judge_norm: G H SHUFELT

text: The appeal is denied as to both issues.

text:
BVA9422002
DOCKET NO.  91-46 916     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in New Orleans,
Louisiana

THE ISSUES

1.        Entitlement to an increased evaluation for fragment wound scar
of the left knee with retained foreign metallic body,
currently rated 10 percent disabling.

2.        Entitlement to an increased (compensable) evaluation for
psychophysiological gastrointestinal reaction.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

L. J. Vecchiollo, Associate Counsel

INTRODUCTION

The veteran had active service from September 1968 to April 1972.

This matter came before the Board of Veterans' Appeals (Board) on
an appeal from the March 1991 rating action of the Department of
Veterans Affairs (VA) New Orleans, Louisiana, Regional Office
(RO), which confirmed and continued the prior 10 percent
evaluation for service-connected fragment wound scar of the left
knee with retained foreign metallic body, and the noncompensable
evaluation for psychophysiological gastrointestinal reaction.  He
filed a notice of disagreement in April 1991.  He was furnished a
statement of the case in April 1991.  He filed a substantive
appeal that was received in June 1991.    The Board remanded the
case in October 1992.

In an August 1993 decision, the RO granted entitlement to service
connection for post-traumatic stress disorder (PTSD) and assigned
a 50 percent rating.

CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends that his fragment wound scar of the left
knee with retained foreign metallic body should be rated more
than 10 percent disabling, as the symptoms and manifestations of
the disability from which he suffers have increased in severity.
The veteran maintains that his psychophysiological
gastrointestinal reaction should be rated more than zero percent
disabling, as the symptoms and manifestations of this disability
have also increased in severity.  The veteran's representative
asserts that the veteran's psychophysiological gastrointestinal
reaction disability rating should be combined with his service-
connected post-traumatic stress disorder, currently rated as 50
percent disabling to produce a higher rating.

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 a disability rating of more than 10 percent for the
veteran's service-connected fragment wound scar of the left knee
with retained foreign metallic body is not warranted and the
evidence does not support a compensable rating for the veteran's
service-connected psychophysiological gastrointestinal reaction.

FINDINGS OF FACT

1.        The medical evidence reflects that the veteran's service-
connected fragment wound scar of the left knee with retained
foreign metallic body involves no more than slight muscle
disability and is manifested by a scar with no keloid
formation, adherence, herniation, inflammation, swelling,
depression, abnormality of vascular supply, ulceration,
tenderness or pain.  The scar has no effect on the function of
the veteran's left knee or leg.

2.        The veteran currently does not have psychiatric problems
affecting a gastrointestinal condition.

CONCLUSIONS OF LAW

1.        A disability rating higher than 10 percent for the veteran's
service-connected fragment wound scar of the left knee with
retained foreign metallic body is not warranted.  38 U.S.C.A.
�� 1155, 5107 (West 1991); 38 C.F.R. �� 4.3, 4.56, 4.118,
Diagnostic Code 7805-5257 (1993).

2.        A disability rating higher than zero percent for the veteran's
service-connected psychophysiological gastrointestinal
reaction is not warranted.  38 U.S.C.A. �� 1155, 5107 (West
1991); 38 C.F.R. �� 4.3, 4.132, Diagnostic Code 9502 (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4
(1993), is a guide in the evaluation of disability resulting from
all types of diseases and injuries encountered as a result of or
incident to military service.  38 U.S.C.A. � 1155 (West 1991);
38 C.F.R. � 4.1 (1993).  The evaluation assigned for a disability
is established by comparing the manifestations indicated in
medical findings with manifestations described in prior medical
findings, and with the criteria in the VA's Schedule for Rating
Disabilities.  In applying the rating criteria, it is also
necessary to note that when there is a question as to which of
two evaluations should be applied, the higher evaluation will be
assigned if the disability picture more nearly approximates the
criteria required for that rating.  Otherwise, the lower rating
will be assigned.  38 C.F.R. � 4.7 (1993).

I.  Entitlement to an Increased Evaluation for Fragment Wound
Scar of the Left Knee with Retained Foreign Metallic Body

According to entries in the veteran's service medical records, he
was seen in August 1970 with complaints of a fragment would of
the left knee.  It was noted that there was a small entry point
and slight swelling.  On the following day, the veteran was
discharged from the medical facility with an ace bandage.
Approximately three days later, it was reported that the wound
was well healed, with no induration, tenderness, or limitation of
motion.  The RO granted service connection for a fragment would
scar of the left knee and assigned a non compensable rating for
this disability in a January 1976 decision.  The RO assigned a 10
percent rating for this disability in a May 1990 decision.

A VA examination was conducted in April 1990.  The veteran
presented with aching, numbness and occasional pain and swelling
in the left knee.  An x-ray evaluation of the left knee revealed
a small foreign metallic body superior and lateral to the
patella.  An impression of small visible scar, non limiting the
range of motion; the veteran described thigh and calf
paresthesia's and thigh hypoesthesias, weight bearing pain in
cold weather.  The examiner also stated that a small scar and
minimal subpatellar clicking were the only objective clinical
findings detected.

A VA examination was conducted in February 1991.  The examination
of the knee and accompanying scar was negative.  However, the
veteran reported left knee pain which restricted its range of
motion.

In May 1991, the veteran presented with left knee pain and
occasional stiffness.  Decreased range of motion secondary to
pain was noted.  An impression of irritation of the left knee
secondary to a foreign body was given.

The most recent VA examination of the knees was conducted in
January 1993.  The lower extremities were found to be
symmetrical.  The veteran's gait was somewhat exaggerated,
favoring the left lower extremity.  The veteran was able to
heel/toe walk, tandem walk and perform a full squat.  No foreign
bodies could be palpated over the left knee.  The range of motion
of each knee was to 135 degrees flexion and to 0 degrees
extension.  There was no tenderness, swelling, deformity,
subluxation, lateral instability or loose motion of either knee.
A diagnosis of history of left knee injury in 1969 with a small
retained metal fragment in soft tissue, left anterolateral above
the patella with no evidence of involvement of the knee joint was
given.

A VA examination of the veteran's fragment wound scar of the left
knee was conducted that same month.  A well-healed thin scar,
one-half inch by one-eighth inch, on the left lateral knee,
slightly above the upper margin of the patella, secondary to the
service-connected shrapnel injury, was noted.  Two other scars
were noted on the left knee, one due to a stab wound and the
other was of unknown origin.  The service-connected scar's
texture was soft and its color did not vary from the rest of the
knee.  There was no keloid formation, adherence, herniation,
inflammation, swelling, depression, abnormality of vascular
supply, ulceration, tenderness or pain.  There was no evidence of
limitation of the part affected.

In this case, the veteran's disability could be rated under
several rating provisions.  As is shown by the service medical
records, the veteran's wound resulted in a small entry point, and
the wound healed within a few days.  Under the provisions of 38
C.F.R. � 4.56 (1993), a simple wound without debridement or
infection, which heals with good functional results may be
considered as disability involving slight muscle impairment.
Diagnostic Code 7803 states that superficial scars which are
poorly nourished, with repeated ulceration are assigned a 10
percent evaluation.  Diagnostic Code 7804 maintains that a 10
percent evaluation is warranted for superficial scars which are
tender and painful on objective demonstration.  However, as the
veteran's scar is not poorly nourished, ulcerated, tender or
painful, we find Diagnostic Code 7805 most appropriate.  It
states that other scars are rated on limitation of function of
the affected part.  In this case, the scar affects the veteran's
left leg and knee.  The rating schedule provides a 10 percent
evaluation for a slight impairment of the knee.  The rating
schedule also provides that a 20 percent evaluation for moderate
impairment of the knee and a 30 percent evaluation for severe
impairment of the knee as measured by the degree of recurrent
subluxation or lateral instability.  38 C.F.R. Diagnostic Code
5257.

The veteran does not meet the criteria for moderate impairment of
the knee under Diagnostic Code 5257, as he lacked any objective
findings of recurrent subluxation or lateral instability.  The
Board has considered the possible application of other Diagnostic
Codes and does not find any other Diagnostic Code that can be
applied to grant the veteran a higher rating.  38 C.F.R. � 4.21
(1993).  The veteran's left knee has full range of motion, thus
Diagnostic Codes 5260 and 5261 are inapplicable.  Diagnostic Code
5258 is inapplicable because there is no evidence in the record
that the veteran's semilunar cartilage is dislocated.

Under 38 C.F.R. � 4.40 (1993), functional loss of part of the
body due to pain is also considered a disability.  Functional
loss is the inability to perform normal working movements, and
must be supported by adequate pathology and evidenced by the
visible behavior of the veteran.  In this case, the veteran has
no functional loss nor has any painful motion been demonstrated
and therefore, a higher rating under this regulation is not
warranted.

II.  Entitlement to an Increased (Compensable) Evaluation for
Psychophysiological Gastrointestinal Reaction

The criteria for evaluating psychophysiological gastrointestinal
disabilities are found at 38 C.F.R. Part 4, Diagnostic Code 9502.

The RO assigned a non compensable rating for this disability in a
January 1976 decision.

A VA examination was conducted in February 1991.  The veteran
reported that when he gets angry a knot forms in his stomach
which further increases his anger.  The examiner noted the
abdomen to be flat and muscular, without scarring.  No masses or
tenderness was noted.

The most recent VA examination of the stomach was conducted in
January 1993.  Examination of the chest revealed the heart to be
normal in size with no evidence of disease.  The lungs were clear
with no evidence of disease.  The abdomen was slightly obese with
no tenderness or masses.  Bowel sounds were normal.  A barium
contrast x-ray evaluation was conducted by the VA that same
month.  It indicated that the veteran's esophagus, stomach,
duodenal bulb and proximal small bowel were normal.  Diagnoses of
psychophysiological gastrointestinal reaction from records and a
normal upper gastrointestinal tract were given.

Since no upper gastrointestinal disability was demonstrated at
the last VA examination, the Board finds that a compensable
rating for a functional gastrointestinal disorder is not
warranted.

The veteran's representative asserts that the veteran's
psychophysiological gastrointestinal reaction disability rating
should be combined with his service-connected post-traumatic
stress disorder to produce a higher rating.  Under the law, when
two diagnoses, one organic and the other psychophysiologic or
psychoneurotic, are presented covering the organic and
psychiatric aspects of a single disability entity, only one
percentage evaluation will be assigned under the appropriate
diagnostic code determined by the rating board to represent the
major degree of disability. 38 C.F.R. 4.132, Note No. 4.  In this
regard the Board notes that the veteran is currently rated as 50
percent service-connected disabled for PTSD.  As stated above,
organic symptoms attributable to a psychiatric disability cannot
be combined.  As no gastrointestinal disability was demonstrated
at the last VA examination, the veteran's psychiatric disability
represents the major degree of disability and the veteran's
psychophysiological gastrointestinal reaction disability rating
will not be combined with it.

The Board has also considered whether the veteran is entitled to
an extraschedular rating under 38 C.F.R. � 3.321(b)(1) (1993).
That regulation permits the application of an extraschedular
rating in exceptional cases where the schedular ratings do not
adequately represent the disability picture.  However, the
schedular ratings in this case do adequately represent the
disability picture.  That is, his service-connected disability
does not require frequent periods of hospitalization nor has
marked interference with employment been shown.  38 C.F.R.
� 3.321(b)(1) (1993).

ORDER

The appeal is denied as to both issues.

          G. H. SHUFELT
          Member, Board of Veterans' Appeals

(CONTINUED ON NEXT PAGE)
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: NANCY I PHILLIPS

judge_role: Member, Board of Veterans' Appeals

disposition: granted

condition: headache

condition: back

text:
BVA9423002
DOCKET NO.  92-55 72      )       DATE
          )
          )

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

THE ISSUES

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

2.  Entitlement to an increased (compensable) evaluation for low
back pain syndrome.

REPRESENTATION

Appellant represented by: The American Legion

ATTORNEY FOR THE BOARD

William J. Jefferson, III  Counsel

INTRODUCTION

The veteran had active service from August 1986 to August 1990.

This case comes before the Board of Veterans' Appeals (Board) on
appeal from a rating decision of the Department of Veterans
Affairs (VA) St. Petersburg, Florida, Regional Office (RO).

A rating decision dated in August 1991 granted service connection
for low back syndrome, which was non-compensably evaluated, and
denied service connection for residuals of a concussion (head
injury), including headaches and blackouts, as well as claimed
lightheadedness and dizziness.  The veteran disagreed with those
determinations and an appeal ensued.

In March 1993, the case was remanded to the RO to obtain
additional information.

CONTENTIONS OF APPELLANT ON APPEAL

The veteran argues that while in service, she was involved in an
automobile accident which resulted in a concussion, and since
that time she has residuals of the head injury, including
headaches, dizziness, blackouts, and lightheadedness.  She argues
that service connection for residuals of the head injury is
warranted.  She also contends that her low back disorder is
manifested by radiating pain, and it is far more disabling than
the current non-compensable evaluation indicates.

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 preponderance of the evidence is in favor of the
veteran's claim of entitlement to service connection for
headaches which are residuals of a head injury, and an increased
evaluation for low back pain.

FINDINGS OF FACT

1.  The veteran sustained a closed head injury in an automobile
accident during service, and residual headaches are shown after
service.

2.  The low back syndrome is productive of pain on motion and
slight limitation of motion of lumbar spine; but muscle spasm on
extreme forward bending and unilateral loss of lateral spine
motion in a standing position or moderate limitation of motion of
the lumbar spine are not shown.

CONCLUSIONS OF LAW

1.  Headaches which are residuals of a head injury were incurred
in peacetime service.  38 U.S.C.A. �� 1131, 5107 (West 1991); 38
C.F.R.� 3.303 (1993).

2.  A 10 percent disability evaluation for low back syndrome is
warranted.  38 U.S.C.A. �� 1151, 5107 (West 1991); 38 C.F.R.
� 4.7, Part 4, Codes 5292, 5295 (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

We find that the veteran's claims are "well grounded" within the
meaning of 38 U.S.C.A. �  5107(a).  That is we find that she has
presented claims which are not implausible.  The record shows that
the RO has attempted to obtain further information concerning the
automobile accident that the veteran was involved in during
service.  Specifically, police reports, a hospital summary, and
the veteran's service separation physical examination report.
However, a review of the record shows that several attempts to
obtain those records have resulted in negative results.  We are
satisfied that all relevant facts have been properly developed.
38 U.S.C.A. � 5107(a).

I.  Residuals of a Head Injury

In August 1990, a service medical entry reported that the veteran
was hospitalized with bruises, multiple contusions and loss of
consciousness for an unknown time.  It was reported that she was
oriented times three and hypoactive.  There was tenderness over
the frontal maxillary area.  It was indicated that the rest of
the ear, nose, and throat examination was normal.  Small
hematomas and tenderness were reported over the entire back to
palpation.  She had full range of motion of the back.  The
diagnostic assessment was status post motor vehicle accident with
unknown loss of consciousness, with multiple contusions.  She was
treat conservatively.  The veteran was released from service in
August 1990.

In a VA application for compensation or pension, received in May
1991, the veteran reported that in August 1990 she was involved
in an automobile accident, and that she sustained a back injury
and a concussion, with resultant headaches.  Details of the
service accident were reported in a VA Form 21-4176, report of
accidental injury, dated in May 1991.

A VA neurological examination was performed in June 1991.  The
veteran complained of headaches and blackouts.  It was reported
that in June 1990, she was involved in a motor vehicle accident,
and rendered unconscious.  It was reported that she was taken to
a hospital, and at that time she was informed that she had a
brain concussion and an injury to her back.  X-rays and a brain
scan were normal at that time.  The veteran stated that she had
had intermittent headaches and low back pain which radiated into
her right hip, particularly when she moved.  An evaluation of
cranial nerves revealed mild left facial asymmetry may have been
chronic.  The diagnostic impression was history of cerebral
trauma a year ago with no evidence of cerebral defect, probably
mild, resolving cerebral concussion.

At a November 1991 VA examination, the veteran complained of
headaches.  An evaluation of the nervous system revealed that the
veteran claimed a mild concussion syndrome.  It was reported that
it was really difficult to evaluate her complaints.

A VA outpatient treatment record from late November 1991 reported
the veteran's complaints of light headedness, dizziness,
headaches "migraine," fever, and aching.  It was indicated that
she had been given antibiotics presumably for a urinary tract
infection the day before.  A similar episode in September 1990
caused by a urinary tract infection was reported.  In the
assessment, it was indicated that the veteran had not begun
antibiotics, and it seemed likely that her symptoms were due to a
urinary tract infection, as in the past.

 A VA neurological examination was performed in March 1994.  It
was indicated that the veteran reported head pain every two week,
lasting from several hours to a day, accompanied by some nausea
and photophobia.  Aspirin provided some mild relief.  It was
reported that she did not remember having a brain scan.  An
evaluation of the cranial nerves revealed that there was no
facial asymmetry.  The diagnostic impression revealed a history
of a closed head injury with residual headaches, which appeared
to be migrainous in nature without evidence of structural,
cerebral disease.

Analysis

After a review of the entire evidentiary data of record, the
Board concludes that the preponderance of the evidence is in
favor of the veteran's claim of entitlement to service connection
for headaches, residuals of a head injury.

It is pertinent to note that service connection may be granted
for disability resulting from disease or injury incurred during
service.  38 U.S.C.A. � 1131.

The clinical data shows in August 1990, near the very end of her
period of active service,  the veteran was involved in a motor
vehicle accident in which she sustained a head injury and lost
consciousness.

Some eight months later, the veteran reported recurrent
headaches.  It is important to note that the post-service
clinical data consistently reveals the veteran's continued
complaints of headaches.  Furthermore, VA clinicians, since an
examination in 1991, have recognized, and assessed mild residuals
of concussion and a history of a closed head injury with
headaches.  There are no contrary findings regarding residuals of
the head injury.  Based on the service and post-service clinical
data, we must conclude that the veteran incurred a head injury
during service, manifested by headaches.

The Board is aware that the veteran has also complained of
dizziness, blackouts, and lightheadedness on occasion, which she
apparently attributes to her service head injury.  However, the
medical evidence does not show that these symptoms are related to
the veteran's closed head injury.  In any event, we find that the
overall record supports a finding of a head injury incurred
during service, with resultant disability, namely headaches.

II.  Low Back Pain Syndrome

The RO has assigned a noncompensable disability evaluation for
low back pain syndrome, under the provisions of Diagnostic Code
5295, lumbosacral strain, of the VA's Schedule for Rating
Disabilities, 38 C.F.R. Part 4.  The Board is of the opinion that
the rating provisions of Diagnostic Codes 5292, involving
limitation of motion of the lumbar spine, are also applicable.

Service medical records show that in August 1990, the veteran was
involved in an automobile accident resulting in small hematomas
and tenderness of the back.  Full range of motion of the back was
reported.

A VA outpatient treatment entry dated in November 1990 revealed
the veteran's complaints of occasional low back pain.  Decreased
range of motion of the back in side bending and to the right was
reported, along with right palpable muscle tenderness.  Straight
leg raising was normal.  Low back strain was the diagnosis.

At a VA neurological examination in June 1991, it was indicated
that the veteran reported intermittent back pain, which radiated
into the upper thoracic region and right hip, particularly when
she moved.  An examination of the back revealed upper lumbar
tenderness and subjective motility of the hips. Straight leg
raising was negative bilaterally.  An X-ray of the lumbar spine
was normal.  The diagnostic impression indicated a history of
lumbar trauma without evidence of physiological defect, lumbar
sprain.  On VA orthopedic examination in June 1991, examination
of the spine showed normal range of motion with no paravertebral
muscle spasm or tenderness.  A September 1991 VA outpatient
clinical entry dated in reported complaints of low back pain.
Tenderness at L1 and L2 and right paravertebral muscle spasms
were reported.  Straight leg raising was negative bilaterally.
Mild back strain was the diagnosis.

At a November 1991 VA examination, the veteran complained of back
pain for which she had been given muscle relaxants earlier that
month.  The evaluation of the spine revealed that the veteran
flexed the lumbosacral spine gingerly to 80 degrees; extension
backwards and lateral flexion were to 25 degrees.  The examiner
indicated that it was difficult to tell if the veteran really had
that much pain.  It was reported that she appeared to be very
apprehensive and there appeared to be a marked supratentorial
element to her complaints.  An X-ray of the lumbar spine revealed
a questionable minimal levoscoliosis.  The diagnostic assessment
was history of car accident, with residual pain over the entire
spine, more marked in the lower spine, rule out myofascial
syndrome.

December 1991 and May 1992 clinical entries reported back pain
incurred while lifting furniture.  There was mild tenderness at
L3,4,5;  marked muscle spasms on the right; and decreased range
of motion of the back. The assessments were mild back strain, and
chronic back problem with acute strain and minimal spasms.

A VA orthopedic examination was performed in March 1994.  Back
pain and leg pain with numbness were reported.  It was indicated
that range of motion of the spine was essentially good.  Straight
leg testing was negative.  Lasegue's sign was positive to 75
degrees.  Babinski's sign was positive on the right.  Reflexes
were equal and active bilaterally.  Palpation of the spine
revealed pain all along the left, in the upper lumbar area.  It
was reported that specifically range of motion revealed that
(lumbar) forward flexion was to 95 degrees; backward extension
was to 35 degrees; left and right lateral flexion were to 30
degrees; and left and right rotation was to 25 degrees and
questionable.  It was indicated that there was objective evidence
of pain on motion; the veteran complained orally on movements of
the spine.  An X-ray of the lumbosacral spine was negative.
Chronic postural strain of the dorsal lumbar spine was the
diagnostic assessment.

At a March 1994 VA neurological examination, it was reported that
the veteran complained of back pain, radiating into the hips and
left leg.  The evaluation of the back revealed that Lasegue's
sign was positive, 40 degrees on the left and 50 degrees on the
right.  There was fairly good anterior mobility, and mild
diminution of posterior mobility.  Good lateral mobility was
reported.  The veteran's heel, toe, and tandem gaits were normal.
The impression indicated that the veteran had chronic low back
syndrome, with some mechanical findings particularly in the left
leg.  There were no other result's indicative of radiculopathy or
myelopathy.   It was indicated that the veteran was primarily
inhibited by her symptomatology which appeared to be somewhat
disproportionate to the objective findings.

Analysis

After a review of the evidentiary data of record, the Board
concludes that the preponderance of the evidence is in favor of
the veteran's claim of an increased evaluation for low back pain
syndrome.

The data of record since the service injury shows continued
complaints of low back pain.  Objective clinical findings have
included lumbosacral tenderness to palpation, paravertebral
muscle spasm, and limited motion.  The most recent range of
motion studies of the veteran's lumbar spine reveal some
limitation of motion, particularly on lateral flexion and
rotation, overall, which can best be described as slight.  In
addition, pain on motion of the spine has been indicated.   The
veteran has reported radiation of pain from the low back into the
extremities.  We note however, that there are no findings which
support any associated neurological impairment.  The most recent
neurological examination revealed no results indicative of
radiculopathy.  While the severity of the veteran's subjective
complaints in relation to actual objective pathology has been
questioned, the records overwhelmingly show some low back
pathology.

The VA rating schedule, under Diagnostic Code 5295, provides for
a 10 percent disability evaluation for lumbosacral strain with
characteristic pain on motion.  A 20 percent disability
evaluation is warranted for lumbosacral strain with muscle spasm
on extreme forward bend and unilateral loss of spine motion in a
standing position.  A 10  percent disability evaluation is also
available for slight limitation of motion of the lumbar spine,
under  Diagnostic Code 5292.  A 20 percent disability evaluation
requires moderate limited motion.  Based on the clinical data of
record in this case, the Board concludes that a 10 percent
disability evaluation is warranted under either of the
aforementioned Diagnostic Code provisions.  Characteristic pain
on motion and slight limitation of motion of the lumbar spine has
been demonstrated.  While the clinical records have noted muscle
spasm on same occasions, but not on others, these records do not
reveal muscle spasms on extreme forward bending and unilateral
loss of later spine motion in a standing position or evidence of
moderate limitation of motion of the lumbar spine.

There is no evidence of an exceptional or unusual disability
picture which renders impractical the application of the regular
schedular standards.  The Board concludes that the preponderance
of the evidence is in favor of the veteran's claim, and a 10
percent disability evaluation for low back pain syndrome is
warranted.

(CONTINUED ON NEXT PAGE)

ORDER

Service connection for headaches which are residuals of a head
injury is granted.

A 10 percent disability evaluation for low back pain syndrome is
granted, subject to the laws and regulations regarding the award
of monetary benefits.

          NANCY I. PHILLIPS
          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: THOMAS J DANNAHER

disposition: remanded

text:
BVA9413003
DOCKET NO.  90-45 752     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Los Angeles,
California

THE ISSUE

Entitlement to an increased rating for tinea pedis, currently
evaluated as 10 percent disabling.

REPRESENTATION

Appellant represented by: The American Legion

ATTORNEY FOR THE BOARD

R. E. Coppola, Associate Counsel

INTRODUCTION

The veteran had active service from August 1951 to June 1963.

This matter initially came before the Board of Veterans' Appeals
(Board) on appeal from a March 1990 rating decision of the Los
Angeles, California, Regional Office (RO), which denied the
veteran's claim for an increased rating for service-connected
tinea pedis.  In April 1991, the Board remanded the case to the RO
for further development.  In June 1992, the Board issued a
decision denying the claim for an increased rating.  Thereafter,
the veteran appealed the Board's decision to the United States
Court of Veterans Appeals (Court).

In [citation redacted],
the Court vacated the Board's June 1992 decision under 38 U.S.C.A.
� 7261(a) (West 1991), and remanded the case to the Board, under
the authority of 38 U.S.C.A. � 7252(a) (West 1991), for
readjudication consistent with the Court's opinion.

The case has been returned to the Board from the Department of
Veterans Affairs (VA) General Counsel's Office.  Accordingly, the
Board will now proceed in accordance with the Court's opinion, a
copy of which is contained in the claims folder.

REMAND

In June 1992, the Board issued a decision denying the veteran's
claim for an increased rating for tinea pedis.  The Board
determined that the evidence did not support a finding that the
service-connected tinea pedis was manifested by constant exudation
or itching, extensive lesions, or marked disfigurement.  38 C.F.R.
� 4.118, Diagnostic Code 7806 (1993).

In its April 1994 decision, the Court held that the evidence of
record was inadequate because the Board did not fulfill its duty
to assist the veteran in the development of facts pertinent to his
claim.  38 U.S.C.A. � 5107(a) (West 1991).  The Court notes that
the veteran's tinea pedis consists of an active stage and an
inactive stage during which the condition improves.  The Court
held that the September 1991 VA examination was not adequate
because it did not include a complete assessment of the history of
remission and recurrence of tinea pedis.  See 38 C.F.R. � 4.2
(1993); see also Abernathy v. Principi, 3 Vet.App. 461, 464 (1992)
(Board decision was erroneous where it relied on an incomplete
examination).  The Court also held that despite the fluctuating
nature of the veteran's tinea pedis, the VA examination was not
performed during the active stage of the condition.  Finally, the
Court held that although an "id reaction" affecting the hands and
lips had been found in the past, the September 1991 VA examination
did not mention any such manifestations, and it was not clear
whether the examiner evaluated the veteran for such a reaction.
The Court instructed the Board to provide an adequate examination
during the active stage of the veteran's tinea pedis, and on the
basis of that examination and all evidence of record, ascertain
the existence, extent, and significance under the rating schedule
of any "id reaction" due to tinea pedis.  [citation redacted].

In the June 1992 decision, the Board determined that entitlement
to an extraschedular evaluation pursuant to the provisions of 38
C.F.R. � 3.321(b)(1) (1993), was not warranted.  The Court held
that the Board did not make the requisite findings of fact or give
reasons or bases for its decision, and that this must be completed
prior to final adjudication.  [citation redacted].

Under the circumstances of this case, additional development is
necessary.  Accordingly, the case is REMANDED for the following
actions:

1.  The veteran should be contacted and
asked to list the names, addresses, dates
of treatment, etc., by any private or VA
physicians who have recently treated him
for skin problems and provide the
appropriate authorizations.  Copies of any
VA or private medical records pertaining to
the veteran's skin disorder that are dated
subsequent to those on file should be
obtained and associated with the claims
folder.

2.  The veteran should be afforded VA
dermatology examination during the active
stage of his tinea pedis, conducted by a
specialist, in order to determine the
manifestations and severity of the tinea
pedis and to assess any "id reaction."  The
examination should be conducted in
accordance with VA's Physician's Guide for
Disability Evaluation Examinations.  It
should be indicated to the examiner that
the veteran's tinea pedis consists of
active and inactive stages during which the
condition improves, and that there is
evidence of an "id reaction" affecting the
hands and lips in the past.  The
examination should include all appropriate
testing and evaluations and the results
should be reported in detail, including a
complete assessment of the history of
remission and recurrence of tinea pedis.
The examiner should also ascertain the
existence, extent, and significance of any
"id reaction" due to tinea pedis, based on
the examination of tinea pedis during an
active stage and all evidence of record.
The claims folder and a copy of this remand
must be made available to the examiner and
the history of the disability should be
reviewed.

3.  The RO should then readjudicate the
claim for an increased rating for tinea
pedis, including a determination of whether
the case should be submitted to the Chief
Benefits Director or the Director of
Compensation and Pension for consideration
of entitlement to an extraschedular
evaluation pursuant to the provisions of 38
C.F.R. � 3.321(b)(1) (1993).  If it is
decided that the case will not be submitted
for extraschedular consideration, the
reasons for this decision should be clearly
explained.

Following completion of these actions, the veteran and his
representative should be provided with a supplemental
statement of the case if appropriate, and the case should be
returned to the Board for further appellate consideration.
No action is required of the veteran until he is notified.

          THOMAS J. DANNAHER
          Member, Board of Veterans' Appeals

(Continued on next page)

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: HOLLY E MOEHLMANN

disposition: denied

text:
BVA9414003
DOCKET NO.  92-24 760     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Montgomery,
Alabama

THE ISSUE

Whether new and material evidence has been submitted to reopen a
claim for service connection for a back disability.

REPRESENTATION

Appellant represented by: Alabama Department of Veterans
Affairs

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

J. Andrew Ahlberg, Associate Counsel

INTRODUCTION

The veteran served on active duty from July 1955 to June 1959.

This case comes before the Board of Veterans' Appeals
(hereinafter Board) on appeal from adverse rating action by the
Montgomery, Alabama, Regional Office (hereinafter RO).

CONTENTIONS

The veteran essentially contends that he has submitted additional
evidence that is sufficient to reopen and allow his claim for
service connection for a back disability.  He also contends that
the RO should attempt to obtain additional service medical
records and that he should be afforded a VA medical examination.

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 has failed to submit new and material
evidence sufficient to reopen his claim for service connection
for a back disability.

FINDINGS OF FACT

1.  All relevant available evidence necessary for an equitable
disposition of the veteran's appeal has been obtained by the RO.

2.  Service connection for a back disability was originally
denied by a July 1963 rating decision to which a timely appeal
was not submitted.

3.  Additional evidence submitted by the veteran consisting of
private treatment records dated from December 1966 to February
1992 is "new" but is not "material" because it is not probative
as to service incurrence of a back disability.

4.  The evidence contained in the transcript from the September
1992 hearing is either not "new" because it is cumulative of
evidence previously considered in July 1963 or not "material"
because it is not probative as to service incurrence of a back
disability.

CONCLUSION OF LAW

Evidence received since the July 1963 rating decision denying
entitlement to service connection for a back disability is not
both "new" and "material" and the veteran's claim is not
reopened.  38 U.S.C.A. �� 1101, 1112, 1113, 1131, 5107, 5108
(West 1991); 38 C.F.R. �� 3.156, 3.303, 3.307, 3.309 (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Board concedes that the veteran has presented a claim which
is "well-grounded" or plausible within the meaning of 38 U.S.C.A.
� 5107(a).  The Board is also satisfied that the duty to assist
mandated by 38 U.S.C.A. � 5107(a) has been fulfilled as there is
sufficient evidence of record to make an equitable decision in
the veteran's appeal.

While we have considered the veteran's request with regard to
obtaining additional service medical records, we note that the RO
already had requested all of the veteran's medical records from
service according to a VA Form 3101 (Request for Information)
dated in March 1963.  It was also noted on this form that the
veteran was to specify the months of treatment for dislocated
vertebrae alleged by him to have occurred in 1958 and 1959 in
order to facilitate a search.  This information was requested by
the RO by way of letters sent to the veteran dated in April and
May of 1963, but there is no response from the veteran providing
the months of the alleged treatment of record.  The Board notes
that the duty to assist is not a "one way street," and the
veteran may not simply passively wait for evidence to be provided
by the RO when it is essential for him to provide information in
his possession that is necessary for a productive search for
records.  See, Wood v. Derwinski, 1 Vet.App. 190,193 (1991);
Olson v. Principi, 3 Vet.App. 480, 483 (1992).  Even were we to
assume, for the sake of argument, that an additional search for
records would produce sick call records showing treatment for a
back disability caused by the alleged accident in service, these
records would be unlikely to show that the veteran had a chronic
back disorder in service given the fact that the separation
examination is negative and that, as will be explained below,
there is no objective clinical evidence of record linking a
current back disorder to service.  Therefore, the Board concludes
that the further delay in the final adjudication of the veteran's
case that would result from a remand for a "fishing expedition"
to search for additional service medical records would not be
justified since it is not likely to produce additional
information essential to the adjudication of the veteran's claim.
See, Gobber v. Derwinski, 2 Vet.App. 470, 472 (1992).

For service connection to be granted, it is required that the
facts, as shown by the evidence, establish that a particular
injury or disease resulting in chronic disability was incurred in
service, or, if pre-existing service, was aggravated therein.
38 U.S.C.A. �� 1131 (West 1991); 38 C.F.R. � 3.303 (1993).  There
are some disabilities, including arthritis, where service
connection may be presumed if the disorder is manifested to a
degree of 10 percent within one year of separation from service.
38 U.S.C.A. �� 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R.
�� 3.307, 3.309 (1993).

For the showing of a chronic disease in service, there is
required a combination of manifestations sufficient to identify
the disease entity, and sufficient observation to establish
chronicity at the time, as distinguished from merely isolated
findings or a diagnosis including the word "chronic".  Continuity
of symptomatology is required where the condition noted during
service 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).

If new and material evidence is presented or secured with respect
to a claim which has been disallowed, the Secretary shall reopen
the claim and review the former disposition of the claim.
38 U.S.C.A. � 5108; 38 C.F.R. � 3.156.

The United States Court of Veteran's Appeals has held that the
Board must perform a two-step analysis when a veteran seeks to
reopen a claim based on new evidence.  First, the Board must
determine whether the additional evidence is "new" and
"material."  Second, if the Board determines that new and
material evidence has been added to the record, the claim is
reopened and the Board must evaluate the merits of the veteran's
claim in light of all the evidence, both new and old.  Manio v.
Derwinski, 1 Vet.App. 140 (1991).  "New" evidence means more than
evidence which was not previously of record.  To be "new", the
additional evidence must be more than merely cumulative.  Colvin
v. Derwinski, 1 Vet.App. 171 (1991).  To be "material", the
additional evidence must be probative of the issue at hand.
Also, to be "material", there must be a reasonable possibility
that the new evidence, when viewed in the context of all the
evidence, both old and new, would change the outcome of the
previous decision.  Smith v. Derwinski, 1 Vet.App. 178 (1991).

The evidence before the RO at the time of its July 1963 rating
decision denying service connection for a back disability
included the veteran's service medical records, including entries
while on the USS Chemung from 1957 to 1959 and the report from
the separation examination, which were negative for symptoms or
treatment of a chronic back disorder and reports from a March
1963 VA examination that was essentially negative for a back
disability.  The examination diagnosis was history of a sprain of
the lumbosacral.  Included in the reports from this examination
is a history given to the examiner by the veteran of an injury to
his back incurred aboard a ship while moving a heavy object up
some stairs with a fellow serviceman.  The veteran reported that
he was treated for his back pain in sick bay with the application
of heat to the affected area.  He further stated that during
treatment for a toe injury in a hospital sometime thereafter, he
requested treatment for his back but nothing was done.

Also of record before the RO in July 1963 was a report from G. R.
Bergman, M.D., dated in May 1963 describing three episodes of
treatment in 1960, 1961 and 1962 for what he diagnosed as
recurrent acute muscular strain in the veteran's lower back.
Rather than relating the pathology to service, the veteran stated
that the back problems were precipitated by heavy lifting in his
yard and at his place of employment.

Evidence of record submitted in an attempt to reopen the veteran'
claim includes private medical records dated from December 1966
to February 1992 and sworn testimony given at a September 1992
hearing at the RO.  While these records referred to
hospitalization for viral pneumonia (December 1966); treatment
for injuries, largely involving fractures of the legs, sustained
in an automobile accident (intermittently from August 1969 to
November 1976); hospitalization for treatment of ischemic heart
disease (September and October 1979); surgery for osteomyelitis
of the left tibia (June and July 1984); and treatment for a
pneumothorax and multiple rib and leg fractures, post motor
vehicle accident (July and August 1991); none of these records
contained any clinical evidence linking a back disorder to
service.

The Board notes that while treatment for back disorders,
variously diagnosed as lumbosacral strain, degenerative joint
disease and degenerative disc disease, was shown on private
treatment records dated from August 1982 to April 1989, none of
these records in any way link the back symptoms shown at that
time to service.  In this regard, the report from hospitalization
for back pain beginning in August 1982 indicated the veteran was
first seen for back pain in an outpatient clinic in June 1982,
and that he said his back began hurting him only four days prior
to this visit.  While this evidence is "new", it is not
"material" because it is not probative and there is no reasonable
possibility that the additional evidence, when viewed in the
context of all the evidence, both new and old, would change the
outcome:  None of the additional evidence provides any
information linking a current back disability to an event in
service.  Colvin v. Derwinski, 1 Vet.App. 171, 178 (1991); Smith
v. Derwinski, 1 Vet.App. 178 (1991).

As for the September 1992 testimony, the Board finds much of it
be repetitive of the history given by the veteran at the time of
the March 1963 examination and therefore not "new."  On both
occasions, the veteran described an accident involving a fall
while carrying a heavy object up some stairs while on board a
ship that he alleged was the cause of his back disability.  He
also repeated his contention at his hearing that although he
complained about his back while he was hospitalized for
treatement of a toe injury in service, no treatment for the back
was provided.  The Board notes also with regard to the veteran's
testimony contending that the current back disability was
originally caused by an in-service accident that the veteran is
not competent to make such a conclusion because he does not have
the requisite medical knowledge.  Therefore, such a conclusion is
of minimal probative value under Espiritu v. Derwinski, 2
Vet.App. 492 (1992).  While the remaining testimony is "new", it
is nevertheless not "material" because it is not probative as to
the issue of the relationship between current back pathology and
any incident in service.

While we have considered the contention with regard to providing
the veteran with a VA examination, such an examination so many
years after service is not likely to produce any probative
evidence as to whether the veteran's variously diagnosed back
disorder is related to an injury in service.  See, Shoop v.
Derwinski, 3 Vet.App. 45 (1992); (Single judge decision finding
no duty to provide an audiometric examination because it "would
have no bearing on the question of when this hearing loss first
became manifest").

ORDER

The claim for service connection for a back disability is not
reopened; the benefit sought is denied.

          (CONTINUED ON NEXT PAGE)

          HOLLY E. MOEHLMANN
          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: JANE E SHARP

condition: tinnitus

text:
BVA9415003
DOCKET NO.  92-13 399     )       DATE
          )
          )

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

THE ISSUES

1.  Entitlement to service connection for a perforated eardrum
with associated hearing loss, left ear.

2.  Entitlement to service connection for tinnitus.

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

REPRESENTATION

Appellant represented by: The American Legion

WITNESS AT HEARING ON APPEAL

The veteran

ATTORNEY FOR THE BOARD

R. E. Coppola, Associate Counsel

INTRODUCTION

The veteran served on active duty from October 1943 to December
1945.

By a rating decision dated in March 1982, the St. Petersburg,
Florida, Regional Office (RO) denied entitlement to service
connection for ear disability, including a perforated eardrum and
hearing loss.  The RO also denied entitlement to service
connection for residuals of a foot injury, listed as Achilles
tendon problems of the heel.  The veteran was notified of that
determination by letter dated April 13, 1982.  The veteran
submitted a notice of disagreement which was received on April
13, 1983.  A statement of the case was issued in May 1983.
Thereafter, the veteran submitted a substantive appeal which was
received on April 23, 1984.  The RO issued a notice to the
veteran, dated April 27, 1984, which stated that his appeal had
not been completed in a timely manner and that the April 1982
rating decision was final.

This matter came before the Board of Veterans' Appeals (Board) on
appeal from a rating decision of October 1986 by the RO.  The
notice of disagreement was received in November 1986.  In January
1991, the veteran explained that he was seeking service
connection for left ear hearing loss and a left foot disorder.
By a November 1991 rating decision, the RO held that new and
material evidence had not been submitted to reopen the claim.
The statement of the case was issued in November 1991.  The
substantive appeal was received in December 1991.  A personal
hearing on appeal was held at the RO in March 1992.  In April
1992, the hearing officer held that the veteran had submitted new
and material evidence to reopen his claims.  However, he also
held that service connection was not warranted based on the
entire evidence of record, both old and new.  In January 1993,
the Board remanded the case to the RO for further development.
The case was returned to the Board in July 1994.

CONTENTIONS

The veteran contends that the RO committed error in not granting
service connection for a perforated eardrum with associated left
ear hearing loss and tinnitus because it did not take into
account or properly weigh the evidence of record, including
service medical records, Department of Veterans' Affairs (VA) and
private clinical evidence, personal hearing testimony and
statements submitted in support of the claim.  He claims that his
left ear problems began during navigation training school, and
that these problems were incurred as a result of flying in
unpressurized aircraft.  He argues that the exposure to loud
noise from the propellers and the pressure associated with
ascending and descending in the aircraft caused his perforated
left eardrum, hearing loss and tinnitus.  He also contends that
the RO committed error in not granting service connection for a
residuals of a left foot injury.  He maintains that he was
hospitalized during service for foot problems which were
initially caused by the military boots used during basic
training.  He claims that he has had residual foot problems since
that time.

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
claims of service connection for a perforated left eardrum with
associated hearing loss, tinnitus and residuals of a left foot
injury.

FINDINGS OF FACT

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

2.  A left ear perforation or hearing loss was not shown during
active service or for many years thereafter.  The veteran's left
ear, including hearing and the tympanic membrane, was normal at
service separation.

3.  Chronic left ear disorders are not credibly shown until about
10 years after service and there is no medical evidence relating
them to service.

4.  Tinnitus was not shown during service or noted in post-service
medical evidence.

5.  A sore left heel tendon and/or friction burns of the feet as a
result of improper footwear, for which the veteran was briefly
hospitalized during service, had resolved without residuals prior
to separation from service; his feet were normal on the service
discharge examination and he was found to have had no sequelae
from the previous foot problems.

6.  Arthritis of the left ankle, first documented decades after
service, has not been related to service foot problems by medical
evidence and there is no clinical documentation of any residuals
of the left foot problems during service.

CONCLUSIONS OF LAW

1.  A perforated left eardrum with associated hearing loss was
neither incurred in nor aggravated by active service.  38 U.S.C.A.
�� 1110, 5107 (West 1991); 38 C.F.R. � 3.303 (1993).

2.  Tinnitus was neither incurred in nor aggravated by active
service.  38 U.S.C.A. �� 1110, 5107; 38 C.F.R. � 3.303.

3.  Residuals of a left foot injury were not incurred in or
aggravated by active service nor may arthritis of the left ankle
be presumed to have been incurred in service.  38 U.S.C.A. ��
1101, 1110, 1112, 1113, 5107 (West 1991); 38 C.F.R. �� 3.303,
3.307, 3.309 (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

Based upon the evidence submitted in support of the claim,
including statements of personal observation and the veteran's
personal hearing testimony, the Board finds that the claims are
well-grounded within the meaning of 38 U.S.C.A. � 5107(a).

In a July 1991 application for disability compensation, the
veteran indicated that he had received medical treatment for his
ear condition in 1945, during navigation training at the 2523rd
AAFBU, Hondo, Texas.  He also indicated that he received medical
treatment for his foot injury in 1944, during basic training at
Keesler Field, Biloxi, Mississippi.  Finally, he indicated the he
received post-service medical treatment for his ear condition,
including treatment in 1955 from Bernard Churchill, M.D.,
Milwaukee, Wisconsin, and in 1975 at the VA Hospital, Milwaukee,
Wisconsin.  It was argued that the veteran's service medical
records are not complete and that additional records exist which
substantiate his claims for service connection.

In January 1993, the Board remanded the case to the RO in an
attempt to locate and obtain copies of any additional records.
It appears from a review of the claims folder that the RO has
properly requested and obtained, to the extent possible, the
information sought in the Board's remand action.  The evidence
obtained consists of hospital admission summaries from the Office
of the Surgeon General (SGO) which contain no reference to an ear
condition during navigation training at the 2523rd AAFBU, Hondo,
Texas, in 1945 or at any other time during service.  The record
shows that several attempts were made to obtain evidence of VA
treatment in 1975 at the VA Hospital, Milwaukee, Wisconsin;
however, the response from each VA facility that has had
possession of the veteran's records since that time is negative.
The veteran was requested to provide additional information
regarding treatment by Dr. Churchill.  He submitted a written
release for his records, which indicated only that Dr. Churchill
was no longer practicing medicine.  It appears that these records
of treatment are no longer available. The veteran has not
indicated that additional, relevant evidence has not yet been
obtained.  Therefore, we find that the facts relevant to the
issues on appeal have been properly developed to the extent
possible  and that the statutory obligation to assist the veteran
has been satisfied.  Id.

The veteran seeks service connection for a perforated left
eardrum with associated hearing loss, bilateral tinnitus and
residuals of a left foot injury.  Service connection for VA
disability compensation purposes will be awarded for a disease or
injury that was incurred during active service or, if pre-
existing active service, was aggravated therein.  38 U.S.C.A.
� 1110; 38 C.F.R. � 3.303.  Certain chronic diseases, including
arthritis and sensorineural hearing loss, may be presumed to have
been incurred in service if they are compensably manifested
within a year after service discharge.  38 U.S.C.A. �� 1101,
1112, 1113; 38 C.F.R. �� 3.307, 3.309.  Although service
connection is warranted for a chronic disease or residuals of
injuries shown as such in service, this rule does not mean that
any findings in service will permit service connection.
38 C.F.R. � 3.303(b) (1993).  For the showing of chronic disease
in service there is required a combination of manifestations
sufficient to identify the disease entity, and sufficient
observation to establish chronicity at the time, as distinguished
from merely isolated findings or a diagnosis including the word
"chronic."  Id.  In fact, continuity of symptomatology is
required where the condition noted during service is not shown to
be chronic or where the diagnosis of chronicity may be
legitimately questioned.  Id.  When chronicity in service is not
adequately supported, then a showing of continuity after
discharge is required to support the claim.  Id.  Direct service
connection may also be granted for any disease or residuals of
injuries diagnosed after discharge, when all the evidence,
including that pertinent to service, establishes that the disease
was incurred or aggravated during active service.  38 C.F.R.
� 3.303(d) (1993).

Left Eardrum Perforation With Hearing Loss

The service medical records show that the veteran's ears and
hearing acuity were reported as normal at induction in October
1943.  On physical examination for flying in April 1945, it was
noted that he had previously qualified for flight detail during a
November 1944 examination.  The April 1945 examination report
states that the tympanic membranes were scarred, bilaterally, but
the examiner indicated that this condition did not disqualify the
veteran from flying.  At that time, the veteran denied a history
of ear trouble.  Hearing was 20/20 in each ear.  The service
records show that another examination was conducted in June 1945.
Hearing was 20/20 in each ear.  That report does not show any
left ear pathology.  On separation examination in December 1945,
the examiner reported that both ears, including the tympanic
membranes, were normal.  Hearing was 15/15 in each ear.  Although
a medical history was reported , it did not include any ear
problems.

The service medical records do not show a perforation of the left
eardrum.  Although "scarring" of the tympanic membranes was noted
in April 1945, physical examination about two months later showed
no ear pathology and the service discharge examination was
similarly negative.  There is no medical evidence showing that
the left tympanic membrane was perforated during service and
clearly there was no perforation demonstrated at service
discharge.  The veteran's left ear hearing was normal on all
occasions of testing during service.  These objective records
support a finding that the veteran did not have a chronic left
ear disability, including a left tympanic perforation or hearing
loss, during active service.  38 C.F.R. � 3.303(b).

At his personal hearing in March 1992, the veteran testified that
he did not seek medical attention for hearing loss or ear
problems during active service.  Transcript, pp. 7-8, 10.  In
fact, he testified that he did not seek medical treatment prior
to 1955 for hearing or ear problems.  Tr. at 9, 10.  Finally, he
testified that it was 1955 "when the perforated eardrums showed
up."  Tr. at 9.  The Board accepts the veteran's testimony that
he was treated for a left perforated eardrum with hearing loss
beginning in 1955; however, that was about 10 years after
service.  The evidence indicates that he was next treated in
1975, approximately 20 years after the initial post-service
treatment, at the VA Hospital, Milwaukee, Wisconsin, in order to
correct a left eardrum perforation.  Also, there is an
appointment card indicating that the veteran had two appointments
at a VA ear, nose & throat clinic in early 1981.

Finally, there is a December 1991 statement from Marc P. Grenier,
M.D., indicating that the veteran "has a history of an old
perforation with an attempt at tympanoplasty many years in the
past.  The perforation has persisted."  Although
this evidence shows a history of ear surgery (apparently a
reference to surgery in 1975) for an "old" perforation, the
perforation had to have been of post-service origin since the
tympanic membranes were found to be normal on the service
discharge examination.  Dr. Grenier's statement does not relate
any post-service ear problems to the veteran's service.  Also Dr.
Grenier did not mention hearing loss and there is no competent
evidence that any post-service hearing loss is related in any way
to service.  As already stated, service medical records
repeatedly show normal hearing.   For these reasons, the board
finds that the medical evidence does not support a finding of
that a chronic ear disorder is of service origin.   38 U.S.C.A.
� 1110; 38 C.F.R. � 3.303(b).

In support of the claim is an October 1991 statement by the
veteran's brother.  He states that the veteran's hearing problems
began during navigation training as a result of flying in
unpressurized aircraft.  Since neither left ear hearing loss nor
any chronic left ear disorder was shown in service, the opinion
that the veteran's left ear problems are the result of service is
not probative.  The veteran's brother has not been shown to be
qualified to provide competent evidence of medical causation.
See Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992).  The
remainder of the statement relates to post-service treatment
beginning in 1975.  This evidence has previously been discussed
and it does not show left ear disability of service origin.

Although the veteran testified that he had hearing loss at
discharge from service, this is in conflict with the service
discharge examination report that shows normal hearing.  He also
testified that in 1955 he had a perforated tympanic membrane and
was found to have hearing loss based on testing and that he had
ear infections between 1945 and 1955.  Tr. at 8-9, 11.  The
testimony that he had post-service ear infections does not
establish the service onset of chronic ear pathology, especially
since no ear infections are mentioned in the service medical
records, including by history.  Consequently, the veteran's
testimony, given in support of his claim for VA benefits, is less
probative than the history and findings noted in service.

In summary, the service medical records do not show evidence of a
left eardrum perforation, chronic left ear problems or hearing
loss during active service.  The veteran's hearing was normal
when tested during service and his ears were entirely normal on
the discharge examination.  The post-service medical evidence
does not show that the veteran's current left ear problems had
their onset in service or are related to any incident of service.
For the above reasons, the Board concludes that the evidence is
not evenly balanced in this case and it does not establish that a
perforated left eardrum with associated hearing loss was incurred
in or aggravated by active service.  38 U.S.C.A. �� 1110, 5107;
38 C.F.R. � 3.303.

Tinnitus

The Board has determined that the veteran's claim for service
connection tinnitus is well-grounded because of his testimony
that he was exposed to loud noise during service and has
experienced ringing in his ears since that time.  Tr. at 6-8.
The veteran is competent to testify to his personal observations
and the credibility of that evidence is not at issue for the
purpose of determining whether the claim is well-grounded.

We note, however, that the service medical records do not contain
any evidence of tinnitus, including by history   The VA and
private medical evidence of record does not reflect a diagnosis
of tinnitus, in spite of the fact that Dr. Grenier has listed the
veteran's various symptoms.  In fact, there is currently no
objective medical evidence of record which substantiates the
veteran's claim that he has tinnitus.  The letter from the
veteran's brother mentions the veteran's ear problems but does
not refer to tinnitus.

At the personal hearing, the veteran testified that he has
experienced constant ringing in his ears since the day he began
navigation training during service.  He stated that he has
experienced such ringing "100 percent constantly all the time day
and night" and indicated that he forgot to mention that
disability earlier.  Tr. at 7.  However, the veteran did not
claim tinnitus or ringing in his ears in his original application
for disability compensation, nor did he claim service connection
for tinnitus in his current application.  In fact, the veteran
did not mention ringing in his ears prior to his testimony.  The
Board finds that the veteran's personal hearing testimony
regarding the service onset and continuation of tinnitus since
service is not credible and has no probative value.

In summary, the service medical records do not show evidence of
tinnitus, and the post-service medical evidence does not show
either a diagnosis of tinnitus or evidence indicating a causal
relationship between the veteran's current complaints of ringing
in the ears and active service.  For all the above reasons, the
Board concludes that the evidence is not evenly balanced in this
case and it does not establish that tinnitus was incurred in or
aggravated by active service.  38 U.S.C.A. �� 1110, 5107;
38 C.F.R. � 3.303.

Residuals Of A Left Foot Injury

The veteran seeks service connection for residuals of an injury
of the left foot, which he claims was incurred as a result of
physical training during basic training.  A review of the
December 1945 report of physical examination at separation,
indicates that he was hospitalized for one week in December 1943
for "[l]eft heel-sore tendon" at Keesler Field, Mississippi.  It
was stated that there were no sequelae associated with that
injury.  Pursuant to the January 1993 remand, the RO obtained
hospital admission summaries from the SGO which indicate that the
veteran was hospitalized in December 1943 for tenosynovitis and
in July 1944 for abraded wounds described as friction burns.  The
latter summary lists the causative agent as "ill-fitting" shoes,
and both reports  indicate that he was returned to duty following
hospitalization.  The veteran testified that medical personnel
told him he had "sore feet" from hiking.  Tr. at 2.  He also
testified that subsequent to hospitalization, he was issued new
boots and that his condition improved.  Id.  In response to a
question regarding whether he sought additional treatment during
service, he responded in the negative but indicated that he was
given special considerations such as exemptions from long hikes.
Tr. at 2,6.

When the veteran was given an examination for flying in April
1945, his feet were described as "normal" and although a medical
history was noted, it did not include any foot or heel
conditions.   On the examination in December 1945 for service
separation, the veteran's bones, joints, muscles, and feet were
found to be normal.  At that time, a history of a sore tendon of
the left heel in December 1943, with "no sequelae" was noted.
While the veteran testified that at separation "they checked it
out (and) it showed that the tendon was still sore and in bad
shape," this testimony is based on memory of events almost 50
years earlier and conflicts with the actual medical evidence at
the time of that examination.  Tr. at 3.  For these reasons, the
testimony has limited probative value.  The service medical
evidence, as described above, strongly supports a finding that
the foot/heel problems during service had resolved completely
prior to the veteran's discharge from service.  The Board finds
that the veteran was not treated for a chronic left foot
disability during active service, and that chronicity in service
is not adequately supported.  38 C.F.R. � 3.303(b).

The post-service evidence includes the veteran's testimony at his
personal hearing. Although, in response to a question whether he
sought treatment after service, the veteran testified that he did
not because his work did not require much walking and he could
not afford a doctor (Tr. at 3),  he did obtain private, and
apparently VA, treatment for ear problems after service.  The
initial post-service medical evidence regarding the left foot is
an October 1991 private medical record indicating that the
veteran reported having always had a problem with his Achilles
tendon and that he had occasional arthritis about once a year.
It was noted that he had a history of gout and that he had had a
"tendon problem in this ankle many years ago."  The impression
was arthritis.  There is no indication that the current left
ankle arthritis is related to the in-service problems.  The
recent diagnosis of arthritis of the left ankle, about 50 years
after service, has not been linked to the left foot problems in
service by any medical evidence.  Moreover, tenosynovitis has not
been shown since the episode in 1943.

In conclusion, service medical records show brief hospitalization
during service for a sore left heel tendon and/or friction burns
of the feet as a result of improper footwear; however, the
evidence indicates that this condition had resolved by the time
of separation from service as findings then were normal and it
was stated that there were no sequelae of the previous foot
problem.  The evidence does not show post-service medical
treatment for over 45 years after service, or that the recently
noted arthritis of the left ankle is related to any foot/heel
problems during service.   For all the above reasons, the Board
concludes that the evidence is not evenly balanced in this case
and it does not establish that residuals of a left foot injury
were incurred in active service.  38 U.S.C.A. �� 1101,1110, 1112,
1113, 5107; 38 C.F.R. �� 3.303, 3.307, 3.309.

ORDER

Entitlement to service connection for a perforated ear drum with
associated hearing loss, left ear, is denied.

Entitlement to service connection for tinnitus is denied.

Entitlement to service connection for residuals of a left foot
injury is denied.

          JANE E. SHARP
          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: ROBERT E SULLIVAN

text:
BVA9501000
DOCKET NO.  93-01 206     )       DATE
          )
          )

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

THE ISSUE

Entitlement to an effective date earlier than December 4, 1989,
for a 100 percent rating for post-traumatic stress disorder
(PTSD) with dysthymia.

REPRESENTATION

Appellant represented by: Paralyzed Veterans of America,
Inc.

ATTORNEY FOR THE BOARD

Nancy S. Kettelle, Counsel

REMAND

The veteran had active duty from September 1969 to September
1971.

This matter comes to the Board of Veterans' Appeals (Board) on
appeal from a rating decision of the Department of Veterans
Affairs (VA) Regional Office (RO) in Seattle, Washington.

In his substantive appeal with respect to the earlier effective
date issue, the veteran raised the issue of permanency of his
currently assigned total rating.  In view of decisions of the
Court of Veterans Appeals in EF v. Derwinski, 1 Vet.App. 180
(1991) and Payne v. Derwinski, 1 Vet.App. 85 (1990), the Board
finds that the raised issue should be referred to the RO for
further action.

Review of the claims file indicates that there may be available
additional VA treatment, counseling and Vocational Rehabilitation
records that are not presently associated with the veteran's
claims file.  To ensure that VA has met its duty to assist the
veteran in developing the facts pertinent to the claim and to
ensure full compliance with due process requirements, the case is
REMANDED to the RO for the following development:

1.  The RO should obtain and associate with
the claims file all VA psychological
counseling records and all VA outpatient
and hospital records for the veteran dated
from October 1987 to December 1989.

2.  The RO should obtain the veteran's
Chapter 31 vocational rehabilitation folder
and associate it with the claims folder.

3.  The RO should obtain from the Social
Security Administration copies of all
exhibits referenced in its December 1990
decision granting the veteran Social
Security disability benefits.

4.  The RO should undertake any indicated
development with respect to the veteran's
claim of permanency of his 100 percent
rating for PTSD with dysthymia.

5.  After the development requested above
has been completed to the extent possible,
the RO should again review the record and
readjudicate the issue of entitlement to an
effective date earlier than December 4,
1989 for a 100 percent rating for PTSD with
dysthymia.  In addition, the RO should
adjudicate the veteran's claim of
permanency of his 100 percent rating for
PTSD with dysthymia.

If the benefit sought on appeal is not granted to the veteran's
satisfaction, or if a timely Notice of Disagreement is received
with respect to any other matter, including the raised issue, the
RO should issue a Supplemental Statement of the Case addressing
all issues in appellate status, and the veteran and his
representative should be provided an opportunity to respond.
Thereafter, the case should be returned to the Board for further
consideration, if otherwise in order.

By this REMAND, the Board implies no conclusion, either legal or
factual, as to any final outcome warranted.  The veteran need
take no action unless otherwise notified by the RO.

          ROBERT E. SULLIVAN
          Member, Board of Veterans' Appeals
          (CONTINUED ON NEXT PAGE)

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: CHARLES E HOGEBOOM

condition: psychiatric

text:
BVA9502000
DOCKET NO.  92-02 636     )       DATE
          )
          )

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

THE ISSUE

Entitlement to service connection for schizophrenia.

REPRESENTATION

Appellant represented by: The American Legion

WITNESS AT HEARING ON APPEAL

The veteran

ATTORNEY FOR THE BOARD

John D. Nachmann, Associate Counsel

INTRODUCTION

The veteran had active military service from January 1981 to
October 1982.

This matter comes before the Board of Veterans' Appeals (Board)
on appeal from a rating decision of May 1992 by the Department of
Veterans Affairs (VA) Nashville, Tennessee, Regional Office (RO).

CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends that the RO was incorrect in not granting
his claim of entitlement to service connection for schizophrenia.
He maintains that service connection for schizophrenia is
warranted because he developed a personality disorder during
service and has recently been diagnosed with schizophrenia.
Therefore, he requests a favorable determination by the Board.

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 of entitlement to service connection for
schizophrenia.

FINDINGS OF FACT

1.  All relevant evidence necessary for an equitable disposition
of the veteran's appeal has been obtained by the RO.

2.  Schizophrenia was not clinically manifested during active
service or within one year following his separation from service.

CONCLUSION OF LAW

Schizophrenia was not incurred in or aggravated by active service
nor may it be presumed to have been incurred in service.
38 U.S.C.A. �� 1101, 1131, 1133, 5107 (West 1991); 38 C.F.R.
�� 3.303, 3.307, 3.309 (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The veteran has submitted a well-grounded claim within the
meaning of 38 U.S.C.A. � 5107(a).  See Murphy v. Derwinski,
1 Vet.App. 78, 81 (1990); Gilbert v. Derwinski, 1 Vet.App. 49, 55
(1990).  That is, the Board finds that he has submitted a claim
which is plausible.  The Board is also satisfied that all
relevant evidence necessary for an equitable disposition of the
veteran's appeal has been obtained and that no further assistance
is required to comply with the duty to assist him mandated by
38 U.S.C.A. � 5107(a).  In this regard, it is noted that the
veteran's case was remanded for further development, to include
the conduction of a VA examination, in November 1993.  While the
report of a February 1994 VA examination indicates that the
veteran is apparently receiving Social Security disability
benefits as a result of his schizophrenia, the Board finds that a
failure to obtain these records does not violate the VA's duty to
assist the veteran as there is no indication that they are
pertinent to the question of whether the veteran developed
schizophrenia during service or within one year following his
separation from service.  Specifically, the veteran has never
alleged that such records show the development of schizophrenia
during service or within one year following separation from
active service and the report of the February 1994 VA examination
indicates that the veteran began to receive Social Security
benefits only in "recent years."

Service connection may be granted for disability resulting from
disease or injury incurred in or aggravated by active service.
38 U.S.C.A. � 1131; 38 C.F.R. � 3.303.  In addition, where a
psychosis becomes manifest to a degree of ten percent within one
year from date of termination of service, such disease shall be
presumed to have been incurred in service, even though there is
no evidence of such disease during the period of service.
38 U.S.C.A. �� 1101, 1133; 38 C.F.R. �� 3.307, 3.309.

The service medical records indicate that the veteran was
admitted to the Naval Regional Medical Center in Portsmouth,
Virginia, for psychiatric observation in August 1982.  Several
days prior to his admission, the veteran developed suicidal
ideation and intended to set himself on fire, but subsequently
changed his mind.  The veteran's suicidal ideation continued and
he was therefore referred to this facility.  Upon admission, the
veteran reported a life-long history of dysphoria, low self-
esteem, rapid mood swings, feelings of loneliness and emptiness,
and recurrent suicidal ideation.  The veteran was alert, fully
oriented, and disheveled in appearance.  His mood was depressed
and his affect was constricted.  The veteran's speech was sparse
and frequently mumbled in nature, but it was logical and goal
directed.  No evidence of delusional material or hallucinatory
experiences was discovered.  The veteran did express suicidal
ideation but he denied homicidal ideation.  A diagnosis of severe
borderline personality disorder was recorded.  The veteran's
disorder was noted to have existed prior to service as it had
been manifested by a number of life-long symptoms.

In October 1982, a Medical Board found the veteran to be
unsuitable for service due to his borderline personality disorder
and he was discharged later that month.

Records from The Jackson Counseling Center and Psychiatric
Hospital, Inc., reveal that the veteran was first referred to
that facility in November 1982.  Upon examination, the veteran
was angry, agitated, and hostile.  His affect was mostly
inappropriate throughout the interview.  A diagnosis of
borderline personality disorder was recorded.  The veteran
continued to seek outpatient treatment from this facility on an
irregular basis until February 1984.

The veteran was hospitalized at the Western Mental Health
Institute in August 1983 for a forensic evaluation as he had been
arrested for the manufacturing, possession, and disposition of a
fire bomb.  On admission, the veteran appeared slightly withdrawn
and he showed marked impairment of functioning in goal directed
activities.  His affect was mildly flat and his speech was
spontaneous, coherent, and relevant.  The veteran denied having
any hallucinations or delusions and he was oriented to three
spheres.  His memory was intact and his potential for suicide and
violence was not significant.  The report of a September 1983
psychological examination indicates that although the veteran's
MMPI profile and some of his behavior during the testing
suggested some degree of paranoia, he did not appear to meet the
diagnostic criteria of schizophrenia as outlined in the DSM III.
This report further shows that the examiner felt that a diagnosis
of mixed personality disorder with paranoid, borderline, and
antisocial features was more appropriate at that time, but that
if more information suggestive of a psychosis was obtained in the
future, a diagnosis of paranoid schizophrenia should be
considered.  At the time of his discharge in September 1983, the
veteran was guarded, vague, and evasive, but he did not show and
signs of overt psychosis.  In addition, the veteran did not have
any suicidal or homicidal thoughts.  A final diagnosis of
atypical, mixed, or other personality disorder was recorded.

In October 1983, the veteran was readmitted to the Western Mental
Health Institute because he set fire to his mattress while in
jail and he admitted to suicidal thoughts.  On admission, the
veteran's affect was flat and he had ideas of reference.  The
veteran also admitted to visual as well as auditory
hallucinations and suicidal thoughts.  He was oriented times
three and his memory was intact.  During his hospitalization, the
veteran was given neuroleptic therapy and individual counseling.
A final diagnosis of chronic paranoid schizophrenia with acute
exacerbation was recorded.

During a June 1984 personal hearing at the RO, the veteran
testified that he lost his mental capacities due to a number of
stressful events that he experienced during active service.  He
further testified that he had not been prescribed any medication
for his psychiatric condition during service and that he was
receiving outpatient treatment at that time.

Records from the West Tennessee Behavioral Center indicate that
the veteran received outpatient treatment on a number of
occasions from December 1992 to March 1994.  These records reveal
that the veteran was diagnosed with schizophrenia numerous times
and that he had been prescribed medications for this psychiatric
disorder.

The report of a January 1993 psychological evaluation by the
Tennessee Disability Determination Services indicates that the
veteran was casually dressed and adequately groomed upon his
arrival for the evaluation.  He was cooperative during the
evaluation, but his verbalizations were difficult to follow as
they had a delusional and hallucinatory theme.  The veteran was
preoccupied with being persecuted as well as with the end of the
world.  His insight was questionable and his judgment was
limited.  A diagnosis of chronic paranoid schizophrenia was
recorded.

During a December 1993 VA examination, the veteran was alert and
oriented times three.  He described himself as "happy" and his
affect was appropriate.  The veteran's speech was regular in rate
and rhythm and his memory was intact for one out of three objects
in five minutes.  Some evidence of paranoia and delusions was
found and the veteran admitted to auditory and visual
hallucinations.  The veteran's insight was poor and his judgment
was limited.  The examiner suggested that the veteran be
reevaluated after undergoing additional psychological testing.

The report of a February 1994 VA examination indicates that the
veteran was oriented times three and his sensorium was clear.  He
described himself as "happy" and the examiner noted that the
veteran's affect was somewhat constricted.  Generally, the
veteran's thoughts were organized and goal directed, but they
occasionally seemed vague and disjointed.  The examiner found
evidence of hallucinations, delusions, and projective thinking.
The veteran reported that he did not enjoy being alone, but that
at the same time he actively avoided people.  He admitted to
having problems controlling both his temper and his impulses.

The VA examiner who conducted the February 1994 examination noted
that the veteran had a personality disorder and probably also had
schizophrenia.  He doubted the diagnosis of schizophrenia that
was made during the veteran's hospitalization in the Western
Mental Health Institute in late 1983 due to the prior and
subsequent diagnoses that were rendered as well as the fact that
the veteran took psychiatric medication only sporadically between
1984 and 1986 and not at all between 1986 and 1992.  The examiner
noted that if the veteran were truly schizophrenic in 1982 or
1983, it would be unlikely that he would have gone almost eight
years with little or no antipsychotic medication from 1984 to
1992.  In addition, the examiner indicated that he tended to
trust the veteran's report that he began receiving Social
Security disability benefits in recent years for schizophrenia
and that he had been receiving psychiatric treatment and
antipsychotic medications since approximately 1992.  The examiner
indicated that these factors supported the conclusion that the
veteran did not develop schizophrenia until approximately ten
years after his separation from service.  In fact, the examiner
concluded that there was no convincing evidence that the veteran
developed schizophrenia during service or within one year
following his separation from service.  An Axis I diagnosis of
paranoid schizophrenia and an Axis II diagnosis of personality
disorder, not otherwise specified, were recorded.

The evidence of record does not establish that service connection
for schizophrenia is warranted.  In this regard, the Board notes
that a diagnosis of schizophrenia was not made during service or
within one year following the veteran's separation from service.
Even if the diagnosis of schizophrenia that was made during the
veteran's hospitalization at the Western Mental Health Institute
in late October or November 1983 had occurred within one year
following the veteran's separation from service, service
connection would still not be warranted due to the reasons
enumerated by the examiner who conducted the February 1994 VA
examination, which the Board finds persuasive.  There is no
contrary medical opinion linking schizophrenia to the symptoms
associated with a personality disorder during service.  Although
the veteran has attempted to link his current diagnosis of
schizophrenia with the symptoms he manifested during active
service, he, as a layman, is not competent to address issues
requiring expert opinion.  See Espiritu v. Derwinski, 2 Vet.App.
492, 494-95 (1992).

Given all of the foregoing, the Board finds that the
preponderance of the evidence is against the veteran's claim of
entitlement to service connection for schizophrenia.  As such,
there is not an approximate balance of positive and negative
evidence regarding the merits of the veteran's claim which would
give rise to a reasonable doubt which could be resolved in the
veteran's favor.  38 U.S.C.A. � 5107(b).  Accordingly, the appeal
must be denied.

ORDER

Service connection for schizophrenia is denied.

          CHARLES E. HOGEBOOM
          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.