Citation Nr: 9913964 Decision Date: 05/21/99 Archive Date: 05/26/99 DOCKET NO. 97-31 897 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUE Entitlement to non service-connected pension benefits. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD C. A. Kersten, Associate Counsel INTRODUCTION The veteran served on active duty from April 1963 to April 1965. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 1996 Department of Veterans Affairs (VA) Regional Office (RO) rating decision which denied entitlement to nonservice-connected pension benefits. The veteran requested a hearing before a member of the Board. He was scheduled for a Travel Board hearing at the RO in December 1998. However, he canceled his hearing and did not request a new hearing. Though the report of contact filed by the RO seemed to indicate that the veteran wished to withdraw his appeal, the veteran did not confirm this in writing, as is required by 38 C.F.R. § 20.204, and the claim has progressed to the Board for consideration on appeal. The Board notes that in his VA Form 9, submitted in September 1997, the veteran contended that he was entitled to service connection for emphysema, which he claimed arose secondary to his in-service tonsillectomy. In October 1997, the RO issued a rating decision in which it denied service connection for pulmonary emphysema and for bilateral foot injuries diagnosed as plantar fasciitis. The veteran did not appeal that determination, and these matters are not before the Board at this time. FINDINGS OF FACT 1. The veteran's combined disability rating is 40 percent, and is comprised of a bilateral foot disability rated at 10 percent each (plus the bilateral factor); a respiratory condition rated at 10 percent; and hiatal hernia with reflux rated at 10 percent. 2. The veteran's disabilities are not productive of total disability and are not sufficient to preclude the average person from following a substantially gainful occupation. 3. The veteran is not unemployable by reason of his disabilities, age, education and occupational history. CONCLUSION OF LAW The requirements for entitlement to a permanent and total disability rating for pension purposes have not been met. 38 U.S.C.A. §§ 1155, 1502, 1521, (West 1991); 38 C.F.R. §§ 3.321, 3.340, 3.342, Part 4, 4.15, 4.17 (1998). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran essentially contends that he is unemployable on the basis of both service-connected and nonservice-connected disabilities and that he is therefore entitled to non service-connected pension benefits. The veteran's claim of entitlement to pension benefits is well-grounded for the purposes of 38 U.S.C.A. § 5107(a) (West 1991), as the veteran had active service during a period of war and has contended that he is precluded from gainful employment due to disabilities. Cf. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). For the purpose of clarity, the Board will first set forth the general law and regulations pertaining to non service- connected pension benefits and the rating of disabilities, present the relevant facts pertinent to the veteran's claim, proceed to rate each of the veteran's current disabilities and then assess his claim of entitlement to non service- connected pension benefits. Relevant Law and Regulations Non service-connected pension claims A veteran who has served for 90 or more days during a period of war [which is not at issue in this case] is entitled to VA non-service-connected pension if he is permanently and totally disabled from non-service-connected disability, not the result of his willful misconduct. 38 U.S.C. § 1521(a), (j) (West 1991). A permanent and total disability may be found if the veteran suffers from a disability which would render it impossible for the average person to follow a substantially gainful occupation, and it is reasonably certain that the disability will continue throughout the veteran's life. 38 U.S.C. § 1502(a). See 38 C.F.R. § 3.340(a),(b). "Substantially gainful employment" is that "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore (Robert) v. Derwinski, 1 Vet. App. 356, 358 (1991). A veteran is eligible to be rated permanently and totally disabled for pension purposes if he meets schedular criteria which require that he must be rated at least 60 percent for a single disability, or at least 70 percent for combined disabilities, with at least one of the disabilities rated as 40 percent or more. 38 C.F.R. §§ 4.16; 4.17 (1998). If the veteran is not eligible for consideration under the schedular criteria, he may nevertheless be awarded non-service- connected pension benefits if he meets extra-schedular rating standards of unemployability "by reason of his . . . disabilit(ies), age, occupational background and other related factors." 38 C.F.R. § 3.321(b)(2). However, "entitlement to pension benefits may be denied even where there is no evidence of current employability, if there is also no evidence that the veteran's condition is permanent." Block v. Brown, 7 Vet. App. 343, 347 (1994). See Grantham v. Brown, 8 Vet. App. 228 (1995). The applicable statutory and regulatory provisions have been interpreted to allow a finding of a permanent and total disability by finding either that (1) the veteran is unemployable as a result of a lifetime disability (the "subjective" standard and is based on the veteran's individual work experience, training and disabilities), or (2) if not unemployable, the veteran suffers from a lifetime disability which would render it impossible for the average person with the same disability to follow a substantially gainful occupation (the "objective" standard). In making these determinations, the RO must also apply the percentage standards of 38 C.F.R. §§ 4.16 and 4.17 (i.e., the objective standard), and also consider entitlement to extraschedular evaluations under 38 C.F.R. § 3.321(b)(2) (i.e., the "subjective" standard). See Brown v. Derwinski, 2 Vet. App. 444, 446 (1992). Finally, if the veteran does not meet either the "average person" or the "unemployability" tests, a determination is required as to whether the veteran should be granted entitlement to non service-connected disability pension on an extraschedular basis, pursuant to the provisions of 38 C.F.R. § 3.321(b)(2), on the basis that he or she is unemployable by virtue of age, occupational background or other related factors. The United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (hereinafter, "Court") has effectively determined that in claims of entitlement to VA disability pension, the VA has a duty to insure: that an appropriate rating for each disability of record is assigned using the approach mandated by Schafrath v. Derwinski, 1 Vet. App. 589 (1991); that the "average person" and "unemployability" tests are both applied; and that if the benefit may not be awarded under "average person" or "unemployability" tests, a determination must then be made whether there is entitlement to non service-connected disability pension on an extraschedular basis. See Talley v. Derwinski, 2 Vet. App. 282 (1992); Roberts v. Derwinski, 2 Vet. App. 387 (1992) and Brown, 2 Vet. App. 444. Rating Disabilities Disability evaluations are determined by the application of the VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.321(a), 4.1 (1998). Separate diagnostic codes identify the various disabilities. VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. The requirements set forth in these regulations for evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decisions based on a single, incomplete or inaccurate report, and to enable the VA to make a more precise evaluation of the level of the disability and of any changes in the condition. Schafrath, 1 Vet. App. at 593-94. Where entitlement to compensation has already been established and the correct current disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55 (1994); 38 C.F.R. § 4.2 (1998). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1998). The Board notes that where the law or regulations change while a case is pending, the version most favorable to the claimant applies, absent Congressional intent to the contrary. Karnas v. Derwinski, 1 Vet. App. 308, 312-313 (1991). In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31 (1998). Standard of Proof When 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); 38 C.F.R. § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990), the Court stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the evidence must preponderate against the claim. See also Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Factual Background In a rating decision dated in December 1984, service connection was established for a tonsillectomy which was performed during service, and for a fracture of the distal shaft of the left fourth metatarsal. Both conditions have been evaluated by the RO as noncompensable. Treatment records dating from May 1990 from the VA Medical Center (VAMC) in Kerrville, Texas show that the veteran was evaluated for atypical chest pain. A diagnosis of cardiac disease was ruled-out, though diagnoses of anxiety disorder and alopecia secondary to anxiety were stated. Treatment records from the VA outpatient clinic (OPC) in McAllen, Texas dating from July 1989 to August 1996 show various dates of treatment for upper respiratory infections, including sinusitis and bronchitis, with an October 1990 chest x-ray noting probable obstructive lung disease. In August 1991, the veteran was treated for a bilateral otitis, and was also evaluated in the psychiatry unit and assessed with a general anxiety disorder. In January 1992, a VA chest x-ray report revealed findings consistent with chronic obstructive pulmonary disease (COPD). Though the veteran stated a history of asthma, no current diagnosis of asthma was stated. VA treatment records from March 1992 show complaints of pain in the right foot, congestion and shortness of breath with exertion. X-rays of the sinuses suggested bilateral maxillary sinusitis. Private pulmonary function test (PFT) and spirogram testing revealed an assessment of mild restrictive ventilatory defect without response after bronchodilators. Though right ankle x-rays revealed a subtle irregularity of the cortex of the posterior malleolus, and mild soft tissue swelling, no diagnosis other than right ankle pain was assessed. Treatment notes from later in March 1992 revealed assessments of sinusitis and chronic bronchitis, as well as right foot pain. Though the veteran was referred to the podiatry clinic, it appears that several appointments were canceled, and that he was not evaluated until 1995 for bilateral foot complaints. In August 1992, the veteran was assessed with bilateral otitis externa and right ear otitis media, and a left chest wall contusion secondary to a recent rib injury. In February 1993, the veteran was assessed with right ear otitis externa and media, as well as contact dermatitis. The evidence of record does not contain any current diagnosis of otitis, dermatitis, any chest wall injury or residuals thereof, or any psychiatric disorder. VAMC treatment records show that in January 1995, the veteran complained of mid-back pain and watering of the eyes. Reported assessments included allergic rhinitis, bronchitis, allergic conjunctivitis and arthritis. Chest x-rays dated in January 1995 were negative. In April 1995, the veteran was also evaluated for a rash, and dermatitis was assessed. In November 1995, the veteran was treated for complaints of a tight chest and coughing following the onset of a cold two weeks earlier. He reported a history of asthma. November 1995 chest x-rays were negative, and after evaluation, an assessment of bronchitis with a history of asthma was stated. In January 1995, the veteran also complained of bilateral foot pain. X-rays of both feet revealed no abnormalities. In March 1995, the veteran was evaluated at the podiatry clinic for complaints of progressively painful arches and heels over the preceding year. An assessment of bilateral plantar fasciitis with an acute medial calcaneal tubercle was stated. He was treated with an injection, insoles and the use of Motrin(r). On reevaluation in April 1995, the examiner noted approximately 85 percent improvement in the plantar fasciitis, with evidence of pain on palpation at the medial arches. Feldene(r) was prescribed, and continued use of insoles and icing the feet were recommended. Though it does not appear that the veteran reported for a follow-up appointment in August 1995, in November 1995, he reported that pain in the plantar surfaces of his feet was shooting into his groin area. In January 1996, he sought treatment at the McAllen VA Outpatient Clinic for complaints of chronic bilateral mid-plantar pain. Pain on palpation was again noted, and the veteran was instructed to use Motrin(r) and Cytotec(r). A referral to the podiatry clinic was also recommended, though no record of such a visit is of record. VA treatment records dating from August 1996 from the VAMC in San Antonio, Texas show that the veteran was hospitalized for one week for evaluation of complaints of chest pain associated with eating. On admission, an assessment of atypical chest pain was stated, with histories of glucose intolerance, hiatal hernia and generalized anxiety disorder. The discharge summary shows that the veteran reported experiencing chest pain while working in the garden, though he had also experienced pain while at rest in the past. The report noted an employment history including work as a migrant worker, including work on heavy machinery. The veteran denied any history of an incurrence of similar pain related to work levels. Upon discharge, a diagnosis of gastroesophageal reflux disease and small hiatal hernia was stated. A diagnosis of bilateral foot pain with no treatment was also stated in the discharge report. In September 1996, the veteran submitted a claim of entitlement to VA pension benefits, and included a copy of an August 1996 physician's recommendation that he avoid heavy work due to atypical cardiac pain. He reported that he had completed the 8th grade, and that he became unemployed in approximately July 1996 from his last job as a field laborer. In February 1997, a VA report of an x-ray of the veteran's wrist showed a benign cystic lesion in the base of the fifth metacarpal requiring a bone scan (the report did not specify which wrist was viewed). A whole-body bone scan dated in March 1997 showed degenerative changes noted in the shoulder joints, elbows, wrists, knees and ankles. A subchondral cyst was identified in the distal right ulnar, right capitate bone and an oval lucency was identified in the base of the left fifth metacarpal bone. No fractures or dislocations were identified, and minimal degenerative changes were noted in the first metacarpal phalangeal joints bilaterally. In March 1997, the veteran was admitted to the VAMC in San Antonio for evaluation of complaints of chest pain, dyspnea on exertion and fatigue. He reported a worsening of symptoms and a sharp left-sided chest pain which radiated to the right chest. He noted that dyspnea was relieved by rest, and chest pains and other symptoms were relieved with belching and sublingual Nitroglycerin. He reported a history of hiatal hernia and asthma. After undergoing cardiac catheterization, normal left ventricular function and normal coronaries were identified. A discharge diagnosis of noncardiac chest pain was assessed. The report on discharge also noted clinical diagnoses not related to the admission diagnosis of hiatal hernia and asthma. On discharge, the patient discharge instruction sheet advised the veteran to continue with activities as tolerated, to take nitroglycerin for recurrence of chest pain, and to follow-up with his VA OPC physician. In his September 1997 VA Form 9, substantive appeal, the veteran stated that his bilateral foot injury was incurred during service and should be assigned a minimum of 30 percent disability rating. He contended that this disability restricted the type of employment which he could pursue. The veteran also reported that his claimed pulmonary emphysema should be service-connected as it related to service. He associated continued throat and chest problems with the removal of his tonsils in service, and contended that he was entitled to a 25 percent disability evaluation for his claimed tonsils/respiratory condition. The veteran was afforded a VA general examination in December 1997 in connection with his claim of entitlement to nonservice-connected pension benefits. At his examination, the veteran reported that since service he had worked as a truck driver and in construction, and that he was currently working in the cotton gins. He reported chief complaints of bilateral foot pain and difficulty breathing. He denied any skin complaints, except for a rash on his right foot, which was to be evaluated by the podiatrist. He denied any headaches, loss of consciousness or seizures, denied any hearing loss or tinnitus, but reported infrequent but occasional otitis media. He denied any allergies or sinus problems, thyroid problems or diabetes mellitus. He denied any history of liver, gallbladder or colon problems, and reported that his genitourinary system functioned well. The veteran reported that he had asthma as a child with no problems until service in Germany, when he had to sleep in the snow and developed a respiratory infection with bronchitis. He reported that ever since that time, he has had trouble breathing. He reported shortness of breath, a dry cough without sputum and occasional wheezing at night. He denied taking any medication for his condition and stated that he had never been hospitalized because of his shortness of breath. He reported being able to climb one flight of stairs or walk one block before stopping due to shortness of breath. The veteran reported that he was informed of abnormal electrocardiogram and cardiac catheterization results, and of a normal CAT scan in February 1997 at the VAMC in San Antonio. He was prescribed aspirin and nitroglycerin, and reportedly took one nitroglycerin tablet per week. He denied hypertension, but stated that he had elevated cholesterol levels, though he was not taking any medication for it. He reported currently taking Cimetidine(r) for a hiatal hernia and reflux condition. The veteran reported having been assessed with cysts in both wrists, and reported that he was losing the grip strength in his wrists. He also reported bilateral knee problems, particularly with going up and down stairs. He complained of low back pain from time to time, but nothing severe enough to prevent him from working. He denied any known injury to his knees or back. On examination, the veteran's ears were normal and no current diagnosis was identified. His nose, sinuses, mouth and throat were negative on examination, his neck was also normal. Examination of his chest revealed that his lungs were clear to auscultation and percussion; no rales, rhonchi or wheezes were heard, though a dry cough was observed with deep inspiration. The veteran's heart exhibited a normal sinus rhythm with no friction rub or extrasystoles. His abdominal organs were within normal limits; there were no masses and there were no umbilical or inguinal hernias, though some epigastric tenderness was noted. X-rays of the chest revealed chronic obstructive pulmonary disease with probable chronic increased interstitial markings. Evaluation of the musculoskeletal system revealed symmetrical extremities, full range of motion of both knees with extension and flexion from zero to 130 degrees bilaterally, no patellofemoral crepitation and no edema. Good peripheral pulses in the dorsalis pedis and the posterior tibialis were also noted. X-rays of the veteran's wrists revealed a non- specific cyst in the distal right ulnar epiphysis. Normal knees were observed from bilateral x-rays of the knees. Lumbosacral spine x-rays were also normal. The veteran underwent pulmonary function testing, which revealed normal findings of an FEV-1 level at 91 percent of predicted values, and a FEV-1/FVC ratio of 114 percent of predicted. The general medical examination report included diagnoses of subclinical asthma, a bone cyst on the distal right ulna, and no abnormalities of the knees or lumbosacral spine. The veteran underwent a special surgical VA examination to include evaluation of his esophagus and hiatal hernia. The veteran's history of complaints and treatment was noted and the examiner noted subjective complaints of continued regurgitation at night once per week and epigastric pain during the day once per week. The veteran reported taking Ibuprofen and Aspirin for back pain, and believed that this worsened his condition. Examination revealed no masses, no tenderness, no organomegaly and no costovertebral angle tenderness, a scar from right inguinal hernia repair, without objective evidence of any inguinal hernias. The VA examiner stated a diagnosis of hiatal hernia with esophageal reflux uncontrolled by medical management, and ordered an upper gastrointestinal air contrast study. A final "upper GI series" was completed, showing no intrinsic or extrinsic abnormalities of the esophagus and a small sliding hiatal hernia with no evidence of reflux. The stomach, pylorus, duodenal bulb and duodenal sweep were all within normal limits. An impression of a small sliding hiatal hernia with no reflux was stated and the examiner also noted that the upper GI series also revealed a probable bronchiectasis at the right lung base. The veteran also underwent a VA orthopedic examination. He reported soreness in the plantar central region of the mid- sole bilaterally. He reported recent treatment with injections into his soles, with improvement of symptoms, and current management with Ibuprofen. Examination of the feet revealed pes planus and tenderness to palpation in the central band of the plantar fascia on the soles of both feet. An assessment of pes planus and plantar fasciitis was stated. With respect to the veteran's statement that he believed that his foot injuries had resulted in his back problems, the examiner noted that he did not find an immediate correlation to these symptoms with the veteran's constellation of the lower extremity complaints which he attributed to radiating symptoms more proximally into his legs from the symptom area. He opined that it might later result that with persistent plantar fascial symptoms, antalgic gait could precipitate some muscle over use and soreness. The examiner also opined that the examination results suggested that the veteran's complaints were "out of proportion to physical findings." The Board notes that in a pre-examination questionnaire dated in December 1997, the veteran reported his current complaints as pulmonary emphysema and bilateral foot injuries which resulted in a back problem. He stated his current occupation as "unemployed - laid off". In an October 1997 rating decision, the RO evaluated the veteran's claimed disabilities, both service-connected and nonservice-connected, and determined that a 10 percent evaluation was in order for chronic obstructive pulmonary disease (claimed as pulmonary emphysema), that a 10 percent evaluation was in order for bilateral plantar fasciitis, and that a 10 percent evaluation was also in order for hiatal hernia with gastroesophageal reflux disease. Other conditions were evaluated as noncompensable. Neither the service-connected march fracture of the right foot nor the tonsillectomy residuals were evaluated as warranting a compensable evaluation. In August 1998, the veteran submitted a request for a reevaluation of his "0% service connected disability". He referred to a respiratory condition and to a "skeletal system" disability. He did not specify what musculoskeletal system condition he referred to, nor did he state whether he was seeking service connection for his current respiratory condition. In January 1999, the veteran was informed that he was not entitled to an examination for evaluation of his service-connected conditions as he had not presented any evidence regarding his conditions, nor alleged that either disability had increased in severity since the last rating. The veteran has not submitted any further evidence in support of his claim. Analysis The Board will first separately discuss the level of disabilities claimed by the veteran to currently exist. The Board will then evaluate the veteran's pension claim by applying the various standards enunciated by the Court. Respiratory condition One of the veteran's primary complaints has been described by him generally as difficulty breathing and as pulmonary emphysema. His complaints have been characterized in the medical evidence of record as dyspnea (shortness of breath on exertion), non-productive or dry cough and wheezing; chronic obstructive pulmonary disease (COPD) has also been diagnosed. There is of record evidence of several diagnoses of chronic bronchitis and of a reported history of asthma, which has been incorporated into medical assessments, though it has not been definitively diagnosed. Chronic bronchitis, bronchial asthma, pulmonary emphysema and COPD are rated under the portion of the Rating Schedule that pertains to the respiratory system and diseases of the trachea and bronchi. 38 C.F.R. § 4.97, Diagnostic Codes 6600 to 6603, and 6604. Effective October 7, 1996, the rating schedule for diseases of the trachea and bronchi was amended without redesignation, except for the addition of a separate rating code section for COPD at 38 C.F.R. § 4.97, DC 6604. 61 Fed. Reg. 46728 (Sept. 5, 1996). Therefore, pursuant to the above, the veteran's various disabilities will be evaluated under both the new and old law. See Karnas, 1 Vet. App. at 312-313. Pursuant to the VA Rating Schedule in effect before October 7, 1996, a noncompensable evaluation is warranted for mild chronic bronchitis with slight cough, no dyspnea and few rales. A 10 percent rating is provided for moderate chronic bronchitis with considerable night or morning cough, slight dyspnea on exercise and scattered bilateral rales. A 30 percent rating is provided for moderately severe chronic bronchitis with persistent cough at intervals throughout the day, considerable expectoration, considerable dyspnea on exercise, rales throughout the chest and beginning chronic airway obstruction. A 60 percent evaluation is warranted for severe chronic bronchitis with severe productive cough and dyspnea on slight exertion and pulmonary function tests indicative of severe ventilatory impairment. A 100 percent evaluation is warranted for pronounced chronic bronchitis with copious productive cough and dyspnea at rest, pulmonary function testing showing a severe degree of chronic airway obstruction, with symptoms of associated severe emphysema or cyanosis and findings of rightsided heart involvement. 38 C.F.R. § 4.97, DC 6600 (1996). With respect to bronchial asthma, a 10 percent rating is provided for mild symptoms with paroxysms of asthmatic type breathing (high pitched expiratory wheezing and dyspnea) occurring several times a year with no clinical findings between attacks. A 30 percent rating is provided for moderate bronchial asthma, with rather frequent asthmatic attacks (separated by only 10-14 day intervals) with moderate dyspnea on exertion between attacks. A 60 percent rating is provided for severe bronchial asthma, characterized by frequent attacks of asthma (one or more attacks weekly), with marked dyspnea on exertion between attacks with only temporary relief by medication; and preclusion of more than light manual labor. A 100 percent rating is warranted for pronounced symptoms, characterized by very frequent asthmatic attacks with severe dyspnea on slight exertion between attacks and with marked loss of weight or other evidence of severe impairment of health. In the absence of clinical findings of asthma at the time of the examination, a verified history of asthmatic attacks must be of record. 38 C.F.R. § 4.97, DC 6602 (1996). Under the pre-October 7, 1996 Rating Schedule, a 10 percent rating is provided for mild pulmonary emphysema, with evidence of ventilatory impairment on pulmonary function test and/or definite dyspnea on prolonged exertion. A 30 percent rating is provided for moderate symptoms of moderate dyspnea occurring after climbing one flight of steps or walking more than one block on level surface, or for PFT's consistent with findings of moderate emphysema. A 60 percent rating is provided for severe symptoms, characterized by exertional dyspnea sufficient to prevent climbing one flight of steps or walking one block without stopping; or ventilatory impairment of severe degree confirmed by pulmonary function tests with marked impairment of health. A 100 percent disability evaluation is provided for pronounced pulmonary emphysema which is intractable and totally incapacitating with dyspnea at rest or marked dyspnea and cyanosis on mild exertion; the severity of emphysema confirmed by chest x-rays and PFT's. 38 C.F.R.§ 4.97, DC 6603 (1996). Ratings under Diagnostic Codes 6600 to 6618, inclusive, and 6821, will not be combined with each other. Rather, in rating coexisting respiratory conditions, a single rating will be assigned which reflects the predominant disability picture with elevation to the next higher evaluation where the severity of the overall disability picture warrants such elevation. 38 C.F.R. § 4.96(a) (1996); 38 C.F.R. § 4.96(a) (1998). The revised diagnostic codes in effect as of October 7, 1996 provide that chronic bronchitis, bronchial asthma, pulmonary emphysema and COPD are to be evaluated based on the results of pulmonary function tests. The specific pulmonary function tests include the percent of predicted values for Forced Expiratory Volume in one second (FEV-1) and Forced Vital Capacity (FVC), the ratio of FEV-1 to FVC (FEV-1/FVC), the percent of predicted value for Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)), and the veteran's maximum exercise capacity in terms of milligrams/kilograms/minute (ml/kg/min)of oxygen consumption. 38 C.F.R. § 4.97, Diagnostic Codes 6600, 6602, 6603 and 6604 (1998). Pursuant to the revised Rating Schedule for chronic bronchitis, pulmonary emphysema and COPD, a 10 percent disability rating is warranted for a condition characterized by FEV-1 of 71 to 80 percent of predicted, FEV-1/FVC of 71 to 80 percent, or DLCO (SB) between 66 and 80 percent of predicted. A 30 percent rating is warranted for FEV-1 of 56 to 70 percent predicted, FEV-1/FVC of 56 to 70 percent or DLCO (SB) of 56 to 65 percent. A 60 percent rating is warranted for FEV-1 of 40 to 55 percent of predicted, FEV- 1/FVC of 40 to 55 percent, DLCO (SB) of 40 to 55 percent, or maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit). A 100 percent rating is warranted for FEV-1 of less than 40 percent of the predicted value, FEV-1/FVC of less than 40 percent, DLCO (SB) of less than 40 percent, a maximum exercise capacity of less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), cor pulmonale (right heart failure), right ventricular hypertrophy, pulmonary hypertension (shown by Echo or cardiac catheterization), episodes of acute respiratory failure, or symptoms requiring outpatient oxygen therapy. 38 C.F.R. § 4.97, DC 6600, 6603, 6604 (1998). Under the revised Rating Schedule, the rating criteria for bronchial asthma provides for a 10 percent disability evaluation for FEV-1 levels of 71 to 80 percent of predicted, or FEV-1/FVC of 71 to 80 percent, or; intermittent inhalation or oral bronchodilator therapy. A 30 percent evaluation is warranted for FEV-1 of 56 to 70 percent, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalation or oral bronchodilator therapy, or; inhalation anti-inflammatory medication. A 60 percent evaluation is provided for FEV-1 of 40- to 55 percent, or; FEV-1/FVC of 40- to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. A 100 percent evaluation is provided for FEV-1 of less than 40 percent, or; FEV-1/FVC of less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications. Again, failing clinical findings of asthma at the time of examination, a verified history of asthmatic attacks must be of record. 38 C.F.R. § 4.97, DC 6602 (1998). In assessing the severity of the veteran's respiratory condition, the Board notes that COPD was diagnosed on VA evaluation in December 1997, that objective symptoms consisted of a dry cough on inspiration, and that the veteran reported dyspnea on exertion. Pulmonary function testing was normal. Though a history of asthma has been reported in the record, there is no medical evidence of a current diagnosis of the condition based on objective evidence. The Board is not bound to accept medical opinions which are based on history supplied by the veteran where that history is unsupported by the medical evidence. See Black v. Brown, 5 Vet. App. 177 (1993); Swann v. Brown, 5 Vet. App. 229 (1993); Reonal v. Brown, 5 Vet. App. 458 (1993); Guimond v. Brown, 6 Vet. App. 69 (1993). The March 1997 discharge report included a clinical diagnosis "not related to admission diagnosis" of asthma. However, because there was no medical evidence to provide a basis for such a diagnosis, and because the diagnosis seemed rather to be based on the veteran's reported history, the Board finds that the March 1997 diagnosis of asthma is not a valid current diagnosis for the purposes of evaluating the veteran's respiratory disability. In determining the proper diagnostic code for the evaluation of the veteran's respiratory disability, the Board notes that the older Rating Schedule did not provide a specific diagnosis code for evaluating COPD. Therefore, the criteria for chronic bronchitis or pulmonary emphysema may be considered by way of analogy. See 38 C.F.R. § 4.20 and Pernorio v. Derwinski, 2 Vet. App. 625 (1992) [when the regulations do not provide diagnostic codes for specific disorders, the VA must evaluate those conditions under codes for similar disorders or codes that may provide a general description that may encompass many ailments]. In evaluating the veteran's respiratory condition under the old criteria for chronic bronchitis, the Board finds the veteran's reported symptoms of coughing episodes, occasional wheezing and shortness of breath are most analogous to the symptoms associated with a moderate disability under DC 6600 (considerable night or morning cough, slight dyspnea on exercise, scattered bilateral rales). In addition, the Board notes that the evidence of record shows that the veteran has been diagnosed with bronchitis on several occasions, most recently in November 1995. At that time, the veteran's symptoms were reported to be a tight chest and coughing with a small amount of white mucous production. The veteran's respiratory condition does not warrant a higher evaluation under the criteria for chronic bronchitis because there is no evidence of a respiratory condition which can be said to be analogous to a "moderately severe" or more severe chronic bronchitis, which is characterized by the symptomatology described above, including persistent cough with increased levels of expectoration, greater levels of dyspnea, rales or beginning chronic airway obstruction. Though the symptoms associated with chronic bronchitis vary from those described by the veteran, the Board finds that these criteria, of those available for an analogous rating, are most closely reflective of the veteran's symptoms. The Board further finds that the evidence of record does not warrant an evaluation in excess of 10 percent. The criteria for higher evaluations under the rating code for chronic bronchitis, described above, require evidence of a far more severe disability picture than is presented here. As noted December 1997 pulmonary function tests were normal. The Board notes that though the veteran has characterized his pulmonary condition as pulmonary emphysema, there is no current diagnosis of record showing that to be the effective diagnosis. Nevertheless, because the veteran's reported symptoms seem also to resemble, at least in part, those addressed in the criteria for pulmonary emphysema, Diagnostic Code 6603 will also be considered by analogy. 38 C.F.R. § 4.20 (1998). The Board finds that no more than a 10 percent rating is in order under Diagnostic Code 6603. The evidence of record shows that the veteran reported dyspnea on exertion, though the PFT of December 1997 revealed normal findings. On recent examinations, a dry cough with each aspiration and COPD were the only objectively observed symptoms. Shortness of breath was reported by the veteran in VA treatment records. Though the veteran complained of dyspnea on climbing one flight of stairs or walking more than a block, there is of record no medical evidence of confirming or supporting the severity of the veteran's claimed dyspnea. Moderate dyspnea has not been objectively verified nor supported by PFT results which show normal findings nor confirmed by examination findings. Essentially, there is no medical evidence showing either PFT results or any other findings consistent with findings of moderate or more severe emphysema under 38 C.F.R. § 4.97, DC 6603 (1996). With respect to the rating criteria set forth for the evaluation of bronchial asthma, the Board finds that because the rating criteria contemplates the occurrence of paroxysms or attacks of asthmatic type breathing, and requires evidence of such episodes in order to warrant evaluation for such symptoms, use of this diagnostic code for evaluating the veteran's reported symptoms of dyspnea, coughing and wheezing is inappropriate. Unverified symptoms may not form the basis of a rating under this code, and the evidence of record therefore does not allow the Board to speculate as to the severity and nature of the veteran's claimed symptoms for the purpose of establishing an evaluation, even if by analogy. See 38 C.F.R. § 4.97, DC 6602, note (1996). Under the current criteria for COPD, chronic bronchitis and pulmonary emphysema, the recent PFT results indicate that the veteran's claimed pulmonary condition does not warrant a compensable evaluation. In order to warrant a compensable evaluations under any of the revised rating codes, the veteran's PFT results would have had to show a greater incapacitation. As it is, results revealed normal pulmonary functioning and FEV-1 of 91 percent of the predicted level, FEV-1/FVC ratio of 114 percent. These results represent the veteran's pre-bronchodilator PFT findings, and testing with a bronchodilator was not utilized. As the rating criteria for compensable ratings for COPD, chronic bronchitis and pulmonary emphysema from 10- to 60 percent all require increasing levels of disability as shown on PFT, the veteran does not qualify for an evaluation at any of those levels. Furthermore, the veteran does not qualify for a 100 percent evaluation because there is no evidence of cor pulmonale, right ventricular hypertrophy, pulmonary hypertension, episodes of acute respiratory failure, or required outpatient oxygen therapy. With respect to the rating criteria for bronchial asthma, again, the Board finds that the rating criteria is not applicable in the veteran's case, as there is no evidence of clinical findings at the time of the examination and no verified history of asthmatic attacks of record. Even under an analogous rating, the Board finds no basis on which to find that any of the criteria for a compensable evaluation have been met. 38 C.F.R. § 4.97, DC 6600, 6602, 6603, 6604 (1998). Thus, the Board finds after evaluating the veteran's respiratory condition under all appropriate rating codes and under both the new and revised Rating Schedule that the most favorable evaluation for the veteran's condition comes by analogy to the "old" rating criteria for chronic bronchitis, and that the veteran's condition warrants no more than a 10 percent evaluation under 38 C.F.R. § 4.97, DC 6600 (1996). Hiatal Hernia The evaluation of hiatal hernia conditions is based on 38 C.F.R. § 4.114, DC 7346 (1998), which provides that a 60 percent evaluation is warranted for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. A 30 percent evaluation is warranted for persistently recurrent epigastric distress with dysphagia, pyrosis and regurgitation, accompanied by substernal or arm or shoulder pain productive of considerable impairment of health. Finally, a 10 percent evaluation is warranted for two or more of the symptoms for the 30 percent evaluation of less severity. In the veteran's case, the most recent examination report dates from December 1997 and includes a general surgical consultation and an upper GI series. The Board notes that the veteran reported daytime epigastric pain and nighttime regurgitation approximately once per week despite treatment of reflux with Cimetidine(r). The upper GI series revealed only a small sliding hiatal hernia without reflux. Recent medical treatment records show evidence of mild reflux treated with relief in March 1997 and an impression of mild reflux esophagitis and small hiatal hernia with gastroesophageal reflux in August 1996. The Board finds that the most recent medical evidence demonstrates a disability picture which, evaluated under the rating criteria at 38 C.F.R. § 4.114, DC 7346, most closely resembles the criteria for a 10 percent disability rating. There is evidence of pyrosis (heartburn) and regurgitation, but not dysphasia. Though the veteran has been treated for complaints of chest and arm pain associated with hiatal hernia in August 1996, the evidence of record does not show that the complaints have continued, nor that they were productive of a considerable impairment of health. Therefore, the Board finds that a rating in excess of 10 percent is not warranted. The veteran has not alleged any incurrence of the symptomatology associated with the criteria for a 60 percent evaluation under 38 C.F.R. § 4.115, DC 7346. Accordingly, the Board finds that the veteran's hiatal hernia condition warrants no more than a 10 percent disability evaluation. Bilateral foot condition The evidence of record indicates that the veteran has been diagnosed with bilateral pes planus and plantar fasciitis. Pes planus is evaluated under the rating criteria for acquired flatfoot pursuant to 38 C.F.R. § 4.71a, DC 5276, which provides for an award of a 50 percent disability evaluation for bilateral pronounced flatfoot with 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. A 30 percent evaluation is warranted for severe bilateral flatfoot, with objective evidence of marked deformity (pronation, abduction, etc.), accentuated pain on manipulation and use, with indications of swelling on use, and characteristic callosities. A 10 percent evaluation is warranted for moderate bilateral flatfoot, with weight- bearing line over or medial to the great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet. Mild symptoms relieved by built-up shoe or arch support warrant a noncompensable evaluation. 38 C.F.R. § 4.71a, DC 5276 (1998). The rating criteria for bilateral weak foot, a symptomatic condition secondary to many constitutional conditions and characterized by atrophy of the musculature, disturbed circulation and weakness, provides that the condition is to be rated pursuant to the underlying condition, with a minimum rating of 10 percent. 38 C.F.R. § 4.71a, DC 5277 (1998). Other foot injuries are to be evaluated as 30 percent disabling where severe, 20 percent disabling where moderately severe, and 10 percent disabling where moderate. The actual loss of use of the foot warrants a rating of 40 percent disability. 38 C.F.R. § 4.71a, DC 5284 (1998). The words "slight", "moderate" and "severe" are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just". 38 C.F.R. § 4.6 (1998). It should also be noted that use of terminology such as "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6 (1998). In the case at hand, the veteran is shown to have flat feet and plantar fasciitis of both feet, characterized by tenderness on palpation. Treatment notes indicate that the veteran has complained of tenderness in the mid-plantar aspect of both feet, and that pain was reduced significantly (85 percent) with injections to the area, Ibuprofen and shoe inserts. No evidence of deformity other than flatness of the feet has been identified on examination, bilateral x-rays dated in January 1995 showed no deformities, and there is no indication whatsoever that the veteran's gait has been affected by his condition. Though the veteran has contended that the pain from his bilateral foot condition has a tendency to radiate to his groin area, a VA orthopedic examiner has expressed the opinion that such a correlation was not apparent in the veteran's case. The examiner also noted that the severity of the veteran's complaints was out of proportion with physical findings. The only characteristic symptomatology associated with the veteran's bilateral foot condition has been complaint of pain on use and pain on palpation or manipulation. Under the criteria for evaluating pes planus, pain on manipulation is only one of the elements required for a showing of a "moderate" disability worthy of a 10 percent evaluation. Evaluations of the veteran's feet have not revealed any weight-bearing changes, nor any inward bowing of the tendo Achilles. Nevertheless, the Board finds that giving the veteran the benefit of the doubt with respect to the level of his discomfort with the tenderness caused by plantar fasciitis, the Board finds that a 10 percent evaluation for each foot is warranted. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. There is, however, no evidence of record showing a severe disability with evidence of marked deformity, evidence of swelling on use or characteristic callosities warranting a 30 percent evaluation. Likewise, there is no evidence of "pronounced" symptoms of marked pronation, extreme tenderness, marked inward displacement and severe spasm. The Board finds that in rating the veteran's bilateral foot disability under either the rating criteria set forth above for pes planus (DC 5276) or those for other foot injuries (DC 5284), an assessment of entitlement to no more than a 10 percent disability evaluation is appropriate. Evaluation of the evidence of record under either diagnostic code reveals symptoms which are, in the opinion of the Board, best described as no more than "moderate" in nature. There is no objective evidence of record which shows that the veteran is incapacitated by his foot pain, and his symptoms have been shown to improve with the use of medication and shoe inserts. The evidence of record is not clear as to whether symptom of the pain on palpation and with walking is more closely associated with pes planus or with plantar fasciitis. Nevertheless, it is not necessary to distinguish between the two conditions for the purposes of evaluating the veteran's bilateral foot disability, as the Board finds that there is no evidence of symptoms to suggest that a "moderately severe" or "severe" disability may be associated with plantar fasciitis so as to warrant either a 20- or 30 percent evaluation under Diagnostic Code 5284. There is absolutely no evidence of actual loss of use of either of the veteran's feet. The Board notes that the veteran has reported that his bilateral foot problem has affected the type of employment he may engage in. However, he has provided no specific information on the matter, and there is no objective evidence of record to support a finding that the current bilateral foot disability results in the interference with his employment possibilities so as to warrant a higher evaluation. Similarly, there is absolutely no medical evidence of record showing any radiation of symptoms related to the veteran's bilateral foot condition. The Board notes that when a partial disability results from disease or injury of both arms, or of both legs, or of paired skeletal muscles, the ratings for the disabilities of the right and left sides will be combined as usual, and 10 percent of this value will be added (i.e., not combined) before proceeding with further combinations, or converting to degree of disability. 38 C.F.R. § 4.26 (1998). In the case at hand, prior to calculating the total combined rating for the veteran's disabilities, the bilateral factor must be calculated for his bilateral foot condition. The Board finds no basis on which to evaluate the veteran's service-connected left foot fracture of the distal fourth metatarsal as a separate current disability. The most recent x-rays of the veteran's feet show no abnormality, and there is no medical evidence showing a separate disability related to a march fracture. As an aside, the Board notes that when evaluating the veteran's claim of entitlement to pension benefits, the RO apparently mischaracterized the veteran's service-connected left foot condition as a right foot condition. This is of no consequence to the Board's evaluation of the veteran's current bilateral foot disability. Other claimed conditions The Board notes that in reviewing the veteran's treatment records from years past, several conditions are referred to which were not identified as disabilities on the most recent VA examination or in more recent treatment records. The Board also notes that there are conditions which the veteran has identified which have also not been confirmed by current medical evidence. As all of a veteran's disabilities must be evaluated for the purpose of determining entitlement to nonservice-connected pension benefits, the Board must determine whether certain claimed conditions actually qualify as "current disabilities". "Current disability" means a disability shown by competent medical evidence to exist at the time of the award. Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Chelte v. Brown, 10 Vet. App. 286 (1997). The regulatory definition of "disability" is the ". . . impairment of earning capacity resulting from such diseases or injuries and their residual conditions . . ." 38 C.F.R. § 4.1 (1998); Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991). Upon evaluation of all of the evidence of record, the Board finds that there is no evidence of current disabilities related to the veteran's in-service tonsillectomy or his service-connected march fracture, no current diagnosis of dermatitis, sinusitis, otitis media or externa, or anxiety disorder. With respect to the veteran's bilateral otitis media and externa, the Board notes that diseases of the ears, including otitis media are rated on the basis of hearing loss. See 38 C.F.R. § 4.87a, DC 6200, 6211 (1998). At his December 1997 VA examination, the veteran reported that he did not experience any hearing loss, and none was evidently identified by the examiner. Although the veteran has been evaluated for complaints of chest pain, there has been no diagnosis or assessment of any cardiovascular disability, but only "chest pain, noncardiac" and "atypical chest pain". Symptoms related to the veteran's complaints have been evaluated as elements of the veteran's hiatal hernia/reflux condition and his respiratory disability. The Board is not qualified to draw medical conclusions from the evidence of record, and therefore the Board cannot determine that a diagnosis of a cardiovascular or any other disability exists when none has been diagnosed by a physician. See Colvin v. Derwinski, 1 Vet. App. 171 (1991). The Board notes that the veteran has complained of several conditions affecting the musculoskeletal system, including a bilateral wrist disability, a bilateral knee disability and a low back disability. There is of record a report of a full- body bone scan which was completed in March 1997 and revealed evidence of degenerative changes in various joints, including the shoulders, elbows, wrists, knees and ankles, as well as two cysts in the left hand. Despite the bone scan results and other x-ray evidence of a bone cyst in the wrist, there is no evidence of record showing any current disability associated with any of these findings. On VA examination in December 1997, the examiner specifically found that x-rays of the knees and low back were normal, and that other than an osseous density or cyst in the right distal ulnar epiphysis, no abnormalities were found. Physical examination of the veteran revealed full range of motion of both knees without any difficulty, no crepitation, edema or other abnormality. The veteran had no complaint of current back pain and no abnormality was evidenced on examination, The examiner reported no disability associated with the veteran's complaint of occasional back pain. With respect to the veteran's wrists, he has complained of a loss of grip strength, however there is no medical evidence confirming his subjective complaint or showing that a disability or impairment of earning capacity exists with respect to it. There is no evidence of record to support a finding that any disability has been associated with the minimal cystic growth which has been identified. A current disability must be exhibited by an impairment in earning capacity, as shown by medical evidence. Pursuant to the guidelines set forth in 38 C.F.R. § 4.17, without evidence of the existence of a permanent disability, no rating may be established for the purpose of establishing entitlement to nonservice-connected pension benefits. The conditions mentioned here have either not been shown to exist currently, or have not been shown to involve a current impairment to the veteran's earning capacity, much less a permanent impairment. Therefore, they cannot be evaluated and assigned a disability rating under the Rating Schedule for the purpose of determining the veteran's entitlement to nonservice-connected pension benefits under 38 C.F.R. §§ 4.16 and 4.17. Accordingly, the Board finds that disability ratings are not warranted for any additional conditions whether identified in the medical record or claimed by the veteran. Pension evaluation Under the "objective" standard as is set forth above, the veteran is not permanently and totally disabled. The veteran's combined disability rating of 40 percent is comprised of two 10 percent evaluations for pes planus with plantar fasciitis (10 percent for each foot, to which the "bilateral factor" applies); a 10 percent evaluation for a respiratory condition characterized as COPD; and a 10 percent evaluation for a hiatal hernia condition with reflux. When combined pursuant to 38 C.F.R. §§ 4.25 and 4.26 (1998), these ratings result in a 40 percent disability evaluation. A 40 percent combined disability rating does not meet the objective standard set forth in 38 C.F.R. § 4.16(a). As previously discussed, entitlement to pension benefits may be found if the veteran has a permanent (or "lifetime") impairment which would render it impossible for an average person to follow a substantially gainful occupation. 38 U.S.C.A. § 1502(a); 38 C.F.R. § 4.15. In this case, none of the veteran's disabilities constitutes a permanent and total disability as contemplated by 38 C.F.R. §§ 4.16, 4.17. Because the veteran's disabilities collectively do not meet the percentage requirements of 38 C.F.R. § 4.16, the Board must determine whether the veteran is entitled to pension benefits based on subjective criteria, including age, education and occupational history. 38 C.F.R. §§ 3.321, 4.15. In this regard, the Board notes that the veteran is 59 years old and has an eighth grade education. The veteran has reported past employment as a truck driver, a construction worker and most recently, as a field laborer, including work with heavy machinery. He reported in September 1996 that he was last employed in August 1996. However, he gave conflicting information at his VA examination in December 1997. On an questionnaire prior to examination, he reported that he was unemployed and "laid-off", yet at the time of his examination, he reported current employment at the "cotton gins". He did not report any interference with employment as a result of his claimed disabilities to any of the VA examiners who evaluated him, nor did any of the examination reports from December 1997 mention that any disability, or combination of disabilities, was so severe as to result in unemployability. The Board further observes that the veteran's statements have been somewhat contradictory. In September 1996, the veteran reported that he was disabled due to chest pain. In September 1997, he reported that his foot disability, which he apparently considered to be at least 30 percent disabling, restricted the type of employment he could pursue. At his December 1997 VA examination, he reported his principal complaints were related to his reported breathing problems and his bilateral foot pain. Though medical treatment records from August 1996 indicate that the veteran was unable to perform heavy work due to chest pain, it does not appear that he was precluded from employment generally. Upon discharge from an evaluation for chest pain in March 1997, the veteran was instructed to continue with his daily activities as tolerated. There was no indication that the veteran was prohibited from working due to his condition, nor that it was suggested that he avoid any certain activities. The Board notes that there was no restriction put on the veteran's use of equipment. At the time of his 1997 VA examination, he did not report any inability to work related to his reported chest pain, and indeed did not complain of chest pain, but noted that he took nitroglycerin once a week. No cardiovascular disability was identified on examination. With respect to the veteran's bilateral foot complaints, there is no medical evidence supporting the veteran's claim that the disability interferes with his employment. In fact, the VA orthopedic examination report specifically stated that the physical findings suggested that the veteran's complaints were not proportional to his disability. The veteran himself has only contended that the condition interferes with the type of job he can pursue. This is not satisfactory evidence of unemployability. The veteran's breathing problems have not been associated with a limitation on employment by any medical professional. Though the veteran has contended that shortness of breath and coughing are among his primary complaints, he has not presented any evidence to show the extent to which these symptoms might presently interfere with his employability. In short, there is no medical evidence of record reflecting that the veteran cannot perform an occupation involving farm labor, construction work, truck driving or similar duties. Upon consideration of the combined effect of the veteran's disabilities, as well as his age, education and occupational history, the Board is not persuaded that the veteran is permanently and totally disabled and unemployable. An allowance of pension benefits based on extra-schedular criteria is thus not warranted. Finally, the Board has considered whether a permanent and total disability rating for pension purposes on an extraschedular basis may be authorized pursuant to 38 C.F.R. § 3.321(b)(1). The Board observes that there is no evidence of record that he has been hospitalized for his claimed disabilities, although cardiac studies were performed at a VA facility on an inpatient basis in March 1997. The cardiac catheterization was normal and treadmill testing was negative. The discharge report indicated that the veteran "stayed an extra couple of days due to transportation [not being available]". No exceptional or unusual aspects of the veteran's disabilities, alone or in any combination, have been identified by the Board, and the veteran has not pointed to any. The veteran thus has not presented such an unusual disability picture that it can be shown that he is precluded from sustaining gainful employment as a result of his disabilities. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The veteran thus has not demonstrated that his present condition renders him unemployable on an extraschedular basis under 38 C.F.R. § 3.321(b)(1). For the reasons and bases discussed at length above, the Board is not persuaded that the veteran's disabilities are so incapacitating as to preclude the performance of substantially gainful employment. The weight of the evidence in favor of the veteran's claim of entitlement to VA pension benefits on the basis of unemployability due to disability is outweighed by the preponderance of the evidence, which is against his claim. Thus, the Board finds that the veteran is not entitled to the benefit of the doubt, and that his claim of entitlement to nonservice-connected pension benefits is denied. ORDER Entitlement to a permanent and total disability rating for pension purposes is denied. Barry F. Bohan Member, Board of Veterans' Appeals