BVA9420031 DOCKET NO. 92-24 975 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUES Entitlement to service connection for a left knee disability. Entitlement to an increased rating for a postoperative right ankle injury with traumatic arthritis, currently rated as 10 percent disabling. Entitlement to an increased rating for lumbosacral strain, currently rated as 10 percent disabling. Entitlement to an increased (compensable) rating for hypertension. REPRESENTATION Appellant represented by: North Carolina Division of Veterans Affairs ATTORNEY FOR THE BOARD K. J. Kunz, Associate Counsel INTRODUCTION The veteran had active service from September 1977 to November 1991. This appeal arises from a March 1992 rating decision of the Winston-Salem, North Carolina, regional office (RO). In that decision, the RO denied service connection for a left knee disability, and assigned noncompensable ratings for a right ankle disability, a low back disability, and hypertension. In a July 1992 rating decision, the RO increased the ratings for the right ankle disability and the low back disability to 10 percent. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends he has pain in his left knee that is a result of his back and ankle disabilities. He contends that VA rating examinations have been insufficient to evaluate his knee condition. He also contends that his right ankle disability warrants a higher rating. He reports that he has pain in his ankle on weight bearing. He asserts that a higher rating is warranted for his low back disability, which, he reports, produces constant pain and pain with movement. Finally, he contends that his hypertension warrants a compensable rating. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the claim for service connection for a left knee disability, that the preponderance of the evidence is against the claims for increased ratings for a postoperative right ankle injury with traumatic arthritis and for lumbosacral strain, and that the record supports a 10 percent disability rating for hypertension. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the originating agency. 2. No current disability of the left knee is shown. 3. A postoperative right ankle injury with traumatic arthritis is manifested by pain on weight-bearing and slight tenderness on palpation, but no limitation of motion. 4. A low back disability is manifested by low back pain without muscle spasm or unilateral loss of lateral motion. 5. Hypertension is manifested by diastolic pressure of predominantly 100 or more, but with no findings of diastolic pressure of 110 or more. 6. Neither an exceptional nor an unusual disability picture has been presented so as to render impractical the application of the regular schedular standards. CONCLUSIONS OF LAW 1. A left knee disability was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.303 (1993). 2. The criteria for an evaluation in excess of 10 percent for a postoperative right ankle injury with traumatic arthritis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b), 4.1, 4.2, 4.7, 4.10, 4.41, 4.45, 4.59, 4.71, Part 4, Codes 5003, 5010, 5271 (1993). 3. The criteria for an evaluation in excess of 10 percent for mechanical low back pain with sacroiliac strain have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b), 4.1, 4.2, 4.7, 4.10, 4.41, 4.45, 4.59, 4.66, Part 4, Code 5295 (1993). 4. The criteria for a 10 percent evaluation for hypertension have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b), 4.1, 4.2, 4.7, 4.10, Part 4, Code 7101 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, we note that the veteran has presented well-grounded claims within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). Therefore, the Department of Veterans Affairs (VA) has a duty to assist the veteran in the development of his claims. The veteran contends that the VA rating examination, which was performed in December 1991 and January 1992, was insufficient to show whether his knee condition is secondary to his back and ankle disabilities. Examination records show that the left knee was examined for evidence of effusion, tenderness to palpation, limitation of motion, and ligamentous instability or laxity. In addition, x-rays were taken of the left knee. Examination by these means did not reveal any disease or injury of the left knee; therefore there was no analysis of the etiology of a knee disease or injury. We find that the VA rating examination was performed in a manner sufficient to analyze the condition of the veteran's left knee. We also find that the facts relevant to the left knee issue and the other issues on appeal have been properly developed, and that VA's statutory obligation to assist the veteran in the development of his claim has been satisfied. 38 U.S.C.A. § 5107(a) (West 1991). I. Service Connection for a Left Knee Disability Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1993). Service connection may also be granted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (1993). Medical records from reserve service prior to the veteran's entry into active duty include the report of a January 1976 screening physical examination. At that time, he reported being involved in a motorcycle accident in December 1975, and having some problems with walking because of a left leg injury sustained in the accident. This report does not state whether the left leg injury involved the left knee. Service medical records show outpatient treatment for shin splints, but no complaints or treatment regarding the knees. There are no findings regarding the knees in the reports of medical examinations during service. The report of the VA examination in December 1991 and January 1992 indicates that the veteran complained that both knees hurt with walking. On orthopedic examination, he complained of left knee pain over the past year, with no history of trauma. Examination of the left knee revealed no evidence of effusion, and no tenderness to palpation over the patellofemoral joint. The range of motion was from 0 to 140 degrees, with no ligamentous instability or laxity. X-rays of the left knee demonstrated no significant pathology. The orthopedist's impression was left knee arthralgia with normal exam and no evidence of pathology. The veteran's symptom of left knee arthralgia, or joint pain, does not establish an existing disease or injury of the left knee incurred in or aggravated by service. As there is no medical evidence of a current disability of the left knee, there is no basis for direct or secondary service connection for a left knee disability. II. Increased Rating for a Right Ankle Disability Disability evaluations are based upon the average impairment of earning capacity as determined by a schedule for rating disabilities. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1993). Separate rating codes identify the various disabilities. 38 C.F.R. Part 4 (1993). In determining the current level of impairment, the disability must be considered in the context of the whole recorded history, including service medical records. 38 C.F.R. §§ 4.2, 4.41 (1993). An evaluation of the level of disability present also includes consideration of the functional impairment of the veteran's ability to engage in ordinary activities, including employment, and the effect of pain on the functional abilities. 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59 (1993). During service the veteran received treatment, including arthroscopic surgery, for a right ankle injury. He is service- connected for a postoperative right ankle injury with traumatic arthritis, currently evaluated as 10 percent disabling. Traumatic arthritis is rated as degenerative arthritis. 38 C.F.R. Part 4, Code 5010 (1993). Degenerative arthritis is rated based on limitation of motion under the appropriate diagnostic code, or, when the limitation of motion for the specific joint is noncompensable, a rating of 10 percent for each major joint is applicable. 38 C.F.R. Part 4, Code 5003 (1993). Moderate limitation of motion of the ankle warrants a 10 percent disability rating, while marked limitation of motion warrants a 20 percent rating. 38 C.F.R. Part 4, Code 5271. Evaluation of disabilities of the joints also requires consideration of related factors, including pain on movement, disturbance of locomotion, and interference with standing and weight-bearing. 38 C.F.R. § 4.45 (1993). On VA orthopedic examination of the veteran's right ankle in December 1991, the veteran reported an ankle injury in 1988, which was treated with minimal relief. He reported pain with normal walking since the injury. The range of motion was 45 degrees of dorsiflexion and 40 degrees of plantar flexion, not less than the full range of motion indicated in 38 C.F.R. § 4.71 (1993). Sub-talar motion was good. There were several well healed scars. There was slight tenderness to palpation over the anterior medial joint line. In his appeal, the veteran has emphasized that he has pain in the right ankle on weight bearing. Taking into consideration the full range of motion of the ankle, the veteran's reports pain on walking and weight-bearing, and VA examination findings of slight tenderness to palpation, we conclude that the current 10 percent rating for arthritis of the right ankle is the appropriate rating for the overall disability picture. Limitations of function sufficient to warrant a higher disability rating have not been shown. III. Increased Rating for a Low Back Disability The veteran received outpatient treatment for low back pain during service. He is service-connected for mechanical low back pain and sacroiliac strain, which is evaluated under Diagnostic Code 5295, lumbosacral strain. Under that Code, a 0 percent disability rating is assigned with slight subjective symptoms only. A 10 percent rating is warranted with characteristic pain on motion. A 20 percent rating is warranted with muscle spasm on extreme forward bending, and loss of lateral spine motion, unilateral, in standing position. A 40 percent rating is warranted for severe lumbosacral strain, with listing of the whole spine to the opposite side, marked limitation of forward bending in standing position, loss of lateral motion with osteo-arthritic changes, or narrowing or irregularity of joint space, or some of the above with abnormal mobility on forced motion. On VA examination in December 1991 and January 1992, he reported having low back pain about eighty percent of the time. He stated that the pain was aggravated by prolonged walking, bending, stooping or sitting. Examination revealed mild tenderness to palpation over the right sacroiliac area, without palpable spasm. The range of motion of the lumbar spine was 70 degrees of flexion, 20 degrees of extension, and 20 degrees of lateral bending. Straight leg raising was negative to 90 degrees. On x- rays the lumbosacral spine showed slight straightening of the normal lordotic curve, but was otherwise unremarkable. The orthopedist's impression was mechanical low back pain with no radicular symptoms. The veteran has described pain on motion, and examination confirmed mild tenderness to palpation. The current 10 percent rating is warranted. But as examination did not reveal muscle spasm or unilateral loss of lateral motion, the criteria for a 20 percent rating have not been met. IV. Increased Rating for Hypertension Service medical records show some treatment of the veteran for hypertension. Hypertension is evaluated under Diagnostic Code 7101, under which diastolic pressure predominantly 100 or more warrants a 10 percent disability rating. Diastolic pressure predominantly 110 or more, with definite symptoms, warrants a 20 percent rating. Diastolic pressure predominantly 120 or more, and moderately severe symptoms, warrants a 40 percent disability rating. Diastolic pressure predominantly 130 or more, and severe symptoms, warrants a 60 percent disability rating. During service, the veteran's blood pressure was measured as 140/80 in September 1977, 126/72 in January 1981, 120/82 in February 1984, 140/88 in February 1985, 130/90 in May 1986, 152/102 in November 1987, 150/100 in February 1988, and 140/90 in September 1988. On VA examination in December 1991 and January 1992, the veteran's blood pressure was 140/98 sitting, 144/100 recumbent, and 140/90 standing. At the time of an electrocardiograph, blood pressure was recorded as 140/100. The most recent measurements of the veteran's diastolic pressure have ranged between 90 and 100, with two of the four measurements at the last examination at 100. While a proportion of half is not predominant, taking into consideration measurements of 100 or more in 1987 and 1988, it is possible to allow that the diastolic pressure has been measured at 100 or more sufficiently frequently to warrant a 10 percent disability rating under Diagnostic Code 7101. As there have been no measurements of diastolic pressure at 110 or more, a 20 percent rating is not warranted. With respect to each of the disabilities at issue in this appeal, an exceptional or unusual disability picture has not been presented such as would warrant an extra-schedular evaluation under 38 C.F.R. § 3.321(b) (1993). Specifically, there has been no demonstration of marked interference with employment or frequent periods of hospitalization so as to render impractical the application of the regular schedular criteria. ORDER Entitlement to service connection for a left knee disability is denied. Entitlement to an increased rating for a right ankle disability is denied. Entitlement to an increased rating for a low back disability is denied. Entitlement to a 10 percent rating for hypertension is granted. JACK W. BLASINGAME Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. (CONTINUED ON NEXT PAGE) NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.