Citation Nr: 18148517 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 16-39 407 DATE: November 7, 2018 ORDER Service connection for a bilateral eye disorder/loss of vision is denied. Service connection for right ear hearing loss is denied. Service connection for periodontal disease is denied. A rating in excess of 10 percent for right knee patellofemoral syndrome is denied. A compensable rating for Raynaud's syndrome, bilateral hands, is denied. A compensable rating for hallux valgus, left foot, is denied. FINDINGS OF FACT 1. The Veteran had active service from September 1968 to January 1997 and August 1998 to December 2013. 2. A bilateral eye disorder was not shown in service; a current bilateral eye disorder related to loss of vision is not shown. 3. A diagnosis of right ear hearing loss has not been shown. 4. A dental disorder for which compensation can be authorized has not been shown. 5. A right knee disorder is manifested by subjective complaints of pain; objective findings include painful motion and limitation of flexion. 6. Raynaud's syndrome is manifested by subjective complaints of pain when working in the cold; objective findings include tingling and red fingertips when working in the cold. 7. Left foot hallux valgus is manifested by subjective complaints of pain; objective findings include pain and tenderness. CONCLUSIONS OF LAW 1. A bilateral eye disorder/loss of vision was not incurred in service. 38 U.S.C. §§ 1110, 1111, 1112, 1113, 1116, 5103(a), 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309 (2017). 2. Right hearing loss was not incurred in service. 38 U.S.C. §§ 1131, 1112, 5103, 5103A (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 3. A dental disorder for compensation purposes was not incurred in service. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.381, 4.150 (2017). 4. The criteria for a rating in excess of 10 percent for right knee patellofemoral syndrome have not been met. 38 U.S.C. §§ 1155, 5107(a), 5107A (2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DCs) 5257-5262 (2017). 5. The criteria for a compensable rating for Raynaud's syndrome, bilateral hands, have not been met. 38 U.S.C. §§ 1155, 5107(a), 5107A (2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, DC 7117 (2017). 6. The criteria for a compensable rating for hallux valgus, left foot, have not been met. 38 U.S.C. §§ 1155, 5107(a), 5107A (2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, DC 5280 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service Connection Claims Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Bilateral Eye Disorder/Loss of Vision The evidence does not show that the Veteran has a current bilateral eye disorder related to his loss of vision. A January 2014 VA examiner diagnosed dry eye syndrome, as well as left eye superficial punctuate keratotomy. However, the examiner found the latter to be a symptom of dry eyes, and neither to be the cause of the Veteran’s loss of vision. The examiner further found that for the claimed loss of vision there was no pathology to render a diagnosis. Thus, as the diagnosed dry eye syndrome did not cause loss of vision and there is no diagnosed disorder with respect to vision loss, the medical evidence weighs against the claim. Right Ear Hearing Loss For VA purposes, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels (dB) or greater, the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, and 4000 Hz are 26 dB or greater, or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Additionally, the Court has held that “the threshold for normal hearing is from 0 to 20 dBs, and higher threshold levels indicate some degree of hearing loss.” See Hensley v. Brown, 5 Vet. App. 155, 157 (1993). Turning to the evidence, the Veteran has not been diagnosed with a right ear hearing loss disability that meets the VA regulatory criteria under 38 C.F.R. § 3.385. Specifically, a December 2013 VA audiological examination revealed the following: HERTZ 500 1000 2000 3000 4000 Avg. RIGHT 25 35 20 15 10 20 LEFT 10 5 5 10 10 7.5 Speech audiometry revealed speech recognition ability of 100 percent in both ears. As such, neither ear had sufficient hearing impairment to qualify as a disability for VA purposes. No other VA or private audiogram was submitted reflecting a higher level of impairment. The first element of service connection is that there must be a current disability. The record does not support a diagnosis of right ear hearing loss for the period on appeal. Therefore, the medical evidence weighs against the claim for service connection for right ear hearing loss. Periodontal Disease In addition to the laws and regulations outlined above, compensation is only available for certain types of dental and oral conditions, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. See 38 C.F.R. § 4.150. Compensation is available under DC 9913 for loss of teeth only if such loss is due to loss of substance of the body of the maxilla or mandible during service due to in-service trauma or disease such as osteomyelitis, and not the loss of the alveolar process as a result of periodontal disease. Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease cannot be service connected for purpose of compensation. 38 C.F.R. § 3.381. For a compensation purposes, the term “service trauma” does not include the intended effects of therapy or restorative dental care and treatment provided during a veteran’s military service. VAOGCPREC 5-97, 62 Fed. Reg. 15566 (1997); Nielson v. Shinseki, 607 F.3d 802, 804 (Fed. Cir. 2010). The Veteran claims he has periodontal disease, specifically gum disease, caused by active service. He is separately service-connected for temporomandibular joint syndrome. Turning to the evidence, a January 2014 VA examiner diagnosed the Veteran with periodontal disease, but no other disability. Under 38 C.F.R. § 3.381(b), periodontal disease alone is not a compensable disability for the purpose of compensation. VA and private medical records do not show any other, nonservice-connected dental disease. As such, the medical evidence weighs against finding the first element of service connection. The Board has considered the Veteran’s lay statements that disorders were due to service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, he is not competent to offer an opinion as to the etiology of his current claims due to the medical complexity of the matter involved. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462. Such competent evidence has been provided by the medical personnel who have examined the Veteran during the current appeal and by service records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the examination report and clinical findings than to his statements. As such, the weight of the competent evidence is against the claims and the appeals are denied. Increased Rating Claims Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Rating in Excess of 10 percent for Right Knee Disorder The Veteran is rated under DC 5260 for limitation of extension of the leg and 38 C.F.R. § 4.59 regarding painful motion. The Board will also consider all potentially relevant diagnostic codes. In order to warrant a higher rating, the evidence must show: • ankylosis of the knee with a favorable angle in full extension or in slight flexion between 0 and 10 degrees (30% under DC 5256); • moderate recurrent subluxation or lateral instability (20% under DC 5257); • dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint (20% under DC 5258); • flexion of the knee limited to 30 degrees (20% under DC 5260); • extension of the knee limited to 15 degrees (20% under DC 5261); or • impairment of the tibia or fibula with a moderate knee disability (20% under DC 5262). Turning to the evidence, the Veteran has not claimed, nor has evidence, including VA examinations in December 2013 and June 2015, and VA medical records, shown ankylosis of the knee at any angle, impairment of the tibia or fibula, or dislocated semilunar cartilage. As such, the medical evidence does not warrant a higher rating under DC 5256, 5258, or 5262. Next, neither VA examiner found any medical evidence of instability or subluxation. Similarly, VA medical records failed to note any objective signs of instability. As such, the medical evidence weighs against a higher rating under DC 5257. Finally, the medical evidence has shown limitation of motion in the Veteran’s right knee, but not to such a degree to warrant a higher rating. The December 2013 VA examiner measured right knee flexion to 130 degrees, and the June 2016 examiner found no limitation of motion. Similarly, right knee extension was measured as normal in both. As such, the medical evidence does not support a higher rating under either DC 5260 or DC 5261. Compensable Rating for Raynaud's Syndrome, Bilateral Hands To warrant a higher rating under DC 7117, the evidence must show characteristic attacks occurring one to three times a week. Characteristic attacks consist of sequential color changes of the digits lasting minutes to hours, sometimes with pain and paresthesias, and precipitated by exposure to cold or by emotional upsets. During a December 2013 VA examination, the Veteran claimed that when he worked in the cold, his fingertips would tingle and become red and that he subsequently had to warm his fingers to perform other activities. The examiner found that the Veteran had characteristic attacks less than once a week. He has not provided other medical or other lay evidence to show attacks occurring with the frequency to warrant a higher rating. As such, the medical evidence does not support a compensable rating. Compensable Rating for Hallux Valgus, Left Foot The Veteran is currently service connected for hallux valgus, left foot, and claims his disability warrants a compensable rating. To warrant a compensable rating under DC 5280, the evidence must show: • unilateral hallux valgus operated with a resection of the metatarsal head; or • severe unilateral hallux valgus, if equivalent to the amputation of the great toe. Turning to the evidence, the Veteran has not submitted evidence nor has he claimed to have had surgery on his hallux valgus, left foot. No medical evidence has noted such a surgery. As such, the medical evidence does not support a compensable rating due to an operation. Next, a June 2016 VA examiner found the disability to be mild or moderate, and that it did not rise to the level of severity equivalent with amputation of the great toe. A December 2013 VA examiner similarly found his symptoms, described as occasional pain, to be mild or moderate. No VA or private medical records show a higher level of severity. As such, the medical evidence does not support a compensable rating for severity. It should be noted, that the June 2016 VA examiner diagnosed the Veteran with multiple disabilities for each foot, including bilateral pes planus, bilateral metatarsalgia, hallux valgus right foot, and bilateral plantar fasciitis. The Veteran has not been service-connected for these disabilities. With respect to the increased rating claims, the Board has considered the Veteran’s lay statements that his disabilities are worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, Layno v. Brown, 6 Vet. App. 465, 470 (1994), he is not competent to identify a specific level of disability of these disorders according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran’s disabilities have been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which these disabilities are evaluated. Moreover, as the examiners had the requisite medical expertise to render medical opinions regarding the degree of impairment caused by these disabilities and had sufficient facts and data on which to base their conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran’s subjective evidence of complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable and the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Brendan A. Evans, Associate Counsel