Citation Nr: 1238121 Decision Date: 11/07/12 Archive Date: 11/16/12 DOCKET NO. 09-22 079 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUE 1. Entitlement to an initial evaluation in excess of 10 percent for residuals of lymphatic filariasis involving the groin area. 2. Entitlement to a separate evaluation for residuals of lymphatic filariasis manifested by edema in the right lower extremity. 3. Entitlement to a separate evaluation for residuals of lymphatic filariasis manifested by edema in the left lower extremity. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. P. Simpson, Counsel INTRODUCTION The Veteran served on active duty from April 1964 to October 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. The Board has reviewed the Veteran's claims file and the record maintained in the Virtual VA paperless claims processing system. The Board notes that in the February 2011 remand, the Board indicated in the Introduction that the rating decision being appealed was from October 2008. In going through the claims file again, the Board realizes that the rating decision on appeal is the November 2000 rating decision, which awarded service connection for lymphatic filariasis and assigned a noncompensable evaluation, effective September 22, 1999. The basis for this determination is that following the issuance of the November 2000 rating decision, the Veteran submitted a timely notice of disagreement, and the RO issued a statement of the case in February 2001. In June 2001, which is within one year of the November 2000 rating decision, the Veteran submitted a statement that should have been construed as a timely substantive appeal. See VA Form 21-4138 with attached statement. For this reason, the Board finds that the November 2000 rating decision is the one on appeal. Moreover, no prejudice results to the Veteran by the Board considering the November 2000 rating decision as the one on appeal, as the evidence considered herein has been considered by the Agency of Original Jurisdiction in rating decisions dated in November 2000 and May 2002 and the statement of the case dated in February 2001. In a May 2002 rating decision, the RO granted a 10 percent evaluation, effective September 22, 1999, and thus, the 10 percent evaluation was granted as of the effective date service connection was awarded. Thus, there is no staged rating during the appeal period. Additionally, in the June 2001 statement, the Veteran stated he had a hernia and a hydrocele. Following this statement, the RO adjudicated claims for entitlement to service connection for a hydrocele and inguinal hernia and denied them. See May 2002 rating decision. The Veteran did not appeal the rating decision. Thus, those issues are not part of the current appeal. FINDINGS OF FACT 1. Lymphatic filariasis has been manifested by edema in the groin area but has not been manifested by exudation or itching constant, with extensive lesions or marked disfigurement or involving 20 to 40 percent of the entire body or systemic therapy such as corticosteroids or other immunosuppressive drugs that were required for a total duration of six weeks or more, but not constantly, during the past 12-month period. 2. There is competent evidence that the edema in the right and left lower extremities is due to the service-connected lymphatic filariasis. CONCLUSIONS OF LAW 1. The criteria for an initial evaluation in excess of 10 percent for residuals of lymphatic filariasis involving the groin area have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.321, 4.3, 4.7, 4.118, Diagnostic Code 6305 (2012), Diagnostic Code 7806 (2000 & 2008). 2. The criteria for a compensable evaluation for residuals of lymphatic filariasis manifested by edema in the right lower extremity have been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 4.104, Diagnostic Code 7121 (2012). 3. The criteria for a compensable evaluation for residuals of lymphatic filariasis manifested by edema in the left lower extremity have been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 4.104, Diagnostic Code 7121 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Increased Rating The Veteran seeks a rating in excess of 10 percent for the service-connected residuals of lymphatic filariasis. The Veteran describes having inflammation in his groin area, which includes his scrotum and penis. He has stated that this area is always inflamed, but that that once every three months, he gets increased swelling, erythema, and a fever. Disability evaluations are determined by the application of a schedule of ratings which is based on the average impairment of earning capacity resulting from a disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). As stated in the Introduction, the appeal of the Veteran's claim for increase is based on the assignment of an initial evaluation following an initial award of service connection for lymphatic filariasis. As such, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Id. The rating schedule provides that when an unlisted disability is encountered, it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20 . When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. §§ 3.102, 4.3. Under Diagnostic Code 6305, it indicates to rate lymphatic filariasis as 100 percent disabling as an active disease. See 38 C.F.R. § 4.88b, Diagnostic Code 6305. Thereafter, the disability is evaluated based upon the residuals, such as epididymitis or lymphangitis under the appropriate system. Id. The Board notes there is no indication in the file, either by a medical professional or by the Veteran, that lymphatic filariasis is active. Thus, the disability is evaluated based on the residuals. The RO has rated the service-connected residuals of lymphatic filariasis under Diagnostic Code 7806, which addresses dermatitis or eczema. During the pendency of the appeal, the applicable rating criteria for skin disorders, found at 38 C.F.R. § 4.118, were amended on two occasions: August 2002 and October 2008. As to the October 2008 revisions, they are applicable only to applications for benefits received by VA on or after October 23, 2008. See 73 Fed. Reg. 54708 (September 23, 2008). The Veteran filed his claim in January 2000 and has not specifically requested consideration of his claim under the most recent amended regulations nor did the RO apply the this criteria. Thus, only the pre-October 2008 versions of the schedular criteria are applicable. The Board notes that the criteria under Diagnostic Code 6305 have not changed during the appeal period (from January 2000 to the present time). Generally, where the rating criteria are amended during the course of the appeal for an increased rating, both the former and the current schedular criteria are considered. Should an increased rating be warranted under the revised criteria, that award may not be made effective before the effective date of the change. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003) (overruling Karnas v. Derwinski, 1 Vet. App. 308, 312-13 (1991), to the extent it held that, where a law or regulation changes after a claim has been filed or reopened but before the administrative or judicial appeal process has been concluded, the version more favorable to appellant should apply). Under Diagnostic Code 7806 prior to August 2002, a noncompensable evaluation was warranted for slight, if any, exfoliation, exudation or itching on a nonexposed surface or small area. 38 C.F.R. § 4.118, Code 7806. A 10 percent evaluation required exfoliation, exudation or itching and involvement of an exposed surface or extensive area. Id. A 30 percent evaluation was available for eczema if it was characterized by exudation or itching constant, with extensive lesions or marked disfigurement. Id. A 50 percent evaluation is available for eczema if it was characterized with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or exceptionally repugnant. Id. The Veteran was informed of these criteria and they were applied by the RO in the April 2009 statement of the case; these criteria were also considered by the RO in the May 2002 rating decision. Under Diagnostic Code 7806 after August 2002, a 10 percent evaluation is assignable when at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas are affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of less than six weeks during the past 12-month period. A 30 percent evaluation is assignable when 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas are affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 60 percent evaluation is assignable when more than 40 percent of the entire body or more than 40 percent of exposed areas are affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs were required during the past 12-month period. 38 C.F.R. § 4.118 , Diagnostic Code 7806. These criteria were considered in the September 2010 supplemental statement of the case. After having carefully reviewed the evidence of record, the Board finds that the preponderance of the evidence is against the grant of an evaluation in excess of 10 percent for residuals of lymphatic filariasis involving the groin area whether considering the former criteria or the amended criteria. The Board also finds that separate compensable evaluations are warranted for edema in the right and left lower extremities. The Board will address the residuals involving the groin area and the residuals involving the lower extremities separately, as the Board finds that they warrant evaluations under different diagnostic codes. A. Groin area The evidence shows that the residuals of lymphatic filariasis have caused chronic inflammation of the groin area, including the scrotum and penis. The Board is aware that the Veteran has reported some urinary symptoms and difficulty with obtaining erections. As to the latter symptom, VA has awarded service connection for erectile dysfunction. See May 2002 rating decision. As to the former symptoms, at the September 2008 VA examination, the Veteran reported nocturia 3 to 4 times a night and urinating 3 to 4 times during the day. He reported slight urinary hesitancy and that his stream was not as full as normal. He denied urinary incontinence and urinary tract infections. The examiner diagnosed both mild chronic azotemia and benign prostatic hyperplasia, which he stated was unrelated to scrotal edema and filariasis. Subsequent to this examination, the Veteran denied any genitourinary system symptoms. For example, when seen in December 2008, he denied frequency, polyuria, nocturia, burning, hematuria, urgency, decreased force, hesitancy, dribbling, or incontinence. See December 2, 2008, VA treatment record. Additionally, the Veteran was given a genitourinary examination in December 2009. There, the examiner noted, "As far as his urologic concerns are concerned[,] it does not have any necessary effect upon urinary flow. His daily frequency, as well as night frequency are not issues at this time, nor is any urinary incontinence an issue." See report. Thus, the Board has not considered the urinary symptoms as part of the service-connected disability since the medical evidence establishes that there is no relationship between any genitourinary symptoms and the service-connected disability. Going back to the impact that the residuals of lymphatic filariasis has on the groin area, the residuals have impacted the scrotum and the penis as well. VA treatment records prior to 2000 show swelling in the groin area. See June 1996, January 1997, August 1997, April 1998, and March 1999 VA treatment records (but see September 1998 VA treatment record, where there was no scrotal swelling). At the May 2002 VA examination, the Veteran reported that during exacerbations, he would have extreme tenderness and inflammation. Otherwise, he had residual edema and thickened skin. See examination report. At the September 2008 VA examination, the Veteran reported that he had increased swelling on his scrotum, which involved erythema and groin tenderness about every other week, which symptoms would last for three to four days. The last episode had occurred two weeks prior. The examiner described generalized scrotal and penile edema. The testicles were palpable, bilaterally, and seemed normal to palpation. The scrotal skin was edematous and indurated. There was no excess tenderness noted. There was edema of the foreskin of the penis, and there was no palpable lymphadenopathy. See VA examination report. At the March 2011 VA examination, the examiner noted that the Veteran's scrotum was edematous and enlarged. The skin about the scrotum was thickened, indurated, and slightly erythematous. There was no tenderness. The testicles were palpable, and appeared relatively normal. There was slight swelling in the suprapubic area. See VA examination report. The scrotum was 6 inches in length and width and 4 inches in depth. During the Decision Review Officer hearing, the Veteran testified that he had scrotal edema and swelling of the pouch area above the penis. His scrotal area would sometimes be very red and inflamed, such that it had become "leathery pouch type skin." See hearing transcript at p. 2. He would also sometimes get a low grade fever, which would last three days, approximately two times per month. Thus, excluding the lower extremities, the Board finds that the preponderance of the evidence is against a finding that the lymphatic filariasis has been characterized by exudation or itching constant with extensive lesions or marked disfigurement to warrant a 30 percent evaluation under the former criteria. The groin area is not an extensive area of the body, and the swelling was limited to that area (again, not including the lower extremities). Additionally, the swelling does not cause symptoms that resemble exudation or itching constant. For example, in May 2002, the examiner noted that there was no ulceration or skin breakdown. While the Veteran has reported having tenderness, this does not constitute constant itching or exudation. While the swelling in the groin caused enlargement of the scrotum, the Veteran described it as a leathery pouch, and the May 2002 VA examiner described the condition as being "cosmetic [], secondary to the gross enlargement of the area," the Board finds that while this is a disfigurement of the area, it is not a marked disfigurement. Moreover, the evidence does not show extensive lesions, extensive exfoliation, or crusting. In addition, neither the medical practitioners nor the Veteran described the condition as exceptionally repugnant. The preponderance of the evidence is thus against a higher evaluation under the former criteria. Considering the amended criteria and, again, excluding the lower extremities, the clinical findings in the VA treatment records and these examination reports show that less than 20 percent of the entire body is affected by the residuals of lymphatic filariasis. In going through the other evidence in the claims file, medical professionals have described the affected area as being the groin and the lower extremities only. In other words, no medical professional has described areas of skin other than these as being impacted by lymphatic filariasis. The Veteran himself has not alleged areas other than the groin and lower extremities being affected. Again, the Board will address the lower extremities separately. Thus, the affected area is the groin area. This is less than 20 percent of the entire body. Therefore, an evaluation in excess of 10 percent is not warranted. The groin area is not an exposed area, and thus that criteria would not apply to these symptoms. Additionally, while the Veteran has fevers, the evidence does not show that the Veteran needs systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of six weeks or more, but not constantly, during the past 12-month period to warrant the next higher evaluation based upon this criteria. At the March 2011 VA examination, the Veteran reported he had taken antibiotics three times over the past two years. Thus, a 30 percent evaluation under the amended criteria is not warranted. Finally, there is no evidence that the manifestations of the Veteran's service-connected residuals of lymphatic filariasis involving the groin area are unusual or exceptional to demonstrate that the rating schedule is inadequate for determining the proper level of disability. Furthermore, as there is no indication in the record as to why the Veteran's case is not appropriately rated under the schedular criteria, extraschedular consideration is not warranted in this case, particularly where, as here, the extent of the effect that the lymphatic filariasis has on the groin area (less than 20 percent of the entire body) is addressed by the relevant criteria discussed above. See Thun v. Peake, 22 Vet. App 111, 115-16 (2008). The criteria for rating dermatitis and/or eczema, by its very nature, consider the Veteran's symptoms of skin changes, including edema, based on the amount of his body that is affected by the residual disease process. Thus, the symptoms affecting the groin area are addressed by the rating criteria under which this disability is rated. The Veteran reports pain when he has the edema, which is contemplated by the schedular criteria. In other words, the skin in this area is impacted, and the criteria address the affected area. Systemic manifestations are also contemplated by the schedular criteria. Accordingly, the schedular evaluation is not inadequate. There are no additional symptoms of the residuals of lymphatic filariasis that are not addressed by the rating schedule. The rating criteria reasonably describe the Veteran's disability level and symptomatology for his service-connected disability. Consequently, referral of this case for consideration of an extra-schedular rating is not warranted. Thun v. Peake, 22 Vet. App 111, 115-16 (2008). Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996). The Board has not applied the benefit-of-the-doubt doctrine in reaching this conclusion, as the preponderance of the evidence is against a higher rating involving the groin area. 38 U.S.C.A. 5107(b) (West 2002); 38 C.F.R. § 3.102 (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1991); Alemany v. Brown, 9 Vet. App. 518 (1996). B. Lower extremities After having carefully reviewed the evidence of record, the Board finds that the evidence supports the award of a compensable evaluation for each lower extremity under Diagnostic Code 7121. The Board will lay out why it has not assigned a specific compensable evaluation and why it has chosen this Diagnostic Code below. The evidence shows that the Veteran has intermittent edema in his lower extremities. For example, in October 1999, the examiner stated the Veteran had no peripheral edema. In the September 2008 VA examination report, the examiner noted that the Veteran had 2+ pitting pedal and pretibial edema about the left lower extremity and 1+ pitting pedal and pretibial edema about the right lower extremity. When his lower extremities were examined in October 2008, December 2008, March 2009, and June 2009, there was no edema. See VA treatment records. Later in June 2009, there was 1+ edema in both lower extremities. See June 29, 2009, VA treatment record. In December 2009, there was 1+ pitting edema to the ankles, but no edema to the thighs or calf area. See VA examination report. In April 2010, there was generalized edema in the lower extremities, and pre-tibial edema was 2+. See VA examination report. In September 2010, there was no edema in the lower extremities early in the month, but there was trace edema in them later in the month. See VA treatment records. The Board sought out an opinion from an infectious disease specialist. After reviewing the evidence of record and addressing the common residuals of lymphatic filariasis, the examiner found that it was at least as likely as not that the Veteran's leg edema was the result of lymphatic filariasis. He acknowledged that while other medical disabilities would contribute to the development of leg edema, the lymphatic filariasis had caused pre-existing abnormalities in lymphatic drainage. The March 2011 examiner also determined that it was at least as likely as not that the swelling in the lower extremities was at least in part related to the filiarisis. Thus, the Board finds that the evidence supports a finding that the edema in the lower extremities is due to the lymphatic filariasis. In reviewing the Rating Schedule, the Board finds that the symptoms described under Diagnostic Code 7121 seems to be the closest symptoms to what the Veteran experiences in his lower extremities. This Diagnostic Code addresses post-phlebitic syndrome. (There has been no change in the criteria under this Diagnostic Code since January 2000.) Under this code, a noncompensable rating is warranted when "asymptomatic palpable or visible varicose veins." A 10 percent rating is warranted where there is intermittent edema of an extremity or aching and fatigue in the leg after prolonged standing or walking, with symptoms relieved by elevation of the extremity or compression hosiery. A 20 percent rating is warranted for persistent edema, incompletely relieved by elevation of the extremity, with or without beginning stasis pigmentation or eczema. A 40 percent rating is warranted for persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration. A 60 percent rating requires persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration. A 100 percent rating is assigned when there is massive board-like edema with constant pain at rest. 38 U.S.C.A. § 4.104, Diagnostic Code 7121. The Board finds that the symptoms the Veteran experiences in his lower extremities meet the criteria for at least a compensable evaluation in each lower extremity, i.e., at least a 10 percent evaluation in the right lower extremity and at least a 10 percent evaluation in the left lower extremity. The Board finds that to avoid any prejudice to the Veteran, it will have the agency of original jurisdiction assign the compensable evaluation in the first instance to allow the Veteran an opportunity to appeal the evaluation and/or the effective date assigned by the agency of original jurisdiction. If the Board assigned an evaluation and effective date in this decision for the compensable evaluations, the Veteran would have to appeal the decision to the Court if he disagreed with the Board's determination. By the Board assigning the evaluation in the first instance, this takes away the Veteran's ability to have both the agency of original jurisdiction and the Board review his claim for increase. For these reasons, the Board will not assign the specific compensable evaluation that each lower extremity should be granted. That will be left up to the agency of original jurisdiction. Thus, in sum, the Board finds the evidence supports the award of a compensable evaluation for the edema in the right lower extremity and a compensable evaluation for the edema in the left lower extremity. The Board has applied the benefit-of-the-doubt doctrine in reaching this conclusion. 38 U.S.C.A. 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49; Alemany, 9 Vet. App. 518. II. Duties to Notify & Assist Upon receipt of a complete or substantially complete application, VA must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide. 38 U.S.C.A. § 5103(a). The notice requirements apply to all five elements of a service connection claim: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473 (2006). The notice must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App.112 (2004). The notice requirements may be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). The issue before the RO at the time of the November 2000 rating decision was entitlement to service connection for lymphatic filariasis, which benefit was granted. 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. Dingess/Hartman, 19 Vet. App. at 490; Dunlap v. Nicholson, 21 Vet. App. 112, 116-17 (2007) (noting that once an initial VA decision awarding service connection and assigning a disability evaluation and effective date has been made, section 5103(a) notice is no longer required). As to duty to assist, VA obtained VA treatment records and the records relied upon by the Social Security Administration to award disability benefits. VA provided the Veteran with a VA examinations in September 2008 and May 2011, which examination reports were based on medical examinations and provided relevant clinical findings to assist with determining the proper evaluation for the service-connected disability. While the September 2008 examiner did not report a review of the claims folder, such is not prejudicial error as the examination report shows clinical findings pertaining to the service-connected disability. The Board sought out two expert opinions from infectious disease specialists from the Veterans Health Administration because examiners had expressed issues related to the fact that the Veteran had edema in his lower extremities and whether it was related to the service-connected residuals of lymphatic filariasis. The first opinion request was sent in March 2012. A response was received in May 2012, which was not responsive to the questions the Board had asked. Specifically, the VA expert made a determination that the Veteran did not have lymphatic filariasis, which conclusion was not based upon objective evidence. The Veteran is service connected for lymphatic filariasis, and an opinion that he never had it does not assist the Board in determining the proper evaluation to assign to the service-connected disability. Thus, in July 2012, the Board sought out an opinion from a different infectious disease specialist. In August 2012, the Board received a response, which answered the questions asked. Thus, the Board finds that the August 2012 medical opinion was responsive to the information the Board found was necessary in order to properly evaluate the service-connected disability. There has also been substantial compliance with the Board's remand as additional VA treatment records were obtained and a VA examination was provided which included a review of the claims folder, addressed whether the disease process was active, and reported the severity of the residuals of the Veteran's filiarisis. The Board notes that it has the authority from Congress to seek out a medical opinion when it finds that such is warranted by the medical complexity or controversy involved in a case. 38 U.S.C.A. § 7109(a). In compliance with this law, the Veteran was provided with copies of the opinion requests and the responses and provided an opportunity to respond. Id. at (c). In October 2012, the Veteran responded he had no further argument or evidence to submit and wanted the Board to proceed with deciding his appeal. Thus, the Board concludes that it followed the proper procedures in allowing the Veteran to comment on the medical opinion requests and responses. With respect to the aforementioned Decision Review Officer (DRO) hearing, the Court of Appeals for Veterans Claims held in Bryant v. Shinseki, 23 Vet. App. 488 (2010), that 38 C.F.R. 3.103(c)(2) requires that the RO official or VLJ who conducts a hearing fulfill two duties to comply with the above the regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. Here, the DRO noted the appellate issue at the beginning of the hearing, described generally what was required for an increased rating, and asked questions to clarify the Veteran's contentions. Thereafter, the case was remanded in order to obtain additional VA treatment records and to afford the Veteran a VA examination. The Veteran has not asserted that VA failed to comply with 38 C.F.R. 3.103(c)(2), nor has he identified any prejudice in the conduct of the hearing. For the above reasons, the Board concludes VA has complied with the notice and assistance requirements and the Veteran is not prejudiced by a decision on the claim for increase at this time. (CONTINUED ON NEXT PAGE) ORDER Entitlement to an initial evaluation in excess of 10 percent for residuals of lymphatic filariasis involving the groin area is denied. Entitlement to a separate compensable evaluation for edema in the right lower extremity is granted, subject to the controlling regulations applicable to the payment of monetary benefits. Entitlement to a separate compensable evaluation for edema in the left lower extremity is granted, subject to the controlling regulations applicable to the payment of monetary benefits. ____________________________________________ S. S. TOTH Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs