Citation NR: 9729656 Decision Date: 08/27/97 Archive Date: 09/02/97 DOCKET NO. 94-40 476 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for traumatic arthritis. 2. Entitlement to service connection for a disability manifested by bilateral hand/finger pain. 3. Entitlement to service connection for residuals of right leg (knee) strain or contusion. 4. Entitlement to service connection for residuals of a right ankle sprain. 5. Entitlement to service connection for residuals of a left ankle sprain or fracture. 6. Entitlement to service connection for bilateral impaired hearing disability. 7. Entitlement to service connection for otitis externa. 8. Adequacy of appeal from a denial of service connection for hypertension and for residuals of the excision of a cyst from the sole of the right foot. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD William L. Pine, Counsel INTRODUCTION The appellant had active service from November 1980 to January 1993, with over seven years of prior active service. This appeal is from a June 1993 rating decision by the Department of Veterans Affairs (VA) St. Petersburg, Florida, Regional Office (RO). It appears from the June 1996 statement of Dr. Mercer that the appellant may be raising a claim of entitlement to service connection for a left knee disability. Construing the communication to possibly raise such a claim, the matter is referred to the RO for any appropriate action. The Board will not reach the merits of the claims related to hypertension and excision of a cyst from the right foot, but rather will consider the adequacy of the substantive appeal in this case as to those issues. See 38 C.F.R. § 20.203 (1996). The appellant and his representative were advised in a separate letter of May 1997 of the Board’s intention to address the issue of adequacy of appeals. No response has been received from the appellant, and his representative has stated, of record, that it has no further comment on the matter. The issue of entitlement to service connection for a disability manifested by bilateral hand/finger pain is the subject of the Remand herein. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that he suffers current disability from each of the disorders allegedly incurred in service. The appellant avers that the issues have been poorly identified by the RO and that a VA examination report of April 1993 was inadequate for rating purposes for lack of range of motion studies and radiologic studies. He further avers that the examination could not present an accurate picture of his alleged otitis, because the intermittent condition was absent at the time of the examination. The appellant argues that the entire case should be remanded. He further argues that even if certain claims are not well grounded, the Board must determine whether the RO complied with the claim development instruction in VA Adjudication Procedure Manual M21-1, and remand any not well-grounded claims for development as provided in that manual. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1997), 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 appellant has not submitted an appeal on the issues of service connection for hypertension and for residuals of excision of a cyst from the right foot adequate to establish the Board’s jurisdiction over those matters, and that he has not met the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the any of the claims for service connection subject to the instant decision are well grounded. FINDING OF FACT 1. The substantive appeal received by the RO in September 1993 did not allege specific error of fact or law in the June 1993 rating decision denying service connection for hypertension and for residuals of excision of a cyst from the sole of the right foot; it explicitly stated the appeal from the denial of all claims decided in this appeal and was silent regarding hypertension and cyst of the right foot. 2. The appellant has not submitted evidence of the current existence of traumatic arthritis, residuals of a right leg (knee) strain or contusion, residuals of a right ankle sprain, residuals of a left ankle sprain or fracture, bilateral impaired hearing disability, or otitis externa. CONCLUSIONS OF LAW 1. The substantive appeal of September 1993 is inadequate to perfect an appeal from the June 1993 rating decision denying service connection for hypertension and for residuals of the excision of a cyst from the sole of the right foot, and is not in conformity with law; the Board is proscribed from entertaining such an appeal. 38 U.S.C.A. §§ 7105(d)(3-5), 7108 (West 1991); 38 C.F.R. § 20.202 (1996). 2. Claims of entitlement to service connection for traumatic arthritis, residuals of a right leg (knee) strain or contusion, residuals of a right ankle sprain, residuals of a left ankle sprain or fracture, bilateral impaired hearing disability, and otitis externa are not well grounded, and VA has no duty to assist the appellant to obtain evidence in support of any of those claims. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. BACKGROUND Service medical records reveal the appellant’s June 1972 entrance medical history report of a broken left wrist without limitation of motion. Entrance physical examination was essentially normal, except for positive findings of right-sided otitis externa, rule out otitis media. For convenience, all audiometry testing results obtained in service are summarized here. Audiometry testing on entrance revealed the following puretone sensitivity thresholds, in decibels: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 0 10 5 LEFT 10 10 5 20 15 Multiple hearing conservation records indicate he worked in high noise areas using ear protection of one or more types at various times. Fifteen reports of periodic audiometry testing subsequent to that done on entrance are of record. None measured three or more puretone thresholds of 26 decibels or greater at frequencies of 500, 1000, 2000, 3000, or 4000 Hertz. None measured any single puretone threshold in either ear of 40 decibels at 500, 1000, 2000, 3000, or 4000 Hertz. On separation the 6000 Hertz measurement was 35 decibels, and the diagnosis was high frequency hearing loss, mild, at 6000 Hertz, non-progressive. Speech sensitivity was not measured in service. The significant audiometry measurements on separation were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 10 0 5 10 LEFT 10 15 10 25 20 A separation examination of December 1975 was negative for all systems. In January 1980, the appellant sustained a fracture of the right distal ulna. X-ray study in April 1980 revealed normal healing process. A May 1980 x-ray study report revealed a small avulsion fracture at the anterior dorsum of the talus of the left ankle. No other clinical reports related to the left ankle are of record. A November 1980 periodic medical history noted a left wrist fracture at age 12; physical examination was negative for all systems. In January 1981, the appellant sustained a right ankle sprain, initially thought a possible avulsion fracture, but deemed a severe sprain upon review by a radiologist of an x- ray study. The sprain was described as resolving a week after initial treatment. In March 1981, the appellant complained he was hit in the left ear two weeks previously. The tympanic membranes were retracted and slightly injected bilaterally. The assessment was bilateral Eustachian tube dysfunction. In October 1981, he complained of no hearing in the right ear for two weeks. The external auditory canal was slightly erythematous and edematous, and both tympanic membranes were retracted. The impression was early right otitis externa and bilateral Eustachian tube dysfunction. On follow-up later that month, the right external auditory canal was clear and the tympanic membrane was clear and mobile. In November 1981, the ear drums were normal. In January 1982, on complaint of five days of right-sided ear ache and decreased hearing, he was diagnosed with right-sided otitis interna and externa. In February 1982, there was an impression of otitis. A medical history taken in November 1981 noted the appellant’s report of fractured ribs at age five and a fractured left clavicle at age 17, in addition to the previously noted wrist injury. The right forearm fracture sustained at age 26 was noted to have no complications and no sequelae (NCNS). In March 1984, the appellant complained of right knee pain subsequent to a twisting athletic injury. He was advised to continue his treatment of Ben-Gay and bandage wrap. No assessment was noted. Subsequently that month, the condition was improved. Complaints of right upper calf pain were assessed as tendonitis. In April 1986, the appellant complained of right leg and ankle pain after he fell approximately 10 feet. It was assessed as a soft tissue injury. Subsequent x-ray study that month of the right ankle showed questionable cortical separation at the lateral aspect of the distal tibial shaft, which was thought possibly to represent a chip fracture. The x-ray was ultimately deemed within normal limits. In April 1987, the appellant sustained an athletic injury resulting in right calf pain, which was assessed as a possible popliteal muscle tear or strain and contusion. In January 1990, the appellant sustained a twisting injury of the left knee while skiing, assessed as a medial collateral ligament sprain. In June 1990, the appellant was seen for complaints of left ear pain assessed as intermittent Eustachian tube dysfunction and pharyngitis. In September 1990, the appellant complained of a popping noise in the left shoulder after diving off a 30-foot cliff three weeks previously. There was no pain, no swelling, and no difficulty performing regular duties. The assessment was non-specific left shoulder irritation, probably ligamentous. In January 1991, the appellant fractured the distal phalanx of the left thumb while skiing. The thumb was splinted for five weeks and he was counseled about post-traumatic arthritis. X-ray study of February 1991 showed the fracture to be healing. In December 1991, x-ray studies of both hands were normal. In a medical history for retirement in August 1992, the appellant reported fractured ribs in childhood with full recovery, NCNS; fracture of the left wrist, 1967, NCNS; fractured left clavicle, NCNS; broken nose, 1976, NCNS; fractured right radius and ulna, 1979, NCNS; fractured left thumb, 1989 with arthritis, limitation of motion, and otherwise NCNS. Separation physical examination was essentially normal. Fingers had full range of motion, full strength and were non-tender. The right forearm had no weakness, deformity, or limitation of motion. The left wrist had no weakness, deformity, or limitation of motion. Audiology finding was as noted, above. On a hearing conservation questionnaire, the appellant denied frequent ear infection. In September 1992, the appellant complained of continued aching pain in the proximal interphalangeal joints of the fingers, bilaterally, without morning stiffness. There was decreased pain with use. The assessment was questionable overuse syndrome. On VA examination in April 1993, the appellant reported a left ankle injury in 1980 or 1985, with no trouble now. He reported an episode of otitis in the past; he did not remember which ear; he had no symptoms currently. He reported hearing loss, left side worse than right, and some difficulty hearing speech when in crowds. He complained of pain in the right knee, not aggravated by any particular activity. On physical examination, his carriage, posture, and gait were normal. He was able to dress and undress easily. The external and internal ears, canals and tympanic membranes were normal. The knees and ankles were without deformity, swelling, redness or tenderness, bilaterally. The appellant squatted and arose normally. He toe and heel walked well. Range of motion of the knees was 0 to 145 degrees, bilaterally, and circumference of the knees was 15½ inches, bilaterally. Both ankles had full ranges of motion in dorsiflexion, plantar flexion, inversion and eversions. Deep tendon reflexes were normal throughout. X-ray studies of the hands, left ankle, and right knee were normal. X-ray study of the right forearm showed an old, healed fracture of the ulna with slight deformity. The diagnoses included history of fracture of the left thumb with negative x-ray; history of fracture of the right ulna with slight deformity, asymptomatic; history of fracture of the left ankle with negative x-ray; history of otitis externa; and history of right knee pain with negative x-ray. On the VA audiological evaluation in May 1993, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 10 0 10 15 LEFT 15 15 5 20 20 Speech audiometry using the Maryland CNC Test revealed speech recognition of 100 percent in each ear. In September 1993, the appellant was seen on multiple occasions by Dr. Fanney for complaints of swollen hands and elbows. The diagnosis was osteoarthritis. Subsequent evaluation by private physicians in October 1993 and in January 1994 diagnosed polyneuropathy and peripheral neuropathy. A C5-6 herniated disc was diagnosed by magnetic resonance imaging in November 1993, and the appellant underwent disc surgery in January 1994. In June 1993, the RO denied claims of entitlement to service connection for hypertension and for residuals of excision of a cyst on the sole of the right foot, the issue then styled as for plantar wart, and informed the appellant of the decision and of his appellate rights by letter of July 1993. The appellant filed a notice of disagreement in August 1993, including those issues. The RO issued a statement of the case (SOC)in September 1993, and the appellant filed a substantive appeal in response to the SOC that month. The substantive appeal stated, “I appeal VA decisions denying service-connected hearing loss . . . ,” and proceeded to address explicitly each issue listed in the SOC except entitlement to service connection for hypertension and for residuals of excision of a cyst from the sole of the right foot. As to those issues, the substantive appeal was silent. Subsequent to further adjudication on other claims at issue, the RO issued supplemental statements of the case (SSOC) in October 1993 and in February and May 1994, each of which displayed as issues on appeal the two claims not mentioned in the substantive appeal. A cover letter transmitted with each SSOC advised the appellant that he must submit a substantive appeal within 60 days as to any issue on the SSOC regarding which he had not done so previously. The letters also advised the appellant that a substantive appeal need not be filed as to any issue included in a prior SOC or SSOC. The appellant’s representative included the hypertension and the cyst issues on an August 1994 statement of accredited representation in appealed case, filed more than 60 days after the May 1994 SSOC. On VA examination in January 1994, the examiner made positive neurologic findings of sensation deficits, and diagnosed cervical disc disease with herniated disc at C5-6 and peripheral neuropathy. He opined that the cervical disc disease explained certain symptoms, but not all, and that others were consistent with peripheral neuropathy. On private post-operative follow-up in April 1994 the appellant was without complaint. Examination revealed strength and sensation [of the hands] to be normal throughout. A June 1996 statement from J. Mercer, M.D., noted he had treated the appellant since October 1994 for recurrent knee pain, especially with activity. Dr. Mercer reported that review of medical records showed this to be a problem of many years’ duration, initially felt to be ligamentous, but thought by Dr. Mercer to be related to early arthritic changes. He further stated that military records showed a herniated cervical disk. II. ANALYSIS A. Adequacy of Substantive Appeal Statute and regulation prescribe that an appeal is initiated by a notice of disagreement and completed by a substantive appeal after the SOC is furnished as prescribed. 38 U.S.C.A. § 7105(a) (West 1991); 38 C.F.R. § 20.200 (1996). Once a sufficient notice of disagreement is of record and any necessary development completed, if the benefit sought is not granted or the appeal withdrawn, the SOC is issued. The claimant must then file a formal appeal that satisfies the liberal, minimal substantive requirements for formal appeals. That is, the appeal “should set out specific allegations of error of fact or law, such allegations related to specific items in the statement of the case.” 38 U.S.C.A. § 7105(d)(3) (West 1991). The regulation prescribing the minimum contents required of a statement to be an adequate substantive appeal provides, If the Statement of the Case and any prior Supplemental Statements of the Case addressed several issues, the Substantive Appeal must either indicate that the appeal is being perfected as to all of those issues or must specifically identify the issues appealed. The Substantive Appeal should set out specific arguments relating to errors of fact or law made by the agency of original jurisdiction in reaching the determination, or determinations, being appealed. To the extent feasible, the argument should be related to specific items in the Statement of the Case and any prior Supplemental Statements of the Case. The Board will construe such arguments in a liberal manner for purposes of determining whether they raise issues on appeal, but the Board may dismiss any appeal which fails to allege specific error of fact or law in the determination, or determinations, being appealed. 38 C.F.R. § 20.202 (1996). See also 38 U.S.C.A. § 7105(d)(5). Moreover, “[a]n application for review on appeal shall not be entertained unless it is in conformity with [chapter 71, title 38, United States Code].” 38 U.S.C.A. § 7108 (West 1991). The silence of the appellant’s substantive appeal of September 1993 renders it noncompliant with all of the requirements of a substantive appeal. As it stated no error of fact or law as to the issues of hypertension and right foot cyst, the Board may dismiss those appeals. 38 C.F.R. § 20.202 (1996). The letters transmitted with the SSOCs issued subsequently to the SOC in this case contained apparently contradictory instructions, informing the appellant that he must perfect his appeal as to any issue listed on the SSOC as to which he had not previously perfected an appeal. The letter also stated he need not submit a substantive appeal as to any issue previously listed on an SOC or a prior SSOC. Unfortunately, the letter apparently contemplated only the situation in which an appeal had been perfected as to all issues on an SOC, or it failed to contemplate the erroneous inclusion in an SSOC of an issue listed on an SOC regarding which a claimant had not perfected an appeal. Regardless, the jurisdiction of the Board is mandated by statute, and as a general rule, the RO may not confer jurisdiction on the Board in contravention of statute. See, e.g., 38 C.F.R. § 19.35. The substantive appeal did not state general language of appeal with all denials in the June 1993 rating decision. It was specific and explicit as to each of the matters denied in the decision from which appeal was taken except as to hypertension and the right foot cyst. Its specificity triggered the requirement to state explicitly those adverse decisions the appellant wished to appeal. Consequently, in addition to, or superseding, the Board’s discretionary authority to dismiss the appeal, the failure to mention either hypertension or the right foot cyst in the substantive appeal of September 1993 compels the Board to find the substantive appeal inadequate to confer jurisdiction, because it is not in conformity with chapter 71, title 38, United States Code, and the Board may not entertain it. 38 U.S.C.A. § 7108 (West 1991). B. Service Connection Claims on Appeal The appellant has not informed VA of the existence of any specific evidence germane to any claim at issue that would complete an incomplete application for compensation, i.e., well ground an otherwise not well-grounded claim, if submitted. Consequently no duty arises in this case to inform the appellant that his application is incomplete or of actions necessary to complete it. See 38 U.S.C.A. § 5103(a) (West 1991); Beausoleil v. Brown, 8 Vet.App. 459, 465 (1996); Johnson v. Brown, 8 Vet.App. 423, 427 (1995); cf. Robinette v. Brown, 8 Vet.App. 69 (1995) (when a claim is not well grounded and claimant informs VA of the existence of certain evidence that could well ground the claim, VA has duty under 38 U.S.C. § 5103(a) to inform claimant that application for compensation is incomplete and to submit the pertinent evidence). The appellant’s representative argues that provisions of the VA Adjudication Procedure Manual, M21-1, Part III, 1.03 (Feb. 23, 1996), and M21-1, Part VI, 2.10(f) (Aug. 5, 1996), abrogate the requirement of a well-grounded claim set forth by statute, see 38 U.S.C.A. § 5107(a) (West 1991), as a condition precedent to obligating VA to assist the appellant to develop facts in support of his claim. The representative further contends that the M21-1 provisions indicate that the claim must be fully developed prior to determining whether the claim is well grounded, and that this requirement is binding on the Board. The representative argues that the Board must remand this case if it finds the claim is not well grounded and VA has not implemented the cited manual provisions. The Board does not concur in either the view that it must remand the case to ensure compliance with the cited manual provisions or that VA has abrogated, or legally can abrogate, a statute by manual provision. A claim must be well grounded before VA has a duty to assist the appellant in developing that claim. 38 U.S.C.A. § 5107(a) (West 1991). The United States Court of Veterans Appeals has held that if the veteran fails to submit a well-grounded claim, the VA is under no duty to assist him in any further development of the claim. 38 U.S.C.A. § 5107(a); see Gilbert v. Derwinski, 1 Vet.App. 49, 55 (1990); see also Grottveit v. Brown, 5 Vet.App. 91, 93 (1993); 38 C.F.R. § 3.159(a). The veteran's representative contends that, subsequent to the Court's decisions pertaining to this issue, the VA expanded its duty to assist the veteran in developing evidence to include the situation in which the veteran has not submitted a well-grounded claim. Veterans Benefits Administration Manual M21-1, Part III, Chapter 1, 1.03(a), and Part VI, Chapter 2, 2.10(f) (1996). The Board, however, is required to follow the precedent opinions of the Court. 38 U.S.C.A. § 7269; see also Tobler v. Derwinski, 2 Vet.App. 8, 14 (1991). Subsequent to the revisions to the M21-1 manual, in Meyer v. Brown, 9 Vet.App. 425 (1996), the Court held that the Board is not required to remand a claim for additional development, in accordance with 38 C.F.R. § 19.9, prior to determining that a claim is not well- grounded. Moreover, “[t]he Board is not bound by Department manuals, circulars, or similar administrative issues.” 38 C.F.R. § 19.5 (1996). Especially, the Board is not bound by an administrative issuance that is in conflict with binding judicial decisions, and the Court's holdings on the issue of the VA's duty to assist in connection with the well- grounded claim determination are quite clear. See Bernard v Brown, 4 Vet.App. 384, 394 (1993). The Board has determined, therefore, that, in the absence of a well-grounded claim, the VA has no duty to assist the veteran in developing his case. Contrary to the contentions of the appellant’s representative, most of the issues on appeal are well identified. The claim for traumatic arthritis, discussed below, is not, and the claim pertaining to the hands, which is the subject of a remand, infra, is not. The appellant expressed his claims in a formal application for compensation. VA Form 21-526 (March 3, 1993). The RO adjudicated them and provided the appellant notice of the rating decision, naming each of the issues decided. The appellant responded with a notice of disagreement, adopting the nomenclature for his claims used by the RO. Given that the anatomical site and alleged etiology of each claimed disability is identified, the Board finds the claims sufficiently identified that no remand for clarification is warranted. See 38 C.F.R. § 19.9 (1996). Additionally, contrary to the assertions of the appellant’s representative, the Board notes for the record that the VA examination of April 1993 did report ranges of motion and radiology findings. "[A] person who submits a claim for benefits under a law administered by the Secretary [of Veterans Affairs] shall have 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). “[I]n order for a claim to be well grounded, there must be competent evidence of a current disability (a medical diagnosis); of incurrence or aggravation of a disease or injury in service (lay or medical evidence); and of a nexus between the in-service disease or injury and the current disability (medical evidence).” Caluza v. Brown, 7 Vet.App. 498, 506 (1995)(citations omitted) aff’d 78 F.3d 604 (Fed. Cir. 1996) (Table); see Grottveit v. Brown, 5 Vet.App. 91 (1993) (characterizing the type of evidence, lay versus medical, necessary to well ground a claim as dependent on the nature of the matter to be proven); see also Espiritu v. Derwinski, 2 Vet.App. 492 (1992) (lay individuals are competent to testify about matters of common experience, but expert qualification is necessary for VA to take cognizance of testimony that is rendered reliable only by expertise pertinent to object of inquiry). The salient feature of each of the issues in the instant case now ripe for appellate review is that the appellant has not submitted competent medical evidence that he currently has any of the disabilities claimed. None of the claimed disabilities was present when he was examined for retirement from service, and none were present on VA examination in April and May 1993. The appellant has not submitted private medical evidence of the existence of any of the claimed disabilities. 1. Traumatic Arthritis The appellant has never specified the joint or joints that have traumatic arthritis. To the extent he intends the claim to pertain to some anatomical site also the subject of one of the specifically identified sites of disability, it is redundant and thus moot. To the extent he means that some joint or joints not identified have traumatic arthritis, he has not presented a well-grounded claim. The service medical record refers to potential traumatic arthritis of the left thumb, which is already service connected and thus cannot be the subject of the instant claim. No traumatic arthritis is actually diagnosed by any physician of record. The June 1996 statement from Dr. Mercer did not identify which knee was referenced in his report, but the Board presumes he meant the left, because only that knee is reported in the service medical record to have suffered ligament injury. However, Dr. Mercer’s report is not medical evidence of traumatic arthritis upon which a claim may be well grounded, because he did not characterize the “early arthritic changes” of the (presumably left) knee as post-traumatic. As noted in the Introduction, supra, a claim of entitlement to service connection for a left knee disability has not been adjudicated on any basis, and is not now within the Board jurisdiction. Dr. Fanney’s September 1993 report of an impression of “osteoarthritis” of the hands is likewise not evidence of “traumatic” arthritis. The claim of entitlement to service connection for traumatic arthritis cannot be well grounded on evidence of arthritis of some other etiology. In sum, the appellant has submitted a claim for service connection for traumatic arthritis without submitting evidence he has traumatic arthritis. A claim for compensation for a disability not shown by competent medical evidence, Grottveit v. Brown, 5 Vet.App. 91 (1993); Espiritu v. Derwinski, 2 Vet.App. 492 (1992), to exist cannot be well grounded, See Rabideau v. Derwinski, 2 Vet.App. 141 (1992), and must be denied. Edenfield v. Brown, 6 Vet.App. 432 (1994). 2. Residual of a Right Leg (Knee) Strain or Contusion Whether the appellant sustained the injury alleged as the cause of residual disability is not at issue. Service medical records reveal such an injury. They also fail to contain, and hence fail to constitute, evidence of residual disability. The April 1993 VA examination was negative both clinically and radiologically. The appellant’s subjective report of pain, as distinguished from a clinical finding of pain by a competent physician, without objective clinical correlation, does not constitute the type of medical evidence necessary to establish a current diagnosis. Caluza, 7 Vet.App. 498; Grottveit, 5 Vet.App. 91. The material question in claims for VA disability compensation is whether there is current disability, because VA is authorized to pay compensation for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). The fact of injury or sickness in service alone is insufficient without evidence of current disability. The claim for service connection for residuals of a right knee injury is not well grounded, 38 U.S.C.A. § 5107(a) (West 1991), because the appellant has not submitted competent medical evidence, Caluza, 7 Vet.App. 498, that a disability of the right knee currently exists. Rabideau, 2 Vet.App. 141. Such a claim must be denied. Edenfield, 6 Vet App 432. 3. Residuals of Right Ankle Sprain Again, the fact of a right ankle sprain in service is not disputed. The appellant has not submitted competent medical evidence of the current existence of a right ankle disability, which, as noted, is prerequisite to well grounding a claim for VA disability compensation. Rabideau, 2 Vet.App. 141. Two ankle injuries are documented in the service medical record, one in January 1981, another in April 1986. Medical records from the years of service after 1986, including the separation examination report, are silent about residual disability in the right ankle. On VA examination the appellant was clinically negative for right ankle dysfunction, and in fact reported only a history of left ankle injury. In sum, the appellant has not submitted evidence of the current existence of a right ankle disability. Consequently, the claim is not well grounded, 38 U.S.C.A. § 5107(a) (West 1991), and must be denied. Edenfield, 6 Vet App 432. 4. Residuals of a Left Ankle Sprain or Fracture As with the right ankle, the fact of injury, in this case avulsion fracture in May 1980, is not in dispute. Notably, the service medical record for the 12½ years following the injury is silent regarding the left injury. The VA examination found the appellant to be without current disability of the left ankle. The appellant has filed a claim for VA disability compensation without submitting competent medical evidence that he has such a disability. The claim is not well grounded, Rabideau, 2 Vet.App. 141; 38 U.S.C.A. § 5107(a) (West 1991), and must be denied. Edenfield, 6 Vet App 432. 5. Bilateral Impaired Hearing Disability The high level hearing loss at 6000 Hertz diagnosed in service is not a hearing disability within the meaning of the governing regulation. 38 C.F.R. § 3.385 (1996). A well grounded claim for impaired hearing disability must include evidence that a hearing loss, as defined by regulation, exists. “Impaired hearing will be considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent.” 38 C.F.R. § 3.385 (1996) As the record reveals, the appellant has not submitted evidence his hearing is impaired to a disabling degree as defined by section 3.385. Consequently, his claim is for compensation for a disability that, as a matter of law, does not currently exist, and thus the claim cannot be well grounded. Rabideau, 2 Vet.App. 141; 38 U.S.C.A. § 5107(a) (West 1991). The claim must be denied. Edenfield, 6 Vet App 432. 6. Otitis Externa The appellant’s assertion that he has a chronic, recurrent ear infection is insufficient evidence to well ground his claim. He is not competent to identify recurrent infections as a single pathology. Espiritu, 2 Vet.App. 492. Such a determination requires medical expertise the appellant does not have. Id. Moreover, the appellant denied frequent ear infections at the time of his August 1992 retirement examination, and he told the April 1992 VA examiner that he had no symptoms currently. Although the appellant has argued that he was, essentially, merely asymptomatic at the time of the examination, the Board notes that in the more than three years between that examination and July 1996, when the appellant last submitted evidence in support of another claim at issue on appeal, he has not submitted any other evidence of otitis. Thus, as is required by statute, 38 U.S.C.A. § 5107(a), the burden is the appellant’s to produce competent medical evidence that the claimed disability currently exists. Whereas he has not submitted competent medical evidence that the alleged disability currently exists, Rabideau, 2 Vet.App. 141, the claim is not well grounded, 38 U.S.C.A. § 5107(a), and it must be denied. Edenfield, 6 Vet App 432. ORDER No appeal was filed from the June 1993 denial of service connection for hypertension and for residuals of excision of a cyst from the right foot, and those issues are dismissed. Service connection for traumatic arthritis, residuals of a right leg (knee) strain or contusion, residuals of a right ankle sprain, residuals of a left ankle sprain or fracture, bilateral impaired hearing disability, and otitis externa is denied, as the claims are not well grounded. REMAND It appears that the RO has misconstrued the scope of the claim of entitlement to service connection for disability manifested by bilateral hand/finger pain. Initially adjudicated as if a claim for arthritis, the RO ultimately based the denial of the claim on a finding that medical evidence showed the symptoms were caused by cervical disc disease that is not service connected. Such a finding begs the question whether the cervical disc disease should be service connected. The appellant is not expected to be a physician. His claim for disability for identified symptomatology is surely sufficient to encompass the etiology of the symptomatology. Consequently, the identification of the etiology of the bilateral upper extremity condition without more left the adjudication of the issue incomplete. Notably the medical record, most recently the January 1994 VA examination report, raises the question whether one or more than one pathology is at work. One physician suggested that chemical exposure in service could have caused certain symptoms. More than one physician attributes certain symptoms to herniated disc and other symptoms to peripheral neuropathy, with the apparent implication of other etiology than the cervical disc. The fact that the appellant was symptomatic post-operatively on VA examination and not on private follow-up several months later seems to the Board to require additional corroborating medical evidence of the current status as well as of the etiology of any currently identified symptoms. These possibly complex medical matters should be addressed by further examination. Legally, the question exists whether there is a presumptive disorder present. See 38 C.F.R. §§ 3.307, 3.309 (1996). The facts clearly raise the question whether the peripheral neuropathy constitutes “other disease of the nervous system.” See 38 C.F.R. § 3.309 (1996). 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 (Historical and Statutory Notes) (West Supp. 1997). 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. Accordingly, the case is REMANDED for the following action: 1. Schedule the appellant for a VA examination, including neurologic and orthopedic consultation with nerve conduction studies, MRI, or other tests, if indicated, to diagnose or rule out any pathology manifested by bilateral hand/finger pain. Provide the examiner with the claims folder. The examiner should interview the appellant about his history of occupational exposure to toxic materials and review the medical records in the claims folder, with special attention to the statements and records from Drs. Fanney, Lopez, and Reid; the January 1994 VA examination report; and the October 1993 nerve conduction study report and the November 1993 MRI report. The examiners should provide an opinion whether any current symptomatology and any pathology found to be the cause originated during active service or is related to events in service. 2. Readjudicate the claim for service connection for a disability manifested by bilateral hand/finger pain. The appellant is free to submit additional evidence or argument in support of this claim. Quarles v. Derwinski, 3 Vet.App. 129, 141 (1992). If the benefits sought are not allowed, provide the appellant and his representative with a supplemental statement of the case and allow an appropriate period for response. Following completion of the above actions, the case should be returned to the Board for further appellate consideration, as appropriate. No action is required of the appellant until he receives further notice. This REMAND is to develop evidence and to ensure the appellant is afforded due process of law. Further appellate review is deferred pending completion of the dictates of this order. The Board intimates no opinion as to the final outcome warranted in this case. J. SHERMAN Member, Board of Veterans' Appeals 38 U.S.C.A. § 7102 (West Supp. 1997) 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. 1997), 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, 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 -