Citation Nr: 0809993 Decision Date: 03/26/08 Archive Date: 04/09/08 DOCKET NO. 06-04 199 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to service connection for residuals of a left ear hematoma. 2. Entitlement to service connection for bronchitis. 3. Entitlement to service connection for myopic astigmatism, status post PRK surgery. 4. Entitlement to an initial evaluation in excess of 10 percent for left knee disability, status post arthroscopy, with synovectomy and chondroplasty of the lateral femoral condyle. 5. Entitlement to an initial evaluation in excess of 30 percent for bilateral pes planus with plantar fasciitis and heel spurs, status post lithotripsy. 6. Entitlement to an initial evaluation in excess of 10 percent for irritable bowel syndrome. 7. Entitlement to an initial evaluation in excess of 10 percent for alopecia areata of the lower extremities. 8. Entitlement to an initial evaluation in excess of 10 percent for migraine headaches. 9. Entitlement to an initial compensable evaluation for left foot arthritis. 10. Entitlement to an initial compensable evaluation for onychomycosis of the feet. ATTORNEY FOR THE BOARD W. Donnelly, Associate Counsel INTRODUCTION The veteran served on active duty with the United States Army from August 1982 to February 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2004 decision by the Washington, DC, Regional Office (RO) of the Department of Veterans Affairs (VA). The Roanoke, Virginia, RO later assumed jurisdiction over the claim based on the veteran's state of residence. A Notice of Disagreement (NOD) was filed in December 2004, and a Statement of the Case (SOC) was issued in November 2005. The veteran perfected his appeal with the filing of a VA Form 9, Appeal to Board of Veterans' Appeals, in December 2005. In April 2006, the RO issued a Supplemental SOC (SSOC) on the appealed issues, as well as a rating decision granting increased evaluations for several disabilities currently on appeal. In response, the veteran stated that he wished to continue his appeal on all issues. In light of the decision below, the issue of evaluation of residuals of a left ear hematoma is referred to the RO for appropriate action. FINDINGS OF FACT 1. There is a residual scar of the left ear due to drainage of a hematoma. 2. There is no current medical evidence of bronchitis. 3. Myopic astigmatism is a congenital or developmental condition not show to have been aggravated by military service. 4. Left knee disability, status post arthroscopy, with synovectomy and chondroplasty of the lateral femoral condyle, is manifested by limitation of motion from 0 to 80 degrees, with no instability. 5. Bilateral pes planus with plantar fasciitis and heel spurs, status post lithotripsy, is manifested by tenderness to palpation, a need for orthopedic shoes without relief of symptoms, swelling, and functional impairment on walking. 6. Irritable bowel syndrome is manifested by frequent, daily diarrhea with abdominal pain, causing loss of weight. 7. Alopecia areata of the lower extremities is manifested by a loss of body hair below the knees, and has been treated with topical lotions. 8. Migraine headaches occur several times a week, and respond to medication; attacks are not typically prostrating. 9. Left foot arthritis is shown on x-ray, with no painful or limited motion attributed to the degenerative changes. 10. The veteran has residual fungal infection diagnosed as onychomycosis confined to the second toes of each foot. CONCLUSIONS OF LAW 1. Service connection for residuals of a left ear hematoma is warranted. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2007). 2. Service connection for bronchitis is not warranted. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2007). 3. Service connection for myopic astigmatism, status post PRK surgery, is not warranted. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2007). 4. The criteria for an evaluation in excess of 10 percent for a left knee disability, status post arthroscopy, with synovectomy and chondroplasty of the lateral femoral condyle, are not met. 38 U.S.C.A. §§ 1110, 1131, 1155, 5103, 5103A, 5107 (West 2007); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.40, 4.44, 4.45, 4.59, 4.71a, Diagnostic Code 5260. (2007). 5. The criteria for an evaluation in excess of 30 percent for bilateral pes planus with plantar fasciitis and heel spurs, status post lithotripsy, are not met. 38 U.S.C.A. §§ 1110, 1131, 1155, 5103, 5103A, 5107 (West 2007); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.71a, Diagnostic Code 5276. (2007). 6. The criteria for an increased evaluation to 30 percent for irritable bowel syndrome are met. 38 U.S.C.A. §§ 1110, 1131, 1155, 5103, 5103A, 5107 (West 2007); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.114, Diagnostic Code 7319. (2007). 7. The criteria for an evaluation in excess of 10 percent for alopecia areata of the lower extremities are not met. 38 U.S.C.A. §§ 1110, 1131, 1155, 5103, 5103A, 5107 (West 2007); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.118, Diagnostic Code 7831. (2007). 8. The criteria for an evaluation in excess of 10 percent for migraine headaches are not met. 38 U.S.C.A. §§ 1110, 1131, 1155, 5103, 5103A, 5107 (West 2007); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.124a, Diagnostic Code 8100. (2007). 9. The criteria for a compensable evaluation for left foot arthritis are not met. 38 U.S.C.A. §§ 1110, 1131, 1155, 5103, 5103A, 5107 (West 2007); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.44, 4.45, 4.71a, Diagnostic Code 5003. (2007). 10. The criteria for a compensable evaluation of onychomycosis of the feet are not met. 38 U.S.C.A. §§ 1110, 1131, 1155, 5103, 5103A, 5107 (West 2007); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.118, Diagnostic Codes 7806 and 7820. (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VA's Duties to Assist and Notify As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs (VA) has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2007). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA must inform the claimant of any information and evidence not of record that is necessary to substantiate the claim. VA should notify the veteran of the information and evidence that VA will seek to provide and of the information and evidence that the claimant is expected to provide. Proper notice should invite the claimant to provide any evidence in his possession that pertains to the claim in accordance with 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). This appeal arises in part from the veteran's disagreement with the initial evaluation following a grant of service connection for multiple disabilities. Courts have held that once service connection is granted the claim is substantiated, additional notice is not required, and any defect in the notice is not prejudicial. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). Therefore, as regards evaluation following the initial grant of service connection for a left knee disability, bilateral pes planus with plantar fasciitis, irritable bowel syndrome, alopecia areata, migraine headaches, left foot arthritis, and oncychomycosis of the feet, no additional discussion of VA's duty to notify is required. With regard to the claims of service connection for left ear hematoma, bronchitis, and post-surgical myopic astigmatism, the Board finds that the duty to notify was satisfied prior to the initial AOJ adjudication. Correspondence sent to the veteran in October 2003 informed the appellant of what evidence was required to substantiate the claims and of the appellant's and VA's respective duties for obtaining evidence. Moreover, the veteran was counseled prior to his separation from service, as is shown by an October 2003 memorandum showing his participation in the Benefits Delivery at Discharge (BDD) program. While the memorandum does not specifically set out what notice was provided the veteran at his counseling session, the veteran subsequently provided evidence and information in his possession, on an ongoing basis, thereby demonstrating his actual knowledge of this notice element. There is no prejudice to the veteran in proceeding. VA additionally has a duty to assist the veteran in the development of the claim. This duty includes assisting the veteran in the procurement of service medical records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the appellant. See Bernard v. Brown, 4 Vet. App. 384 (1993). The RO has obtained complete service treatment records; there is no indication of any VA treatment. The veteran submitted private medical records from P Medical Center and Dr. JB from GMO. He has also provided records from the Dewitt Army Hospital at Fort Belvoir and from Walter Reed Army Medical Center following his separation, and which are not part of the service treatment records. The appellant was afforded VA medical examinations in November and December 2003, as well as in February 2006 through a VA contract service. Significantly, the appellant has not identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. The Board notes that because the veteran has submitted private records covering all periods identified by him, no request for records was required from the RO. Hence, no further notice or assistance to the appellant is required to fulfill VA's duty to assist the appellant in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Service Connection Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service. Watson v. Brown, 4 Vet. App. 309, 314 (1993); see also Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). To establish service connection, there must be: (1) a medical diagnosis of a current disability; (2) medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 252 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd 78 F.3d 604 (Fed. Cir. 1996). A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997). See also Bostain v. West, 11 Vet. App. 124, 127 (1998) citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992) (a layperson without the appropriate medical training and expertise is not competent to provide a probative opinion on a medical matter, to include a diagnosis of a specific disability and a determination of the origins of a specific disorder). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence means any evidence not requiring that the proponent have specialize d education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). A disorder will be service connected if the evidence of record, regardless of its date, shows that the veteran had a chronic disorder in service or during an applicable presumption period, and that the veteran still has the same disorder. With chronic disease shown as such in service (or within the presumptive period under § 3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." 38 C.F.R. § 3.303(b). A determination as to whether medical evidence is needed to demonstrate that a veteran presently has the same condition he or she had in service or during a presumption period, or whether lay evidence will suffice, depends on the nature of the veteran's present condition (e.g., whether the veteran's present condition is of a type that requires medical expertise to identify it as the same condition as that in service or during a presumption period, or whether it can be so identified by lay observation). Savage v. Gober, 10 Vet. App. 488, 494-97 (1997). If the disorder is not chronic, it will still be service connected if the disorder is observed in service or an applicable presumptive period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present disorder to that symptomatology. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. Again, whether medical evidence or lay evidence is sufficient to relate the current disorder to the in-service symptomatology depends on the nature of the disorder in question. Savage, 10 Vet. App. at 497. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Residuals of a Left Ear Hematoma Service treatment records reveal that in October 2001, external otitis was diagnosed. No hematoma was noted at that time, though the ear was tender. Topical ointment was prescribed. In February 2002, the veteran again reported pain in the left ear. Tenderness and mild swelling were noted, and a hematoma was diagnosed. The hematoma was drained several times in February and March 2002. On December 2003 VA examination, while the veteran was still in service, he reported that he had the hematoma drained again in June 2003; this treatment is not reflected in service records. The VA examiner noted some slight induration of the left ear. Private medical records show no findings or treatment related to the left ear hematoma. During a February 2006 VA contract examination, a VA examiner noted well healed scars of the left ear which he related to drainage of the hematoma. The examiner did not indicate if the scars were tender or describe their size or any disfiguring characteristics. There was no active infection, though the veteran reported that the ear was swollen about once a month and was painful. Service medical records clearly show that the veteran required aspiration of the hematoma at least once during service, and two subsequent examiners have described scars or other physical changes of the skin of the left ear as a result of the treatment. The diagnosed scarring is a current chronic residual of the left ear hematoma. Service connection is warranted. This represents a full grant of the benefit sought on appeal. Bronchitis Service treatment records reveal periodic treatment for respiratory complaints, including sinus and bronchial illnesses. A chronic condition was not shown during service or at separation. Neither VA nor private treatment records following service show a diagnosis of a chronic bronchitis. In November 2003, the veteran reported a history of seasonal allergies which often progress to bronchitis, and a recent bout of pneumonia. On examination, however, there was no disease diagnosed. The report of a February 2006 examination was similarly negative for any finding related to bronchitis. The lungs were clear and examination was within normal limits. Private medical records also show no bronchitis diagnosis. In short, while the records show that the veteran had some treatment for bronchial problems during service, he did not develop a chronic problem during service and no chronic bronchial disability is shown since service. In the absence of a current disability, service connection cannot be granted. The claim must be denied. The Board notes that the veteran has been granted service connected for allergic rhinitis. Myopic Astigmatism, status post PRK surgery Service treatment records reveal that the veteran was diagnosed with myopic astigmatism during service and underwent elective PRK surgery to correct the vision impairment in 2002. A VA contract examination dated in February 2006 shows nearly normal uncorrected vision, including nearly normal acuity and nearly normal visual field testing. The diagnosis was bilateral refractive error, post surgical correction VA regulations specifically exclude refractive errors such as the veteran's from service connection. They are not diseases or injuries within the meaning of the law. 38 C.F.R. § 3.303(c). Therefore, service connection for the surgically corrected myopic astigmatism must be denied as a matter of law. Evaluation of Service Connected Disabilities Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 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 the residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Compensation for service-connected injury is limited to those claims which show present disability. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as "staged" ratings." Fenderson v. West, 12 Vet. App. 119, 126-127 (1999); Hart v. Mansfield, No. 05-2424 (U.S. Vet. App. Nov. 19, 2007). If the evidence for and against a claim is in equipoise, the claim will be granted. A claim will be denied only if the preponderance of the evidence is against the claim. See 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Left Knee Disability, Status Post Arthroscopy, with Synovectomy and Chondroplasty of the Lateral Femoral Condyle The veteran's left knee disability is currently evaluated under Diagnostic Code 5260, for rating limitation of flexion of the leg. Under Diagnostic ode 5260, flexion of the leg limited to 60 degrees is rated 0 percent disabling; flexion of the leg limited to 45 degrees is rated 10 percent disabling; flexion of the leg limited to 30 degrees is rated 20 percent disabling; and flexion of the leg limited to 15 degrees is rated 30 percent disabling. 38 C.F.R. § 4.71a. Additional, separate evaluations are also available for limitation of extension (under Diagnostic Code 5261) and instability of the knee joint (under Diagnostic Code 5257). See VAOPGCPREC 23-97 and 09-04. As is discussed below, however, there is no evidence of instability or impaired extension, and hence these Diagnostic Codes are not applicable here. Evaluating a service-connected disability involving a joint rated on limitation of motion requires adequate consideration of functional loss due to pain under 38 C.F.R. § 4.40 and functional loss due to weakness, fatigability, incoordination or pain on movement of a joint under 38 C.F.R. § 4.45. DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. § 4.40 state that disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence of part, or all, of the necessary bones, joints and muscles, or associated structures. It may also be due to pain supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. 38 C.F.R. § 4.40. The factors of disability affecting joints are reduction of normal excursion of movements in different planes, weakened movement, excess fatigability, swelling and pain on movement. 38 C.F.R. § 4.45. Service medical records reveal that the veteran underwent arthroscopy of the left knee in July 2003, and a cystectomy in September 2003. During a November 2003 VA examination, the veteran reported pain on walking, a popping sound, and feelings of weakness and instability. Physical examination showed tenderness to palpation, with a range of motion from 0 to 145 degrees. There was crepitus present, but the veteran did not report pain with motion. Private medical records from Dr. JB reveal continued complaints of knee pain in 2004 following separation from service. During a February 2006 VA contract examination, the veteran complained of weakness and stiffness of the left knee, with swelling at night. He reported giving way of the knee at times, as well as occasional locking and dislocation. He complained of a lack of endurance and fatigue in the joint. Pain was almost constant, and was relieved with rest and medication. Range of motion of the left knee was from 0 to 140 degrees, with pain at 80 degrees of flexion. Repeated movement caused increased pain, fatigue, weakness, and lack of endurance. Pain was the greatest limiting factor, and limitation increased by about 10 degrees with repeated movement. The knee joint was fully stable on objective testing. The Board finds that no greater than a 10 percent evaluation is warranted for the left knee disability. The limitation of motion of the left knee is solely in flexion, and the joint is stable. The limited flexion warrants the compensable evaluation under Code 5260 when actual functional limitation due to pain, weakness, fatigue, and lack of endurance on repeated motion are considered, even though the measured range of motion is not strictly compensable. However, the actual functional impairment is not considered the equivalent of limitation to 30 degrees flexion and hence a higher 20 percent evaluation is not warranted under Code 5260. The Board further notes that there are no objective medical findings of locking or dislocation due to cartilage damage which would warrant a 20 percent evaluation under Code 5258. Staged ratings are not appropriate in this instance. The veteran has consistently reported pain in the knee with movement, and all reasonable doubt is resolved in favor of the veteran. Bilateral Pes Planus with Plantar Fasciitis and Heel Spurs, Status Post Lithotripsy As the RO noted in an April 2006 rating decision, the service connected disabilities of pes planus and plantar fasciitis with heels spurs are properly evaluated under the same criteria, and therefore assignment of separate evaluations for each disability would constitute prohibited pyramiding under 38 C.F.R. § 4.14. The disabilities are therefore considered together, and a single evaluation is assigned under Code 5276. Diagnostic Code 5276 provides ratings for acquired flatfoot. Mild flatfoot with symptoms, relieved by built-up shoe or arch support, are rated as noncompensably (0 percent) disabling. Moderate flatfoot with weight-bearing line over or medial to the great toe, inward bowing of the atendo achillis, pain on manipulation and use of the feet, bilateral or unilateral, is rated 10 percent disabling. Severe flatfoot, with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities, is rated 20 percent disabling for unilateral disability, and is rated 30 percent disabling for bilateral disability. 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, that is not improved by orthopedic shoes or appliances, is rated 30 percent disabling for unilateral disability, and is rated 50 percent disabling for bilateral disability. 38 C.F.R. § 4.71a. Service medical records reveal complaints of and treatment for pes planus and plantar fasciitis, including surgeries in 2003. During the November 2003 VA examination, no specific complaints were noted related to the bilateral foot disabilities. Specifically, the examiner reported bilateral pes planus, but stated that the foot examination was otherwise normal. Private medical records from Dr. JB reveal complaints of "achiness" in the heels in September 2004. In November 2004, bilateral lithotripsies were performed; subsequent records do not show complaints of foot pain. During the February 2006 VA contract examination, the veteran complained of constant bilateral foot pain, particularly with activity. Both feet were tender on physical examination. Pes planus was present bilaterally. The Achilles tendons were well-aligned. Standing and walking caused pain and additional functional limitation. Special shoes were required, but the examiner did not indicate they provided relief from symptoms. The current symptoms and findings support assignment of a 30 percent evaluation, but no higher, for bilateral pes planus and plantar fasciitis with heel spurs, status post lithotripsy. While there is no severe physical deformity noted, there is pain on manipulation and use warranting the 30 percent evaluation. The absence of evidence showing marked pronation or extreme tenderness, and the ongoing treatment records showing successful management, if not resolution, of symptoms, precludes assignment of a higher, 50 percent evaluation at any point during the appellate period. No staged rating is applicable. Irritable Bowel Syndrome Service medical records reveal the onset of gastrointestinal disturbances on active duty. Intermittent diarrhea was noted. Repeated colonoscopies were negative. The November 2003 VA examiner noted gastrointestinal problems, but made no specific findings. Doctors at P Medical Center noted the presence of high levels of H. Pylori bacteria in January 2005. Dr. JB also noted irritable bowel syndrome in ongoing orthopedic treatment records. In March 2005, the veteran reported an increase in abdominal discomfort when treated at Fort Belvoir as a civilian. Treatment notes from April to August 2005 reveal daily diarrhea, with multiple bowel movements after meals. The movements are accompanied by abdominal pain, and are worse with spicy or fried foods. At the February 2006 VA contract examination, the veteran reported that he had diarrhea all day, every day, and was losing weight rapidly as a result. There was abdominal pain frequently. Mild abdominal tenderness was noted on physical examination; the rectal examination was unremarkable. Diagnostic Code 7319 provides ratings for irritable colon syndrome (spastic colitis, mucous colitis, etc.). Mild irritable colon syndrome, with disturbances of bowel function with occasional episodes of abdominal distress, is rated noncompensably (0 percent) disabling. Moderate irritable colon syndrome, with frequent episodes of bowel disturbance with abdominal distress, is rated 10 percent disabling. Severe irritable colon syndrome, with diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress, is rated 30 percent disabling. 38 C.F.R. § 4.114. The Board finds that an evaluation of 30 percent is properly assigned for irritable bowel syndrome. The disability picture presented best reflects a severe impairment. The veteran reports daily diarrhea, and this allegation is supported by ongoing treatment records. Abdominal pain is very frequent, and the condition has contributed to weight loss. The highest schedular evaluation of 30 percent is warranted under Code 7319. A higher rating on an extra- schedular basis is not warranted, as the condition has not been shown to result in frequent hospitalization or loss of time from work. Alopecia Areata of the Lower Extremities The veteran's alopecia of the legs is rated 10 percent by the RO under Diagnostic Code 7806, which is used to evaluate dermatitis or eczema, but is also applied to evaluate multiple other skin conditions. The other skin conditions specifically refer an evaluator to the criteria of Code 7806, or are rated by analogy to that Code when no other Code is specifically applicable. Here, the use of Code 7806 to evaluate alopecia areata is not proper. The rating schedule provides that alopecia areata is to be rated under Code 7831; this Code does not provide for application of the criteria of Code 7806, and the RO has not provided any rationale for abandoning the schedular provisions. The Board will therefore consider the evaluation of the disability solely under the provisions of Code 7831. That Diagnostic Code provides that where the loss f hair is limited to the face and scalp, alopecia areata is to be rated noncompensable. With the loss of all hair over the entire body, a 10 percent evaluation is assigned. Here, service records and VA examination reports following service clearly show that the loss of hair is restricted to the lower legs, from the knees down. There is no scalp of face involvement, and the hair on a majority of the body remains unaffected. Under the correctly applicable Code, no compensable evaluation should be assigned. While the Board will not act to end the currently assigned compensable evaluation even in light of the apparent error, it cannot assign any higher schedular evaluation. The Board notes that there is no basis for assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b), as there are no exceptional or unusual circumstances which would render application of the schedule impractical. The claim is denied. Migraine Headaches Diagnostic Code 8100 provides ratings for migraine headaches. Migraine headaches with less frequent attacks than the criteria for a 10 percent rating are rated as noncompensably (0 percent) disabling. Migraine headaches with characteristic prostrating attacks averaging one in 2 months over the last several months are rated 10 percent disabling. Migraine headaches with characteristic prostrating attacks occurring on an average once a month over last several months are rated 30 percent disabling. Migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability are rated 50 percent disabling. 38 C.F.R. § 4.124a. In November 2003, the veteran reported to a VA examiner that he has severe left-side migraine headaches. Headaches occur at least once a week. He states he is light sensitive and has gastrointestinal problems. He is prescribed multiple medications, but feels they are not effective. The veteran reports that past MRIs and CT scans have been negative. Private medical records reveal reports of headaches since leaving service. In May 2004, the veteran reported headaches 4 to 5 days a week. He denied photophobia or nausea. Headaches were again reported, though not described in detail, in June 2005. On February 2006 VA contract examination, the veteran reported that he has headaches twice a week, with attacks lasting an hour. He is able to work when they occur. The neurological examination was unremarkable. No greater than a 10 percent evaluation is warranted for migraine headaches, based on the frequency of the attacks. No characteristic prostrating attacks are noted, and the veteran states he is able to continue to work when having a headache. Since service he has not reported photophobia. While the frequency of less disabling attacks is considered the equivalent of more severe, more rare headaches, the disability picture presented cannot be described as more than mildly to moderately impairing. The claim for increased evaluation must be denied. Left Foot Arthritis A noncompensable evaluation has been assigned for left foot arthritis under Diagnostic Code 5003, which provides that degenerative arthritis that is established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When there is no limitation of motion of the specific joint or joints that involve degenerative arthritis, Diagnostic Code 5003 provides a 20 percent rating for degenerative arthritis with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations, and a 10 percent rating for degenerative arthritis with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. Note (1) provides that the 20 percent and 10 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. Note (2) provides that the 20 percent and 10 percent ratings based on X-ray findings, above, will not be utilized in rating conditions listed under Diagnostic Codes 5013 to 5024, inclusive. When there is some limitation of motion of the specific joint or joints involved that is noncompensable (0 percent) under the appropriate diagnostic codes, Diagnostic Code 5003 provides a rating of 10 percent for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. When there is limitation of motion of the specific joint or joints that is compensable (10 percent or higher) under the appropriate diagnostic codes, the compensable limitation of motion should be rated under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a. Service medical records include x-ray reports showing early degenerative changes of the left foot dated in April 2003. While subsequent x-rays by VA examiners and private doctors do not support this finding, the diagnosis is accepted, and has been repeated by doctors even in the absence of current x-rays. The findings on X-ray examination at the time of the November 2003 VA examination show degenerative changes, but do not describe any functional impairment of the foot related to such. Private treatment records do not specify a diagnosis of arthritis of the feet, though they do refer to pain and discomfort. This, however, appears to be solely in reference to heel spurs and not to arthritis. During the February 2006 VA contract examination, the examiner reported the same findings for plantar fasciitis and pes planus as for arthritis of the foot, and he in fact discusses as treatment the lithotripsy associated with heel spurs. The physical examination shows the left foot to be in good alignment; x-rays showed a calcaneal spur and spurring at the distal tibia. The veteran is already service connected for left foot spurs and plantar facsciitis. Evaluation of disability due to arthritis does not show additional symptoms warranting a separate compensable rating. There has been no finding of limitation of motion of the joints of the foot, which constitute as group of minor joints under 38 C.F.R. § 4.45(f). Additionally, the evidence does not show evidence of painful motion of the joints of the foot, apart from the pain already considered in assigning an evaluation for pes planus and plantar fasciitis. Therefore, because only one group of minor joints is involved at this time, no compensable evaluation is assignable under Code 5003. Onychomycosis of the Feet The veteran is currently evaluated as 0 percent disabling for onychomycosis of both feet. Onychomycosis is a fungal infection of the toenails, and is rated under Code 7820, which provides that infections of the skin, including fungal infections, are to be rated as disfigurement of the head, face or neck; as scars; or as dermatitis, whichever best reflects the predominant disability. Here, as there is no scarring, and the head, face or neck are not involved, rating under Code 7806 for dermatitis is most appropriate. Diagnostic Code 7806 provides that dermatitis or eczema that involves less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and that requires no more than topical therapy during the past 12-month period, is rated noncompensably (0 percent) disabling. Dermatitis or eczema that involves at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period, is rated 10 percent disabling. Dermatitis or eczema that involves 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or that requires systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of six weeks or more, but not constantly, during the past 12-month period, is rated 30 percent disabling. Dermatitis or eczema that involves more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or that requires constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs during the past 12-month period, is rated 60 percent disabling. 38 C.F.R. § 4.118. During a December 2003 VA skin examination, the veteran reported that he was being treated with oral medication for an ongoing fungal infection of the feet. The examiner noted that the right great toenail was partly hyperkeratotic and discolored. The second and fourth toenails of both feet were also lightly hyperpigmented. Private doctors do not report any findings or complaints related to the infection of the feet. In February 2006, a VA contract examiner commented that there is "residual onychomycosis of the 2nd toenail" bilaterally. The evidence of record establishes that no compensable evaluation is warranted for onychomycosis of the feet. Oral medications appear to have effectively treated the infection, as improvement is shown from 2003 to 2006. The affected areas (at present involving only two toes, and historically perhaps involving five toes) do not constitute sufficient body area to warrant a compensable evaluation. For sake of comparison, under the "Rule of Nine" for burn injuries, a generally accepted method for estimating body surface area affected, the entire hand is approximately 1 percent of the body area. The claim must be denied. ORDER Service connection for residuals of a left ear hematoma is granted. Service connection for bronchitis is denied. Service connection for myopic astigmatism, status post PRK surgery, is denied. An evaluation in excess of 10 percent for left knee disability, status post arthroscopy, with synovectomy and chondroplasty of the lateral femoral condyle, is denied. An evaluation in excess of 30 percent for bilateral pes planus with plantar fasciitis and heel spurs, status post lithotripsy, is denied. A 30 percent evaluation for irritable bowel syndrome is granted, subject to the laws and regulations governing payment of monetary benefits. An evaluation in excess of 10 percent for alopecia areata of the lower extremities is denied. An evaluation in excess of 10 percent for migraine headaches is denied. A compensable evaluation for left foot arthritis is denied. A compensable evaluation for onychomycosis of the feet is denied. ____________________________________________ DENNIS F. CHIAPPETTA Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs