Citation NR: 9734060 Decision Date: 10/07/97 Archive Date: 10/09/97 DOCKET NO. 95-03 992 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for a chronic pulmonary disorder to include asthma and bronchitis. 2. Entitlement to service connection for chronic laryngitis. 3. Entitlement to service connection for a chronic sinus disorder to include sinusitis. 4. Entitlement to service connection for a chronic back disorder to include back strain. 5. Entitlement to service connection for a bilateral shoulder disorder. 6. Entitlement to service connection for a chronic bilateral hand disorder to include joint pain. 7. Entitlement to service connection for a chronic bilateral foot disorder to include plantar warts and recurrent cysts. 8. Entitlement to service connection for dermatophytosis of the feet. 9. Entitlement to an increased disability evaluation for headaches, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD J. T. Hutcheson, Counsel INTRODUCTION The veteran had certified active service from March 1990 to November 1992. This matter came before the Board of Veterans' Appeals (Board) on appeal from an August 1993 rating decision of the St. Petersburg, Florida, Regional Office (RO) which established service connection for headaches; assigned a noncompensable evaluation for that disability; and denied service connection for a pulmonary disorder to include asthma, bronchitis, and respiratory complaints; laryngitis; a sinus disorder to include sinusitis; a gastrointestinal disorder to include gastroenteritis and duodenitis; a back disorder to include back strain; a bilateral shoulder disorder; a bilateral hand disorder to include joint pain; a bilateral foot disorder to include plantar warts and recurrent cysts; and dermatophytosis of the feet. In June 1994, the veteran submitted a notice of disagreement. In December 1994, the RO issued a statement of the case to the veteran and her accredited representative. In January 1995, the veteran submitted a substantive appeal. In June 1995, the veteran was afforded a hearing before a Department of Veterans Affairs (VA) hearing officer. In July 1995, the RO determined that the veteran had not submitted a well-grounded claim of entitlement to service connection for a left foot nerve disorder and denied her claim. The veteran was informed in writing of the adverse decision and her appellate rights in July 1995. In October 1995, the RO granted service connection for gastritis and duodenitis; assigned a 10 percent evaluation for that disability; established service connection for pharyngitis, upper respiratory infections, and rhinitis; assigned a noncompensable evaluation for that disability; and increased the evaluation for the veteran’s headaches from noncompensable to 10 percent. The veteran has been represented throughout this appeal by the American Legion. Preliminary review of the record does not reveal that the RO expressly considered referral of the veteran’s claim for an increased disability evaluation for headaches to the VA Undersecretary for Benefits or the Director, VA Compensation and Pension Service for the assignment of an extraschedular rating under 38 C.F.R. § 3.321(b)(1) (1996). That regulation provides that to accord justice in an exceptional case where the schedular standards are found to be inadequate, the field station is authorized to refer the case to the Undersecretary for Benefits or the Director, VA Compensation and Pension Service for assignment of an extraschedular evaluation commensurate with the average earning capacity impairment. The governing criteria for such an award is a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. The United States Court of Veterans Appeals (Court) has held that the Board is precluded by regulation from assigning an extraschedular rating under 38 C.F.R. § 3.321(b)(1) (1996) in the first instance; however, the Board is not precluded from raising this question, and in fact is obligated to liberally read all documents and oral testimony of record and identify all potential theories of entitlement to a benefit under the law and regulations. Floyd v. Brown, 9 Vet.App. 88 (1996). The Court has further held that the Board must address referral under 38 C.F.R. § 3.321(b)(1) only where circumstances are presented which the Director of VA’s Compensation and Pension Service might consider exceptional or unusual. Shipwash v. Brown, 8 Vet.App. 218, 227 (1995). Having reviewed the record with these mandates in mind, the Board finds no basis for further action on this question. VAOPGCPREC. 6-96 (1996). The veteran did not submitted a notice of disagreement with the RO’s July 1995 determination that she had not submitted a well-grounded claim for service connection for a left foot nerve disorder. Therefore, the issue is not before the Board for appellate review and will not be addressed below. The Court has established that jurisdiction does matter. See Roy v. Brown, 5 Vet.App. 554 (1993); Rowell v. Principi, 4 Vet.App. 9 (1993). CONTENTIONS OF APPELLANT ON APPEAL The veteran asserts that service connection is warranted for chronic laryngitis, chronic sinusitis, a chronic back disorder, a bilateral shoulder disorder, a chronic bilateral hand disorder, a chronic bilateral foot disorder to include plantar warts and recurrent cysts, and dermatophytosis of the feet and the record supports assignment of an evaluation in excess of 10 percent for her headaches. She contends that the claimed disorders were initially manifested and treated during active service. The veteran advances that she has migraine headaches with characteristic prostrating attacks approximately every six months. 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 veteran has not submitted well-grounded claims for chronic laryngitis, a chronic sinus disorder, a chronic back disorder, a bilateral shoulder disorder, a chronic bilateral hand disorder, a chronic bilateral foot disorder, and dermatophytosis of the feet. The Board further concludes that a preponderance of the evidence is against the veteran’s claim for an increased disability evaluation for headaches. FINDINGS OF FACT 1. The veteran was treated for laryngitis during active service which resolved without chronic residuals. 2. Chronic laryngitis was not manifested during active service or at any time thereafter. 3. The veteran was treated for sinus complaints during active service which resolved without chronic residuals. 4. A chronic acquired sinus disorder was not manifested during active service or at any time thereafter. 5. The veteran was treated for back muscle strain during active service which resolved without chronic residuals. 6. A chronic back disorder was not manifested during active service or at any time thereafter. 7. A bilateral shoulder disorder was not manifested during active service or at any time thereafter. 8. The veteran was treated for warts on both thumbs, multiple accidental “finger sticks,” a left fifth finger laceration, and a left hand contusion/tendonitis during active service which resolved without chronic residuals. 9. A chronic bilateral hand disorder was not manifested during active service or at any time thereafter. 10. The veteran was treated for bilateral ingrown toenails, a plantar corn, and a left foot laceration during active service which resolved without chronic residuals. 11. A chronic bilateral foot disorder was not manifested during active service. The record contains no competent evidence attributing the veteran’s current left foot hallux valgus deformity to active service. 12. Dermatophytosis of the feet was not manifested during active service. The record contains no competent evidence attributing the veteran’s current dermatophytosis of the feet to active service. 13. The veteran experiences headaches with characteristic prostrating attacks approximately every six months. CONCLUSIONS OF LAW 1. The veteran has not submitted a well-grounded claim of entitlement to service connection for chronic laryngitis. 38 U.S.C.A. § 5107 (West 1991). 2. The veteran has not submitted a well-grounded claim of entitlement to service connection for a chronic sinus disorder to include sinusitis. 38 U.S.C.A. § 5107 (West 1991). 3. The veteran has not submitted a well-grounded claim of entitlement to service connection for a chronic back disorder to include back strain. 38 U.S.C.A. § 5107 (West 1991). 4. The veteran has not submitted a well-grounded claim of entitlement to service connection for a bilateral shoulder disorder. 38 U.S.C.A. § 5107 (West 1991). 5. The veteran has not submitted a well-grounded claim of entitlement to service connection for a chronic bilateral hand disorder to include joint pain. 38 U.S.C.A. § 5107 (West 1991). 6. The veteran has not submitted a well-grounded claim of entitlement to service connection for a chronic bilateral foot disorder to include plantar warts and recurrent cysts. 38 U.S.C.A. § 5107 (West 1991). 7. The veteran has not submitted a well-grounded claim of entitlement to service connection for dermatophytosis of the feet. 38 U.S.C.A. § 5107 (West 1991). 8. The criteria for an evaluation in excess of 10 percent for headaches have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, including § 4.20 and Diagnostic Code 8100 (1996). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS 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), and if so, whether the VA has properly assisted her in the development of her claims. Generally, a "well-grounded" claim is one which is plausible. The Court has directed that, in order for a claim for service connection to be well-grounded, there must be (1) competent evidence of a current disability; (2) proof as to incurrence or aggravation of a disease or injury in service; and (3) competent evidence as to a nexus between the inservice injury or disease and the current disability. Caluza v. Brown, 7 Vet.App. 498 (1995). When a veteran’s claim is determined to be not well-grounded, the VA does not have a statutory duty to assist her in developing the facts pertinent to her claim. However, VA may be obligated under the provisions of 38 U.S.C.A. § 5103(a) (West 1991) to advise her of the evidence needed to complete her application. This obligation is dependent upon the particular facts of the claim and the extent to which the Secretary of the VA has advised the appellant of the evidence necessary to support a claim for VA benefits. Robinette v. Brown, 8 Vet.App. 69 (1995). The veteran has alleged that she was treated for some of the claimed disorders at Lee Memorial Health Park Hospital. The RO contacted the hospital; requested copies of all relevant clinical documentation; and subsequently received no response to its request for clinical documentation. Therefore, the Board concludes that there are no additional relevant records which may be incorporated into the record. The veteran is fully aware of the reasons for the denials and the deficiencies in the record. The veteran is seeking service connection for chronic laryngitis, a chronic sinus disorder, a chronic back disorder, a bilateral shoulder disorder, a chronic bilateral hand disorder, a chronic bilateral foot disorder, and dermatophytosis of the feet and an increased disability evaluation for her headache disorder. It is necessary to determine if she has submitted a well-grounded claim with respect to each issue. I. Service Connection Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1996). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1996). A. Laryngitis The veteran’s service medical records indicate that she was treated for laryngitis on several occasions. Treatment records dated in December 1988 state that the veteran complained of a sore throat and laryngitis. She reported that she was “hardly able to speak.” Treating naval medical personnel noted that the veteran’s voice was very hoarse. An April 1989 treatment entry notes that the veteran complained of a cough and the loss of her voice of one day’s duration. Naval clinical documentation dated in July 1989 conveys that the veteran complained of having “laryngitis throughout the year.” A July 1990 treatment record notes that the veteran complained of laryngitis. On examination, the veteran’s throat was mildly inflamed. An impression of probable viral pharyngitis/laryngitis was advanced. A February 1991 treatment entry relates that the veteran complained of “several months’ worth of recurrent laryngitis” which was not always associated with an infectious process. An impression of probable laryngitis secondary to an upper respiratory infection and an allergy was advanced. A September 1991 treatment record indicates that the veteran’s tonsils were found to be red. Impressions of laryngitis and an upper respiratory infection were advanced. At her November 1992 physical examination for service separation, the veteran exhibited no throat abnormalities. At a June 1993 VA examination for compensation purposes, the veteran complained of recurrent laryngitis of approximately five years’ duration. On examination, the veteran exhibited no throat abnormalities. At the June 1995 hearing on appeal, the veteran stated that she was diagnosed with laryngitis during active service and was treated with antibiotics and “total voice rest.” The clinical documentation of record conveys that the veteran was treated for laryngitis during active service. The report of the June 1993 VA examination for compensation purposes identified no current throat abnormalities. In addition, the separation examination was normal. In the absence of evidence of current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet.App. 223, 225 (1992). As the record lacks competent evidence establishing that the veteran currently exhibits chronic laryngitis, the Board concludes that the veteran’s claim for service connection is not well-grounded. Accordingly, the instant claim is denied. 38 U.S.C.A. § 5107 (West 1991). The veteran is informed that if she is able to produce competent evidence that she currently has the claimed disability, she should petition to reopen her claim. The Board acknowledges that it has decided the current appeal on a different basis than did the RO. When the Board addresses in a decision a question that has not been addressed by the RO, it must be considered whether the veteran has been given adequate notice and opportunity to respond and, if not, whether she will be prejudiced thereby. See Bernard v. Brown, 4 Vet.App. 384 (1993). The Board concludes that she has not been prejudiced by the decision herein. The veteran was denied by the RO. The Board considered the same law and regulations. The Board merely concludes that the veteran did not meet the initial threshold evidentiary requirements for a well-grounded claim. The result is the same. See Meyer v. Brown, 9 Vet. App. 425 (1996). B. Sinus Disorder At a July 1987 naval physical examination for occupational exposure to ionizing radiation, the veteran checked the box indicating that she had previously had sinusitis. She clarified that she had “a history of sinus allergies.” On examination, the veteran exhibited no sinusal abnormalities. At a January 1988 physical examination for extension, the veteran reported a history of chronic sinusitis with “no know allergies.” On examination, the veteran exhibited no sinusal abnormalities. A July 1988 treatment entry states that the veteran complained of a mild headache, nausea, and a fever. On examination, the veteran exhibited tenderness over the right maxillary area. Contemporaneous X-ray studies of the sinuses were reported to reveal no abnormalities. Impressions of gastroenteritis and a viral syndrome were advanced. A February 1992 treatment record notes that the veteran complained of headaches with associated sinus tenderness. On examination, the veteran exhibited no sinus tenderness and was diagnosed with a viral upper respiratory infection with sinus headaches. At her November 1992 physical examination for service separation, the veteran checked the box indicating that she had previously had sinusitis. She clarified that she had sinus headaches. On examination, the veteran exhibited no sinusal abnormalities. At the June 1993 VA examination for compensation purposes, the veteran presented a history of sinusitis. The VA examiner observed no sinusal abnormalities. Contemporaneous X-ray studies of the sinuses noted that the veteran’s frontal sinus was not developed. No other sinusal abnormalities were identified. At the hearing on appeal, the veteran testified that she was diagnosed with and treated for sinusitis during active service. She stated that she had self-medicated her sinusitis following service separation. The clinical documentation of record conveys that the veteran was treated for right maxillary tenderness associated with a viral infection and sinus headaches during active service. Service connection has been established for a chronic headache disorder. The report of the June 1993 VA examination for compensation purposes identified no chronic acquired sinusal abnormalities. In the absence of evidence of current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet.App. 223, 225 (1992). As the record lacks competent evidence establishing that the veteran currently exhibits a chronic sinus disorder, the Board concludes that the veteran’s claim for service connection is not well-grounded. Accordingly, the instant claim is denied. 38 U.S.C.A. § 5107 (West 1991). The veteran is informed that if she is able to produce competent evidence that she currently has the claimed disability, she should petition to reopen her claim. The Board acknowledges that it has decided the current appeal on a different basis than did the RO. When the Board addresses in a decision a question that has not been addressed by the RO, it must be considered whether the veteran has been given adequate notice and opportunity to respond and, if not, whether she will be prejudiced thereby. See Bernard v. Brown, 4 Vet.App. 384 (1993). The Board concludes that she has not been prejudiced by the decision herein. The veteran was denied by the RO. The Board considered the same law and regulations. The Board merely concludes that the veteran did not meet the initial threshold evidentiary requirements for a well-grounded claim. The result is the same. See Meyer v. Brown, 9 Vet. App. 425 (1996). C. Back Disorder An October 1987 naval treatment record states that the veteran complained of gradually progressive non-radiating left buttock pain after “slamming on [the] brakes.” She gave a history of back pain. The veteran exhibited a full range of motion of the back without pain. An impression of muscle strain was advanced. At her November 1992 physical examination for service separation, the veteran complained of recurrent back pain. She reported that her back had been “manipulated” by a naval doctor.” On examination, the naval examiner identified no spinal or other musculoskeletal abnormalities. At the June 1993 VA examination for compensation purposes, the veteran complained of low back pain associated with lifting. She reported that she experienced low back pain “since the late 1980’s” and denied any trauma. On examination, the veteran exhibited “some exaggeration of the normal lordotic curve;” a range of motion of the lumbar spine of forward flexion to 90 degrees, extension to 45 degrees, “right and left tilt” to 35 degrees, and bilateral rotation to 90 degrees; and “normal functional effects.” Contemporaneous X-ray studies of the lumbosacral spine revealed no abnormalities. A February 1995 VA treatment record conveys that the veteran used Extra-Strength Motrin for back pain. At the hearing on appeal, the veteran stated that she was an emergency medical technician during active service and was required to lift people into ambulances. She testified that she was unaware of a specific incident which precipitated her current back complaints. The veteran clarified that her complaints were focused in her upper middle back and were treated once during active service. She related that she self-treated her back complaints with Motrin and massage following service separation. In her March 1997 Written Brief Presentation, the national accredited representative advanced that service connection was “thoroughly warranted” for back strain given the veteran’s strenuous inservice duties as an emergency medical technician. The clinical documentation of record conveys that the veteran was treated for low back muscle strain during active service. The report of the June 1993 VA examination for compensation purposes identified no current spinal or other musculoskeletal abnormalities. In the absence of evidence of current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet.App. 223, 225 (1992). As the record lacks competent evidence establishing that the veteran currently exhibits a chronic back disorder, the Board concludes that the veteran’s claim for service connection is not well-grounded. Accordingly, the instant claim is denied. 38 U.S.C.A. § 5107 (West 1991). The veteran is informed that if she is able to produce competent evidence that she currently has the claimed disability, she should petition to reopen her claim. The Board acknowledges that it has decided the current appeal on a different basis than did the RO. When the Board addresses in a decision a question that has not been addressed by the RO, it must be considered whether the veteran has been given adequate notice and opportunity to respond and, if not, whether she will be prejudiced thereby. See Bernard v. Brown, 4 Vet.App. 384 (1993). The Board concludes that she has not been prejudiced by the decision herein. The veteran was denied by the RO. The Board considered the same law and regulations. The Board merely concludes that the veteran did not meet the initial threshold evidentiary requirements for a well-grounded claim. The result is the same. See Meyer v. Brown, 9 Vet. App. 425 (1996). D. Bilateral Shoulder Disorder At her November 1992 physical examination for service separation, the veteran complained of recurrent shoulder pain. On examination, the veteran exhibited no upper extremity abnormalities. At the June 1993 VA examination for compensation purposes, the veteran complained of bilateral shoulder aching of one and one-half years’ duration. The VA examiner reported a full range of motion of the shoulders and “normal functional effects.” Contemporaneous X-ray studies of the shoulders revealed no abnormalities. At the hearing on appeal, the veteran testified that she experienced shoulder pain during active service associated with lifting patients. She stated that she had experienced monthly shoulder pain following service separation which she self-treated. She clarified that many of her inservice complaints were not documented in her service medical records as she would informally seek medical treatment from her medical co-workers. In her March 1997 Written Brief Presentation, the national accredited representative advanced that service connection was “thoroughly warranted” for shoulder given the repetitive motion associated with the veteran’s strenuous inservice duties as an emergency medical technician. The Board observes that a bilateral shoulder disorder was not objectively shown during active service or at any time thereafter. In the absence of evidence of current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet.App. 223, 225 (1992). As the record lacks competent evidence establishing that the veteran has ever been diagnosed with the claimed disorder, the Board concludes that her claim for service connection is not well-grounded. Accordingly, the instant claim is denied. 38 U.S.C.A. § 5107 (West 1991). The veteran is informed that if she is able to produce competent evidence that she currently has the claimed disability, she should petition to reopen her claim. The Board acknowledges that it has decided the current appeal on a different basis than did the RO. When the Board addresses in a decision a question that has not been addressed by the RO, it must be considered whether the veteran has been given adequate notice and opportunity to respond and, if not, whether she will be prejudiced thereby. See Bernard v. Brown, 4 Vet.App. 384 (1993). The Board concludes that she has not been prejudiced by the decision herein. The veteran was denied by the RO. The Board considered the same law and regulations. The Board merely concludes that the veteran did not meet the initial threshold evidentiary requirements for a well-grounded claim. The result is the same. See Meyer v. Brown, 9 Vet. App. 425 (1996). E. Bilateral Hand Disorder Naval clinical documentation dated in July 1983 relates that the veteran had a wart on her right thumb which was removed with liquid nitrogen. Treatment records dated in October 1983 show that the veteran was treated for an accidental right middle finger “needle stick.” Treating naval medical personnel observed that the veteran’s wound was well-healed. Treatment entries dated in November 1983 and February 1984 note that the veteran was treated for additional accidental finger “needle sticks.” The veteran’s puncture wounds were found to be clean and dry. An April 1984 treatment record relates that the veteran had a verruca (wart) on her left thumb which was removed with liquid nitrogen. A May 1985 treatment records states that the veteran sustained a superficial laceration to the medial aspect of her left fifth finger. The veteran’s wound was cleaned and dressed. A November 1989 treatment record indicates that the veteran complained of left hand pain associated with gripping and reduced left hand grip strength. She reported that her left hand had been crushed between a cart and a wall during the previous night. A contemporaneous X-ray study of the left hand revealed no significant abnormalities. An impression of a left hand contusion/mild tendonitis was advanced. The veteran’s left hand was placed in a volar splint. An undated treatment record states that the veteran sustained a right middle finger accidental “needle stick” with questionable penetration of the epidermis. At her November 1992 physical examination for service separation, the veteran complained of “swollen or painful” joints in her hands. On examination, the veteran exhibited no upper extremity abnormalities. In her May 1993 Veteran’s Application for Compensation or Pension (VA Form 21-526), the veteran advanced that she had experienced bilateral hand joint pain and swelling during active service between 1988 and 1990. At the June 1993 VA examination for compensation purposes, the veteran complained of bilateral thumb and index finger proximal and distal interphalangeal joint pain and swelling. The VA examiner commented that “there is no objective evidence of swelling of any joint of either hand. Contemporaneous X-ray studies of the fingers showed no abnormalities. At the hearing on appeal, the veteran testified that she had injured her left hand during active service when it was caught between a cart and a wall in 1989 and was subsequently diagnosed with tendonitis. She stated that she still experienced left hand pain for which she took Motrin. She clarified that many of her inservice complaints were not documented in her service medical records as she would informally seek medical treatment from her medical co-workers. In her March 1997 Written Brief Presentation, the national accredited representative advanced that service connection was “thoroughly warranted” for a bilateral hand disorder given the repetitive motion associated with the veteran’s strenuous inservice duties as an emergency medical technician. The clinical documentation of record conveys that the veteran was treated for warts on both thumbs, multiple accidental “finger sticks,” a left fifth finger laceration, and a left hand contusion/tendonitis. The report of the veteran’s physical examination for service separation and the June 1993 VA examination for compensation purposes identified no current hand abnormalities. In the absence of evidence of current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet.App. 223, 225 (1992). As the record lacks competent evidence establishing that the veteran currently exhibits a chronic bilateral hand disorder, the Board concludes that the veteran’s claim for service connection is not well-grounded. Accordingly, the instant claim is denied. 38 U.S.C.A. § 5107 (West 1991). The veteran is informed that if she is able to produce competent evidence that she currently has the claimed disability, she should petition to reopen her claim. The Board acknowledges that it has decided the current appeal on a different basis than did the RO. When the Board addresses in a decision a question that has not been addressed by the RO, it must be considered whether the veteran has been given adequate notice and opportunity to respond and, if not, whether she will be prejudiced thereby. See Bernard v. Brown, 4 Vet.App. 384 (1993). The Board concludes that she has not been prejudiced by the decision herein. The veteran was denied by the RO. The Board considered the same law and regulations. The Board merely concludes that the veteran did not meet the initial threshold evidentiary requirements for a well-grounded claim. The result is the same. See Meyer v. Brown, 9 Vet. App. 425 (1996). F. Bilateral Foot Disorder A January 1984 naval treatment record reflects that the veteran complained of right great toenail discomfort of two to three days’ duration. She presented a history of prior ingrown toenails. An impression of an ingrown right great toenail was advanced. A March 1984 treatment entry states that the veteran complained of a red and inflamed area on the right great toe. She denied having any toe pain or tenderness. Treating naval medical personnel observed erythema and a white discoloration of the skin on the tip of the right great toe and no pain, tenderness, or peeling skin. An impression of a probable right great toe soft tissue injury was advanced. An April 1984 dermatological evaluation conveys that the veteran exhibited a plantar corn and a left foot ingrown toenail. Naval clinical documentation dated in April and May 1984 indicates that the veteran stepped on a piece of glass and sustained a superficial laceration to the plantar aspect of the left foot. A September 1986 treatment entry reports that the veteran had an ingrown right great toenail. A November 1986 treatment record conveys that the veteran was being treated for bilateral ingrown great toenails. An August 1988 naval podiatric evaluation states that the veteran complained of persistent left distal foot pain which was not relieved by a change of shoes or padding of one and one-half months’ duration. On examination, the veteran exhibited palpable discomfort in the left first interspace region with radiating pain along the medial border of the second toe. An impression of left foot first interspace “neuroma-like symptoms” was advanced. A September 1988 X-ray study of the left foot revealed no significant abnormalities. At her November 1992 physical examination for service separation, the veteran complained of bilateral foot “trouble.” She reported that she was treated for “trapped nerves” by naval medical personnel. On examination, the naval examiner identified no foot abnormalities. In her May 1993 Veteran’s Application for Compensation or Pension (VA Form 21-526), the veteran advanced that she had experienced recurrent foot cyst/plantar warts during active service between 1985 and 1991. At the June 1993 VA examination for compensation purposes, the veteran complained of recurrent plantar warts. She clarified that her prior “cysts” were actually plantar warts. The VA examiner identified no active plantar warts. Contemporaneous X-ray studies of the left foot revealed a hallux valgus deformity. A February 1995 VA treatment record notes that the veteran was issued shoe inserts to alleviate left foot pain associated with a possible neuroma. At the hearing on appeal, the veteran testified that she was diagnosed with plantar warts during active service which were treated and resolved. She clarified that her plantar warts had not reoccurred. She advanced that she also developed bilateral plantar calluses during active service; was instructed by naval medical personnel on how to self-treat the calluses; and had successfully treated her calluses following service separation. The veteran stated that she had received shoe inserts from the VA. In her March 1997 Written Brief Presentation, the national accredited representative advanced that service connection was “thoroughly warranted” for recurrent plantar warts given the disability reoccurs after the veteran has been on her feet for extended periods of time. The clinical documentation of record conveys that the veteran was treated for bilateral ingrown toenails, a plantar corn, and a left foot laceration during active service. The veteran’s physical examination for service separation and the June 1993 VA examination for compensation purposes identified no chronic residuals of the veteran’s inservice foot complaints. The veteran has acknowledged on appeal that she has not experienced a reoccurrence of her inservice plantar warts. The veteran’s current left foot hallux valgus deformity was first identified by a post-service evaluation. Indeed, the veteran’s claim is supported solely by the accredited representative’s statements and the veteran’s own testimony and statements on appeal. The Court has held that lay assertions of medical causation do not constitute competent evidence to render a claim well-grounded. Grottveit v. Brown, 5 Vet.App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992). The Court has commented that: Just as the BVA must point to a medical basis other than its own unsubstantiated opinion (Colvin [v. Derwinski, 1 Vet.App. 171, 175 (1991)]), the veteran cannot meet his initial burden by relying upon his own, or his representative’s, opinions as to medical matters. Robinette v. Brown, 8 Vet.App. 69, 74 (1995) citing Moray v. Brown, 5 Vet.App. 211, 214 (1993). Further, the Court has clarified that statements as to what the veteran may have been told by a physician during or after service, standing alone, are insufficient to establish a medical diagnosis. Warren v. Brown, 6 Vet.App. 4, 6 (1993). As the record lacks competent evidence establishing that a chronic foot disorder was incurred in or was aggravated by active service, the Board concludes that the veteran’s claim for service connection is not well-grounded. Accordingly, the instant claim is denied. 38 U.S.C.A. § 7105(d) (West 1991). The veteran is informed that if she is able to produce competent evidence attributing the onset of the claimed disorder to active service to reopen her claim. The Board acknowledges that it has decided the current appeal on a different basis than did the RO. When the Board addresses in a decision a question that has not been addressed by the RO, it must be considered whether the veteran has been given adequate notice and opportunity to respond and, if not, whether she will be prejudiced thereby. See Bernard v. Brown, 4 Vet.App. 384 (1993). The Board concludes that she has not been prejudiced by the decision herein. The veteran was denied by the RO. The Board considered the same law and regulations. The Board merely concludes that the veteran did not meet the initial threshold evidentiary requirements for a well-grounded claim. The result is the same. See Meyer v. Brown, 9 Vet. App. 425 (1996). G. Dermatophytosis of the Feet The veteran’s service medical records make no reference to dermatophytosis of the feet. At her November 1992 physical examination for service separation, the veteran neither complained of nor exhibited dermatophytosis of the feet or other skin abnormalities. At the June 1993 VA examination for compensation purposes, the veteran exhibited mild dermatophytosis between her toes. At the hearing on appeal, the veteran testified that she had dermatophytosis which she treated with powders. The Board observes that dermatophytosis of the feet was not objectively shown during active service. The first clinical documentation of the claimed disorder is the report of the June 1993 VA examination for compensation purposes. Indeed, the veteran’s claim is supported solely by the accredited representative’s statements and the veteran’s own testimony and statements on appeal. Such lay statements do not constitute competent evidence to render the veteran’s claim well-grounded. Grottveit v. Brown, 5 Vet.App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992). Statements as to what the veteran may have been told by a physician during or after service, standing alone, are insufficient to establish a medical diagnosis. Warren v. Brown, 6 Vet.App. 4, 6 (1993). As the record lacks competent evidence establishing that dermatophytosis of the feet was incurred in or aggravated by active service, the Board concludes that the veteran’s claim for service connection is not well-grounded. The veteran is informed that if she is able to produce competent evidence attributing the onset of the claimed disorder to active service to reopen her claim. The Board acknowledges that it has decided the current appeal on a different basis than did the RO. When the Board addresses in a decision a question that has not been addressed by the RO, it must be considered whether the veteran has been given adequate notice and opportunity to respond and, if not, whether she will be prejudiced thereby. See Bernard v. Brown, 4 Vet.App. 384 (1993). The Board concludes that she has not been prejudiced by the decision herein. The veteran was denied by the RO. The Board considered the same law and regulations. The Board merely concludes that the veteran did not meet the initial threshold evidentiary requirements for a well-grounded claim. The result is the same. See Meyer v. Brown, 9 Vet. App. 425 (1996). II. Increased Disability Evaluation A review of the record indicates that the veteran's claim for an increased disability evaluation is plausible and that all relevant facts have been properly developed. The veteran’s service medical records indicate that she was diagnosed with a headache disorder variously characterized as migraine headaches, muscle tension headaches, and stress headaches. In August 1993, the RO established service connection for headaches and assigned a noncompensable evaluation for that disability. In October 1995, the RO increased the evaluation for the veteran’s headaches from noncompensable to 10 percent. Disability evaluations are determined by comparing the veteran's current symptomatology with the criteria set forth in the Schedule For Rating Disabilities. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1996). The rating schedule does not specifically address headaches. In such situations, it is permissible to evaluate the veteran's service-connected disorder under provisions of the schedule which pertain to a closely-related disease or injury which is analogous in terms of the function affected, anatomical localization and symptomatology. 38 C.F.R. § 4.20 (1996). The Board finds that the veteran's service-connected headache disorder is most closely analogous to migraines. A 10 percent disability evaluation is warranted for migraines with characteristic prostrating attacks averaging one every two months over the last several months. A 30 percent evaluation requires characteristic prostrating attacks occurring on an average of once a month over the last several months. 38 C.F.R. Part 4, Diagnostic Code 8100 (1996). At the June 1993 VA examination for compensation purposes, the veteran complained of bilateral headaches. She stated that her headaches were brought on by bright lights and/or stress; were relieved by Fiorinal; could last up to two days; and occurred at intervals of between one week and six months. VA clinical documentation dated between June 1993 and February 1995 indicates that the veteran was prescribed Fiorinal for chronic headaches. At the hearing on appeal, the veteran testified that she did not have headaches “real frequently.” She related that she had a severe headache “about every six months.” The veteran stated that she last had a headache two months prior to the hearing. The headache necessitated that she leave work for the day. The Board has reviewed the probative evidence of record including the veteran’s testimony and statements on appeal. The veteran has related that she experienced severe headaches with characteristic prostrating attacks approximately once every six months. In the absence of evidence establishing that the veteran’s headaches occur on an average of once a month over the last several months, the Board concludes that the current 10 percent evaluation adequately reflects the current disability picture associated with the veteran’s headaches. Representative statement The Board has also considered the contention that the case should be remanded on the ground that VA has extended the duty to assist to claims that are not well grounded. In support of that argument, the veteran refers to VA ADJUDICATION PROCEDURE MANUAL M21-1 (M21-1). She argues that, to the extent the relevant provisions in M21-1 have limited administrative action, those provisions are the equivalent of VA regulations and are applicable to this claim. See Hayes v. Brown, 5 Vet.App. 60, 67 (1993); Fugere v. Derwinski, 1 Vet.App. 103, 107 (1990). First, the Board notes that it is bound by the applicable statutes and regulations pertaining to VA and precedential opinions of the Office of the General Counsel of VA. 38 C.F.R. § 19.5 (1995). However, the Board is specifically not bound by VA manuals, circulars, or other administrative issues. Ibid. Moreover, the cited provisions of M21-1 have not been promulgated pursuant to the regulatory requirements of 38 C.F.R. § 1.12 (1995). See also 61 Fed. Reg. 11309 (1996) (deleting 38 C.F.R. § 1.551 (1995)). Second, the cited provisions of M21-1 that require full development of a claim during the pendency of a determination on the threshold issue of well-groundedness do not stand for the proposition that the duty to assist extends to claims that are not well grounded. Third, the veteran’s arguments are moot because VA has complied with any policy implicit or explicit in M21-1 regarding development of non-well-grounded claims by attempting to obtain the evidence relied upon by the veteran and by informing him of the evidence needed. VA examined the veteran. Additionally, as noted above, the RO has sought to obtain records of all possible records. The Board finds that the RO’s development of the evidence in this case was as full and thorough as possible, under the circumstances, and that the RO has sought all available avenues of obtaining evidence on the veteran’s behalf. The representative also cited to certain cases and opined that the veteran’s complaints could be due to a variety of causes. The representatives attempt to attribute complaints to various diseases or injuries constitutes wild speculation. No competent evidence was submitted. In regard to the case citations, the references are misplaced. In the absence of underlying disease or injury productive of disability there can be no valid claim for service connection. The Board has found no case law that supports the argument that service connection may be granted for a mere complaint of pain unsupported by adequate pathology. ORDER Service connection for chronic laryngitis is denied. Service connection for a chronic acquired sinus disorder to include sinusitis is denied. Service connection for a chronic back disorder to include muscle strain is denied. Service connection for a bilateral shoulder disorder is denied. Service connection for a chronic bilateral hand disorder to include joint pain is denied. Service connection for a chronic bilateral foot disorder to include recurrent cysts and plantar warts is denied. Service connection for dermatophytosis of the feet is denied. An increased evaluation for headaches is denied. REMAND The veteran asserts that service connection is warranted for a chronic pulmonary disorder to include bronchitis and asthma as the claimed disability was incurred during active service. In reviewing the claims file, the Board observes that the veteran was diagnosed with bronchitis and exercise-induced asthma during active service and treated with medication including a Proventil inhaler. At the June 1993 VA examination for compensation purposes, the veteran reported that she became short of breath following exertion such as climbing one flight of stairs. On examination, the veteran was found to be “quite obese” and to exhibit no respiratory abnormalities. A contemporaneous chest X-ray study revealed no abnormalities. The veteran was diagnosed with a “[history] of ‘asthma,’ exertion-related.” A June 1994 VA treatment record reflects that the veteran’s medications included a “Proventil inhaler p.r.n. [as necessary] asthma.” At the June 1995 hearing on appeal, the veteran testified that she was diagnosed with exercise-induced asthma during active service; was prescribed an inhaler and other medications by naval medical personnel; and had essentially not used her inhaler following service separation as she did not exercise. As the clinical documentation is unclear as to whether the veteran currently has chronic asthma, the Board finds that additional VA evaluation would be helpful in resolving the issues raised by the instant appeal. This case is REMANDED for the following action: 1. The RO should schedule the veteran for a VA examination which is sufficiently broad enough to accurately determine the current nature and severity of her alleged chronic pulmonary disorder to include bronchitis and asthma. All indicated tests and studies should be accomplished and the findings reported in detail. The examiner should express an opinion as to the etiology of all identified chronic pulmonary disorders and their relationship, if any, to her inservice pulmonary complaints. The claims files, including a copy of this REMAND, should be made available to the examiner. The examination report should reflect that such a review was conducted. 2. In representing the VA before the Court, the General Counsel of the VA has noted that the RO has duties. Pursuant to 38 C.F.R. § 3.655 (1996), when the veteran without good cause fails to report for examination, her claim for service connection will be decided upon the evidence of record. However, the Secretary of the VA must show a lack of good cause for failing to report. Further, the VA has a duty to fully inform the veteran of the consequences of the failure to undergo the scheduled examination. The RO must comply with all notification requirements regarding the duty to report and the failure to report for examination. 3. The veteran’s claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board or the Court for additional development or other appropriate action must be handled in an expeditious manner. See the Veterans’ Benefits Improvement Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994) and 38 U.S.C.A. § 5101 (West 1991 and Supp. 1997) (Historical and Statutory Notes). In addition, the Veterans Benefits Administration’s ADJUDICATION PROCEDURE MANUAL, M21-1, Part IV, directs the RO is 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. When the requested action has been completed the RO should issue a supplemental statement of the case. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration if appropriate. The purpose of this REMAND is to allow for further development of the record. No inference should be drawn from it regarding the final disposition of the veteran's claim. H. N. SCHWARTZ Member, Board of Veterans' Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 and West Supp. 1997), a decision of the Board granting less than the complete benefit, or benefits, sought on appeal is appealable to the Court 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 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. 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 -