disposition: dismissed

text:
BVA9503000
DOCKET NO.  89-07 896     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Buffalo, New
York

THE ISSUE

Entitlement to service connection for the cause of the veteran's
death.

REPRESENTATION

Appellant represented by: New York Division of Veterans'
Affairs

ATTORNEY FOR THE BOARD

Harold A. Beach, Counsel

INTRODUCTION

The veteran, who died in June 1986, served on active duty at
various times between July 1950 and August 1974.  Thereafter, he
retired with more than twenty-one years of honorable service.
The appellant is his widow, who seeks service connection for the
cause of his death.

The death certificate shows that the veteran died at the age of
55 as a result of Pseudomonas septicemia due to chronic
lymphocytic leukemia.

In June 1986, the Department of Veterans Affairs (VA) Regional
Office (RO) in Buffalo, New York, denied entitlement to service
connection for the cause of the veteran's death.  The appellant
was notified of that decision; however, she did not appeal.

In October 1988, the appellant requested that her claim for
service connection for the cause of the veteran's death be
reopened.  The following month, the RO confirmed and continued
the prior denial.  The appellant disagreed with that decision,
and this appeal ensued.  She contended that the veteran's fatal
leukemia was due, at least in part, to his exposure to Agent
Orange in the Republic of Vietnam.

In July 1989, the Board of Veterans' Appeals remanded the case
due to a federal district court decision which had voided all
benefit denials under 38 C.F.R. � 3.311a(d), the regulation which
then governed claims for the residuals of Agent Orange exposure.
The Board noted that the case would have to be readjudicated
under new instructions which were to be issued as a result of the
court's decision.  Those instructions have recently been set
forth by the VA.

In November 1994, after considering the new regulations, the RO
again confirmed and continued the denial of service connection
for the cause of the veteran's death.  The case was then returned
to the Board for further appellate consideration.

As noted above, the appellant did not appeal the RO's decision in
1986.  This raises questions of finality of that decision and the
need to submit new and material evidence in order to reopen the
claim.  38 U.S.C.A. �� 5108, 7105(c) (West 1991); 38 C.F.R.
�� 3.104, 20.302(a) (1993).  In October 1988, however, the RO
apparently decided the case on a de novo basis despite noting
that it was a reopened claim.  In order to avoid any prejudice to
the appellant, the Board will also proceed on a de novo basis .

CONTENTIONS OF APPELLANT ON APPEAL

It is contended by and on behalf of the appellant that the
veteran's fatal leukemia was due, at least in part, to his
exposure to Agent Orange in the Republic of Vietnam; that prior
to his exposure, he had been healthy and athletic; that he died
at a relatively young age; and that there had been no previous
cases of cancer in his family.  She notes that when it was
discovered it was far-advanced and that it could well have been
present for many years.  She, therefore, maintains that service
connection for the cause of his death is warranted.

DECISION OF THE BOARD

The Board, in accordance with the provisions of 38 U.S.C.A.
� 7104 (West 1991), has reviewed and considered all of the
evidence and material of record in the veteran's claims
file(s).  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 a well-grounded claim for service connection for
the cause of the veteran's death.

FINDINGS OF FACT

1.  All evidence necessary for an equitable disposition of
the appellant's claim has been obtained by the RO.

2.  The claim for service connection for the cause of the
veteran's death is not plausible.

CONCLUSION OF LAW

The claim for service connection for the cause of the veteran's
death is not well-grounded.  38 U.S.C.A. � 5107(a) (West 1991).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The threshold question to be decided in this case is whether or
not the appellant has submitted a claim which is well-grounded
within the meaning of 38 U.S.C.A. � 5107(a); that is, a claim
which is plausible.  If she has not, the appeal must fail.  The
VA would have no further duty to assist her in the development of
the claim, as such development would be futile.  38 U.S.C.A. �
5107(a); Colvin v. Derwinski, 1 Vet. App. 171 (1991); Murphy v.
Derwinski, 1 Vet.App. 78(1990); Grottveit v. Brown, 5 Vet.App.
91(1993).

In order to establish service connection for the cause of the
veteran's death, the evidence must show that disability incurred
in or aggravated by service either caused or contributed
substantially or materially to cause death.  For a service-
connected disability to be the cause of death, it must singly or
with some other condition be the immediate or underlying cause,
or be etiologically related.  For a service-connected disability
to constitute a contributory cause, it is not sufficient to show
that it casually shared in producing death, but rather, it must
show that there was a causal connection.  38 U.S.C.A. � 1310
(West 1991); 38 C.F.R. � 3.312 (1993).

Service connection connotes many factors, but basically it means
that the facts, shown by the evidence, establish that a
particular disease or injury, resulting in disability, was
incurred coincident with service in the Armed Forces.
38 U.S.C.A. � 1110, 1131 (West 1991); 38 C.F.R. � 3.303(a)
(1993).  For certain disorders, such as leukemia, service
connection is presumed, when that disorder is shown to a degree
of ten percent during the first year after the veteran's
separation from service.  38 U.S.C.A. �� 1101, 1110, 1112, 1113,
1131, 1137 (West 1991); 38 C.F.R. �� 3.307, 3.309 (1993).

The veteran's service medical records are completely negative for
any complaints or findings of Pseudomonas septicemia or leukemia.
Neither disorder was clinically reported until the mid-1980's,
and there were no findings that they were in any way related to
service.

The appellant maintains that when it was discovered, the fatal
leukemia was far-advanced and that it could well have been
present back to service.  By themselves, however, her contentions
are not enough.  Tirpak v. Derwinski, 2 Vet. App. 609 (1992).  As
a lay person, she is not competent to diagnose leukemia or to
render an opinion as to its etiology.  Any conclusions regarding
medical causation must be supported by expert opinion.  See,
e.g., Espiritu v. Derwinski, 2 Vet. App. 492 (1992) and Grottveit
v. Brown, 5 Vet. App. 91 (1993).

At the time of the veteran's death, service connection was in
effect for the following disorders:  Degenerative joint disease
of the shoulders, hands, and ankles, evaluated as 50 percent
disabling; bilateral sensorineural deafness, evaluated as
noncompensable; chronic proctitis and hemorrhoids, evaluated as
noncompensable; and prostatitis by history, evaluated as
noncompensable.  There were no findings, however, that any of his
service-connected disabilities contributed in any way to the
cause of death.

The primary thrust of the appellant's contentions is that the
fatal leukemia was the result of the veteran's exposure to Agent
Orange in the Republic of Vietnam.  The recently issued VA
regulations, however, presume a relationship only between Agent
Orange and chloracne, Hodgkin's disease, non-Hodgkin's lymphoma,
porphyria cutanea tarda, and soft tissue sarcoma.  Disease
subject to presumptive service connection, 59 Fed. Reg. 5107,
29724 (1994) (to be codified at 38 C.F.R. � 3.309(e)).  Although
septicemia or leukemia are not among the "presumed" residuals of
Agent Orange exposure, the appellant is not precluded from
submitting evidence of sound scientific or medical evidence of a
relationship to service.  38 U.S.C.A. � 1113 (West 1991).  To
date, such evidence has not been submitted.

In light of the foregoing, the Board finds no plausible basis for
service connection for the cause of the veteran's death.  As
such, it is not well-grounded.

Although the Board has considered and denied the foregoing claim
different from that of the RO, that is, whether the claim for
service connection for the cause of the veteran's death is well
grounded rather than whether she is entitled to prevail on the
merits the appellant has not been prejudiced.  In deciding these
claims as it did, the Board accorded her greater consideration
than was actually warranted under the circumstances.  To remand
the case to the RO for consideration of whether the appellant's
claim is well grounded would be pointless, and in light of the
law and regulations cited above would not result in a decision
favorable to the appellant.  See Bernard v. Brown, 4 Vet. App.
384, 392-94 (1993) VA O.G.C. Prec. Op. 16-92, 57 Fed. Reg. 49,
747(1992).

ORDER

Evidence of a well-grounded claim not having been submitted, the
claim for service connection for the cause of the veteran's death
is dismissed.

          ROBERT E. SULLIVAN
          Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, � 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. � 7266 (West
1991), a decision of the Board of Veterans' Appeals granting less
than the complete benefit, or benefits, sought on appeal is
appealable to the United States Court of Veterans Appeals within
120 days from the date of mailing of notice of the decision,
provided that a Notice of Disagreement concerning an issue which
was before the Board was filed with the agency of original
jurisdiction on or after November 18, 1988.  Veterans' Judicial
Review Act, Pub. L. No. 100-687, � 402 (1988).  The date which
appears on the face of this decision constitutes the date of
mailing and the copy of this decision which you have received is
your notice of the action taken on your appeal by the Board of
Veterans' Appeals.


series: legacy

judge_norm: BRUCE KANNEE

judge_role: Member, Board of Veterans' Appeals

disposition: remanded

text:
BVA9504000
DOCKET NO.  93-13 022     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Nashville,
Tennessee

THE ISSUE

Entitlement to service connection for a heart disorder, including
hypertension.

REPRESENTATION

Appellant represented by: Veterans of Foreign Wars of the
United States

ATTORNEY FOR THE BOARD

Brian J. Milmoe, Counsel

REMAND

The veteran served on active duty from February 1951 to December
1952.

It has been alleged that the veteran served in the military prior
to February 1951, and although an attempt was made by personnel
of the Department of Veterans Affairs (VA) Regional Office (RO)
in Nashville, Tennessee, to verify any additional service, the
reply from the National Personnel Records Center in January 1993
was unresponsive.  The veteran has also indicated that he was
treated in service in Cuba, North Africa, and Newfoundland, for a
heart disorder or hypertension, and that shortly after his
discharge from service, he was hospitalized at a private facility
for management of hypertension.  However, records relating to the
claimed treatment are not now contained within the claims folder.
It is noted that the RO in December 1992 requested that the
veteran document any additional service and sign a release to
permit the RO to obtain records from Hudson Hospital, to which he
did not respond.  While the veteran to date has not fully
cooperated with the RO, his military service must still be
verified and an attempt made to secure all pertinent records
relating to claimed inservice treatment of a heart disorder,
including hypertension.  Inasmuch as further action is deemed
warranted regarding service verification and retrieval of service
medical records, the veteran should be afforded one last
opportunity to furnish a release with respect to any and all
physicians or facilities treating him in post-service years for a
heart disorder, including hypertension.

Accordingly, this case is REMANDED to the RO for the completion
of the following actions:

1.  The RO should through contact with the
service department and/or the National
Personnel Records Center verify all of the
veteran's active duty, including that
served prior to February 1951.  Also,
records of treatment relating to any
additional period of service, as well as
those compiled in the course of alleged
treatment of a heart disorder, including
hypertension, in Cuba, North Africa, and
Newfoundland, should be obtained and
associated with the claims folder.

2.  The veteran should be contacted in
writing and asked to provide the names and
addresses of all physicians and/or
facilities treating him for a heart
disorder, including hypertension, during
post-service years, particularly the period
of time immediately following his discharge
from service.  In addition, he should be
asked to furnish a signed release for each
such physician or facility, so as to permit
the RO to obtain all pertinent record from
the listed providers.  Efforts should be
made by the RO to obtain all relevant
records, but particularly the records from
Hudson Memorial Hospital, where the veteran
reportedly was hospitalized within two
months of service discharge because of
hypertension.

3.  The RO should obtain all medical and
administrative records utilized by the
Social Security Administration in its
processing of the veteran's application for
disability benefits and the award thereof,
effective from June 1992.  Once obtained,
those records should be incorporated into
the claims folder.

Thereafter, the record should be reviewed in its entirety by the
RO and the certified issue readjudicated.  If the action taken
remains adverse to the veteran in any way, he and his
representative should be provided a supplemental statement of the
case.  They should then be afforded a reasonable period of time
in which to respond.  The case should then be returned to the
Board for further appellate consideration.

          BRUCE KANNEE
          Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, � 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

Under 38 U.S.C.A. � 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals.  This 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) (1994).


judge_norm: BRUCE E HYMAN

text:
BVA9505000
DOCKET NO.  92-05 319     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Boston,
Massachusetts

THE ISSUES

1.  Entitlement to an increased rating for a psychophysiological
gastrointestinal disorder with anxiety symptoms, currently
evaluated as 50 percent disabling.

2.  Entitlement to service connection for impotency, claimed as
secondary to a service-connected psychophysiological
gastrointestinal disorder with anxiety symptoms.

REPRESENTATION

Appellant represented by: Disabled American Veterans

WITNESSES AT HEARING ON APPEAL

The appellant and his spouse

INTRODUCTION

This matter came before the Board of Veterans' Appeals
(hereinafter the Board) on appeal from a rating decision of May
1991 from the Boston, Massachusetts, Regional Office (hereinafter
RO) of the Department of Veterans Affairs (VA).  The veteran had
verified active service  from July 1954 to January 1960.  The
case was remanded by the Board in July 1993 for further
development.  Most of that development has been completed and the
case has been returned to the Board for further consideration.

REMAND

In July 1993, the Board requested further examinations to
ascertain the current severity of the service-connected neurosis,
the current presence or absence of impotence, and, if present,
the etiology of the impotence.  The veteran had contended at the
time that medications he was taking for his service-connected
psychiatric disorder had caused impotence.

Pursuant to the remand order the veteran was given a psychiatric
examination in August 1993, which was completely adequate for
rating purposes.  It appears that he was also accorded VA
gastrointestinal and genitourinary examinations.  On the
genitourinary examination there was a diagnosis of sexual
impotence.  The physician failed to comment on the etiology of
the impotence as requested by the Board.

The Board points out for the RO's guidance that since the
decision of the United States Court of Veterans Appeals in Austin
v. Brown, 6 Vet.App. 547 (1994), the Board is no longer able to
make decisions on appeals on the basis of medical opinions from
its own medical advisors.  As such, the opinions of VA physicians
who examine veterans have become a primary source of answering
medical questions raised by the evidence of record.

The case is remanded for the following action:

(1).  The veteran should be asked which
specific medication(s) that he is taking
for his service-connected neurosis is
believed by him to have caused impotence.
He should further be asked whether any
physician who has treated him expressed the
opinion that such medication caused
impotence.  If he identifies a
physician(s), the RO should request
complete treatment records from such
physician(s) for association with the
claims folder.  Such physician(s) should
also be asked what there opinion(s) is as
to the etiology of the veteran's impotence.

(2).  The complete original VA outpatient
treatment records folder, and, if one
exists, the complete VA hospital clinical
records folder for the veteran should be
obtained for association with the claims
folder.

(3).  The veteran should be accorded a
further VA genitourinary examination to
ascertain the etiology of the impotence
reported on VA examination in October 1993.
The examining physician must completely
review the claims folder including all
records requested above in this remand
order, prior to the examination.  Following
such review and examination of the veteran
he should express an opinion as to whether
the veteran's impotence is caused by his
neurosis or medication which he takes for
his neurosis as distinguished from non
service-connected causes, such as diabetes
mellitus.

Following completion of these actions, the RO should  review the
evidence and determine whether the appellant's claims may now be
granted.  If not, the appellant and his representative should be
provided with an appropriate supplemental statement of the case
and be given a reasonable opportunity in which to respond
thereto.  Thereafter, the case should be returned to the Board
for further appellate consideration.

          BRUCE E. HYMAN
          Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, � 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

Under 38 U.S.C.A. � 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals.  This 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) (1994).


judge_norm: JOHN E ORMOND

text:
BVA9506000
DOCKET NO.  93-13 639     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in St. Louis,
Missouri

THE ISSUE

Entitlement to an increased disability rating for an anxiety
reaction, with psychophysiological gastrointestinal features,
currently evaluated as 30 percent disabling.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

Theresa M. Catino, Associate Counsel

INTRODUCTION

The veteran served on active military duty from November 1945 to
November 1947 and from February 1948 to January 1953.

REMAND

At a VA examination conducted in March 1993, the examiner
diagnosed a generalized anxiety disorder with periodic occasional
underlying depression.  The examiner also expressed his opinion
that the veteran has mild to moderate incapacity as a result of
his anxiety disorder.

Significantly, however, the examiner did not specifically mention
the extent of the veteran's social and industrial impairment
resulting from his anxiety disorder.  The regulations clearly
provide that the examiner's classification of a psychiatric
disease as "mild," "moderate," or "severe" is not determinative
of the degree of disability, but the report and the analysis of
the symptomatology and the full consideration of the whole
history by the rating agency will be.  38 C.F.R. Part 4, � 4.130
(1994).  Consequently, the Board of Veterans' Appeals (Board) is
not required to accept a description by an examiner regarding the
incapacity resulting from a psychiatric disorder.

The Board concludes that further assistance to the veteran is
required.  Accordingly, the case is REMANDED to the RO for the
following:

1.  The veteran should be contacted and
requested to furnish a complete list of all
medical personnel and facilities from which
he has received treatment for his
service-connected anxiety reaction with
psychophysiological gastrointestinal
features since March 1993.  The Board is
particularly interested in records of any
treatment that the veteran may have
received from the local VA medical center
as well as any private physicians.  After
obtaining the appropriate releases from the
veteran where necessary, the health care
providers should be contacted and requested
to provide all treatment records in their
possession pertaining to the veteran.  If
these records are unavailable, that fact
should be annotated in the claims folder.
Any available records should be associated
with the claims folder.

2.  Following the above, the veteran should
be examined by a VA psychiatrist, who has
not previously examined him, to determine
the nature and extent of his
service-connected anxiety reaction with
psychophysiological gastrointestinal
features.  The examination should be
conducted in accordance with the diagnostic
procedures outlined in the VA Physician's
Guide for Disability Evaluation
Examinations.  The report of examination
should include a detailed account of all
manifestations of psychiatric pathology
found to be present.  If there are
different psychiatric disorders, the
psychiatrist should reconcile the
diagnoses, where possible, and should
specify which symptoms are associated with
and which disorders are part of or caused
by the service-connected anxiety disorder.
All necessary special studies or tests,
including psychological testing, are to be
accomplished.

3.  The psychiatrist should describe how
the symptoms of this service-connected
disorder affect the veteran's social and
industrial capacity.  The examiner should
be requested to express an opinion as to
the extent of industrial impairment which
is the result of this disorder.  The
examiner should comment upon the

veteran's functional impairment resulting
only from his service-connected anxiety
reaction with psychophysiological
gastrointestinal features, by utilizing the
Global Assessment of Functioning Scale
found in the American Psychiatric
Association:  Diagnostic and Statistical
Manual of Mental Disorders.  It is
imperative that the physician explain the
significance of the numerical code
assigned.   The entire claims folder and a
copy of this remand must be made available
to and reviewed by the examiner prior to
the examination.

4.  The regional office should also arrange
for the veteran to be examined by a
gastroenterologist  in order to determine
the extent of any gastrointestinal
disability which is attributable to the
service-connected disorder.  All indicated
and medically appropriate tests should be
conducted.

5.  Thereafter, the RO should formally
adjudicate the issue of entitlement to an
increased rating for anxiety reaction with
psychophysiological gastrointestinal
features.

Following completion of these actions, and, if the decision
remains unfavorable, the veteran and his representative should be
provided with a supplemental statement of the case and afforded a
reasonable period of time in which to respond.  Thereafter, the
case, in accordance with the current appellate procedures, should
be returned to the Board for completion of appellate review.

The purpose of this REMAND is to obtain clarifying evidence.  No
action is required of the veteran until further notice is issued.

          JOHN E. ORMOND
          Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, � 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

Under 38 U.S.C.A. � 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals.  This 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) (1994).


judge_norm: DEREK R BROWN

disposition: granted

text:
BVA9508000
DOCKET NO.  93-14 489     )       DATE
          )
          )

On appeal from a case certified by the
Department of Veterans Affairs Regional Office in Oakland,
California

THE ISSUE

Entitlement to service connection for a sensorineural hearing
loss in the left ear.

REPRESENTATION

Appellant represented by: California Department of
Veterans Affairs

ATTORNEY FOR THE BOARD

Ronald R. Bosch, Counsel

INTRODUCTION

The veteran served on active duty from February 1941 to October
1945 and from January 1947 to July 1968.

This appeal arose from an August 1992 rating decision of the
Department of Veterans Affairs (VA) Regional Office (RO) in San
Francisco, California (now located in Oakland, California).  The
RO, in relevant part, granted entitlement to service connection
for a right ear sensorineural hearing loss, and denied
entitlement to service connection for a left ear sensorineural
hearing loss.

Subsequent to forwarding of his case to the Board for appellate
review, a claim for an increased evaluation for the appellant's
service-connected right nephrectomy with renal insufficiency was
received and medical documentation pertaining to such claim was
associated with the claims file.  This issue is referred to the
RO for initial consideration and appropriate action.

CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends that he spent his entire Air Force career
constantly exposed to a hazardous noisy environment both on the
flight line and in the hangar areas.  The appellant states that
he had nearly perfect hearing acuity when he entered the Air
Force.  Subsequent to service he states that he worked in a noise
free environment as a clerk in a hardware store.  The claimant
avers that it stands to reason that his noise exposure during
service accounts for his hearing loss in his left ear, as well as
his right ear for which service connection has been granted.

DECISION OF THE BOARD

The Board, in accordance with the provisions of 38 U.S.C.A.
� 7104 (West 1991), has reviewed and considered all of the
evidence and material of record in the veteran's claims file.
Based on its review of the relevant evidence in this matter, and
for the following reasons and bases, it is the decision of the
Board that after resolving reasonable doubt in the veteran�s
favor that the record supports a grant of entitlement to service
connection for a left ear sensorineural hearing loss.

FINDINGS OF FACT

1.  The veteran spent a large portion of his Air Force career as
an aircraft maintenance technician both on the flight line and in
the hangar areas.

2.  The February 1968 report of medical examination for
retirement shows there was a 45 decibel loss at 6000 Hertz in the
left ear.

3.  Post service VA and non-VA audiology studies show the veteran
has a bilateral sensorineural hearing loss, and the evidence
presented includes an opinion from a physician that this disorder
is compatible with noise induced hearing loss.

CONCLUSION OF LAW

After resolving reasonable doubt in the veteran�s favor the Board
finds that left ear sensorineural hearing loss was incurred
during the veteran�s active duty service.  38 U.S.C.A. �� 1110,
1131, 5107 (West 1991);  38 C.F.R. �� 3.102, 3.303(b) (1994).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Initially the Board finds that the veteran's claim is well
grounded within the meaning of 38 U.S.C.A. � 5107(a), in that he
has presented a claim which is plausible.  The Board is satisfied
that all relevant facts have been properly developed, and that no
further assistance to the veteran is required in order to comply
with 38 U.S.C.A. � 5107(a).

Service connection has been granted for a sensorineural hearing
loss in the right ear, and for tinnitus.

The veteran contends that his post service diagnosed
sensorineural hearing loss in the left ear is related to his
exposure to a hazardous noisy environment as an aircraft
maintenance technician in the Air Force.  There is no dispute
that the veteran spent many years while on active duty as an
aircraft maintenance technician.

The service medical records show that sensorineural defective
hearing was apparent in the right ear by audiology studies
conducted at his February 1968 retirement examination.  That
examination report also shows that the veteran had a 45 decibel
loss at 6000 Hertz in the left ear.  This decibel loss is
significant, and it cannot be satisfactorily dissociated from the
post service diagnosed sensorineural hearing loss in the left ear
by VA and non-VA medical health professionals.  In this regard,
the Board observes that in June 1989 Michael A. Matus, M.D., a
private physician, diagnosed the veteran with a bilateral
sensorineural hearing loss.  Dr. Matus noted that the veteran had
previously worked around jet aircraft and had gradually noticed
increasing difficulty understanding conversation.  Dr. Matus
opined that the veteran's history was certainly compatible with a
noise-induced sensorineural hearing loss.

VA audiology studies conducted in December 1991 concluded in a
finding of bilateral high frequency sensorineural hearing loss.
The VA audiologist took cognizance of the veteran's history of
noise exposure.

In view of the veteran's documented history of years of exposure
in service to a noisy environment as an aircraft maintenance
technician, the Board finds it would be unreasonable to
dissociate the post service diagnosed sensorineural hearing loss
in the left ear from his active duty service.  Furthermore, a
private medical health professional has determined that the
veteran's bilateral sensorineural hearing loss is compatible with
a noise induced hearing loss.  There is no evidence that the
veteran worked in an acoustic environment postservice which was
similar to the environment within which he served on active duty.

Although not diagnosed in service with a sensorineural hearing
loss, the veteran demonstrated an indication of the onset of such
a disorder when he was examined at retirement and found to have a
45 decibel loss at 6000 Hertz.  Hence, the Board concludes that
the record raises a reasonable doubt.  Accordingly, the Board
concludes that service connection for a left ear sensorineural
hearing loss is warranted.

ORDER

Entitlement to service connection for a sensorineural hearing
loss in the left ear is granted.

          DEREK R. BROWN
          Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, � 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. � 7266 (West
1991), a decision of the Board of Veterans' Appeals granting less
than the complete benefit, or benefits, sought on appeal is
appealable to the United States Court of Veterans Appeals within
120 days from the date of mailing of notice of the decision,
provided that a Notice of Disagreement concerning an issue which
was before the Board was filed with the agency of original
jurisdiction on or after November 18, 1988.  Veterans' Judicial
Review Act, Pub. L. No. 100-687, � 402 (1988).  The date which
appears on the face of this decision constitutes the date of
mailing and the copy of this decision which you have received is
your notice of the action taken on your appeal by the Board of
Veterans' Appeals.


judge_norm: RENÉE M PELLETIER

text:
BVA9509000
DOCKET NO.  93-13 683     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in San Juan,
Puerto Rico

THE ISSUE

Entitlement to an evaluation in excess of 50 percent for a
generalized anxiety disorder with very strong depressive
features.

REPRESENTATION

Appellant represented by: Puerto Rico Public Advocate for
Veterans Affairs

WITNESSES AT HEARING ON APPEAL

Appellant and his sister, Mrs. [redacted]

ATTORNEY FOR THE BOARD

Paul J. Somelofske, Associate Counsel
INTRODUCTION

The veteran served on active duty from November  1941 to October
1944.

This matter came before the Board of Veterans' Appeals (Board) on
appeal from a December 1990 rating decision of the Department of
Veterans Affairs (VA), San Juan, Puerto Rico, Regional Office
(RO), that denied an evaluation in excess of 50 percent for a
generalized anxiety disorder with very strong depressive
features, an evaluation in excess of 40 percent for an enucleated
left eye, and a total disability evaluation based on individual
unemployability due to service-connected disabilities.

Subsequent to filing his substantive appeal in June 1991, the
veteran testified at a hearing at the RO in November 1991.  A
March 1993 rating decision granted service connection for a right
eye disability, as directly due to the veteran's service-
connected left eye disability, and assigned a 100 percent
evaluation for an enucleated left eye, glaucoma, cataract, right
eye, under the provisions of 38 C.F.R. � 3.383.  The veteran was
also afforded special monthly compensation benefits under the
provisions of 38 C.F.R. � 3.350.

Accordingly, as the veteran is receiving the maximum benefit for
his service-connected enucleated left eye, his appeal for an
increased rating is rendered moot.  In addition, as a total
disability evaluation has been granted for the veteran's
bilateral eye disability, the issue of entitlement to a total
disability evaluation based on individual unemployability due to
service-connected disabilities is also rendered moot.  The issue
before the Board is most appropriately set forth on the cover
page of this remand.

REMAND

The veteran contends that his service-connected psychiatric
disorder is more severe than the current evaluation reflects.  He
asserts that he has difficulty sleeping and requires medication,
is affected by loud noises, does not get along with people, and
is constantly irritable.

At his November 1991 hearing at the RO, the veteran indicated
that he seeks treatment for his service-connected psychiatric
disorder at the VA hospital every two months, and that he was
scheduled for an appointment in February 1992.  The most recent
VA treatment records on file are dated in September 1990.  In
addition, the veteran testified that he has not seen any private
doctors for his psychiatric disorder.

The most recent VA psychiatric examination report, dated in July
1992, indicated diagnoses of generalized anxiety disorder with
strong depressive features, and stressors, not determined.  The
examination, however, did not assign a Global Assessment of
Functioning Score and explain what the assigned score represents,
and did not objectively relate the veteran's pertinent
symptomatology to his social and industrial adaptability, or lack
thereof.  It is noted that the medical folder, but not the claims
folder, was available to the examiner.  It is the belief of the
Board that further psychological testing will be helpful in
assessing the current status of the veteran's service-connected
psychiatric disorder.

The VA has a duty to assist the veteran in the development of
facts pertinent to his claim.  38 U.S.C.A. � 5107(a) (West 1991);
38 C.F.R. � 3.103(a) (1994).  This duty includes assisting the
veteran in securing clinical and treatment records when such
records exist, but are not on file.  Murphy v. Derwinski, 1
Vet.App. 78 (1990); Littke v. Derwinski, 1 Vet.App. 90 (1990).
This duty also includes affording the veteran a VA examination
where the reasonable probability of a valid claim is indicated.
38 C.F.R. � 3.326(a) (1994).

Under the circumstances of this case, it is believed that further
development is necessary prior to the final disposition of the
issue on appeal.  This case, therefore, is REMANDED to the RO for
the following actions:

1.  The RO should afford the veteran the
opportunity to submit or identify any other
evidence pertinent to his claim for an
evaluation in excess of 50 percent for a
generalized anxiety disorder with very
strong depressive features.  Any evidence
identified should be obtained by the RO.

2.  The RO should ascertain from the
veteran the location of all VA facilities
in which he has sought treatment since
1990.  The RO should then attempt to secure
all treatment and clinical records
pertaining to the veteran from all
facilities indicated for the period of
September 1990 to the present.  Any records
obtained should be associated with the
claims folder.

3.  After the above has been completed and
all records, if any, have been associated
with the claims folder, the veteran should
be afforded a VA psychiatric examination
by a psychiatrist to determine the current
status of his service-connected
psychiatric disorder.  This examination
must be conducted in accordance with the
VA Physician's Guide for Disability
Evaluation Examination.  All indicated
tests and studies must be conducted.  The
claims folder must be made available to
and reviewed by the psychiatrist prior to
the requested examination.  If there are
different psychiatric disorders, the
psychiatrist is to associate, insofar as
possible, the specific symptoms with each
disorder, and the bases for such
diagnoses.  The clinical findings are to
be reported legibly and in detail.  The
psychiatrist must assign a Global
Assessment of Functioning (GAF) score
consistent with the American Psychiatric
Association's DIAGNOSTIC AND STATISTICAL
MANUAL FOR MENTAL DISORDERS (3d ed. rev.,
1987), and explain what the assigned score
represents.  The psychiatrist's opinion
should also include a statement as to the
relationship between the manifestations of
the veteran's service-connected
generalized anxiety disorder with strong
depressive features and his social and
industrial adaptability, or lack thereof,
with a complete rationale for any opinion
expressed.

4.  Following completion of the foregoing
examination, the RO must review the claims
folder and ensure that all of the requested
development has been conducted and
completed in full.  If any development is
incomplete, appropriate corrective action
is to be taken.

5.  After the foregoing has been completed,
the RO should readjudicate the veteran's
claim for an evaluation in excess of 50
percent for a generalized anxiety disorder
with very strong depressive features.

After the above has been completed, if the benefit sought on
appeal remains denied, the veteran and his representative should
be issued a supplemental statement of the case, which includes
adequate reasons and bases for the RO's decision.  Thereafter,
they should be afforded an opportunity to respond.  The case must
then be returned to the Board for further appellate
consideration.  The veteran and his representative need take no
further action until notified by the RO.

The purpose of this remand is to assist the veteran in the
development of his claim.

          REN�E M. PELLETIER
          Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, � 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

Under 38 U.S.C.A. � 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals.  This 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) (1994).


judge_norm: THOMAS J DANNAHER

text:
BVA9511000
DOCKET NO.  93-21 667     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Jackson,
Mississippi

THE ISSUE

Entitlement to an increased evaluation for post-traumatic
stress disorder (PTSD), currently rated as 30 percent
disabling.

REPRESENTATION

Appellant represented by: Paralyzed Veterans of America,
Inc.

ATTORNEY FOR THE BOARD

T. Hal Smith, Counsel

INTRODUCTION

The veteran served on active duty from April 1969 to March
1971.  This appeal ensued following a September 1991 rating
decision of the Department of Veterans Affairs (VA) Regional
Office (RO) in Jackson, Mississippi.  In that decision, an
increased evaluation for PTSD was denied.

REMAND

VA treatment records from 1989 through 1992 are of record.
When examined in 1989, it was noted that the veteran
described some features of PTSD, such as frequent ruminations
of combat experiences, great social detachment,
hypervigilance, history of angry outbursts and increased
startle response.  The physician's impression was that the
veteran met the minimal criteria for PTSD diagnosis, but
there was the possibility that many of these symptoms could
be attributed to a diagnosis of passive aggressive antisocial
personality disorder.  Alcohol and marijuana abuse were
reported.  An addendum from July 1990 notes that additional
psychological testing from November 1987 supported a
diagnosis of PTSD.  It was also noted that the veteran's
alcohol abuse dated at least to 1986, and according to
medical records, began after returning from Vietnam.  The
examiner opined that the veteran appeared to use alcohol to
treat anxiety, which resulted from PTSD, when medications
were unavailable.  Therefore, he felt that this was part of
the appellant's PTSD.

The diagnosis following VA examination in September 1991 was
PTSD, chronic, substance abuse and dependence, including
alcohol and cannabis.  In November 1992, a VA physician noted
that the veteran appeared to satisfy the criteria for PTSD
and that he also abused alcohol.

In March 1994, the veteran's representative argued in an
informal hearing presentation, that the veteran's alcoholism
was either a symptom of the PTSD or a chronic disability
which had been incurred secondary to the PTSD.  This issue is
inextricably intertwined with the issue of the proper rating
for the veteran's PTSD.  The Board finds that additional
medical development is necessary to reconcile the current
medical findings prior to assignment of a rating for PTSD.

Accordingly, the claim is REMANDED for the following actions:

1.  The veteran should state where he has
received inpatient and/or outpatient
treatment for PTSD and/or alcoholism
since 1992.  After obtaining any needed
authorization from the veteran, the RO
should obtain copies of all these
records.

2.  The veteran should then be afforded a
psychiatric examination in order to
determine the severity and manifestations
of his service-connected PTSD.  The
claims folder must be made available to
the examiner prior to the examination.
The examination should be conducted in
accordance with VA's Physician's Guide
for Disability Evaluation Examinations.
Any psychological testing deemed
necessary to make a complete diagnostic
evaluation and to differentiate symptoms
attributable to PTSD from those due to
other conditions should be accomplished.
The examiner should also specifically
discuss the reduction, if any, in
initiative, efficiency, and reliability
levels which is due to PTSD.  In this
regard, the terms mild, definite,
considerable, severe and total are the
preferred descriptive adjectives.
Finally, the examiner should express an
opinion regarding the etiology of
alcoholism and the degree of probability
that alcoholism is a symptom of or
secondary to PTSD.

3.  Following completion of this
development, the RO should review the
veteran's claims, including the claim
that alcoholism is a symptom of PTSD or
secondary to PTSD.  The rating decision
should reflect consideration of all
potentially applicable criteria, to
include consideration of the
applicability of 38 C.F.R. � 3.321(b)(1)
(1994).  If the decision remains adverse
to the veteran in any way, he and his
representative should be furnished with a
supplemental statement of the case which
summarizes the pertinent evidence and
reflects detailed reasons and bases for
the decisions.  They should then be
afforded the applicable time period to
respond.

Thereafter, the case should be returned to the Board for
further appellate consideration.  No action by the veteran is
required until he is contacted by the RO.  The purpose of
this REMAND is to obtain additional clarifying medical data
and to ensure due process of law.  No inference should be
drawn regarding the final disposition of the claim as a
result of this action.

          THOMAS J. DANNAHER
          Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, � 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

Under 38 U.S.C.A. � 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals.  This action has been taken in
accordance with the Veterans' Benefits Improvements Act of
1994, Pub. L. No. 103-446, � 303, 108 Stat. 4645, ___ (1994),
and 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) (1994).


judge_norm: C P RUSSELL

disposition: denied

condition: respiratory

text:
BVA9512000
DOCKET NO.  92-22 406     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Seattle,
Washington

THE ISSUES

1.  Entitlement to an increased (compensable) evaluation for
benign pulmonary nodule of the right mid-lung field.

2.  Entitlement to a certificate for civil service preference
predicated on ascertainable residuals from benign pulmonary
nodule of the right mid-lung field.

REPRESENTATION

Appellant represented by: Veterans of Foreign Wars of
the United States

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

William L. Pine, Counsel

INTRODUCTION

The appellant served on active duty from January 1976 to
March 1977.

This appeal is from the August 1991 rating decision of the
Department of Veterans Affairs (VA) Regional Office (RO)
denying entitlement to the benefits at issue.

The appellant apparently wishes to raise claims of clear and
unmistakable error (CUE) in all denials in the RO rating
decision of July 1989 and in the Board of Veterans' Appeals
(Board) decision of July 1991.  Although the RO lacks
jurisdiction to review a decision of the Board for CUE, Smith
v. Brown, 3 F.3d 1516 (Fed. Cir. 1994), the appellant may
file a motion for reconsideration of the Board�s decision
with the Chairman of the Board.  38 C.F.R. �� 20.1000,
20.1001 (1994).  Such claims of CUE over which the RO may
have jurisdiction are referred to the RO for appropriate
action.

Pursuant to the Board�s remand of September 1994, the RO
adjudicated a claim for service connection "inextricably
intertwined," Harris v. Derwinski, 1 Vet.App. 180 (1991),
with the instant claim for increased rating.  The RO notified
the appellant of the denial of his claim for service
connection for chronic obstructive pulmonary disease (COPD)
in April 1995.  Whereas no disagreement with the rating
decision is of record, there is no appeal from the rating
decision of which the Board can take cognizance, and the
matter is not further addressed herein.

CONTENTIONS OF APPELLANT ON APPEAL

The appellant contends that he is at least 10 percent
disabled by benign pulmonary nodule of the right mid-lung
field and that he is entitled thereby to a certificate of
veteran�s civil service preference.

DECISION OF THE BOARD

The Board, in accordance with the provisions of 38 U.S.C.A.
� 7104 (West 1991), has reviewed and considered all of the
evidence and material of record in the veteran's claims
file(s).  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 neither a compensable rating
for benign pulmonary nodule of the right mid-lung field or a
certificate of veteran�s civil service preference is
warranted.

FINDINGS OF FACT

1.  The appellant suffers no impairment of pulmonary function
attributable to service-connected benign pulmonary nodule of
the right mid-lung field.

2.  The appellant is less than 10 percent disabled by
service-connected benign pulmonary nodule of the right mid-
lung field.

CONCLUSIONS OF LAW

1.  The schedular criteria for a compensable rating for
benign pulmonary nodule of the right mid-lung field are not
met.  38 U.S.C.A. �� 1155, 5107 (West 1991); 38 C.F.R.
�� 4.1, 4.2, 4.10, 4.20, 4.31, 4.97, Diagnostic Code 6820-
6603 (1994).

2.  The regulatory criteria for entitlement to a certificate
of civil service preference are not met.  38 U.S.C.A. ��
4214(a)(1), (b)(1)(C), 5107 (West 1991); 38 C.F.R. � 3.357
(1994).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The appellant presents a well-grounded claim, and the
pertinent facts have been developed.  38 U.S.C.A. � 5107(a)
(West 1991).  An August 1989 statement from J.E. Whitman,
M.D., indicates that the appellant had a pulmonary function
test (PFT) in October 1980.  Those records need not be
obtained, because evidence of pulmonary function in 1980 is
not pertinent to the question whether the appellant is now
compensably disabled by his pulmonary nodule.  The appellant
failed to report for a VA examination ordered to evaluate the
current nature and severity of the service-connected
disorder.  The duty to assist is discharged.  Id.  The
question before the Board is whether the evidence supports
the claim.

1.  Increased (Compensable) Rating

In review of claims for increased ratings, the Board
considers all of the medical evidence of record, including
the appellant's relevant medical history.  Peyton v.
Derwinski, 1 Vet.App. 282, 285 (1991); Schafrath v.
Derwinski, 1 Vet.App. 589, 595 (1991).  The medical findings
are compared to the criteria in the VA Schedule for Rating
Disabilities, 38 C.F.R. Part 4 (1994), to determine the
extent to which a service-connected disability adversely
affects the ability of the body to function under the
ordinary conditions of daily life, including employment.
38 C.F.R. �� 4.2, 4.10 (1994).

The appellant�s service-connected benign pulmonary nodule of
the right mid-lung field is rated as a benign new growth of
the respiratory system, 38 C.F.R. � 4.97, diagnostic code
6820 (1994), by analogy, 38 C.F.R. � 4.20 (1994), to
emphysema.  38 C.F.R. �� 4.27, 4.97, diagnostic code 6603
(1994) [hereinafter code 6603].  For a 10 percent rating, the
rated condition must produce �evidence of ventilatory
impairment on pulmonary function tests and /or definite
dyspnea on prolonged exertion.�  Code 6603.

Service medical records reveal that the appellant was found
to have a benign pulmonary nodule of the right mid-lung field
by x-ray and Tomography (CT) in July 1986.  No change in the
size or appearance of the nodule was noted during the
remainder of service.

VA outpatient records from July 1986 to March 1989 show that
the appellant was followed for several years to observe the
status of the nodule.  In November 1986, a CT scan report
noted the nodule and that early malignancy could not be ruled
out.  Subsequent x-rays and reviews of serial x-rays showed
no change or decrease in the size of the nodule, which was
noted in September 1988 to be a small, stable, solitary
nodule, probably a granuloma, as suggested by review of x-
rays of November 1986, March 1988, May 1988 and August 1988.
Although it was deemed to warrant continuing observation
because of its presence in a young smoker, it was felt to be
benign because of the essential stability in size over a
significant period of time.  On x-ray in March 1989, it was
noted to have coalesced and apparently calcified.  During the
same period of time, the appellant had occasional complaints
of dyspnea on exertion or chest pain.  A diagnosis of COPD
was noted, with some relief from Alupent inhaler.  His
continued smoking and repeated recommendations to quit were
noted.  At the time of the first recorded complaint of
shortness of breath, September 8, 1987, the examiner noted
the appellant was very inactive and suspected deconditioning
and smoking as the cause of his complaints.

On VA examination in June 1989, the appellant complained, �I
can feel my nodule inside my lung.�  Historically, it was
noted he had been followed for some time for a pulmonary
nodule in the right lower lobe, observed for many years to
gradually decrease in size and become calcified.  Also noted
were slightly abnormal pulmonary function tests in the past,
showing decreased air flow in  the small airways.  The
examiner commented that he assured the appellant that it was
extremely unlikely the nodule was a threat.  On examination,
the lungs were clear to auscultation and percussion.  The
diagnoses were history of benign pulmonary nodule, etiology
unknown; mild COPD, well controlled with Alupent.

On VA examination in July 1991, the appellant complained of
shortness of breath after minimal exertion and chronic
coughing and wheezing.  On clinical examination, it was noted
that after initial finding of the nodule and full evaluation
in service, no surgery was advised, nor had any ever been
advised or done since.  He reported that since service, he
had intermittently felt a right parasternal anterior chest
pain and tenderness, generally associated with heavy
exertion.  He reported reducing smoking from one to one-half
pack a day.  He stated he had a mild cough occasionally,
without sputum or hemoptysis.  On clinical examination, there
was no evidence of cough, wheezing or shortness of breath.
The lungs demonstrated full volume breath sounds bilaterally,
with some coarse breath sounds and rhonchi bilaterally.
Chest x-rays were compared with films of June 1990, and said
again to show a normal lung without infiltrate, with the
previous question of a right mid-lung field nodule now shown
to be essentially normal, with perhaps a linear scar,
certainly not developed in a mass.  The impression was
essentially normal chest; no definite mass lesion had
developed.  The overall impression from the examination was
benign pulmonary nodule by history.

In a statement of September 1990, the appellant�s wife
stated, inter alia, the appellant got spots on his lungs
during military training as a chemical specialist.

The appellant testified at a hearing in May 1992 that he had
had breathing problems in the service, where a nodule was
found in his lung.  He stated trouble breathing has become
worse since service, and he had suffered an ascertainable
decrease in his ability to exercise.  He stated, essentially,
that bronchitis, COPD, or any other existing pulmonary or
respiratory diseases are part and parcel of the disability
attributable to the right lung nodule, and the rating of his
service-connected disability should include disability due to
them.

Review of the evidence reveals that the only concern
regarding the right lung nodule ever expressed by any medical
practitioner was to occasionally observe the nodule to see if
it was malignant.  The record clearly shows that it is not.
No medical practitioner has ever expressed the opinion that
the nodule is responsible for, or even contributes to, any
pulmonary or respiratory disease or symptoms.  No
practitioner has ever expressed the opinion that the nodule
causes or contributes to any ascertainable disability or
impairment in pulmonary or any other function.  The
appellant�s belief that he can feel the nodule or that it
causes certain symptoms and impairments such as shortness of
breath or reduced exercise tolerance is purely his own
unsubstantiated medical opinion; it is not competent,
credible evidence for the purpose of evaluating the degree of
impairment for work caused by the nodule.  See Espiritu v.
Derwinski, 2 Vet.App. 492 (1992).

The clear preponderance of the evidence is that the service-
connected benign pulmonary nodule of the right mid-lung field
does not cause ventilatory impairment of any degree, whatever
the etiology of certain symptoms may be.  Consequently, the
preponderance of the evidence is against granting a
compensable disability rating for the service-connected
disability.  38 C.F.R. � 4.31 (1994).

2.  Certificate of Civil Service Preference

�It is . . . the policy of the United States . . . to promote
the maximum of employment and job advancement opportunities
within the Federal Government for disabled veterans . . . .�
38 U.S.C.A. � 4214(a)(1) (West 1991).  �[A] veteran who is
entitled to disability compensation under the laws
administered by the Department of Veterans Affairs . . .shall
be given a preference [in certain Federal appointments] over
other veterans.�  38 U.S.C.A. � 4214(b)(1)(C) (West 1991).
�For the purpose of certifying civil service disability
preference only, a service-connected disability may be
assigned an evaluation of �less than ten percent.�  Any
directly or presumptively service-connected disease or injury
which exhibits some extent of actual impairment may be held
to exist at the level of less than ten percent.�  38 C.F.R.
� 3.157 (1994).

The clear preponderance of the evidence is that the appellant
is less than ten percent disabled by benign pulmonary nodule
of the right mid-lung field.  Such a level of disability does
not qualify for or entitle the appellant to a certificate of
civil service preference.  38 C.F.R. � 3.157 (1994).

ORDER

A compensable rating for benign pulmonary nodule of the right
mid-lung field is denied.  A certificate of civil service
preference is denied.

          C.P. RUSSELL
          Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, � 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. � 7266 (West
1991), a decision of the Board of Veterans' Appeals granting
less than the complete benefit, or benefits, sought on appeal
is appealable to the United States Court of Veterans Appeals
within 120 days from the date of mailing of notice of the
decision, provided that a Notice of Disagreement concerning
an issue which was before the Board was filed with the agency
of original jurisdiction on or after November 18, 1988.
Veterans' Judicial Review Act, Pub. L. No. 100-687, � 402
(1988).  The date which appears on the face of this decision
constitutes the date of mailing and the copy of this decision
which you have received is your notice of the action taken on
your appeal by the Board of Veterans' Appeals.


judge_norm: GEORGE R SENYK

condition: psychiatric

condition: radiculopathy

text:
BVA9513000
DOCKET NO.  93-12 782     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Manila,
Philippines

THE ISSUES

Entitlement to service connection for peripheral neuropathy.

Entitlement to service connection for a psychiatric disorder,
to include depressive neurosis and post-traumatic stress
disorder (PTSD).

ATTORNEY FOR THE BOARD

J. F. Gussio, Associate Counsel

INTRODUCTION

The veteran had recognized active service from December 1941
to August 1942 and from August 1945 to June 1946.  He was a
prisoner of war (POW) of the Japanese from April 1942 to
August 1942.

In the substantive appeal received in May 1993, the veteran
claims service connection for post-traumatic arthritis.  This
claim has not been developed for appellate review and is
referred to the RO for appropriate action.

CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends that service connection is warranted for
peripheral neuropathy, a depressive neurosis and PTSD.  He
claims, in effect, that these disorders are a result of his
confinement as a POW.  He asserts that VA examination
revealed depressed mood, which is a symptom of a dysthymic
disorder.

DECISION OF THE BOARD

The Board, in accordance with the provisions of 38 U.S.C.A.
� 7104 (West 1991), has reviewed and considered all of the
evidence and material of record in the veteran's claims file.
Based on its review of the relevant evidence in this matter,
and for the following reasons and bases, it is the decision
of the Board that the veteran's claim for service connection
for a psychiatric disorder, to include depressive neurosis
and PTSD, is not well-grounded.  It is also the decision of
the Board that the evidence supports a grant of service
connection for peripheral neuropathy.

FINDINGS OF FACT

1.  The veteran was a prisoner of war in excess of 30 days.

2.  The veteran�s only diagnosed psychiatric disorder is
senile dementia, which is not shown to be related to service;
neither a dysthymic disorder nor PTSD has been diagnosed.

3.  The veteran has peripheral neuropathy with
electrodiagnostic studies indicative of partial active
denervation involving muscles of the left upper and both
lower limbs.

CONCLUSIONS OF LAW

1.  The veteran has not presented evidence of a well-grounded
claim for service connection for a psychiatric disorder, to
include a depressive neurosis and PTSD.  38 U.S.C.A. �� 1110,
1112, 1113, 5107(a); (West 1991); 38 C.F.R. �� 3.303, 3.304,
3.307, 3.309.  (1994).

2.  The veteran�s peripheral neuropathy is presumed to have
been incurred in service. 38 U.S.C.A. �� 1110, 1112, 1113,
5107(b); (West 1991); 38 C.F.R. � 3.307, 3.309 (1994).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

I.  Service Connection for a Psychiatric Disorder

It is the burden of a claimant to present evidence of a well-
grounded claim.  If the claim is not well grounded, the
appeal must fail; and there is no VA duty to assist the
claimant because such additional development would be futile.
38 U.S.C.A. � 5107 (a)(West 1991).

To establish service connection, it must be shown that the
claimed disorder exists and was incurred in or aggravated by
active military service or is secondary to a service-
connected disability.  38 U.S.C.A. � 1110 (West 1991); 38
C.F.R. �� 3.303, 3.310(a).  Service connection is warranted
for depressive neurosis or anxiety state if either becomes
manifest to a degree of 10 percent in a former prisoner of
war who was detained or interned for not less than 30 days.
38 U.S.C.A. �� 1112, 1113 (West 1991); 38 C.F.R. �� 3.307,
3.309 (1994).

Service connection for PTSD requires medical evidence
establishing a clear diagnosis of the condition, credible
supporting evidence that the claimed inservice stressor
actually occurred, and a link, established by medical
evidence, between current symptomatology and the claimed
inservice stressor.  If the claimed stressor is related to
combat, service department evidence that the veteran engaged
in combat or that the veteran was awarded the Purple Heart,
Combat Infantry Badge, or similar combat citation will be
accepted, in the absence of evidence to the contrary, as
conclusive evidence of the claimed inservice stressor.
38 C.F.R. � 3.304(f) (1994).

The veteran's service medical records, including a report of
his hospitalization in September 1942 and the report of an
examination in August 1945 and a processing affidavit dated
in October 1945, contain no mention of treatment for or
diagnosis of a psychiatric disorder.

On VA Former POW protocol examination, completed in September
1990, the veteran reported that he was unable to sleep during
captivity due to fear and anxiety.  It was checked that he
witnessed beatings and physical torture and experienced
psychological torture and was unable to function or work due
to psychological or emotional distress.  Psychological
evaluation revealed signs of senility.  No psychiatric
diagnosis was given.

On VA Former POW protocol examination, in February 1992, the
veteran again reported experiencing anxiety and fear in
service.  He also reported that he participated in the "Death
March" and witnessed thousands of soldiers dying due to
hunger and disease.  On the VA neuropsychiatric examination,
depressed mood was noted.   The veteran displayed psychomotor
retardation, slurring of speech, poor attention, blunted
affect and disorientation.  Senile dementia was diagnosed.

The threshold question here is whether the claim for service
connection for a psychiatric disorder is well-grounded.  For
a claim for service connection to be well-grounded, there
must be evidence that the claimed disorder exists and
evidence of a nexus between the existing disorder and service
or a service connected disability.  The veteran claims that
service connection for a psychiatric disorder is warranted
because his psychiatric disorder is either a dysthymic
disorder or an anxiety state (which would be service
connected on a presumptive basis) or is PTSD (resulting from
the stressors associated with being a prisoner of war).  It
is not in dispute that if the veteran was found to be
suffering from a dysthymic disorder or anxiety state he would
be entitled to the presumptions for those disorders afforded
to former POWs.  Nor is there any question that he was
subjected to stressful events during his incarceration as a
POW (although it is noteworthy that during the interim
between those experiences and his return to active duty in
1945, he served the Japanese in the Philippine Constabulary).
There is, however, no competent evidence supporting his
assertion that his psychiatric disorder is a dysthymic
disorder (depressive neurosis), an anxiety state, or PTSD.
No such disorder has been diagnosed.  As a layperson, the
veteran is not competent to establish such diagnosis.  As
none of these disorders is shown present, the claim for
service connection for a psychiatric disorder based on the
theory that the veteran�s psychiatric disorder is one of
these three disorders is not well grounded.

The veteran�s diagnosed psychiatric disability is senile
dementia.  By definition this is related to the aging process
and there is no evidence of a nexus between this disorder and
service.  In the absence of a nexus between senile dementia
and service, a claim for service connection for this disorder
is, likewise, not well-grounded.

II.  Service Connection for Peripheral Neuropathy

The veteran's claim for service connection for peripheral
neuropathy is well grounded within the meaning of 38 U.S.C.A.
� 5107(a) (1991).  That is, he has presented a claim which is
plausible.  The Board is satisfied that all relevant facts
have been properly developed.  No further assistance to the
veteran is required in order to comply with the duty to
assist him as mandated by 38 U.S.C.A. � 5107(a) (West 1991).

If peripheral neuropathy, which is not shown to be due to
infectious disease becomes manifest to a degree of 10 percent
in a former POW who was detained or interned for not less
than 30 days, it is presumed to have been incurred in
service.  38 U.S.C.A. �� 1112, 1113 (West 1991); 38 C.F.R.
�� 3.307, 3.309. (1994).

As is noted above, the veteran was a prisoner of war of the
Japanese from April to August 1942.  On VA examination in
June 1992, the veteran complained of numbness in both hands
and swelling of both lower extremities.  While physical
evaluation of the upper and lower extremities was essentially
normal, with only subjective complaints reported,
electrodiagnostic studies which were ordered in conjunction
with the examination were much more revealing.  EMG studies
were interpreted as showing evidence of chronic neuropathic
changes indicative of a partial active denervation process
involving muscles of the left upper and both lower limbs.
Nerve conduction studies produced findings consistent with a
distal symmetrical sensorimotor polyneuropathy, involving
sural, peroneal, tibial, ulnar and median nerves (with
complete failure in motor conduction of the left common
peroneal).

It is noteworthy that with several of the nerves in which
polyneuropathy is shown here, i.e., common peroneal, median,
only mild incomplete paralysis, neuritis or neuralgia needs
to be shown to warrant a compensable rating.  Based on the
electrodiagnostic studies, including complete motor
conduction failure in the left common peroneal,  the
veteran�s peripheral polyneuropathy would clearly warrant a
compensable evaluation.  There is no indication that the
peripheral polyneuropathy is directly attributable to
infectious causes.  According the veteran the POW presumption
to which he is entitled under 38 U.S.C.A. �� 1112, 1113,
(West 1991); 38 C.F.R. ��  3.307, 3.309 (1994), the Board
concludes that service connection for peripheral neuropathy
is warranted.

ORDER

The veteran's claim for service connection for a psychiatric
disorder, to include depressive neurosis and PTSD, is
dismissed.

Service connection for peripheral neuropathy is granted.

          GEORGE R. SENYK
          Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, � 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. � 7266 (West
1991), a decision of the Board of Veterans' Appeals granting
less than the complete benefit, or benefits, sought on appeal
is appealable to the United States Court of Veterans Appeals
within 120 days from the date of mailing of notice of the
decision, provided that a Notice of Disagreement concerning
an issue which was before the Board was filed with the agency
of original jurisdiction on or after November 18, 1988.
Veterans' Judicial Review Act, Pub. L. No. 100-687, � 402
(1988).  The date which appears on the face of this decision
constitutes the date of mailing and the copy of this decision
which you have received is your notice of the action taken on
your appeal by the Board of Veterans' Appeals.


text:
Decision Date: 07/31/95				Archive Date:
08/03/95
DOCKET NO.  93-21 897	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Chicago,
Illinois

THE ISSUE

Entitlement to service connection for a psychiatric disorder
to include generalized anxiety disorder.

ATTORNEY FOR THE BOARD

D. B. Weiss, Associate Counsel
INTRODUCTION

The veteran had active military service from May 1948 to May
1952.

CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends, in a January 1993 letter, that 2
phosphorous bombs were accidentally dropped near his
quarters by the Air Force between July and September 1950.
Thereafter, he says, he began to experience symptoms
including gastric discomfort, nervousness, headaches, etc.,
for which he was treated.  He acknowledges that the only
service record reflecting nervousness is dated in October
1950, but feels that earlier relevant records were
destroyed, as well as some later records.  He recognizes
that he is not qualified to say whether the accidental
bombing caused his symptoms, but is confident that they
began in service.  He asks for an independent review of his
records by a psychiatrist or for a medical evaluation.

In his substantive appeal, the veteran describes having a
chronic nervous condition including an anxiety disorder with
panic attacks.  He asserts that its symptoms persisted from
service and required almost constant treatment since then.
He adds that the debilitation from these symptoms grew over
the years until he was forced to retire early due to an
inability to work with the symptoms.

DECISION OF THE BOARD

The Board of Veterans' Appeals (Board), in accordance with
the provisions of 38 U.S.C.A. � 7104 (West 1991), has
reviewed and considered all of the evidence and material of
record in the veteran's claims file.  Based on its review of
the relevant evidence in this matter, and for the following
reasons and bases, it is the decision of the Board that the
preponderance of the evidence is against the claim.

FINDINGS OF FACT

1.  A chronic psychiatric disorder was not manifested in
service, and the veteran's current psychiatric disorder is
not shown to be related to service.

2.  This case does not present a question of medical
complexity or controversy.

CONCLUSIONS OF LAW

1.  A psychiatric disorder, including generalized anxiety
disorder, was not incurred in or aggravated by service.  38
U.S.C.A. �� 1110, 1131, 5107 (West 1991); 38 C.F.R. � 3.303
(1994).

2.  An independent medical expert's opinion as to any part
of this claim is not warranted.  38 U.S.C.A. � 7109 (West
1991).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

Initially, the Board notes that the provisions of 38
U.S.C.A. � 5107 have been met, in that the claim is well
grounded and adequately developed.  The Board has considered
the request for a VA examination.  However, after careful
review of the record, the Board determines that the current
evidence of record is adequate to render a determination on
this claim without the necessity of a remand for duty to
assist purposes.  The request for an independent medical
expert's opinion will be addressed below.

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.

Service connection connotes many factors but basically it
means that the facts, shown by evidence, establish that a
particular injury or disease resulting in disability was
incurred coincident with service in the Armed Forces.  This
may be accomplished by affirmatively showing inception or
aggravation during service or through the application of
statutory presumptions.  Each disabling condition shown by a
veteran's service records, or for which he seeks service
connection must be considered on the basis of the places,
types and circumstances of his service as shown by service
records, the official history of each organization in which
he served, his medical records and all pertinent medical and
lay evidence.  Determinations as to service connection will
be based on review of the entire evidence of record, with
due consideration to the policy of the Department of
Veterans Affairs (VA) to administer the law under a broad
and liberal interpretation consistent with the facts in each
individual case.  38 C.F.R. � 3.303(a).

With a chronic disease shown as such in service (or within
an applicable presumptive period), subsequent manifestations
of the same chronic disease at any later date are service
connected unless clearly attributable to intercurrent cause.
For the showing of chronic disease in service, 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," is required.
Continuity of symptomatology is required only where the
condition noted during service (or in the presumptive
period) is not, in fact, shown to be chronic or where the
diagnosis of chronicity may be legitimately questioned.
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).

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).

Where a veteran served for 90 days or more during a period
of war or during peacetime, and a psychosis develops to a
degree of 10 percent or more within one year from date of
service separation, then such disease may be service
connected even though there is no evidence of such disease
in service.  This presumption is rebuttable by affirmative
evidence to the contrary.  38 U.S.C.A. �� 1101, 1112, 1113,
1137 (West 1991); 38 C.F.R. �� 3.307, 3.309 (1994).

At the enlistment medical examination in May 1948, the
veteran's neuropsychiatric system was described as normal.
In October 1950, he was treated for a furuncle.  He
complained later that month of feeling nervous inside with
intermittent chills but no fever.  A few days later, he
reported that he felt better but had an itch from what the
examiner described as scabitic lesions on his trunk, elbow,
and forearms.  In November 1950, he was treated for
dermatitis, erythema, and papular areas on several
occasions.  In November 1950, he complained of tiredness of
his eyes, headache, and inability to get to sleep, but
reported that no particular problems were worrying him.  At
separation examination in May 1952, the veteran's
psychiatric system was described as normal.

The veteran has also submitted records from the Office of
the Surgeon General which confirm that he was treated for
erythema in November 1950, as well as sick reports of his
service organization which confirm that he was the subject
of such reports on numerous occasions in October and
November 1950.

The veteran has submitted copies of his private medical
records beginning in 1955.  The earliest notation of
symptoms he feels to be relevant, as indicated by his
highlighting of same, is dated in January 1956, when he
complained of feeling that he was getting the flu, losing
his appetite, aching all over, and having pains in his
chest, shortness of breath (SOB) and a raw throat.  The
impression was mild upper respiratory infection ("URI").  He
complained of similar symptoms with a feeling of drowsiness
in October 1956, when the impression was nonfollicular
tonsillitis.  In May 1957, the veteran complained of
tiredness, his legs feeling weak, a crazy feeling in his
head, his eyes not focusing right, a toothache, nervousness,
and tender, swollen gums.  Follow-up notes indicate that he
had a tooth pulled.  In August 1957, he underwent a blood
test for marriage.

In April 1960, the veteran complained of feeling nervousness
of 3 days' duration, trembling, head pain, dizziness, and
sleeplessnsss, among other symptoms.  Later the same month,
he was referred to A. Greditzer, M.D., a psychiatrist.  Dr.
Greditzer's notes of an April 1960 office visit show that
the chief complaint was of having nerve trouble of 3 weeks'
duration.  The veteran's relevant past history included
having always been "nervous" and a "momma's boy," and having
had marital difficulties with religious differences between
his wife and his own family.  One month before, his wife's
sister's husband had had a "nervous breakdown," at which
time he professed his love for the veteran's wife.  Although
the veteran felt that his wife did not participate in this,
he had nagging doubts.  Since that time he had had
increasing depressive symptoms, loss of interest and
spontaneity, withdrawal, decreased energy, and loss of
appetite.  On mental status examination, he was obviously
tense and depressed.  The impression was of depressive
reaction in a passive dependent character, rule out
impending psychiatric break of a schizophrenic nature.

Dr. Greditzer advised in a May 1960 letter to the veteran's
family physician, L. T. Basch, M.D., that the veteran's past
history indicated that he had always been a rather
introverted, passive, dependent man who was closely attached
to his own family and keenly felt marital responsibilities.
He had been advised not to spend time alone with his
children since it made him nervous.  The differential
diagnosis was said to include a depressive reaction with
possibly the beginning of more serious disorganization.

At Dr. Greditzer's recommendation, the veteran was seen by
another private psychiatric care provider in May 1960, when
he gave a similar history including the episode involving
his brother-in-law.  He added that for the past several
years he had had spells of SOB, associated with palpitations
and an apprehensive feeling.  He said he had crazy thoughts
flashing through his own mind after reading about some
horrible incident in the paper.  He had felt life was not
worth living.  The differential diagnoses were manic
depressive disease with considerable anxiety and symptoms of
obsessions, or anxiety reaction with secondary depression
(inadequate personality).  Later the same month, the veteran
reiterated that his symptoms were of several years'
duration.  It was determined that he had an anxiety
neurosis, not an hysteria.  He continued treatment and was
discharged in July 1960, after the assurance that he could
return to treatment if he ever felt that he could not handle
his nerves himself.

The veteran has submitted private medical records which
essentially indicate that since 1960, he has intermittently
received treatment for a chronic psychoneurosis, variously
characterized.  A May 1989 letter from M. Houston, M.D., of
the Carbondale Clinic, indicated that the clinical diagnosis
was chronic anxiety disorder with panic attacks.  A
psychiatric consultation by Y. Modali, M.D., in April 1991
reflected a complaint of panic attacks of 10-12 years'
duration.  A disability examination in June 1991 by H. Lyle,
Jr., M.D., revealed the veteran's pertinent history of
feeling generally well until 1987, when he was at work and
had an episode of feeling nervous, with palpitations and
tachycardia.  He had been referred to a local hospital,
where it was determined that he had had a panic attack, and
that he needed hypertension treatment.  After Dr. Lyle's
examination, the pertinent impression was anxiety state with
panic disorder.  A consultation by Dr. Modali in July 1992
reflected an impression of generalized anxiety disorder with
panic attacks, which seemed to get worse under stress.  Dr.
Modali indicated that the veteran said that he had had
relevant symptoms since being in the Air Force.

The veteran has submitted evidence of his having taken an
early retirement due to his psychiatric condition.  Also, L.
T. Basch, M.D., submitted a statement in May 1993 to the
effect that he had treated the veteran from 1955 to 1979,
during which he was treated for recurrent episodes of
anxiety, depression, and obsessive symptoms, for which a
referral to Dr. Greditzer had been made in 1960.  Dr.
Houston advised in May 1993 that he had treated the veteran
for 10 years, and that a panic/anxiety disorder had been
present since the inception of the treatment.

J. Basola, the veteran's sister, advised in May 1993 that,
although she was too young to be able to recall this
personally, it was known in her family that her brother
changed while in service, coming out a nervous person and a
chronic worrier, which problems had persisted since service.
G. Wooden advised in May 1993 that the veteran had been
"aggravated with a nervous condition" since his service, due
in part to bombs exploding near his quarters.

The Board has reviewed the relevant evidence.  It
essentially shows that the veteran complained one time of
nervousness in service, that no psychiatric disorder was
diagnosed, and that the psychiatric diagnosis at separation
was normal.  There was no finding that skin or other
physical manifestations in service represented
psychoneurotic signs or symptoms, there is no objective
evidence that service medical records are missing, and there
is no objective evidence of 2 bombs exploding near the
veteran's quarters.  It was not until 1960, years after
separation, that a chronic psychiatric disorder was first
diagnosed, by Dr. Greditzer.  This diagnosis has been
variously characterized over the years as different types of
psychoneurosis, and has never been linked by medical
evidence to the service years.

The Board recognizes that at the time the veteran initiated
psychiatric treatment in 1960, he gave, intermittently, a
history of pertinent symptoms of several years' duration.
However, at no time did he give a history of symptoms going
back nearly 8 years, or any other history which would
effectively have placed the symptoms' onset during service.
Nor did he complain of his service having been a stressful
time in his life, but rather referred to marriage and
children as stresses.  Also, the first time that medical
records indicate that any complaint of the veteran's was
viewed as psychiatric in nature was after the time of his
blood test for marriage in 1957.  While a psychiatric
consultation by Dr. Modali in July 1992 reflected a
complaint of panic attacks since service, this history,
remote from the onset of symptoms, is far less probative
than the contemporaneous records.  It is also noted that the
veteran had previously told Dr. Modali, in April 1991, that
his complaint was of panic attacks of 10-12 years' duration.

Based on the evidence discussed above, it is clear that
service connection for a psychiatric disorder asserted to
have begun in service and continued since service cannot be
granted.  A psychiatric disorder was not shown in service,
but was first shown years after service.  Thus, continuity
and chronicity of symptomatology is not shown, as required
by VA regulation, to permit service connection for a
psychiatric disorder.  38 C.F.R. � 3.303(b).  The Board
bears in mind that 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).
However, in this case, all of the evidence, including that
pertinent to service, does not establish that a chronic
psychiatric disorder was incurred in service, but, rather,
shows rather conclusively that one developed years after
service.

This conclusion would be inevitable even if the Board
agreed, arguendo, with the veteran's arguments that URI
symptoms in 1956, years after service, were, in fact,
symptoms of a psychiatric disorder.  The Board also notes
that Dr. Basch's 1993 statement that he had treated the
veteran from 1955 does not indicate that a psychiatric
disorder was present in 1955, and that, even if Dr. Basch
intended his statement to have such a meaning, this would
still place the onset of a psychiatric disorder years after
service.

At one time the veteran was suspected to have a psychosis,
manic depressive disorder, but this possibility was
discounted, and a psychosis was never clearly shown.  Thus,
the provisions pertinent to presumptive service connection
are not for application.  38 U.S.C.A. � 1112, 1113 (West
1991); 38 C.F.R. �� 3.307, 3.309.

The Board has also considered the statement to the effect
that it is well known in the veteran's family that his
mental status was changed by service and the statement that
he was aggravated by a nervous condition beginning in
service.  While the statements are credible evidence, they
are limited in probative value.  They establish only that
the veteran appeared to have nervous difficulty after
service; they are not sufficient to establish that he had "a
particular injury or disease" while in service or that such
disorder is of service origin.  The persons making the
statements are laypersons and are not competent to make such
judgments.  See Espiritu v. Derwinski, 2 Vet.App. 492, 494
(1992); 38 C.F.R. � 3.303(a).  While the statements serve to
bolster the veteran's claim, the ultimate requirement, that
he have had a psychiatric disorder during service, which
persists to the present day, is a requirement met only by
medical evidence, and which cannot be satisfied by lay
evidence.  This requirement, of medical evidence to support
the claim, (which, it is stressed, need not be satisfied by
service medical evidence) has not been met in the instant
case.  See Caluza v. Brown, 7 Vet.App. 498 (1995).

An independent medical opinion was requested in this case.
However, the Board finds that this case does not present a
question of medical complexity or controversy, as there is
no significant disagreement in the medical records, nor are
there any areas of unclarity in those records which call for
expert elucidation.  The preponderance of the evidence is
against the claim.

ORDER

Service connection for a psychiatric disorder is denied.

	GEORGE R. SENYK
	Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, � 6, 108 Stat. 740,
___ (1994), permits a proceeding instituted before the Board
to be assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. � 7266 (West
1991), a decision of the Board of Veterans' Appeals granting
less than the complete benefit, or benefits, sought on
appeal is appealable to the United States Court of Veterans
Appeals within 120 days from the date of mailing of notice
of the decision, provided that a Notice of Disagreement
concerning an issue which was before the Board was filed
with the agency of original jurisdiction on or after
November 18, 1988.  Veterans' Judicial Review Act, Pub. L.
No. 100-687, � 402 (1988).  The date which appears on the
face of this decision constitutes the date of mailing and
the copy of this decision which you have received is your
notice of the action taken on your appeal by the Board of
Veterans' Appeals.

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