sinusitis (Diagnostic Code6513) is to be assigned a noncompensable evaluation is assigned for sinusitis that is detected by an x-ray only. A 10 percent evaluation is warranted for one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent evaluation is warranted when there are three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 50 percent evaluation is warranted following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. A note following this section provides that an incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. 38 C.F.R. § 4.97, Diagnostic Code 6513 (2001). In Karnas v. Derwinski, 1 Vet. App. 308 (1991), the United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (Court) held, in pertinent part, that where the law or regulation changed after a claim had been filed but before the administrative or judicial appeal process had been concluded, the version most favorable to the appellant was to be applied. In this regard, the General Counsel of VA has held that where a law or regulation changes during the pendency of a claim for an increased rating, the Board should first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the former and revised versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C.A. § 5110(g) can be no earlier than the effective date of that change. The Board, however, must apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. As such, VA must consider the claim pursuant to the both criteria during the course of the entire appeal. See VAOPGCPREC 3-2000 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Further, as the RO has considered the claim under the former and revised criteria in the December 2001 supplemental statement of the case, there is no prejudice to the veteran in the Board doing likewise, and applying the more favorable result. 1. For the period from September 9, 1996 through July 24, 2001 The Board notes that the RO has assigned a rating of 10 percent under Diagnostic Code 6513 for the period from September 9, 1996 through July 24, 2001. Applying the former criteria, the Board finds that there is no persuasive evidence that the veteran's sinusitis produced more than a moderate (10 percent) degree of impairment during this period. The medical evidence notes that the veteran was seen for exacerbations of his sinusitis symptoms of congestion, phlegm, sinus tenderness and periodic headaches. This falls far short of demonstrating more than a moderate level of disability. There is no evidence of frequent incapacitating recurrences, severe and frequent headaches, radical operation, chronic osteomyelitis requiring repeated curettage, or severe symptoms after repeated operations. Therefore, for the period from September 9, 1996 through July 24, 2001, more than a 10 percent rating under the former criteria is not warranted. 38 C.F.R. § 4.97, Diagnostic Code 6513 (1996). With respect to the revised rating criteria, medical evidence for the period from September 9, 1996 through July 24, 2001 more nearly approximates the rating criteria for a 30 percent evaluation: three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. The evidence shows that veteran was seen with complaints of sinusitis with headaches, sinus pain, phlegm and discharge at least every two months, and often more frequently. His physicians prescribed various antibiotics, including Amoxicillin, Augmentin and Cipro. No more than a 30 percent rating is warranted, however, as there is no evidence of radical surgery with chronic osteomyelitis, or near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. The Board notes that the retroactive reach of the new regulation under 38 U.S.C.A. § 5110(g) can be no earlier than the effective date of that change. With that in mind, under the revised rating criteria, the 30 percent rating can be assigned no earlier than October 7, 1996. In conclusion, the Board finds that the weight of the evidence establishes that the veteran's service-connected sinusitis, from September 9, 1996 through October 6, 1996, was no more than 10 percent disabling under the former criteria for evaluating respiratory disorders, but that the weight of the evidence also establishes that the veteran's service-connected sinusitis, from October 7, 1996 through July 24, 2001, was 30 percent disabling under the revised criteria for evaluating respiratory disorders. 2. For the period from July 25, 2001 through October 5, 2001 The Board notes that the RO has assigned a rating of 30 percent under Diagnostic Code 6513 for the period from July 25, 2001 through October 5, 2001. Applying the former criteria, the Board finds that there is no persuasive evidence that the veteran's sinusitis produced more than a severe (30 percent) degree of impairment during this period. The medical evidence does not show that the veteran underwent notes that the veteran was seen for exacerbations of his sinusitis symptoms during this period, but does not show evidence of radical operation, or severe symptoms after repeated operations. A July 25, 2001 VA examination report notes that the veteran did not have chronic osteomyelitis requiring repeated curettage. Therefore, for the period from July 25, 2001 through October 5, 2001, more than a 30 percent rating under the former criteria is not warranted. 38 C.F.R. § 4.97, Diagnostic Code 6513 (1996). With respect to the revised rating criteria, the Board finds that there is no persuasive evidence that the veteran's sinusitis produced more than a 30 percent degree of impairment during this period. The medical evidence for the period from July 25, 2001 through October 5, 2001 does not show that the veteran underwent radical surgery with chronic osteomyelitis, or had near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. In fact, a July 25, 2001 VA examination report notes that the veteran had not undergone any surgeries on his sinuses and did not have chronic osteomyelitis. In conclusion, the Board finds that the weight of the evidence establishes that the veteran's service-connected sinusitis, for the period from July 25, 2001 through October 5, 2001, was no more than 30 percent disabling under either the former or revised regulations concerning ratings for respiratory disorders. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply, and an increased rating must be denied. 38 U.S.C.A. § 5107(b); Gilbert1 Vet. App 49 (1990). B. Bilateral Pes Planus Bilateral pes planus is rated in accordance with 38 C.F.R. Part 4, Diagnostic Code 5276 (2001). Under that Code, a noncompensable evaluation is warranted for mild acquired pes planus, when symptoms are relieved by built-up shoe or arch support. A 10 percent evaluation is warranted for moderate pes planus, and requires the weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, and pain on manipulation and use of the feet. A 30 percent evaluation is warranted for severe bilateral pes planus and requires objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, an indication of swelling on use, and characteristic callosities. A 50 percent evaluation is warranted for pronounced bilateral pes planus and requires marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276 (2001). The Board concludes that the veteran's current noncompensable evaluation fully contemplates the level of disability due to his service-connected bilateral pes planus. Private treatment records, VA outpatient clinic treatment notations and VA examination reports note the veteran's complaints of bilateral foot pain and use of arch supports, but all fail to disclose objective evidence of the weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, evidence of swelling on use, or characteristic callosities. Furthermore, in a July 2002 opinion, a VA examiner noted that there were very few clinical symptoms attributable to the veteran's service-connected pes planus. He further stated that the symptoms attributed to the veteran's pes planus were not disabling. The Board notes that the veteran has been diagnosed with other foot disabilities, to include Morton's neuroma and calcaneal spur; however, the July 2002 VA examiner stated that these disabilities were not related to the veteran's service-connected pes planus. Under 38 C.F.R. § 4.14, the use of manifestations not resulting from service-connected disability in establishing the service-connected evaluation is to be avoided. The Board concludes that the veteran's pes planus is no more than mild in degree, and his symptoms are consistent with the initial and current noncompensable evaluation assigned for that condition. The Board finds no basis for assigning the minimum compensable rating of 10 percent for pes planus at any stage since the grant of service connection in this case. While the rating schedule also provides for 30 and 50 percent ratings for pes planus, in view of the foregoing, it logically follows that the veteran also does not meet the criteria for any higher evaluation for pes planus at any stage since the grant of service connection for bilateral pes planus. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply, and an increased rating must be denied. 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet. App at 55-57. ORDER A rating for sinusitis in excess of 10 percent for the period from September 9, 1996 through October 6, 1996 is denied. A rating for sinusitis in excess of 30 percent for the period from October 7, 1996 through July 24, 2001 is granted, subject to regulations governing awards of monetary benefits. A rating for sinusitis in excess of 30 percent for the period from July 25, 2001 through October 5, 2001 is denied. A compensable rating for bilateral pes planus is denied. JACQUELINE E. MONROE Member, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.