Citation Nr: 0600580 Decision Date: 01/09/06 Archive Date: 01/19/06 DOCKET NO. 99-14 628 ) DATE ) ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, the Commonwealth of Puerto Rico THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disability, to include post traumatic stress disorder (PTSD). 2. Entitlement to service connection for a low back disability. 3. Entitlement to an increased initial rating in excess of 10 percent for status post left inguinal herniorrhaphy. 4. Entitlement to an initial rating in excess of 10 percent for second degree burns of left axilla, left forearm, right flank, right lateral thigh, and right cheek. REPRESENTATION Appellant represented by: Michael E. Wildhaber, Esq. - Private Attorney WITNESS AT HEARING ON APPEAL Veteran/Appellant ATTORNEY FOR THE BOARD Matthew W. Blackwelder, Associate Counsel INTRODUCTION The veteran had active service from January 1980 to January 1983. This matter comes before the Board of Veterans' Appeals (Board) on appeal from decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. A May 2001 Board decision denied the veteran's claims for service connection for a lower back disability and for an increased rating for second degree burns of the left arm, left axilla, and right lumbar region, and remanded among other issues, a claim for service connection for PTSD, and a claim for a rating in excess of 10 percent for an inguinal hernia. The veteran appealed the denials to the United States Court of Appeals for Veterans Claims (Court). In a September 2003 order, the Court vacated and remanded the Board's decision. The Board then remanded the claims in May 2004. In a letter dated in May 2005, the veteran withdrew from consideration his claims of entitlement to service connection for hypertension; entitlement to service connection for hypothyroidism; and entitlement to an increased initial (compensable) rating for hemorrhoids. FINDINGS OF FACT 1. The veteran is currently diagnosed with PTSD which has been related by medical professionals to a traumatic experience in service. 2. The preponderance of evidence fails to link the veteran's lower back disability with his time in service. 3. The evidence shows that the veteran's inguinal hernia is postoperative, recurrent, and not reducible. 4. The evidence fails to show that the veteran has residuals of third degree burns. 5. The preponderance of evidence shows that the veteran has slight scars on his left axilla, left forearm, right flank, right lateral thigh, and right cheek as a result of being burned in service, which cover a surface area less than 144 square inches. 6. The burn scar on the veteran's cheek is 1.75 inches long and 1 inch wide, but is not painful to palpation, the skin is normal and the scar is superficial, stable, and not deep. 7. The evidence shows that less than 20 percent of the veteran's total exposed skin, and less than 20 percent of his total skin, is affected by dermatitis. CONCLUSIONS OF LAW 1. The criteria for service connection for PTSD are met. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. § 3.303 (2005). 2. The criteria for service connection for a lower back disability are not met. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. § 3.303 (2005). 3. The criteria for a rating of 30 percent for a left inguinal hernia have been met. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.2 4.7, 4.114, DC 7338 (2005). 4. The criteria for a rating in excess of 10 percent for residuals of second degree burns have not been met. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.2 4.7, 4.118, DC 7806 (2005); 38 C.F.R. § 4.118, DC 7800, 7801, 7802 (1998). 5. The criteria for a separate 10 percent rating for a facial burn scar have been met, effective August 20, 2002. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.2 4.7, 4.118, DC 7800 (2005). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection In seeking VA disability compensation, a veteran generally seeks to establish that a current disability results from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110. "Service connection" basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. This may be accomplished by affirmatively showing inception or aggravation during service or through the application of statutory presumptions. Where chronicity of a disease is not shown in service, service connection may yet be established by showing continuity of symptomatology between the currently claimed disability and a condition noted in service. A veteran may also establish service connection if all of the evidence, including that pertaining to service, shows that a disease first diagnosed after service was incurred in service. 38 C.F.R. § 3.303. PTSD To establish entitlement to service connection for PTSD a veteran must provide: 1) medical evidence diagnosing PTSD; 2) a link, established by medical evidence, between current symptoms of PTSD and an in-service stressor; and 3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). The veteran asserted (such as at his hearing) that he has nightmares and flashbacks stemming from an in-service accident in which he was burned at a barbecue. Medical treatment records from the time of the accident indicate that the veteran incurred first and second degree burns on 25 percent of his body. The veteran stated that whenever he sees people grilling it causes him to "freak out." Several doctors have diagnosed the veteran with PTSD and linked it to the veteran's inservice accident. In July 1999, Dr. Munoz recounted the veteran's traumatic experience from the burns during service, including his belief that he was going to die; and, the doctor diagnosed the veteran with PTSD and major depressive disorder (severe), indicating that the veteran needs a lot of psychotherapy to try to diminish the recurrence of exacerbations of the anxiety caused by his life threatening traumatic experience. A second psychologist, Dr. Gerdeman, hired to evaluate the veteran's psychiatric situation, confirmed Dr. Munoz's diagnosis of PTSD. Dr. Gerdeman, who was the director of a PTSD rehabilitation center for 10 years, indicated that in his clinical judgment all of the criteria for the diagnosis of PTSD, chronic with delayed onset, are met in the veteran's case: the veteran was confronted with a traumatic event (namely clothing catching fire), he has reexperiencing symptoms, such as flashbacks about the fire; he has avoidance and numbing symptoms, such as becoming estranged from his family and not wanting to leave the house; he has increased arousal, manifested by angry outbursts and difficulty sleeping; he has experienced PTSD symptoms for many years prior to seeking treatment; and he has shown gradual deterioration in his social and occupational functioning for a number of years. Accordingly, Dr. Gerdeman concluded that the veteran had PTSD as a result of the traumatic experience of catching on fire during service. While there is medical consensus as to the fact that the veteran has a psychiatric disability, the medical opinions of record differ with regard to whether the veteran has PTSD, and whether his psychiatric disability is related to an event in service. Several VA examiners felt that the veteran did not have PTSD as there was no evidence of a traumatic event in service. At a May 2000 VA examination, the veteran was assessed with a depressive disorder, but the examiner opined that the veteran did not meet the diagnostic criteria for PTSD, although the examiner acknowledged that the veteran had been diagnosed with PTSD by Dr. Velazquez in July 1999. At a second VA examination in November 2002, the veteran was diagnosed with a depressive disorder, and the examiner noted that no extreme definite traumatic stressor was identified. The psychiatrist noted that the veteran first sought psychiatric treatment in 1999, and opined that his mental condition does not meet the DSM-IV criteria for PTSD, as no stressor could be identified. The psychiatrist indicated that the veteran had not been in combat and that he could not describe in detail a severe and horribly traumatic event in service. Regardless of the conflicting medical opinions, the veteran has submitted opinions from two medical professionals indicating that he currently has PTSD and relating it to his experience during service. Additionally, Dr. Gerdeman's opinion directly refuted the VA examiners' conclusions that the veteran was not involved in a traumatic event, indicating that according to the DSM IV criteria, any event which is perceived as life threatening, whether from natural causes, such as an earthquake, or man made causes such as war, can be considered a traumatic event, so long as it is accompanied by intense fear, horror, or helplessness. As such, the Board finds that the evidence presented by the veteran is at least in equipoise with the conflicting evidence, and, as such, the benefit of the doubt rule mandates that we decide in his favor. Accordingly, the Board finds that the record is sufficient to establish service connection for PTSD. Lower Back Disability The veteran has been diagnosed with several lower back disabilities, which he attributes to several in-service falls. In his letter in support of the veteran's claim, the veteran's representative described the incidents it is contended resulted in current disability. These included a June 1981 record in which the veteran presented for treatment of low-back pain after falling in a foxhole. In October 1981, the veteran fell off his bicycle, but did not apparently seek treatment for his back. In March 1982, the veteran again sought treatment for his back. It was noted that the veteran had fallen in a foxhole, and the veteran was accordingly diagnosed with a back strain. He was prescribed pain medication and instructed not to participate in lifting or physical training for seventy-two hours. On the veteran's separation physical he reported that he was taking Demerol and that at the time he suffered from recurrent back pain. The Board notes that many of the veteran's service medical records are no longer associated with the claims file, and therefore, the Board will accept the descriptions of these records as true. The first post-service treatment record of the veteran's back was an MRI conducted in December 1998, more than 15 years after service, which revealed degenerative disc disease. Thus, the veteran obviously has a current lower back disability, but the medical opinions differ as to the etiology of the veteran's back disability. At a medical evaluation of the veteran's back in August 1999, the evaluator noted both the current disability, as well the veteran's fall into a foxhole in 1982, with no studies conducted after the initial treatment. The doctor concluded that the veteran "shows symptoms related while active in service in the US ARMY." In May 2000, the veteran underwent a VA examination. The examiner carefully reviewed the veteran's claims folder, noting the various in service complaints of back pain. Nevertheless, he indicated that the veteran's back condition was acute and transitory and resolved with treatment. Given that the veteran did not seek treatment for his back for 15 years following service, the examiner opined that the veteran's current back disability is not the result of falls during military service. The same VA examiner reexamined the veteran's in October 2004, but reached the same conclusion that the veteran's back disability was not the result of falls during military service. The veteran also submitted the opinion of a private physician, Dr. Bash, who provided an opinion without examining the veteran. Dr. Bash after reviewing the veteran's service and post-service medical records, and conducting a phone interview with the veteran concluded that the veteran's current back condition is most likely due to his multiple in-service falls. His reasoning for his conclusion was that the veteran entered service fit for duty, he had multiple serious in-service falls with associated injuries; and that the literature supports an association between spine injuries early in life and the development of advanced degenerative arthritis. He went on that the veteran has low back pain of 10/10, numbness in left lower extremity to the level of his calf muscles according to a recent evaluation dated 2000; the absence of medical records documenting any plausible etiology for the veteran's back disability other than the in-service falls; and that his opinion is consistent with the veteran's private doctor in 1999. While the Board may not ignore a medical opinion, it is not error for the Board to favor the opinion of one competent medical expert over that of another when the Board gives an adequate statement of reasons and bases; rather, it is the Board's duty to assess the credibility and probative value of evidence, and, provided that it supplies an adequate statement of its reasons or bases, it may assign greater probative weight to one medical opinion than to another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). In this case, the Board assigns greater weight to the VA examiner's opinion, as the 15 year period between discharge from service and the veteran's first post service back treatment raises considerable doubt that in-service back injuries were other than acute and transitory. It is noted the hired physician did not explain the passage of time between the in-service events and post service treatment. Likewise, the veteran's private doctor's 1999 opinion, does not satisfactorily explain why the veteran failed to seek treatment following service, and his conclusion that the veteran "shows symptoms related while active in service in the US ARMY" is confusing. As such, the Board finds that VA examiner's conclusion is the most plausible and as such greater weight will be given to it. As such, the evidence is not in equipoise, and there is no reasonable doubt to be resolved. Accordingly, the veteran's claim of service connection for a lower back disability is denied. II. Increased Rating Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and there must be emphasis upon the limitation of activity imposed by the disabling condition. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Inguinal Hernia The veteran is currently assigned a 10 percent rating for his inguinal hernia under 38 C.F.R. § 4.114, DC 7338. A 10 percent rating is assigned when the inguinal hernia is postoperative recurrent, readily reducible and well supported by truss or belt. A 30 percent rating is assigned when the inguinal hernia is small and postoperative but recurrent; where it is inoperable and irremediable, not well supported by truss; or where it is not readily reducible. A 60 percent rating is assigned where the inguinal hernia is large, postoperative, and recurrent, and is not well supported under ordinary conditions and is not readily reducible, when considered inoperable. The medical evidence shows that the veteran's hernia warrants a 30 percent rating. At a VA examination in October 2002, the examiner indicated that there was a fading scar which was moderately tender to palpitation, and that upon palpitation there was a left recurrent, inguinal hernia. Additionally, the examiner found that the inguinal hernia was reducible in the stretcher while laying and supported by a truss, but that it was not reducible when the veteran was standing. The hernia was noted to be operable. The veteran does not meet the criteria for a 60 percent rating as the veteran's left inguinal hernia has not been described by the medical evidence as being either large or not well supported. Accordingly, a 30 percent rating for the veteran's inguinal hernia is granted. Burns/Dermatitis The veteran is currently rated as 10 percent disabled under 38 C.F.R. § 4.118, DC 7802. When the veteran's claim was initiated this diagnostic code provided a 10 percent rating for second degree burns over an area or areas approximating 1 square foot, which was the highest rating available under this code. However, if the burns covered widely separated areas, as on two or more extremities or on anterior and posterior surfaces of extremities or trunk, they were to be separately rated and combined. A higher rating was available for third degree burns; but, actual third degree residual involvement was required. The rating criteria also provided a rating under 38 C.F.R. § 4.118, DC 7800 for disfiguring scars of the head, face or neck. A noncompensable rating was assigned when the disfigurement was slight; a 10 percent rating was assigned for moderate disfiguring; and a 30 percent rating was assigned for severe disfigurement, especially if it produced a marked and unsightly deformity of eyelids, lips, or auricles. The Board notes that during the course of this appeal the regulations for rating disabilities of the skin were revised effective August 30, 2002. 67 Fed. Reg. 49,596 (July 31, 2002). The Board will consider all applicable versions of the rating criteria, as did the RO. However, only the new criteria are to be applied as of that effective date (i.e., at no earlier date). See VAOPGCPREC 3-2000 (Apr. 10, 2000). Under the revised 38 C.F.R. § 4.118, DC 7800, a 10 percent rating is assigned for disfigurement of the head, face, or neck with one characteristic of disfigurement. The 8 characteristics of disfigurement are: 1) Scar 5 or more inches (13 or more cm.) in length; 2) Scar at least one- quarter inch (0.6 cm.) wide at widest part; 3) Surface contour of scar elevated or depressed on palpation; 4) Scar adherent to underlying tissue; 5) Skin hypo-or hyper- pigmented in an area exceeding six square inches (39 sq. cm.); 6) Skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.); 7) Underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.); and, 8) Skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.). A 30 percent rating is assigned for disfigurement of the head, face, or neck with either visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or with two or three characteristics of disfigurement. Under 38 C.F.R. § 4.118, DC 7802, a 10 percent rating is assigned for scars, other than on the head, face, or neck, that are superficial and that do not cause limited motion, so long as the affected area or areas is 144 square inches (929 sq. cm.) or greater. Scars in widely separated areas, as on two or more extremities or on anterior and posterior surfaces of extremities or trunk, will be separately rated and combined. 38 C.F.R. § 4.118, DC 7802, Note (1). A superficial scar is one not associated with underlying soft tissue damage. Id. at Note (2). Service medical records show that in June 1981 the veteran was treated for second degree burns over 15 percent of his body surface distributed: 8 percent to chest and flank, 4 percent upper extremities, 1 percent face, and 2 percent right leg. An additional 10 percent of the veteran's body surface was covered by first degree burns. By mid-June, the veteran had healed without any scars and in July 1981 his wounds were noted to have healed well and the veteran was without complaints. At a VA examination in August 1998, the veteran was observed to have burn scars on his left hand which were 10x10cm with smooth skin, as well as burn scars in the left axillary region which were 20x15cm with hypochromic skin, and burn scars on the right lumbar region which were 20x20cm with hypo-hyperchromic skin. There was no underlying tissue loss, and the scars were not seen as cosmetically disfiguring. No adhesions, depressions, or ulcerations were noted. Converting the measurements into inches, the total area noted by the examination to be affected was 121.68 square inches. At a VA examination in May 2000, the examiner found no objective evidence of a scar on the left arm. On the left axilla, a 10x8cm nontender scar was noted. On the left forearm there was no visual evidence of a scar. In the right lumber region, a 16x20cm, nontender scar was noted. The examiner observed that none of the aforementioned scars were inflamed, swollen, or depressed; and all of the scars had a good vascular supply, no ulcerations, no keloid formation, no adherence, and no herniations. Converting the measurements into inches, the total area noted by the examination to be affected was 61.23 square inches. At a VA examination in September 2004, the examiner noted that skin located on the left axilla (scar 5.5x3 inches), left forearm (scar 7.5x3 inches), right flank (scar 8.5x6 inches), right lateral thigh (scar 6.25x4 inches), and right cheek (scar 1.75x1 inches) were affected. The examiner found that 15 percent of the veteran's entire skin was affected, and only 1 percent of his exposed skin was affected; and the examiner noted that no disfigurement was seen. The scars were not found to be painful, and there was no adherence to the underlying tissue. The texture of the veteran's skin was normal, and the scars were found to be superficial, stable, and not deep. The scars also failed to cause any gross distortion or asymmetry of the veteran's face. The total area noted by the examination to be affected was 116.75 square inches. While the measurements of the veteran's scarring varied somewhat between his three VA examinations, the Board will rate based on the severest findings described; and, since the disability is scars, the Board will assume that the scars were present for the entire appeal period. The medical evidence shows that the scars stemming from the veteran's in-service burns are no more than slight. While the rating schedule does not specifically define "slight" or "moderate," the veteran's scars have been described as not cosmetically disfiguring. The scars have also not been observed to be inflamed, swollen, or depressed; and on his most recent VA examination only 1 percent of the veteran's exposed skin was found to be affected. The veteran's scars have also not been found to be painful, or to adhere to the underlying tissue. As such, the Board finds that the veteran is entitled to no more than a slight evaluation under the old 38 C.F.R. § 4.118, DC 7800. While the veteran has some scars associated with his burns, the medical treatment records and examination reports fail to show they cover an area sufficient to warrant a higher rating and there is no evidence of third degree burns. As such, a higher rating is not available under the old 38 C.F.R. § 4.118, DC 7801. The veteran is also not entitled to a rating under the old 38 C.F.R. § 4.118, DC 7802 as there is no limitation of function caused by his scars and the scars are not big enough to rate separately. As noted above, in order to merit a 10 percent rating for second degree burns, an affected area or affected areas must approximate 1 square foot or 144 square inches. However, the veteran's burn scars, totaled only 116.75 and 121.68 square inches, on the September 2004 and August 1998 VA examinations respectively. Under the revised DC 7800, the veteran is entitled to a separate 10 percent rating for having one characteristic of disfigurement, with respect to his facial scar, which was measured to be 1.75x1 inches on the September 2004 VA examination. It is therefore wider than one-quarter of an inch. However, the evidence fails to show that it has any of the other characteristics of disfigurement noted above, and, as such, a rating in excess of 10 percent is not available. Accordingly, a separate 10 percent rating is assigned, effective August 30, 2002, for the right cheek scar. A higher rating is unavailable under the revised DC 7802. As noted, the veteran's burn scars total only 121.68 square inches (using the most favorable examination result) in the affected areas which is less than the 144 square inches required for a 10 percent rating. While the veteran's private medical expert opined that the veteran's scars stemming from his in-service burns totaled an area in excess of 144 square inches, the Board notes that the private doctor never actually examined the veteran in person, but rather, relied on photographs of the veteran to reach his conclusion. The Board finds that the in-person examinations conducted by the VA examiners provide a more accurate measurement of the veteran's burn scars, and, as such, they are relied upon in denying a rating under DC 7802. The veteran's representative asserted that the veteran's burn related skin disorder should be rated under the criteria for dermatitis. Under 38 C.F.R. § 4.118, DC 7806 for either dermatitis or eczema; a 30 percent rating is assigned where 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas are affected, or where systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of six weeks or more, but not constantly, during the past 12-month period. While the veteran uses hydrocortisone cream one percent twice per day, hydrocortisone cream is not a systemic therapy, and as such is not sufficient to warrant a higher rating. The veteran has complained that his burn scars are itchy and painful. In support of his contentions, he submitted a private medical opinion from a doctor who is a professor of radiology and nuclear medicine. The doctor, after reviewing the veteran's service medical records, post service medical records, and interviewing the veteran over the phone, opined that the veteran has scars from his in-service burn injury that cover an extensive area of his skin totalling in excess of 144 square inches, and that the pain syndrome he demonstrates more closely resembles the symptoms of dermatitis as these scars are a form of burn induced dermatitis. While the Board does not dispute that the veteran may have some type of skin condition, such as dermatitis, as a result of his burns, in order to merit a rating in excess of 10 percent, 20 to 40 percent of the veteran's entire body or 20 to 40 percent of his exposed areas must be affected. At a VA examination of the veteran's skin in 2004, the examiner noted that 15 percent of the veteran's entire skin was affected, and less than 1 percent of his exposed skin was affected; and when the veteran was initially burned, only 15 percent of his body contained second degree burns. As such, the Board finds that the evidence of record fails to show that a sufficient area of the veteran's skin is affected to warrant a rating in excess of 10 percent. While the Board may not ignore a medical opinion, it is not error for the Board to favor the opinion of one competent medical expert over that of another when the Board gives an adequate statement of reasons and bases; rather, it is the Board's duty to assess the credibility and probative value of evidence, and, provided that it supplies an adequate statement of its reasons or bases, it may assign greater probative weight to one medical opinion than to another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). In this case, the veteran's doctor never physically examined the veteran. Instead, he appears merely to have conducted a phone interview with the veteran and reviewed the records from various examinations and treatments. While this may have been sufficient to diagnose the veteran with dermatitis, the Board finds that the VA examiners' full, in-person examinations of the veteran are more probative to the determination of the extent of the veteran's affected areas. The Board acknowledges the veteran's opinion that the VA examiner did not fully examine all of his burn areas, but a review of the VA examination report yields no indication that the examination was insufficient for rating purposes. Accordingly, the Board finds that the veteran is not entitled to a rating in excess of 10 percent for dermatitis, as less than 20 percent of his total skin is affected, and less than 20 percent of his exposed skin is affected. III. Duties to Notify and Assist Under applicable criteria, VA has certain notice and assistance obligations to claimants. See 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). Notice must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits and 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. Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II). In the present case, notice was provided to the veteran in a letter dated in July 2004, which informed the veteran of all four elements required by the Pelegrini II Court as stated above. The Board finds that any defect concerning the timing of the notice requirement was harmless error. Although the notice provided to the veteran in July 2004 was not given prior to the first adjudication of the claim, it was given prior to a subsequent adjudication (in a November 2004 supplemental statement of the case). In short, the veteran has been provided with every opportunity to submit evidence and argument in support of his claim and ample time to respond to VA notices. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005). Numerous VA treatment records have been obtained, and private medical records have been obtained and translated. The veteran has also been provided with numerous VA examinations (the reports of which have been associated with the claims file). Additionally, the veteran was provided with a hearing before a local hearing officer, and was offered the opportunity to testify at a hearing before the Board, but he declined. VA has satisfied its duties to notify and assist, and additional development efforts would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Therefore, the veteran is not prejudiced by the Board's adjudication of his claims. ORDER Service connection for PTSD is granted. Service connection for a lower back disability is denied. A rating of 30 percent for a left inguinal hernia is granted A rating in excess of 10 percent for second degree burn scars of the left axilla, left forearm, right flank, and right lateral thigh is denied. A 10 percent rating for a facial scar with one characteristic of disfigurement is granted, effective August 30, 2002. ____________________________________________ MICHAEL E. KILCOYNE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs