Citation Nr: 0810184 Decision Date: 03/27/08 Archive Date: 04/09/08 DOCKET NO. 99-16 119 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Milwaukee, Wisconsin THE ISSUES 1. Whether new and material evidence has been received to reopen the veteran's claim of entitlement to service connection for a chronic back disorder. 2. Entitlement to an initial compensable disability evaluation for the veteran's pulmonary pleural plaquing. REPRESENTATION Appellant represented by: Larry David, Attorney ATTORNEY FOR THE BOARD J. T. Hutcheson, Counsel INTRODUCTION The veteran had active service from June 1946 to December 1947; from July 1948 to March 1950; from August 1950 to June 1954; and from December 1954 to May 1969. This matter came before the Board of Veterans' Appeals (Board) on appeal from a December 1998 rating decision of the Milwaukee, Wisconsin, Regional Office (RO) which denied service connection for a chronic back disorder to include lumbar spine degenerative changes; denied compensation under the provisions of 38 U.S.C.A. § 1151 for a left eye disorder; and denied increased evaluations for the veteran's right knee degenerative arthritis, post-operative left knee arthritis, and right (major) thumb fracture residuals. In January 2001, the RO granted a separate 10 percent evaluation for left knee laxity. In March 2001, the Board denied increased evaluations for the veteran's right knee and left knee disabilities and remanded the issue of the veteran's entitlement to service connection for a chronic back disorder to the RO for additional action. In July 2002, the RO denied increased evaluations for the veteran's right knee degenerative arthritis, post-operative left knee arthritis, and left knee laxity. In August 2003, the RO established service connection for pulmonary pleural plaquing and assigned a noncompensable evaluation for that disability. In June 2006, the Board determined that new and material evidence had not been received to reopen the veteran's claim of entitlement to compensation under the provisions of 38 U.S.C.A. § 1151 for a left eye disorder; denied service connection for a hip disorder; denied increased evaluations for the veteran's right knee and left knee disabilities; and remanded the issues of service connection for a back disorder and an initial compensable evaluation for the veteran's pulmonary pleural plaquing to the RO for additional action. In July 2007, the Board requested an opinion from a Veterans Health Administration (VHA) medical expert. In September 2007, the requested VHA opinion was incorporated into the record. In October 2007, the veteran was provided with a copy of the VHA opinion. As to the issue of whether new and material evidence has been received to reopen the veteran's claim of entitlement to service connection for a chronic back disorder, the Board is required to consider the question of whether new and material evidence has been received to reopen the veteran's claim without regard to the RO's determination in order to establish the Board's jurisdiction to address the underlying claim and to adjudicate the claim on a de novo basis. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001); Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). The Board observes that the veteran has appealed from the initial evaluation assigned for his service-connected pulmonary pleural plaquing. In Fenderson v. West, 12 Vet. App. 119 (1999), the United States Court of Appeals for Veterans Claims (Court) addressed a similar appeal and directed that it was specifically not a claim for an increased disability evaluation. However, the Court did not provided a specific name for the issue in lieu of "increased disability evaluation." In the absence of such direction, the Board has framed the issue as an initial compensable evaluation for the veteran's pleural plaquing. The veteran is not prejudiced by such action. The veteran has submitted a claim of entitlement to service connection for chronic pneumonia residuals. It appears that the RO has not had an opportunity to act upon the claim. Absent an adjudication, a notice of disagreement (NOD), a statement of the case, and a substantive appeal, the Board does not have jurisdiction over the issue. Rowell v. Principi, 4 Vet. App. 9 (1993); Roy v. Brown, 5 Vet. App. 554 (1993); Black v. Brown, 10 Vet. App. 279, 284 (1997); Shockley v. West, 11 Vet. App. 208 (1998). Jurisdiction does matter and it is not "harmless" when the VA fails to consider threshold jurisdictional issues during the claim adjudication process. Furthermore, this Veterans Law Judge cannot have jurisdiction of the issue*. 38 C.F.R. § 19.13 (2007). The Court has noted that: Furthermore, 38 U.S.C.A. § 7105 (West 1991) establishes a series of very specific, sequential, procedural steps that must be carried out by a claimant and the RO or other "agency of original jurisdiction" (AOJ) (see Machado v. Derwinski, 928 F.2d 389, 391 (Fed. Cir. 1991)) before a claimant may secure "appellate review" by the BVA. Subsection (a) of that section establishes the basic framework for the appellate process, as follows: "Appellate review will be initiated by a notice of disagreement [(NOD)] and completed by a substantive appeal after a statement of the case is furnished as prescribed in this section." Bernard v. Brown, 4 Vet. App. 384 (1994). All steps required for jurisdiction have not been satisfied. More recently, the Court again established that jurisdiction counts. Specifically, the Court could not remand a matter over which it has no jurisdiction. Hazan v. Gober, 10 Vet. App. 511 (1997). Therefore, the issue is referred to the RO for action as may be appropriate. Black v. Brown, 10 Vet. App. 279 (1997). If the veteran wishes to appeal from the decision, he has an obligation to file a timely NOD and a timely substantive appeal following the issuance of the statement of the case. 38 C.F.R. § 20.200 (2007). FINDINGS OF FACT 1. In February 1982, the RO denied service connection for a chronic back disorder. The veteran was informed in writing of the adverse decision and his appellate rights in March 1982. The veteran did not submit a NOD with the decision. 2. The documentation received since the February 1982 RO decision is relevant and probative of the issue at hand. 3. A chronic back disorder was not manifested during or for many years after active service. The veteran's chronic lumbar spine degenerative disc disease, degenerative joint disease, arthritis, and spinal stenosis have not been objectively shown to have originated during active service. 4. Service connection is currently in effect for post-operative bladder cancer residuals with radical bladder resection residuals, ileal conduit, prostatectomy residuals, and chronic urinary tract infections; right knee degenerative arthritis; post-operative left knee degenerative arthritis; left knee laxity; right (major) thumb fracture residuals; pulmonary pleural plaquing; chronic bowel obstruction residuals, and chronic erectile dysfunction. 5. The veteran's chronic lumbar spine disabilities have not been shown to be etiologically related to his service-connected disabilities. 6. The veteran's pulmonary pleural plaquing has been shown to be essentially asymptomatic on repeated VA evaluation. CONCLUSIONS OF LAW 1. The February 1982 rating decision denying service connection for a chronic back disorder is final. New and material evidence sufficient to reopen the veteran's claim of entitlement to service connection for a chronic back disorder has been presented. 38 U.S.C.A. §§ 5103, 5103A, 5107, 5108, 7105 (West 2002); 38 C.F.R. § 3.156 (2001); 38 C.F.R. §§ 3.102, 3.159, 3.326(a), 20.1103 (2007). 2. A chronic back disorder was not incurred in or aggravated by active service and arthritis may not be presumed to have been incurred during such service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.326(a), 3.307, 3.309 (2007). 3. A chronic back disorder was not proximately due to or the result of the veteran's service-connected disabilities. 38 U.S.C.A. §§ 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.310(a), 3.326(a) (2007). 4. The criteria for an initial compensable evaluation for the veteran's pulmonary pleural plaquing have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321(b)(1), 3.326(a), 4.20, 4.96, 4.97, Diagnostic Code 6833 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Veterans Claims Assistance Act of 2000 In Pelegrini v. Principi, 18 Vet. App. 112 (2004), the Court held, in part, that a Veterans Claims Assistance Act of 2000 (VCAA) notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable RO decision on a claim for VA benefits. In reviewing the veteran's application to reopen his claim of entitlement to service connection for a chronic back disorder and the evaluation for his pulmonary pleural plaquing, the Board observes that the RO issued VCAA notices to the veteran in April 2001, February 2003, March 2004, March 2006, and April 2006 which informed him of the evidence needed to support an application to reopen a claim of entitlement to service connection, a claim for service connection, and the assignment of an evaluation and effective date of an initial award of service connection; what actions he needed to undertake; and how the VA would assist him in developing his application and claim. Such notice effectively informed him of the need to submit any relevant evidence in his possession. The VA has attempted to secure all relevant documentation. The veteran has been afforded multiple VA examinations for compensation purposes. The examination reports are of record. The Board requested a VHA opinion. The VHA opinion was subsequently provided to the veteran and incorporated into the record. The veteran requested a hearing before a Veterans Law Judge. He was scheduled for a December 2000 hearing before a Veterans Law Judge. He subsequently cancelled the scheduled hearing. All relevant facts have been developed to the extent possible. 38 U.S.C.A. §§ 5103, 5103A, 5107 (West 2002); 38 C.F.R §§ 3.102, 3.159, 3.326(a) (2007). Quartuccio v. Principi, 16 Vet. App. 183 (2002); Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, No. 05-7157 (Fed. Cir. Apr. 5, 2006); Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006); Kent v. Nicholson, 20 Vet.App. 1 (2006); Sanders v. Nicholson, No. 06-7001 (Fed. Cir. May 16, 2007); Vazquez-Flores v. Peake, No. 05-0355 (U.S. Vet. App. January 30, 2008). II. Application to Reopen Generally, absent the filing of a NOD within one year of the date of mailing of the notification of the initial review and determination of a veteran's claim and the subsequent filing of a timely substantive appeal, a rating determination is final and is not subject to revision upon the same factual basis except upon a finding of clear and unmistakable error. 38 U.S.C.A. §§ 5108, 7105 (West 2002); 38 C.F.R. §§ 20.200, 20.300, 20.1103 (2007). A. Prior RO Decision In February 1982, the RO denied service connection for a chronic back disorder as the claimed disability was not shown by the clinical documentation of record. The veteran was informed in writing of the adverse decision and his appellate rights in March 1982. The veteran did not submit a NOD with the decision. The evidence considered by the RO in formulating its February 1982 rating decision may be briefly summarized. The veteran's service medical records make no reference to a chronic back or spine disorder. In his December 1981 claim for service connection, the veteran reported that his service-connected left knee injury necessitated that he limp which in turn caused "some back pain." B. New and Material Evidence "New and material evidence" is defined by the provisions of 38 C.F.R. § 3.156. That regulation has been amended during the pendency of the instant appeal. The amended version of 38 C.F.R. § 3.156(a) applies only to applications filed on or after August 29, 2001. As the veteran's application to reopen his claim of entitlement to service connection for a chronic back disorder was received in May 1998, the prior version of 38 C.F.R. § 3.156 is for application. Title 38 of the Code of Federal Regulations (2001) states, in pertinent part, that: "New and material evidence" means evidence not previously submitted to agency decision makers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant and which, by itself or in connection with the evidence previously assembled, is so significant that it must be considered in order to fairly decide the merits of the case. 38 C.F.R. § 3.156 (2001). The Court has elaborated on what constitutes "new and material evidence." New evidence is not that which is cumulative of other evidence already present in the record. In determining whether new and material evidence has been submitted, the Board must consider the specific reasons for the prior denial. Evans v. Brown, 9 Vet. App 273, 283 (1996). See Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). The evidence submitted since the February 1982 RO decision denying service connection for a chronic back disorder consists of VA examination and clinical documentation; private clinical documentation; and written statements from the veteran and his spouse, children, and other relatives. In his May 1998 application to reopen his claim for service connection, the veteran advanced the he had injured his back in the same incident in which he sustained his service-connected knee disabilities or, in the alternative, he incurred a chronic back disorder secondary to his service-connected knee disabilities. VA clinical documentation dated in November 1997 indicates that the veteran complained of chronic back pain of 20 or 30 years' duration. He reported that he had twisted his back in 1965 while climbing over a fence. Contemporaneous X-ray studies of the lumbosacral spine revealed findings consistent with lumbar spine degenerative joint disease and lumbar spine degenerative disc disease. In reviewing the additional documentation submitted into the record since the February 1982 RO decision, the Board observes that the veteran's May 1998 application to reopen and the VA clinical documentation constitute new and material evidence in that they are of such significance that they must be considered in order to fairly decide the merits of the case. As new and material evidence has been received, the veteran's claim of entitlement to service connection for a chronic back disorder is reopened. C. Service Connection Service connection may be granted for chronic disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131 (West 2002). Where a veteran served continuously for ninety days or more during a period of war or during peacetime service after December 31, 1946, and arthritis (degenerative joint disease) becomes manifest to a degree of ten percent within one year of termination of such service, such disease shall be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2007). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. Presumptive periods are not intended to limit service connection to diseases so diagnosed when the evidence warrants direct service connection. The presumptive provisions of the statute and VA regulations implementing them are intended as liberalizations applicable when the evidence would not warrant service connection without their aid. 38 C.F.R. § 3.303(d) (2007). Service connection may also be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (2007). The Court has clarified that service connection shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310(a) where it is demonstrated that a service-connected disorder has aggravated a nonservice-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Service connection is currently in effect for post-operative bladder cancer residuals with radical bladder resection residuals, ileal conduit, prostatectomy residuals, and chronic urinary tract infections; right knee degenerative arthritis; post-operative left knee degenerative arthritis; left knee laxity; right (major) thumb fracture residuals; pulmonary pleural plaquing; chronic bowel obstruction residuals, and chronic erectile dysfunction. The Court has clarified that while there may be multiple theories or means of establishing entitlement to a benefit for a disability, if the theories all pertain to the same benefit for the same disability, they constitute a single claim. Roebuck v. Nicholson, 20 Vet.App. 307, 313 (2006). The veteran's service medical records make no reference to a chronic back or spine disability. Clinical documentation from Memorial Hospital dated in October 1978 reflects that the veteran complained of low back pain of three to four days' duration associated with moving a television set. Contemporaneous X-ray studies of the lumbar spine revealed L4-5 disc space narrowing. The veteran was diagnosed with low back strain. In his December 1981 claim for service connection, the veteran reported that his service-connected left knee injury caused him to limp which precipitated "some back pain." A March 1984 VA treatment record states that the veteran complained of low back pain. An impression of low back pain of unknown etiology was advanced. Clinical documentation from the Burlington Clinic dated in October 1987 states that the veteran presented a "longstanding history of low back pain and discomfort." The veteran was diagnosed with severe osteoarthritis. An August 1989 treatment record from Richard Rodarte, M.D., conveys that the veteran had a "long history of recurrent back problems." VA clinical documentation dated in November 1997 indicates that the veteran complained of chronic radiating back pain of 20 to 30 years' duration. The veteran reported that he had twisted his back while going over a fence during active service in 1965. Contemporaneous X-ray studies of the lumbosacral spine revealed findings consistent with lumbosacral spine degenerative arthritis and lumbar spine degenerative disc disease. An April 1998 VA physical evaluation states that the veteran complained of chronic back pain since active service. Treating VA medical personnel noted the veteran's history of degenerative disc disease, degenerative joint disease, and associated nerve root compression. An impression of a "UMN lesion of [unknown] etiology" was advanced. Contemporaneous X-ray studies of the spine revealed findings consistent with osteopenia and degenerative changes of the lower thoracic and upper lumbar spinal segments. In his May 1998 application to reopen his claim for service connection, the veteran advanced the he injured his back in the same incidents in which he sustained his service-connected knee disabilities or, in the alternative, he incurred a chronic back disorder secondary to his service-connected knee disabilities. At a November 2001 VA examination for compensation purposes, the veteran complained of chronic back pain. The veteran was diagnosed with severe lumbar spine degenerative joint disease and associated lumbar spine stenosis and polymyalgia rheumatica. The examiner commented that: Patient has developed a combination of polymyalgia rheumatica and severe degenerative joint disease in the lumbar spine resulting in lumbar stenosis. ... It is clear that the patient's knee problem did not directly cause his low back condition, either the polymyalgia rheumatica or the lumbar stenosis. Given the relatively symmetrical gait noted on today's examination as well as lack of evidence of a significant limp in previous examination, it is less likely then (sic) not that the present back condition was aggravated by the knee condition. An undated written statement from the veteran's spouse received in December 2001 conveys that the veteran initially experienced back pain following his inservice knee injury. A March 2003 written statement from the veteran's son indicates that he was 10 years old at the time of the veteran's service retirement. He recalled that his father had a back disorder at that time. At a March 2003 VA examination for compensation purposes, the veteran was noted to have started to experience low back pain in 1987. A recent magnetic resonance imaging study was reported to show significant lumbar spinal canal stenosis. The Board has reviewed the probative evidence of record including the veteran's written statements on appeal. A chronic back disorder was not shown during active service or for many years thereafter. The veteran's chronic lumbar spine degenerative disc disease, degenerative joint disease, and spinal stenosis have not been objectively shown to have originated during active service or to be etiologically related to his service-connected knee and other disabilities. Indeed, the existence of such etiological relationships where specifically negated by the VA examiner at the November 2001 VA examination for compensation purposes. The veteran advances that he sustained a chronic back disability as the result of an inservice injury sustained while climbing a fence or, in the alternative, secondary to his service-connected knee disabilities. The veteran's claim is supported solely by his own, his wife's, and children's written statements on appeal. The veteran is competent to state that he sustained trauma to his back during active service. However, the Court has held that a lay witness is generally not capable of offering evidence involving medical knowledge such as the causation of a particular medical condition. Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). The lay written statements are thus insufficient to establish an etiological relationship between the claimed disorder and either active service or the veteran's service-connected disabilities. Therefore, the Board concludes that a preponderance of the evidence is against the veteran's claim of entitlement to service connection for a chronic back disorder. III. Pulmonary Pleural Plaquing A. Historical Review The veteran's service personnel records reflect that he served as a firefighter. The report of a July 2003 VA examination for compensation purposes states that the veteran was diagnosed with "probable asbestos exposure and pneumonia during active military service." The examiner concluded that it was "as likely as not that [the veteran's] current pleural plaquing is related that asbestos exposure and/or prior pneumonia." In August 2003, the RO established service connection for pulmonary pleural plaquing; assigned a noncompensable evaluation for that disability; and effectuated the award as of July 15, 2002. B. Increased Evaluation Disability evaluations are determined by comparing the veteran's current symptomatology with the criteria set forth in the Schedule For Rating Disabilities. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2007). The rating schedule does not specifically address pulmonary pleural plaquing. In such situations, it is permissible to evaluate the veteran's service-connected disorder under provisions of the schedule which pertain to a closely-related disease or injury which is analogous in terms of the function affected, anatomical localization and symptomatology. 38 C.F.R. § 4.20 (2007). The Board finds that the veteran's service-connected pulmonary pleural plaquing is most closely analogous to asbestosis as both disorders are manifested by similar symptomatologies. Asbestosis is to be evaluated under the General Rating Formula for Interstitial Lung Disease. The General Rating Formula for Interstitial Lung Disease provides that a 10 percent evaluation is warranted for Forced Vital Capacity (FVC) of 75 to 80 percent predicted or Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) of 66 to 80 percent predicted. A 30 percent evaluation requires FVC of 65 to 74 percent predicted or DLCO (SB) 56 to 65 percent predicted. Post-bronchodilator studies are required when pulmonary function tests (PFT) are done for disability evaluation purposes except when the results of pre-bronchodilator pulmonary function tests are normal or when the examiner determines that post-bronchodilator studies should not be done. When evaluating based on PFT's, use post- bronchodilator results in applying the evaluation criteria in the rating schedule unless the post-bronchodilator results were poorer than the pre-bronchodilator results. In those cases, use the pre-bronchodilator values for rating purposes. 38 C.F.R. §§ 4.96, 4.97, Diagnostic Code 6833 (2007). Evaluations shall be based as far as practicable, upon the average impairments of earning capacity with the additional proviso that the Secretary shall from time to time readjust this schedule of ratings in accordance with experience. To accord justice, therefore, to the exceptional case where the schedular evaluations are found to be inadequate, the Under Secretary for Benefits or the Director, Compensation and Pension Service, upon field station submission, is authorized to approve on the basis of the criteria set forth in this paragraph an extra-schedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities. The governing norm in these exceptional cases is: A finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1) (2007). At the July 2003 VA examination for compensation purposes, the examiner noted that: the veteran had an inservice history of asbestos exposure; a 1991 VA computerized tomography study revealed pulmonary emphysema with increased interstitial markings, minimal mediastinal adenopathy, a small left upper lobe ovoid pulmonary nodule, and adjacent focal pleural thickening; and a September 2001 VA computerized tomography study revealed focal areas of pleural plaques and bilateral pleural thickening. An impression of "probable asbestos exposure and pneumonia during active military service" was advanced. The examiner commented that: It is as likely as not that his current pulmonary pleural plaquing is related to that asbestos exposure and/or prior pneumonia. Patient's current symptoms of dyspnea are unrelated to any pulmonary or cardiac condition, but probably related to generalized weakness related to his general conditioning and polymyalgia rheumatica. At an August 2006 VA examination for compensation purposes, the veteran was diagnosed with pleural plaque disease without evidence of asbestosis. The examiner concluded that: As stated earlier, lung volumes were not obtained during this study because patient refused. However, his lung volumes and diffusion were normal in 2004. The characteristic lung function abnormalities in patients with asbestosis include reduced lung volumes, particularly the vital capacity and total lung capacity and diminished DLCO. There are no findings in the lung parenchyma on imaging to suggest a fibrotic process which would be consistent with asbestosis. The report of a December 2006 VA examination for compensation purposes relates that the veteran was diagnosed with asbestos lung plaques with minimal sequelae. The examiner opined that: Upon review of his pulmonary doctors from North Chicago's notes and his PFTs and CT scans, it is not as least as likely as not that the veteran's poor pulmonary function testing is due [to] the pleural plaques on his lungs. The pleural plaques would cause minimal clinical symptoms. The veteran is currently oxygen dependent mainly due to his deteriorating heart condition. ... The veteran also two years prior had a large pulmonary embolism which caused oxygen/ventilation mismatching of the lungs. He is also on Methotrexate for his polymyalgia rheumatica. He has been on Methotrexate for a number of years and Methotrexate is known to cause some pulmonary disease. The Methotrexate and pulmonary embolism and the congestive heart failure from the heart condition are much more likely to be the cause for the veteran's poor pulmonary function. The September 2007 VHA opinion conveys that the claims folders had been reviewed. The physician opined that: 2. Are the veteran's repeated abnormal VA PFT results, or any component thereof, a manifestation of or otherwise attributable to his service-connected asbestos exposure-related pulmonary disability? No. Since his repeated complete PFT's done on 12/10/01, 9/4/02, 1/27/03 and 2/23/04 showed normal spirometry and lung volumes. Asbestos lung disease causes restrictive lung disease. The repeated mild reduction of diffusion capacity noted in this patient could be related to multifactorial causes-pneumonia scarring he had in the past, effect of long term use of methothrexate on the lungs the patient is taking for back, ankle and hand pains, repeated heart attacks, and pulmonary embolism. The veteran's service-connected pulmonary pleural plaquing alone has been repeatedly found to be essentially asymptomatic on multiple physical evaluations. The veteran's current pulmonary impairment has been attributed to his multiple other disabilities. The September 2007 VHA concurred in these assessments. In the absence of any objective evidence of pulmonary or other impairment associated with the veteran's pulmonary pleural plaquing, an initial compensable evaluation on either a schedular or extra-schedular basis is not warranted. 38 C.F.R. §§ 3.321(b)(1), 4.20, 4.96, 4.97, Diagnostic Code 6833 (2007). Hart v. Mansfield, 21 Vet. App. 505 (2007). ORDER The veteran's application to reopen his claim of entitlement to service connection for a chronic back disorder is granted. Service connection for a chronic back disorder is denied. An initial compensable evaluation for the veteran's pulmonary pleural plaquing is denied. ____________________________________________ MILO H. HAWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs