Citation Nr: 1306953 Decision Date: 02/28/13 Archive Date: 03/01/13 DOCKET NO. 08-10 235 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Whether new and material evidence has been submitted to reopen the claim for service connection for onychomycosis. 2. Whether new and material evidence has been submitted to reopen the claim for service connection for various dental conditions for compensation purposes, to include removal of wisdom teeth, crowns, braces and teeth implants. 3. Entitlement to an increased disability rating for bunionectomy with corns, right foot, with heel spur, status post arthroplasty 5th digit, currently rated as 10 percent disabling. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD E. I. Velez, Counsel INTRODUCTION The Veteran served on active duty from March 1979 to September 1992. This matter is before the Board of Veterans' Appeals (Board) on appeal of a November 2007 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. In March 2011, the Veteran testified at a Central Office hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In June 2011, the Board remanded the claims for further development. The requested development has been substantially complied with and the claims are ready for appellate review. As noted in the June 2011 decision and remand, in a December 2002 rating decision, the RO denied the Veteran's claim of entitlement to service connection for temporomandibular joint disorder (TMJ). The Veteran did not appeal that determination. Notably however, at the March 2011 hearing, the Veteran testified that she still experiences TMJ, and that she began treatment for TMJ during her active duty service. See the March 2011 hearing transcript, pages 23-25. It appears that the Veteran is attempting to reopen her previously-denied service-connection claim for TMJ. As that claim has not yet been adjudicated by the Agency of Original Jurisdiction (AOJ), the Board does not have jurisdiction over it. See Godfrey v. Brown, 7 Vet. App. 398 (1995). A review of the claim file shows that this issue has not been addressed by the RO and it is therefore REFERRED to the AOJ for appropriate action. Additionally, with respect to the Veteran's dental compensation claim currently on appeal, the Board notes that a claim for service connection for a dental disorder is also a claim for VA outpatient dental treatment. See Mays v. Brown, 5 Vet. App. 302 (1993). Although it appears that the RO has already referred the Veteran's dental treatment claim to the VA Medical Center (VAMC) of jurisdiction for initial consideration [see the RO's November 2007 rating decision, page 3], it is unclear from the record whether any action was taken by the VAMC to address that claim. Significantly, the RO notified the Veteran in an October 2010 supplemental statement of the case (SSOC) that she may apply for dental treatment at her nearest VA Medical Center, suggesting that the RO may have never actually referred the Veteran's dental treatment claim to the VAMC in the first place. Accordingly, the issue of whether the Veteran is eligible for VA dental treatment is again REFERRED to the RO to clarify whether adjudication of that claim has already taken place, and if not, to ensure that such is accomplished. Additionally, the Board notes that, with respect to the Veteran's dental claim, by denying the Veteran's dental claim on its merits, the RO apparently determined that new and material evidence had been submitted that was sufficient to reopen her previously-denied dental claim, without specifically stating as much. Notably however, under Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996), before considering a previously adjudicated claim, the Board must determine that new and material evidence was presented or secured for the claim, making RO determination in that regard irrelevant. [Emphasis added by the Board]. See also Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001) [the Board has a jurisdictional responsibility to consider whether it was proper for the RO to reopen a previously denied claim]. Thus, the Board is required to address the Veteran's previously-denied dental claim first as a claim to reopen, and then if new and material evidence has been submitted, as a claim on the merits. FINDINGS OF FACT 1. In a February 2003 rating decision, the RO denied service connection for various dental procedures, to include removal of wisdom teeth, crown, braces and teeth implants. 2. Evidence received since the February 2003 rating decision does not raise a reasonable possibly of substantiating the claim for service connection for various dental procedures for compensation purposes. 3. Service connection for onychomycosis was denied by the RO in a decision of June 2005. The Veteran was informed of the decision and he did not appeal. 4. The evidence submitted with regards to the claim for service connection for onychomycosis since the RO's June 2005 rating decision is cumulative. 5. Resolving all doubt in the Veteran's favor, the symptoms associated with bunionectomy with corns, right foot, with heel spur, status post arthroplasty 5th digit, more closely approximate a severe level. CONCLUSIONS OF LAW 1. The February 2003 rating decision, in which the RO denied the Veteran's claim of entitlement to service connection for various dental procedures for compensation purposes, is final. 38 U.S.C.A. § 7105(c) (West 2002). 2. New and material evidence has not been received to reopen a claim of entitlement to service connection for various dental procedures for compensation purposes. 38 U.S.C.A. §§ 5103A, 5107, 5108 (West 2002); 38 C.F.R. § 3.156 (2012). 3. The June 2005 rating decision denying service connection for onychomycosis is final. 38 U.S.C.A. § 7105(c)(West 2002). 4. Evidence received since the June 2005 rating decision is not new and material and the claim for service connection for onychomycosis is not reopened. 38 U.S.C.A. §§ 38 U.S.C.A. §§ 5103A, 5107, 5108 (West 2002); 38 C.F.R. § 3.156 (2012). 5. The criteria for 30 percent disability rating for bunionectomy with corns, right foot, with heel spur, status post arthroplasty 5th digit, have been met. 3 8 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Code 5284 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist In correspondence dated in August 2006, December 2006, July 2007 and July 2011, the RO satisfied its duty to notify the Veteran under 38 U.S.C.A. § 5103(a) (West 2002) and 38 C.F.R. § 3.159(b) (2012), known as the Veterans Claims Assistance Act of 2000 (VCAA). Specifically, the RO notified the Veteran of: information and evidence necessary to substantiate the claims; information and evidence that VA would seek to provide; and information and evidence that the Veteran was expected to provide. Those letters also notified the Veteran of the process by which disability ratings and effective dates are established. Dingess v. Nicholson, 19 Vet. App. 473 (2006). Specific to requests to reopen, the Veteran must be notified of both the reopening criteria and the criteria for establishing the underlying claim for service connection. See Kent v. Nicholson, 20 Vet. App. 1 (2006). In this case, the July 2007 notice letter included the criteria for reopening the previously denied claim for service connection for onychomycosis and information concerning why the claims were previously denied. The letter predated the rating decision. In regards to the request to reopen the claim for dental conditions, proper notice was not provided until July 2011, after the initial rating decision. However, this notice was provided as a result of a Board remand of June 2011. Moreover, the claim was thereafter readjudicated in a supplemental statement of the case of October 2012. Accordingly, any deficiencies with the timing requirement are harmless. Consequently, the Board finds that adequate notice has been provided. As to the claim for an increased disability rating for bunionectomy of the right foot, proper notice was provided in the December 2006 notice letter, including evidence as to how the Board determines disability ratings and assigns effective dates in accordance with Dingess v. Nicholson, supra. The notice letter predated the rating decision. VA has done everything reasonably possible to assist the Veteran with respect to her claims for benefits in accordance with 38 U.S.C.A. § 5103A (West 2002) and 38 C.F.R. § 3.159(c) (2012). All identified and available treatment records have been secured. The Veteran's service treatment records and post-service medical records are in the claims folder. With respect to the Veteran's claims to reopen, as set forth below, the Veteran has not submitted new and material evidence to reopen the claim for service connection for a dental condition and onychomycosis. Accordingly, VA has no further duty to assist her in the development of his claims. Nonetheless, the Board did request additional development regarding the request to reopen the claim for service connection for onychomycosis in the July 2011 remand. Moreover, all available and identified service and post service treatment records have been obtained. As such, there is no additional development to be conducted regarding these claims. With respect to the claim for an increased evaluation for bunionectomy, the Veteran was provided with a VA examination in September of 2006 and September 2010. The examination reports reflect that the examiner reviewed the Veteran's past medical history, recorded her current complaints, conducted an appropriate evaluation of the Veteran, and rendered an appropriate diagnosis and opinion consistent with the remainder of the evidence of record. Additionally, neither the Veteran nor her representative has stated nor is there evidence indicating that there has been a material change in the severity of her bunionectomy of the right foot since she was examined in September 2010. See 38 C.F.R. § 3.327(a) (2012). The duty to assist does not require that a claim be remanded solely because of the passage of time since an otherwise adequate VA examination was conducted. See VAOPGCPREC 11-95 (April 7, 1995). Therefore, the Board concludes that the examination reports are adequate for purposes of rendering a decision in the instant appeal. See 38 CF.R. § 4.2 (2012); see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Additionally, the Veteran availed herself of the opportunity to present personal testimony before a Veterans Law Judge. A transcript of the hearing is of record. The Board finds that no additional RO action to further develop the record on the claims is warranted. Overall, there is no evidence of any VA error in notifying or assisting the Veteran that reasonably affects the fairness of this adjudication. Legal Criteria and Analysis I. Claim to Reopen Service connection will be granted if it is shown that a Veteran has a disability resulting from an injury or disease contracted in the line of duty, or for aggravation of a preexisting injury or disease contracted in the line of duty in the active military, naval or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. That an injury incurred in service alone is not enough. There must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Further, service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that a disease was incurred in service. 38 C.F.R. § 3.303(d). In general, VA rating decisions or Board decisions that are not timely appealed are final. See 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. §§ 20.1100 , 20.1103 (2012). Pursuant to 38 U.S.C.A. § 5108, a finally disallowed claim may be reopened when new and material evidence is presented or secured with respect to that claim. New evidence is defined as evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. See 38 C.F.R. § 3.156(a) (2012). An adjudicator must follow a two-step process in evaluating a previously denied claim. First, the adjudicator must determine whether the evidence added to the record since the last final decision is new and material. If new and material evidence is presented or secured with respect to a claim that has been finally denied, the claim will be reopened and decided upon the merits. Once it has been determined that a claimant has produced new and material evidence, the adjudicator must evaluate the merits of the claim in light of all the evidence, both new and old, after ensuring that the VA's statutory duty to assist the appellant in the development of her claim has been fulfilled. See 38 U.S.C.A. § 5108 (West 2002); Elkins v. West, 12 Vet. App. 209 (1999); Vargas-Gonzalez v. West, 12 Vet. App. 321, 328 (1999). The Court has recently stated that the language of VA regulations does not require the submission of new and material evidence as to each previously unproven element of a claim for that claim to be reopened. See Shade v. Shinseki, 24 Vet. App 110 (2011). For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). It is VA's defined and consistently applied policy to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt it is meant that an approximate balance of positive and negative evidence exists which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. A. Dental Procedures The RO previously denied the Veteran's claim of entitlement to service connection for various dental procedures to include removal of wisdom teeth, crown, braces and teeth implants, for compensation purposes, in a rating decision dated February 2003. The RO denied the claim on the basis that treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal diseases are only service connectable for purposes of establishing eligibility for outpatient dental treatment and, there is no regulatory basis on which to grant compensation for such conditions. The RO notified the Veteran of its decision and her appellate rights with regard thereto, but the Veteran did not appeal the decision to the Board. Therefore, February 2003 decision is final. 38 U.S.C.A. § 7105(c) (West 2002); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2012). Under current VA regulations, compensation is only available for certain types of dental and oral conditions listed under 38 C.F.R. § 4150, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. Compensation is available for loss of teeth only if such is due to loss of substance of body of maxilla or mandible. See Simmington v. West, 11 Vet. App. 41 (1998). For loss of the teeth, bone loss through trauma or disease such as to osteomyelitis must be shown for purposes of compensability. The loss of the alveolar process as a result of periodontal disease is not considered disabling. See Note to Diagnostic Code 9913, 38 C.F.R. § 4.150. Generally, treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are not considered disabling conditions and, therefore, they may not be service connected except for the purpose of establishing entitlement to VA outpatient dental treatment as provided in 38 C.F.R. § 17.161. 38 C.F.R. § 3.381(a) (2012). In other words, in general, replaceable missing teeth are not considered a disability for purposes of VA compensation. Therefore, for the evidence submitted since the February 2003 rating decision to be considered new and material sufficient to reopen the claim for service connection for dental procedures for compensation purposes, the evidence must show that the evidence falls within the parameters of 38 C.F.R. § 4.150. The evidence at the time of the February 2003 denial included service treatment records and post-service treatment records showing treatment for removal of wisdom teeth, caries, teeth implants, placement of crowns, and braces. The evidence that has been associated with the claims file since the RO's February 2003 rating decision includes VA outpatient treatment records, and the Veteran's hearing testimony and written statements. The evidence shows continued treatment for dental problems, including lose implants and crowns. A review of the evidence shows that this evidence is new. It was not previously submitted to agency decision makers and is neither cumulative, nor redundant of the evidence of record at the time of the last prior final denial. This evidence is not material, however, because, by itself or when considered with the evidence previously of record, it does not relate to an unestablished fact necessary to substantiate the claim for service connection for dental procedures, to include removal of wisdom teeth, crown, braces and teeth implants, for compensation purposes, and does not raise a reasonable possibility of substantiating that claim. None of the evidence submitted since the prior denial of February 2003, cures the evidentiary defect which existed at the time of the prior denial. None of the evidence shows that the Veteran has a current dental condition which is compensable under VA regulation. Therefore, the evidentiary defect that existed at the time of the prior denial in February 2003 has not been cured and there is no basis on which to reopen the claim for service connection for dental procedures for compensation purposes. The Board acknowledges the Veteran's belief, as she testified at the March 2011 hearing, that some of her dental problems, specifically the shifting of teeth, was a result of her wisdom teeth being removed in service. However, the Veteran's argument amounts to no more than an assertion by her that her dental problems are due to service, an assertion which she had already made at the time of the prior denial in February 2003. The Veteran's current statements and testimony do not constitute new evidence. Cf. Bostain v. West, 11 Vet. App. (1998) (noting lay testimony that is cumulative of previous contentions considered by the decision maker at the time of the prior final disallowance of the claim is not new evidence). See also, Reid v. Derwinski, 2 Vet. App. 312 , 315 (1992). Therefore, her testimony at the hearing is not considered new and material evidence sufficient to reopen the claim. Having determined that new and material evidence has not been received, the Board may not reopen and must deny the Veteran's claim of entitlement to service connection for dental procedures for compensation purposes. B. Onychomycosis The Veteran seeks to reopen her claim for service connection for onychomycosis. Entitlement to service connection for onychomycosis was previously denied by the RO in a rating decision of June 2005. The RO denied the claim on the basis that there was no competent evidence of a nexus to service. The Veteran was informed of the decision and she did no appeal. At the time of the decision, the record included service medical treatment records that are silent for any treatment or diagnosis of onychomycosis and post-service outpatient treatment records showing a diagnosis of onychomycosis. Submitted since the RO's June 2005 rating decision are additional VA outpatient treatment records documenting a diagnosis of onychomycosis and treatment thereof. Also added, is the Veteran's testimony at the March 2011 hearing wherein she testified she believed that her problems with onychomycosis started while in service. The Board has made a careful review of the evidence of record. In the present claim, the submitted VA outpatient treatment records and testimony at the hearing are not new and material as they do not relate to an unestablished fact necessary to substantiate the claim, namely, that the Veteran's onychomycosis is related to service. No new evidence has been introduced that onychomycosis is related to service. In fact, at the March 2011 hearing the Veteran testified that no doctor had ever told her that her onychomycosis is related to service. Therefore, the evidence submitted since the June 2005 is cumulative; namely, evidence of a diagnosis of and treatment for onychomycosis. Thus, as the additional evidence is cumulative of the evidence of record at the time of the June 2005 rating decision and does not raise a reasonable possibility of substantiating the claim, the request to reopen the claim of service connection for onychomycosis is denied. 38 C.F.R. § 3.156(a). Stated differently, at the time of the prior denial there was no competent evidence of onychomycosis in service and no competent evidence of a nexus to service. There was post-service evidence of a diagnosis of and treatment for onychomycosis. Since then, the Veteran has submitted evidence of onychomycosis, but such fact had previously been established and this cumulative. In regard to her assertion as to cause, such is repetitive of her initial claim and is also cumulative and is insufficient to reopen the claim. See Bostain, supra. The evidence added to the file does not relate to a previously unestablished fact, and the claim for service connection for onychomycosis is not reopened. II. Increased Rating The Veteran seeks a disability rating in excess of 10 percent for the service connected bunionectomy with corns, right foot, with heel spur, status post arthroplasty 5th digit. After a careful review of the evidence of records, and resolving all reasonable doubt in the Veteran's favor, the Board finds that the disability picture more nearly approximates a 30 percent disability rating. Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. The Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Veteran was afforded a VA examination in September 2006. At the time she reported she has had burning and numbness in the right great toe and corns have developed on the top of the fourth right toe. She also reported pain on the bottom of her right heel if she walks excessively. The pain has increased in the past one to two years. She reported being able to walk a half a mile without apparent or significant difficulty. She further reported burning, numbness, and pain in the foot and heel areas. Physical examination revealed two scars of the right foot. There was no sign of abnormal weightbearing and no callosities or skin breakdown. The Veteran's posture and gait were normal. The examiner noted that the Veteran did not require any devices for ambulation, but she did use foot inserts to relieve discomfort when walking. There was no painful motion, edema, disturbed circulation, weakness, atrophy of the musculature, or tenderness bilaterally. There are two small corns located on the top of the right fourth toe. Each of these measured 5 mm in size with an elevation of 3mm to 4 mm. There was no evidence of flat feet and no signs of deformity (no inward rotation, medial tilting, marked pronation, or forefoot dorsiflexion). There was slight tenderness over the right heel area. The Achilles tendon had good alignment. The Veteran did not have clawfeet, dropfoot or varus deformity. Dorsiflexion of the toes produced no pain. There were no hammertoes and no tenderness over the metatarsal heads of the toes. There were no signs of Morton's metatarsalgia and no hallux valgus. There was mild limited function for standing and walking in that she has mild pain in the right foot with prolonged walking or standing. She does not require any type of corrective shoe. X-rays showed a plantar calcaneal spur. The Veteran was afforded another VA examination in September 2010. At the time, she reported pain in the corns on the third and fourth digits, and sometimes up the fibula and heel which occurs four times per week and lasts a day. The pain travels to the end of the toes and sometimes the great toe is painful. She reported the pain is crushing, squeezing, burning, aching, sharp and cramping. Pain level was reported at 8 out of 10. The pain can be exacerbated by physical activity and stress. It comes on spontaneously and is relieved by rest, foot soaks, spa pedicure and hydrating oils. At the time of pain, she can function without medication. She reported pain at rest, but no weakness, stiffness, swelling, and fatigue. While standing and walking, she has pain and fatigue, but no weakness, stiffness or swelling. The bone condition has never been infected. She reported residual numbness at the site of the surgery. She reported functional impairment in the form of pain in the feet or legs when on the treadmill. Regarding the heel spur, she reported pain in the heel once a month and lasting for a half hour and a level of 6 out of 10. The pain is exacerbated by physical activity and stress. At the time of pain, she can function without medication. At rest and while standing or walking, she has pain, but no weakness, stiffness, swelling and fatigue. Regarding the arthroplasty of the fifth toe, she reported pain in the side of the fourth digit where the fifth digit rests which occurs three times per month each time lasting an hour. She reports the pain is oppressive and is at a level of 5 out of 10. At the time of pain, she can function without medication. At rest, she has pain but no weakness, stiffness, swelling and fatigue. While standing or walking she has no pain, weakness, swelling, stiffness or fatigue. Physical examination showed the Veteran limps at times due to pain on her feet. There were no signs of abnormal weight bearing or breakdown, callosities or any unusual shoe wear pattern and she does not require any assistive devices for ambulation. There was tenderness on the right foot, especially over the plantar surface; but no painful motion, edema, disturbed circulation, weakness, atrophy of the musculature, heat, redness or instability. There is active motion in the metatarsophalangeal joint of the right toe. Alignment of the Achilles tendon was normal. There was pes planus present. There was also a slight degree of valgus which could be corrected with manipulation. There was slight malalignment of the forefoot/midfoot which can be corrected with manipulation. There was no deformity such as inward rotation of the superior portion of the os calis, medial tilting of the upper border of the talus, marked pronation of the whole foot everted. No hammertoes were found. Morton's metatarsalgia was not present, and no hallux valgus or hallux rigidus. She is limited to standing for 20 minutes. She requires no orthopedic shoes, corrective shoes, arch supports, foot supports or build up of the shoes, but does use insoles. X-rays showed degenerative joint disease at the first metatarsal phalangeal joint and prior surgery. The ratings for status post bunionectomy with corns of the right foot, status post arthroplasty of the 5th digit, has been assigned under Diagnostic Code 5280 for unilateral hallux valgus. Under this diagnostic code, a maximum 10 percent rating is warranted for unilateral hallux valgus that was operated with a resection of the metatarsal head or when severe, if equivalent to the amputation of the great toe. 38 C.F.R. § 4.71a, Diagnostic Code 5280. Therefore, the Veteran is not entitled to a higher disability rating under that code. However, in considering other potentially applicable codes, the Board finds that the Veteran's disability more nearly approximates a 30 percent disability rating under Diagnostic Code 5284, for a severe foot injury. Under this diagnostic code, a maximum 30 percent disability rating is warranted for a severe foot injury. A note to Diagnostic Code 5284 provides that a 40 percent disability rating will be assigned for actual loss of use of the foot. 38 C.F.R. § 4.71a, Diagnostic Code 5284. In this regard, the Board notes that the most recent VA examination of September 2010 notes that the Veteran can only stand for 20 minutes. She reported painful toes at a level of 8 out of 10. Moreover, she reported oppressive pain on her fourth digit. Tenderness over the plantar surface was also noted as was a slight degree of valgus, and slight malalignment of the forefoot/midfoot. Moreover, the examiner noted that the Veteran limped due to the pain on her foot. Considering the Veteran's symptoms as a whole, the Board finds that the symptoms more nearly approximate a severe level. Significantly, it was reported she could only stand for 20 minutes which is a short period of time. The Board acknowledges that the Veteran has now been diagnosed with arthritis of the first metatarsal phalangeal joint and flat foot. Neither of these disabilities is service connected. Moreover, the examiner did not differentiate between the symptoms caused by the service connected disability and those caused by the non-service connected disabilities. Therefore, the Board will resolve all reasonable doubt in the Veteran's favor and will grant a 30 percent disability rating under Diagnostic Code 5284. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). The Board has considered all other potentially applicable rating criteria and finds that a disability rating in excess of 30 percent is not warranted. There is no claw foot shown, and while flat foot on the right is shown, there is no evidence of pronounced bilateral flat foot. Finally, there is no showing of the equivalent of the loss of the foot. ORDER The application to reopen a claim of entitlement to service connection for various dental conditions for compensation purposes, to include removal of wisdom teeth, crowns, braces and teeth implants, is denied. The application to reopen a claim of entitlement to service connection for onychomycosis is denied. An evaluation of 30 percent, but not higher, for bunionectomy with corns, right foot, with heel spur, status post arthroplasty 5th digit, is granted subject to the regulations governing the award of monetary benefits. ____________________________________________ DAVID L. WIGHT Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs