Citation Nr: 0811498 Decision Date: 04/08/08 Archive Date: 04/23/08 DOCKET NO. 05-28 882 ) DATE ) ) Received from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to an initial compensable evaluation for patellofemoral pain syndrome of the right knee. 2. Entitlement to an initial compensable evaluation for residuals of a left shoulder strain. 3. Entitlement to an initial compensable evaluation for residuals of a fracture of the right little finger with scar. 4. Entitlement to an initial compensable evaluation for bursitis of the right femoral condyle. 5. Entitlement to an initial compensable evaluation for residuals of left inguinal herniorrhaphy. 6. Entitlement to an initial compensable evaluation for a scar of the right shoulder. 7. Entitlement to service connection for a left knee disability. 8. Entitlement to service connection for a lumbar spine disability. 9. Entitlement to service connection for bilateral hearing loss. ATTORNEY FOR THE BOARD Joseph R. Keselyak, Associate Counsel INTRODUCTION The veteran served on active duty from September 1990 to June 2003. This matter comes to the Board of Veterans' Appeals (Board) from a June 2003 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. Jurisdiction over the veteran's claims file was later transferred to the Los Angeles, California RO. The Board notes that the veteran submitted a timely notice of disagreement as to the issues of entitlement to an increased rating for right rotator cuff syndrome and post septoplasty and rhinoplasty with sinusitis and allergic rhinitis addressed by the RO in June 2003 and that in July 2005 a statement of the case (SOC) containing these issues was issued. However, the veteran, as part of his August 2005 substantive appeal, specifically withdrew these increased rating claims from appellate consideration. FINDINGS OF FACT 1. The veteran's patellofemoral pain syndrome of the right knee is largely asymptomatic, and has not manifested by limitation of motion, subluxation, lateral instability or by any pathology related to the semilunar cartilage. 2. The veteran's residuals of a left shoulder strain do not cause limitation of motion of the arm to shoulder level; flexion and abduction of the left shoulder are to 170 degrees. 3. The veteran's status post fracture of right little finger with scar is not manifested by significant residuals, scar associated with this condition is not deep, does not cause limitation of motion, and measures less than six square inches in area, is not unstable or painful, but does exhibit mild hypopigmentation. 4. The veteran's right hip disability is not manifested by pain, limited motion, ankylosis or flail joint. 5. The residuals of the veteran's left inguinal herniorrhaphy are not manifested by recurrent hernia and the scar associated with this condition is not deep, does not cause limitation of motion, and measures less than six square inches in area, is not unstable or painful, but does exhibit mild hypopigmentation. 6. The scar of the veteran's right shoulder is not deep, does not cause limitation of motion, measures less than six square inches in area, is not unstable or painful, but does exhibit mild hypopigmentation. 7. The veteran is not currently diagnosed as having a left knee disability. 8. The veteran is not currently diagnosed as having a lumbar spine disability. 9. The veteran does not have bilateral hearing loss which can be considered a disability for VA compensation purposes. CONCLUSIONS OF LAW 1. The criteria for an initial compensable evaluation for patellofemoral pain syndrome of the right knee have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5257-5261, 5099-5019 (2007). 2. The schedular criteria for an initial compensable evaluation for the veteran's service-connected residuals of a left shoulder strain have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201 (2007). 3. The criteria for a compensable evaluation for residuals of a fracture of the right little finger with scar have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a; 38 C.F.R. § 4.71a, Diagnostic Codes, 5227, 5230; 38 C.F.R. § 4.118, Diagnostic Codes 7801-7805 (2007). 4. The criteria for a compensable evaluation for bursitis of the right femoral condyle have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5299-5255 (2007). 5. The criteria for an initial compensable evaluation for left inguinal herniorrhaphy have not been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002 & Supp. 2007); 38 C.F.R., 4.7, 4.114, Diagnostic Code 7338 (2007); 38 C.F.R. § 4.118, Diagnostic Codes 7801-7805 (2007). 6. The criteria for a compensable evaluation for a scar of the right shoulder have not been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002 & Supp. 2007); 38 C.F.R. § 4.118, Diagnostic Codes 7801-7805 (2007). 7. Service connection for a left knee disability is not established. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2007). 8. Service connection for a lumbar spine disability is not established. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2007). 9. Service connection for a bilateral hearing loss is not established. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.385 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Notice and Assistance Upon receipt of a complete or substantially complete application, VA must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide. 38 U.S.C.A. § 5103(a). VA must request that the claimant provide any evidence in the claimant's possession that pertains to a claim. 38 C.F.R. § 3.159. The notice requirements apply to all five elements of a service connection claim: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473 (2006). The notice must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App.112 (2004). The notice requirements may be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The RO provided the appellant with notice in March 2005 subsequent to the initial adjudication. While the notice was not provided prior to the initial adjudication, the claimant has had the opportunity to submit additional argument and evidence, and to meaningfully participate in the adjudication process. The claim was subsequently readjudicated in an August 2005 statement of the case, following the provision of notice. The veteran has not alleged any prejudice as a result of the untimely notification, nor has any been shown. The notification substantially complied with the requirements of Quartuccio v. Principi, 16 Vet. App. 183 (2002), identifying the evidence necessary to substantiate a claim and the relative duties of VA and the claimant to obtain evidence; and Pelegrini v. Principi, 18 Vet. App. 112 (2004), requesting the claimant to provide evidence in his or her possession that pertains to the claims. In this case, although the notice provided did not address either the rating criteria or effective date provisions that are pertinent to the appellant's claim, such error was harmless given that the veteran's claims for service connection are being denied, and hence no rating or effective date will be assigned with respect to these claimed disabilities. In this case, the veteran was awarded service connection for patellofemoral pain syndrome of the right knee, residuals of a left shoulder strain, residuals of a fracture of the right little finger, with scar, residuals of left inguinal herniorrhaphy and a scar of the right shoulder and assigned a disability rating and an effective date in the June 2003 rating decision on appeal. Thus, these claims were substantiated in June 2003. Therefore, following that decision, VA had no further duty to notify the veteran how to substantiate his claim pursuant to 38 U.S.C.A. § 5103(a) or 38 C.F.R. § 3.159 (b); the purpose of the notice had been served. See Dingess, 19 Vet. App. at 493. VA has obtained service medical records (SMRs), assisted the veteran in obtaining evidence, afforded the veteran physical examinations, and obtained medical opinions as to the severity of his service-connected disabilities. The examiner did not provide etiology opinions with respect to the service connection claims; however, the Board finds a remand for another examination is not necessary because the examiner noted no pathology present to render a diagnosis regarding the left knee or low back. Indeed, as shown below, the record contains sufficient medical evidence to decide the claims of service connection for a left knee disability, lumbar spine disability and bilateral hearing loss. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). All known and available records relevant to the issues on appeal have been obtained and associated with the veteran's claim file; and the veteran has not contended otherwise. VA has substantially complied with the notice and assistance requirements and the veteran is not prejudiced by a decision on the claim at this time. Increased Evaluation Claims Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2007). Separate rating codes identify the various disabilities. 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability is resolved in favor of the veteran. 38 C.F.R. § 4.3. The VA schedule of ratings will apply unless there are exceptional or unusual factors which would render application of the schedule impractical. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). Where entitlement to compensation has already 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). In addition, an appeal from the initial assignment of a disability rating requires consideration of the entire time period involved, and contemplates "staged ratings" where warranted. See Fenderson v. West, 12 Vet. App. 119 (1999). Rating factors for a disability of the musculoskeletal system included functional loss due to pain supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion, weakened movement, excess fatigability, swelling and pain on movement. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). Also with any form of arthritis, painful motion is factor to be considered. 38 C.F.R. § 4.59. The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the diagnosis and demonstrated symptomatology. Any change in a diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). Patellofemoral Pain Syndrome, Right Knee Based upon the principle set forth in Esteban v. Brown, 6 Vet. App. 259 (1994), the VA General Counsel held that a knee disability may receive separate ratings under diagnostic codes evaluating instability (Diagnostic Codes 5257, 5262, and 5263) and those evaluating range of motion (Diagnostic Codes 5003, 5010, 5256, 5260, and 5261). See VAOPGCPREC 23- 97. A veteran who evidences symptoms of restricted range of motion and instability in a knee joint with a service- connected disability can receive separate evaluations on the same joint. See VAOPGCPREC 23-97 (holding that a veteran, who has arthritis with restricted motion and instability in the knee, may receive separate ratings for each set of symptomatology under different diagnostic codes). Additionally, a separate rating under Code 5260 (leg, limitation of flexion) and Code 5261 (leg, limitation of extension) may be assigned for disability of the same joint. See VAOPGCPREC 9-2004. For rating purposes, normal range of motion in a knee joint is from zero to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II. In this case, the veteran's service-connected right knee disability has been assigned a noncompensable rating under Diagnostic Code 5099-5019. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. Diagnostic Code 5099 is used to identify musculoskeletal system disabilities that are not specifically listed in the schedule, but are rated by analogy to similar disabilities under the schedule. See 38 C.F.R. §§ 4.20, 4.27. Diagnostic Code 5019 pertains to bursitis. Under that code, the veteran's knee disability is rated on limitation of motion as degenerative arthritis. Under Diagnostic Code 5003, degenerative arthritis established by X-ray findings is rated on the basis of limitation of motion under the appropriate Diagnostic Codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate Diagnostic Codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined and not added, under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, x-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations warrants a 20 percent evaluation. X-ray evidence of involvement of two or more major joints or two or more minor joints warrants a 10 percent evaluation. See 38 C.F.R. § 4, 71a, Diagnostic Code 5003. Under Diagnostic Code 5257, a rating of 10 percent is warranted when the veteran experiences slight subluxation or lateral instability. A rating of 20 percent is proper when the veteran experiences moderate subluxation or lateral instability. A rating of 30 percent is warranted when the veteran experiences severe subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Diagnostic Code 5258 pertains to dislocation of the semilunar cartilage with frequent episodes of locking, pain and effusion into the joint and is rated as 20 percent disabling. 38 C.F.R. § 4.71a, Diagnostic Code 5258. Under Diagnostic Code 5259, a single 10 percent rating is for application for semilunar removal of cartilage with symptomatology. A higher disability evaluation is not provided under this code. 38 C.F.R. § 4.71a, Diagnostic Code 5259. Under Diagnostic Code 5260, limitation of flexion is rated 10 percent when flexion is limited to 45 degrees, 20 percent when flexion is limited to 30 degrees and 30 percent when flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under Diagnostic Code 5261, limitation of extension is rated 10 percent when extension is limited to 10 degrees, at 20 percent when extension is limited to 15 degrees, at 30 percent when extension is limited to 20 degrees, at 40 percent when extension is limited to 30 degrees, and at a maximum 50 percent when extension is limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. In April 2003, the veteran was afforded a pre-discharge examination for VA of his right knee. In recording the history of the complaint, the examiner noted that it was felt that the veteran had chondromalacia of the right knee. The veteran reported symptoms of chronic discomfort, becoming more symptomatic after any type of running or prolonged periods of standing. He denied locking or swelling as well as instability. Examination of the knee demonstrated no abnormalities on inspection and palpation. The veteran had normal range of motion, flexion from zero to 140 degrees and extension to zero degrees. McMurray and drawer tests were negative. X-rays of the right knee were normal. Neurological testing was likewise normal. The examiner noted that range of motion was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination. The examiner, in the diagnosis section of the examination report, noted that there was no clear pathology to render a diagnosis. The veteran was afforded another VA examination in April 2005, at which time he complained of pain in the right knee and stated that he had been diagnosed previously as having patellofemoral syndrome of the right knee. He described sharp pain in the back of this knee and that the knee would occasionally "pop out." He stated that the pain was aggravated by walking or climbing stairs, but that the symptoms were not constant. He described on and off flare- ups occurring about once per month, lasting for two days. He found it difficult to walk or climb stairs during flare-ups. The veteran denied incapacitation from this condition. He related treatment in the form of painkillers, namely, Motrin and aspirin. He denied prosthetic implant, but acknowledged some functional impairment as he could not run, jog or lift and carry heavy objects. He reported some time lost from work, at least two times per month. Examination resulted in an impression of normally appearing knee joints. Drawer and McMurray's signs were negative. There was no crepitus, joint effusion, locking pain, subluxation or ankylosis. Range of motion of the right knee was within normal limits: flexion was to 140 degrees, extension was to zero degrees. There was no pain, fatigue, weakness, lack of endurance or incoordination on movement of the right knee joint. The examiner diagnosed patellofemoral syndrome of the right knee, resolved. The veteran is not entitled to an initial compensable evaluation for patellofemoral pain syndrome (chondromalacia patella) of his right knee. His right knee disability is not manifested by any impairment, such as limitation of motion, instability or any other abnormality. Examination of this knee in April 2003 did not identify sufficient pathology to render a diagnosis, although the veteran reported chronic discomfort. The April 2005 VA examination did not result in objective signs of pain or discomfort or any other symptomatology. The April 2005 VA examiner diagnosed patellofemoral syndrome of the right knee, resolved. There is no X-ray evidence of degenerative arthritis. Under Diagnostic Code 5003, a compensable evaluation is not warranted in the absence of X-ray evidence of arthritis. With respect to Diagnostic Codes 5260 and 5261, a compensable evaluation is not warranted because the veteran's right knee exhibits full range of motion. In regards to Diagnostic Code 5257 a compensable evaluation is not established, because there is no pathology showing subluxation or lateral instability. McMurray's and drawer test were negative. For Diagnostic Codes 5258 and 5259, there is likewise no pathology shown in relation to the semilunar cartilage of the right knee. The veteran's right knee is grossly normal. For these reasons, the claim for an initial compensable evaluation for the veteran's service-connected right knee disability must be denied. Residuals of a Left Shoulder Strain The veteran's service-connected left shoulder strain has been assigned a noncompensable rating under Diagnostic Code 5201, which provides criteria for the rating of disability from limitation of motion of the shoulder and arm. Under that diagnostic code, limitation of motion of the arm to elevation at the shoulder level is assigned a rating of 20 percent. If motion of the arm is limited to midway between the side and shoulder, a 30 percent evaluation is assigned for the major side and a 20 percent evaluation is assigned for the minor side. If arm motion is limited to 25 degrees from the side, a rating of 40 percent is assigned for the major side and a 30 percent rating is assigned for the minor side. 38 C.F.R. § 4.71a, Diagnostic Code 5201 (2007). Full range of motion of the shoulder is measured from zero degrees to 180 degrees for forward elevation, zero to 180 degrees for shoulder abduction, and zero to 90 degrees for external and internal rotation. 38 C.F.R. § 4.71a, Plate I (2007). At his April 2003 VA pre-discharge examination the veteran complained of pain on rotation of the shoulder, and perhaps a very slight decrease in strength. He reported pain down in to the biceps of his left arm, sometimes farther. The examiner noted that the veteran was right-handed. The examination showed normal range of motion, minimal discomfort with abduction and external rotation of the shoulder. There was no crepitation or other changes noted. The examiner stated that range of motion was "additionally limited by pain, but not by fatigue, weakness, lack of endurance or incoordination." The examination did not, however, quantify or attempt to quantify the extent of limitation of motion caused by pain. The examiner diagnosed left shoulder strain with residual pain on motion, but noted that there was no pain in the arm shown at the examination. At the April 2005 VA examination, the veteran complained of sharp pain in his left shoulder, which he described as off and on. He also reported a popping sensation. He stated that the symptoms were not constant, but that flare-ups would occur at least two times per month, with pain lasting for one day. The examiner found no functional impairment from the left shoulder condition. The veteran treated his left shoulder pain with painkillers, namely, Motrin and aspirin. There was no prosthetic implant. The veteran had lost no time from work due to this disorder. Examination resulted in an impression of normal appearance of the left shoulder. There was no ankylosis of the left shoulder. Abduction was 170 degrees out of 180 degrees. Forward flexion was 170 degrees out of 180 degrees. External rotation was to 90 degrees out of 90 degrees. Internal rotation was to 90 degrees out of 90 degrees. The examiner noted pain with left shoulder flexion and abduction at 170 degrees. He found that range of motion was limited by pain, but not by fatigue, weakness, lack of endurance or incoordination after repetitive use. Entitlement to an initial compensable evaluation for the veteran's residuals of a left shoulder strain is not warranted. Examination has shown, with consideration of the DeLuca factors that the veteran's shoulder is limited only in abduction and flexion to 170 degrees, which is well above midway between the side and shoulder level and well in excess of 25 degrees. Those findings do not more closely approximate the criteria required for a compensable rating. Accordingly, the claim must be denied. The Board does not find Diagnostic Codes 5200, 5202 and 5203 to be applicable in this case. There is no evidence of ankylosis of the veteran's left shoulder, thus rendering Diagnostic Code 5200 in applicable. With respect to Diagnostic Coe 5202, there is no sign that the veteran's humerus is impaired, thus rendering this diagnostic code inapplicable. Likewise, Diagnostic Code 5203 is not applicable because there is no evidence of clavicle or scapula disability. Status Post Fracture of Right Little Finger In the rating action on appeal, the RO granted service connection and assigned a noncompensable rating under Diagnostic Code 5230. Diagnostic Codes 5227 and 5230 provide a maximum noncompensable evaluation for unfavorable or favorable ankylosis and any limitation of motion for a ring or little finger. See 38 C.F.R. § 4.71a. At the April 2003 VA pre-discharge examination the examiner noted a history of right fifth metacarpal fracture in 1991 and open reduction an internal fixation because of a poor healing fracture. At the time, the veteran reported difficulty in being able to get a full grip and discomfort in this hand. The veteran also felt that he had some decreased range of motion as well, and reported difficulty writing for a long period of time and holding onto a pen. The examiner noted that the veteran had had a total of three surgical procedures on this hand. Examination of the hand resulted in a diagnosis of status post fracture of the fifth metacarpal without significant evident residuals. It was noted that the veteran was right hand dominant and could make a good fist and had good hand strength. He was able to use his right hand for grasping, pushing, pulling, writing, buttoning clothing and picking up small objects. He was able to fully approximate the tips of the fingers to the median transverse fold of the palm. There were no abnormalities on inspection or palpation. There was no heat, redness, swelling, effusion, drainage, instability, weakness or abnormal movement. Range of motion was normal. X-rays revealed a slight deformity of the fifth metacarpal compatible with an old healed fracture. VA examination in April 2005 noted that the veteran could tie his shoes, fasten buttons, and pick up and tear a piece of paper without difficulty. The tips of the fingers of both hands could approximate the proximal transverse crease of the palms. Hand strength was normal bilaterally. There was no ankylosis of the hands or thumbs. Range of motion of the thumbs and fingers was within normal limits in both hands. The veteran is not entitled to a compensable evaluation for status post fracture of right little finger. The veteran's right little finger exhibits no limitation of motion. Although the veteran has indicated having discomfort, decreased strength and limited motion, there is no clinical evidence of this symptomatology. VA examination has indicated normal function of the right little finger. Even if this finger did exhibit such limitation of motion or ankylosis, the applicable diagnostic codes do not provide for a compensable evaluation for limitation of motion or ankylosis. Accordingly, a compensable evaluation is not warranted. Bursitis of the Right Femoral Condyle The veteran's service-connected bursitis of the right femoral condyle is currently evaluated at a noncompensable level under DC 5299-5255, as analogous to impairment of the femur. 38 C.F.R. § 4.20. Normal ranges of motion of the hip are from hip flexion from 0 degrees to 125 degrees, and hip abduction from 0 degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II. Diagnostic Code 5250 provides for rating the hip on the basis of ankylosis. Favorable ankylosis of the hip in flexion at an angle between 20 degrees and 40 degrees and slight adduction or abduction is to be rated 60 percent disabling. Intermediate ankylosis of the hip is to be rated 70 percent disabling. And extremely unfavorable ankylosis, with the foot not reaching ground, crutches necessitated, is to be rated 90 percent disabling, and is entitled to special monthly compensation. 38 C.F.R. § 4.71a. Diagnostic Code 5251 provides a 10 percent disability rating for limitation of extension of the thigh that is limited to 5 degrees. Diagnostic Code 5252 provides ratings based on limitation of flexion of the thigh. A 10 percent disability rating is for flexion of the thigh that is limited to 45 degrees. A 20 percent rating is for flexion of the thigh that is limited to 30 degrees. A 30 percent rating is for flexion of the thigh that is limited to 20 degrees. A 40 percent rating is for flexion of the thigh that is limited to 10 degrees. Under Diagnostic Code 5253, limitation of adduction and an inability to cross legs, or limitation of rotation with an inability to toe-out the affected leg more than 15 degrees warrants a 10 percent rating. Limitation of abduction of a thigh with motion lost beyond 10 degrees warrants a 20 percent rating. Diagnostic Code 5254 provides for a singular maximum evaluation of 80 percent for flail joint of the hip. Diagnostic Code 5255 deals with impairment of the femur. Under this code, malunion of the femur with slight knee or hip disability warrants a 10 percent evaluation. Malunion of the femur with moderate knee or hip disability warrants a 20 percent evaluation. Malunion of the femur with marked knee or hip disability warrants a 30 percent evaluation. Fracture of surgical neck of femur, with false joint, or fracture of shaft or anatomical neck of femur with nonunion, without loose motion, weight bearing preserved with aid of brace, warrants a 60 percent evaluation. The highest rating available under that code, 80 percent, is warranted for fracture of shaft or anatomical neck of femur, with nonunion, with loose motion (spiral or oblique fracture). The terms "slight," "moderate" and "severe" are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are "equitable and just" 38 C.F.R. § 4.6. At his VA examination in April 2003, the veteran reported having some degree of discomfort in his right hip after walking or running, as well as discomfort from standing for long periods of time. He reported no loss of motion, but difficulty in doing any impact activities. Examination of the hip joint revealed modest tenderness to palpation deeply on the posterior femoral condyle, but no other changes. Range of motion was normal. Flexion was zero to 125 degrees. Extension was zero to 30 degrees. Adduction was zero to 25 degrees. Abduction was zero to 45 degrees. External rotation was zero to 60 degrees. Internal rotation was zero to 40 degrees. Range of motion was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination. X-rays of the right hip were normal. The examiner diagnosed right femoral condylar bursitis. In April 2005, the veteran received another VA examination of his right hip. At the time, he complained of sharp pain in the right hip, which worsened with standing, walking and climbing stairs. He reported on and off symptoms, with flare-ups three to four times per month. He reported being able to perform his daily functions during flare-ups, but with slight difficulty because it would become difficult for him to walk or stand for prolonged periods, to climb stairs or to lift and carry heavy objects. He reported treating his pain with Motrin and aspirin. He reported time lost from work at least two days per month because of flare-ups. Examination showed normal posture and gait with equal leg length. The feet showed no signs of abnormal weight bearing. The veteran did not require any device for walking. Examination of the femur was normal bilaterally. Range of motion of the right hip joint was normal in all planes. Flexion was to 125 degrees; extension 30 degrees; adduction to 25 degrees; abduction to 45 degrees. Exterior rotation was to 60 degrees; internal rotation to 40 degrees. There was no pain, fatigue, weakness, lack of endurance or incoordination on movement of the right hip joint. Bursitis, right femoral condyle, resolved, was diagnosed. Initially, with reference to the examination findings outlined above, the Board notes that Diagnostic Codes 5250 and 5254 are inapplicable. The veteran's right hip disability is not manifested by ankylosis or flail joint. Similarly, with respect to Diagnostic Codes 5251, 5252 and 5253, a compensable evaluation is not warranted because there is no limitation of motion of the veteran's right hip. Finally, the Board finds that an increased rating is not warranted under Diagnostic Code 5255 for slight impairment of the femur. The most recent VA examination included the diagnosis of bursitis, right femoral condyle, resolved. There was no impairment noted. Status Post Left Inguinal Hernia The veteran is currently assigned a noncompensable disability evaluation for residuals of a left inguinal hernia repair under Diagnostic Code 7338 pertaining to inguinal hernia. See 38 C.F.R. § 4.114, Diagnostic Code 7338 (2007). Diagnostic Code 7338 is deemed by the Board to be the most appropriate diagnostic code, primarily because it pertains specifically to the diagnosed disability in the present case (inguinal hernia). Evidence of a past hernia operation justifies rating the disability under Diagnostic Code 7338. The Board can identify no more appropriate diagnostic code, and the veteran has pointed to none. Under Diagnostic Code 7338 a noncompensable rating is warranted where the inguinal hernia is small, reducible, or without true hernia protrusion, or where it is not operated, but remediable. A zero percent evaluation will be assigned when the symptomatology required for a compensable rating is not shown. See 38 C.F.R. § 4.31 (2007). A 10 percent rating is for assignment where there is postoperative recurrence of the hernia that is easily reducible and well supported by truss or belt. In essence, a rating at the 10 percent level requires a recurrent hernia. Id. In April 2003, the VA examiner noted a prior history of herniorrhaphy. The veteran reported that since this surgery, he had difficulty eating. He reported early satiety and that he had to eat much smaller and frequent meals. He also described having more frequent bowel movements, three to four a day. He denied blood, either per rectum or hematemesis, as well as pyrosis or dysphagia. He denied lower abdominal cramps and weight loss. Examination revealed a well-healed left inguinal hernia scar, which showed no disfigurement or contractures. The examiner diagnosed status left herniorrhaphy, without current residual. At the April 2005 VA examination, the veteran complained of repair of left inguinal hernia, performed in 1998. He stated that since his hernia his appetite was poor and on and off heartburn. The examiner found no functional impairment from the hernia surgery. There was no loss of work. Examination of the abdomen showed positive bowel sounds. It was non- tender and non-distended. Inguinal hernia was absent. There was no ventral hernia or femoral hernia present. The veteran is not entitled to a compensable evaluation for status post left inguinal hernia. Diagnostic Code 7338 clearly requires the presence of recurrent hernia for a compensable evaluation. The evidence of record shows that the veteran had only one occurrence of an inguinal hernia, which was resolved after surgery and has not reoccurred. The veteran's subjective complaints of digestive problems have not been attributed to his status post left inguinal hernia, so it is not necessary for the Board to explore application of any diagnostic codes relating to this symptomatology. See Butts, 5 Vet. App. at 538. Accordingly, the claim for a compensable evaluation for status post left inguinal hernia must be denied. Scars of the Little Finger, Abdomen and Right Shoulder Diagnostic Code 7801 provides ratings for scars, other than the head, face, or neck, that are deep or that cause limited motion. Scars that are deep or that cause limited motion in an area or areas exceeding 6 square inches (39 sq. cm.) are rated 10 percent disabling. Scars in an area or areas exceeding 12 square inches (77 sq. cm.) are rated 20 percent disabling. Scars in an area or areas exceeding 72 square inches (465 sq. cm.) are rated 30 percent disabling. Scars in an area or areas exceeding 144 square inches (929 sq.cm.) are rated 40 percent disabling. Note (1) to Diagnostic Code 7802 provides that scars in widely separated areas, as on two or more extremities or on anterior and posterior surfaces of extremities or trunk, will be separately rated and combined in accordance with 38 C.F.R. § 4.25. Note (2) provides that a deep scar is one associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Diagnostic Code 7802 provides ratings for scars, other than the head, face, or neck, that are superficial or that do not cause limited motion. Superficial scars that do not cause limited motion, in an area or areas of 144 square inches (929 sq. cm.) or greater, are rated 10 percent disabling. Note (1) to Diagnostic Code 7802 provides that scars in widely separated areas, as on two or more extremities or on anterior and posterior surfaces of extremities or trunk, will be separately rated and combined in accordance with 38 C.F.R. § 4.25. Note (2) provides that a superficial scar is one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Diagnostic Code 7803 provides a 10 percent rating for superficial unstable scars. Note (1) to Diagnostic Code 7803 provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that a superficial scar is one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Diagnostic Code 7804 provides a 10 percent rating for superficial scars that are painful on examination. Note (1) to Diagnostic Code 7804 provides that a superficial scar is one not associated with underlying soft tissue damage. Note (2) provides that a 10-percent rating will be assigned for a scar on the tip of a finger or toe even though amputation of the part would not warrant a compensable rating. 38 C.F.R. § 4.118. Diagnostic Code 7804 also directs the rater to see 38 C.F.R. § 4.68 (amputation rule). 38 C.F.R. § 4.118. Diagnostic Code 7805 provides that other scars are to be rated on limitation of function of affected part. 38 C.F.R. § 4.118. April 2003 examination showed a well-healed incisional scar at the anterior aspect of the veteran's right shoulder, extending into the crook of his axilla, which was about 5 cm. in length and showed no disfigurement, adherence, tenderness, keloid or other changes. The veteran also had a well-healed left inguinal hernia scar which showed no disfigurement or contractures. The April 2005 examiner noted the presence of several scars. There was a 6.5 cm. long, curved, well-healed scar on the anterior aspect of the right shoulder. There was also a well-healed scar from the left inguinal hernia repair, which measured 9 cm. long in the left lower quadrant of the abdomen. The veteran had a 5 cm. well-healed scar on the dorsal aspect of the 5th metacarpal bone. These scars were all level and without tenderness. There was no disfigurement, ulceration, keloid formation, hyperpigmentation, or abnormal texture. These scars did not cause limitation of motion and were mildly hypopigmented. Each of them measured less than six square inches. With respect to the scars of the veteran's right little finger, right shoulder and abdomen, the Board does not find that these warrant a compensable evaluation as shown by the applicable diagnostic codes pertaining to scars of areas other than the head, face or neck. These scars are not deep and do not cause him any limitation of motion of the relevant anatomic regions. They are all less than six square inches in area. They are not unstable or painful. Because none of these scars is compensable, consideration under 38 C.F.R. § 4.25 is not warranted. Although they exhibit some mild hypopigmentation, this does not result in a compensable evaluation. Accordingly, a compensable evaluation is not warranted for these scars. Service Connection Claims Service connection is granted for disability resulting from disease or injury incurred or aggravated in active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). In claims for VA benefits, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107(b) (West 2002); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Left Knee Disability The Board has reviewed the veteran's SMRs and has found no evidence of complaints or treatment of a left knee disability. At the April 2003 VA pre-discharge examination, the veteran was felt to have chondromalacia of both knees, and reported chronic discomfort for six to eight years, after any type of running or prolonged periods of standing. After examination, the examiner felt that there was no pathology to render a diagnosis. Entitlement to service connection for a left knee disability must be denied. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). As reflected by the veteran's SMRs and VA examinations he has never been diagnosed as having a left knee disability. Accordingly, service connection for a left knee disability must be denied. Lumbar Spine Disability The veteran's service medical records are silent with respect to complaints or treatment of the low back, but for an August 1996 treatment note reflecting a complaint of back pain. The veteran's pre-discharge VA examination in April 2003 shows that at the time the veteran complained of localized discomfort in his lumbar area, which he reported as recurring on an average of twice per week, lasting for nearly a full day. There were no radicular symptoms or spasm reported, or episodes of pain that disqualified him from being able to work. The examiner found no pathology to render a diagnosis. Entitlement to service connection for a lumbar spine disability is not established. As stated above, without proof of a present disability there can be no valid claim. Id. As reflected by the veteran's SMRs and VA examination he has never been diagnosed as having a lumbar spine disability; thus, this claim must be denied. Bilateral Hearing Loss Hearing loss will be considered to be a disability when the auditory threshold in any of the frequencies of 500, 1000, 2000, 3000 or 4000 Hertz is 40 decibels or greater, when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 2000, 3000 or 4000 Hertz are 26 decibels or greater, or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2007). The veteran's SMRs contain numerous audiometric reports. None of these reports resulted in a diagnosis of bilateral hearing loss. None of them show audiometric results sufficient to establish hearing loss for VA purposes. Id. In April 2003, the veteran was given a pre-discharge VA audiologic examination. Pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 5 5 15 20 LEFT 10 10 5 10 15 Speech audiometry revealed speech recognition ability of 100 percent in the right ear and of 100 percent in the left ear. The veteran was found to not have measurable hearing loss in either ear. Entitlement to service connection for bilateral hearing loss is not established. The veteran's SMRs and pre-discharge VA examination do not show diagnosis of bilateral hearing loss or hearing loss sufficient for VA purposes. The auditory thresholds and the speech recognition scores contained in the audiometrics do not show hearing loss as required for VA purposes. Id. Accordingly, the claim must be denied. ORDER Entitlement to an initial compensable evaluation for patellofemoral pain syndrome of the right knee is denied. Entitlement to an initial compensable evaluation for residuals of a left shoulder strain is denied. Entitlement to an initial compensable evaluation for residuals of a fracture of the right little finger with scar is denied. Entitlement to an initial compensable evaluation for bursitis of the right femoral condyle is denied. Entitlement to an initial compensable evaluation for residuals of left inguinal herniorrhaphy is denied. Entitlement to an initial compensable evaluation for a scar of the right shoulder is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a lumbar spine disability is denied. Entitlement to service connection for bilateral hearing loss is denied. ____________________________________________ M. E. LARKIN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs