Citation NR: 9801655 Decision Date: 01/22/98 Archive Date: 02/02/98 DOCKET NO. 95-27 301 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for arteriosclerotic heart disease. 2. Entitlement to service connection for arthritis of the hands. 3. Entitlement to an increased rating for post-operative duodenal ulcer, currently evaluated as 10 percent disabling. 4. Entitlement to an increased (compensable) rating for a scar of the web space of the left hand between the thumb and index finger. 5. Entitlement to an increased (compensable) rating for a scar of the right lower leg. 6. Entitlement to a temporary total rating for hospitalization in November 1993. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD J. L. Prichard, Counsel INTRODUCTION The veteran had active service from August 1950 to August 1953, and from December 1956 to June 1957. In his August 1995 Substantive Appeal, the veteran requested a hearing before the Board of Veterans’ Appeals (Board) to be conducted at the regional office (RO). He requested that his hearing be rescheduled in September 1997. Additional September 1997 correspondence indicated that the veteran wished to withdraw his request for a hearing. Therefore, the Board will proceed with review of the veteran’s claims. The RO’ rating decision in August 1994 included a denial of entitlement to special monthly pension by reason of being in need of regular aid and attendance or on account of being housebound. The veteran filed a notice of disagreement with this determination in July 1995. The August 1995 statement of the case did not include this issue. The RO affirmed the prior denial of entitlement to special monthly pension when it issued a rating decision in September 1996. The September 1997 supplemental statement of the case was silent for this issue. The service representative at the RO included this issue in his May 1997 statement on behalf of the veteran. Since this issue has been neither procedurally prepared nor certified for appellate review, the Board is referring it to the RO for appropriate action. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he has developed arteriosclerotic heart disease and arthritis of the hands as a result of active service. In the alternative, he contends that these disorders have developed secondary to service connected disorders. He argues that his arteriosclerotic heart disease is the result of service-connected peptic ulcer disease, and that his arthritis of the hands is the result of a service- connected scar of the left hand. The veteran further contends that the evaluations for his service connected duodenal ulcer disease, scar of the left hand, and scar of the right lower leg are inadequate to reflect their current level of severity. Finally, the veteran contends that he is entitled to a temporary total hospitalization due to hospitalization for service connected disorders. 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 presented evidence of well grounded claims for entitlement to service connection for arteriosclerotic heart disease or for arthritis of the hands. It is the decision of the Board that the preponderance of the evidence is against the claims of entitlement to increased evaluations for post-operative duodenal ulcer disease, a scar of the left hand, and a scar of the lower right leg It is the decision of the Board that the preponderance of the evidence is against the claim of entitlement to a temporary total rating for hospitalization in November 1993. FINDINGS OF FACT 1. The claim for service connection for arteriosclerotic heart disease is not supported by cognizable evidence showing that the claim is plausible or capable of substantiation. 2. The claim for service connection for arthritis of the hands is not supported by cognizable evidence showing that the claim is plausible or capable of substantiation. 3. The veteran’s post-operative duodenal ulcer is not productive of greater than mild symptomatology. 4. The veteran’s scar of the left hand does not result in impairment of function of the hand, and is not tender, painful, poorly nourished, or ulcerating. 5. The veteran’s scar of the right lower leg does not result in impairment of function of the right leg, and is not tender, painful, poorly nourished, or ulcerating. 6. The veteran was hospitalized at a Department of Veterans Affairs (VA) facility from November 9, 1993 to November 17, 1993, primarily for treatment of a possible myocardial infarction (MI) and a heart disorder. CONCLUSIONS OF LAW 1. The claim for entitlement to service connection for arteriosclerotic heart disease is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 2. The claim for entitlement to service connection for arthritis of the hands is not well grounded. 38 U.S.C.A. § 5107. 3. The criteria for an evaluation greater than 10 percent for a post-operative duodenal ulcer have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.114, Diagnostic Code 7305 (1996). 4. The criteria for a compensable evaluation for a scar of the web space of the hand between the thumb and the index finger have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.31, 4.118, Diagnostic Codes 7803, 7804, 7805 (1996). 5. The criteria for a compensable evaluation for a scar of the right lower leg have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.31, 4.118, Diagnostic Codes 7803, 7804, 7805 (1996). 6. The criteria for a temporary total rating for hospitalization in November 1993 have not been met. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. § 4.29 (1996). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Entitlement to service connection for arteriosclerotic heart disease and arthritis of the hands. Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131. If arthritis, arteriosclerosis, and cardiovascular-renal disease, including hypertension, become manifest to a degree of 10 percent within one year of separation from active service, then they are presumed to have been incurred during active service, even though there is no evidence of these disorders during service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310(a). A person who submits a claim for benefits under a law administered by the Secretary 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 well grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. The claim does not need to be conclusive, but only possible in order to be well grounded. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The appellant has the burden of submitting evidence to show that the claim is plausible. Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). In order for there to be a well grounded claim for service connection, there must be evidence of incurrence or aggravation of a disease or injury during service, competent evidence that the veteran currently has the claimed disability, and evidence of a nexus between the inservice disease or injury and the current disability. Caluza v. Brown, 7 Vet. App. 498 (1995); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Factual Background A review of the service medical records from the veteran’s first period of active service reveals that he was seen for complaints of chest pain in September 1950. The pain was located around the heart and the top of the scapula. On examination, the chest was clear, and the heart sounds were normal. The veteran was also noted to have recently experienced some polyarthritis, but no specific type of joint involvement was seen. Additional September 1950 records show that the veteran continued to be seen for chest pains. He had a history of pain dating from 1948. He experienced pain and pressure around the heart and in the left chest area. The pain was aggravated by work, and relieved by rest. The veteran was said to have lived his entire life in pain, and to have a history of nervousness. The examiner noted that the veteran was sick all of the time, and had already been seen on ten occasions since entering active service. The impression was severe somatization reaction. The veteran was afforded an X-ray study of the chest in October 1950. The study revealed that his heart was normal. The remainder of the veteran’s service medical records for this period are entirely negative for complaints of chest pains or polyarthritis. February 1953 records show that the veteran sustained a laceration of the palm of his left hand, but are negative for an injury to the joints of this hand. The July 1953 separation examination indicated that the veteran’s heart and musculoskeletal system were normal. The service medical records for the veteran’s second period of active service indicate that the December 1956 entrance examination was negative for a heart disorder or for arthritis of the hands. A medical history obtained at that time was also negative. However, March 1957 records reveal that the veteran had experienced an attack of the heart, in which he experienced fluttering for about three minutes, with associated dizziness. He had not experienced any previous attacks. An examination was negative for a chronic heart disorder. The impression was probable paroxysmal atrial tachycardia. A medical history was obtained in May 1957 prior to the veteran’s discharge from his second period of active service. He answered “no” to a history of “pain or pressure in chest”, and for a history of “palpitation or pounding heart”. He also answered “no” to a history of arthritis. The May 1957 discharge examination stated that the veteran experienced shortness of breath after exercise, with no complications. The cardiovascular examination was normal. A chest X-ray study was also normal. The diagnoses included arthritis of the left shoulder. March 1965 VA hospital records show that the veteran was treated for chronic ulcer disease. The hospital report was negative for arteriosclerotic heart disease, and included a normal chest X-ray study. The post-service medical records include the report of a VA examination conducted in December 1970. This examination was negative for arteriosclerotic heart disease. The diagnoses included cervical arthritis, and arthritis of the left shoulder. A scar of the web-space of the left hand between the thumb and index finger was noted. However, the examination was negative for arthritis of the hands. A December 1970 chest X-ray study noted that the heart shadow was normal. VA hospital records from March 1971 to April 1971 show that the veteran was seen for complaints of severe right foot pain for two or three weeks associated with numbness, tingling, and edema. An electrocardiogram (EKG) showed normal sinus rhythm with left axis deviation. The chest was within normal limits. Due to the unusual nature of the veteran’s complaints, he underwent examination by several services. A cardiology examination was scheduled to rule out questionable involvement to the right leg, and concluded that the veteran had possible arthritis and some other embolic phenomenon. A rheumatology examination found that there was no indication of arthritis. Further testing revealed occlusion of the right distal posterior popliteal tibial and common peroneal arteries. The diagnoses included arteriosclerotic occlusive disease of the right lower extremity, as well as postoperative bilateral vagotomy and pyloroplasty. A VA examination conducted in June 1971 included a diagnosis of postoperative scar due to bilateral vagotomy for chronic duodenal ulcer disease, with mild residual disability. Arteriosclerotic heart disease was not noted. The veteran was admitted to a VA hospital in April 1978 for treatment of reflux esophagitis. A chest X-ray study revealed a normal heart, and an EKG showed axis minus 30 degrees, rate 60, with no acute changes. VA hospital records dated from April 1990 to May 1990 state that the veteran had a long history of epigastric discomfort, and was admitted for chest pain. He had experienced a myocardial infarction (MI) about 10 years previously, but was not hospitalized. He had also experienced recurrent epigastric pain. An EKG revealed left anterior hemiblock. An MI was ruled out. A cardiology opinion stated that the findings represented new onset unstable angina. Catheterization was recommended as soon as possible. An exercise echo study revealed mild biatrial enlargement, with grossly normal left ventricle wall motion at rest, structurally normal valves, and no effusion. The diagnoses included unstable angina, epigastric discomfort, and peripheral vascular disease. The hospital records did not include an opinion relating the veteran’s unstable angina to active service or to his peptic ulcer disease. VA treatment records dated from 1990 to January 1994 are of record. These records show treatment for various complaints, including a heart disorder and peptic ulcer disorder. January 1992 records show that the veteran’s history included multiple MI’s and coronary artery disease. February 1992 records show complaints of chest pain. April 1992 records include a diagnosis of atherosclerotic coronary artery disease. April 1993 records include diagnoses of coronary artery disease and peptic ulcer disease. November 1993 hospital records show that the veteran was admitted for a possible MI. These records do not contain an opinion showing a relationship between the MI or heart disease and peptic ulcer disease. Other November 1993 records reveal an abnormal EKG. December 1993 records show coronary artery disease. The veteran was hospitalized for a variety of disorders in October 1994. A coronary artery disease and a history of peptic ulcer disease was diagnosed. Arthritis of the hands was not noted. However, these records are all completely negative for any opinion relating the arteriosclerotic heart disorder to active service or to peptic ulcer disease. There is also no opinion pertaining to arthritis of the hands and a scar of the left hand. The veteran was afforded VA examinations in September 1995. Atherosclerotic heart disease was noted to have been diagnosed in 1990. He had undergone cardiac catheterization three or four times, and was found to have one vessel disease. The last catheterization had been performed in November 1993, and showed minimal coronary artery disease. The examiner stated that there was no documented history of MI. The diagnoses of the general examination included peptic ulcer disease and mild arteriosclerotic heart disease. A September 1995 EKG was abnormal. The examination report did not contain any opinion relating the heart disease to active service or to peptic ulcer disease. A September 1995 examination of the joints noted that the veteran had injured his left hand during service. The hand had become numb after the injury, with partial paralysis, but these symptoms had gradually resolved. On examination, a healed scar was noted. However, the diagnoses did not include arthritis of the hands. Analysis Section 5107 of Title 38, United States Code unequivocally places an initial burden upon the claimant to produce evidence that his claim is well grounded; that is, that his claim is plausible. Grivois v. Brown, 6 Vet. App. 136, 139 (1994); Grottveit v. Brown, 5 Vet. App. 91, 92 (1993). Because the veteran has failed to meet this burden, the Board finds that his claims for service connection for arteriosclerotic heart disease and arthritis of the hands are not well grounded and should be dismissed. Arteriosclerotic Heart Disease The Board is unable to find that the veteran has presented evidence of a well grounded claim for entitlement to service connection for arteriosclerotic heart disease on either a direct basis or as secondary to service-connected disorders. Current medical records indicate that the veteran is receiving treatment for arteriosclerotic heart disease, as well as other cardiovascular disorders. The service medical records show treatment for chest pain in September 1950. However, repeated examinations were completely negative for a heart disorder, and the diagnosis was severe somatization reaction. The remainder of the service medical records are completely negative for a heart disorder. Post service medical records are also negative for a heart disorder for many years after discharge from service. Finally, the current medical records do no contain a medical opinion showing a history of heart disorder during service, and do not relate the current arteriosclerotic heart disorder to active service. Without evidence of treatment during service or of a nexus between current treatment and active service, his claim for service connection on a direct basis is not well grounded. Caluza v. Brown, 7 Vet. App. 498 (1995). Moreover, the veteran has not submitted a medical opinion that relates arteriosclerotic heart disorder to his service connected duodenal ulcer disease. The treatment records are also completely negative for such an opinion. The Board notes that the veteran believes that his ulcer has resulted in his heart disorder, but he is not a physician, and he is not qualified to express a medical opinion as to such a relationship. Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). Therefore, the veteran has not submitted evidence of a plausible claim, and his claim for service connection for arteriosclerotic heart disease on a secondary basis is also not well grounded. Arthritis of the Hands The Board is also unable to find that the veteran’s claim for entitlement to service connection for arthritis of the hands is well grounded. September 1950 service medical records show that the veteran was seen for complaints of polyarthritis. However, arthritis of the hands was not noted, and the diagnosis was severe somatization disorder. Musculoskeletal examinations were negative for arthritis of the hands. Post-service medical records were also negative for arthritis of the hands. The current medical records continue to be negative for arthritis of the hands. The September 1995 VA examination noted complaints of numbness in the opponens muscle of the left hand following an injury in service. However, these symptoms resolved, and the examination was negative for arthritis. Therefore, without evidence of arthritis of the hands during service, and without evidence of a current diagnosis of arthritis of the hands, the veteran’s claim for service connection on a direct basis is not well grounded. As arthritis of the hands has not been shown to exist, the Board finds the claim that such disorder is secondary to the service-connected scar of the left hand is not a competent assertion. As the veteran has not submitted evidence to show that his claim is plausible, his claim for service connection on a secondary basis is also not well grounded. Although the Board considered and denied the appellant’s claims on a ground different from that of the RO which denied the claims on the merits, the appellant has not been prejudiced by the decision. This is because in assuming that the claims were well grounded, the RO accorded the appellant greater consideration than his claims in fact warranted under the circumstances. Bernard v. Brown, 4 Vet. App. 384 (1993). In view of the implausibility of the veteran’s claims and the failure to meet his initial burden in the adjudication process, the Board concludes that he has not been prejudiced by the decision to deny his appeal for service connection for arteriosclerotic heart disease and arthritis of the hands. The Board further finds that the RO has advised the appellant of the evidence necessary to establish a well grounded claim, and the veteran has not indicated the existence of any post service medical evidence that has not already been obtained that would well ground his claims. Epps v. Brown, 9 Vet. App. 341, 344 (1996), aff’d sub nom. Epps v. Gober, No. 97- 7014 (Fed.Cir. Oct. 7, 1997). II. Entitlement to increased evaluations for post-operative duodenal ulcer, currently evaluated as 10 percent disabling; and for a scar of the web space of the left hand between the thumb and index finger, and a scar of the right lower leg, each evaluated as noncompensable. Duodenal ulcer Criteria Initially, the Board finds that the veteran’s claim for an increased evaluation for post-operative duodenal ulcer is “well-grounded” within the meaning of 38 U.S.C.A. § 5107(a); that is, a plausible claim has been presented. Murphy v. Derwinski, 1 Vet. App. 78 (1990). An allegation of increased disability is sufficient to establish a well-grounded claim seeking an increased rating. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The Board is also satisfied that all relevant facts have been properly developed to their full extent and that VA has met its duty to assist. White v. Derwinski, 1 Vet. App. 519 (1991); Godwin v. Derwinski, 1 Vet. App. 419 (1991). The evaluation of service-connected disabilities is based on the average impairment of earning capacity they produce, as determined by considering current symptomatology in the light of appropriate rating criteria. 38 U.S.C.A. § 1155. Consideration is given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they are raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In addition, the entire history of the veteran's disability is also considered. Consideration must be given to the ability of the veteran to function under the ordinary conditions of daily life. 38 C.F.R. § 4.10. If there is a question as to which of two evaluations should apply, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. 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. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). The veteran’s disorder is evaluated under the rating code for duodenal ulcers. A severe duodenal ulcer is manifested by symptomatology including pain that is only partially relieved by standard ulcer therapy, with periodic vomiting, recurrent hematemesis or melena, and with manifestations of anemia and weight loss productive of definite impairment of health, and is evaluated as 60 percent disabling. A moderately severe duodenal ulcer is manifested by symptomatology that is less than severe, but with impairment of health manifested by anemia and weight loss, or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year, and is evaluated as 40 percent disabling. A moderate duodenal ulcer has recurring episodes of severe symptoms two or three times a year averaging 10 days in duration, or with continuous moderate manifestations, and merits a 20 percent evaluation. A mild duodenal ulcer with recurring symptoms once or twice a year merits a continuation of the 10 percent evaluation currently in effect. 38 C.F.R. § 4.114, Code 7305. Minor weight loss or greater loss of weight for periods of brief duration are not considered of importance in rating. Rather, weight loss becomes of importance where there is appreciable loss which is sustained over a period of time. In evaluating weight loss generally, consideration will be given not only to standard age, height, and weight tables, but also to the particular individual’s predominant weight pattern as reflected by the records. The use of the term “inability to gain weight” indicates that there has been a significant weight loss with inability to regain it despite appropriate therapy. 38 C.F.R. § 4.112. Factual Background The record indicates that entitlement to service connection for a duodenal ulcer was established in a February 1971 rating decision. This decision evaluated the ulcer as zero percent disabling, effective from June 1970. However, an August 1971 rating decision increased the evaluation to 10 percent, also effective from June 1970. The 10 percent evaluation currently remains in effect. The current evidence for consideration includes VA treatment records dated from July 1990. July 1990 records indicate that the veteran had a history of dumping syndrome. April 1991 records show that the veteran was afforded a gastrointestinal examination. He was noted to have chronic diarrhea, and was status post ulcer surgery in 1963. A July 1991 X-ray study was positive for gallstones. April 1992 records reveal that the veteran presented with complaints of epigastric pain. The diagnosis was probable acute cholecystitis with probable common bile duct stone. April 1993 VA treatment records show a history of peptic ulcer disease, with no new problems. VA treatment records dated in October 1993 indicate that the veteran was seen for complaints of diarrhea for two weeks. He was feeling weak, and experienced abdominal burns. This was believed to be due to his ulcers. He denied any abdominal pain or melena. He did experience nausea. January 1993 hospital records reveal that the veteran was admitted for treatment of a possible MI. The discharge diagnoses included an episode of gastrointestinal bleed. Other diagnoses included a history of peptic ulcer disease, and parasitic diarrhea. The records show that the veteran was well developed and well nourished, and treatment for ulcer disease was not shown. November 1993 VA treatment records indicate that the veteran was seen for black tarry stools. The veteran was stable, and without chest pain. Testing appeared negative for an upper gastrointestinal bleed. A November 1993 VA nutritional assessment shows that the veteran was negative for nausea, vomiting, diarrhea, and constipation. His current weight was 162 pounds, his usual weight was 192 pounds, and his ideal weight was 142 pounds. His nutritional status was described as normal. It was recommended that dairy products be eliminated due to intolerance. However, December 1993 VA treatment records show that the veteran had experienced a parasite in his intestine the previous month. He had a history of chronic diarrhea secondary to this infection. January 1994 VA hospital records indicate that the veteran was admitted for treatment of pneumonia, with pleuritic chest pain. His past medical history included peptic ulcer disease, and his surgical history included truncal vagotomy, as well as a partial gastrectomy. Current treatment for ulcer disease was not noted during this hospitalization. October 1994 VA hospital records show that the veteran was admitted for treatment of deep venous thrombosis. A history of peptic ulcer disease was noted. The veteran denied weight loss and blood in his stools, and did not undergo treatment for his ulcer disorder. The ulcer disorder was said to be well controlled with medication. Additional records from this period of hospitalization show that the veteran was positive for chronic diarrhea. VA treatment records dated in February 1995 continue to show a history of constant diarrhea. The veteran was afforded a VA examination in September 1995. The general examination showed a history of peptic ulcer disease, with a subtotal gastrectomy in 1965. Other pertinent medical history included a cholecystectomy. His pertinent complaints included a history of loose stools for 30 years. On examination, the veteran weighed 173 pounds. The abdomen was soft and benign. There was no organomegaly, and no remarkable tenderness. The diagnoses included peptic ulcer disease, status post subtotal gastrectomy, and probable dumping syndrome. Analysis The Board is unable to find that an increased rating is merited for the veteran’s duodenal ulcer. The medical records for consideration reveal that the veteran experienced a burning sensation in October 1993. There was an episode of black tarry stools in November 1993. Testing was negative for continued gastrointestinal bleeding, and this episode was not specifically attributed to his ulcer disorder. The veteran experienced some abdominal pain in 1991 and 1992, but the diagnosis was gallstones, and he eventually underwent surgery for this disorder. The veteran also has a history of chronic diarrhea, but treatment records have attributed this symptom at least in part to parasite infection. The records indicate that the veteran is well nourished, and his weight increased from 162 in November 1993 to 173 in September 1995. The record is negative for a current diagnosis of anemia. This evidence does not demonstrate greater than mild symptomatology. The provisions of 38 C.F.R. § 4.7 have been noted, but the evidence does not show that the veteran experiences recurring episodes of severe symptoms two or three times a year, or continuous moderate manifestations. Therefore, the preponderance of the evidence is against the veteran’s claim for entitlement to an increased rating for duodenal ulcer. 38 C.F.R. § 4.114, Code 7305. Scars of the left hand and right lower leg Initially, the Board finds that the veteran’s claim for an increased evaluation for post-operative duodenal ulcer is “well-grounded” within the meaning of 38 U.S.C.A. § 5107(a); that is, a plausible claim has been presented. Murphy v. Derwinski, 1 Vet. App. 78 (1990). An allegation of increased disability is sufficient to establish a well-grounded claim seeking an increased rating. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The Board is also satisfied that all relevant facts have been properly developed to their full extent and that VA has met its duty to assist. White v. Derwinski, 1 Vet. App. 519 (1991); Godwin v. Derwinski, 1 Vet. App. 419 (1991). The evaluation of service-connected disabilities is based on the average impairment of earning capacity they produce, as determined by considering current symptomatology in the light of appropriate rating criteria. 38 U.S.C.A. § 1155. Consideration is given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they are raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In addition, the entire history of the veteran's disability is also considered. Consideration must be given to the ability of the veteran to function under the ordinary conditions of daily life. 38 C.F.R. § 4.10. If there is a question as to which of two evaluations should apply, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. The veteran’s scars are currently evaluated according to the limitation of function of the part affected. 38 C.F.R. § 4.118, Code 7805. Scars that are superficial, poorly nourished, and have repeated ulceration merit a 10 percent evaluation. 38 C.F.R. § 4.118, Code 7803. Scars that are superficial, tender, and painful on objective demonstration also warrant a 10 percent evaluation. 38 C.F.R. § 4.118, Code 7803. Where the minimum schedular evaluation requires residuals and the schedule does not provide a noncompensable evaluation, a noncompensable evaluation will be assigned when the required residuals are not shown. 38 C.F.R. § 4.31. Factual Background Entitlement to service connection for a scar of the web space of the left hand between the thumb and index finger was established in a February 1971 rating decision. A zero percent evaluation was assigned for that disorder. Entitlement to service connection for a scar of the right lower leg with a zero percent evaluation was also established in this rating decision. The zero percent evaluations currently remain in effect for each disorder. The current evidence for consideration includes VA treatment records dated from July 1990 to the present. These records are negative for treatment pertaining to the veteran’s scar of the left hand or scar of the right lower leg. The veteran was afforded a VA examination in September 1995. The general examination noted a small scar in the area of the right mid-leg medially, which was related to the removal of a clot in the past. His gait was normal, and his mobility was not limited. He did not need any assistance with getting to the scales or the table, and he walked without assistance. The orthopedic examination noted that the veteran had injured his left hand during service when he slipped on ice and caught the hand on a spike on the top of a fence. The injury was cleaned and debrided, and healed uneventfully. He had experienced partial numbness and paralysis, but these symptoms had gradually resolved. On examination, the right leg had a two inch by three inch flat scar that was healed, nontender, and mobile. There was a zigzag scar on the palm of the left hand, measuring approximately two inches long, due to the penetration of the spike on the fence. Analysis The Board finds that the preponderance of the evidence is against entitlement to an increased rating for both the scar of the left hand and the scar of the right leg. The September 1995 VA examination noted that the veteran had experienced numbness and paralysis of the left hand following his injury, but these symptoms had resolved, and no current impairment of function is indicated. The wound was said to have healed normally, and pain, tenderness, or ulceration was not reported. Therefore, the criteria for a compensable evaluation for the scar of the left hand have not been met. 38 C.F.R. § 4.118, Codes 7803, 7804, 7805. Similarly, the scar of the right lower leg was reported to be healed, nontender, and mobile. No impairment of function of the right lower leg was indicated. The criteria for a compensable evaluation under any of the appropriate rating codes have not been met. 38 C.F.R. § 4.118, Codes 7803, 7804, 7805. The provisions of 38 C.F.R. § 4.7 were considered in reaching these decisions, but the veteran’s symptomatology does not more nearly resemble that of the next highest evaluation for either scar under any of the applicable rating codes. III. Entitlement to a temporary total rating for hospitalization in November 1993. Criteria A total rating will be assigned without regard to other provisions of the rating schedule when it is established that a service-connected disability has required hospital treatment in a VA or an approved hospital for a period in excess of 21 days or hospital observation at VA expense for a service-connected disability for a period in excess of 21 days. 38 C.F.R. § 4.29. Factual Background The veteran’s November 1993 claim indicates that he was admitted to a VA facility for treatment of his service- connected duodenal ulcer on November 9, 1993. The hospital summary from the VA medical clinic in Houston, Texas reveals that the veteran was admitted on November 9, 1993. He was admitted for complaints of severe substernal chest pain. The diagnosis was possible MI. His medical history noted surgery for problems related to peptic ulcer disease 27 years previously. The course of the veteran’s hospitalization reveals that he underwent thrombolytic therapy for treatment of his cardiac complaints. Following thrombolysis, the veteran had an unremarkable course except for an episode of gastrointestinal bleeding, in which he passed a black stool. There was no significant drop in hematocrit or hemoglobin, and the veteran was closely monitored for further blood loss. The veteran then underwent additional treatment for his cardiac complaints, including a Holter monitor and cardiac catheterization. The discharge diagnoses included the episode of gastrointestinal bleed, but did not include a service-connected disorder. However, additional diagnoses were listed, and this included a history of peptic ulcer disease. The list of procedures contained in the report did not show any treatment for the service-connected ulcer. Additional treatment records for this period of hospitalization show that the veteran’s history of peptic ulcer disease was noted. He had a single episode lasting approximately one day of passing a black, tarry stool. The veteran was also afforded a nutritional screening during his hospitalization. However, these records are negative for treatment of the ulcer disorder, and this disorder was noted by history only. The veteran was discharged on November 17, 1993. Analysis The Board is unable to find that the veteran is entitled to a temporary total rating under the provisions of 38 C.F.R. § 4.29 for the hospitalization in question. The record clearly shows that the veteran was admitted for treatment of a possible MI and for cardiac complaints, and not for treatment of his duodenal ulcer or any other service- connected disability. The veteran did experience an episode suggestive of a gastrointestinal bleed, but this passed in approximately one day, and the bleed was not specifically linked to the ulcer by any medical opinion. Finally, the entire hospitalization was for less than the 21 day period required in order to receive a temporary total rating for treatment of a service-connected disability. Therefore, as the hospitalization was not for treatment of a service-connected disorder, and did not last for the required period, entitlement to a total rating is not warranted. ORDER The veteran not having submitted a well grounded claim of entitlement to service connection for arteriosclerotic heart disease, the appeal is denied. The veteran not having submitted a well grounded claim of entitlement to service connection for arthritis of the hands, the appeal is denied. Entitlement to an increased rating for post-operative duodenal ulcer is denied. Entitlement to an increased rating for a scar of the web space of the left hand between the thumb and index finger is denied. Entitlement to an increased rating for a scar of the right lower leg is denied. Entitlement to a temporary total rating for hospitalization in November 1993 is denied. RONALD R. BOSCH Member, Board of Veterans' Appeals 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 which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals. - 2 -