Citation Nr: 0811448 Decision Date: 04/07/08 Archive Date: 04/23/08 DOCKET NO. 03-33 967 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina THE ISSUES 1. Entitlement to service connection for sinus allergies/allergic rhinitis. 2. Entitlement to an initial rating in excess of 10 percent for hemorrhoids. 3. Entitlement to an initial rating in excess of 10 percent for tinea corporis eczema/rashes, prior to February 14, 2006. 4. Entitlement to a rating in excess of 30 percent for tinea corporis eczema/rashes, from February 14, 2006. 5. Entitlement to an initial rating in excess of 10 percent for right foot hammertoe deformities along with hallux valgus and hallux limitus. 6. Entitlement to an initial rating in excess of 10 percent for left foot hammertoe deformities along with hallux valgus and hallux limitus. 7. Entitlement to an initial, compensable rating for left knee tendonitis. 8. Entitlement to an initial, compensable rating for pseudofolliculitis barbae. 9. Entitlement to an initial rating in excess of 10 percent for irritable bowel syndrome (IBS). REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD M. Donovan, Associate Counsel INTRODUCTION The veteran served on active duty from October 1981 to October 2002. These matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2002 rating decision in which the RO, inter alia, granted service connection and assigned initial ratings for hemorrhoids, for tinea corporis eczema/rashes, for bilateral hammertoe deformities with hallux valgus and hallux limitus, for pseudofolliculitis barbae, for left knee tendonitis, and for IBS, each effective November 1, 2002; but denied service connection for sinus allergies/allergic rhinitis, for residuals of electrical shock to the left side of the face, and for arthritis in the fifth finger of the left hand. In November 2002, the veteran filed a notice of disagreement (NOD) with the initial ratings assigned, and the denials of service connection. The RO issued a statement of the case (SOC) in January 2003; and the veteran filed a substantive appeal in March 2003. In April 2005, the Board remanded these matters to the RO (via the Appeals Management Center (AMC), in Washington, DC) for further action, to include an additional VA examination. After accomplishing the requested action, the AMC awarded a higher initial rating of 10 percent for IBS, and awarded an increased rating of 30 percent for tinea corporis eczema/rashes, effective February 14, 2006, but continued the denial of the remaining claims on appeal (as reflected in an October 2006 supplemental SOC (SSOC)) and returned these matters to the Board for further appellate consideration. In April 2007, the Board denied service connection for residuals of electric shock to the left side of the face and arthritis of the fifth finger of the left hand, and remanded the claims remaining on appeal to the RO via the AMC for further action. After accomplishing the requested action, the AMC continued the denial of the claims remaining on appeal (as reflected in an October 2007 SSOC) and returned these matters to the Board for further appellate consideration. As the veteran has perfected an appeal as to the initial ratings assigned for the conditions for which service connection has been granted (as identified on the title page), the Board has characterized these issues in accordance with the decision in Fenderson v. West, 12 Vet. App. 119, 126 (1999) (distinguishing appeals from original awards from claims for increased ratings), which requires consideration of the evidence since the effective date of the grant of service connection. Moreover, although higher ratings have been assigned for tinea corporis eczema/rashes and IBS, because higher ratings are available for each disability, and the veteran is presumed to seek the maximum available benefit for a disability, the claims for higher ratings for these disabilities remain viable on appeal. Id.; AB v. Brown, 6 Vet. App. 35, 38 (1993). The Board's decision addressing the claims for higher initial ratings for hemorrhoids, tinea corporis eczema/rashes, pseudofolliculitis barbae, and IBS is set forth below. The claim for service connection for sinus allergies/allergic rhinitis, and the claims for higher initial ratings for right and left foot hammertoe deformities with hallux valgus and hallux limitus, and left knee tendonitis are addressed in the remand following the order; these matters are being remanded to the RO via the AMC. VA will notify the appellant when further action, on his part, is required. FINDINGS OF FACT 1. All notification and development actions needed to fairly adjudicate the claims herein decided have been accomplished. 2. Since the November 1, 2002 effective date of the grant of service connection, the veteran's hemorrhoids have not been manifested by persistent bleeding with fissures or secondary anemia. 3. From November 1, 2002, the effective date of the grant of service connection, through February 13, 2006, the veteran's tinea corporis eczema/rashes were manifested by maculopapular plaques scattered over the upper back of the left dorsal arm and the right upper arm and a 5-6cm. lesion on the right neck, and findings of and treatment for non-specific dermatitis. 4. Since February 14, 2006, the veteran's tinea corporis eczema/rashes have been manifested by multiple papules scattered over no more than 31 percent of the total body surface. 5. Since the November 1, 2002 effective date of the grant of service connection, the veteran's pseudofolliculitis barbae has not been shown to cover 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 affected areas; and has not been shown to require intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of less than six weeks during the past 12 month period. 9. Since the November 1, 2002 effective date of the grant of service connection, the veteran's IBS has been manifested, at most, by moderate symptoms consisting of complaints of constipation, cramping, and abdominal pain; there has been no medical evidence of severe IBS, with diarrhea or alternating diarrhea and constipation with more or less constant abdominal distress. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for hemorrhoids 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, 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7336 (2007). 2. The criteria for an initial rating in excess of 10 percent for tinea corporis eczema/rashes, for the period prior to February 14, 2006 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, 4.1, 4.3, 4.7, 4.118, Diagnostic Codes 7800, 7806 (2007). 3. The criteria for a rating in excess of 30 percent for tinea corporis eczema/rashes, for the period from February 14, 2006, 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, 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7806 (2007). 4. The criteria for an initial, compensable rating for pseudofolliculitis barbae 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, 4.1, 4.3, 4.7, 4.31, 4.118, Diagnostic Codes 7806, 7813 (2007). 5. The criteria for an initial rating in excess of 10 percent for IBS 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, 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7319 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2007)) includes enhanced duties to notify and assist claimants for VA benefits. VA regulations implementing the VCAA have been codified, as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2007). Notice requirements under the VCAA essentially require VA to notify a claimant of any evidence that is necessary to substantiate the claim(s), as well as the evidence that VA will attempt to obtain and which evidence he or she is responsible for providing. See, e.g., Quartuccio v. Principi, 16 Vet. App. 183 (2002) (addressing the duties imposed by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)). As delineated in Pelegrini v. Principi, 18 Vet. App. 112 (2004), after a substantially complete application for benefits is received, proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim(s); (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim(s), in accordance with 38 C.F.R. § 3.159(b)(1). In rating cases, a claimant must be provided with information pertaining to assignment of disability ratings (to include the rating criteria for all higher ratings for a disability), as well as information regarding the effective date that may be assigned. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Court has also held that, in rating cases, VA must notify the claimant that, to substantiate a claim for an increased rating: (1) the claimant must provide, or ask VA to obtain, medical or lay evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on the claimant's employment and daily life; (2) if the diagnostic code under which the claimant is rated contains criteria necessary for entitlement to a higher disability rating that would not be satisfied by the claimant demonstrating a noticeable worsening or increase in severity of the disability and the effect of that worsening on the claimant's employment and daily life (such as a specific measurement or test result), the Secretary must provide at least general notice of that requirement to the claimant; (3) the claimant must be notified that, should an increase in disability be found, a disability rating will be determined by applying relevant diagnostic codes; and (4) the notice must also provide examples of the types of medical and lay evidence that the claimant may submit (or ask VA to obtain) that are relevant to establishing entitlement to increased compensation. See Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008). VCAA-compliant notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO, to include the AMC). Id.; Pelegrini, 18 Vet. App. at 112. See also Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). However, the VCAA notice requirements may, nonetheless, be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Id. In this appeal, April 2005 and April 2007 post-rating letters provided notice to the veteran regarding what information and evidence was needed to substantiate the claims for higher ratings for hemorrhoids, tinea corporis eczema/rashes, pseudofolliculitis, and IBS, as well as what information and evidence must be submitted by the veteran and what information and evidence would be obtained by VA. These letters specifically informed the veteran to submit any evidence in his possession pertinent to the claims, thus satisfying the fourth element of the duty to notify. The April 2007 letter also provided the veteran information pertaining to the assignment of disability ratings and effective dates, as well as the type of evidence that impacts those determinations, consistent with Dingess/Hartman. After issuance of each letter, and opportunity for the veteran to respond, the October 2007 SSOC reflects readjudication of the claims. Hence, the veteran is not shown to be prejudiced by the timing of VCAA-compliant notice. See Mayfield v. Nicholson, 20 Vet. App. 537, 543 (2006); see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as in a statement of the SOC or SSOC, is sufficient to cure a timing defect). In addition, the Board finds that the April 2005 VCAA letter, which informed the veteran of the information and evidence necessary to substantiate his claims for increased ratings, when read together with the April 2007 VCAA letter, which informed the veteran of the information and evidence necessary to substantiate his claims for increased ratings and explained how disability ratings are determined, and the January 2003 SOC and October 2007 SSOC, which included the pertinent rating criteria, satisfy the notice requirements of Vazquez-Flores. The record also reflects that VA has made reasonable efforts to obtain or to assist in obtaining all relevant records pertinent to the matters decided herein. The Board acknowledges that the veteran's representative asserted in his February 2008 Informal Hearing Presentation, that VA failed in its duty to assist the veteran by not requesting an examination. In this regard, the veteran's representative pointed out that the Board's April 2007 remand stated that, after completing the requested action, and any additional development deemed warranted, the RO should readjudicate the claims. However, the Board finds that, as the claims file reveals no evidence of worsening, since the most recent VA examination, of the disabilities for which the Board is denying entitlement to higher initial ratings, and since the record contains medical evidence responsive to the pertinent rating criteria for those disabilities, another VA examination is not warranted. Pertinent medical evidence associated with the claims file consists of the veteran's service medical records, VA and private medical records and the reports of VA examinations conducted in September 2002 and February and June 2006. Also of record are various written statements provided by the veteran, as well as by his representative, on his behalf. The Board notes that a January 2006 record of VA treatment indicates that the veteran had a non-VA physician, Dr. Omole, but that records of treatment by Dr. Omole have not been associated with the claims file. The Board further notes, however, that the veteran has not indicated or alleged that such treatment records are pertinent to the claims on appeal, and he has not submitted the required release to obtain such records. VA is only required to obtain evidence that a claimant "adequately identifies" and authorizes the Secretary to obtain. 38 U.S.C.A. § 5103A(b), (c). As the veteran has not provided release forms for treatment records from this physician, he has not authorized VA to obtain them. Further, the Board notes that, in a June 2007 VCAA notice response, the veteran stated that he had no other information or evidence to give VA to substantiate his claim. As such, neither the veteran, nor his representative, has identified, and the record does not otherwise indicate, any existing, pertinent evidence that needs to be obtained. The record also presents no basis for further development to create any additional evidence to be considered in connection with the claim. In summary, the duties imposed by the VCAA have been considered and satisfied. Through various notices of the RO/AMC, the veteran has been notified and made aware of the evidence needed to substantiate his claims, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. There is no additional notice that should be provided, nor is there any indication that there is additional existing evidence to obtain or development required to create any additional evidence to be considered in connection with any of these claims. Consequently, any error in the sequence of events or content of the notice is not shown to prejudice the veteran or to have any effect on the appeal. Any such error is deemed harmless and does not preclude appellate consideration of the matters decided herein, at this juncture. See Mayfield, 20 Vet. App. at 543 (rejecting the argument that the Board lacks authority to consider harmless error). See also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. Analysis Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities, which assigns ratings based on average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. The veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the question for consideration is entitlement to a higher initial rating since the grant of service connection, evaluation of the medical evidence since the grant of service connection to consider the appropriateness of "staged rating" (assignment of different ratings for distinct periods of time, based on the facts found) is required. Fenderson, 12 Vet. App. at 126. A. Hemorrhoids The October 2002 rating decision granted service connection and assigned an initial 10 percent rating for hemorrhoids, pursuant to Diagnostic Code 7336, effective November 1, 2002. Under Diagnostic Code 7336, a 10 percent rating is assignable for large or thrombotic, irreducible hemorrhoids with excessive redundant tissue, evidencing frequent recurrences. A maximum 20 percent rating is assigned for hemorrhoids with persistent bleeding and with secondary anemia, or with fissures. 38 C.F.R. § 4.114, Diagnostic Code 7336 (2007). Considering the medical evidence in light of the above-noted criteria, the Board finds that an initial rating in excess of 10 percent for the veteran's hemorrhoids is not warranted. On VA examination in September 2002, the veteran described external hemorrhoids which flared six or seven times a month, adding that these hemorrhoids itched and burned. He reported blood on the toilet paper, but none in the bowel or the stool. He added that he had been told that he also had some internal hemorrhoids. On examination, the veteran had external hemorrhoids which were not inflamed, with no evidence of active bleeding. The pertinent impression was external and internal hemorrhoids. In his November 2002 NOD, the veteran reiterated that his hemorrhoids flared-up 6 to 7 times a month, with each flare- up lasting 2 to 3 days (for a total of 12 to 21 days a month), and added that bleeding occurred during these flare- ups. He therefore argued that these flare-ups constituted persistent bleeding. Records of VA treatment from December 2002 to January 2006 include findings of and treatment for hemorrhoids. In February 2005 the veteran described his hemorrhoids as burning and swelling, with slight bleeding on the toilet paper. In a May 2005 statement, the veteran described continual daily bleeding, burning, and itching from his hemorrhoid flare-ups. He stated that he had to apply Preparation H daily to temporarily relieve the pain. Records of private treatment from April 2001 to January 2006 are negative for complaints regarding or treatment for hemorrhoids. In fact, on review of systems in October 2005, the veteran denied bloody or black stool. Under these circumstances, the Board finds that the record presents no basis for assignment of a higher initial schedular rating under the applicable rating criteria. Even if the veteran's complaints of bleeding hemorrhoids 12 to 21 days per month were found to more nearly approximate persistent bleeding, there is simply no medical evidence of record of secondary anemia or fissures. As such, the criteria for an initial schedular rating in excess of 10 percent are not met. See 38 C.F.R. § 4.114, Diagnostic Code 7336. B. Tinea Corporis Eczema/Rashes The October 2002 rating decision granted service connection and assigned an initial 10 percent rating for tinea corporis eczema/rashes, pursuant to Diagnostic Code 7806, effective November 1, 2002. The October 2006 rating decision granted an increased rating of 30 percent effective February 14, 2006. Under Diagnostic Code 7806, dermatitis or eczema affecting 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, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of less than 6 weeks during the past 12-month period, warrants a 10 percent rating. A 30 percent rating requires that 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas be affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of 6 weeks or more, but not constantly, during the past 12-month period. A 60 percent rating requires more than 40 percent of the entire body or more than 40 percent of exposed areas be affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs during the past 12-month period. 38 C.F.R. 4.118, DC 7806 (2007). 1. Period Prior to February 14, 2006 During the period from the grant of service connection, November 1, 2002, through February 13, 2006, the veteran received VA and private treatment and was afforded a VA examination in September 2002. On VA examination in September 2002, the veteran described rashes on the posterior neck, posterior arm, posterior head, inner arm, and left leg, which would come and go since 1993. He reported using oral and topical medication for these rashes. He stated that the rashes itched and burned, but did not weep. On examination, the veteran had maculopapular plaques scattered over his upper back of the left dorsal upper arm and his right upper arm. He also had a 5-6cm. diameter lesion on his right neck, which was round and had heaped up margins. The pertinent diagnosis was rashes, which at this point have defied definitive diagnoses, which began in Saudi Arabia in approximately 1993. In his November 2002 NOD, the veteran reported that more of 20 percent of his body was affected by tinea corporis eczema/rashes, in that his entire back, entire chest, front and back of both arms and legs, and his head and neck were affected. He reported that nothing could stop the rash from appearing on any part of his body, and he experienced flare- ups one or two times every two weeks. He reported using topical medication to keep the burning and itching of the flare-ups to a minimum, and took Tetracycline orally every other day to help clear up scarring of his skin from the rash. Records of VA treatment from December 2002 to January 2006 include diagnoses of and treatment for non-specific dermatitis. Review of systems in January 2006 was negative for skin changes and examination revealed no concerning lesions. Records of private treatment from April 2001 to January 2006 include a note during treatment in April 2001, prior to separation from service, that the veteran had keratotic lesions on the bilateral feet, but these records are otherwise negative for complaints regarding or treatment for tinea corporis eczema/rashes. In fact, during treatment in October 2005, the veteran denied rash, flaking or peeling skin, or itchy skin on review of systems. Based on the foregoing, the Board finds that the record presents no basis for assignment of a higher initial schedular rating under the applicable rating criteria. In this regard, there is no medical evidence during the period in question that the veteran's tinea corporis eczema/rashes affected 20 to 40 percent of the entire body, or 20 to 40 percent of exposed areas affected. In this regard the September 2002 VA examination noted only that the veteran's upper back of the left dorsal upper arm and his right upper arm were affected, and that he had a 5-6cm. diameter lesion on his right neck. According to the "rule of nines" which is an assessment tool to accurately determine the total body surface involved in burn injury, each arm equates with 9 percent of the body surface and the head and neck equate to 9 percent of the body surface. Only the upper portion of each arm was noted to be affected on the September 2002 VA examination, as such, 4.5 percent of each arm was affected. While there was only one lesion noted on the right neck, resolving all doubt in the veteran's favor, the Board finds that this involvement of the neck approximates 4.5 percent of the body surface (as the neck, but not the head was found to be affected). However, such involvement approximates 13.5 percent of the total body surface, and not 20 percent as required for a higher initial rating. See STEDMAN'S MEDICAL DICTIONARY 1583 (27TH Ed. 2000). In addition, there is no medical evidence during the period prior to February 14, 2006, which indicates that the veteran's tinea corporis eczema/rashes required systemic therapy, such as corticosteroids or other immunosuppressive drugs, let alone for a period of at least six weeks duration. In this regard, while the veteran described using Tetracycline, and a December 2002 record of VA treatment reflects that the veteran was using this medication to treat nonspecific dermatitis, this medication is an antibiotic, rather than a corticosteroid or immunosuppressive drug. See Medline Plus Drug Information, available at http://www.nlm.nih.gov/medlineplus/druginformation.html. As such, the criteria for an initial rating in excess of 10 percent prior to February 14, 2006 are not met. 38 C.F.R. § 4.118, Diagnostic Code 7806. Because the September 2002 VA examiner noted a 5-6 cm. lesion on the veteran's neck, the Board has considered entitlement to an initial rating in excess of 10 percent for the veteran's service-connected skin disability under Diagnostic Code 7800. Diagnostic Code 7800 is applicable to scars of the head, face, and neck. This diagnostic code identifies eight characteristics of disfigurement that are used to evaluate scars affecting the head, face, or neck. The eight characteristics of disfigurement are: scar 5 or more inches (13 or more cm.) in length, scar at least one-quarter inch (0.6 cm) wide at widest part, surface contour of scar elevated or depressed on palpation, scar adherent to underlying tissue, skin hypo- or hyper-pigmented in an area exceeding six square inches (39 sq. cm.), skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.), underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.), and skin indurated an inflexible in an area exceeding six square inches (39 sq. cm.). 38 C.F.R. § 4.118, Diagnostic Code 7800, Note (1). Under Diagnostic Code 7800, a 10 percent rating is warranted for disfigurement of the head, face, or neck, with one characteristic of disfigurement. The next higher rating of 30 percent requires 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. 38 C.F.R. § 4.118, Diagnostic Code 7800. While the September 2002 VA examination revealed a 5-6 cm. lesion on the neck, this lesion did not result in gross distortion or asymmetry of one feature or paired set of features, and, as the lesion measured only 5-6 cm. in diameter, with no indication that this lesion had an elevated or depressed contour on palpation, or was adherent to underlying tissue, at least two of the characteristics of disfigurement were not demonstrated. As such, the criteria for an initial rating in excess of 10 percent prior to February 14, 2006 under this diagnostic code are not met. 38 C.F.R. § 4.118, Diagnostic Code 7800. The Board has also considered entitlement to a rating in excess of 10 percent under Diagnostic Code 7801, for scars, other than the head, face, or neck, that are deep or that cause limited motion. A rating in excess of 10 percent under this diagnostic code requires that such scars have an area or areas exceeding 12 square inches (77 sq. cm.). However, the claims file reveals no medical evidence that the veteran's maculopapular plaques or lesion on the neck are deep or cause limitation of motion. As such, consideration of entitlement to a higher initial rating under this diagnostic code is not warranted. 38 C.F.R. § 4.118, Diagnostic Code 7801. Under these circumstances, the Board finds that the record presents no basis for assignment of a higher initial schedular rating under the applicable rating criteria for the period prior to February 14, 2006. 2. Period since February 14, 2006 The only medical evidence pertinent to the rating of the severity of the veteran's tinea corporis eczema/rashes since February 14, 2006, is the report of a VA examination conducted on that date and a June 2006 VA examination. On VA examination in February 2006, the veteran reported that he developed a rash on the back of his neck in the early 1990s which was present intermittently since then until the late 1990s, which had been treated with miscellaneous local medications without any apparent benefit. The examiner acknowledged review of the claims file and noted that, while the rash on the veteran's neck resolved around 1999, a similar rash occurred on other parts of his body in 2000 and had been present intermittently since that time on various parts of the trunk. The veteran reported using topical medications for the past few years, but no oral medications. The veteran added that, to his knowledge, he had never used systemic corticosteroids, and he was certain that he had not used any such medications during the previous 12 months. The veteran stated that, during the past year, he used only ammonium lactate, 12 percent lotion, which he applied every day after his shower, and kept his skin condition under control. He added that he still had small lesions on his trunk and arms which itched occasionally. On examination, no rash was visible on any exposed body surface. The examiner specifically noted that 0 percent of exposed body surfaces were affected. There were multiple, scattered, very small, reddish papules occasionally coalescing into larger lesions, but none of them greater than 1/4 inch wide and 1 inch long on the upper abdomen, upper back, and upper arms. The examiner added that the vast majority of the lesions measured no more than 4 to 5 mm. in diameter. None of the lesions appeared to be inflamed, and none were infected. There was no apparent scarring, and none of the lesions were unstable or painful. None of the lesions caused limitation of motion of any joint, and none were disfiguring. There was no visible or palpable tissue loss, and no gross or even minor distortion or asymmetry of any features. The papules were scattered over approximately 25 percent of the total body surface, but did not appear on the exposed body surface. The pertinent diagnosis was eczema. On VA examination in June 2006, the veteran described his current problem as small scattered papules which began in service, and which had been intermittent with remissions since that time. The current treatment was lotion prescribed by his primary care physician. He described symptoms of intermittent itching and an intermittent rash. There was no urticaria, primary cutaneous vasculitis, or erythema multiforme. The examiner noted that between 20 and 40 percent of the total body area was affected. The diagnosis was eczema, and the examiner described problems associated with the diagnosis as small scattered papules with 31 percent of the body surface covered, with no significant effects on the veteran's usual occupation, and no effects on his daily activities. Based on the foregoing, the Board finds that the record presents no basis for assignment of a higher schedular rating under the applicable rating criteria since February 14, 2006. In this regard, there is simply no evidence that the veteran's tinea corporis eczema/rashes affects more than 40 percent of the entire body, or more than 40 percent of exposed areas affected. In this regard, the February 2006 VA examiner specifically indicated that 25 percent of the body surface was affected, with no exposed areas affected, and the June 2006 VA examiner indicated that 31 percent of the body was affected. Further, there is simply no evidence of constant or near-constant systemic therapy such as corticosteroid or other immunosuppressive drugs required during the past 12 month period. Rather, the veteran specifically denied using oral medications for the past few years, and added that, to his knowledge, he had never used systemic corticosteroids, and was certain he had not used this type of medication during the past 12 months. As such, the criteria for an initial rating in excess of 30 percent, since February 14, 2006, under Diagnostic Code 7806 are not met. See 38 C.F.R. § 4.118, Diagnostic Code 7806. As there is no medical evidence that the veteran's tinea corporis eczema/rashes has affected the head, face, or neck, since February 14, 2006, consideration of entitlement to a rating in excess of 30 percent under Diagnostic Code 7800 is not warranted. The Board has considered the fact that a rating in excess of 30 percent is available under Diagnostic Code 7801, which provides a 40 percent rating for scars, other than the head, face, or neck, which are deep or that cause limited motion, and have an area or areas exceeding 144 square inches (929 sq. cm.). However, there is no medical evidence that the veteran's service-connected skin disability more nearly approximates such scarring, as there has been no indication that the lesions are deep, and the February 2006 VA examiner specifically indicated that these lesions did not cause limitation of motion of any joint. As such, the criteria for an initial rating in excess of 30 percent since February 14, 2006 under Diagnostic Code 7801 are also not met. See 38 C.F.R. § 4.118, Diagnostic Code 7801. Under these circumstances, the Board finds that, since February 14, 2006, the record presents no basis for assignment of a higher schedular rating under any applicable rating criteria. C. Pseudofolliculitis Barbae In the October 2002 rating decision, the RO granted service connection and assigned an initial noncompensable rating for pseudofolliculitis barbae, pursuant to Diagnostic Code 7806- 7813, effective November 1, 2002. Diagnostic Code 7813 is for rating dermatophytosis (or tinea corporis, tinea capitis, tinea pedis, tinea barbae, tinea unguium, and tinea cruris) as disfigurement of the head, face, or neck (Diagnostic Code 7800), scars (Diagnostic Codes 7801-7805) or dermatitis (Diagnostic Code 7806), depending upon the predominant disability. 38 C.F.R. § 4.118, Diagnostic Code 7813 (2007). Diagnostic Code 7806 provides for assignment of a noncompensable rating for dermatitis or eczema affecting less than 5 percent of the entire body, or less than 5 percent of exposed areas affected, and; no more than topical therapy required during the past 12-month period. As discussed above, a 10 percent rating requires dermatitis or eczema affecting 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, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of less than 6 weeks during the past 12- month period. 38 C.F.R. § 4.118, Diagnostic Code 7806. The rating schedule authorizes the assignment of a zero percent (noncompensable) rating in every instance in which the rating schedule does not provide such a rating and the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. On VA examination in September 2002, the veteran reported that his pseudofolliculitis barbae began in October 1981, and that he had been on a waiver ever since. He added that this was still a problem, and he used barber clippers rather than a razor. On examination the veteran had stubble of a beard, with some pseudofolliculitis barbae and folliculitis within that. The pertinent impression was pseudofolliculitis barbae. In his November 2002 NOD, the veteran reported that, as a result of pseudofolliculitis barbae, he was only able to use hair clippers and could only shave every 7 days due to facial irritation. He added that this resulted in constant beard stubble over his entire face. Records of VA treatment from December 2002 to January 2006 and records of private treatment from April 2001 to January 2006 are negative for complaints regarding or treatment for pseudofolliculitis barbae. On VA skin examination in February 2006, the veteran reported that he experienced shaving bumps in service and had dealt with the problem since that time by using barber clippers most days and shaving once a week. He reported that this kept the problem under control, and that folliculitis had not recurred in recent months. The examiner noted that the veteran's face appeared normal, with a short beard, but without any sign of folliculitis or scarring from prior folliculitis. The pertinent diagnosis was no current signs of folliculitis barbae. Under these circumstances, the Board finds that the record presents no basis for assignment of an initial compensable schedular rating under the applicable rating criteria. Despite the veteran's statement that his pseudofolliculitis barbae requires that he use barber clippers and shave only once every 7 days, there is simply no medical evidence of pseudofolliculitis barbae since the effective date of the grant of service connection. Rather, the veteran himself reported that his routine kept the problem under control, and the February 2006 VA examiner found no signs of folliculitis or scarring from prior folliculitis. As such, there is no medical evidence demonstrating that 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 are affected by pseudofolliculitis barbae. There is also no medical evidence indicating that this service- connected disability has required the use of systemic therapy, such as corticosteroids or other immunosuppressive drugs. Rather, the veteran specifically stated during the February 2006 VA skin examination that, to his knowledge, he had never used systemic corticosteroids, and was certain he had not used any in the previous 12 months. As such, the criteria for an initial compensable schedular rating under Diagnostic Code 7806 are not met. 38 C.F.R. § 4.118, Diagnostic Code 7806. Similarly, the Board finds that no compensable schedular rating for the veteran's pseudofolliculitis barbae is assignable under any other pertinent diagnostic criteria for rating scars. While the veteran's pseudofolliculitis barbae may also be rated as disfigurement of the head, face, or neck under Diagnostic Code 7800, or as scars under Diagnostic Codes 7801, 7802, 7803, 7804, or 7805, depending upon the predominant disability, no citation to, or discussion of the criteria of any of these diagnostic codes is necessary. Simply stated, a rating under any of these diagnostic codes is not appropriate in this case, in the absence of pertinent pathology. No medical evidence since the effective date of the grant of service connection, to specifically include the February 2006 VA examination report, reflects that pseudofolliculitis barbae results in any scars or disfigurement of the head, face, or neck, or scars of any other part of the body to warrant a rating in excess of 10 percent. Rather, the VA examiner specifically concluded that there was no sign of folliculitis or scarring from prior folliculitis. Under these circumstances, the Board finds that, since the effective date of the grant of service connection, the record presents no basis for assignment of a compensable schedular rating under any applicable rating criteria. E. IBS In the October 2002 rating decision, the RO granted service connection and assigned an initial noncompensable rating for IBS, pursuant to Diagnostic Code 7319, effective November 1, 2002. The October 2006 rating decision subsequently granted a higher initial rating of 10 percent, effective November 1, 2002. Under Diagnostic Code 7319, a 10 percent rating is assignable for moderate irritable colon syndrome; with frequent episodes of bowel disturbance with abdominal distress. A maximum 30 percent rating is assigned for severe irritable colon syndrome; with diarrhea or alternating diarrhea and constipation, with more or less constant abdominal distress. 38 C.F.R. § 4.114, Diagnostic Code 7319 (2007). Considering the medical evidence in light of the above-noted criteria, the Board finds that an initial rating in excess of 10 percent for the veteran's IBS is not warranted. On VA examination in September 2002, the veteran described an irritable bowel and constipation. He reported that these symptoms began in 2001. He denied nausea or vomiting, and reported that he took FiberCon with good relief. On examination, the abdomen was soft and nontender with normoactive bowel sounds and no hepatic or splenic enlargement, or palpable masses. The pertinent impression was constipation and mild irritable bowel syndrome. In his November 2002 NOD, the veteran described constant episodes of bowel disturbance and abdominal distress, adding that he had abdominal pain and irregular bowel functions. Records of VA treatment from December 2002 to January 2006 include findings of and treatment for IBS. In December 2002 the veteran described some constipation and cramping as well as abdominal pain. The assessment included IBS. In November 2003 the veteran reported that his bowels were about the same, "ok with fiber." A November 2004 record of treatment reflects that the veteran was taking lactulose for IBS, and he stated that, if he did not take this, he had a bowel movement every 4-5 days, but that, with this medication, he had one bowel movement a day. In February 2005 the veteran reported that he was using Metamucil for regular bowel movements. On review of systems in January 2006, the veteran denied abdominal pain, nausea, vomiting, diarrhea, and constipation. Records of private treatment from April 2001 to January 2006 include findings of constipation. In August 2004 the veteran denied diarrhea. The veteran was prescribed Kristalose for IBS. On review of systems in October 2005 the veteran denied abdominal pain, nausea or vomiting, and diarrhea. Under these circumstances, the Board finds that the record presents no basis for assignment of a higher initial schedular rating under the applicable rating criteria. In this regard, the medical evidence indicates constipation and the veteran has reported abdominal cramping and abdominal pain. The medical evidence, however, reflects that the veteran has had regular bowel movements on medication. Further, there has been no medical evidence of diarrhea, or diarrhea and alternating constipation. Rather, the treatment records reflect that the veteran has denied diarrhea on several occasions. Moreover, there is simply no objective evidence of severe symptoms of IBS, rather, the impression of the September 2002 VA examiner was only mild IBS. Thus, despite the veteran's November 2002 report of constant abdominal distress, the objective medical evidence simply does not demonstrate severe symptoms of abdominal distress as required to warrant a 30 percent rating under Diagnostic Code 7319. As such, the criteria for an initial schedular rating in excess of 10 percent are not met. See 38 C.F.R. § 4.114, Diagnostic Code 7319. F. All Claims Decided The above determinations are based on consideration of applicable provisions of VA's rating schedule, the Board finds that there is no showing that, under any period under consideration, the veteran's service-connected hemorrhoids, tinea corporis eczema/rashes, pseudofolliculitis barbae, or IBS have reflected so exceptional or so unusual a disability picture as to warrant the assignment of any higher rating on an extra-schedular basis. See 38 C.F.R. § 3.321(b) (cited in the January 2003 SOC and considered in the October 2007 SSOC). In this regard, the Board notes that the disabilities have not objectively been shown to markedly interfere with employment (i.e., beyond that contemplated in any assigned rating). The Board has considered the veteran's assertions, advanced in a December 2006 statement, that his service- connected disabilities caused him to leave employment with a railroad and the U.S. Postal Service, and that, although he was able to find employment with another agency, the pain and discomfort from his service-connected disabilities was affecting his duty performance and quality of life. The Board notes however, that the veteran has, nevertheless, maintained employment and there is no objective evidence establishing that any of the service-connected disabilities under consideration has negatively impacted or compromised that employment. There also is no objective evidence that the veteran's service-connected hemorrhoids, tinea corporis eczema/rashes, pseudofolliculitis barbae, or IBS have warranted frequent periods of hospitalization, or that these disabilities have otherwise rendered impractical the application of the regular schedular standards. In the absence of evidence of any of the factors outlined above, the criteria for invoking the procedures set forth in 38 C.F.R. § 3.321(b)(1) have not been met. See Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). For all the foregoing reasons, the Board concludes that there is no basis for staged rating of any of the disabilities herein considered, pursuant to Fenderson, and that each claim for a higher initial rating must be denied. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against assignment of any higher rating for hemorrhoids, tinea corporis eczema/rashes, pseudofolliculitis barbae, or IBS, that doctrine is not for application. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER An initial rating in excess of 10 percent for hemorrhoids is denied. An initial rating in excess of 10 percent for tinea corporis eczema/rashes, prior to February 14, 2006, is denied. A rating in excess of 30 percent for tinea corporis eczema/rashes, from February 14, 2006, is denied. An initial, compensable rating for pseudofolliculitis barbae is denied. An initial rating in excess of 10 percent for IBS is denied. REMAND Unfortunately, the Board finds that additional RO action on the claims for service connection for sinus allergies/allergic rhinitis, and the claims for higher initial ratings for right and left foot hammertoe deformities with hallux valgus and hallux limitus, and for left knee tendonitis is warranted, even though it will, regrettably, further delay an appellate decision on these matters. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 2002 & Supp 2007); 38 C.F.R. § 3.303 (2007). Service connection may be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2007). VA will provide a medical examination or obtain a medical opinion if the evidence indicates the existence of a current disability or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease in service, but the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C.A. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The threshold for determining whether the evidence "indicates" that there "may" be a nexus between a current disability and an in- service event, injury, or disease is a low one. McLendon, 20 Vet. App. at 83. Service medical records include a finding of sinusitis in March 2002. On VA examination in September 2002, prior to separation from service, the veteran described seasonal allergies, and added that he took Flonase with good relief. The pertinent impression was seasonal allergies. Records of VA treatment from December 2002 to January 2006 include findings of allergic rhinitis. In his November 2002 NOD, the veteran reported that his sinus allergies/allergic rhinitis began in service and continued to the present. This report of a continuity of symptomatology, when considered along with the finding of seasonal allergies prior to separation from service and the recent VA treatment records, suggests that the veteran may have current sinus allergies/allergic rhinitis related to service. However, the record includes no actual medical opinion addressing the medical relationship, if any, between any such current disability and service. Given the above-described evidence, the Board finds that VA examination and medical opinion as to the relationship, if any, between any sinus allergies/allergic rhinitis and service-based on full consideration of the veteran's documented medical history and assertions, and supported by stated rationale-is needed to resolve the claim for service connection on appeal. See 38 U.S.C.A. § 5103A. Regarding the claims for higher initial ratings for right and left foot hammertoe deformities with hallux valgus and hallux limitus, the Board notes that these disabilities were most recently evaluated on VA examination in September 2002, prior to separation from service. The assessment was hallux valgus deformity, hallux limitus, bilateral hammertoes, and forefoot varus bilaterally. The impression was chronic pain associated with the fifth digits bilaterally, and hammertoe deformities, along with hallux valgus and hallux limitus. X- ray revealed a normal bilateral foot. During VA treatment in November 2004, the veteran reported that his disability had worsened, specifically describing pain in the feet, toes, bottom of his feet, and ankles. He added that he was seeing a private podiatrist. The assessment was chronic foot pain. A June 2004 record from the veteran's podiatrist includes an assessment of foot pain, metatarsalgia, and plantar fasciitis. As the veteran has reported a worsening of his right and left foot disabilities, to ensure that the record reflects the current severity of these disabilities, the Board finds that a more contemporaneous examination, with findings responsive to the applicable rating criteria, is needed to properly evaluate these disabilities. See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. See also Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA has a duty to provide the veteran with a thorough and contemporaneous medical examination) and Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (an examination too remote for rating purposes cannot be considered contemporaneous). Accordingly, the RO should arrange for the veteran to undergo VA examination to evaluate the right and left foot disabilities at an appropriate VA medical facility. Finally, regarding the claim for a higher initial rating for left knee tendonitis, the Board notes that the left knee was also evaluated during VA examination in September 2002. Range of motion was from 0 to 130 degrees with no instability. There was no diminution of strength on range of motion with repetitive testing. The pertinent impression was left knee patellofemoral pain syndrome. X-ray revealed a normal left knee. In his November 2002 NOD, the veteran reported pain in his left knee during range of motion movements. The veteran has been awarded an initial noncompensable rating for left knee tendonitis under Diagnostic Codes 5099-5024, which is indicative of nonspecific left knee disability rated, by analogy, to tenosynovitis. See 38 C.F.R. §§ 4.20, 4.27. Under Diagnostic Code 5024, tenosynovitis will be rated based on limitation of motion of the affected part. 38 C.F.R. § 4.71a, Diagnostic Code 5024. Under Diagnostic Code 5260, limitation of flexion of either leg to 60 degrees warrants a noncompensable (0 percent) rating. A 10 percent rating requires flexion limited to 45 degrees. A 20 percent rating requires flexion limited to 30 degrees. A 30 percent rating requires flexion limited to 15 degrees. See 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under Diagnostic Code 5261, limitation of extension of either leg to 5 degrees warrants a noncompensable (zero percent) rating. A 10 percent rating requires extension limited to 10 degrees. A 20 percent rating requires extension limited to 15 degrees. A 30 percent rating requires extension limited to 20 degrees. A 40 percent rating requires extension limited to 30 degrees. A 50 percent rating requires extension limited to 45 degrees. See 38 C.F.R. § 4.71a, DC 5261. Standard knee range of motion is from 0 degrees (extension) to 140 degrees (flexion). See 38 C.F.R. § 4.71a, Plate II. When evaluating musculoskeletal disabilities, VA may, in addition to applying schedular criteria, consider granting a higher rating in cases in which the claimant experiences additional functional loss due to pain, weakness, excess fatigability, or incoordination, to include with repeated use or during flare-ups, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7 (1996). While the September 2002 VA examination report included the range of motion of the left knee, the examiner did not make any findings as to any additional loss in range of motion due to any of the factors set forth in 38 C.F.R. §§ 4.40 and 4.45 and DeLuca. Such findings are essential in evaluating the veteran's left knee disability. Hence, the Board finds that further VA orthopedic examination of the veteran's left knee at an appropriate VA medical facility, with specific findings responsive to the applicable rating criteria, as well as 38 C.F.R. §§ 4.40, 4.45, and DeLuca, is needed to fully and fairly evaluate the veteran's claim for a higher initial rating. See 38 U.S.C.A. § 5103A. The veteran is hereby notified that failure to report to any scheduled examination(s), without good cause, may result in a denial of the claim(s) (as adjudication will be based on the evidence of record). See 38 C.F.R. § 3.655. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant and death of an immediate family member. If the veteran fails to report to the scheduled examinations, the RO should obtain and associate with the claims file (a) copy(ies) of the notice(s) of the examinations sent to him by the pertinent VA medical facility. Prior to arranging for the veteran to undergo further examination(s), the RO should obtain and associate with the claims file all outstanding VA medical records. The claims file currently includes outpatient treatment records from the Charleston VA Medical Center (VAMC) dated from December 2002 to February 2005 and from the Atlanta VAMC dated in January 2006. The Board emphasizes that records generated by VA facilities that may have an impact on the adjudication of a claim are considered constructively in the possession of VA adjudicators during the consideration of a claim, regardless of whether those records are physically on file. See Dunn v. West, 11 Vet. App. 462, 466-67 (1998); Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). Hence, the RO must obtain all outstanding pertinent treatment records from the Charleston and Atlanta VAMCs, since February 2005 and January 2006, respectively, following the current procedures prescribed in 38 C.F.R. § 3.159 as regards requests for records from Federal facilities. To ensure that all due process requirements are met, the RO should also give the veteran another opportunity to present information and/or evidence pertinent to the claims remaining on appeal. The RO's notice letter to the veteran should explain that he has a full one-year period for response. See 38 U.S.C.A § 5103(b)(1) (West 2002); but see 38 U.S.C.A. § 5103(b)(3) (West Supp. 2007) (amending the relevant statute to clarify that VA may make a decision on a claim before the expiration of the one-year notice period). The RO should invite the veteran to submit all pertinent evidence in his possession (not previously requested). After providing the appropriate notice, the RO should attempt to obtain any additional evidence for which the veteran provides sufficient information, and, if needed, authorization, following the current procedures prescribed in 38 C.F.R. § 3.159. The actions identified herein are consistent with the duties imposed by the VCAA. See 38 U.S.C.A. §§ 5103, 5103A; 38 C.F.R. § 3.159. However, identification of specific actions requested on remand does not relieve the RO of the responsibility to ensure full compliance with the VCAA and its implementing regulations. Hence, in addition to the actions requested above, the RO should also undertake any other development and/or notification action deemed warranted by the VCAA prior to adjudicating the claims on appeal. The RO's adjudication of the claims for higher initial ratings should include consideration of whether "staged rating" (assignment of different ratings for different periods of time, based on the facts found), pursuant to Fenderson, is warranted. Accordingly, these matters are hereby REMANDED to the RO, via the AMC, for the following action: 1. The RO should obtain all records of evaluation and/or treatment of the veteran's sinus allergies/allergic rhinitis, right and left foot disabilities, or the left knee, from the Charleston and Atlanta VAMCs since February 2005 and January 2006, respectively. The RO must follow the procedures set forth in 38 C.F.R. § 3.159(c) as regards requesting records from Federal facilities. All records and/or responses received should be associated with the claims file. 2. The RO should send to the veteran and his representative a letter requesting that the veteran provide sufficient information, and if necessary, authorization to enable it to obtain any additional evidence pertinent to the claims remaining on appeal that is not currently of record. The RO's letter should clearly explain to the veteran that he has a full one-year period to respond (although VA may decide the claim within the one-year period). 3. If the veteran responds, the RO should assist him in obtaining any additional evidence identified by following the current procedures set forth in 38 C.F.R. § 3.159. All records/responses received should be associated with the claims file. If any records sought are not obtained, the RO should notify him and his representative of the records that were not obtained, explain the efforts taken to obtain them, and describe further action to be taken. 4. After all records and/or responses received from each contacted entity have been associated with the claims file, the RO should arrange for the veteran to undergo VA respiratory examination, by an appropriate physician, at a VA medical facility. The entire claims file, to include a complete copy of the REMAND, must be made available to the physician designated to examine the veteran, and the report of examination should include discussion of the veteran's documented medical history and assertions. All appropriate tests and studies should be accomplished (with all results made available to the examining physician prior to the completion of his or her report), and all clinical findings should be reported in detail. The examiner should identify all current respiratory disabilitiy/ies claumed as sinus allergies/allergic rhinitis. Then, with respect to each such diagnosed disability, the examiner should offer an opinion, consistent with sound medical judgment, as to whether it is at least as likely as not (i.e., there is a 50 percent or greater probability) that the disability is medically related to service, to particularly include the symptoms noted therein. The physician should set forth all examination findings, along with complete rationale the conclusions reached, in a printed (typewritten) report. 5. The RO should also arrange for the veteran to undergo VA orthopedic examination of his right and left feet and left knee, by an appropriate physician, at a VA medical facility. The entire claims file, to include a complete copy of the REMAND, must be made available to the physician designated to examine the veteran, and the report of examination should include discussion of the veteran's documented medical history and assertions. All appropriate tests and studies (to include X-rays) should be accomplished (with all results made available to the examining physician(s) prior to the completion of his or her report), and all clinical findings should be reported in detail. The physician should clearly describe the current condition of each foot. The examiner should also provide an assessment of the severity of the overall impairment of each foot, specifically indicating whether the impairment is best characterized as moderate, moderately severe, or severe, and whether there is actual loss of use of each foot. With regard to the left knee, the examiner should conduct range of motion testing (expressed in degrees), noting the exact measurements for flexion and extension, and specifically identifying range of motion accompanied by pain. If pain on motion in is observed, the examiner should comment on the extent of pain, and indicate at which point pain begins. The extent of any incoordination, weakened movement and excess fatigability on use should be described. In addition, the physician should indicate whether, and to what extent, the veteran experiences likely additional functional loss due to pain and/or any of the other symptoms noted above during flare-ups and/or with repeated use; to the extent possible, the examiner should express such functional loss in terms of additional degrees of limited motion. The examiner should specifically indicate the presence or absence of any lateral instability and/or recurrent subluxation in the left knee. If instability is present, the examiner should, based on the examination results and the veteran's documented medical history and assertions, assess whether such instability is slight, moderate or severe. The examiner should also indicate whether the veteran experiences dislocation in the left knee, and if so, whether such dislocations are accompanied by frequent episodes of locking, pain and/or effusion into the joint. The examiner should set forth all examination findings, along with the complete rationale for the conclusions reached, in a printed (typewritten) report. 6. If the veteran fails to report to any scheduled examination(s), the RO must obtain and associate with the claims file (a) copy(ies) of any notice(s) of the date and time of the examination(s) sent to the veteran by the pertinent VA medical facility. 7. To help avoid future remand, the RO must ensure that all requested actions have been accomplished (to the extent possible) in compliance with this REMAND. If any action is not undertaken, or is taken in a deficient manner, appropriate corrective action should be undertaken. Stegall v. West, 11 Vet. App. 268 (1998). 8. After completing the requested actions, and any additional notification and/or development deemed warranted, the RO should adjudicate the claims remaining on appeal in light of all pertinent evidence and legal authority. The RO's adjudication of the claims for higher initial ratings should include consideration of whether "staged rating", pursuant to Fenderson (cited to above), is warranted 9. If any benefit sought on appeal remains denied, the RO must furnish to the veteran and his representative an appropriate supplemental SOC that clear reasons and bases for all determinations, and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. The purpose of this REMAND is to afford due process; it is not the Board's intent to imply whether the benefits requested should be granted or denied. The veteran need take no action until otherwise notified, but he may furnish additional evidence and/or argument during the appropriate time frame. See Kutscherousky v. West, 12 Vet. App. 369 (1999); Colon v. Brown, 9 Vet. App. 104, 108 (1996); Booth v. Brown, 8 Vet. App. 109 (1995); Quarles v. Derwinski, 3 Vet. App. 129, 141 (1992). This REMAND must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). ______________________________________________ JACQUELINE E. MONROE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs