Citation Nr: 1321111 Decision Date: 07/01/13 Archive Date: 07/12/13 DOCKET NO. 07-40 151 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, the Commonwealth of Puerto Rico THE ISSUES 1. Entitlement to service connection for rectal bleeding due to external hemorrhoid and anal fissure, claimed as hemorrhoid condition. 2. Entitlement to service connection for an eye disability. 3. Entitlement to service connection for a respiratory disability other than sleep apnea. 4. Entitlement to an initial rating in excess of 10 percent for umbilical and inguinal left herniorrhaphy, well healed, with scar. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Jebby Rasputnis, Associate Counsel INTRODUCTION The Veteran served on active duty from October 1968 to October 1970, and from December 2003 to February 2005. After his first period of active duty service, he also served in the U.S. Army Reserve until his retirement in November 2005. This appeal to the Board of Veterans' Appeals (Board) arose from July 2007 and October 2007 rating decisions. In the July 2007 rating decision, the RO granted service connection, and assigned an initial, noncompensable rating, for umbilical and left inguinal herniorrhaphy, well healed, with scar, effective March 1, 2005. The RO also denied service connection for an eye disability, right arm tendonitis, rectal bleeding due to external hemorrhoid and anal fissure, respiratory problems, and bilateral carpal tunnel syndrome. In the October 2007 rating decision, the RO denied service connection for major depressive disorder with psychotic features, claimed as a nervous/mental condition. The Veteran perfected timely appeals as to the denials of service connection as well as the initial rating assigned for umbilical and left inguinal herniorrhaphy. In January 2011, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge at the RO. A transcript of that hearing has been associated with the record. During the Board hearing, the Veteran withdrew several issues on appeal. After the hearing, the Board issued an August 2011 decision withdrawing the issues requested by the Veteran and remanding the matters remaining on appeal to the RO, via the Appeals Management Center (AMC) in Washington, DC, for further action, to include additional development of the evidence. In an August 2012 rating decision, the Appeals Management Center (AMC) granted an higher, initial 10 percent, rating for the service-connected umbilical and left inguinal herniorrhaphy, well healed, with scar. The rating action describes the assignment of an initial 10 percent rating as a full grant of the benefits sought on appeal. However, despite the assignment of an increased rating, as higher ratings are available for that disability and the appellant is presumed to be seeking the maximum available benefit, the issue remains on appeal and the Board has characterized the issue as reflected on the title page. See AB v. Brown, 6 Vet. App. 35, 38 (1993). In a November 2012 rating decision, the AMC granted service connection for major depressive disorder, bilateral carpal tunnel syndrome, and supraspinatus tendinitis (claimed as right arm tendinitis). Those awards represent a full grant of the benefits sought with respect to the issues of service connection for major depressive disorder, bilateral carpal tunnel syndrome, and right arm tendinitis. As such, and since the Veteran has not expressed any disagreement with the November 2012 rating actions, those issues are no longer before the Board for consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). After accomplishing further action with regard to the issues remaining on appeal, the AMC issued a November 2012 supplemental statement of the case (SSOC), reflecting continued denial of the Veteran's claims for service connection for a respiratory disability, an eye disability, and rectal bleeding (claimed as hemorrhoids). The AMC then returned these matters to the Board for further appellate consideration. As regards characterization of the appeal, the Board observes that the Veteran initially, in 2006, claimed service connection to a respiratory disorder that he characterized as respiratory problems for which he had received treatment while serving in Kuwait in 2004. Service records reflect that the Veteran was diagnosed with bronchitis while serving in Kuwait. Although the Veteran discussed a diagnosis of obstructive sleep apnea while testifying as to his respiratory disorder during the January 2011 hearing, sleep apnea is not considered part of the respiratory claim on appeal. The United States Court of Appeals for Veterans Claims (Court) has determined that the breadth of a claim is determined by "several factors including: the claimant's description of the claim; the symptoms the claimant describes; and the information the claimant submits or that the Secretary obtains in support of the claim." See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Since, prior to the hearing, neither the Veteran nor the evidence of record raised the issue of service connection for sleep apnea, and, during the hearing, he was advised that such a claim was regarded as distinct from his claim for service connection for a respiratory disorder, the Board has characterized this issue on appeal as reflected on the title page. As a final preliminary matter, the Board notes that the issue of the Veteran's entitlement to service connection for obstructive sleep apnea was raised during the January 2011 hearing. However, as this matter has not been adjudicated by the RO, it is not properly before the Board and is referred to the RO for appropriate action. FINDINGS OF FACT 1. All notification and development actions needed to fairly adjudicate each claim herein decided have been accomplished. 2. The Veteran currently has a hemorrhoid disability and competent evidence indicates that it was incurred during a period of active duty for training. 3. The Veteran currently has an eye disability diagnosed as recurrent bilateral pterygiums and competent evidence indicates this disability began during, and has continued since, his initial term of active duty service. 4. Although the Veteran was diagnosed with bronchitis during service, there is no credible evidence of any subsequent findings or diagnoses of any such respiratory disorder. 5. The Veteran's residuals of inguinal left herniorrhaphy consist of a well-healed scar; the scar and surrounding skin can be painful. CONCLUSIONS OF LAW 1. Resolving all reasonable doubt in the Veteran's favor, the criteria for service connection for hemorrhoids are met. U.S.C.A. §§ 101, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 2. Resolving all reasonable doubt in the Veteran's favor, the criteria for service connection for recurrent bilateral pterygiums are met. U.S.C.A. §§ 101, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 3. The criteria for service connection for a respiratory disorder, other than sleep apnea, are not met. 38 U.S.C.A. §§ 1101, 1110, 1131, 5103, 5103A, 5107(b) (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2012). 4. The criteria for an initial disability rating in excess of 10 percent for inguinal left herniorrhaphy are not met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 4.1, 4.7, 4.20, 4.27, 4.114 (Diagnostic Code 7338) (2012), 4.118 (Diagnostic Code 7804 (2006, 2012)). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Due Process Considerations The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2012)) includes enhanced duties to notify and assist claimants for VA benefits. VA regulations implementing the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). Given the award of service connection for hemorrhoids and recurrent bilateral pterygiums, the Board finds that all notification and development actions needed to fairly adjudicate these claims on appeal have been accomplished. As regards the remaining claims on appeal, notice requirements under the VCAA essentially require VA to notify a claimant of any evidence that is necessary to substantiate the claim, as well as the evidence that VA will attempt to obtain and which evidence he or she is responsible for providing. See, e.g., Quartuccio v. Principi, 16 Vet. App. 183 (2002) (addressing the duties imposed by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)). As delineated in Pelegrini v. Principi, 18 Vet. App. 112 (2004), after a substantially complete application for benefits is received, proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim, in accordance with 38 C.F.R. § 3.159(b)(1). The Board notes that, effective May 30, 2008, 38 C.F.R. § 3.159 has been revised, in part. See 73 Fed. Reg. 23,353 -23,356 (April 30, 2008). Notably, the final rule removes the third sentence of 38 C.F.R. § 3.159(b) (1), which had stated that VA will request that a claimant provide any pertinent evidence in his or her possession. VA's notice requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). In rating cases, a claimant must be provided with information pertaining to assignment of disability ratings (to include the rating criteria for all higher ratings for a disability), as well as information regarding the effective date that may be assigned. Id. VCAA-compliant notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the AOJ (in this case, the RO, to include the AMC). Id.; Pelegrini, 18 Vet. App. at 112. See also Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). However, the VCAA notice requirements may, nonetheless, be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Id. In this appeal, a May 2005 pre-rating letter provided notice to the Veteran as to what information and evidence was needed to substantiate a claim for service connection for a hernia residuals and a May 2006 letter provided the same notice in regard to service connection for a respiratory disorder. Post rating, in a February 2012 letter, the AMC re-advised him of the information and evidence that was needed to substantiate a claim for service connection as well as the evidence required to substantiate a claim for an increased rating. In that letter, the AMC also provided notice of the information generally pertaining to the assignment of disability ratings and effective dates, as well as the type of evidence that impacts those determinations, consistent with Dingess/Hartman. The 2012 letter also advised him of what information and evidence must be submitted by him, and what information and evidence would be obtained by VA. Since providing the additional notice in 2012, the AMC readjudicated the claims-the claim for an increased rating for umbilical and left inguinal herniorrhaphy was readjudicated in rating decisions issued in September and December 2012 and the issue of service connection for a respiratory disorder was readjudicated in a December 2012 SSOC. As a result of these readjudications, any timing defect in the provision of this additional notice has been rectified ("cured"). See Mayfield v. Nicholson, 499 F.3d 1317, 1323 (Fed. Cir. 2007); (Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). The record also reflects that VA has made reasonable efforts to obtain or to assist in obtaining all relevant records pertinent to the matters herein decided. Pertinent evidence associated with the claims file consists of service treatment records, records from the Social Security Administration (SSA), VA and private treatment records, and the reports of VA examinations conducted in June 2005, April 2010, and February 2012. Also of record and considered in connection with the appeal are various written statements provided by the Veteran and other lay individuals, on his behalf. The Board notes that, in addition to the paper claims file, there is a paperless, electronic (Virtual VA) claims file associated with the Veteran's claim. A review of the paperless claims processing system revealed additional medical evidence that has been carefully reviewed by the Board. Also of record and considered in connection will the appeal are various written statements provided by the Veteran, as well as by his representative, on his behalf. The Board finds that no additional RO action to further develop the record in connection with any of these claims, prior to appellate consideration, is required. Specifically as regards the Veteran's January 2011 Board hearing, it is noted that the United States Court of Appeals for Veterans Claims (Court) has held that that provisions of 38 C.F.R. § 3.103(c) (2) impose two distinct duties on VA employees, including Board personnel, in conducting hearings: to explain fully the issues, and to suggest the submission of evidence that may have been overlooked. Bryant v. Shinseki, 23 Vet. App. 488 (2010). During the hearing in this case, the undersigned Veterans Law Judge discussed the evidence necessary to substantiate claims for service connection as well as to support a claim for increased rating. The Veterans Law Judge specifically inquired as to basis of the Veteran's contentions as to why service connection was warranted for the appealed issues and advised that medical evidence supportive of his contentions (that he experienced current disabilities that were incurred in service) and reflecting the current severity of his umbilical and inguinal left herniorrhaphy, would assist him in substantiating his claims. Accordingly, the Board finds that the Bryant duties were met, the hearing is legally sufficient. The Board also notes that, although the Veteran's complete service treatment records are not associated with the claims file, inquiries to the National Personnel Records Center (NPRC) reflect that additional records are not available. In an April 2007 letter from the RO, the Veteran was advised that not all of his service records could be located. In June 2007, the RO issued a Memorandum of Formal Finding on the Unavailability of Records. As the claims were remanded in August 2011, additional searches were conducted in an attempt to gather additional service records, but the searches were unsuccessful. The Veteran was advised of the searches in a March 2012 letter from the AMC. Similarly, although the claims file reflects that some VA treatment records from the San Juan Outpatient Clinic may (italics added for emphasis since the Board notes that at least some VA treatment notes from the identified time frame are associated with the record) be outstanding, the AMC has advised the Veteran and taken appropriate steps to obtain all available records. See June 2012 Formal Finding of Unavailability. Under the circumstances, the Board finds that the RO and the AMC have undertaken sufficient and appropriate action to attempt to assist the Veteran in obtaining additional evidence and that no further action in this regard is warranted. As noted directly above, all requested development was accomplished regarding records collection on remand. In the August 2011 remand, the Board also directed the RO/AMC to obtain translations of various Spanish language documents within the claims file, to afford the Veteran VA examinations, and to readjudicate the claims and issue the Veteran an appropriate SSOC. Document translations have been added to the claims file and the Veteran was afforded a VA respiratory disorders examination, as well as VA examinations for scars and hernia, in February 2012. The claim for service connection for a respiratory disorder was readjudicated in a December 2012 SSOC, which, as directed by the Board, cited to 38 C.F.R. § 3.317. The claim for an increased rating for umbilical and inguinal left herniorrhaphy was readjudicated in rating decisions issued in September and December 2012. Although the RO/AMC did not issue a subsequent SSOC in regard to the increased rating claim, that claim was readjudicated so there was substantial compliance with all of the remand directives. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Further, as the Veteran's representative submitted an April 2013 Informal Hearing Presentation reflecting knowledge that the increased rating claim remained on appeal, the Board also finds that he is not prejudiced by the lack of an SSOC on this issue. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). As mentioned, on remand, the Veteran was afforded VA examinations with resulting medical opinions in February 2012. The Board finds that such VA examinations and accompanying opinions are adequate to decide the issues, as they are predicated on interviews with the Veteran, reviews of the record, and physical examinations. The opinions proffered considered all of the pertinent evidence of record and provided complete rationales, relying on and citing to the records reviewed. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination has been met. 38 C.F.R. § 3.159(c) (4). In summary, the duties imposed by the VCAA have been considered and satisfied. Through various notices of the RO/AMC, the Veteran has been notified and made aware of the evidence needed to substantiate his claims, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. There is no additional notice that should be provided, nor is there any indication that there is additional existing evidence to obtain or development required to create any additional evidence to be considered in connection with any of these claims. Consequently, any error in the sequence of events or content of the notice is not shown to prejudice the Veteran or to have any effect on the appeal. Any such error is deemed harmless and does not preclude appellate consideration of the matter on appeal, at this juncture. See Mayfield v. Nicholson, 20 Vet. App. 537, 543 (2006) (rejecting the argument that the Board lacks authority to consider harmless error). See also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. Analyses A. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Such a determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). If a chronic disease, such as arthritis, becomes manifest to a degree of 10 percent within one year of separation from active service, then it is presumed to have been incurred during active service, even though there is no evidence of such disease during service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1111, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In some cases, service connection may be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) a chronic disease shown as such in service (or within an applicable presumptive period under 38 C.F.R. § 3.307) and (ii) subsequent manifestations of the same chronic disease; or (b) if the fact of chronicity in service is not adequately supported, by evidence of continuity of symptomatology. The United States Court of Appeals for the Federal Circuit has held that the provisions of 38 C.F.R. § 3.303(b) relating to establishing service connection on the basis of continuity of symptomatology in lieu of a medical nexus opinion is limited to disorders explicitly recognized as chronic under 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Board observes that, with respect to the Veteran's Reserve service, the applicable laws and regulations permit service connection only for disability resulting from disease or injury incurred or aggravated while performing active duty for training (ACDUTRA) or injury incurred or aggravated while performing inactive duty for training (INACDUTRA). See 38 U.S.C.A. § 101(22), (24); 38 C.F.R. § 3.6. In adjudicating a claim for VA benefits, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 C.F.R. § 3.102. See also 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 1. Hemorrhoids The Veteran seeks service connection for a hemorrhoid disability that he contends was incurred during active duty for training in 1983. He has alternately contended that should be entitled to service connection on the basis of aggravation since he experienced hemorrhoids prior to his service in the Middle East and he has alleged that they worsened during that service. As noted above, the Veteran served on active duty from October 1968 to October 1970 and from December 2003 to February 2005 as well as completing years of reserve service in between his periods of active duty service. His service records indicate that he completed multiple annual trainings as part of his reserve service. Pursuant to 10 U.S.C. § 101(22), a period of annual training is considered a period of ADUCTRA. The reports of the Veteran's July 1968 pre-induction examination, as well as his August 1970 separation examination, reflect a normal evaluation, negative for hemorrhoids. He reported no rectal disease at the time of his separation in August 1970. He was again examined as normal in October 1982 at his examination for enlistment into the reserves. The "anus and rectum (hemorrhoids, fistula, prostate, if indicated)" portion of the examination is specifically marked as within normal limits. However, in July 1983, the Veteran, upon returning from being in the field for several days of annual training, reported for treatment of bloody stools and abdominal pain. He informed the treating health care provider that he had been in the field for five days without any bowel movement when he strained and forcefully defecated bloody stools. The initial treatment records reflect that he reported no prior history of such a condition and was referred for additional evaluation. Additional evaluation revealed slight fever as well as rectal fissure, with active bleeding. A sick slip dated July 25, 1983 states that stomach ache, constipation, fever, and rectal bleeding were incurred in the line of duty. A June 2001 VA medical certificate states that the Veteran began experiencing "bright red bleeding episodes" with stool passage "several years ago" and had his last episode approximately two months earlier. An October 2002 VA treatment note reflects that the Veteran had experienced bloody stool and anal discomfort the month prior, but had recovered. An April 2003 VA colonoscopy was normal, but reflected a small hemorrhoid. The Veteran was afforded an initial VA examination in June 2005. The examiner diagnosed "rectal bleeding, stable, controlled, due to external hemorrhoid and anal fissure." Among the other service records associated with the claims file are a September 2005 medical summary reflecting note of a "rectal bleeding" condition, a September 2005 self report of medical history on which the Veteran reported hemorrhoids. A subsequent private treatment note dated in August 2006 reflects bleeding from an "anal laceration." The report of a privately conducted May 2007 colonoscopy reflects diagnosis of "Grade I hemorrhoids" in the rectum. That finding is reiterated on the reports of January 2008, January 2009, February 2009, and March 2009 private physical examination reports. In a handwritten report provided to VA in March 2012, the Veteran also attested that he had experienced "frequent rectal bleeding" while stationed in Kuwait in 2004 and 2005. He was afforded a VA examination in February 2012; at that time, the examiner noted review of the entire claims file. The examiner stated that the medical evidence of record showed that the Veteran experienced "a superficial tear (fissure) at the anus and some external and internal hemorrhoids" "... in 1983 after being in the field x 5 days." The examiner also observed that this was a chronic disability as it had, since initially manifesting, "been a recurring symptom off and on over the last 20 years." The examiner further opined that the Veteran's hemorrhoid disability had progressed naturally, resulting in infrequent bleeding and discomfort. In conclusion, the examiner stated that "the initial hemorrhoid and fissure was incurred in 1983 while in the field for active duty." A veteran is generally considered competent to report his or her symptoms, such as pain. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Here, the Veteran is competent to report his rectal discomfort and observable blood in his stool. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that lay evidence also may be competent to establish medical etiology or nexus (see Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009)), but it also noted that VA "may give it whatever weight it concludes the evidence is entitled to." Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). However, the Board has a duty to assess the credibility of the evidence. Smith v. Derwinski, 1 Vet. App. 235, 237-38 (1991); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). In so doing, the Board may discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. See Caluza v. Brown, 7 Vet. App. 498 (1995). The Board finds the Veteran credible in his account of in-service onset of hemorrhoids. Not only has his account has been consistent over the years, but it is supported, at least in part, by contemporaneous medical evidence of record. See Curry v. Brown, 7 Vet. App. 59, 68 (1994). Further, the 2012 VA examiner opined, after reviewing the claims file and interviewing and examining the Veteran, that he was disabled by hemorrhoids during his 1983 annual training and the disability continued to present day. The fact that the examiner based his opinion, in part, upon the Veteran's own self-reported history of continuous problems with hemorrhoids does not diminish the probative value of the opinion evidence, particularly, where, as here Board has accepted the Veteran's assertions as credible. In light of this evidence, and with resolution of all reasonable doubt in the Veteran's favor, the Board finds that the Veteran's currently diagnosed hemorrhoids had their onset during, and are the result of injury incurred in the line of duty during, the period of ACDUTRA he completed in July 1983 for annual training. . Accordingly, the criteria for direct service connection are met. 2.Service Connection for an Eye Disorder The Veteran seeks service connection for an eye disability that he contends manifested during his first period of active duty service. His April 2005 claim for benefits reflects his contention that it manifested in 1969. The report of the Veteran's July 1968 pre-induction examination is negative for any eye disabilities other than correctible near vision. However, the Veteran reported having experienced "eye trouble" in March 1970 at the time of his August 1970 separation examination. The examiner observed bilateral pterygiums and noted that, on the left side, the pterygium extended over half of the cornea, but not over the pupil. Vision corrected by glasses was again notes. A post-service April 1971 VA treatment note reflects surgical correction for a left eye pterygium. Subsequent service records show the following: right eye pterygium noted on October 1982 examination; an October 2004 ocular evaluation reflecting bilateral pterygiums, greater on the right, and referring to a 1969 left eye pterygium surgery and a 1995 right eye pterygium surgery; a December 2004 line of duty medical report indicating that UV light exposure had aggravated a right eye pterygium requiring issuance of additional protective eyewear; a separate December 2004 "statement of medical examination" states that the Veteran experienced blurry vision while on active duty as the result of a right eye pterygium and was advised to seek surgery upon returning home; complaint of "eyes" condition on a September 2005 self report of medical history; an undated medical history on which the Veteran reported that he last received an eye examination (from a private physician) in January 2003 and had a history of cataract surgery. A June 2001 VA treatment note reflects that the Veteran needed new glasses for his myopia and astigmatism. In March 2005, a VA physician observed that the Veteran experienced a right eye pterygium. An April 2005 private treatment note attests that the Veteran experienced ocular discomfort, greater in the right eye, as the result of bilateral pterygium. VA afforded the Veteran an eye examination in June 2005. The examiner noted the he had undergone a pterygium surgery to the left eye in 1970. On examination, the Veteran was noted to have a temporal pterygium of the left eye and a right eye nasal pterygium. In additional to the pterygiums, the examiner diagnosed incipient senile cataracts and asymptomatic extropia. Although observing that the Veteran experienced decreased vision, the examiner stated that was most likely caused by, or a result of, refractive error and cataracts. In December 2005, a private physician noted that the Veteran experienced a history of bilateral astigmatism and also reported decreased vision; the physician attributed decreased vision to astigmatism. A December 2005 VA treatment noted documents a diagnosis of a small right pterygium as well as astigmatism. In September 2006, the Veteran had VA treatment for blurry vision, and was observed to have a pterygium in each eye, larger on the right side. The Veteran submitted a statement by A.C.M. in October 2007. A.C.M. identified himself as a fellow service member who was stationed with the Veteran during his initial term of active duty service in 1969/1970. A.C.M. attested that the Veteran underwent surgery for the left eye in September 1969 and March 1970 while on active duty, and in 1971 at a VA facility in San Juan, after separation. In a March 2012 written statement, the Veteran reported first experiencing pterygium while on active duty in 1969. He stated that he underwent surgery while on active duty and after separation in 1971. The Veteran also contended that, while serving in Kuwait in 2004, his vision began to deteriorate and blur. An August 2010 VA treatment note indicates that the Veteran was seen for symptomatic inflamed recurrent pterygium of the right eye. He was also initially diagnosed with glaucoma. In June 2011, the right eye pterygium was surgically removed. A follow-up VA ophthalmology appointment in December 2011 reflects a diagnosis of recurrent ptyergium and observes that the Veteran had experienced "several, both eyes." In connection with a May 2012 appointment, nasal pterygium scars were noted, bilaterally. VA afforded the Veteran another VA examination in October 2012. The examiner indicated review of the claims file and noted established diagnoses for bilateral pterygiums and senile cataracts. On examination, the Veteran was noted to have a small left eye pterygium as well as a nasal keratectomy scar on the right eye, status post surgical removal of pterygium. The examiner explained that the scar did not result in any decreased vision because it was not in the visual axis and the left eye pterygium also was not near the visual axis. The examiner also observed inflammation (blepharitis) and dryness and diagnosed the Veteran with glaucoma, but opined that the Veteran's decreased vision was the result of his senile cataracts and refractive error. In conclusion, the 2012 examiner opined that, based on review of the evidence of record and examination of the Veteran "it is as least as likely as not that pterygium in both eyes was incurred during service," but that senile cataracts and glaucoma were not related to service or secondary to pterygiums. The examiner noted that glaucoma was not diagnosed until 2010, many years after service and specified that cataracts were of the senile type - senile cataracts are "the most common kind of cataract... developing without any traumatic, ocular, systemic, or congenital disorder... associated solely with aging." DORLANDS ILLUSTRATED MEDICAL DICTIONARY 309 (31st Ed. 2007); and see Kirwin v. Brown, 8 Vet. App. 148, 153 (1995) (three judge panel decision) (holding that the Board had erroneously placed "reliance on [a] medical treatise [] for more than purely definitional purposes"). The Board notes that the corollary of Kirwin is that information from medical sources outside the record can be used for purely definitional purposes. Initially, the Board notes that the Veteran has been diagnosed with loss of visual acuity attributed to refractive error and astigmatism. However, under 38 C.F.R. § 3.303(c), refractive error and astigmatism are not considered disabilities for VA compensation purposes. See 38 C.F.R. §§ 3.303(c), 4.9; McNeely v. Principi, 3 Vet. App. 357, 364 (1992). While the Board notes that service connection may be granted, in limited circumstances, for disability due to aggravation of a constitutional or developmental abnormality by in-service disease or injury, superimposed for a defect (see VAOPGCPREC 82-90, 55 Fed. Reg. 45,711 (1990); Carpenter v. Brown, 8 Vet. App. 240, 245 (1995); and Monroe v. Brown, 4 Vet. App. 513, 514-15 (1993)), there is no competent evidence that such has occurred in this case. The Veteran has also been diagnosed with cataracts and glaucoma. Although, during the Board hearing, the Veteran's authorized representative contended that the Veteran began to experience "eye problems due to his cataract" during his second term of active duty service, competent medical evidence plainly indicates that cataracts were not incurred during active duty, but rather, are solely a product of aging. See DORLANDS ILLUSTRATED MEDICAL DICTIONARY 309. Specifically, there is no evidence of cataracts during the Veteran's first period of active duty service and the Veteran reported during his second period of active duty service that his eyes were last evaluated in January 2003 and, at that time, he had a history of cataract surgery-i.e, cataracts occurred in between his periods of active duty service. The evidence of record also does not suggest, and the Veteran does not contend that, cataracts were incurred or aggravated while he was performing ACDUTRA or INACDUTRA. In regard to glaucoma, the claims file shows that disorder did not develop until 2010. Further, no medical professional has indicated, and the Veteran has not contended, glaucoma is related to his service. Two (2005 and 2012) VA examiners and the Veteran's own private physician (in a December 2005 letter) attributed his visual symptoms to astigmatism and refractive error. However, in this case, the Board finds that, resolving all reasonable doubt in the Veteran's favor, the record does present a basis for award of service connection for bilateral pterygiums. The Veteran has contended, and service treatment records appear to reflect, that he first experienced pterygiums of both eyes during his first period of active duty service. He has reported experiencing recurrent pterygiums in both eyes since that time, some of which have required surgical intervention. The Board finds no reason to question the veracity of the Veteran's assertions in this regard. Furthermore, the Board determines that the 2012 VA eye examiner's opinion-again, based, at least in part, upon the Veteran's credible assertions-to the effect that pterygium in both eyes was as likely as not incurred during service, but that (consistent with sound medical judgment) senile cataracts and glaucoma were not related to service or secondary to pterygiums-constitutes probative evidence on these points. In so finding, the Board notes that the examiner reviewed the Veteran's claims file thoroughly, analyzed his medical history, and provided thorough opinions with rationale. See, e.g., Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). See also Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion). Further, the opinion is not contradicted by any competent evidence of record. Although, the examiner's opinion on the question of the in-service incurrence of bilateral ptyerygiums is not definitive, it has been written in such terms as to warrant application of the benefit-of-the-doubt doctrine. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 3.102. See also 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Considering the above in light of the collective lay and medical evidence of record, the Board finds that the criteria for service connection for recurrent bilateral pterygiums are met. 3. Respiratory Disorder other than Sleep Apnea The Veteran contends that he has a respiratory disorder as the result of his active duty service, specifically, his service in Kuwait. In his May 2006 claim for service connection, he asserted that he first experienced respiratory problems, for which he received private treatment, in 2004. Service treatment records dated prior to the Veteran's second period of active duty service do not reflect diagnosis of respiratory disability. At the time of his separation from his first period of active duty in 1970, his respiratory system was evaluated as normal and he denied respiratory problems. His respiratory system was also evaluated as normal in October 1982 when he enlisted in the reserves. Subsequent reserve treatment records associated with the claims file do not reflect diagnosis of respiratory disorder. However, during the Veteran's second term of active duty service (which began in December 2003), he was seen for respiratory complaints. Specifically, in January 2004, he reported for treatment of a viral syndrome - an Individual Sick Slip reflects that he experienced headache, fever, and cough and was diagnosed with an upper respiratory syndrome. In July 2004, he reported for treatment of occasional chest pain that was initially categorized as respiratory in nature. However, the Veteran denied shortness of breath or "exertional component" and was diagnosed with atypical chest pain and esophageal reflux. During a follow-up appointment in August 2004, his lungs were noted to be clear to auscultation and he again denied experiencing any shortness of breath or that the pain occurred with exertion; the pain was noted to be "most likely GI [gastrointestinal]." A July 2005 note-written after the Veteran's separation from active duty, but prior to his retirement from the reserves-reflects diagnoses of hyperventilation and posttraumatic stress disorder (PTSD). The Veteran denied respiratory problems-including chronic cough, asthma, wheezing, shortness of breath, and "any breathing problems related to exercise" - on a self report of medical history completed in October 2005. VA treatment notes reflect that the Veteran underwent chest x-ray in May 2005 that showed a normal result. The Veteran was afforded a general VA examination in June 2005 and did not report any respiratory complaints at that time. The examiner determined that he had normal nose, nostrils, turbinate mucosa, free upper airways, clear lungs, and symmetrical chest expansion with normal thoracic bony structure and shape. At a September 2005 VA mental health appointment, the Veteran reported exposure to "gases that he call toxic" and stated that when he was tense, he had breathing problems. In April 2006, the Veteran was seen by his private physician and was noted to experience anxiety; the treatment note also states "R/O asthma" and reflects that the Veteran was prescribed an inhaler. Although subsequent notes from the physician appear in the record, they do not reflect diagnosis of a respiratory disability. A May 2006 VA psychiatric treatment note indicates that the Veteran reported experiencing continued flashbacks and nightmares as well as sensations of "air hunger" and "feeling hot." In February 2007, he was seen by his private physician and diagnosed with viral syndrome; the note indicates that his albuterol inhaler had run out, but a new one was not prescribed. A March 2007 note states that his lungs were clear to auscultation. An October 2007 summary from the Veteran's private physician reflects that he had been diagnosed with hyperventilation syndrome as well as anxiety and panic disorder. The Veteran submitted two lay statements pertinent to his claim for a respiratory disorder in October 2007. O.S. wrote that he was stationed with the Veteran in Kuwait and "observed him developing... respiratory problems." W.R. also wrote that he was stationed with the Veteran in Kuwait and "observed him developing... respiratory problems." A June 2008 treatment note from the Veteran's private physician reflects that his lungs were clear to auscultation. In January 2009, he underwent a private sleep study that resulted in a diagnosis of obstructive sleep apnea. The Veteran testified at a Board hearing in January 2011 and reported having experienced bronchitis while serving in Kuwait. He testified that bronchitis lasted "a series of weeks" and that he experienced "a series of conditions" related to in-service exposure to an incinerator. The Veteran testified that his current respiratory condition was sleep apnea. VA afforded the Veteran a respiratory disorders examination in February 2012. The examiner noted that the Veteran had experienced respiratory infection during service and characterized it as bronchitis. Although the Veteran informed the examiner that his exposure to burn pits in Kuwait irritated his bronchitis, the examiner noted that he did not have a chronic pulmonary disease or recurring symptoms of shortness of breath. The examiner observed that chest x-ray was normal as were the results of pulmonary function tests - "normal spirometry and respiratory loop patterns as well as normal airway resistance and gas transfer." The examiner noted that the Veteran had been diagnosed with obstructive sleep apnea, but opined that diagnosis was not associated with any prior respiratory infection, to include the bronchitis for which the Veteran was seeking service connection. In March 2012, the Veteran wrote to VA and contended that he was exposed to dust, fungus, gas pollution, motor gas, electric generator and solid waste odors, fumes from construction materials like paint and detergents, in addition to "gases." He stated that he caught a cold while in Kuwait that "got even wors[e] with a severe pneumonia for several months." Initially, the Board notes again that, in some cases, service connection may be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) a chronic disease shown as such in service (or within an applicable presumptive period under 38 C.F.R. § 3.307) and (ii) subsequent manifestations of the same chronic disease; or (b) if the fact of chronicity in service is not adequately supported, by evidence of continuity of symptomatology. However, as the Veteran has not been diagnosed with a respiratory disorder listed at 38 C.F.R. § 3.309(a), service connection cannot be granted solely on the basis of continuity of symptomatology in his case. Walker, 708 F.3d 1331. The Board also observes that, based on the Veteran's service in Kuwait, he is considered a Persian Gulf Veteran. See 38 U.S.C.A. § 1117(f); 38 C.F.R. § 3.317(d). Under 38 U.S.C.A. § 1117(a)(1), compensation is warranted for a Persian Gulf veteran who exhibits objective indications of a "qualifying chronic disability" that became manifest during service on active duty in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent during the presumptive period prescribed by the Secretary. For purposes of 38 U.S.C.A. § 1117, the chronic disability must not be attributed to any known clinical disease by history, physical examination, or laboratory tests. See 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317(a), (b). However, these provisions cannot be favorably applied to the Veteran's claim as he has not exhibited objective indications of a chronic respiratory disability that has not been attributed to known clinical diagnoses. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a). The Veteran has submitted multiple statements attesting to having experienced respiratory disability on a new continuous basis ever since his service in Kuwait. However, here, the Veteran's assertions-advanced in connection with a claim for monetary benefits-as to what respiratory conditions he experienced in the past and how long he experienced them, are not consistent with contemporaneous evidence. Although laypersons are competent to report on matters observed or within their personal knowledge (see Layno v. Brown, 6 Vet. App. 465, 470 (1994)), as well as to report a continuity of symptomatology (see Charles, 16 Vet. App. at 370), such report must be weighed against the medical and other evidence. Cf. Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). The Veteran has reported experiencing respiratory disorder during his service in Kuwait and thereafter. He specifically contested that he experienced a respiratory infection, bronchitis, that progressed to pneumonia that lasted for "months." However, the claims file reflects only diagnosis of an upper respiratory infection that resolved with treatment. Further, the Veteran's own statements are not consistent with having had near continuous symptoms since he denied experiencing respiratory problems on an October 2005 self report of medical history and, at the January 2011 hearing, provided testimony indicating that he did not have any respiratory diagnosis other than sleep apnea. Treatment notes, both private and VA, do reflect that, after service, the Veteran experienced breathing difficulty characterized as hyperventilation, but clinicians associated those symptoms with psychiatric issues and did not diagnose other respiratory disorder. It is the responsibility of the Board to assess the credibility and weight to be given the evidence (see Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992))) and, due to the inconsistencies between the Veteran's statements and the other evidence of record, the Board finds his lay assertions are not credible. Here, there is no contrary, competent medical evidence or opinion supporting a finding of any diagnosable respiratory disorder that began during the Veteran's Kuwait service and continued. In this case, the Board finds the VA respiratory examiner's opinion-to the effect that there no current respiratory disorder etiologically related to the Veteran's service-the most persuasive evidence on, and dispositive of, the medical nexus question. See, e.g., Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). See also Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion)). In so finding, the Board notes that the expert reviewed the Veteran's claims file thoroughly, summarized his contentions, analyzed his medical history, and provided thorough discussions as to the etiologies of his diagnosed respiratory conditions. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.") Finally, to whatever extent the Veteran is attempting to establish that there exists a medical nexus between any post-service respiratory problems and service on the basis of lay assertions, alone, such attempt must fail. Although claimants are competent to describe their symptoms, a layperson is generally not capable of opining on matters requiring medical knowledge. See Bostain v. West, 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992); Routen v. Brown, 10 Vet. App. 183, 186 (1997). Respiratory conditions are complex in nature and result from internal processes not observable to the human eye - they are too complex for diagnosis without special knowledge, training, and experience. See Kahana v. Shinseki, 24 Vet. App. 428, 433, 438 (2011); Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Hence, the Veteran's assertions as to matters of diagnosis or medical etiology have no probative value. To the extent that lay statements from fellow service members attest that he experienced respiratory problems in service, they have little probative value since this case turns on whether there is a current (italics added for emphasis) respiratory disability etiologically related to service. As noted above, there is no competent medical evidence that the Veteran has been diagnosed during the appellate period with any respiratory disorder other than sleep apnea and the existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. § 1131; Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). For all the foregoing reasons, the Board finds that the claim for service connection for a respiratory disorder must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). B. Higher Rating Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 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 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. A 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 already has 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). However, where, as here, the question for consideration is the propriety of the initial rating assigned, evaluation of the medical evidence since the award of service connection and consideration of the appropriateness of "staged rating" (i.e., assignment of different ratings for distinct periods of time, based on the facts found) is required. See Fenderson, 12 Vet. App. at 126. Historically, the Veteran was granted service connection for umbilical and inguinal left herniorrhaphy, well healed, with scar in a July 2007 rating decision. In the rating decision, the RO specifically granted service connection for residuals of a left inguinal hernia incurred in 2002 and assigned a 0 percent (noncompensable) rating, effective March 1, 2005, the day following his discharge from his second period of active duty service. Although the rating for the disability has been assigned under Diagnostic Codes 7399-7338-which inexplicably indicates that it is a non-listed disability rated, by analogy, to inguinal hernia (rated under Diagnostic Code 7338), see 38 C.F.R. §§ 4.20 and 4.27-clearly, the disability was rated under the criteria of Diagnostic Code 7338. Diagnostic Code 7338 provides that small inguinal hernia, reducible, or without true hernia protrusion, is rated as noncompensable (0 percent) disabling. Inguinal hernia that is not operated, but is remediable, also is rated as non-compensable (0 percent) disabling. Postoperative recurrent inguinal hernia, readily reducible, well supported by truss or belt, is rated 10 percent disabling. Small inguinal hernia, postoperative recurrent, or unoperated irremediable, not well supported by truss, or not readily reducible, is rated 30 percent disabling. Large inguinal hernia, postoperative recurrent, not well supported under ordinary conditions and not readily reducible, when considered inoperable, is rated 60 percent disabling. A Note to Code 7338 provides that 10 percent is to be added for bilateral involvement, provided the second hernia is compensable. This means that the more severely disabling hernia is to be rated, and 10 percent, only, added for the second hernia, if the second hernia is of compensable degree. 38 C.F.R. § 4.114. The pertinent medical evidence of record consists of the Veteran's lay statements, service records, SSA records, VA treatment records, private treatment records, and reports of VA examination. In November 2002, while the Veteran was participating in training, he fell to the ground while carrying equipment. He was diagnosed with left inguinal hernia in December 2002 and subsequently sought treatment, receiving surgical repair from a VA facility in March 2003. A July 2003 post-surgical note documents that the Veteran reported experiencing occasional discomfort in the surgical area, but acknowledged that he was able to work full time without limitation. The VA physician examined the Veteran and determined that he had no objective signs of hernia, inflammation, or pain. Subsequently, the Veteran reported hernia pain while on active duty in January 2004. Specifically, he reported that he was not feeling well and his left testicle was tender. On examination, his testicle was not tender and there was no observable swelling or hernia; the Veteran was diagnosed with, and treated for, viral syndrome. Following his release from active duty service, he filed for service connection in April 2005 and was afforded a general VA examination in June 2005. The examiner observed a well-healed scar from a prior epigastric hernia repair as well as a well-healed scar from left inguinal herniorrhaphy and a non-tender abdomen with no masses. Based on physical examination of the Veteran, the examiner diagnosed umbilical and left inguinal herniorrhaphy, well-healed, surgical scar. [As the examiner did not explain the basis for use of the term umbilica, it would appear that, given the examination findings, the examiner mistakenly used the word umbilical instead of the word epigastric.] A July 2005 reserve service record notes that the Veteran's medical history included an inguinal hernia with "still some discomfort." In July 2006, the Veteran reported for treatment of a right inguinal hernia. The VA physician noted that the Veteran had been treated in the past for a reducible left inguinal hernia that had not recurred and had healed well. Although the left testicle was observed to be somewhat atrophied, the physician described it as normal. VA records reflect surgical correction of the right hernia in August 2006 and that the Veteran was subsequently seen for follow-up. At the later August 2006 appointment, he reported no pain, but swelling of the right testicle. At a September 2006 VA follow-up appointment, the Veteran reported residual pain from the right hernia surgery that, at times, prevented him from walking. The examining physician also noted residual swelling of the right testicle. The Veteran reported for complaint of left scrotal pain, post left inguinal herniorrhaphy, in November 2006. On examination, there was observable mild tenderness of the left scrotum. An ultrasound revealed bilateral epididymal cysts. The VA physician diagnosed orchialgia and prescribed analgesics. However, VA treatment notes reflect that the Veteran reported continued left testicle pain in April 2007. The physician advised monitoring of the testicle. As noted above, the RO issued a July 2007 rating decision awarding service connection for the residuals of the left inguinal hernia. An October 2007 note from the Veteran's private urologist states that he was initially seen in September 2005 and diagnosed with a reducible right inguinal hernia, obstructive urinary symptoms, and erectile dysfunction. Due to results of PSA testing in November 2005, cystoscopy was performed and showed tri-lobular obstructive prostate, but no nodes. The Veteran was subsequently treated with Flomax. The RO denied service connection for a right inguinal hernia as well as left testicular atrophy in a March 2008 rating decision. He was afforded a VA hernia examination in April 2010. The examiner noted that the Veteran had healed well from left inguinal hernia surgery and currently only experienced left testicle atrophy and a scar. The examiner reported that the claims file reflected repair of umbilical hernia in 1969 that had also healed well, but the Board notes that the file reflects only prior repair of an epigastric hernia-with residual well healed scar as observed by the June 2005 examiner. As the evidence does not reflect, and the Veteran has not reported, an umbilical hernia, the carryover of the term "umbilical" from the 2005 examination to the 2010 examination appears erroneous. Regardless, the Board observes that service connection is in effect, and the rating is on appeal, only for residuals of the 2002 left inguinal hernia. A December 2010 VA treatment note again reflects that the Veteran reported left testicular pain. The VA urologist described the pain as recurrent and stated that a scrotal sonogram revealed abnormal left testicle consistent with chronic infection. The urologist diagnosed bilateral cysts. In February 2012, the Veteran was afforded another VA examination to assess the severity of his left inguinal hernia residuals. The examiner noted that there was no current left inguinal hernia and that the Veteran did not need to wear a supporting belt. The examiner noted that there was a scar associated with the Veteran's left inguinal hernia repair and checked a box indicating that the scar was "painful and/or unstable" or larger than 39 square centimeters. The examiner specified that the inguinal area, to include the scar, was mildly uncomfortable when rubbed with clothing. However, there was no recurrence of hernia and the scar was stable, without break down, and did not limit movement. The examiner described the scar as "very faint" and non-palpable, non-tender, and well-healed; it was 4.5 centimeters long. No other scars were noted. The examiner also noted post-operative atrophy of the left testicle as a residual of the left inguinal hernia repair. The Veteran wrote to VA in March 2012 and reported that, after his left inguinal herniorrhaphy, he experienced "an internal detachment, which cause[d] [him] to feel itch and hot." He stated that even wearing underwear was, at times, uncomfortable. Although the Veteran is competent to report his symptoms, the Board notes that he does not have the appropriate training or expertise to render diagnoses of internal processes such as the alleged "internal detachment." See, e.g., Bostain v. West, 11 Vet. App. 124, 127 (1998); see also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). Thus, although considered, the Veteran's assertion as to the diagnosable residuals from his left herniorrhaphy are not considered competent or more persuasive than clinical findings of record. In an August 2012 rating decision, the RO assigned an initial 10 percent, disability rating effective March 1, 2005. The rating decision specified that the 10 percent was granted on the basis of painful scar and changed the Diagnostic Code designation to 7338-7804. Under current 38 C.F.R. § 4.118, Code 7804, one or two scars that are unstable or painful warrants a 10 percent disability evaluation. A higher evaluation is not warranted unless a scar is both painful and unstable or when there are three or more scars that are either painful or unstable. 38 C.F.R. § 4.118 (2012). The Board notes that the criteria for rating scars were revised during the pendency of this appeal, effective October 23, 2008. The AMC considered the amended regulations in the August and November 2012 rating decisions. Nevertheless, the revised criteria only apply to claims filed on or after October 23, 2008, and to those claims where a request for consideration of the new criteria has been received. See 73 Fed. Reg. 54708 (Sept. 23, 2008); see also 77 Fed. Reg. 2909 (Jan. 12, 2012) (correcting the applicability-date language for the revised rating criteria for scars). As the claim for service connection was filed prior to the effective date of the revised criteria, and the Veteran has not requested consideration of his claims under the revised criteria, those criteria are not for application. Thus, below, the Board refers to diagnostic codes, pertinent to scars, in effect prior to October 23, 2008. The Veteran is not prejudiced by the Board's application of the prior criteria as the RO issued the Veteran an SOC in October 2007, when the former criteria were in effect. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). Diagnostic Code 7804 provides a 10 percent rating for superficial scars (plural) that are painful on examination. 38 C.F.R. § 4.118, Diagnostic Code 7804. However, here the Veteran only has one scar from his left inguinal hernia. Scars may also be rated pursuant to 38 C.F.R. § 4.118, Diagnostic Codes 7801, 7802, 7803, and 7805. Diagnostic Code 7801 is not applicable here as it pertains to, scars, other than of the head, face, or neck, that are deep or cause limited motion. Although Diagnostic Code 7802 pertains to scars, other than of the head, face, or neck, that are superficial and that do not cause limited motion, such scars must affect an area, or areas, of at least 144 square inches to warrant a compensable rating; as the Veteran's scar is smaller than 144 square inches, application of Code 7802 does not avail the Veteran of a higher rating. As Diagnostic Code 7803 pertains to scars that are superficial and unstable, and the Veteran's scar is not unstable, that Code is not applicable. Similarly, Code 7805 is not applicable as it pertains to scars that result in limitation of motion and the Veteran's scar does not cause any such limitation. As noted above, under Code 7338, applicable to inguinal hernias, the minimum, compensable (10 percent) rating is not warranted unless there is a recurrent, reducible hernia well supported by truss or belt. Not operated, but remedial, hernias or small, reducible, and non-protruding hernias warrant 0 percent rating. The Veteran's non-recurring, well-healed, inguinal hernia does not warrant a compensable evaluation under this Code. Although a 10 percent rating is assignable for bilateral involvement, the Veteran's right inguinal hernia (and residuals) is not service-connected and therefore not subject to compensation. As a VA urologist and the 2012 VA examiner indicated that some degree of left testicle atrophy also was attributable to the Veteran's left inguinal hernia repair, the Board has also examined Diagnostic Code 7523, which pertains to atrophy of the testes. However, that Code is not applicable here as it is meant to rate complete atrophy of either or both testicles-here the Veteran simply has some atrophy. Regardless, under that Code, a compensable evaluation is not warranted unless there is complete atrophy of both testicles, which is not true here. Further, service connection for testicle atrophy was denied in an unappealed March 2008 rating decision. Although the Board also noted that Veteran has also attributed testicular pain to his left inguinal herniorrhaphy, the Board notes that pain has been clearly attributed to epidydimal cysts shown on ultrasound. Based on the Board's analysis of the medical evidence in correlation to the applicable portions of VA's Schedule for Rating Disabilities, there is no diagnostic criteria under which the Veteran is entitled to a compensable rating for his left inguinal herniorrhaphy with scar. Although the version of Code 7804 in effect prior to October 23, 2008 does provide for a 10 percent rating for superficial scars that are painful on examination, the rating criteria specifically refer to "scars," plural, and the Veteran only has one post-surgical scar. However, the 2012 examiner noted the Veteran's reports of discomfort on the skin of his left inguinal area, specifically extending beyond the boundaries of his scar, and attributed that discomfort to residuals of his left inguinal herniorrhaphy. Further, the Veteran is competent to report his own symptoms. See, e.g., Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994). As the competent lay and medical evidence of record indicates that skin nearby the scar, as well as the scar itself, is at least uncomfortable on examination, the Board finds that, in light of 38 C.F.R. § 4.21, the currently assigned initial 10 percent rating is appropriate for the Veteran's disability. Pursuant to 38 C.F.R. § 4.21, it is not expected that all cases will show the findings specified and ratings are expected to coordinate with level of impairment. As noted above, the Board has determined that no higher rating is assignable under any potentially applicable provision of VA's rating schedule. As such, and as the competent and probative medical evidence of record reflects that the Veteran's left inguinal herniorrhaphy with scar is stable, and has not changed during the appellate period, there is no basis for staged rating, pursuant to Fenderson (cited above). The above determinations are based upon consideration of applicable provisions of VA's rating schedule. Additionally, the Board finds that at no point pertinent to this appeal has the disability been shown to be so exceptional or unusual to warrant the assignment of any higher rating on an extra-schedular basis. See 38 C.F.R. § 3.321(b)(1) (cited in the October 2007 SOC). The threshold factor for extra-schedular consideration is a finding on the part of the RO or the Board that the evidence presents such an exceptional disability picture that the available schedular ratings for the service-connected disability at issue are inadequate. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). See also 38 C.F.R. § 3.321(b)(1); VA Adjudication Procedure Manual, Pt. III, Subpart iv, Ch. 6, Sec. B(5)(c). Therefore, initially, there must be a comparison between the level of severity and the symptomatology of the claimant's disabilities with the established criteria provided in the rating schedule for the disabilities. If the criteria reasonably describe the claimant's disability level and symptomatology, then the disability picture is contemplated by the rating schedule, the assigned ratings are therefore adequate, and no referral for extra-schedular consideration is required. See VAOGCPREC 6-96 (Aug. 16, 1996). Thun v. Peake, 22 Vet. App. 111 (2008). If the rating schedule does not contemplate the claimant's level of disability and symptomatology, and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms" (including marked interference with employment and frequent periods of hospitalization). 38 C.F.R. § 3.321(b)(1). If so, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for completion of the third step: a determination of whether, to accord justice, the claimant's disability picture requires the assignment of an extra-schedular rating. Thun, supra. In this case, the Board finds that the schedular rating criteria are adequate to rate the disability under consideration at all pertinent points. A comparison between the symptomatology of the claimant's disability with the established criteria provided in the rating schedule reveals that his disability picture is adequately addressed by the rating schedule. Specifically, Diagnostic Codes 7804 and 7338 contemplate the symptoms experienced by the Veteran and more symptoms. Specifically, the Veteran's painful scarring resulting from inguinal hernia surgery. The criteria further encompass symptoms, not experienced by the Veteran, such as recurrence, multiple scars, and unstable scars. Here, the rating schedule more than fully contemplates the symptomatology described by the Veteran and provides for ratings higher than that assigned for more significant impairment (i.e. recurrent hernia and larger, unstable scars). Although some medical professionals have also associated testicular atrophy with his herniorrhaphy, the Board has noted that symptom is listed in the rating schedule, but is not service-connected and, regardless, the Veteran does not experience atrophy to any extent recognized by the rating schedule. Significantly, there is no medical indication or argument that the applicable criteria are otherwise inadequate to rate the disability. Thus, the threshold requirement for invoking the procedures set forth in 38 C.F.R. § 3.321(b)(1) is not met. See Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). For all the foregoing reasons, the Board concludes that the claim for a higher initial rating must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the doubt doctrine; however, as the preponderance of the evidence is against assignment of a rating in excess of 10 percent, on any basis, at any point pertinent to this appeal, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER Service connection for hemorrhoids is granted. Service connection for bilateral pterygiums is granted. Service connection for a respiratory disorder is denied. A rating in excess of 10 percent for umbilical and inguinal left herniorrhaphy, well healed, with scar is denied. ____________________________________________ JACQUELINE E. MONROE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs