Citation Nr: 1000892 Decision Date: 01/07/10 Archive Date: 01/15/10 DOCKET NO. 05-23 001 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to an initial rating in excess of 10 percent for service-connected peripheral neuropathy with peripheral vascular disease of the right lower extremity for the portion of the appeal prior to March 17, 2008. 2. Entitlement to an initial rating in excess of 10 percent for service-connected peripheral neuropathy with peripheral vascular disease of the left lower extremity for the portion of the appeal prior to March 17, 2008. 3. Entitlement to an initial rating in excess of 40 percent for service-connected peripheral neuropathy with peripheral vascular disease of the right lower extremity for the portion of the appeal beginning March 17, 2008. 4. Entitlement to an initial rating in excess of 40 percent for service-connected peripheral neuropathy with peripheral vascular disease of the left lower extremity for the portion of the appeal beginning March 17, 2008. 5. Entitlement to a rating in excess of 30 percent for service-connected bilateral hearing loss. 6. Entitlement to an initial compensable rating for diabetic retinopathy of both eyes. 7. Entitlement to an initial compensable rating for erectile dysfunction. 8. Entitlement to a rating in excess of 20 percent for service-connected diabetes mellitus type II. 9. Entitlement to a rating in excess of 10 percent for chronic synovitis with degenerative changes of the left knee. 10. Entitlement to a rating in excess of 10 percent for chronic synovitis with degenerative changes of the right knee. 11. Entitlement to a rating in excess of 10 percent for chronic lumbosacral strain. 12. Entitlement to an earlier effective date for service connection of diabetes mellitus type II. 13. Entitlement to an earlier effective date for the award of an 100 percent disability rating for service-connected posttraumatic stress disorder (PTSD). 14. Entitlement to an earlier effective date for the award of service connection for bilateral hearing loss. 15. Entitlement to an earlier effective date for the award of special monthly compensation based on housebound status. 16. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for a shrapnel injury to the left leg. 17. Entitlement to service connection for arthritis of the lumbar spine. 18. Entitlement to service connection for loss of teeth due to pyorrhea, to include as secondary to service-connected diabetes mellitus type II. 19. Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus type II. 20. Entitlement to service connection for chloracne, to include as due to Agent Orange exposure. 21. Entitlement to service connection for purigo modularis, to include as due to Agent Orange exposure. 22. Entitlement to service connection for urticaria, to include as due to Agent Orange exposure. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD E. McGuire, Associate Counsel INTRODUCTION The Veteran served on active duty from September 1966 to September 1969. This matter is before the Board of Veterans' Appeals (Board) from a June 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. FINDINGS OF FACT 1. For the portion of the appeal period prior to March 17, 2008, the symptomatology associated with the Veteran's peripheral neuropathy with peripheral vascular disease of the right and left lower extremities does not show an overall disability picture that more closely approximates moderate incomplete paralysis of the sciatic nerve. 2. From March 17, 2008, the symptomatology associated with the Veteran's peripheral neuropathy with peripheral vascular disease of the right and left lower extremities does not show an overall disability picture that more closely approximates severe incomplete paralysis of the sciatic nerve with marked muscular atrophy. 3. In a letter dated in July 2009, the Veteran's representative withdrew from appellate consideration the issues of entitlement to an increased rating for bilateral hearing loss, an initial compensable rating for diabetic retinopathy of both eyes, an initial compensable rating for erectile dysfunction, an increased rating for diabetes mellitus, an increased rating for a left knee disability, an increased rating for a right knee disability, an increased rating for lumbosacral strain, an earlier effective date for service connection of diabetes mellitus, an earlier effective date for an 100 percent rating for PTSD, an earlier effective date for service connection of bilateral hearing loss, an earlier effective date for the award of special monthly compensation based on housebound status, service connection for arthritis of the lumbar spine, service connection for loss of teeth due to pyorrhea, service connection for hypertension, service connection for chloracne, service connection for purigo modularis, service connection for urticaria, as well as the issue of whether new and material evidence had been submitted to reopen a claim of entitlement to service connection for residuals of a shrapnel injury to the left leg. CONCLUSIONS OF LAW 1. The criteria for an initial evaluation higher than 10 percent for service-connected peripheral neuropathy with peripheral vascular disease for the right lower extremity have not been met or approximated for the portion of the appeal period prior to March 17, 2008. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.104, 4.123, 4.124a, Diagnostic Codes 8620 & 7114 (2009). 2. The criteria for an initial evaluation higher than 10 percent for service-connected peripheral neuropathy with peripheral vascular disease for the left lower extremity have not been met or approximated for the portion of the appeal period prior to March 17, 2008. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.104, 4.123, 4.124a, Diagnostic Codes 8620 & 7114 (2009). 3. The criteria for an initial evaluation higher than 40 percent for service-connected peripheral neuropathy with peripheral vascular disease for the right lower extremity have not been met or approximated for the portion of the appeal period from March 17, 2008. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.104, 4.123, 4.124a, Diagnostic Codes 8620 & 7114 (2009). 4. The criteria for an initial evaluation higher than 40 percent for service-connected peripheral neuropathy with peripheral vascular disease for the left lower extremity have not been met or approximated for the portion of the appeal period from March 17, 2008. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.104, 4.123, 4.124a, Diagnostic Codes 8620 & 7114 (2009). 5. The criteria for withdrawal of a substantive appeal by the Veteran have been met in regard to the issues of entitlement to an increased rating for bilateral hearing loss, an initial compensable rating for diabetic retinopathy of both eyes, an initial compensable rating for erectile dysfunction, an increased rating for diabetes mellitus, an increased rating for a left knee disability, an increased rating for a right knee disability, an increased rating for lumbosacral strain, an earlier effective date for service connection of diabetes mellitus, an earlier effective date for an 100 percent rating for PTSD, an earlier effective date for service connection of bilateral hearing loss, an earlier effective date for the award of special monthly compensation based on housebound status, service connection for arthritis of the lumbar spine, service connection for loss of teeth due to pyorrhea, service connection for hypertension, service connection for chloracne, service connection for purigo modularis, service connection for urticaria, as well as the issue of whether new and material evidence had been submitted to reopen a claim of entitlement to service connection for residuals of a shrapnel injury to the left leg. 38 U.S.C.A. § 7105(b)(2) (West 2002); 38 C.F.R. §§ 20.202, 20.204 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Withdrawal of Appeals A substantive appeal may be withdrawn in writing at any time before the Board promulgates a decision. 38 C.F.R. § 20.202. Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.204. In June 2005, the Veteran filed a VA Form 9, indicating that he wished to appeal all 22 issues adjudicated in a May 2005 statement of the case. In a July 2009 letter, the Veteran's representative stated that the Veteran only wanted to appeal the evaluations assigned to the peripheral neuropathy of the lower extremities. The representative stated that the Veteran did not intend to appeal the other issues listed on the May 2005 statement of the case. Accordingly, the Board does not have jurisdiction to review the noted issues, and the appeal is dismissed insofar as those issues are concerned. II. Veterans Claims Assistance Act of 2000 The Veterans Claims Assistance Act of 2000 (VCAA) imposes obligations on VA with respect to its duty to notify and assist a claimant in developing a claim. 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2009). Under the VCAA, upon receipt of a complete or substantially complete application for benefits, VA is required to notify the Veteran and his representative, if any, of any information and medical or lay evidence necessary to substantiate the claim. The United States Court of Appeals for Veterans Claims (Court) has held that these notice requirements apply to all five elements of a service connection claim, which include: (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. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VA law and regulations also indicate that part of notifying a claimant of what is needed to substantiate a claim includes notification as to what information and evidence VA will seek to provide and what evidence the claimant is expected to provide. 38 U.S.C.A. § 5103 (West 2002); 38 C.F.R. § 3.159(a)-(c) (2009). VCAA notice must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004). The Board finds that the requirements of the VCAA have been met and that VA has no further duty prior to Board adjudication. The RO originally provided VCAA notice to the Veteran in correspondence dated in December 2003. In that letter, the RO advised the Veteran of what the evidence must show to establish entitlement to service-connected compensation benefits. The RO advised the Veteran of VA's duties under the VCAA and the delegation of responsibility between VA and the Veteran in procuring the evidence relevant to the claims, including which portion of the information and evidence necessary to substantiate the claims was to be provided by the Veteran and which portion VA would attempt to obtain on behalf of the Veteran. The RO sent a similar letter in January 2004. In a correspondence dated in March 2008, the RO also informed the Veteran that when service connection is granted, a disability rating and effective date of the award is assigned. The RO explained how the disability rating and effective date are determined. Although the AOJ did not provide fully compliant notice until after initial adjudication of the claims, it readjudicated the claims and issued a supplemental statement of the case and a decision review officer decision in July 2009. The issuance of such notice followed by readjudication of the claims remedied any timing defect with respect to issuance of compliant notice. See Prickett v. Nicholson, 20 Vet. App. 370, 376-77 (2006). The Board finds that in issuing this letter, the RO has satisfied the requirements of Dingess/Hartman. Here, the Veteran is challenging initial evaluations assigned following the grant of service connection. In Dingess, the Court of Appeals for Veterans Claims 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. Therefore, VA's duty to notify as to the issues on appeal has been satisfied. The scope of VA's duty to assist will depend on the facts and circumstances of an individual case, but typically, the duty to assist requires VA to obtain relevant records from federal agencies, to make reasonable efforts to obtain relevant records not in the custody of federal agencies, and in certain circumstances, to provide a medical examination or obtain a medical opinion. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2009). The RO has also satisfied VA's duty to assist. The RO has obtained the Veteran's service treatment records and VA medical center (VAMC) treatment records. The Veteran was afforded examinations with regard to the issues on appeal in May 2005 and March 2008. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As noted below, the Board finds that the May 2005 and March 2008 VA examinations obtained in this case is adequate. While the VA examiners did not specifically state that they reviewed the claims file, they demonstrated his familiarity with the Veteran's pertinent medical history in detailed examination reports, which included descriptions of the interview with and examination of the Veteran. The examination reports adequately reflect the current severity of the disabilities on appeal. The Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion for the issues on appeal has been met. 38 C.F.R. § 3.159(c) (4). Lastly, the Veteran has not made the RO or the Board aware of any other evidence relevant to his appeal, and no further development is required to comply with the duty to assist the Veteran in developing the facts pertinent to his claims. Accordingly, the Board will proceed with appellate review. III. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. When the initial evaluation is at issue, the Board must assess the entire period since the original claim was filed. Fenderson v. West, 12 Vet. App. 119 (1999). If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. When the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings, the Board must assign staged ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007) (finding that there was no basis for drawing a distinction between initial ratings and increased-rating claims for the purpose of applying staged ratings). Individual disabilities are assigned separate diagnostic codes. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Legal Criteria and Analysis In a June 2004 rating decision, the RO originally granted service connection and separate 10 percent ratings, effective July 11, 2003, the date of the claim for service connection, for peripheral neuropathy of the lower extremities. The RO also granted service connection for peripheral vascular disease of the lower extremities, assigning noncompensable ratings, in the same decision. In a July 2009 supplemental statement of the case, the RO combined the two disabilities and granted separate 40 percent ratings for peripheral neuropathy with peripheral vascular disease of the right and left lower extremities, effective March 17, 2008, the date of a VA examination. Peripheral neuropathy is not specifically listed in the rating schedule; therefore, it is rated analogously to a disability in which not only the functions affected, but anatomical localization and symptoms, are closely related. 38 C.F.R. § 4.20. The Veteran's peripheral neuropathy of the lower extremities is rated by analogy to incomplete paralysis of the sciatic nerve under Diagnostic Code 8520. Under Diagnostic Code 8520, moderate incomplete paralysis of the sciatic nerve warrants a 20 percent evaluation, moderately severe incomplete paralysis of the sciatic nerve warrants a 40 percent evaluation, and severe (with marked muscular atrophy) incomplete paralysis of the sciatic nerve warrants a 60 percent evaluation. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The term "incomplete paralysis," with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied levels of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings are combined with application of the bilateral factor. Id. Furthermore, neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at time excruciating, is to be rated at a maximum equal to severe, incomplete, paralysis. 38 C.F.R. § 4.123. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. Id. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, is to be rated with a maximum equal to moderate incomplete paralysis. 38 C.F.R. § 4.124. The Veteran has demonstrated poor peripheral pulses, which has been analyzed as peripheral vascular disease under Diagnostic Code 7114. 38 C.F.R. § 4.104. Under Diagnostic Code 7114, a claudication on walking more than 100 yards, and; diminished peripheral pulses or ankle/brachia index of 0.9 or less warrant a 20 percent rating. Claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes (thin skin, absence of hair, dystrophic nails) or ankle/brachial index of 0.7 or less warrant a 40 percent rating. A 60 percent rating requires claudication on walking less than 25 yards on a level grade at 2 miles per hour, and; either persistent coldness of the extremity or ankle/brachial index of 0.5 or less. A 100 percent rating is warranted for ischemic limb pain at rest, and; either deep ischemic ulcers or ankle/brachial index of 0.4 or less. 38 C.F.R. § 4.104, Diagnostic Code 7114. The notes associated with this diagnostic code are set out as follows: Note (1): The ankle/brachial index is the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure. The normal index is 1.0 or greater. Note (2): Evaluate residuals of aortic and large arterial bypass surgery or arterial graft as arteriosclerosis obliterans. Note (3): These evaluations are for involvement of a single extremity. If more than one extremity is affected, evaluate each extremity separately and combine (under § 4.25) using the bilateral factor (§ 4.26) if applicable. Id. Prior to March 17, 2008 During a May 2005 VA examination, the Veteran reported numbness in his feet. He stated that he is able to walk short distances of a few feet at a slow pace, with no limitation of motion. The VA examiner noted no evidence of muscle atrophy, contractures, weakness, or lack of coordination. Reflexes of the lower extremities were normal. There was slightly diminished sensory perception on irregular patches of both feet. Pedal pulses were intact, and dorsalis pedis and posterior tibial pulses were palpable on both sides. The VA examiner noted mild peripheral neuropathy compatible with diabetic neuropathy. Upon VA examination for aid and attendants in October 2005, the VA examiner confirmed the diagnosis of peripheral neuropathy of the lower extremities compatible with diabetic type. The examiner also noted some mild atrophy of the muscles of the legs, along with hyperpigmentation and macular skin discoloration scattered all over the anterior tibial areas. There was discoloration and atrophy in the feet. An October 2005 VAMC treatment note reveals diminished or absent right and left pedal pulses. In a December 2005 VAMC treatment note, the Veteran underwent a fall clinic evaluation and reported sensory difficulties in his feet. He reported a history of falls for the previous three months. The May 2005 VA examiner described the Veteran's neuropathy as mild. There are no subsequent clinical findings in the treatment records of VA examination reports that indicate or suggest any change in this assessment for the appeal period in question. Thus, the Board finds that the Veteran's peripheral neuropathy of the lower extremities was manifested by sensory and motor deficits that more nearly approximate mild incomplete paralysis of the sciatic nerve prior to March 17, 2008. Accordingly, he is not entitled to a rating in excess of 10 percent under Diagnostic Code 8520. Diagnostic Code 7114 also does not provide for a higher rating. Although there was evidence of diminished pedal pulses and trophic changes, an increased rating under Diagnostic Code 7114 is not warranted because there were no findings of claudication. 38 C.F.R. § 4.124a. From March 17, 2008 The Veteran underwent a VA examination on March 17, 2008. The Veteran reported that he could walk no more than five feet without having to rest. He also reported lower leg and foot pain. The examiner stated it was not possible beyond speculation to dissect neuropathy symptoms from those that might be developing from peripheral vascular disease of the lower extremities. Because the Veteran was unable to walk more than five feet, the examiner could not say with any certainty that the Veteran had claudication. The examiner noted no popliteal, dorsalis pedis or posterior tibial pulses in either lower extremity. The lower legs and feet were warm with no unusual swelling or pretibial edema, or evidence of ulceration or breakdown of the skin. Neurological examination confirmed a zone of decreased sensation in both lower extremities. The examiner stated that the findings indicated peripheral vascular disease, and he noted the presence of peripheral sensory neuropathy. A May 2008 VAMC ankle/brachial index (ABI) study revealed ankle brachial indices of 1.22 on the right and 1.19 on the left, slightly higher than normal and suggesting possible non compressible vessels due to diabetes. However, pulse volume recordings were fairly normal at all levels; there was no significant occlusive disease in the major vessels of the lower extremity. In the report of a September 2008 aid and attendants examination, the VA examiner diagnosed severe lower peripheral sensory neuropathy and suspected, not confirmed, peripheral vascular disease, stating that the findings on examination would not at least as likely as not cause claudication. Thus, beginning March 17, 2008, the medical evidence shows that the Veteran's peripheral neuropathy of the lower extremities increased in severity as characterized by worsening sensory disturbance, decreased sensation, pain, and higher than normal ABI levels. The Board notes that the September 2008 VA examiner diagnosed severe lower peripheral sensory neuropathy. However, after consideration of the symptomatology demonstrated by the Veteran during the time relevant to this portion of the appeal period, the Board finds that the disability picture more closely approximates moderately severe impairment of the sciatic nerve warranting the currently assigned rating of 40 percent for each extremity beginning March 17, 2008. In this regard, the Board has considered whether the Veteran is entitled to the next higher rating of 60 percent for his claimed disabilities. However, the criteria specifically contemplate evidence of marked muscular atrophy. While the Veteran has shown some decreased muscle strength in both lower extremities, there is no evidence of marked muscle atrophy in either extremity. Thus, the next higher evaluation of 60 percent is not warranted for peripheral neuropathy at any time relevant to this portion of the appeal period. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Diagnostic Code 7114 also would not provide for a rating in excess of 4- percent because there were no findings of claudication or an ABI of 0.4 or less. Further, the March 2008 VA examiner specifically noted that the Veteran's legs and feet were warm. 38 C.F.R. § 4.104. Consideration has been given to the potential application of the various provisions of 38 C.F.R. § Parts 3 and 4, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). However, a review of the record fails to reveal any additional functional impairment associated with the Veteran's claimed disabilities that warrants further consideration of alternate rating codes. The Board notes that there is no evidence of record that the Veteran's peripheral neuropathy of the lower extremities warrants higher ratings on an extraschedular basis for any time during the appeal period. 38 C.F.R. § 3.321(b). See Id., see also Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996); and Floyd v. Brown, 9 Vet. App. 88, 96 (1996). The currently assigned ratings more than adequately address the Veteran's disability level and symptomatology. The Board is not required to remand this matter to the RO for the procedural actions outlined in 38 C.F.R. § 3.321(b)(1) for assignment of an extraschedular evaluation. Id. Thus, for the foregoing reasons, the Board finds that the preponderance of the evidence weighs against the assignment of ratings higher than the previously assigned 10 and 40 percent for the two appeal periods in question, and consequently, the benefit of the doubt doctrine is not applicable. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Furthermore, the Board has considered whether staged ratings are warranted in this case; the factual findings do show distinct time periods where the Veteran's peripheral neuropathy exhibited symptoms that warranted different ratings. See Hart, supra. Where warranted, staged ratings have been assigned. ORDER Entitlement to an initial evaluation in excess of 10 percent for service-connected peripheral neuropathy with peripheral vascular disease for the right lower extremity for the portion of the appeal period prior to March 17, 2008 is denied. Entitlement to an initial evaluation in excess of 10 percent for service-connected peripheral neuropathy with peripheral vascular disease for the left lower extremity for the portion of the appeal period prior to March 17, 2008 is denied. Entitlement to an initial evaluation in excess of 40 percent for service-connected peripheral neuropathy with peripheral vascular disease for the right lower extremity for the portion of the appeal period from March 17, 2008 is denied. Entitlement to an initial evaluation in excess of 40 percent for service-connected peripheral neuropathy with peripheral vascular disease for the left lower extremity for the portion of the appeal period from March 17, 2008 is denied. The appeal of the claims for entitlement to an increased rating for bilateral hearing loss, an initial compensable rating for diabetic retinopathy of both eyes, an initial compensable rating for erectile dysfunction, an increased rating for diabetes mellitus, an increased rating for a left knee disability, an increased rating for a right knee disability, an increased rating for lumbosacral strain, an earlier effective date for service connection of diabetes mellitus, an earlier effective date for an 100 percent rating for PTSD, an earlier effective date for service connection of bilateral hearing loss, an earlier effective date for the award of special monthly compensation based on housebound status, service connection for arthritis of the lumbar spine, service connection for loss of teeth due to pyorrhea, service connection for hypertension, service connection for chloracne, service connection for purigo modularis, service connection for urticaria, as well as the issue of whether new and material evidence had been submitted to reopen a claim of entitlement to service connection for residuals of a shrapnel injury to the left leg, has been withdrawn and is therefore dismissed. ____________________________________________ LANA K. JENG Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs