Citation Nr: 0814158 Decision Date: 04/30/08 Archive Date: 05/08/08 DOCKET NO. 03-32 399 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to service connection for sinus bradycardia. 2. Entitlement to service connection for hypertension. 3. Entitlement to an initial compensable rating for sinusitis. 4. Entitlement to an initial disability rating greater than 10 percent for recurrent headaches. 5. Entitlement to an initial disability rating greater than 10 percent for chronic strain of the lumbosacral spine. 6. Entitlement to an initial disability rating greater than 10 percent for status post right knee menisectomy. 7. Entitlement to an initial disability rating greater than 10 percent for degenerative joint disease of the right knee. REPRESENTATION Appellant represented by: Virginia Department of Veterans Services ATTORNEY FOR THE BOARD A. D. Jackson, Counsel INTRODUCTION Appellant had active service from July 1986 to April 2001 with 5 years and 6 months of prior active service. This case comes to the Board of Veterans' Appeals (Board) on appeal of a May 2002 rating decision of the Roanoke, Virginia, Regional Office (RO) of the Department of Veterans Affairs (VA). FINDINGS OF FACT 1. It has not been shown, by credible competent evidence, that appellant has an underlying chronic disability manifested by sinus bradycardia related to service. 2. It has not been shown, by credible competent evidence, that appellant has hypertension related to service. Hypertension was not confirmed to be present within 1 year following separation from service. 3. The veteran's sinusitis is manifested by subjective complaints of intermittent sinus infections, and the need for medication; with no objective evidence of symptoms of sinusitis with one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment. 4. The veteran's recurrent headaches do not approximate prostrating attacks occurring on the average of once a month over the last several months. 5. Chronic strain of the lumbosacral spine is manifested by complaints of pain and with 65-90 degrees of flexion and no neurological symptomatology, without evidence of muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as reversed lordosis, or abnormal kyphosis. 6. The right knee disability is manifested by subjective complaints of pain, locking, swelling, and instability with full flexion and full extension, and without objective evidence of tenderness, swelling, locking, ligament instability or evidence of recurrent subluxation of the right knee. CONCLUSIONS OF LAW 1. Appellant does not have an underlying chronic heart disorder manifested by sinus bradycardia, that was incurred in or aggravated by service and organic heart disease may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2007). 2. Appellant does not have hypertension that was incurred in or aggravated by service, nor may hypertension be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2007). 3. The criteria for a compensable rating for sinusitis are not met. 38 U.S.C.A. § 1155, 5107 (West 2002); 38 C.F.R. § 4.97 Part 4, Diagnostic Code 6513 (2007). 4. The criteria for an initial disability evaluation in excess of 10 percent for recurrent headaches, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. Part 4, §§ 4.7, 4.40, Diagnostic Code 8100 (2007). 5. The schedular criteria for an initial evaluation in excess of 10 percent for chronic strain of the lumbosacral spine are not met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5295 effective September 23, 2002; 38 C.F.R. § 4.71a, Diagnostic Codes 5237 effective September 26, 2003. 6. The schedular criteria for an initial evaluation in excess of 10 percent for status post right knee menisectomy are not met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2007). 7. The schedular criteria for an initial evaluation in excess of 10 percent for degenerative joint disease of the right knee are not met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Codes 5010-5003, 5260, and 5261 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Review of the record reveals that all appropriate notice and development has been accomplished. See 38 U.S.C.A. § 5100 et seq. (West 2002 & Supp. 2007). Examinations have been conducted. Notice as to what evidence needed, as well as the type of evidence necessary to establish a disability rating and effective date for that disability, has been provided. Letters of September 2001, February 2006, March 2006, and April 2006 provided pertinent notice and development information. There is no indication that there is additional evidence or development that should be undertaken. For an increased-compensation claim, section § 5103(a) requires, at a minimum, that the Secretary notify the claimant that, to substantiate a claim, the claimant must provide, or ask the Secretary 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. Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008). Further, 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 that worsening has 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. Additionally, the claimant must be notified that, should an increase in disability be found, a disability rating will be determined by applying relevant Diagnostic Codes, which typically provide for a range in severity of a particular disability from noncompensable to as much as 100 percent (depending on the disability involved), based on the nature of the symptoms of the condition for which disability compensation is being sought, their severity and duration, and their impact upon employment and daily life. The notice must also provide examples of the types of medical and lay evidence that the claimant may submit (or ask the Secretary to obtain) that are relevant to establishing entitlement to increased compensation-e.g. competent lay statements describing symptoms, medical and hospitalization records, medical statements, employer statements, job application rejections, and any other evidence showing an increase in the disability or exceptional circumstances relating to the disability. Here, the veteran is challenging the initial evaluation and effective date assigned following the grant of service connection. In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the Court of Appeals for Veterans Claims (Court) held that in cases where service connection has been granted and an initial disability rating and effective date have been assigned, the typical service-connection claim has been more than substantiated, it has been proven, thereby rendering section 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Id. at 490-91. Thus, because the notice that was provided before service connection was granted was legally sufficient, VA's duty to notify in this case has been satisfied. For the above reasons, the Board finds that development of the record is sufficiently complete to permit a fair and just resolution of the appeal, and there has been no prejudicial failure of notice or assistance to the appellant. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claims. The record contains service medical records, VA outpatient records, as well as, reports of QTC examinations that were conducted in November 2001 and June 2005. Entitlement to service connection In general, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131. Service connection will be presumed for certain chronic diseases (e.g. hypertension, cardiovascular disease) which are manifest to a compensable degree within the year after qualifying active service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In order to establish service connection for the claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1, 8 (1999). Hypertension is defined as persistently high arterial blood pressure. Various criteria have been suggested, ranging from 140 millimeter of mercury (mm. Hg) systolic and 90-mm. Hg diastolic to as high as 200-mm. Hg systolic and 110-mm. Hg diastolic. Dorland's Illustrated Medical Dictionary 635 (26th ed. 1981). In this regard, the problem with the veteran's claims for service connection is the first element of Hickson, in that; there is no current medical evidence of the claimed disabilities on a chronic or continuing basis. He claims to have chronic disabilities claimed as a disability manifested by sinus bradycardia and hypertension. Significantly, however, the current record does not support a conclusion that the veteran currently has the hypertension or an underlying disability manifested by sinus bradycardia. There was evidence of the disorders in service, although not clinically confirmed. Without proof of current disability, service connection cannot be granted. See Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439, 448 (1995); Chelte v. Brown, 10 Vet. App. 268, 271 (1997). As to entitlement to service connection for a disability manifested by sinus bradycardia, service medical records starting in October 1998 show the veteran being observed to have sinus bradycardia. Inservice diagnoses include sinus bradycardia compatible with athletic heart syndrome and sinus bradycardia, probable LVH, early repolarization. However, the service medical records, including numerous examinations, do not ever show the veteran being diagnosed with an underlying heart disorder. In fact, post service records show that a QTC examination was conducted in November 2001 and there was no underlying disability found. The heart was considered normal. There is apparently no showing of sinus bradycardia at any time after service. The same is true for hypertension. During service, in 1999 and 2000, the veteran underwent 5 day blood pressure trials. There were no reported diagnoses of hypertension. At one point elevated blood pressure ratings were noted, but described as returning to normal with the utilization of a larger (apparently more appropriate) cuff The QTC examiner in 2001 indicated that the veteran had no pathology to render a diagnosis at that time. The veteran was not taking any medication and the blood pressure readings were normal at that time. These finding are not contradicted by any other medical evidence of record. The June 2005 QTC examination report shows blood pressure readings within normal limits. As there is no evidence of current disabilities, the Board will not address the remaining elements outlined in Hickson. Accordingly, the Board concludes that the preponderance of the evidence is against the claims for service connection for sinus bradycardia and hypertension. General criteria for higher ratings Disability evaluations are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity in civil occupations. See 38 U.S.C.A. § 1155. Separate diagnostic codes identify the various disabilities. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). The Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. See also Fenderson v. West, 12 Vet. App. 119 (1999) concerning initial and staged ratings. The lay statements are considered to be competent evidence when describing symptoms of a disease or disability. However, these statements regarding the severity of the appellant's symptoms must be viewed in conjunction with the objective medical evidence of record and the pertinent rating criteria. Entitlement to a higher evaluation for sinusitis Based on inservice treatment for sinusitis and post service X-ray evidence of maxillary sinusitis the RO, in a May 2002 rating action granted service connection for maxillary sinusitis. A noncompensable disability evaluation was assigned. Under Diagnostic Code 6513, a noncompensable evaluation is warranted when sinusitis is detected by X-ray only. A 10 percent evaluation is warranted for one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis manifested by headaches, pain, and purulent discharge or crusting. A note following this section provides that an incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. In considering the criteria, the evidence does not show that he would meet the requirement of one or two incapacitating episodes per year of sinusitis. The evidence shows that the sinus condition has ever been described as incapacitating. There is no evidence in the medical records of the veteran undergoing antibiotic treatment. Further, it has not been shown that he has one or two non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge, or crusting. A review of the record does not show that these symptoms have been attributed to his sinusitis. An X-ray in November 2001 noted maxillary sinusitis. Significantly, since then, there have been no significant abnormalities noted in the sinuses. Besides erythema in the right nostril, the sinus examination conducted in June 2005 was normal including X-ray study. The medical evidence shows that during this period of time, the veteran's sinusitis has been, for the most part, asymptomatic. Therefore, based on review of the record, the Board finds that the evidence approximates a noncompensable disability evaluation. Entitlement to a higher evaluation for recurrent headaches Based on inservice treatment for headaches, the May 2002 rating action granted service connection for recurrent headaches. A 10 percent disability was assigned. The appellant's service-connected headache disability is evaluated by analogy to migraine headaches under Diagnostic Code 8100. Migraine headaches, with characteristic prostrating attacks occurring on the average of once a month over the last several months, a 30 percent rating is to be assigned. A 10 percent evaluation is appropriate with characteristic prostrating attacks averaging one in two months over the last several months. With less frequent attacks, a noncompensable rating is to be assigned. 38 C.F.R. Part 4, § 4.124, Diagnostic Code 8100. Under this code, migraines are rated based on the frequency and severity of such attacks as well as any resulting economic impairment. The veteran reported at the November 2001 QTC examinations that his headaches occurred 3-4 times a month, which lasted 30 to 45 minutes. He could not identify anything that triggered his headaches. His headaches were relieved by rest. He was not taking any medication. In June 2005, he reported that his headaches were associated with his sinus infections. He averaged headaches every 4 days that lasted 20-30 minutes. He was unable to remember the medication that he was taking for the relief of his headaches. The reports regarding the frequency and severity of headaches are primarily, if not exclusively, subjective in nature. While a September 2003 clinical note from the Naval Medical Clinic shows that the veteran was given Motrin for his headaches, there is no indication in the clinical records that the veteran stayed in bed or was otherwise incapacitated for prolonged or frequent periods due to his service-connected headaches. There are no clinical records demonstrating such a degree of impairment. Characteristic prostrating attacks have not been diagnosed. The Board notes that a veteran is not required to seek treatment. However, the nature and type of treatment may be for consideration in an appropriate case. The veteran's statements and medical reports form a preponderance of evidence which demonstrates that his headaches most closely approximate the criteria for the current 10 percent rating and do not approximate the characteristic prostrating attacks occurring on the average of once a month that are required for the next higher rating. 38 C.F.R. § 4.7. A higher evaluation for recurring headaches in not warranted. Entitlement to a higher evaluation for chronic strain of the lumbosacral spine Based on in-service medical care and VA examination, service connection was granted for chronic strain of the lumbosacral spine in the May 2002 rating action. A 10 percent evaluation was assigned. The veteran filed his claim in May 2001. The regulations for evaluation of certain disabilities of the spine, including intervertebral disc syndrome, were revised, effective on September 23, 2002. Additional revisions were made to the evaluation criteria for disabilities of the spine, as well as re-numbering-effective on September 26, 2003-for purposes of updating the rating schedule with current medical terminology and unambiguous criteria to reflect medical advances since last reviewed. (Former Diagnostic Code 5295 is now Diagnostic Code 5237). It should be pointed out that the revised rating criteria may not be applied to a claim prior to the effective date of the amended regulation. See 38 U.S.C.A. § 5110(g); Rhodan v. West, 12 Vet. App. 55 (1998). Diagnostic Code 5295 was designated for lumbosacral strain. Under this diagnostic code a noncompensable rating was warranted for lumbosacral strain where there are only slight subjective symptoms. A 10 percent evaluation required characteristic pain on motion. A 20 percent rating was warranted for lumbosacral strain where there was muscle spasm on extreme forward bending and unilateral loss of lateral spine motion in a standing position. 38 C.F.R. § 4.71a, Diagnostic Code 5295. 38 C.F.R. § 4.71a, Diagnostic Code 5292 provided that slight limitation of motion of the lumbar spine warranted an evaluation of 10 percent. Moderate limitation of motion warranted an evaluation of 20 percent. Ankylosis of the lumbar segment of the spine at a favorable angle warranted a 40 percent evaluation. A 50 percent evaluation required fixation at an unfavorable angle. 38 C.F.R. Part 4, Diagnostic Code 5289. Functional loss, supported by adequate pathology and evidenced by visible behavior of the veteran undertaking the motion, is recognized as resulting in disability. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.10, 4.40, 4.45. The new regulations provide the following rating criteria: a 20 percent evaluation is appropriate where there is forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 38 C.F.R. § 4.71a, Diagnostic Code 5237 (effective September 26, 2003). A note (2) to this code indicates that for VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, and left and right lateral rotations are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. The Board points out that nowhere is it indicated that the veteran had unilateral loss of lateral spine motion that would be required by Diagnostic Code 5295 for a higher evaluation. The June 2005 QTC examination showed evidence of paravertebral muscle spasm but the reports failed to show any evidence of loss of lateral spine motion in any anatomical position. Furthermore, the reported findings approximate no more than slight limitation of motion. The medical records show that the veteran's lumbar spine motion was decreased to 90 degrees of flexion in November 2001. In June 2005, the range of motion study showed that he had 65 degrees of flexion and 0- 30 degrees of extension, bilateral lateral flexion, and bilateral rotation. This evidence does not support the assignment of a higher disability evaluation under limitation of motion criteria. Still further, the pain on use of his back which the veteran described to examiners was, the Board finds, adequately and appropriately compensated at the 10 percent level and did not warrant an evaluation in excess of 10 percent under 38 C.F.R. §§ 4.40, 4.45, or DeLuca, supra. The examiner at the June 2005 examination noted that the veteran continued to experience severe low back pain. Significantly, there were no postural abnormalities, fixed deformity, weakness, tenderness or lack of endurance or incoordination. X-rays were negative. Motor and sensory functions were normal. The examiner specifically noted that there was no evidence of intervertebral syndrome. The complaints and findings recorded during this period are consistent with not more than slight limitation of motion. Therefore, the Board does not find that a higher evaluation is warranted under the old regulations. In regard to the new regulations, the Board does not find that the veteran's lumbosacral strain exceeds the 10 percent when rated under the new Diagnostic Code 5237. The veteran's forward flexion during this time period varied from 65 to 90 degrees. Therefore, a higher rating is not warranted based on range of motion. In regard to muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis, as noted there has been no evidence of muscle spasm. QTC examinations reports indicate that his posture is erect and his gait is normal. Furthermore, there has never been any evidence of reversed lordosis, or abnormal kyphosis. Moreover, the new General Rating Formula for Diseases and Injuries of the Spine now contemplates symptoms such as pain. So entitlement to an evaluation in excess of 10 percent for his lumbosacral spine disability under Diagnostic Code 5237 is not warranted. The Board has considered the possibility of a rating in excess of 10 percent under other potentially applicable diagnostic codes including those that take in consideration ankylosis and intervertebral disc syndrome. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). However, there is no evidence of these manifestations. After consideration of all of the evidence, the Board finds that the preponderance of the evidence is against the claim for the assignment of a higher evaluation. Entitlement to a higher evaluation for status post right knee meniscectomy The service medical records relate that lateral and medial partial meniscectomy was performed in March 1990. Based on inservice right knee partial meniscectomy, service connection was granted in the May 2002 rating action. A 10 percent disability was assigned. The disability is rated under Diagnostic Codes 5257. Knee impairment with recurrent subluxation and lateral instability is rated 20 percent when moderate and 30 percent when severe. The 10 percent rating is for slight knee subluxation and lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Reconciling the various reports, the veteran's primary complaints are pain, instability, swelling, stiffness, and locking, such that his physical activity is reduced because of his knee. As noted, however, objective findings reveal no more than slight knee impairment. As noted, under Diagnostic Code 5257, moderate recurrent subluxation or lateral instability is indicative of a 20 percent disability evaluation. However, the veteran does not have moderate instability of his right knee. In fact there is no evidence of instability or subluxation. The November 2001 and June 2005 QTC examination reports show that the drawer and McMurray tests were normal. The examiners indicated that there was no evidence of instability. Therefore, a 20 percent rating is not warranted under Diagnostic Code 5257. Under Diagnostic Code 5259, which refers to removal of semi lunar cartilage of the knee. The regulation provides a 10 percent rating for symptomatic removal of the semi lunar cartilage. The examination reports include findings, which may be manifestations of symptomatic removal of the semi lunar cartilage. However, as the veteran is currently rated 10 percent this Diagnostic Code does not provide for a higher rating. As the veteran underwent surgery during service the Board has also considered whether the surgical scars warrant separate compensable evaluations. The rating schedule provides a compensable rating for superficial scars when there is evidence of tenderness and pain on objective demonstration (10 percent) or limitation of function of the part affected. See 38 C.F.R. § 4.118, Diagnostic Codes 7804, 7805. The record as a whole does not show that the post surgical scars are productive of any significant functional impairment, nor otherwise disabling. As the scars have not been shown to result in functional limitation of the right knee, a separate rating is not warranted. See Esteban v. Brown, 6 Vet. App. 259 (1994). Consequently, the preponderance of evidence is against the claim for a higher rating. 38 U.S.C.A. § 5107. Entitlement to a higher evaluation for degenerative joint disease of the right knee The November 2001 QTC X-ray study revealed degenerative osteoarthritis of the right knee. As arthritis and instability of the knee may be rated separately the RO in the May 2002 rating action assigned a separate 10 percent rating for degenerative joint disease of the right knee. See Esteban, Id. Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriated diagnostic codes for the specific joint or joints involved. 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, a 10 percent evaluation will be assigned where there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups. A 20 percent evaluation will be assigned where there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. 38 C.F.R. 4.71a, Diagnostic Code 5003. Limitation of extension of the leg to 5 degrees is rated 0 percent. Extension limited to 10 degrees warrants a 10 percent evaluation. Extension limited to 15 degrees warrants a 20 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Limitation of flexion of a leg to 60 degrees is rated 0 percent. Flexion limited to 45 degrees warrants a 10 percent evaluation, and flexion limited to 30 degrees warrants a 20 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5260. 38 C.F.R. § 4.71, Plate II shows that normal flexion and extension of the knee is from 0 degrees to 140 degrees. The Board does not find that his manifestations warrant a higher evaluation. Although X-rays confirmed the presence of arthritis, there was no impairment in range of motion with flexion to 140 in the right knee. Extension was normal in the right knee. Additionally, there was no reported evidence of warmth, redness, effusion, or locking. There was no reported impairment in the veteran's gait. The Board has considered pain-related functional impairment as set forth in the DeLuca case. The QTC examiner in 2001 indicated that there was no limitation of function on standing or walking. There was no heat, redness, swelling effusion, drainage, abnormal movement, or weakness. Examination of the feet revealed no abnormal signs of weight bearing. The QTC examiner in 2005 added that there was no locking pain, effusion or crepitus. The joint was not limited by pain, fatigue, weakness, lack of endurance, or incoordination. Taking into consideration the veteran's statements regarding pain and the QTC examiners remarks concerning functional loss, the Board concludes that the current 10 percent rating under Diagnostic Code 5010, plus the separate rating under Diagnostic Code 5257, encompasses the degree of functional loss due to pain exhibited by the veteran. ORDER Service connection for sinus bradycardia is denied. Service connection for hypertension is denied. An initial evaluation in excess of 0 percent for sinusitis is denied. An initial evaluation in excess of 10 percent for recurrent headaches is denied. An initial evaluation in excess of 10 percent for the residuals of lumbosacral strain is denied. An initial evaluation in excess of 10 percent for status post right knee menisectomy is denied. An initial evaluation in excess of 10 percent for degenerative joint disease of the right knee is denied. ____________________________________________ MICHAEL D. LYON Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs