Citation NR: 9719269 Decision Date: 06/03/97 Archive Date: 06/13/97 DOCKET NO. 95-03 306 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for residuals of a laceration of the head with contusion, to include post- traumatic headaches. 2. Entitlement to service connection for residuals of a left corneal abrasion. 3. Entitlement to service connection for bronchitis. 4. Entitlement to service connection for allergic rhinitis. 5. Entitlement to service connection for a heart condition, to include abnormal and/or high blood pressure. 6. Entitlement to service connection for a low back disorder. 7. Entitlement to a compensable rating for service-connected hemorrhoids. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Louis J. George, Associate Counsel INTRODUCTION The veteran served on active duty from December 1975 to December 1978, and from May 1980 to August 1993. This claim comes before the Board of Veterans’ Appeals (Board) on appeal from a July 1994 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia, which denied entitlement to service connection for a laceration of the head, a left corneal injury, bronchitis, allergic rhinitis, a heart condition, and low back strain. The same rating decision established service connection for hemorrhoids, and assigned a noncompensable evaluation thereto. Due to the veteran’s relocation during the pendency of this appeal, the RO in St. Petersburg, Florida, assumed jurisdiction of this case. The Board notes that the above rating decision also adjudicated other claims that have not been perfected for appellate review. Specifically, entitlement to an increased rating for varicose veins of the left leg, evaluated as 10 percent disabling, and entitlement to a compensable evaluation for a lipoma of the right forearm were included in the veteran’s notice of disagreement (NOD) and were set forth in the statement of the case (SOC). However, these claims were not included in his substantive appeal, and therefore they are not on appeal before the Board. While the RO certified these issues to the Board in a VA Form 8 of July 1996, such certification is an administrative act which does not confer the Board with jurisdiction over these issues. 38 C.F.R. § 19.35 (1996) In addition, the Board notes that service connection for bilateral hearing loss was denied in a September 1994 rating decision. The veteran filed a notice of disagreement (NOD) in October 1994, and has not been furnished with an SOC relating to that issue. This issue is referred to the RO for appropriate action. For reasons set forth in the REMAND appended to this decision, appellate review is deferred regarding the claims of entitlement to service connection for a laceration of the head with contusion, to include post-traumatic headaches, and of entitlement to service connection for a low back disorder. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that service connection should be established for residuals of a left corneal abrasion, bronchitis, allergic rhinitis, and a heart condition, to include abnormal and/or high blood pressure. The veteran also claims that his service-connected hemorrhoids warrant a compensable evaluation. Regarding his claim for residuals of a left corneal abrasion, the veteran alleges that his left cornea was injured by a metallic foreign body as a result of a motor vehicle accident which occurred during active service. See NOD, received August 23, 1994. In the veteran’s original application for compensation, he claimed that metal shavings were accidentally blown into his eyes. Relating to his claimed allergic rhinitis, he claims that his condition was severe when he was stationed in Washington, D.C., due to the “excessive pollens and pollutants” there. As to his claimed heart condition, he claims that his blood pressure has been high, with diastolic measurements over 90. Regarding his service-connected hemorrhoids, the veteran claims that his hemorrhoids frequently swell and itch, and are manifested by some bleeding. See VA Form 9 (substantive appeal), received December 19, 1994. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1996), 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 veteran has failed to satisfy the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claims for service connection for residuals of a left corneal abrasion, bronchitis, allergic rhinitis, and a heart condition, to include abnormal and/or high blood pressure, are well grounded. It also is the decision of the Board that the preponderance of the evidence is against the assignment of a compensable rating for service-connected hemorrhoids. FINDINGS OF FACT 1. The veteran has not submitted competent medical evidence of residuals of a left corneal abrasion. 2. The veteran has not submitted competent medical evidence of currently manifested bronchitis. 3. The veteran has not submitted competent medical evidence of currently manifested allergic rhinitis. 4. The veteran has not submitted competent medical evidence of a heart condition, to include abnormal and/or high blood pressure. 5. The veteran’s claims for service connection for residuals of a left corneal abrasion, bronchitis, allergic rhinitis, and a heart condition, to include abnormal and/or high blood pressure, are not plausible 6. The veteran’s claim for a compensable rating for service- connected hemorrhoids is plausible, and sufficient evidence is of record for an equitable disposition of the appeal. 7. The veteran’s hemorrhoids are manifested by subjective complaints of frequent swelling and itching with some bleeding. On objective VA examination, it was reported that there were two small external hemorrhoids, and there was no bleeding. The veteran’s hemorrhoids were not large or thrombotic, irreducible, with excessive redundant tissue, nor did they evidence frequent recurrences. CONCLUSIONS OF LAW 1. The veteran has not submitted a well-grounded claim for residuals of a left corneal abrasion. 38 U.S.C.A. § 5107 (West 1991). 2. The veteran has not submitted a well-grounded claim for bronchitis. 38 U.S.C.A. § 5107 (West 1991). 3. The veteran has not submitted a well-grounded claim for allergic rhinitis. 38 U.S.C.A. § 5107 (West 1991). 4. The veteran has not submitted a well-grounded claim for a heart condition, to include abnormal and/or high blood pressure. 38 U.S.C.A. § 5107 (West 1991). 5. The criteria for a compensable evaluation for hemorrhoids are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 4.114, Diagnostic Code 7336 (1996). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background In the Report of Medical History completed by the veteran in connection with his entrance physical examination in November 1975, he reported no physical complaints. In the physical examination report, no abnormality was noted, with the exception of a vaccination scar on the upper left arm. The veteran’s blood pressure while sitting was measured as 106/58 (systolic/diastolic). In the report of an eye examination conducted in May 1976, no disorder of the left cornea was noted. In a March 1977 inpatient narrative summary prepared in connection with a rhinoplasty, the veteran’s blood pressure was recorded as 110/72. A physical examination was essentially normal. In a treatment notation of April 1977, the examiner reported that the veteran complained of itchy eyes following his rhinoplasty. Both eyes were noted as slightly red. No diagnosis was rendered. In the same treatment notation, it was reported that the veteran had bronchial congestion. In a subsequent treatment notation of April 1977, it was noted that the veteran complained of chest congestion for about seven days. The impression was bronchial congestion. The veteran’s blood pressure was reported as 120/58. In June 1978, he underwent a second rhinoplasty, and in the narrative summary of the inpatient treatment, a review of his systems was normal, and a chest x-ray was noted as normal. In March 1978, the veteran complained of dirt in his eye for four days. No abrasions of the left eye were noted on objective examination, and the assessment was deferred. The veteran was referred to ophthalmology. The consultation report noted that the there was hyperemia of the left eye, and by using contrast media, a rusted metallic body in the cornea was noted. The foreign body was removed, and ointment and a pressure patch were applied. In a treatment notation entered two days later, the examiner noted the veteran’s eye injury. The veteran complained that his eye was still red, and he also complained of itching. In a treatment notation entered the next day, the examiner noted that the left cornea was healing at the foreign body site. The veteran was advised to return as necessary. In a treatment notation entered in April 1978, it was reported that the veteran was involved in a motor vehicle accident two days before, and complained of multiple contusions. There were no visual problems or eye injuries noted. In July 1979, the veteran underwent a physical examination in connection with his entrance to United States Air Force Officer Training School. In the Report of Medical History, the veteran indicated that he did not know whether he currently or previously had hay fever or high or low blood pressure. In the physician’s summary, the examiner noted that there was no medical disability from the veteran’s service in the United States Army from December 1975 to December 1978. The examiner reported that the previous year the veteran had rhinorrhea associated with pollen, which did not require medication. The examiner reported that the veteran “did not know” about his blood pressure, but that it was normal on examination. In the report of physical examination, the veteran was noted to have systolic/diastolic blood pressure measurements of 106/72 while sitting, 108/70 while recumbent, and 110/70 while standing. In April 1981, the veteran presented with complaints of a persistent sore throat. The examiner reported no history of allergic disease, and assessed chronic pharyngitis. In September 1981, the veteran complained of chest congestion and a cold. He was diagnosed with bronchitis. In November 1982, the veteran received emergency treatment for an upper respiratory infection, at which time his blood pressure was measured as 108/58. In a September 1983 notation relating to the veteran’s complaints of head and neck pain, his blood pressure was measured as 150/70. In October 1983, the veteran complained of a sore throat and bilateral flank pain for approximately two weeks. His blood pressure was measured as 110/60. The diagnosis included bronchitis. In April 1984, the veteran’s blood pressure was recorded as 120/70. In the report of a periodic physical examination conducted in January 1985, the veteran’s prostate and rectum were reported as normal by digital examination. It was noted that the veteran had a constant sore throat, but he had a normal chest x-ray, and there was no significant medical or surgical change since the last examination. His blood pressure was reported as 100/60. In a coronary artery risk evaluation conducted in January 1985, the veteran’s blood pressure was recorded as 100/60. On physical examination for scuba diving conducted in July 1985, the veteran’s blood pressure was reported as 104/70. A review of the veteran’s systems was normal. In a treatment notation of October 1985, it was noted that the veteran’s blood pressure was 104/60. In May 1986, the veteran underwent a pre-marital physical examination, in which a chest x-ray was negative. In August 1986, the veteran’s blood pressure was measured as 110/70. In an April 1987 treatment notation, the examiner noted that the veteran was in the Coronary Artery Risk Evaluation (CARE) program, since he evidently was diagnosed with high cholesterol, and also had recurring nasal congestion and sore throats. Physical examination was normal, and his blood pressure was measured as 104/60. His “calculated risk” was 1.3, while it should have been 1.0. The examiner made an assessment of post nasal drip and a good CARE assessment. The examiner prescribed a low fat diet, decreased salt, increased aerobic exercise, and recommended that the veteran did not require CARE follow-up at that point in time. In September 1987, the veteran was treated for “bloody eyes” after scuba diving, and was diagnosed with a bilateral subconjunctival hemorrhage. His blood pressure was measured as 114/80. In the report of a chest x-ray conducted in May 1988, the veteran’s chest was found to be normal. In the report of an optometric examination conducted in May 1988, the veteran’s corneas were reported as clear. Although the veteran complained of diminished ability to read objects closely, the examiner found that ocular health was within normal limits. In June 1988, his blood pressure was recorded as 106/74 In November 1988, the veteran complained of a cold and congestion and sore throat. He was diagnosed with an upper respiratory infection and nasopharyngitis. His lungs were clear, and a chest x-ray was negative. His blood pressure was recorded as 100/70. In May 1990, the veteran underwent an optometric examination. His corneas were reported as normal, and ocular health was within normal limits. In a December 1991 treatment notation related to his complaints of a sore throat of one month’s duration, his blood pressure was reported as 124/69. In a December 1992 treatment notation, the examiner noted that the veteran complained of voice loss and a cold. The assessment was bronchitis. His blood pressure was reported as 124/80. In January 1993, the veteran underwent an optometric examination. He complained that he had “increased loss of vision” and noted that in 1977 at the Army sheet metal shop, metal shavings accidentally blew into both of his eyes. In a personal history section of the examination report, the veteran indicated that he did not have high blood pressure, but did indicate that he had an allergy or hay fever. On objective examination, the examiner found that his ocular health was within normal limits. In March 1993, the veteran underwent emergency treatment two days after a motor vehicle accident. His blood pressure was reported as 123/83. In April 1993, the veteran complained of redness, itching, and irritation affecting both eyes for one week. The examiner noted that he had a history of allergic rhinitis with yearly exacerbations during early spring which resulted in a runny nose, congestion, and irritation to both eyes. The veteran currently complained of yellow secretions over the past few days. The examiner made an assessment of allergic rhinitis and mild conjunctivitis bilaterally. His blood pressure was recorded as 137/99. In June 1993, the veteran complained of hemorrhoidal tissue for two weeks. He admitted to rectal bleeding and pain secondary to hemorrhoids. The examiner indicated that the veteran had a positive past history of hemorrhoids, for years. A rectal/stool examination was negative, and there was a positive external hemorrhoid at 5 o’clock without bleeding. There were no fissures or fistulas, and the prostate was minimally enlarged. The assessment was an external hemorrhoid. The veteran’s blood pressure was recorded as 133/78. Subsequent blood pressure readings in June 1993 were 120/84 and 129/66, and 110/71 in July 1993. In August 1993, the veteran underwent a retirement physical examination. In the Report of Medical History completed in connection with the examination, he indicated that his health was poor, and that he currently or previously had eye trouble, ear, nose, or throat trouble, chronic or frequent colds, and hay fever. The veteran did not indicate any problem with a chronic cough, palpitation or pounding heart, heart trouble, or high or low blood pressure. On an attached sheet, the veteran indicated that he sustained an eye injury in March 1978 when metal shavings accidentally blew into both eyes. The veteran also mentioned his progressive worsening of vision, bronchitis, hay fever, hemorrhoidal tissue, and heart palpitations. In the physical examination report, the veteran’s systems were normal. Rectal examination was within normal limits. His blood pressure while sitting was reported as 128/78, and a chest x-ray was normal. The service medical records also contain the veteran’s dental records. In dental patient medical history forms completed by the veteran in January 1986 and March 1987, he indicated that he did not have a history of a heart condition, frequent chest pains, high blood pressure, or shortness of breath. In March 1988, June 1989, and November 1990, he indicated that he did not have these conditions, as well as stating that he did not have hay fever. In May 1991, he indicated that his present health was good, and that he took over-the-counter medication for an allergy. In April 1992, the veteran indicated no complaints. The veteran filed the claims on appeal in October 1993. He was afforded a VA general medical examination in January 1994. The examiner noted that the veteran complained of hemorrhoids which bled occasionally. On physical examination, the veteran’s head, face, and neck, and nose, sinuses, mouth, and throat were normal. His eyes were reported as normal, and the cardiovascular system was normal. Sitting blood pressure was measured as 125/75. There was no abnormality found on examination of the respiratory system. On examination of the genitourinary system, the examiner noted that there were two small external hemorrhoids at 3 and 6 o’clock, and there was no bleeding. The examiner’s diagnosis included hemorrhoids. In a rating decision of July 1994, service connection was granted for hemorrhoids. Service connection was denied for a left corneal injury, bronchitis, allergic rhinitis, and heart problems. II. Analysis A. Entitlement to service connection for a residuals of a left corneal abrasion, bronchitis, allergic rhinitis, and a heart condition, to include abnormal and/or high blood pressure. 1. Well-groundedness determination Initially, it is necessary to determine if the veteran has submitted well-grounded claims within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That same statute mandates a duty to assist the veteran. However, the duty to assist applies only after a well-grounded claim has been submitted. Gilbert v. Derwinski, 1 Vet.App. 49, 55 (1990). In making a claim for service connection, the veteran has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). Generally, a well-grounded claim is “a plausible claim, one which is meritorious on its own or capable of substantiation.” Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). In order to be well grounded, a claim for service connection must be accompanied by supporting evidence that the particular disease, injury, or disability was incurred in or was aggravated by active service; mere allegations are insufficient. Tirpak v. Derwinski, 2 Vet.App. 609, 610-611 (1992); Murphy v. Derwinski, 1 Vet.App. at 81. The quality and quantity of evidence required to make a claim well grounded depend upon the issue presented by the claim. When an issue is factual in nature (e.g., whether an incident or injury occurred in service), competent lay testimony, including the appellant’s solitary testimony, may be sufficient to meet the veteran’s burden. Grottveit v. Brown, 5 Vet.App. 91, 93 (1993) (citing Cartright v. Derwinski, 2 Vet.App. 24 (1991)). Where the determinative issue, however, concerns matters of medical causation or diagnoses, competent medical evidence attesting that the claim is plausible or possible is required. Grottveit v. Brown, 5 Vet.App. at 93 (citing Murphy v. Derwinski, 1 Vet.App. at 81). Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated during service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303(a) (1996). The evidence may show affirmatively that such a disease or injury was incurred in or aggravated by service, or statutory presumptions may be applied to establish service connection. With chronic disease shown as such in service or within the presumptive period so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b) (1996). A claim for service connection requires three elements to be well grounded. It requires competent (medical) evidence of a current disability; competent (lay or medical) evidence of incurrence or aggravation of disease or injury in service; and competent (medical) evidence of a nexus between the in- service injury or disease and the current disability. The third element may be established by the use of statutory presumptions. Caluza v. Brown, 7 Vet.App. 498, 506 (1995), aff’d 78 F.3d 604 (Fed. Cir. 1996) (table). Truthfulness of the evidence is presumed in determining whether a claim is well grounded. Caluza v. Brown, 7 Vet.App. at 504. In Brammer v. Derwinski, 3 Vet.App. 223, 225 (1992), the Court noted that “Congress specifically limits entitlement to service-connected disease or injury to cases where such incidents have resulted in a disability....In the absence of proof of a present disability there can be no valid claim.” 2. Review of claims on appeal a. Entitlement to service connection for residuals of a left corneal abrasion The veteran’s service medical records show that he received inservice treatment in March 1978 for the removal of a foreign body from his left cornea. After follow-up treatment which showed that the left cornea was healing at the foreign body site, no further reference was made to any left eye abnormality. The remainder of the veteran’s service medical records, including his retirement physical examination of August 1993, are negative for any abnormality of the left cornea. Significantly, the veteran’s eyes were reported as normal on VA general medical examination in January 1994. There being no medical evidence of current residuals of a left corneal abrasion, service connection must be denied. See Brammer v. Derwinski, 3 Vet.App. 223, 225 (1992). Accordingly, the veteran’s claim of entitlement to service connection for residuals of a left corneal abrasion is not plausible. b. Entitlement to service connection for bronchitis The veteran’s service medical records document treatment on several occasions for bronchitis. He was last diagnosed with bronchitis in December 1992. The veteran’s service medical records show no diagnosis or treatment of bronchitis as a chronic condition, and chest x-rays made during the veteran’s active service, including on retirement examination in August 1993, were negative for any abnormality. The report of the VA general medical examination of January 1994 is negative for any complaint or diagnosis of bronchitis, either in chronic or episodic form. Since there is no medical evidence of currently manifested bronchitis, service connection must be denied. See Brammer v. Derwinski, 3 Vet.App. 223, 225 (1992). Accordingly, the veteran’s claim of entitlement to service connection for bronchitis is not plausible. c. Entitlement to service connection for allergic rhinitis The veteran has not presented competent medical evidence of currently manifested allergic rhinitis. Although the veteran’s service medical records show that he was treated for allergic rhinitis in April 1993, there was no further treatment noted in his service medical records. Allergic rhinitis was not diagnosed on his separation physical examination, and, significantly, allergic rhinitis was not found on VA general medical examination in January 1994. On VA examination, his respiratory system, and his nose, sinuses, mouth, and throat were reported as normal. Since there is no medical evidence of currently manifested allergic rhinitis, service connection must be denied. See Brammer v. Derwinksi, 3 Vet.App. 223, 225 (1992). Accordingly, the veteran’s claim of entitlement to service connection for allergic rhinitis is not plausible. d. Entitlement to service connection for a heart condition, to include abnormal and/or high blood pressure On VA general medical examination in January 1994, the veteran’s cardiovascular system was reported as normal, and his blood pressure was recorded as 125/75 (systolic/diastolic). High blood pressure or abnormal blood pressure was not diagnosed, and his diastolic blood pressure measurement is not predominantly at 100 or more, which would meet a compensable level for which service connection for hypertensive vascular disease may be established on a presumptive basis. 38 C.F.R. § 4.104, Diagnostic Code 7101 (1996). In addition to not being at the level required for a compensable evaluation pursuant to Diagnostic Code 7101, the veteran has never been diagnosed with abnormal or high blood pressure. The veteran’s service medical records do not show that that he had consistently elevated blood pressure. On one occasion in April 1993, the veteran’s blood pressure was reported as 137/99. However, the remainder of the systolic and diastolic measurements were within normal limits. The veteran’s service medical records do not show any diagnosis or treatment for a heart condition. Although during active service he was enrolled in the Coronary Artery Risk Evaluation (CARE) program, his enrollment in the program was based on his coronary risk factors rather than on actual demonstrated heart disease. Since there is no medical evidence of a currently manifested heart condition or high blood pressure or any abnormal blood pressure, service connection must be denied. See Brammer v. Derwinski, 3 Vet.App. 223, 225 (1992). Accordingly, the veteran’s claim of entitlement to service connection for a heart condition, to include abnormal and/or high blood pressure, is not plausible. 3. Notice The Board notes that the United States Court of Veterans Appeals (Court) has held that, when a claimant fails to submit a well-grounded claim under 38 U.S.C.A. § 5107(a) (West 1991), VA has a duty to advise the claimant of the evidence required to complete the application. 38 U.S.C.A. § 5103(a) (West 1991); Robinette v. Brown, 8 Vet.App. 69, 77- 80 (1995). In this case, the Board finds that this procedural consideration already has been satisfied. The RO fulfilled its procedural obligations under § 5103(a) by informing the veteran of the reason for its denial of service connection, in the rating decision on appeal and in the statement of the case (SOC). In addition, this Board decision informs the veteran of the evidence that is lacking to make his claims well grounded. Although the RO did not notify the veteran, in the rating decision that is the subject of this appeal, that his claim was not well grounded, any such error was nonprejudicial. See Edenfield v. Brown, 8 Vet.App. 384 (1995) (“Assuming, arguendo, that it was error to express a disallowance in terms of the merits where the claim is, in fact and law, not well grounded, the Court should nonetheless affirm the Board’s ‘erroneous’ disallowance of the claim on the merits unless to do so would prejudice the appellant.” [Citations omitted]). In this case, any such error by the RO was nonprejudicial, since the rating decision on appeal and the SOC provided the reasons and bases for the RO’s denial. In March 1997, the veteran’s representative cited provisions of the VA Adjudication Procedure Manual M21-1 (M21-1), specifically, Part III, Paragraph 1.03a, and Part VI, Paragraph 2.10f. The representative requested that “[i]f the Board finds that [the veteran’s] current claim is not well grounded. . . that the Board determine whether the RO followed the M21-1 substantive rules requiring that full development of all claims be undertaken prior to the well grounded determination.” The representative has requested that if the Board finds that such development in accordance with M21-1 did not occur, then the case should be remanded for full development of the claim. The representative also requested that in the Board’s remand order, the RO be directed to notify the veteran of the one year time limit to produce evidence in accordance with 38 U.S.C.A. § 5103(a). See Written Brief Presentation, March 12, 1997, at 3. In addressing these contentions, the Board notes that the RO developed the veteran’s claim in accordance with the provisions of M21-1, by affording the veteran a VA general medical examination. The veteran has not put VA on notice of the existence of any specific, particular piece of evidence that, if submitted, could make his claim well grounded. Although the veteran’s representative has requested that additional VA medical examinations be conducted if relief was not granted, because the veteran has not submitted a well-grounded claim, VA does not yet have a duty to assist him in developing the claim pursuant to 38 U.S.C.A. § 5107(a). B. Entitlement to a compensable rating for service-connected hemorrhoids The veteran has presented a well-grounded claim for a compensable disability rating for service-connected hemorrhoids within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). See Shipwash v. Brown, 8 Vet.App. 218, 224 (1995) (When a claimant appeals the RO’s initial assignment of a disability rating when service connection was established, the claim continues to be well grounded as long as the rating schedule provides for a higher rating and the claim remains open). Since the veteran has presented a well-grounded claim, VA has a statutory duty to assist the veteran in developing the facts pertinent to his claim. Littke v. Derwinski, 1 Vet.App. 90 (1990). In this case, the RO afforded the veteran a VA general medical examination. Sufficient evidence is of record for an equitable disposition of the appeal. Disability ratings are intended to compensate reductions in earning capacity as a result of a specific disorder or combinations of disorders. The ratings are intended, as far as practicably can be determined, to compensate the average impairment of earning capacity resulting from such disorder(s) in civilian occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (1996). The law requires that where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1996). While evaluation of a service-connected disability requires a review of the veteran’s medical history with regard to that disorder, the United States Court of Veterans Appeals (Court) has held that, where entitlement to compensation has already been established, and an increase in the disability rating is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet.App. 55, 58 (1994); Peyton v. Derwinski, 1 Vet.App. 282 (1991); 38 C.F.R. §§ 4.1, 4.2 (1996). The veteran’s service-connected hemorrhoids are rated pursuant to Diagnostic Code 7336 of the VA SCHEDULE FOR RATING DISABILITIES. Utilizing the diagnostic criteria, external or internal hemorrhoids are assigned a noncompensable evaluation when they are mild or moderate. A 10 percent evaluation is warranted when the hemorrhoids are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. A 20 percent evaluation is warranted when the condition is manifested by persistent bleeding and with secondary anemia, or with fissures. 38 C.F.R. § 4.114, Diagnostic Code 7336 (1996). The evidence shows that the veteran’s hemorrhoids do not warrant assignment of a rating greater than the current noncompensable evaluation. On VA general medical examination in January 1994, the examiner noted the veteran’s subjective complaint that he had hemorrhoids which bled occasionally. On objective examination, the examiner reported that there were two small external hemorrhoids at 3 and 6 o’clock, which showed no bleeding. As indicated by the above medical examination, there is no evidence that the veteran’s hemorrhoids are large or thrombotic, irreducible, or have excessive redundant tissue, or evidence frequent recurrence. Rather, the hemorrhoids were described as small and not bleeding. The veteran’s service medical records do not show that he his hemorrhoids were bleeding or that he experienced frequent recurrences of hemorrhoids, and he has not submitted medical evidence showing such recurrence or other characteristics which would warrant assignment of the compensable evaluation. Based on the foregoing, the Board concludes that the impairment resulting from the veteran’s service-connected hemorrhoids is appropriately evaluated as noncompensably disabling. 38 C.F.R. § 4.114, Diagnostic Code 7336 (1996). The preponderance of the evidence being against the veteran’s claim, the benefit of the doubt rule enunciated in 38 U.S.C.A. § 5107(b) is not for application. ORDER Having found the claim not well grounded, the claim of entitlement to service connection for residuals of a left corneal abrasion is denied. Having found the claim not well grounded, the claim of entitlement to service connection for bronchitis is denied. Having found the claim not well grounded, the claim of entitlement to service connection for allergic rhinitis is denied. Having found the claim not well grounded, the claim of entitlement to service connection for a heart condition, to include abnormal and/or high blood pressure, is denied. Entitlement to a compensable rating for service-connected hemorrhoids is denied. REMAND I. Entitlement to service connection for residuals of a laceration of the head with contusion, to include post- traumatic headaches The veteran claims that he was involved in a motor vehicle accident in April 1978, at which time he sustained a laceration to the center of his scalp. The claims folder also contains a lay statement dated in September 1994 from Amando Shols, Sergeant First Class, United States Army, who claims that he and the veteran were passengers in the car that was involved in the 1978 accident. Sergeant Shols described the accident and the identified the occupants of the car and their respective injuries. Sergeant Shols indicated that the veteran sustained body and head contusions and had a small cut in the head area with minor bleeding. See Statement of Amando Shols, dated September 2, 1994. It is unclear whether this lay statement was reviewed by the RO, since a supplemental statement of the case (SSOC) was not issued following receipt of the statement. The Board will not address whether a procedural error occurred, since additional evidentiary development must be conducted prior to consideration of the veteran’s claim. The service medical records document that the veteran sought medical treatment two days after the motor vehicle accident, and that he sustained multiple contusions as a result of the accident. It was noted that he sustained no lacerations. However, in the report of his retirement physical examination in August 1993, the examiner noted that he had a scar in the mid-posterior of the scalp. Despite the above notation in the veteran’s retirement physical examination that he had a scar on his scalp, the report of the VA general medical examination conducted five months later made no reference to any currently manifested scar. In view of this discrepancy, and in view of the lay evidence submitted showing that he sustained a cut on his scalp as a result of an automobile accident, the Board will REMAND this claim so that the veteran may be afforded appropriate VA examinations, including dermatological and neurological examinations, in order to determine the nature, severity, and if possible, the etiology of any currently manifested residuals of scars of the head, to include post- traumatic headaches. II. Entitlement to service connection for a low back disorder The veteran claims that he currently has a low back disorder, which he claims is the result of his sitting at a desk, which he claims was a substantial part of his military duties and which he alleges placed a strain on his back The Board notes that on VA general medical examination in January 1994, the examiner reported that the veteran had a spasm of the muscles of the lumbar area, with no deformity shown. Range of motion was 95 degrees forward flexion, 35 degrees backward extension, 40 degrees left and right lateral flexion, and 35 degrees left and right rotation. The examiner diagnosed back strain. An x-ray of the sacro-lumbar spine was ordered, but was not associated with the claims folder. In a deferred rating decision of September 1994, the RO requested these x-rays, but they were not obtained. In the statement of the case (SOC), the RO noted the veteran’s belief that he may have arthritis of the back, and that the issue of service connection for a back condition would be reconsidered if the veteran submitted medical evidence, to include x-ray evidence, that he had arthritis of the back diagnosed within one year of release from active duty. The x-rays that were conducted as part of the VA general medical examination may be highly relevant as to whether the veteran had arthritis of the back within one year of separation from active service, or had some other back condition. Accordingly, this claim is REMANDED so that the VA x-rays may be obtained. In addition, the veteran should be afforded an additional VA examination, so that the nature, severity, and, if possible, etiology of any currently manifested back disorder may be determined. As a part of this examination, the examiner should review the report of the January 1994 VA general medical examination and the corresponding x-rays made, and render an opinion as to whether arthritis of the back currently is manifested, and, if so, whether it was manifest within one year of separation from active service Accordingly, this claim is REMANDED for the following: 1. Obtain and associate with the claims folder all x-rays conducted in connection with the VA general medical examination conducted in January 1994 at the VA Medical Center in Washington, D.C. 2. Ask the veteran if he has received any further treatment from private or VA health care providers for any residuals of a laceration of the head and for back problems. If so, obtain appropriate releases and obtain the treatment records. Associate all records received with the claims folder. 3. After completion of the above development, the veteran should be afforded comprehensive VA dermatological and neurological examinations to determine the nature, severity, and if possible, etiology of his claimed residuals of a laceration of the head with contusion, to include post-traumatic headaches. The veteran’s claims folder is to be made available to each examiner to review prior to the examinations, and each examiner is asked to indicate in the examination report that he or she has examined the claims folder. All tests deemed necessary by the examiner should be conducted, and the examiner should review the results of any testing prior to the completion of the examination report. A complete rationale for any opinion expressed must be provided. The reports of the above-requested examinations should be associated with the veteran’s claims folder. 4. The veteran should be afforded a comprehensive VA orthopedic examination, in order to determine the nature, severity, and if possible, etiology of any currently manifested low back disorders. The veteran’s claims folder is to be made available to the examiner to review prior to the examination, and the examiner is asked to indicate in the examination report that he or she has examined the claims folder. The examiner should review the report of the VA general medical examination of January 1994, including all x-rays made in connection with that examination. All tests deemed necessary by the examiner should be conducted, and the examiner should review the results of any testing prior to the completion of the examination report. The examiner should be asked to comment specifically on the following: a. Does the veteran currently suffer from a chronic low back disorder? b. If a chronic low back condition currently is shown, the examiner should identify the approximate date of onset, and detail the history of the condition as thoroughly as possible. c. If arthritis currently is shown, when was the approximate date of onset? Was arthritis manifest at the time of the VA general medical examination in January 1994, or within one year of the veteran’s separation from active service? 5. Following completion of the foregoing, the RO must review the claims folder and ensure that all required development actions have been conducted and completed in full. If any development is incomplete, appropriate corrective action is to be implemented. Specific attention is directed to the physical examination reports. If the reports do not include fully detailed descriptions of pathology and all test reports, including adequate responses to the specific opinions requested, the reports must be returned for corrective action. 38 C.F.R. § 4.2 (1996). 6. Thereafter, the RO should readjudicate the claims for service connection for residuals of a laceration of the head with contusion, to include post-traumatic headaches, and service connection for a low back disorder, with consideration given to all of the evidence of record. If any benefit sought on appeal, for which an appeal has been perfected, remains denied, the veteran and his representative should be furnished with a supplemental statement of the case (SSOC) and provided a reasonable opportunity to respond thereto. While this case is in remand status, the veteran and his representative are free to submit additional evidence and argument on the questions at issue. Quarles v. Derwinski, 3 Vet.App. 129, 141 (1992); Booth v. Brown, 8 Vet.App. 109, 112 (1995) Thereafter, subject to current appellate procedures, the case should be returned to the Board for further review, as appropriate. The veteran need take no action until he is so informed. The purpose of this REMAND is to obtain additional evidence. No inference should be drawn regarding the final disposition of the claim as a result of this action. This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Veterans Appeals for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans’ Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1996) (Historical and Statutory Notes). In addition, VBA’s ADJUDICATION PROCEDURE MANUAL, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44-8.45 and 38.02-38.03. MICHAEL S. SIEGEL Acting Member, Board of Veterans' Appeals 38 U.S.C.A. § 7102 (West Supp. 1996) 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. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1996), a decision of the Board of Veterans’ Appeals granting less than the (CONTINUED ON NEXT PAGE 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, 102 Stat. 4105, 4122 (1988). The date that appears on the face of this decision constitutes the date of mailing and the copy of this decision that you have received is your notice of the action taken on your appeal by the Board of Veterans’ Appeals. Appellate rights do not attach to those issues addressed in the remand portion of the Board’s decision, because a remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1996). - 2 -