Citation Nr: 1037048 Decision Date: 09/30/10 Archive Date: 10/05/10 DOCKET NO. 06-30 925 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for bilateral plantar warts. 2. Entitlement to service connection for fungus of the fingers and toes. 3. Entitlement to an initial rating in excess of 30 percent for migraine headaches, for the period from June 1, 2004 to March 24, 2005. 4. Entitlement to a rating in excess of 30 percent for migraine headaches, for the period from March 25, 2005, to the present. 5. Entitlement to an initial compensable rating for internal hemorrhoids, for the period from June 1, 2004 to October 1, 2004. 6. Entitlement to a compensable rating for internal hemorrhoids, for the period from October 2, 2004 to the present. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Timothy D. Rudy, Counsel INTRODUCTION The Veteran served on active duty from July 1981 to December 1982, and from October 1985 to May 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2005 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The Board notes that other issues the Veteran appealed in her August 2005 Notice of Disagreement were resolved in her favor in a June 2006 rating decision and are no longer on appeal. The issues of entitlement to an rating in excess of 30 percent for migraine headaches, for the period from March 25, 2005, to the present, and entitlement to a compensable rating for internal hemorrhoids, for the period from October 2, 2004, to the present, are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, D.C. FINDINGS OF FACT 1. The evidence of record does not show that the Veteran currently has any diagnosed bilateral plantar warts. 2. The evidence of record does not show that the Veteran currently has any diagnosed fungus of the fingers and toes. 3. For the period from June 1, 2004 to March 24, 2005, the evidence does not show that the Veteran's migraine headaches are characterized by very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability. 4. For the period from June 1, 2004 to October 1, 2004, the Veteran's internal hemorrhoid disability is not manifested by large or thrombotic, irreducible internal or external hemorrhoids with excessive redundant tissue evidencing frequent recurrences. CONCLUSIONS OF LAW 1. Bilateral plantar warts was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002 & Supp. 2009); 38 C.F.R. § 3.303 (2009). 2. Fungus of the fingers and toes was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002 & Supp. 2009); 38 C.F.R. § 3.303 (2009). 3. The criteria for an initial rating in excess of 30 percent for migraine headaches, for the period from June 1, 2004 to March 24, 2005, are not met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.7, 4.124a, Diagnostic Code 8100 (2009). 4. The criteria for an initial compensable rating for internal hemorrhoids, for the period from June 1, 2004 to October 1, 2004, are not met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.114, Diagnostic Code 7336 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VCAA The provisions of the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) and as interpreted by the United States Court of Appeals for Veterans Claims (the Court), have been fulfilled by information provided to the Veteran in letters from the RO dated in August 2004 and October 2004. These letters notified the Veteran of VA's responsibilities in obtaining information to assist the Veteran in completing her claims, and identified the Veteran's duties in obtaining information and evidence to substantiate her claims. (See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a), Quartuccio v. Principi, 16 Vet. App. 183 (2002), Pelegrini v. Principi, 18 Vet. App. 112 (2004). See also Mayfield v. Nicholson, 19 Vet. App. 103, 110 (2005), reversed on other grounds, 444 F.3d 1328 (Fed. Cir. 2006), Dingess/Hartman v. Nicholson, 20 Vet. App. 473 (2006); Mayfield v. Nicholson (Mayfield II), 20 Vet. App. 537 (2006)). Thereafter, the Veteran was granted service connection and assigned an initial disability rating and effective date for migraine headaches and for internal hemorrhoids. As these claims were more than substantiated in that they were proven, section 5103(a) notice is no longer required because the purpose that the notice is intended to serve has been fulfilled. Dingess/Hartman, 19 Vet. App. at 490-91. Thus, since the August 2004 and October 2004 letters that were provided before service connection was granted were legally sufficient, the Board finds that VA's duty to notify has been satisfied as to Veteran's headache and hemorrhoid claims. During the pendency of this appeal, the Court in Dingess/Hartman found that the VCAA notice requirements applied to all elements of a claim. An additional notice as to disability ratings and effective dates was not provided to the Veteran; however, this deficiency is not shown to prejudice the Veteran. Because in the decision herein, the Board denies the Veteran's claims for service connection and higher ratings, no effective date is being, or will be assigned; accordingly, there is no possibility of prejudice to the Veteran under the notice requirements of Dingess/Hartman. In any event, the Veteran has neither alleged nor demonstrated any prejudice with regard to the content or timing of the notices. See Shinseki v. Sanders, 129 S.Ct. 1696 (2009) (reversing prior case law imposing a presumption of prejudice on any notice deficiency, and clarifying that the burden of showing that an error is harmful, or prejudicial, normally falls upon the party attacking the agency's determination). In view of the above, the Board finds that the notice requirements pertinent to the issues on appeal have been met. The duty to assist also has been fulfilled as pertinent medical records have been requested and obtained and the Veteran was provided with a VA examination. The Board finds that the available medical evidence is sufficient for an adequate determination. There has been substantial compliance with all pertinent VA laws and regulations and to move forward with the claims decided herein would not cause any prejudice to the Veteran. Service Connection - Laws and Regulations Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in line of duty or for aggravation of preexisting injury suffered or disease contracted in line of duty. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2009). In addition, service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). For the showing of chronic disease in service, there are required a combination of manifestations sufficient to identify a disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. Continuity of symptomatology is required only where the condition noted during service is not, in fact, shown to be chronic or when the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Generally, in order to prevail on the issue of service connection on the merits, there must be medical evidence of (1) 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 present disease or injury. Hickson v. West, 12 Vet. App. 247, 253 (1999). The Federal Circuit has held that a veteran seeking disability benefits must establish the existence of a disability and a connection between service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). Bilateral Planter Warts and Fungus, Fingers and Toes The Veteran seeks service connection for bilateral plantar warts and for fungus on her fingers and toes. Service treatment records indicated that a large blister on the left heel was noted in February 1990. A February 1994 service treatment record showed that the Veteran complained of an approximately one-year history of a painful lesion on the plantar surface of her right foot in the center of the metatarso-phalangeal joint area. Provisional diagnosis was painful right plantar foot lesion or callous versus plantar wart. An evaluation and treatment were requested; however, a search of the Veteran's voluminous 20-year history of service treatment records failed to find a note for such evaluation and treatment. Periodic service examinations in September 1996 and September 2001 noted that the Veteran's feet and upper and lower extremities showed no abnormalities. The September 2001 examination report noted scars of the lower extremities from a fasciotomy that was followed by the orthopedic clinic. The Board notes that the Veteran is service-connected for the residuals of both a right and left leg fasciotomy. Service treatment records dated in June 1997 and July 1997 noted treatment for a nail fungus. A December 2000 service treatment record, largely illegible, appears to refer to treatment for plantar heel pain. An April 2001 service treatment record, largely illegible, appears to refer to plantar foot pain. On a report of medical history dated in September 2001, the Veteran noted that her feet and fingers swelled routinely for two years. A May 2002 service treatment record, largely illegible, indicated that the Veteran was treated for chronic back, leg and foot pain and appeared to state that she had a long history of some type of plantar problem. Her February 2004 discharge examination does not show any abnormalities of the feet or any diagnoses for plantar warts or fungus of the fingers or toes. Shortly after discharge from service, the Veteran underwent a VA examination in October 2004. The VA examiner noted that the Veteran had provided a history of plantar warts, but the examiner saw no evidence of plantar warts. Also according to the VA examination report, the Veteran did not have any current evidence of an active fungus infection, though the examiner noted some thickening of the skin of the margins between the sole and the heels of both feet. Examination of the hands revealed no abnormalities. In her August 2006 VA Form 9, Substantive Appeal, the Veteran claimed that she had treated her plantar warts and fungus of the fingers and toes with over-the-counter medications, that the plantar warts had grown progressively worse on the right foot since February 1994, that she was treated several times in 1997 for the fungus complaint, and that a dermatologist once told her that fungus of the fingers was probably a result of wearing rubber gloves and the constant hand washing associated with her job as a medical corpsman. Having carefully considered these service connection claims in light of the record and the applicable law, the Board is of the opinion that service connection for bilateral plantar warts and for fungus, fingers and toes, is not warranted. The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); ); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. The Board recognizes the Veteran's contentions that she has had plantar wards and fungus of the feet and hands since active service. When a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh that testimony and to make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board finds that plantar warts and certain fungal infections that may infect the feet and hands are readily identifiable by a lay person. In this case, however, an October 2004 VA medical examination has specifically considered the Veteran's complaints and found that there were no plantar warts or fungus infection of the hands or feet at that time. While there is medical evidence a possible plantar wart in February 1994 and nail fungus in 1997, there is no medical evidence reflecting a current diagnosis of plantar warts or fungal infection. In weighing the evidence, the Board finds that the medical evidence carries far more probative value, and casts doubt on the credibility of the Veteran's assertions that she currently has plantar warts or fungus affecting the feet in hands. The Court has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet App. 223, 225 (1992) (service connection presupposes a current diagnosis of the claimed disability). As there is no credible evidence of any current plantar warts or fungus of the fingers and toes on her VA examination, service connection cannot be granted as the Veteran does not manifest a current disability for either service connection claim. See 38 C.F.R. § 3.303; Hickson, 12 Vet. App. at 253. Because the preponderance of the evidence is against these two service connection claims, the benefit of the doubt rule does not apply. 38 U.S.C.A. § 5107(b); see Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Increased Rating - Laws and Regulations Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.1 (2009). 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 Court has held that a claim for a higher rating when placed in appellate status by disagreement with the original or initial rating award (service connection having been allowed, but not yet ultimately resolved), remains an "original claim" and is not a new claim for an increased rating. See Fenderson v. West, 12 Vet. App. 119 (1999). In such cases, separate compensable ratings may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the pendency of the appeal, a practice known as "staged" ratings. Id. at 126. It is the responsibility of the rating specialist to interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2 (2009). Consideration of factors wholly outside the rating criteria constitutes error as a matter of law. Massey v. Brown, 7 Vet. App. 204, 207-08 (1994). Evaluation of disabilities based upon manifestations not resulting from service-connected disease or injury and the pyramiding of ratings for the same disability under various diagnoses are prohibited. 38 C.F.R. § 4.14 (2009). The Court has held that where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence is required. Grottveit v. Brown, 5 Vet. App. 91 (1993); see also Espiritu v. Derwinski, 2 Vet. App. 492 (1992). VA is free to favor one medical opinion over another provided it offers an adequate basis for doing so. See Owens v. Brown, 7 Vet. App. 429 (1995). When there is a question as to which of two evaluations to apply, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating, otherwise the lower rating shall be assigned. 38 C.F.R. § 4.7 (2009). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case with all reasonable doubt to be resolved in favor of the claimant; however, the reasonable doubt rule is not a means for reconciling actual conflict or a contradiction in the evidence. 38 C.F.R. § 4.3 (2009). Migraine Headaches For the Period from June 1, 2004 to March 24, 2005 The RO granted service connection for migraine headaches in the February 2005 rating decision under appeal. At that time a noncompensable rating was assigned pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8100. The Veteran contended in her Notice of Disagreement that she had daily headaches and was entitled to a higher rating. In a June 2006 Statement of the Case and rating decision, the RO awarded an initial 30 percent rating, effective June 1, 2004, the day after her discharge from active duty. As the current rating does not provide the Veteran with the maximum schedular benefit for migraine headaches, her claim for a higher rating still remains in controversy. See Fenderson, 12 Vet. App. at 126; AB v. Brown, 6 Vet. App. 35, 38 (1993). Having carefully considered the initial rating claim for the period from June 1, 2004 to March 24, 2005, in light of the record and the applicable law, the Board is of the opinion that the preponderance of the evidence is against the claim for a higher rating and the appeal will be denied. Currently, the Veteran's migraine headaches are rated as 30 percent disabling under Diagnostic Code 8100. Under this diagnostic code, a 30 percent rating requires characteristic prostrating attacks occurring on an average once a month over the last several months. The maximum 50 percent disability rating is assigned when a veteran has very frequent completely prostrating headaches with prolonged attacks that are productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. The Veteran underwent a VA examination in October 2004. It was noted that the Veteran's headache condition had been present for at least two or more years that the Veteran said that she had been diagnosed with migraine headaches, and that she had been treated with Sumatriptan with equivocal benefit. The Veteran described the headaches as being generalized, often starting in the frontal area, spreading over the entire frontoparietal area to the occipital area. The Veteran described this as feeling like a squeezing pain. It was associated with photophobia, hyperacusis, and nausea. Rest and mild analgesics provided some benefit. It was further noted that the Veteran's headaches did interfere with her ability to work although it was not clear to the examiner how much time the Veteran lost from her current occupation. Diagnosis was migraine headaches that were currently quite frequent. It also was noted that the Veteran presented the examiner with a diary of current headaches. The examiner commented that it was clear that the Veteran could have disabling headaches, but it was not clear from reading her diary how much time the Veteran had actually lost from her work. The Veteran was seen at a naval hospital clinic on March 24, 2005, complaining of ongoing migraine headaches for three days. Her symptoms were described as not as bad as usual and she was using over-the-counter medications, but they were not working. She described her headache as throbbing and said she had been feeling nauseated. A migraine headache was assessed, along with neck and back pain, and the Veteran was referred to the director of medical education. The Board finds that the evidence of record fails to show that the Veteran's headaches are productive of severe economic inadaptability. Indeed, the Veteran has not submitted any evidence to support the criteria that headaches cause impairment of her employment; the Board finds it significant that the Veteran has not submitted any employment records or evidence in general to support the view that her migraines interfere with employment and cause economic inadaptability. In this regard, the Board notes that the October 2004 VA examiner found that the Veteran had disabling headaches, but said her diary evidence was unclear as to how much time she actually lost from work. While the Veteran's symptoms likely had some significant general occupational effects between June 1, 2004 and March 24, 2005, the objective evidence of record does not show that there was severe economic inadaptability. Moreover, some interference with employment is contemplated in the 30 percent disability rating provided. As such, the evidence fails to show that the Veteran meets the criteria for a 50 percent disability rating for the period from June 1, 2004 to March 24, 2005. Hemorrhoids For the Period from June 1, 2004 to October 1, 2004 The RO granted service connection for internal hemorrhoids in the February 2005 rating decision under appeal. At that time a noncompensable rating was assigned pursuant to 38 C.F.R. § 4.114, Diagnostic Code 7336. The Veteran contends the current rating does not accurately reflect the severity of her disability. Having carefully considered the claim for the period from June 1, 2004 to October 1, 2004, in light of the record and the applicable law, the Board is of the opinion that the preponderance of the evidence is against the claim and the appeal will be denied. As noted above, the Veteran's hemorrhoids were rated under Diagnostic Code 7336. Under that Diagnostic Code, mild or moderate hemorrhoids are rated as noncompensable. Large or thrombotic irreducible hemorrhoids manifested by excessive redundant tissue evidencing frequent recurrences warrant a 10 percent disability rating. Hemorrhoids involving persistent bleeding with secondary anemia or with fissures warrant a 20 percent disability rating. 38 C.F.R. § 4.114, Diagnostic Code 7336. The Veteran underwent a VA examination in October 2004. The Veteran complained of some rectal pain and discomfort, but no constipation and there was no current bleeding. A genital/rectal examination was deferred at that time because the Veteran had provided the examiner with a history. At that time the Veteran did not have any acute hemorrhoids. In her August 2006 VA Form 9, Substantive Appeal, the Veteran asserted that her internal hermorrhoids extended to the outside of the anus and sometimes she felt that they hindered evacuation of waste, although doctors and specialists advised her instead on using suppositories and eating more fiber. She described a daily horrible and disabling experience. Given the evidence noted above, the Board finds that the Veteran is not entitled to a compensable rating for her service-connected internal hemorrhoids, for the period from June 1, 2004 to October 1, 2004. Specifically, the October 2004 VA examination failed to reflect any current hemorrhoids. In sum, there was no indication the Veteran's hemorrhoids were large or thrombotic, irreducible, involved excessive redundant tissue or evidenced frequent recurrences. Thus, the evidence indicated that the disability due to the Veteran's hemorrhoids was no more than mild or moderate and intermittent in nature for the period from June 1, 2004, to October 1, 2004. As such, the evidence fails to show that the Veteran meets the criteria for a compensable disability rating for the period from June 1, 2004 to October 1, 2004. Conclusion for Increased Rating Claims The Veteran is competent to report her symptoms relating to migraine headaches and internal hemorrhoids. The Board is aware of the Veteran's assertions as to the severity of each. However, these contentions do not support her claims. As a general matter, lay statements are considered to be competent evidence when describing the features or symptoms of an injury or illness. See Falzone v. Brown, 8 Vet. App. 398, 405 (1995). Despite the Veteran's testimony as to the observable symptoms of her migraines and her hemorrhoids, the objective evidence before the Board shows that the manifestations do not satisfy the diagnostic criteria for a rating in excess of 30 percent for headaches or for a compensable rating for hemorrhoids for the time periods in question. As a result, her assertions do not constitute evidence that either disability warrants an increased rating for the period under discussion. To the extent that the Veteran has asserted that she warrants a higher rating for either migraine headaches or internal hemorrhoids during the applicable time periods, the Board finds that the preponderance of the evidence for the periods on appeal does not support her contentions. The Board is responsible for weighing all of the evidence and finds that the preponderance of the evidence is against an initial rating in excess of 30 percent for migraine headaches, for the period from June 1, 2004 to March 24, 2005, or for an initial compensable rating for internal hemorrhoids, for the period from June 1, 2004, to October 1, 2004. There is no reasonable doubt to be resolved. Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). The above determinations continuing the Veteran's initial 30 percent rating for her migraine headaches, for the period from June 1, 2004, to March 24, 2005, and her initial noncompensable rating for her internal hemorrhoids, for the period from June 1, 2004, to October 1, 2004, are based on application of pertinent provisions of VA's Schedule for Rating Disabilities. The Board notes that there is no indication that referral is warranted in either case for consideration of the assignment of a disability rating on an extraschedular basis during these time frames. See 38 C.F.R. § 3.321(b). The Court clarified the analytical steps necessary to determine whether referral for such consideration is warranted. See Thun v. Peake, 22 Vet. App. 111 (2008). A determination of whether the available applicable schedular rating criteria are inadequate because they do not contemplate the Veteran's level of disability and symptomatology first must be made by the RO or Board. If the rating criteria are inadequate, the RO or Board must proceed to determine whether the Veteran exhibits an exceptional disability picture indicated by other related factors such as marked interference with employment or frequent periods of hospitalization. If such related factors are exhibited, then referral must be made to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for extraschedular consideration. In this case, there has been no showing that the Veteran's disability picture for either headaches or hemorrhoids could not be contemplated adequately by the applicable schedular rating criteria discussed above. The criteria provide for higher ratings in both cases, but as has been explained thoroughly herein, the currently assigned ratings adequately described the severity of the Veteran's symptoms for both disabilities during the applicable time frames. The Veteran's assertions about chronic headaches and hemorrhoids were considered by the RO in the June 2006 Statement of the Case. Given that the applicable schedular rating criteria are adequate, the Board need not consider whether the Veteran's headache and hemorrhoid disability pictures include such exceptional factors as periods of hospitalization and interference with employment. Referral for consideration of the assignment of a disability rating on an extraschedular basis is not warranted. See Thun, 22 Vet. App. at 111; see also Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). The Board also should consider, under Fenderson, 12 Vet. App. at 126, whether a staged rating is appropriate for either claim for an initial rating. However, the appropriateness of staged ratings for both claims may be considered later as the Board has remanded for further development (see below) whether the Veteran is entitled to a rating in excess of 30 percent for her service- connected migraine headaches, for the period from March 25, 2004, to the present, or to a compensable rating for her service- connected internal hemorrhoids, for the period from October 2, 2004, to the present. ORDER Service connection for bilateral plantar wars is denied. Service connection for fungus, fingers and toes, is denied. Entitlement to an initial disability rating in excess of 30 percent for migraine headaches, for the period from June 1, 2004, to March 24, 2005, is denied. Entitlement to an initial compensable rating for internal hemorrhoids, for the period from June 1, 2004, to October 1, 2004, is denied. REMAND Unfortunately, a remand is required with respect to the Veteran's claims for increase as they pertain to the possibility of a higher staged rating for migraine headaches, for the period from March 25, 2005, to the present, and of a higher rating for internal hemorrhoids, for the period from October 2, 2004, to the present. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran's claims so that she is afforded every possible consideration. VA has a duty to assist claimants in obtaining evidence needed to substantiate a claim. 38 U.S.C.A. §§ 5103A, 5107(a) (West 2002 & Supp. 2009); 38 C.F.R. § 3.159(c) (2009). Concerning the issues of entitlement to a rating in excess of 30 percent for migraine headaches and of entitlement to a compensable rating for internal hemorrhoids, the Board notes that the March 2005 treatment records and October 2004 VA examination are, respectively, too remote in time to evaluate the current severity of either disorder. See Allday v. Brown, 7 Vet. App. 517, 526 (1995) (where the record does not adequately reveal the current state of claimant's disability, fulfillment of the statutory duty to assist requires a contemporaneous medical examination--particularly if there is no additional medical evidence that adequately addresses the level of impairment of the disability since the previous examination). Therefore, on remand, the Veteran shall be scheduled for a VA examination to determine the current severity of her service-connected migraine headaches and internal hemorrhoids. Before such examinations are scheduled, however, the RO/AMC should make an attempt to obtain any current private, VA or other governmental medical records concerning the Veteran's headaches and hemorrhoids. The Board notes that within the claims file there are no records for treatment for the Veteran's headaches and hemorrhoids from any VA Medical Center and no records for treatment for the Veteran's headaches and hemorrhoids from a naval hospital clinic at Pensacola, Florida, since July 2005, more than five years ago. Accordingly, the case is REMANDED for the following action: 1. The RO/AMC shall contact the Veteran to obtain the names and addresses of all medical care providers, private or government, who have treated her for migraine headaches or hemorrhoids. After securing the necessary release(s), the RO/AMC shall obtain those records that have not been previously secured and shall specifically request records from the naval hospital clinic in Pensacola, Florida, from July 2005 to the present. To the extent there is an attempt to obtain records that is unsuccessful; the claims file shall contain documentation of the attempts made. The Veteran and her representative shall also be informed of the negative results, and shall be given an opportunity to submit the sought-after records. 2. After the development requested above has been completed, the Veteran shall be provided a VA examination by an appropriate medical professional, and accompanied by any clinical testing deemed appropriate by the examiner, to determine the current extent and severity of any migraine headache disability. The claims folder, and a copy of this Remand, shall be reviewed by the examiner in conjunction with the examination, and the examiner shall acknowledge this receipt and review in any report generated as a result of this Remand. The examiner shall also consider the frequency of any prostrating and prolonged headache attacks and whether such are productive of severe economic inadaptability. A clear rationale for all opinions should be provided, along with a discussion of the facts and medical principles. 3. The Veteran shall also be afforded an examination to ascertain the present severity of her service-connected internal hemorrhoids. All indicated evaluations, studies and tests deemed necessary, including laboratory testing, should be accomplished. The claims file must be made available to and reviewed by the examiner. The examiner is requested to review all pertinent records associated with the claims file and offer comments and an opinion as to the severity of the Veteran's hemorrhoids. In this regard, the examiner should specifically address whether the Veteran has large or thrombotic hemorrhoids, irreducible, with excessive redundant tissue, evidencing frequent recurrences. A clear rationale for all opinions is required, to include a discussion of the facts and medical principles involved. 3. When the development requested has been completed, the RO/AMC shall again review, on the basis of the additional evidence, the Veteran's claims of entitlement to a rating in excess of 30 percent for migraine headaches, for the period from March 25, 2005, to the present, and entitlement to a compensable rating for internal hemorrhoids, for the period from October 1, 2004, to the present. If the benefits sought are not granted, the Veteran and her representative should be furnished a Supplemental Statement of the Case, and be afforded a reasonable opportunity to respond. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). ______________________________________________ JONATHAN B. KRAMER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs