disposition: granted

text:
BVA9423000
DOCKET NO.  91-48 221     )       DATE
          )
          )

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

THE ISSUES

1.  Entitlement to service connection for low back disability.

2.  Entitlement to service connection for gastrointestinal
disability on a secondary basis.

3.  Entitlement to an increased rating for sarcoidosis, currently
rated as 30 percent disabling.

4.  Entitlement to an increased rating for normochromic,
normocytic anemia, currently rated as 30 percent disabling.

REPRESENTATION

Appellant represented by: The American Legion

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

Michael P. Vander Meer, Associate Counsel

INTRODUCTION

The veteran served on active duty from July 1974 to July 1977,
and from July 1977 to October 1988.

This appeal arises from rating decisions of the Department of
Veterans Affairs (VA) Regional Office (RO) in Nashville,
Tennessee.  This case was last before the Board of Veterans'
Appeals (Board) in June 1992, at which time it was remanded for
further development.

In response to the June 1992 remand, a rating decision entered in
April 1993 denied secondary service connection for
gastrointestinal disability.  Such issue was included in a
Supplemental Statement of the Case mailed to the veteran the same
month, and a substantive appeal relative to this issue was
received from the veteran in May 1993.  Accordingly, this issue,
the second issue listed on the title page, is included in the
present appeal.

As pertinent to the issue of entitlement to an increased rating
for sarcoidosis, evaluated as 10 percent disabling when this case
was last before the Board in June 1992, it is noted that a rating
decision entered in June 1994 increased the evaluation for the
veteran's service-connected sarcoidosis from 10 percent disabling
to 30 percent disabling, with which latter evaluation the veteran
has continued to disagree.  Accordingly, the issue of entitlement
to an increased rating for sarcoidosis, currently rated as 30
percent disabling and comprising the third issue listed on the
title page, remains an issue on appeal.

The appeal was returned to and redocketed at the Board in
September 1994.

For reasons that will become clear below, the issue of
entitlement to service connection for low back disability is
addressed in the decision below.  The remaining issues on appeal
will be addressed in a remand appearing at the end of the
decision.

CONTENTIONS OF APPELLANT ON APPEAL

The veteran states that he injured his back during service, in
late 1986 or early 1987, in the course of attempting to attach an
artillery piece to a truck in the field.  He asserts that,
although he was given Motrin, his back thereafter continued to
bother him.  He states that the foregoing incident does not
appear in his service medical records, since he was not a person
to ride sick call.

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 evidence, with resolution of reasonable doubt in
the veteran's favor, supports service connection for a low back
disability.

FINDING OF FACT

Chronic low back pain resulted from lumbar muscle sprain
experienced during peacetime service.

CONCLUSION OF LAW

Chronic low back pain was incurred during peacetime service.
38 U.S.C.A. �� 1131, 5107 (West 1991); 38 C.F.R. � 3.303(b)
(1993).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Board finds that the veteran's claim for service connection
for low back disability is well grounded within the meaning of
38 U.S.C.A. � 5107(a).  That is, the Board finds that this claim
is plausible.  The Board is also satisfied, with respect to such
claim, that all relevant facts have been properly developed, and
that no further assistance to the veteran is required to comply
with 38 U.S.C.A. � 5107(a).

Under the law, service connection may be granted for a disability
resulting from disease or injury incurred in or aggravated by
service.  38 U.S.C.A. �� 1110, 1131.  However, continuity of
symptomatology is required where a condition noted during service
is not, in fact, shown to be chronic.  38 C.F.R. � 3.303(b).

The veteran contends that he has current disability of the low
back which he attributes to having injured his back in the course
of attempting to attach an artillery piece to a truck in late
1986 or early 1987.  He states that, although the foregoing
incident does not appear in his service medical records, he was
given Motrin in the field.  In this regard, the sole reference in
service medical records to an injury of the back is dated in May
1988, at which time the veteran was seen with a complaint of back
pain of one day's duration in the aftermath of having moved
furniture, and which apparently resolved shortly thereafter.
When examined for service separation purposes in September 1988,
the veteran was noted to be experiencing recurrent low back pain.
Subsequent to service, when hospitalized at a VA facility in
response to other problems in May 1990, the veteran alluded to
having developed low back pain over the previous several years;
the diagnoses included chronic lower back pain.  On VA
examination in April 1991, lumbar motion was limited secondary to
pain; the diagnoses included history of low back pain.  On VA
examination in December 1992, the veteran alluded to having
injured his back when moving an artillery piece in service in
1987; the examination diagnosis was low back strain.  Most
recently, in conjunction with VA examinations pertaining to the
veteran's back in April 1994 and May 1994, the veteran, on each
occasion, alluded to the foregoing inservice artillery piece
lifting mishap.  It was the examiner's impression on the April
1994 examination that the veteran had chronic low back pain and
discomfort which was most likely due to a paralumbosacral muscle
sprain during the period of 1987 and 1988.

In evaluating the foregoing opinion by the VA examiner,
ostensibly relating the veteran's current chronic low back pain
to the artillery piece lifting incident asserted by the veteran
to have occurred, variously, in 1986 or 1987, the Board would
reiterate that service medical records are negative for any
reference to such injury.  At the same time, however, the Board
is cognizant of prior hearing testimony by the veteran in
February 1991 in which he specifically indicated that such
incident is not reflected in service medical records and it is
noted, additionally, that the veteran was experiencing recurrent
low back pain when examined for service separation purposes in
September 1988.  The Board is aware that a chronic low back
disability was not assessed on VA examination in April 1991.
However, the Board is of the opinion that the recent VA
examination diagnosis of chronic low back pain thought to be due
to an inservice muscle sprain in years including 1987, when
considered in conjunction with the veteran's hearing testimony,
the finding of recurrent low back pain at the veteran's
separation from service, and the diagnosis of chronic low back
pain made in the course of the veteran's VA hospitalization less
than two years after service in May 1990, is indicative of
current, chronic low back pain for which sufficient continuity of
symptomatology exists to deem it to be, with favorable resolution
of reasonable doubt, a chronic disability of service origin.
Accordingly, service connection for chronic low back pain is
granted.  38 U.S.C.A. �� 1131, 5107(b); 38 C.F.R. � 3.303(b).

ORDER

Service connection for low back disability is granted.

REMAND

With respect to the veteran's claim for service connection for
gastrointestinal disability on a secondary basis, it is noted
that on VA examination in August 1993 the examiner indicated
that, although liver disease occurs in a majority of people with
sarcoidosis, for which the veteran is service-connected, such
assessment could not be made without performing a liver biopsy.
A December 1993 addendum to the report of the foregoing August
1993 examination indicated that the veteran had an enlarged
spleen and liver, thought to be secondary to alcohol or sarcoid,
though no certain attribution to either origin could be made
without a liver biopsy, which the examiner declined to perform
owing to the risks involved.  Inasmuch as the subsequent record
does not reflect that such liver biopsy has yet been performed,
the Board is of the opinion, given the substantial possibility
that the veteran has an enlarged spleen and/or liver related to
his service-connected sarcoidosis, that further medical
development, to possibly include a liver biopsy, should be
performed before a determination bearing on this aspect of the
appeal is made.

The Board is also of the opinion, relative to the veteran's
claims for increased ratings for anemia and sarcoidosis, that
updated VA examinations, as specified in greater detail below,
bearing on each of the foregoing disabilities should be performed
before an appellate adjudication is rendered.

Accordingly, the case is REMANDED for the following:

1.  The RO should contact the veteran and
request him to identify the names,
addresses, and approximate dates of
treatment for any health care provider(s)
to include any VA medical facility other
than the VA Medical Center in Nashville,
Tennessee, who may possess additional
records pertinent to his claims.
Thereafter, in light of the response
received and after obtaining any necessary
authorization, the RO should take
appropriate action to obtain copies of any
clinical records indicated.  In any event,
the RO should obtain copies of all clinical
records reflecting treatment rendered the
veteran since August 1992 at the VA Medical
Center in Nashville, Tennessee.

2.  Thereafter, the RO should arrange for
the veteran to undergo the following
examinations:

a.  A VA examination by a specialist
in gastroenterology to determine
whether the veteran has an enlarged
spleen and/or liver or other
gastrointestinal disability.  If the
veteran is found to have an enlarged
spleen and/or liver, the examiner is
further requested, after undertaking
any special diagnostic studies, to
specifically include a liver biopsy if
medically appropriate, deemed
necessary and after reviewing the
record to specifically include the
report pertaining to the veteran's
August 1993 gastroenterology
examination and the related December
1993 addendum, to offer an opinion
whether the veteran's enlarged spleen
and/or liver or other gastrointestinal
pathology is at least as likely as not
to be related to his service-connected
sarcoidosis.  It is imperative that
the claims folder be made available to
the examiner for review prior to the
examination.  The rationale for all
opinions expressed should be fully
explained.

b.  A VA examination by a specialist
in pulmonary diseases to determine the
status of the veteran's service-
connected sarcoidosis.  Any special
diagnostic studies, including
pulmonary function testing, deemed
necessary should be performed, and the
claims folder must be made available
to the examiner for review prior to
the examination.

c.  A VA examination by a specialist
in hematology to determine the current
severity of the veteran's service-
connected anemia.  Any special
diagnostic studies deemed necessary
should be performed, and the claims
folder must be made available to the
examiner for review prior to the
examination.

3.  Then, after undertaking any development
deemed necessary in addition to that
specified above, the RO should readjudicate
the issues on appeal.

4.  If the benefits sought on appeal are
not granted to the veteran's satisfaction,
the veteran and his representative should
be provided a Supplemental Statement of the
Case on all issues in appellate status.
The veteran should be provided appropriate
notice of the requirements to perfect an
appeal with respect to any issue addressed
therein which does not appear on the title
page of this decision.

Thereafter, the case should be returned to the Board for further
appellate consideration, if otherwise in order.  In taking this
action, the Board implies no conclusions, either legal or
factual, as to any ultimate outcome warranted.  No action is
required of the veteran until he is notified.

          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.

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.  The above 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)
(1993).


series: legacy

judge_norm: WARREN W RICE, JR

judge_role: Member, Board of Veterans' Appeals

disposition: denied

text:
BVA9413001
DOCKET NO.  92-18 747     )       DATE
          )
          )

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

THE ISSUE

Entitlement to an increased (compensable) evaluation for
postoperative pterygium, bilateral.

ATTORNEY FOR THE BOARD

Nancy R. Kegerreis, Associate Counsel

INTRODUCTION

The veteran served on active duty from October 1953 to September
1955.

This matter comes before the Board of Veterans' Appeals (Board)
from a March 1992 rating decision by the Department of Veterans'
Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico, which
denied an increased evaluation for postoperative pterygium,
bilateral condition.

CONTENTIONS

The veteran contends, essentially, that his eyesight has become
worse, as sometimes he can see better with one eye than with the
other.  He states that he feels pressure and discomfort in his
left eye and that both eyes remain red and tear a lot.  He
reported that he was to have additional eye surgery on the left
eye.

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 preponderance of the evidence is against the
veteran's claim for an increased evaluation for postoperative
residuals of pterygia of both eyes.

FINDINGS OF FACT

1.  All relevant evidence necessary for an equitable disposition
of the appeal has been obtained.

2.  The veteran has mild macular pigmentation and bilateral nasal
pterygia.

3.  The veteran's postoperative visual acuity in both eyes is
20/25 with correction.

CONCLUSION OF LAW

The criteria for a compensable disability rating for bilateral
pterygia have not been met.  38 U.S.C.A. �� 1155, 5107(a) (West
1991); 38 C.F.R. �� 3.102, 4.1-4.14, 4.75, 4.83a , Diagnostic
Code 6034 (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The veteran has been rated for postoperative pterygium at a
noncompensable evaluation, effective from September 1986.
Pterygia of both eyes, which were determined to have existed
prior to entry, were diagnosed in service, and in 1957 he had
surgery for removal of the right eye pterygium.  In May 1991, the
veteran requested a review of his claim, contending that his
condition had worsened and that he merited a higher evaluation.
He had had an optometry examination in 1989, which revealed that
he had previously had pterygia removed from both eyes, but that
at that time he was in good ocular health.

A September 1991 eye examination noted that the veteran had had a
history of three operations on his eyes for pterygia.
Examination of visual acuity found that both eyes tested 20/25
with correction.  Nasal conjunctival fold and a mild bilateral
macula pigmentation were noted.  The relevant assessment was
pterygium of both eyes.

The veteran stated in his appeal that he was scheduled for left
eye surgery in July 1992.  It is not known whether the veteran
did have this surgery, as he failed to report for his hearing
which had been scheduled in September 1992.  Under the
circumstances, however, the Board is not persuaded that further
surgery for this disorder would have changed the degree of visual
acuity previously determined.

Disability evaluations are based upon the average impairment of
earning capacity as contemplated by a schedule for rating
disabilities.  38 U.S.C.A. � 1155 (West 1991); 38 C.F.R. �� 4.1,
4.2 (1993).  Regulations provide that each disability be
evaluated in light of the veteran's medical and employment
history, and from the point of view of the veteran's working or
seeking work.  Schafrath v. Derwinski, 1 Vet.App. 589, 592
(1991).

The veteran's eye disorder is evaluated under 38 C.F.R. � 4.84a,
the schedule of ratings for diseases of the eye.  Pursuant to
this regulation, pterygium is rated under Diagnostic Code 6034,
which is referable to � 4.83, impairment of central visual
acuity.  To determine the percentage evaluation allowable for a
loss of visual acuity, one must refer, in turn, to a chart which
provides for an evaluation which combines the degree of visual
acuity of both eyes in order to provide an overall assessment.
For a compensable evaluation of 10 percent, visual impairment
must show, at the minimum, a 20/50 measurement in one eye and
20/40 in the other, when compared to the chart.  The veteran's
eyesight, however, measured 20/25 in both eyes, thus resulting in
a noncompensable evaluation.

The Board has been mindful of the doctrine of reasonable doubt,
but the facts of this case and the regulations which must be
applied afford no basis for the application of this regulation.
The preponderance of the evidence is against the claim for an
increased schedular rating.  Accordingly, an increased evaluation
is not warranted.  The Board has also considered an extra-
schedular compensable evaluation, but finds that this case does
not present such an exceptional or unusual disability picture
with such related factors as marked interference with employment
or frequent periods of hospitalization as to render impractical
the application of the regular schedular standards.  Accordingly,
a compensable evaluation on this basis is not warranted.  See 38
C.F.R. �� 3.321(b).

ORDER

Entitlement to an increased (compensable) evaluation for
postoperative pterygium, bilateral, is denied.

          WARREN W. RICE, JR.
          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: JACQUELINE E MONROE

condition: hypertension

condition: respiratory

condition: psychiatric

text:
BVA9414001
DOCKET NO.  90-18 602     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Detroit,
Michigan

THE ISSUES

Entitlement to service connection for hypertension.

Entitlement to service connection for residuals of a shrapnel
wound to the chest, to include a chronic lung disorder.

Entitlement to service connection for an acquired psychiatric
disorder.

Entitlement to service connection for a left leg and ankle
disorder.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

Michael Martin, Associate Counsel

INTRODUCTION

The veteran had active service from June 1943 to October 1945.

In November 1990, the Board of Veterans' Appeals (Board) denied
each of the claims listed above.  The veteran appealed to the
United States Court of Veterans Appeals (Court).  In September
1992, the Court vacated the November 1990 decision and remanded
the case to the Board for compliance with instructions contained
in a motion for remand submitted to the Court by the Secretary of
Veterans Affairs.

In April 1993, the Board remanded the case to the Department of
Veterans Affairs (VA) Detroit, Michigan, Regional Office (RO) for
additional development.  The RO accomplished the requested
development to the extent possible, and the case has now been
returned to the Board for further appellate review.

CONTENTIONS

The veteran contends that the RO made a mistake by denying his
claim for service connection for hypertension.  The veteran
asserts that he was treated for high blood pressure in 1945 at
Camp Cooke in California.

The veteran also contends that the RO made a mistake by denying
his claim for service connection for residuals of a shrapnel
wound to the chest, to include a chronic lung disorder.  He
asserts that he was wounded in January 1944 just prior to
crossing the Rhine river.  He states that there is still a piece
of shrapnel in his chest.  He believes that the wound has caused
lung problems such as infections and emphysema.

The veteran further contends that the RO made a mistake by
denying his claim for service connection for an acquired
psychiatric disorder.  He asserts that he was treated for a
nervous condition from 1945 to the present time at the VA Medical
Center at Saginaw, Michigan.

Finally, the veteran contends that the RO made a mistake by
denying his claim for service connection for a left leg and ankle
disorder.  He asserts that he broke his ankle in August 1945 and
was treated at a field hospital in Germany.  He states that he
was wearing a cast on his left leg at the time he was discharged,
and that the cast was later removed at the VAMC in Saginaw,
Michigan.

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 preponderance of the evidence is against each of
the veteran's claims.

FINDINGS OF FACT

1.  Hypertension was not present during service and was not
manifest to a compensable degree within one year after separation
from service.

2.  Residuals of a shrapnel wound to the chest, to include a
chronic lung disorder, were not present during service.

3.  An acquired psychiatric disorder was not present during
service.

4.  The veteran does not have a left leg and ankle disorder which
is attributable to an in-service injury.

CONCLUSIONS OF LAW

1.  Hypertension was not incurred in or aggravated by service,
and may not be presumed to have been incurred in service.  38
U.S.C.A. �� 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 1991);
38 C.F.R. �� 3.307, 3.309 (1993).

2.  Residuals of a shrapnel wound to the chest, to include a
chronic lung disorder, were not incurred in or aggravated by
service.  38 U.S.C.A. �� 1110, 5107 (West 1991); 38 C.F.R.
�� 3.303, 3.304 (1993).

3.  An acquired psychiatric disorder was not incurred in or
aggravated by service.  38 U.S.C.A. �� 1110, 5107 (West 1991); 38
C.F.R. �� 3.303, 3.304 (1993).

4.  A left leg and ankle disorder was not incurred in or
aggravated by service.  38 U.S.C.A. �� 1110, 5107 (West 1991); 38
C.F.R. �� 3.303, 3.304 (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Board has found that the veteran's claims are "well-grounded"
within the meaning of 38 U.S.C.A. � 5107(a) (1993).  That is, his
claims are not inherently implausible.  The Board is also
satisfied that all relevant facts have been properly developed.
The veteran's service medical records are not available as they
were apparently destroyed by fire.  Searches of alternative
sources of service records, such as records from the Surgeon
General's Office and morning reports, yielded no information
pertaining to the veteran.  All available post-service medical
treatment records have been obtained.  Although the veteran
reported that he had been treated at a Hospital in Fremont,
Michigan, and at the VA Medical Center (VAMC) in Saginaw,
Michigan, during the 1940's and early 1950's, attempts to locate
such records were not successful.  A disability evaluation
examination was scheduled; however, the veteran reported that he
could not appear for the examination due to the poor state of his
health.  The veteran has declined the opportunity to have a
hearing.  The Board knows of no additional relevant evidence
which is available.  Therefore, no further assistance to the
veteran with the development of evidence is required.

I.  Entitlement to Service Connection for Hypertension.

Service connection may be granted for disability shown to be due
to disease or injury incurred in or aggravated by wartime
service.  See 38 U.S.C.A. � 1110 (West 1991).  Hypertension which
is manifest to a compensable degree within one year after
separation from service may be presumed to have been incurred in
service.  See 38 U.S.C.A. �� 1101, 1112, 1113, 1137 (West 1991);
38 C.F.R. � 3.307, 3.309 (1993).

The veteran has not presented any evidence showing that
hypertension was present during service or was manifest to a
compensable degree within one year after service.  The earliest
medical record which has been presented is a VA hospital
discharge summary dated in January 1959, over thirteen years
after the veteran's separation from service.  The summary shows
that examination revealed that the veteran's blood pressure
reading was only 128/76.  The diagnoses did not include
hypertension.

Although more recent medical records, such as VA and private
medical records dated in the 1980's, show that the veteran has
been treated for cardiovascular disorders including hypertension
and heart disease, those records do not contain any indication
that the disorders are related to the veteran's period of active
service.

Thus, there is no evidence linking the veteran's current
hypertension to his period of service.  For the foregoing
reasons, the Board finds that hypertension was not present during
service and was not manifest to a compensable degree within one
year after separation from service.  Accordingly, the Board
concludes that hypertension was not incurred in or aggravated by
service, and may not be presumed to have been incurred in
service.

II.  Entitlement to Service Connection for Residuals of a
Shrapnel Wound
to the Chest, to include a Chronic Lung Disorder.

The veteran contends that he was wounded in January 1944 just
prior to crossing the Rhine river.  He states that there is still
a piece of shrapnel in his chest.  He believes that the wound has
caused lung problems such as infections and emphysema.

The veteran's WD AGO 53-55 shows that his awards and decorations
did not include the Purple Heart.  Furthermore, under a section
of the document titled "wounds received in action," the word
"none" was entered.

None of the veteran's post-service medical records contain a
history given by the veteran of having received a shrapnel wound.
A VA hospital discharge summary dated in January 1959 shows that
while being treated for a nosebleed, the veteran gave a history
of having an automobile accident in 1957 in which he sustained a
head injury and some broken ribs.  An chest X-ray taken at that
time was interpreted as showing evidence of fractures.  The
record contains no references to shrapnel wounds to the chest or
X-ray evidence of shrapnel retained in the chest.

A private medical record dated in March 1970 also contains a
history which does not support the veteran's contentions.  The
record shows that, while being treated for an injury to his
abdominal muscles, the veteran stated that he had the usual
childhood diseases, but no previous surgery or injury.  He gave a
history of having had bilateral pleural effusion in 1954 or 1955
which was related to welding tanks which had previously been used
for penicillin cultures.  A private medical record dated in
December 1971 contains the same history that is contained in the
March 1970 record.  The Board notes that the veteran's history of
having no previous surgery or injury is contrary to his current
claim of having been wounded during service.  Furthermore, the
veteran's history of having a lung problem which was due to on-
the-job exposure to an infectious agent post-service is contrary
to his current contention of having developed chronic lung
infections due to a wound in service.  The Board notes that the
histories contained in the March 1970 record were given for the
purpose of obtaining medical treatment and are, therefore,
thought to be of greater probative value than histories given in
support of a claim for monetary benefits.

The veteran was afforded a disability evaluation examination in
March 1972.  The report does not contain any references to
shrapnel wounds.  An X-ray of the veteran's chest was interpreted
as revealing bilateral pleurisy.  The X-ray report, however, did
not contain any mention of a retained piece of shrapnel.  Thus,
the disability evaluation report also goes against the veteran's
contentions.

The veteran filed a claim for disability compensation in April
1985.  In his claim form, he stated that he had developed severe
pneumonia and lung congestion in 1944.  He did not, however, make
any mention of having received a shrapnel wound during service.
Similarly, a report of accidental injury prepared by the veteran
in July 1985 shows that the veteran stated that in 1944 he
developed pneumonia in Germany.  Again, he made no mention of
having received a chest wound.  With regard to the history of
developing a lung infection during service, the Board again notes
that such a contention is contrary to the more credible history
contained in the veteran's medical treatment records.

The evidence which was obtained at that time includes a private
medical record dated in June 1982 which shows that the veteran
underwent a triple coronary bypass surgery.  Associated with the
record are reports of three X-rays of the veteran's chest which
were taken in June 1982.  The X-ray interpretation reports do not
contain any indication that metal fragments were present in the
veteran's chest.

A private medical record dated in October 1984 shows that the
veteran was seen for evaluation of S/P bypass surgery and chronic
obstructive pulmonary disease.  The report shows that the veteran
gave a history of being short of breath since 1951.  He stated
that he used to work for Dow Chemical cleaning tanks which
contained mold and other things.  One day he fainted in one of
the tanks and was taken to a hospital where he was found to have
fluid in his lungs.  He reported that he was hospitalized for
about 3-4 weeks at that time.  He stated that since that time he
had been short of breath on exertion.  The report includes a
summary of the veteran's past medical history including fracture
of the ribs on the left side, fracture of the left shoulder, four
stomach surgeries in 1969 due to being hit by a bulldozer, a
skull surgery at age 10 due to a car accident, a fractured
vertebrae in the neck due to an automobile accident two years
earlier, a pleural effusion for which he was hospitalized, and a
blood clot in the right leg in 1975.  It was also noted that the
veteran had smoked cigarettes for 35 years.  The Board notes that
the history contained in this report again is contrary to the
veteran's current contentions.  The record contains no mention of
the veteran having had either a shrapnel wound to the chest or
any type of lung infection during service.

The report also shows that an X-ray of the veteran's chest was
interpreted as revealing features compatible with pulmonary
emphysema, metallic sutures in the sternal area from a previous
thoracotomy, and a metal object like a pellet or bullet in the
right hilar area.  The report does not contain any indication
that the metal object, which was first noted approximately 40
years after service, was related to service.  The same metallic
object is also noted in a VA X-ray report dated in November 1986.
Again, however, there is no medical opinion relating the finding
to service.

The first time that the veteran gave a history of having received
a shrapnel wound to the chest was in a claim for VA compensation
benefits submitted in June 1987.  The veteran has presented
written statements from two persons who state that they were in
service with the veteran and that they recalled that the veteran
was injured.  The statements are vague with regard to the nature
of the injury.  In a statement dated in July 1989, one of the
witnesses stated that he helped the veteran get into a jeep after
the veteran was wounded with blood on his shirt.  In a statement
dated in October 1989, the other witness stated simply that the
veteran was "injured" and had to be helped into a vehicle.

The veteran's own statements and the lay statements which he has
submitted are of lesser probative value as they were prepared
many years after the veteran's separation from service at a time
when memories may have become faded or distorted.  Also, because
the statements were prepared for the purpose of obtaining
compensation, they are not objective.  On the other hand, the
service personnel record which does not indicate that the veteran
was wounded and shows that he did not receive the Purple Heart is
a record contemporaneous to service and therefore is of great
probative value.  The medical histories given by the veteran over
the years in which he did not mention any wounds and related his
lung problems to a job after service also are of great probative
value because the histories were given by the veteran in
connection with medical care where it was to the veteran's
benefit to be as complete and accurate as possible.  Furthermore,
all chest X-rays taken prior to 1984 show that the metallic
object which is now claimed as a residual of a shrapnel wound
during service was not present.  For the foregoing reasons, the
Board finds that residuals of a shrapnel wound to the chest, to
include a chronic lung disorder, were not present during service.
Accordingly, the Board concludes that residuals of a shrapnel
wound, to include a chronic lung disorder, were not incurred in
or aggravated by service.

In reaching this conclusion, the Board has considered the
provisions of 38 U.S.C.A. � 1154(b) (West 1991) and 38 C.F.R.
� 3.304(d) (1993), which provide that "[s]atisfactory lay or
other evidence that an injury or disease was incurred or
aggravated in combat will be accepted as sufficient proof of
service connection if the evidence is consistent with the
circumstances, conditions or hardships of service even though
there is no official record of such incurrence or aggravation."
That section is only applicable when the veteran's service
personnel records show that he was engaged in combat with the
enemy.  See Hayes v. Brown, 5 Vet.App. 60, 67 (1993).  See also
Zarycki v. Brown, 6 Vet.App. 91, 98 (1993).  In the present case,
the veteran's personnel records do not show that he was in
combat.  His military occupational specialty shown on his
separation qualification record was air compressor operator.  His
WD AGO 53-55 also shows a military occupational specialty of ammo
handler.  His awards and decorations did not include any which
are awarded exclusively for combat.  Therefore, the lay
statements alone are not sufficient to demonstrate that the
veteran incurred shrapnel wounds during service.  Furthermore,
even if the provisions of  38 U.S.C.A. � 1154(b) (West 1991) and
38 C.F.R. � 3.304(d) (1993) had been applicable, the lay
statements have been rebutted by clear and convincing evidence to
the contrary, as was discussed above.  For these reasons, the
claim for service connection for residuals of a shrapnel wound,
to include a chronic lung disorder, must be denied.

III.  Entitlement to Service Connection for an Acquired
Psychiatric Disorder.

The veteran has presented several lay statements from
acquaintances which are to the effect that the veteran seemed
very nervous after his separation from service.  Significantly,
however, the diagnosis of a psychiatric disorder is a medical
question which can only be answered by qualified medical
personnel.  See Espiritu v. Derwinski, 2 Vet.App. 492, 494
(1992).  For this reason, the lay statements are of little
probative value.

The record contains very little medical evidence pertaining to a
psychiatric disorder.  The earliest records pertaining to a
psychiatric disorder are dated many years after the veteran's
separation from service.  For example, a report of an examination
conducted by the VA in August 1990 for the purpose of determining
eligibility for increased compensation due to the need for aid
and attendance or on the basis of being housebound shows that the
diagnoses included "chronic anxiety."  Neither that record nor
any other record contains a medical opinion relating a
psychiatric disorder to service.  Based on the lack of material
evidence, the Board finds that an acquired psychiatric disorder
was not present during service.  Accordingly, the Board concludes
that an acquired psychiatric disorder was not incurred in or
aggravated by service.

IV.  Entitlement to Service Connection for a Left Leg and Ankle
Disorder.

The veteran states that he fractured his ankle in August 1945 and
was treated at a field hospital in Germany.  He states that he
was wearing a cast on his left leg at the time he was discharged,
and that the cast was later removed at the VA Medical Cetera in
Saginaw, Michigan.  In support of his claim, the veteran has
presented several lay statements which are to the effect that the
veteran had a cast on his left leg when he returned from service.

Significantly, however, a veteran is entitled to compensation for
service-connected disability only where a disease or injury
occurring during service results in a disability.  The United
States Court of Veterans Appeals has held that in the absence of
proof of a present disability there can be no valid claim.  See
Brammer v. Derwinski, 3 Vet.App. 223, 225 (1992); see also
Rabideau v. Derwinski, 2 Vet.App. 141 (1992), in which the Court
held that even if elevated blood pressure readings noted during
service represented the onset of hypertension, service connection
was not warranted where there was a total lack of evidence of any
hypertension since service.

In the present case, there is no evidence that the veteran has a
disability of the left leg or ankle which is attributable to an
in-service injury.  The post-service medical treatment records,
such as a VA medical record dated in June 1989, show only that
the veteran has swelling of both lower extremities which is
associated with his cardiovascular disorders and
thrombophlebitis.

Thus, even if the veteran's contentions and the lay statements
regarding the veteran being discharged from service in a cast are
accepted as being credible, in the absence of a present
disability of the left leg or ankle due to injury, the evidence
is still not sufficient to support the claim.  For the foregoing
reasons, the Board finds that the veteran does not have a left
leg and ankle disorder which is attributable to an injury during
service.  Accordingly, the Board concludes that a left leg and
ankle disorder was not incurred in or aggravated by service.

ORDER

Service connection for hypertension is denied.

Service connection for residuals of a shrapnel wound to the
chest, to include a chronic lung disorder, is denied.

Service connection for an acquired psychiatric disorder is
denied.

Service connection for a left leg and ankle disorder is denied.

          JACQUELINE E. MONROE
          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: BETTINA S CALLAWAY

disposition: remanded

text: The VA has a duty to assist the appellant in the development of facts pertinent to his claims. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1993). The United States Court of Veterans Appeals (Court) has held that the VA's duty to assist the appellant in obtaining and developing available facts and evidence to support his claim includes obtaining adequate VA medical examinations. Littke v. Derwinski, 1 Vet.App. 90 (1990). Because the Board believes that additional development is necessary before the appellant's claims can be properly adjudicated, the case is REMANDED to the RO for t

text:
BVA9415001
DOCKET NO.  92-22 987     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Albuquerque,
New Mexico

THE ISSUES

1.  Entitlement to service connection for residuals of a neck
injury.

2.  Entitlement to service connection for residuals of a back
injury.

3.  Entitlement to service connection for residuals of a left
knee injury.

4.  Entitlement to service connection for residuals of a right
ankle injury.

5.  Entitlement to service connection for a right hernia.

6.  Entitlement to service connection for arteriosclerotic heart
disease.

7.  Entitlement to service connection for defective hearing.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

C. S. Freret, Counsel

INTRODUCTION

The appellant had active military service from January 1942 to
June 1946, and he indicates that he was in the U. S. Army Reserve
from 1946 to 1968, or to 1976.

This appeal comes before the Board of Veterans' Appeals (Board)
from an April 1991 rating decision by the Albuquerque, New
Mexico, Regional Office (RO), which denied entitlement to service
connection for residuals of a neck injury, residuals of a back
injury, residuals of a left knee injury, residuals of a right
ankle injury, a right hernia, arteriosclerotic heart disease, and
defective hearing.

REMAND

The appellant argues that his right ankle and left knee problems
began during his period of active military service as a result of
injuries sustained in a March 1945 jeep accident.  He claims that
he sustained neck and back injuries in an automobile accident
while on active duty for training in Texas in December 1962.  He
also contends that he has a right hernia, cardiovascular
disability, and defective hearing, each of which is of service
origin.

Review of the claims file reveals that there is no official
record as to the appellant's specific dates of active duty for
training while in the Reserves, that there is a paucity of
service medical records, including a lack of a report of a
retirement medical examination, during his many years in the
Reserves.  Although the National Personnel Records Center in St.
Louis, Missouri, indicated in August 1990 that the appellant's
service medical records may have been destroyed in the July 1973
fire at the Records Center, the Board feels that there is a
chance that his medical records while a Reservist may not have
been destroyed.  The Board also notes that there is no report of
the appellant having undergone a Department of Veterans Affairs
(VA) medical examination.

The VA has a duty to assist the appellant in the development of
facts pertinent to his claims.  38 U.S.C.A. � 5107(a) (West
1991); 38 C.F.R. � 3.103(a) (1993).  The United States Court of
Veterans Appeals (Court) has held that the VA's duty to assist
the appellant in obtaining and developing available facts and
evidence to support his claim includes obtaining adequate VA
medical examinations.  Littke v. Derwinski, 1 Vet.App. 90 (1990).
Because the Board believes that additional development is
necessary before the appellant's claims can be properly
adjudicated, the case is REMANDED to the RO for the following
actions:

1.  The RO should verify the dates and places of
all periods of active duty for training undergone
by the appellant during his years as a Reservist.
The date of his retirement from the Reserves
should be clarified.

2.  The RO should contact the U. S. Army Reserve
Personnel Center (ARPERCEN), ATTN: DARP-PAS, 9700
Page Boulevard, St. Louis, Missouri, 63132-5200,
for the purpose of obtaining any additional
service medical records pertaining to the
appellant's periods of active duty for training
while a Reservist.

3.  The RO should schedule the appellant for a
comprehensive medical examination in order to
ascertain the nature and severity of the
disabilities for which he claims service
connection.  All indicated special studies should
be performed, if not medically contraindicated.
The examiner should set out his findings and
opinions in a clear and concise manner.  The
claims file is to be made available to the
examiner prior to the examination.

4.  The RO should review the examination report to
determine if it is adequate for rating purposes
and in compliance with this remand.  If it is not,
it should be returned to the examiner for
supplemental action.

After the above requested actions have been completed, the RO
should review the appellant's claims with regard to the
additional evidence obtained.  If any of the benefits sought on
appeal remains denied, a supplemental statement of the case
should be furnished to the appellant and his representative.
They should be afforded a reasonable period of time to respond.
Thereafter, the case should be returned to the Board for further
appellate consideration.

The purpose of this REMAND is to obtain addition medical
evidence.  No opinion, either legal or factual, is intimated as
to the merits of the appellant's claims by this REMAND.  He is
not required to undertake any additional action until he receives
further notification from the VA.

          BETTINA S. CALLAWAY
          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) (1993).


judge_norm: LAWRENCE M SULLIVAN

disposition: dismissed

condition: ptsd

text:
BVA9416001
DOCKET NO.  90-29 628     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Phoenix,
Arizona

THE ISSUE

Entitlement to service connection for an acquired psychiatric
disability, to include post traumatic stress disorder.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

K. Ehrman, Associate Counsel

INTRODUCTION

The veteran had honorable active service from July 1972 to July
1975, and from February 1976 to March 1978.

The appeal comes before the Board of Veterans' Appeals (Board)
from a January 1990 rating decision of the Seattle, Washington,
Regional Office.  That determination denied the claim for
entitlement to service connection for post traumatic stress
disorder (PTSD).

The Board issued a remand determination dated in December 1990,
requesting further development of the record.  The regional
office has made reasonable attempts to complete the requested
development, and by rating decision of July 1991, that Regional
Office denied the expanded claim for entitlement to service
connection for an acquired psychiatric disorder, to include post-
traumatic stress disorder.  The appeal was thereafter transferred
to the Phoenix, Arizona, Regional Office (RO).  The RO confirmed
and continued the earlier determinations by rating decision of
April 1992.  The veteran has also raised additional issues but it
is not entirely clear as to what the veteran is actually
claiming.  He should contact the RO  to clarify his wishes.

CONTENTIONS OF APPELLANT ON APPEAL

The veteran essentially contends that the RO erred when it denied
the claim for entitlement to service connection for an acquired
psychiatric disability, to include PTSD.  He contends that he
flew on many flights over Vietnam during service, and that during
the U.S. military evacuation of Vietnam, his duties required that
he place body bags aboard military aircraft.

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 Board is without jurisdiction as to the issue of
entitlement to service connection for an acquired psychiatric
disorder, to include post-traumatic stress disorder.

FINDING OF FACT

Neither an acquired psychiatric disorder due to service, nor
post-traumatic stress disorder are demonstrated.  Any current
psychiatric symptomatology are not plausibly shown to be related
to service.

CONCLUSION OF LAW

The veteran has not submitted a well-grounded claim for
entitlement to service connection for an acquired psychiatric
disorder, to include post-traumatic stress disorder.  38 U.S.C.A.
�� 5107, 7105(d) (West 1991).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The threshold question that must be resolved with regard to every
claim is whether the appellant has presented evidence that the
claim is well-grounded.  38 U.S.C.A. � 5107(a) (West 1991).  This
places upon a claimant the burden of submitting evidence
sufficient to justify a belief by a fair and impartial individual
that the claim is well-grounded, that is, that the claim is
plausible.  Murphy v. Derwinski, 1 Vet. App. 78 (1990).  The
United States Court of Veterans Appeals (the Court) defined
a plausible claim as "one which is meritorious on its own or
capable of substan-tiation."  However, if such plausible claim is
not presented, the appeal fails as to that claim, and the Board
is under no duty to assist in any further development of that
claim, since such development would be futile.  38 U.S.C.A.
� 5107(a) (West 1991); Murphy v. Derwinski, 1 Vet. App. 78
(1990).  In this case, the veteran has not met this initial
statutory requirement and the claim is dismissed as not well-
grounded.

The veteran has not submitted a claim that is meritorious on its
own or capable
of substantiation; he has not supported his claim for entitlement
to service connection for an acquired psychiatric disorder, to
include post-traumatic stress disorder, with any plausible,
probative evidence linking any current psychiatric symptomatology
with disability resulting from service.  Most significantly, the
evidentiary record is completely void of any diagnoses of PTSD,
and the RO has not been able to obtain a detailed statement from
the veteran of any alleged stressor event.  Service personnel
records show no combat with the enemy, and service medical
records show no acquired psychiatric disability resulting from or
related to active service.  Post service medical records show no
psychiatric disability until several years after his discharge
from service.  As such, the evidence of record is completely void
of any plausible evidence linking any current acquired
psychiatric disability to service.

The report of a special Department of Veterans Affairs (VA)
psychiatric examination and evaluation of the veteran by a Board
of two VA psychiatrists in February 1992 does not show that the
veteran currently has an acquired psychiatric disorder including
PTSD related to service.  Rather, he has a post-concussive
syndrome related to a post service episode.  As such his current
claim, as stated, is not plausible.  We must accordingly find
that his claim for entitlement to service connection for an
acquired psychiatric disorder, to include post-traumatic stress
disorder, is not well grounded.  Therefore, the claim must be
dismissed, since no question of fact or law has been submitted
over which the Board has jurisdiction.

The Court has held that a claim that is not well grounded must be
dismissed by the Board.  Recent Court precedent opinion
underlines this initial burden and states:

[a] veteran claiming entitlement to VA
benefits has the burden of submitting
evidence sufficient to justify a belief that
the claim is well grounded.  See 38 U.S.C.A.
� 5107(a) (West 1991); see Tirpak v.
Derwinski, 2 Vet. App. 609, 610-11 (1992).
If a claim is not well grounded, the [Board]
does not have jurisdiction to adjudicate
that claim.  See Grottveit v. Brown, 5 Vet.
App. 91, 93 (1993).

Boeck v. Brown, 6 Vet. App. 14, 17 (1993).

The Court indicates that a well-grounded claim requires more than
the mere submission of an allegation, but, rather, some evidence;
"[a]lthough the claim need not be conclusive, the statute
provides that it must be accompanied by evidence."  Tirpak v.
Derwinski, 2 Vet. App. 609, 610 (1992).  (Emphasis in original).
In that decision, the Court explained that the VA "benefits
system requires more than just an allegation; a claimant must
also submit supporting evidence."  Id. at 611.  Similarly, the
VA's duty to assist is not a license for a "fishing expedition"
to determine if there might be some unspecified information which
could possibly support the claim.  Gobber v. Derwinski, 2 Vet.
App. 470, 472 (1992).  This initial burden has not been met with
regard to the veteran's instant claim.

Under the provisions of 38 U.S.C.A. � 1110 (West 1991), service
connection can be established, in part, for "disability resulting
from personal injury suffered or disease contracted in the line
of duty...."  38 U.S.C.A. � 1110 (West 1991).  It necessarily
follows, however, that a disability or disease must be manifest
for service connection to be granted.  In the absence of evidence
indicating the presence of a disability or disease, a claim for
service connection is not plausible and accordingly is not well
grounded.  Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992).
In concluding that the veteran has not met this initial burden,
we first address the evidence of record which tends to show that
the veteran does not have PTSD, or any acquired psychiatric
disability.

Pursuant to our December 1990 remand request, the veteran was
afforded a special VA psychiatric examination in February 1992 by
two VA psychiatrists.  Their report fails to diagnose any
psychiatric disability or PTSD, and the examiners associated the
complained symptomatology to a physical disorder diagnosed as
post-concussive syndrome, relating to an industrial accident in
1982, years after his discharge from service.  Significantly, the
examiners reviewed the entire claims file for use in the
evaluation of his claim.  The report notes chief complaints to be
"trouble with my thinking," and the history of present illness
indicates no psychiatric illness either prior to or during
service.  While the veteran relates that he flew to Vietnam
frequently, participated in the 1975 evacuation, and recalled
placing body bags aboard aircraft, the examiners specifically
noted no direct combat experience.  Furthermore, the examiners
noted that following his March 1978 discharge, the veteran worked
steadily for four years in three major jobs including three years
working as an aircraft mechanic for Boeing Corporation.  We find
it especially probative to note that the veteran himself dated
the onset of his current problems to an industrial accident at
Boeing in 1982 when he fell approximately 12 feet from an
aircraft wing, loosing consciousness, bleeding from the head and
mouth, and breaking a vial of possibly toxic chemicals in his
hand.  The examiner noted that the veteran has been persistently
dysfunctional since the 1982 accident, with treatment from over
30 different health professionals.  The themes of these visits
include a variety of pain syndromes of the back, neck and
headaches, "seizures" which probable represent transient losses
of consciousness due to vasovagal reactions, and, in at least one
instance, chest pain leading to an admission to rule out
myocardial infarction.  There are repeated suggestions that
definite etiologies for many of these somatic complaints have not
been found, with previous psychiatric evaluations including a
diagnosis of "somatization disorder."

At that time, the examination of the veteran included a mental
status examination which was negative for overt thought process
disorder, with no hallucinations or delusions noted.  The
examiner noted that the veteran's clinical representation is
"very characteristic" of a post-concussive syndrome, and the
veteran had many somatic symptoms of unclear etiology.  Although
considered, somatization disorder did not appear to be supported
by the evidence, and no psychiatric diagnosis was made.  For
physical conditions, diagnoses included post-concussive syndrome,
musculoskeletal pain, and history of vasovagal syncope.
Additionally, psychological stressors were noted by the examiners
as "none present."  The veteran was considered able to manage his
own affairs within a limited context, with more complex tasks
limited by his cognitive impairment.  We find this report to be
highly probative and reliable as it is based upon a review of the
entire claims file and service medical records by a board of 2 VA
psychiatrists.

Our own review of the service medical records indicates no
psychiatric disability prior to, during, or within one year after
separation from service, and current symptoms are not plausibly
related to service.  The July 1972 report of medical examination,
and report of medical history, taken at entrance to active
service, are both negative for preexisting psychiatric
disability.  Service medical records include a May 1974 treatment
record which indicates that the veteran received counseling for
"feelings that some people are against him," and feelings of
anger due to his step-father's recent death.  However, no further
counseling is noted in the remaining service medical records.  A
January 1978 treatment record notes discomfort secondary to back
pain, with the incidental notation that the veteran is
"psychologically stable."  The separation examination report of
February 1978 is negative as to any psychiatric disability
incurred in or aggravated by service, and symptoms compatible
with PTSD are not shown.

The Court has held that the Board is not bound to accept a
claimant's uncorroborated account of his Vietnam experiences.
Wood vs. Derwinski, 1 Vet. App. 190, 192 (1991).  This is
especially true when the remaining evidence of record does not
support the veteran's contentions.  Pursuant to our December 1990
remand determination, the RO issued correspondence dated in
January 1991 and November 1991, requesting that the veteran
provide a statement with regard to the alleged traumatic in
service incident or incidents, allegedly resulting in PTSD.  The
veteran has failed to provide such a statement despite repeated
requests to do so.  The RO has however obtained copies of the
veteran's service personnel records.  Significantly, we note that
the veteran's discharge document, DD Form 214, effective July
1975 for his first period of active service, specifically
indicates no service in Indochina or Korea, and neither this DD
Form 214, nor the later one, affective March 1978, indicates that
the veteran was issued decorations or medals indicative of
combat.  The remaining service personnel records are similarly
silent as to any combat.  Without more, the claim must fail.

While the must recent clinical evidence, and thus most probative,
shows no current psychiatric disability, we have reviewed the
claims file, including physical and psychiatric evaluation of the
veteran subsequent to the 1982 industrial incident.  However,
these records do not support a well-grounded claim.  The claims
file includes the prior VA psychiatric examination report of
December 1989, which includes a diagnosis of borderline
personality disorder, with complaints of multiple pains and
bleeding.  The examiner recommended the veteran for a full PTSD
examination for "some elements of PTSD," but later evaluation did
not find such a diagnosis.

We have noted medical records associated with both the Washington
State Department of Social Services, and the United States
Department of Social Services, Social Security Administration.
These treatment records, include a July 1988 report which also
notes symptoms resulting from a 1982 industrial accident.  The
details of that accident are described essentially as related in
the later February 1992 special VA examination report, as
detailed in our prior discussion.  In the July 1988 report, the
veteran described his military service, but he related his
current disability to the 1982 industrial injury.  Diagnosis was
possible head injury contributing to dementia, with only mild
psychosocial stress in the last year.  Again, no relation is made
to disability resulting from service.

The Board does note that a February 1992 VA examination report,
as well as the earlier July 1988, and December 1989 reports,
indicate some symptomatology resulting from injuries sustained in
a 1982 industrial accident, with various diagnoses since that
time.  However, current diagnosis includes no acquired
psychiatric disability, and no examiner has attributed any
finding to service.  Furthermore, no examiner has diagnosed PTSD.
In essence, the record lacks probative evidence tending to
establish that the veteran has any psychiatric disability or PTSD
due to or resulting from service.  As such, a plausible claim is
not shown.  The veteran has not submitted a well-grounded claim
for entitlement to service connection for an acquired psychiatric
disability, to include PTSD.  38 U.S.C.A. �� 5107, 7105(d) (West
1991).

ORDER

The claim for service connection for an acquired psychiatric
disability, to include post-traumatic stress disorder is
dismissed.

          LAWRENCE M. 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.


judge_norm: M SABULSKY

text:
BVA9418001
DOCKET NO.  93-02 824     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Phoenix,
Arizona

THE ISSUES

Entitlement to service connection for dementia and brain damage.

REPRESENTATION

Appellant represented by: Disabled American Veterans

WITNESSES AT HEARING ON APPEAL

Appellant and his wife

ATTORNEY FOR THE BOARD

T. S. Kelly, Associate Counsel

INTRODUCTION

The veteran had active military service from June 1953 to May
1955

This appeal arises from a January 1991 rating decision of the Los
Angeles, California, Regional Office (RO) that denied service
connection for dementia and brain damage.  The veteran later
moved to a new address, and the Phoenix, Arizona, RO certified
the appeal to the Board of Veterans' Appeals (Board).

REMAND

The RO has attempted to obtain the veteran's service medical
records, including any morning reports, records from the Office
of the Surgeon General and personnel records.  The National
Personnel Records Center advised that any service records on file
at that facility would have been destroyed by fire in 1973.  In
cases where service records are presumed to have been destroyed,
the Board has a heightened obligation to explain its findings and
conclusions and to consider the benefit-of-the-doubt rule.
O'Hare v. Derwinski, 1 Vet.App. 365 (1991).  Since some evidence
that may be pertinent to the veteran's claim is outstanding, it
is incumbent on the Board to obtain such information.

A review of the file demonstrates that at the veteran's personal
hearing in April 1992, both he and his wife testified that he had
undergone some type of brain surgery following an automobile
accident subsequent to service separation.  Neither individual
could recall the exact dates of the surgery nor the location of
the facility where the operation was performed; however, it was
believed that the surgery was performed either in Portland,
Oregon or in Los Angeles, California.  While the veteran and his
wife could not recall the specific dates of the surgery, a June
1987 private neurological consultation report indicated that the
veteran had undergone a craniotomy in 1974 at a Department of
Veterans Affairs (hereinafter, VA) Hospital.  In addition, on his
May 1989 application for compensation and pension, the veteran
indicated he had had surgery performed on his head at the
Wadsworth VA Hospital.  A VA Form 10-7131 dated in March 1971
shows that the veteran was hospitalized at the Wadsworth General
Hospital in Los Angeles, California, for post-cerebral concussion
syndrome.

We also note that the veteran was employed by the City of Los
Angeles for a period of over 20 years.  As the veteran's service
medical records are not available, the Board is of the opinion
that obtaining copies of the veteran's personnel records,
including copies of any physical examinations performed during
the course of the veteran's employment, from the City of Los
Angeles might be of assistance in this matter.  If the veteran is
receiving Social Security disability benefits, the records
associated with that claim may be helpful.

To ensure that the VA has met its duty to assist the claimant in
developing the facts pertinent to the claim and to ensure full
compliance with due process requirements, the case is REMANDED to
the regional office (hereinafter, RO) for the following
development:

1.  The RO should obtain the names and
addresses of all medical care providers who
have treated the veteran for the issue
presently on appeal following his separation
from service.  After securing the necessary
release, the RO should obtain these records.
The RO should request copies of medical
records from the Los Angeles VA Medical
Center, Wadsworth Division, since service
separation, but particularly for the period
from 1970 to 1975, as well as the records for
any VA facilities located near Portland,
Oregon for that same time period.

2.  The RO should, after obtaining the proper
authorization from the veteran, obtain and
associate with the claims folder copies of the
veteran's personnel records, including copies
of all physical examinations performed during
the course of his employment, from the City of
Los Angeles.

3.  If the veteran indicates that he is
receiving Social Security disability benefits,
the RO should obtain from the Social Security
Administration the records pertinent to the
veteran's claim for Social Security disability
benefits as well as the medical records relied
upon concerning that claim.

4.  Thereafter, the veteran should be afforded
VA examination by the appropriate medical
specialist in order to determine the nature of
any brain damage or dementia.  All appropriate
tests and studies should be performed.  The
examiner is then requested to render an
opinion as to the etiology of any brain damage
or dementia found and whether it is related to
service.  The bases for the opinion, e.g.,
history by veteran or information shown in
medical records, should be identified by the
examiner.  The claims folder must be made
available to the examiner for review prior to
the examination.

The RO should then readjudicate the claim in light of all of the
additional evidence.  If any benefit sought on appeal remains
denied, a supplemental statement of the case should be furnished
to the veteran and his representative.  They should be afforded a
reasonable period of time to respond.  Thereafter, the case
should be returned to the Board for further appellate
consideration.  By this remand, the Board intimates no opinion as
to the ultimate outcome of this case.

          M. SABULSKY
          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) (1993).


judge_norm: THE REQUESTED DEVELOPMENT

text: The VA has a statutory duty to assist the veteran in the development of his claim. 38 U.S.C.A. § 5107(a) (West 1991). Inasmuch as there may be outstanding evidence in this case, the Board is of the opinion that such development is warranted prior to final appellate consideration. Accordingly, the case is remanded for the following actions:

text:
BVA9419001
DOCKET NO.  93-22 710     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in No. Little
Rock, Arkansas

THE ISSUES

1.  Whether new and material evidence has been submitted to
reopen a claim of service connection for defective hearing.

2.  Entitlement to service connection for tinnitus.

3.  Entitlement to service connection for an ear infection,
including fungus in the ears

4.  Entitlement to service connection for a left knee disorder.

5.  Entitlement to a compensable evaluation for callous formation
on both heels.

REPRESENTATION

Appellant represented by: Disabled American Veterans

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

Harold A. Beach, Counsel

INTRODUCTION

The veteran, who is the appellant in this case, served on active
duty from September 1961 to November 1965.

In January 1982, the Board of Veterans' Appeals (Board) denied
the veteran's claim for service connection for defective hearing.
In April 1991, he requested that that claim be reopened.  He also
claimed entitlement to service connection for tinnitus; an ear
infection, including fungus in the ears; and a left knee
disorder, as well as a compensable evaluation for service-
connected calluses on both heels.

In October 1991, the Department of Veterans Affairs (VA) Regional
Office (RO) in North Little Rock, Arkansas, denied all of the
foregoing claims.  The veteran disagreed with those decisions,
and this appeal ensued.

In January 1992, the veteran submitted a claim for a permanent
and total disability rating for pension purposes.  Although
initially denied, that claim was granted in August 1993.
Consequently, it is no longer part of the current appeal.

REMAND

In September 1993, the veteran had a hearing before a traveling
member of the Board of Veterans' Appeals.  He testified that
since service, he had been treated at various times for a left
knee disorder, tinnitus, a chronic ear infection, and defective
hearing.  He noted that that treatment had been rendered at the
VA medical centers (MC) in Poplar Bluff, Missouri; Little Rock,
Arkansas; Fayetteville, Arkansas; and Madison, Wisconsin.

A review of the claims folder reveals that numerous treatment
records, dated from 1983 through 1987, have been received from
the VAMC in Little Rock.  Numerous records, dated since 1987,
have also been received from the VAMC in Fayetteville.  Earlier
records from those VAMC's are not contained in the claims folder,
nor do there appear to be any records from the VAMC's in Poplar
Bluff or Madison.

The veteran contends, in part, that his left knee disorder is the
result of his service-connected calluses on his heels.  A report
shows that he underwent a VA examination in August 1991.  On the
request for the examination (VA Form 21-2507), the question of
secondary service connection was noted.  Although
osteoarthropathy was diagnosed in the veteran's left knee, the
examiner did not render an opinion as to the possibility of
secondary service connection.  The veteran was re-examined by the
VA in 1992; however, the question of secondary service connection
was not specifically requested.

The VA has a statutory duty to assist the veteran in the
development of his claim.  38 U.S.C.A. � 5107(a) (West 1991).
Inasmuch as there may be outstanding evidence in this case, the
Board is of the opinion that such development is warranted prior
to final appellate consideration.  Accordingly, the case is
remanded for the following actions:

1.  The RO should contact the VAMC in Little
Rock, Arkansas, and obtain copies of the
veteran's inpatient and outpatient treatment
records, dated from 1965 through 1983, and
from 1983 through the present.  All records
so obtained should be associated with the
claims folder.  All negative responses or
failures to respond to any request should be
documented.

2.  The RO should contact the VAMC in
Fayetteville, Arkansas and obtain copies of
all of the veteran's inpatient and
outpatient treatment records, dated from
1965 through 1990.  All records so obtained
should be associated with the claims folder.
All negative responses or failures to
respond to any request should be documented.

3.  The RO should contact the VAMC's in
Poplar Bluff, Missouri, and Madison,
Wisconsin, and obtain copies of the
veteran's inpatient and outpatient treatment
records, dated from 1965 through the
present.  All records so obtained should be
associated with the claims folder.  All
negative responses or failures to respond to
any request should be documented.

4.  The RO should schedule the veteran for a
VA orthopedic examination to determine the
nature and extent of any left knee disorder.
All appropriate tests and studies should be
performed, including, but not limited to, X-
rays.  Should such a disorder be found, the
examiner should render an opinion as to the
etiology.  Specifically, the examiner should
indicate whether there is a cause-and-effect
relationship with the service-connected
calluses on the veteran's heels.

When requested development has been completed, the RO should
review the veteran's request to reopen his claim of service
connection for defective hearings, as well as his claims for
service connection for a left knee disorder, tinnitus, and an ear
infection..  Should the decision remain adverse to the veteran,
he and his representative must be furnished a Supplemental
Statement of the Case and afforded an opportunity to respond.  38
C.F.R. � 20.302(c) (1993).  Thereafter, the claims folder should
be transferred to the Board for further appellate consideration.

By this REMAND, the Board intimates no opinion as to the final
disposition of any issue.  The purpose is to procure clarifying
medical information.  The veteran need take no action unless he
is notified.

The issue of an increased rating for the veteran's service-
connected calluses on his heels will be held in abeyance pending
the requested development.

          Member, Board of Veterans' Appeals

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) (1993).

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.


judge_norm: J J SCHULE

condition: back

benefit: tdiu

text:
BVA9420001
DOCKET NO.  93-17 592     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in St. Petersburg,
Florida

THE ISSUES

1.  Entitlement to an increased evaluation for a low back
disorder, currently evaluated as 60 percent disabling.

2.  Entitlement to a total rating for compensation purposes based
on individual unemployability.

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

J. Horrigan, Counsel

INTRODUCTION

The veteran served on active duty from November 1965 to August
1968.  This matter came before the Board of Veterans' Appeals
(Board) from a January 1993 rating decision from the St.
Petersburg, Florida, Regional Office (RO).  In April 1994, the
veteran appeared and gave testimony at a hearing in Washington
D.C. before a member of the Board.  The veteran had been
represented by a public interest law clinic, under the
supervision of a private attorney, but the veteran revoked his
power of attorney on March 17, 1994.  The Board member who
conducted the April 1994 hearing has left the Board.  However, in
view of the action taken below, the Board is proceeding with its
decision.

The record indicates that the veteran had also claimed
entitlement to an effective date earlier than March 3, 1989 for a
grant of service connection for his low back disorder, and he was
provided a statement of the case in regard to this issue in July
1992.  Since there has been no further reference to this issue,
it is not before the Board for appellate consideration at this
time.

CONTENTIONS OF APPELLANT ON APPEAL

It is essentially contended, by and on behalf of the veteran,
that his service-connected low back disorder has worsened in
severity and warrants an evaluation in excess of the 60 percent
currently assigned.  It is mainly argued that his back disorder
has rendered him unable to obtain and sustain gainful employment
and that a total rating for compensation purposes based on
individual unemployability is, therefore, 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.
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
veteran's claim for an increased evaluation for a low back
disorder.  It is also the decision of the Board that a total
rating for compensation purposes based on individual
unemployability is warranted.

FINDINGS OF FACT

1.  The veteran's low back disorder accounts for disability which
equates to no more than pronounced lumbar disc disease.

2.  The veteran is college educated and has occupational
experience as an accountant, bookkeeper, office manager, and
security guard; he last worked in October 1992.

3.  The veteran's service-connected low back disorder effectively
precludes him from pursuing gainful employment.

CONCLUSIONS OF LAW

1.  The veteran's status post herniated nucleus pulposus of the
lumbar spine is currently no more than 60 percent disabling
according to the schedular criteria.  38 U.S.C.A. �� 1155,
5107(a) (West 1991); 38 C.F.R. Part 4, Diagnostic Code 5293.
(1993)

2.  A total rating based on individual unemployability is
warranted.  38 U.S.C.A. �� 1155, 5107(a); 38 C.F.R. �� 3.340,
3.341, 4.16, and Part 4 (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

Initially, the Board notes that the veteran's claim is "well
grounded" within the meaning of 38 U.S.C.A. � 5107(a) (West
1991).  That is, he has presented a claim which is not
implausible.  The Board is also satisfied that all reasonable
efforts have been expended to develop the evidence in regard to
this claim.

I.  Low Back Disorder

The veteran has been assigned the maximum contemplated schedular
evaluation of 60 percent under Diagnostic Code 5293 for
pronounced intervertebral disc syndrome with persistent symptoms
compatible with sciatic neuropathy and with characteristic pain
and demonstrable muscle spasms, absent ankle jerk, or other
neurological findings appropriate to the site of the diseased
disc, with little intermittent relief.  Since the veteran's low
back disability does not involve a fractured vertebra or complete
bony fixation of the spine, the criteria of Diagnostic Codes 5285
and 5286, which encompass 100 percent schedular evaluations, are
not for application in this case.

The veteran's service medical records reveal frequent treatment
for back pain.  A rating decision of July 1976 granted service
connection for lumbosacral strain which was evaluated as
noncompensable from April 23, 1976.  Service connection was
denied for postoperative status, herniated nucleus pulposus.  A
Board decision of October 1991 granted service connection for
herniated nucleus pulposus on a new factual basis, and a rating
decision of March 1992 assigned a 60 percent evaluation from
March 3, 1989, for herniated nucleus pulposus, lumbar
laminectomy, history of lumbosacral strain.

On examination by  Frederick W. Smith, M.D., in July 1992, the
veteran was noted to stand erect although he was obviously in a
great deal of discomfort.  The veteran was able to bend forward
"about 10 degrees or so in the lumbar spine," and he was noted to
have severe pain across the low back, radiating into the lower
extremities.  This was said to follow a fairly consistent sciatic
pattern, at least on the right side and to a lesser extent on the
left.  The veteran could walk on his toes and heels with
difficulty and straight leg raising was positive on both sides at
about 30 degrees.  All reflexes in the lower extremities seemed
to be depressed although he was able to move his toes and seemed
to have fairly good sensation.  He complained that the toes on
the right foot frequently got numb.  There was a well-healed
surgical scar over the low back.

On Department of Veterans Affairs (VA) examination in November
1992, range of motion at the waist level was severely restricted
in that the veteran could bend forward to perhaps 10 or
15 degrees at the most.  Lateral rotation and bending were also
markedly decreased from normal.  There was a well-healed lumbar
laminectomy scar.  An X-ray showed a previous laminectomy in the
lumbar spine with a sclerotic bone island in the right ischium.

During subsequent VA outpatient treatment in December 1992, the
veteran was noted to be ambulatory.  Evaluation revealed
diminished sensation in the left lateral calf and positive
straight leg raising, bilaterally.  The assessment was failed
back syndrome.  It was reported that he could not sit or stand
for more than 10 minutes at a time because of his back
disability.  The condition was said to have not improved over the
last few years.  During treatment in December 1993, it was noted
that the veteran needed a walker to get around.

This evidence shows that the veteran clearly has a very serious
service-connected disability in the lumbar spine resulting in
severe, chronic back pain radiating into the lower extremities,
severe limitation of motion in the low back, and diminished
reflexes with complaints of numbness in the lower extremities.
This symptomatology is contemplated by the 60 percent schedular
evaluation assigned for the veteran's low back disorder under
Diagnostic Code 5293.  As noted above, this is the maximum
evaluation contemplated under this diagnostic code.  We have
considered an increased evaluation under the criteria of
38 C.F.R. � 3.321(b) (1993).  However, the evidence shows that
the veteran's low back symptoms are compatible with the criteria
of diagnostic code 5293, and that evidence does not suggest that
the veteran's low back disorder represents such an exceptional or
unusual disability as to render impractical the application of
the regular schedular standards.  Accordingly, a schedular
evaluation for a low back disorder of more than 60 percent is
denied.

II.  A Total Rating for Compensation Purposes Based on
Individual Unemployability

Total disability ratings for compensation may be assigned where
the schedular rating for the service-connected disabilities is
less than 100 percent, when it is found that those disabilities
are sufficient to produce unemployability without regard to
advancing age.  If unemployability is the result of a single
service-connected disability, that disability must be rated at 60
percent or more.  If it is the result of two or more service-
connected disabilities, at least one must be ratable at 40
percent or more, with the other sufficient to bring the combined
rating to 70 percent or more.  38 C.F.R. �� 3.340, 4.16.  In this
case, service connection is in effect for status post herniated
nucleus pulposus of the lumbar spine, evaluated as 60 percent
disabling.  Service connection is also in effect for the
residuals of a shell fragment wound of the right lower arm, but
this disorder has not been shown to result in functional
disability and is evaluated as noncompensable.  The Board notes
that the rating assigned to the veteran's low back disorder meets
the requirements noted above.

The Board also notes that the veteran is college educated and has
considerable and varied work experience which includes
bookkeeper, accountant, officer manager, and security guard.
However, in our opinion, his service-connected low back disorder
so hinders him that he is now effectively precluded from all
forms of substantially gainful employment.  The most recent
clinical records in the claims folder indicate that the veteran
has severe, chronic low back pain and must now use a walker.
Clearly, therefore, he is no longer suitable for employment
requiring any extensive physical movement.  During a recent
hearing the veteran reported that the medications taken for low
back pain, including Valium, Percocet, and Darvocet, put him "on
cloud nine".  Such a regimen would often render him incapable of
the intellectual effort required in such jobs as accountancy,
management and bookkeeping.  It is therefore apparent that the
veteran's low back disability makes more than marginal employment
very unlikely at this time.  Such a conclusion is also supported
by Dr. Smith who reported in July 1992 that he was not optimistic
about the veteran's ability to continue actively working.  We
also note that, in September 1993, a VA physician reported that
the veteran was not employed because of his low back disorder.
Therefore, the Board finds a reasonable basis on which to grant a
total rating.

ORDER

An increased schedular evaluation for the veteran's service-
connected low back disorder is denied.

A total rating for compensation purposes based on individual
unemployability is granted, subject to the law and regulations
governing the payment of monetary benefits by the VA.

          J. J. SCHULE
          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.