judge_norm: ROBERT D PHILIPP

text:
BVA9415000
DOCKET NO.  92-23 051     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Indianapolis,
Indiana

THE ISSUE

Entitlement to an increased rating for a generalized anxiety
disorder, currently rated as 50 percent disabling.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

Robert B. Swanson, Associate Counsel

INTRODUCTION

The veteran had active service from November 1943 to September
1945.

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

CONTENTIONS

The veteran contends that an increased rating for his psychiatric
disability is warranted based upon his symptomatology.

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 against granting
an increased rating for the veteran's generalized anxiety
disorder.

FINDINGS OF FACT

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

2. The current manifestations of the veteran's psychiatric
disability include tremors, and fair insight and judgment.

3. The veteran's psychiatric disability is productive of no more
that considerable social and industrial impairment.

CONCLUSION OF LAW

The criteria for an increased rating for the veteran's
generalized anxiety disorder have not been meet.  38 U.S.C.A.
�� 1155, 5107(b) (West 1991); 38 C.F.R. � 4.132, Diagnostic Code
9400 (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The veteran is seeking an increased rating for his generalized
anxiety disorder.  He has presented a well-grounded claim, which
is a claim that is plausible, as required by 38 U.S.C.A.
� 5107(a) (West 1991).  The VA, in turn, has assisted the veteran
in fully developing the facts relevant to his claim as required
by 38 U.S.C.A. � 5107(a).

The veteran's service medical records reveal that he was
hospitalized at service medical facilities from mid-December 1944
to early February 1945 for treatment of shell fragment wounds.
While hospitalized, he was also treated for anxiety.  In February
1947, a special VA psychiatric examination was conducted.  The
diagnosis was anxiety state.  In April 1947, service connection
for anxiety was granted, and a 10 percent rating was assigned
effective in February 1947.  Following the rating action, special
VA psychiatric examinations were conducted in May 1948, May 1950,
and May 1952.  In September 1976, a private physician, Thomas H.
Fisher, M.D., reported that he had been treating the veteran for
hypertension and anxiety, that the veteran had been totally
disabled for the past six months due to chronic anxiety and
depression, and that the prognosis was poor in that the veteran's
totally disability was probably permanent.  In October 1976, a
special VA psychiatric examination was conducted.  The diagnosis
was severe anxiety neurosis.  In November 1976, an increased
rating of 30 percent for the veteran's anxiety was granted
effective in September 1976.  In September 1978, Dr. Fisher
reported that he had been treating the veteran for anxiety since
August 1975, which was shortly after an incident in which the
veteran was nearly shot while working as a security guard, and
that he had been treating the veteran for hypertension since
March 1976.  In November 1978, the Board granted an increased
rating of 50 percent, which the RO, in December 1978, made
effective in September 1976.

In May 1992, a private physician, Paul G. Wilson, M.D., reported
that he had been treating the veteran since July 1982, that the
veteran had been unemployable since an incident in 1975 where the
veteran was nearly shot while working as a security guard
according to the veteran's records, and that the veteran has not
been employable since he began treating the veteran.

In July 1992, a special VA psychiatric examination was conducted.
During the examination, the veteran complained of constant
pressure and anxiety, and intermittent dizziness.  He reported
that he spent his time watching ball games, and periodically
visiting with his friends at a local filling station.  He also
reported some difficulties with his spouse because she did not
understand his problems, although she was beginning to understand
them.  The examiner found that the veteran appeared his stated
age, that he frequently rubbed his scalp before answering
questions, that he emitted a rancid perspiration odor, and that
he viewed himself as total incapacitated by his anxiety.
Additional findings included fairly relevant and coherent
answers, average intelligence, a tremor, and fair judgment and
insight.  The diagnosis was a moderate generalized anxiety
disorder.  The examiner noted that the overall degree of
psychiatric impairment was probably mild to moderate, and that
the veteran was competent.

The veteran's generalized anxiety disorder is currently rated as
50 percent disabling.  A 50 percent rating for a generalized
anxiety disorder is assigned under the Schedule for Rating
Disabilities (Schedule) when there is considerable impairment in
the ability to secure and maintain favorable relationships and
employment due to psychoneurotic symptoms.  38 C.F.R. � 4.132,
Diagnostic Code 9400.  An increased rating, that is, a 70 percent
rating is assigned under the Schedule when there is severe
impairment in the ability to secure and maintain favorable
relationships and employment due to psychoneurotic symptoms.  Id.

The opinions of a VA examiner and the veteran's family physician
with respect to the degree of impairment caused by the veteran's
psychiatric disability are in conflict.  The probative value of
medical evidence is based upon a physician's personal examination
of the veteran, the physician's skill in analyzing the data, and
the physician's medical conclusion.  Guerrieri v. Brown, 4
Vet.App. 467, 470-71 (1993).  The veteran's family physician, Dr.
Wilson, reported that the veteran was totally disabled.  Dr.
Wilson did not, however, report any findings to support his
conclusion, nor did he report that his conclusion was based upon
a personal psychiatric examination of the veteran.  Moreover,
even if Dr. Wilson had conducted a psychiatric examination, there
is no evidence indicating that Dr. Wilson had any special
expertise in psychiatry with which to analyze his findings.  The
VA examiner reported that the degree of impairment caused by the
veteran's disability was probably mild to moderate.  The VA
examiner's opinion was based on a personal psychiatric
examination of the veteran, and the findings supporting the
opinion, which were mainly positive, were reported.  Moreover,
the VA examiner had special expertise with which to analyze his
findings as he was a psychiatrist.  The medical evidence
indicates, therefore, that the veteran's disability is productive
of mild to moderate social and industrial impairment.

The veteran contends that he did not file a claim for an
increased rating because his condition had grown worse, but
because an increased rating was warranted based on the Schedule
for Rating Disabilities, which was changed in 1988.  He cites
Sabol v. Derwinski, 2 Vet.App. 228 (1992), in support of his
contention.  In Sabol, a veteran filed a claim for an increased
rating for a mental disorder following a change in 1988 in the
Schedule for Rating mental disorders (Schedule).  The pre-1988
Schedule provided for a 50 percent rating when a mental disorder
was productive of severe industrial impairment.  The new Schedule
provided for a 70 rather than a 50 percent rating when a mental
disorder was productive of severe industrial impairment.  The
Court of Veterans Appeals (Court) held that in the absence of new
medical evidence about a veteran's psychiatric disability, the
rating for a mental disorder that was formerly rated as 50
percent disabling would be increased to 70 percent.  Here, unlike
Sabol, new evidence was added to the file subsequent to the
change in the Schedule, and considered in rating the veteran's
psychiatric disability under the Schedule.

Accordingly, the Board finds by a preponderance of the evidence
that no more than a 50 percent rating is warranted for the
veteran's generalized anxiety disorder.  38 U.S.C.A. � 1155; 38
C.F.R. � 4.132, Diagnostic Code 9400.  The evidence is not so
evenly balanced as to raise doubt with respect to any material
issue.  38 U.S.C.A. � 5107(b).  In reaching its decision, the
Board has considered the complete history of the disability at
issue as well as the current clinical manifestations and the
effect the disability may have on the earning capacity of the
veteran.  38 C.F.R. �� 4.1, 4.2, 4.41 (1993).

The Board further finds that the veteran's disability picture is
not so exceptional or unusual as to warrant an extraschedular
evaluation.  38 C.F.R. � 3.321(b) (1993).  The veteran's
disability has not caused marked interference with employment or
necessitated frequent periods of hospitalization.  Although the
veteran is currently unemployed, the sole fact that he is
unemployed and has difficulty securing employment is not
sufficient, alone, to warrant a total rating based upon
individual unemployability.  Van Hoose v. Brown, 4 Vet.App. 361,
363 (1993).  A high rating, alone, is a recognition that an
impairment makes it difficult to secure and maintain employment.
Id.  The issue is whether the veteran is capable of performing
the physical and mental acts required by employment.  Id.  The
veteran has an eleventh grade education, and some training in
sales.  He indicated that he voluntarily resigned from his last
employment after he was nearly hit by gun fire, and that he has
not attempted to secure further employment.  The record on appeal
does not contain any significant extra-schedular factors that
would warrant an increased rating or a total rating based upon
individual unemployability.

ORDER

Entitlement to an increased rating for a generalized anxiety
disorder is denied.

          ROBERT D. PHILIPP
          Member, Board of Veterans' Appeals

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

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


series: legacy

judge_norm: STEPHEN L WILKINS

judge_role: Member, Board of Veterans' Appeals

disposition: dismissed

condition: knee

disposition: denied

condition: back

condition: skin

text:
BVA9416000
DOCKET NO.  92-14 566     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in St. Paul,
Minnesota

THE ISSUES

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

2.  Entitlement to service connection for the claimed residuals
of a fracture of the left arm.

3.  Entitlement to service connection for bilateral defective
hearing.

4.  Entitlement to service connection for the claimed residuals
of an injury to the right eye.

5.  Entitlement to service connection for a claimed disability of
multiple joints.

6.  Entitlement to an increased rating for disability of the
right knee, currently evaluated as 20 percent disabling.

7.  Entitlement to an increased rating for mechanical low back
pain, currently evaluated as 10 percent disabling.

8.  Entitlement to an increased rating for a skin rash on both
thighs, currently evaluated as 10 percent disabling.

REPRESENTATION

Appellant represented by: Paralyzed Veterans of America,
Inc.

WITNESS AT HEARING ON APPEAL

The Veteran

ATTORNEY FOR THE BOARD

Ripley P. Schoenberger, Counsel

INTRODUCTION

The veteran served on active duty from June 1985 to July 1990.

This appeal arises from rating decisions by the Regional Office
(RO) of the Department of Veterans Affairs (VA).

CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends that he was involved in a parachute accident
when he injured both knees, broke his left arm and hurt his back.
Reportedly, subsequent to the

accident, he developed problems with other joints.  Due to his
work on small parts in service, he feels that the vision in his
right eye deteriorated to the point that he had to wear
eyeglasses.  He also contends that the loud noises in his work
place caused him to develop a hearing loss.  In addition, he
maintains that he has pain in his right knee and that his right
knee frequently becomes swollen and gives way.  He also states
that the skin rash on his thighs itches, scabs up, stings, burns
and turns red.

DECISION OF THE BOARD

The Board of Veterans' Appeals (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
meet the burden of submitting evidence sufficient to justify a
belief by a fair and impartial individual that the claims for
service connection for the residuals of an injury to the left
knee, the residuals of a fracture of the left arm, bilateral
defective hearing, the residuals of an injury to the right eye,
and a disability of multiple joints are well grounded.  It is
also the decision of the Board that the preponderance of the
evidence is against the claims for an increased rating for
instability of the right knee, an increased rating for mechanical
low back pain, and an increased rating for a skin rash on both
thighs.

FINDINGS OF FACT

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

2.  No competent evidence has been submitted to show that the
veteran has a disability of the left knee, the claimed residuals
of a fracture of the left arm, a claimed injury to the right eye,
or a claimed disability of multiple joints which can be
attributed to service.

3.  No competent evidence has been submitted to show that the
veteran has defective hearing of either ear due to disease or
injury in service.

4.  The veteran had a full range of motion of his right knee with
no swelling, redness, or tenderness, and there is no excess right
patellar mobility or lateral instability of the right knee.

5.  The veteran has a normal range of motion of his back with no
muscle spasm, tenderness or pain with related functional
limitation.

6.  A rash on his thighs is manifested by mild pinkness in the
inguinal fold with mild to moderate scales, but does not cause
extensive lesions or marked disfigurement.

CONCLUSIONS OF LAW

1.  Well-grounded claims for service connection for a left knee
disorder, the claimed residuals of a fracture of the left arm,
bilateral defective hearing, the claimed residuals of an injury
to the right eye, and a claimed disability of multiple joints
have not been presented.  38 U.S.C.A. �� 1131, 5107, 7104 (West
1991); 38 C.F.R. �� 3.102, 3.303, 3.385 (1993).

2.  The criteria for a rating in excess of 20 percent for
instability of the right knee have not been met.  38 U.S.C.A.
�� 1155, 5107, 7104 (West 1991); 38 C.F.R. �� 3.102, 3.321, 4.7,
4.40, 4.71a, Diagnostic Codes 5257, 5258, 5260, 5261 (1993).

3.  The criteria for a rating in excess of 10 percent for
mechanical low back pain have not been met.  38 U.S.C.A. �� 1155,
5107, 7104 (West 1991); 38 C.F.R. �� 3.102, 3.321, 4.7, 4.20,
4.40, 4.71a, Diagnostic Codes 5292, 5295 (1993).

4.  The criteria for a rating in excess of 10 percent for a skin
rash on both thighs have not been met.  38 U.S.C.A. �� 1155,
5107, 7104 (West 1991); 38 C.F.R. �� 3.102, 3.321, 4.7, 4.20,
4.118, Diagnostic Code 7806-7813 (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

I.  Historical

The service medical records show, on the veteran's induction
examination, that the vision in his right eye was 20/50 corrected
to 20/40.  The vision in his left eye was 20/20.  It was reported
that he had defective vision.  An audiometric test showed that
the pure tone air conduction thresholds were reported as 0, 0, 0,
0, 5 and 10 decibels in the right ear, and 0, 0, 5, 0, 0 and
40 decibels in the left ear at 500, 1,000, 2,000, 3,000, 4,000
and 6,000 hertz, respectively.  On an ophthalmological
examination conducted in September 1987, the vision in his right
eye was reported as 20/40, correctable to 20/20.  The macula was
clear and the slit lamp examination was unremarkable.  The
assessment was hypertrophic astigmatism--ocular health
unremarkable.  Corrective lenses were prescribed.  In August 1988
while landing from a parachute jump, the veteran hit a vehicle.
He sustained trauma to his knee.  He was hospitalized and
underwent a posterior cruciate ligament reconstruction of the
right knee.  In April 1989 he was involved in a motor vehicle
accident.  He struck his knee against the dashboard and wrenched
his back.  He complained of back discomfort.  In March 1990 he
was seen for left groin adenopathy.  On his discharge examination
he complained of a swollen painful knee, frequent and severe
headaches, dizziness or fainting spells, eye trouble (that he
wore glasses), cramps in his legs with increased activity, a
hairline fracture of the left arm, a tumor, recurrent back pain,
a "trick" or locked knee and foot trouble with normal activity.
On examination the vision in his right eye was 20/40, corrected
to 20/20.  The diagnosis was refractive error--amblyopia.  Pure
tone air conduction thresholds were reported as 10, 5, 5, 0, 0
and 5 decibels in the right ear, and 10, 10, 10, 5, 0 and
20 decibels in the left ear at 500, 1,000, 2,000, 3,000, 4,000
and 6,000 hertz, respectively.

As part of his discharge examination he was afforded a special
orthopedic examination.  He stated that he had favored his right
knee so much he had begun to develop problems with his left knee.
However, he had a full range of motion of the left knee.  On a
Medical Evaluation Board the diagnoses were mechanical low back
pain with no evidence of neurological compromise and status post
posterior cruciate ligament reconstruction of the right knee.
The service medical records are devoid of any reference to a
generalized disorder involving multiple joints.

By a rating decision of February 1991, service connection was
granted for instability of the right knee, status post posterior
cruciate ligament reconstruction with semitendinous graft, and a
20 percent evaluation was assigned.  Service-connection was also
granted for mechanical low back pain and a skin rash on both
thighs, both of which were evaluated as noncompensably disabling.

On a fee-basis examination conducted for VA in June 1991, the
veteran complained of pain in his left knee and back pain.  He
described continual pain in his knees which was aggravated by
activity.  He reported he had frequent swelling in his right
knee, and that his right knee was still unstable and frequently
buckled even when walking on a level surface.  He also reported
that he had had intermittent buckling of his left knee.  His
knees were chronically painful and limited his activity
considerably.  He could not walk for long distances or stand for
prolonged periods of time.  His back pain was quite intermittent,
but it occurred without warning.  He reported that he would
suddenly have severe, sharp, stabbing, spasmodic pain which was
associated with immobility.  He also reported problems with a
persistent rash involving the inner aspects of his upper thighs,
bilaterally, and his scrotum.  He reported that, as long as he
kept the area quite dry, he did reasonably well, but that, when
he became hot and sweaty, his skin rash flared up.  His skin rash
was confined to his inner thighs and scrotal area.  He reported
he was not followed on a regular basis by any type of orthopedic
service.

On examination it was reported that his gait and station were
normal.  He did not have a limp and the curvature of his spine
was normal.  There was no tenderness

over the thoracic or lumbar spine and no muscle spasms were
noted.  There was no evidence of muscle atrophy.  The veteran was
able to forward flex the lumbar spine to 95 degrees, extend
backwards to 35 degrees, bend laterally to either side to
40 degrees, and rotate to 35 degrees to either side.  There was
no physical deformity of either knee.  He had a full range of
motion of both knees (from 0 degrees to 140 degrees) and the
range of motion studies were not associated with significant
pain.  There was no tenderness to palpation over either knee and
no effusion in either joint space.  There was no evidence of any
clinical detectable instability of either knee.  Examination of
the genital area showed some slight hyperpigmentation involving
the skin of the upper inner aspect of both thighs, contiguous
with the groin folds, bilaterally, and extending onto the
scrotum.  There was some slight nodular erythematous eruption
along the inferior aspect of both of these areas, which was not
actively inflamed.  The pertinent diagnoses were posterior
cruciate lateral tear, right knee, status post reconstruction
with recurrent instability, instability of the left knee,
mechanical low back pain, and tinea cruris.  The examiner added
that there was questionable instability of the left knee and
numerous musculoskeletal complaints involving the feet, ankles
and low back, of unclear etiology.  It was recommended that the
veteran be evaluated by an orthopedic specialist in this regard.

On an examination conducted by the VA in December 1991, the
veteran's carriage, posture, and gait were normal.  The veteran
dressed, undressed, mounted and dismounted the examining table
normally.  No atrophy of either extremity was noted.  There was
no swelling, redness, tenderness or deformity of either knee.
There was no crepitus on motion of either knee, excess patellar
mobility or lateral instability.  The range of motion of both
knees was from 0 to 140 degrees.  The veteran was able to forward
flex the lumbar spine to 90 degrees and extend backwards to
30 degrees.  There was no tenderness or deformity of the back or
pain when performing the straight leg raising test.  The muscle
strength in the lower extremities was grossly normal.

The veteran complained of pain in multiple joints including his
ankles, knees, hips, elbows, shoulders, wrists, and neck.  He
reported that the pain had been present

since June 1991.  He reported he had persistent clicking of both
knees and swelling of his knees if he stood, walked, or hopped.
His knees became swollen if he stood for over one hour.  The
swelling was bilaterally, but worse in the right knee.  He
reported that he had pain in both knees about 90 percent of the
time.  He denied any special symptoms involving the left upper
extremity except generalized joint pain.  X-ray films of the
lumbosacral spine were interpreted to show slight retrolisthesis
of the 5th lumber vertebra on the 1st sacral segment.  X-ray
films of the right knee were interpreted to show multiple small
calcified densities in the joint space which were consistent with
a previous injury to the medial collateral ligament.  X-ray films
of the left knee were unremarkable.  The relevant diagnoses were
status post right knee surgery with residual right knee
tenderness on examination; no significant left knee abnormality;
no evidence of a fracture of the left arm; and symptoms of
multiple joint pain without objective abnormalities found on the
physical examination.

On a dermatological examination conducted by the VA in December
1991, it was reported that there was mild pinkness in the
inguinal fold with mild to moderate scaling.  The assessment was
tinea cruris versus intertrigo.

By a rating decision of March 1992 the 20 percent evaluation for
instability of the right knee was confirmed and continued, but
the evaluation for mechanical low back pain was increased to
10 percent, and the evaluation for the service-connected skin
rash was increased to 10 percent.

On an ophthalmological examination conducted by the VA in May
1992, it was reported that the vision in the veteran's right eye
was 20/30 corrected to 20/20.  Physical examination of the eye
was within normal limits.  The relevant diagnoses were refractive
error and disc drusen.

On an audiological examination conducted by the VA in May 1992,
pure tone air conduction thresholds were reported as 0, 5, 0, -5,
and 5 decibels in the right ear, and -5, 5, 10, 0 and -5 decibels
in the left ear at 500, 1,000, 2,000, 3,000 and

4,000 hertz, respectively.  The controlled speech recognition
scores were 98 percent in the right ear and 90 percent in the
left ear.  The diagnosis was normal hearing and speech
bilaterally.  A clinical examination also showed that the ears
were normal.

II.  Left Knee Disorder, the Claimed Residuals of a Fracture
of the Left Arm, and a Claimed Disability of Multiple Joints

The threshold question to be answered in this portion of the
veteran's appeal is whether he has presented evidence of well-
grounded claims.  If not, his claims for service connection for
these disabilities must fail, and there is no further duty to
assist him in the development of his claims.  38 U.S.C.A. � 5107;
Murphy v. Derwinski, 1 Vet.App. 78 (1990).  As will be explained
below, the Board finds that the veteran's claims for service
connection for these disabilities are not well grounded.

The United States Court of Veterans Appeals (the Court) has held
that the veteran must submit evidence of a plausible or well-
grounded claim.  Tirpak v. Derwinski, 2 Vet.App. 609 (1992).
When, as in this case, the issue involves a question of medical
diagnosis or medical causation, competent or medical evidence is
required.  Grottveit v. Brown, 5 Vet.App. 91 (1993).  Statements
from the veteran in this regard are not sufficient to establish a
plausible claim as he is not competent to offer medical opinions.
Espiritu v. Derwinski, 2 Vet.App. 42 (1992).  Moreover, the
evidence must show that the veteran currently has a disability
stemming from service.  Brammer v. Derwinski, 3 Vet.App. 223
(1993).

A careful review of the service medical records shows that they
are devoid of any complaints or findings referable to a
disability of multiple joints.  In fact, on the VA examination
performed in December 1991, the veteran reported that his
multiple joint pain had begun in June 1991, approximately one
year after service.  On his discharge examination he did state
that he had suffered a hairline fracture of the left arm.
However, both the service medical records and the postservice
medical studies are negative for any clinical evidence of a
fracture of the left arm, and the veteran has not submitted any
clinical evidence that he did, in fact, suffer a fracture of the
left arm in service.  The veteran has submitted no evidence that
he currently suffers from a disability of multiple joints or left
arm fracture residuals which can be attributed to service.  Thus,
he has not presented well-grounded claims for these two issues.
See Grottveit.

On his discharge examination, the veteran reported that he had
favored his right knee to the extent that he had developed
problems with his left knee.  However, the examination of the
left knee disclosed no abnormality.  Although some indication of
instability of the left knee was reported in connection with the
VA examination in June 1991, the actual clinical findings at that
time did not support this.  In addition, the examiner did not
attribute any instability of the left knee to service or a
service-connected disability.  Moreover, on the subsequent VA
examination performed in December 1991, no abnormality of the
left knee was identified.  The veteran has not submitted any
medical evidence to support his assertion that he suffers from
current left knee disability due to service-incurred disease or
injury.  Thus, since the veteran does not currently have a
disability of the left knee, he has not submitted evidence of a
well-grounded claim.  See Bramer.

The Board has considered the testimony that the veteran gave at
his recent personal hearing.  However, the veteran's unsupported
lay assertions cannot serve to establish a well-grounded claim as
he is not competent to offer an opinion regarding a question of
medical diagnosis or causation.  See Espiritu.  Thus, he has not
presented well-grounded claims.  See Grottveit.  The Board does
not have jurisdiction to consider this portion of the veteran's
appeal.  Boeck v. Brown, 6 Vet.App. 14 (1993).

III.  Bilateral Defective Hearing

The Board also finds that the issue to be addressed in this
portion of the veteran's appeal is not well grounded.  Thus,
there is no further duty to assist him in the development of this
portion of his appeal.  38 U.S.C.A. � 5107; Murphy v. Derwinski,
1 Vet.App. 78 (1990).

The Board points out that service connection for defective
hearing may be established only when the veteran's audiometric
test results, including speech recognition scores, have reached a
certain level.  38 C.F.R. � 3.385 (1993) provides that:

Hearing status shall not be considered
service connected when the thresholds for
the frequencies of 500, 1,000, 2,000, 3,000
and 4,000 hertz are all less than
40 decibels; the thresholds for at least
three of these frequencies are 25 decibels
or less; and speech recognition scores
using the Maryland CNC Test are 94 percent
or better.

The results of the audiometric tests performed in service and by
the VA in May 1992 show that the hearing in the veteran's right
ear does not meet the criteria set forth in 38 C.F.R. � 3.385.
His hearing was reported by the examiner to be normal.  Moreover,
the veteran has not submitted any medical evidence to show that
he currently has a hearing disability involving the right ear due
to disease or injury in service.  Thus, he has not presented a
well-grounded claim for granting service-connection for defective
hearing in his right ear.  See Tirpak and Grottveit.

The results of the audiometric tests performed by VA in May 1992
show that the speech recognition score in his left ear is
90 percent.  Thus, he does meet the criteria set forth in
38 C.F.R. � 3.385.  Nevertheless, service connection is not
warranted for defective hearing in the left ear.  The service
medical records show no evidence of actual hearing problems but,
more importantly, the May 1992 examination indicated that his
hearing was normal.  Hensley v. Brown, 5 Vet.App. 155 (1993).
The veteran has not submitted any medical evidence establishing
that he is suffering from actual left ear hearing disability due
to disease or injury in service.  Thus, he has not submitted
evidence of a well-grounded claim for a hearing loss in the left
ear.  See Grottveit.

Again, the Board points out that the veteran's unsupported lay
assertions (the testimony that he gave at his personal hearing)
cannot be construed as evidence of a well-grounded claim as he is
not competent to offer an opinion concerning a question of
medical diagnosis or causation.  See Espiritu.  Thus, since the
veteran has not submitted any competent evidence, he has not
presented a well-grounded claim for a bilateral hearing loss.
See Grottveit.  Again, the Board does not have jurisdiction to
consider this portion of the veteran's appeal.  Boeck v. Brown,
6 Vet.App. 14 (1993).

IV.  Claimed Residuals of an Injury to the Right Eye

The service medical records show that the veteran had decreased
vision in his right eye when he entered service and do not
document that the vision in his right eye deteriorated during his
period of active duty.  The most recent ophthalmological
examination (May 1992) noted no residual disability due to the
claimed right eye injury in service.  Refractive error and disc
drusen were noted, but the Board points out that a refractive
error is not a disability for which service connection can be
granted.  38 C.F.R. � 3.303.  No competent evidence has been
submitted to show that the veteran currently is suffering from
right eye disability due to disease or injury in service.  Thus,
as lay assertions alone cannot constitute competent evidence, a
well-grounded claim has not been presented.  See Grottveit.

V.  Increased Rating for Instability of the Right Knee, Increased
Rating for Mechanical Low Back Pain, and
Increased Rating for a Skin Rash of Both Thighs

The Board finds that the veteran's claims for increased
compensation benefits for these three disabilities are "well
grounded" within the meaning of 38 U.S.C.A. � 5107(a).  The Board
finds that the claims are plausible.

Instability of the Right Knee

With severe impairment of the knee with recurrent subluxation or
lateral instability, a 30 percent evaluation is assigned.  With
moderate impairment of the knee, a 20 percent evaluation is
assigned.  38 C.F.R. � 4.71a, Diagnostic Code 5257.  When flexion
of the knee is limited to 15 degrees, a 30 percent evaluation is
assigned.  When flexion of the knee is limited to 30 degrees, a
20 percent evaluation is assigned.  38 C.F.R. � 4.71a, Diagnostic
Code 5260.

When extension of the knee is limited to 20 degrees, a 30 percent
evaluation is assigned.  When extension of the knee is limited to
15 degrees, a 20 percent evaluation is assigned.  38 C.F.R.
� 4.71a, Diagnostic Code 5261.

After a review of the claims folder the Board is of the opinion
that the evidence of record does not support the veteran's
position that he is entitled to increased compensation benefits
because of the severity of his service-connected right knee.  The
Board points out that, on both the examinations conducted by the
VA in June 1991 and December 1991, the veteran had a full range
of motion of the right knee and there was no evidence of
instability of the right knee.  In addition, his gait is normal,
and he does not have a limp.

The Board also noted that the testimony that the veteran gave at
his personal hearing is not persuasive.  At his hearing he
testified that he had a lot of pain in his knee and that his
right knee frequently "gave out."  However, on the examination
conducted by the VA in June 1991, it was reported that the range
of motion studies of the right knee were not associated with any
significant pain, and there was no instability of the knee.
Moreover, the current evaluation contemplates the degree of pain
described.  Thus, the criteria for a rating in excess of
20 percent for the service-connected right knee disorder have not
been met.

Mechanical Low Back Pain

The veteran's service-connected back disorder is rated
analogously to lumbosacral strain.  When lumbosacral strain is
manifested by muscle spasms on extreme forward bending, loss of
lateral spine motion, unilaterally, in the standing position, a
20 percent evaluation is assigned.  With characteristic pain on
motion, a 10 percent evaluation is assigned.  38 C.F.R. � 4.71a,
Diagnostic Code 5295.

After a review of the claims folder, the Board is of the opinion
that the evidence of record does not support the veteran's claim
that he is entitled to an increased rating for his service-
connected back disorder.  On both the recent examinations it was
reported that the veteran had a full range of motion of the back
without any muscle spasms or tenderness.  In addition, there was
no muscle atrophy of the muscles of the back.

The Board again finds that the testimony that the veteran gave at
his personal hearing is not persuasive so as to establish that he
is entitled to increased compensation benefits.  He reported that
he had back pain and could not move his back very much.  However,
the evidence shows that the veteran currently has a full range of
motion of the back without muscle spasms or pain with related
functional limitation.  Consequently, the criteria for an
increased rating for the veteran's service-connected back
disorder have not been met.

Skin Rash on Both Thighs

With exfoliation or constant itching, extensive lesions, or
marked disfigurement, skin rashes are rated 30 percent disabling.
With exfoliation, exudation or itching, or if involving an
exposed surface or extensive area, a 10 percent evaluation is
assigned.  38 C.F.R. � 4.118, Diagnostic Code 7806.

After reviewing the claims folder, the Board is of the opinion
that the evidence of record does not support the veteran's
position that he is entitled to increased compensation benefits
because of his service-connected skin rash.  On the special
dermatological examination conducted by the VA in December 1991
it was reported that there was mild pinkness in the inguinal fold
with mild to moderate scaling.  Thus, the evidence shows that the
veteran's service-connected skin rash does not causes exudation,
extensive lesions, or marked disfigurement.

The Board also is of the opinion that the testimony that the
veteran gave at his personal hearing is not persuasive.  At his
hearing, he reported that his skin rash occurs when the weather
is humid or his thighs and groin are wet.  He reported that his
skin rash develops little sores that burst, scab over, and cause
a lot of pain.  In addition, he testified that the area of his
skin involved with the skin rash was scarred.  However, the Board
points out that, on the recent dermatological examination, no
significant lesions or disfigurement was reported.  Consequently,
the criteria for an increased rating for a skin rash have not
been met.

In reaching the determinations that increased compensation
benefits are not warranted for instability of the right knee,
mechanical low back pain, and skin rash, consideration has been
given to the potential application of the various provisions of
38 C.F.R. Parts 3 and 4, as required by Schafrath v. Derwinski,
1 Vet.App. 589 (1991).

38 C.F.R. � 3.321(b)(1) provides that, where the disability
picture is so exceptional or unusual that the normal provisions
of the rating schedule would not adequately compensate the
veteran for his service-connected disabilities, an extraschedular
evaluation will be assigned.  Nevertheless, the evidence does not
show that he has required frequent periods of hospitalization or
experienced marked interference with employment due to the
conditions at issue.  Thus, consideration of the assignment of an
extraschedular evaluation under the provisions of 38 C.F.R.
� 3.321(b)(1) is not indicated.

ORDER

As well-grounded claims for a left knee disorder, the claimed
residuals of a fracture of the left arm, bilateral defective
hearing, the residuals of an injury to the right eye, and a
claimed disability of multiple joints have not been presented,
the appeals on these issues are dismissed.  In this regard, the
RO should take adjudicatory action consistent with this decision.

An increased rating for disability of the right knee is denied.

An increased rating for mechanical low back pain is denied.

An increased rating for a skin rash on both thighs is denied.

          STEPHEN L. WILKINS
          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: ALBERT D TUTERA

disposition: remanded

text:
BVA9418000
DOCKET NO.  93-01 482     )       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 psoriasis

2.  Entitlement to an increased (compensable) evaluation for
epidermophytosis pedis

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

S. Westfall, Counsel

REMAND

The veteran had active duty from February 1954 to February 1956.
He served with a National Guard unit from June 1974 to April
1979.

During active duty, dermatophytosis was diagnosed in
approximately July 1955.  During a period of National Guard duty,
in late May 1975, a maculo-papular rash involving the chest,
abdomen, all extremities, and scalp was diagnosed as dermatitis.
In June 1975, a VA medical provider noted that the veteran had an
allergic body rash.  On VA examination in July 1976, the final
diagnoses included epidermophytosis pedis and a history of
dermatitis based on the veteran's description of bullous-
formation generalized dermatitis during the previous year's
National Guard encampment.  In August 1976, the RO granted
service connection for epidermophytosis pedis assigning a 0
percent evaluation and denied service connection for a
generalized dermatitis as not shown on recent examination.

The VA clinical records show that in 1979, 1983, and 1985,
treatment was afforded the veteran for skin problems variously
diagnosed or described as bullous formations of various sizes,
intermittent eczema, seborrheic dermatitis of the scalp and other
bodily parts, tinea pedis, erythematous maculo-papular eruptions
suggestive of contact dermatitis, and, during an period of VA
hospitalization in February 1986, dermatophytosis of the skin.  A
VA rheumatologist has been suggesting a diagnosis of possible
psoriatic arthritis since February 1986.  However, psoriasis was
not specifically diagnosed on clinical records in the claims file
until a dermatology consult was obtained in February 1988.  At
that time heavy scalp plaques were noted.

The veteran's asserts that the skin lesions shown in May 1975
were similar to those later diagnosed as psoriasis and that his
service connected skin disorder was initially misdiagnosed by the
camp dispensary physician who was not a dermatologist.

Clarification of the veteran's skin disorder(s) is necessary.  VA
has a duty to assist the veteran in developing evidence pertinent
to his claim.  38 U.S.C.A. � 5107 (a) (West 1991).  The RO is
reminded that the dermatology examination requested by the Board
must be scheduled during an active stage of the veteran's skin
disorder which waxes and wanes, according to the veteran's
statements.  Ardison v. Brown, No. 92-1268 (U. S. Vet. App. April
4, 1994).

To ensure full compliance with due process requirements, the case
is REMANDED to the regional office (RO) for the following
development:

1.  The RO should obtain a written report,
if possible, from Dr. L. Ricci, the VA
rheumatologist who has been suggesting the
diagnoses of psoriatic arthritis over the
course of many years.  Dr. Ricci is
requested to explain when he was first
aware that the veteran had psoriasis and
all the circumstances attendant thereto.

2.  The veteran should be afforded a
special VA dermatology examination in order
to determine the nature and extent of the
veteran's skin disorder(s).  The
examination should include all indicated
diagnostic studies deemed necessary to
assess the disorders.  The report of
examination should contain a detailed
account of all manifestations of the skin
disorder(s).  The dermatologist is
requested to offer his opinion with
complete rationale as to whether it can be
said with reasonable medical certainty that
the skin disorder(s) variously diagnosed in
May and June 1975, on VA examination in
July 1976, and on progress notes thereafter
over the years were psoriasis.  Can it be
said with reasonable medical medical
certainty that psoriasis resulted from
service- connected epidermophytosis pedis.
It is requested that the dermatologist
indicate whether it is medically reasonable
that the diagnoses made in 1955 and in 1975
could have mistaken dermatophytosis or
dermatitis for psoriasis.  Is it medically
reasonable that the various skin diagnoses
offered from 1979 and thereafter
represented all those different skin
disorders or did the veteran have psoriasis
all along.  The claims folder and a copy of
this remand should be made available to the
examiner for review before the examination.
In the event that the veteran has any
discernible symptoms referable to
epidermophytosis, the examiner should
describe these.

Thereafter, the case should be returned to the Board, if in
order.  The Board intimates no opinion as to the ultimate outcome
of this case.  The appellant need take no action unless otherwise
notified.

          ALBERT D. TUTERA
          Member, Board of Veterans' Appeals

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

Under 38 U.S.C.A. � 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals.  This remand is in the nature of a
preliminary order and does not constitute a decision of the Board
on the merits of your appeal.  38 C.F.R. � 20.1100(b) (1993).


judge_norm: MICHAEL D LYON

text:
BVA9419000
DOCKET NO.  93-01 866     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Milwaukee,
Wisconsin

THE ISSUE

Entitlement to an increased evaluation for residuals of a right
knee injury, currently evaluated as 10 percent disabling.

REPRESENTATION

Appellant represented by: Wisconsin Department of Veterans
Affairs

ATTORNEY FOR THE BOARD

Melissa F. Marquez, Associate Counsel

INTRODUCTION

The appellant had active service from December 1985 to January
1992.  This matter came before the Board of Veteran's Appeals
(hereinafter Board) on appeal from a July 1992 rating decision of
the Milwaukee, Wisconsin, Regional Office (hereinafter RO), of
the Department of Veteran's Affairs (hereinafter VA), which
granted service connection for a right knee disorder and denied
entitlement to an increased evaluation for residuals of a right
knee injury, currently evaluated as 10 percent disabling.

CONTENTIONS OF APPELLANT ON APPEAL

The appellant contends, in essence, that he is entitled to an
increased evaluation for residuals of a right knee injury,
currently evaluated as ten percent disabling.  He asserts that
upon moderate exertion, he currently experiences pain and
swelling of the right knee, as well as lateral instability of
that knee as indicated by its buckling and clicking.

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 appellant'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 preponderance of the evidence is against an evaluation
in excess of 10 percent for residuals of a right knee injury,
currently evaluated as ten percent disabling.

FINDINGS OF FACT

1.  All available, relevant evidence necessary for disposition of
the appeal has been obtained by the RO.

2.  The appellant's residuals of his right knee injury,
consisting of status post anterior cruciate ligament
reconstruction with a patellar tendon bone graft, are manifested
by subjective complaints of pain, swelling and instability upon
moderate exertion.  Recent clinical evidence indicates
patellofemoral pain with patellar tenderness, and some x-ray
evidence of joint space narrowing.

3.  There is no recent clinical evidence of lateral instability,
ligamentous laxity, subluxation, effusion of the joint, or more
than slight limitation of motion.

CONCLUSION OF LAW

The criteria for an evaluation in excess of 10 percent for
residuals of a right knee injury are not met.  38 U.S.C.A.
�� 1155, 5107 (West 1991); 38 C.F.R. �� 4.1, 4.3, 4.7, 4.10,
4.20, 4.71, Part 4, Codes 5024-5003, 5257, 5258, 5260, 5261
(1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The appellant's claim of entitlement to an evaluation in excess
of 10 percent for residuals of a right knee injury is "well-
grounded" within the meaning of 38 U.S.C.A. � 5107(a) (West
1991), in that he has presented a claim that is plausible.  This
being so, we must examine the record to determine whether the VA
has a further obligation to assist in the development of facts
pertinent to his claim.  38 U.S.C.A. � 5107(a) (West 1991).

After reviewing the record, we are satisfied that all relevant
facts have been properly developed and that no useful purpose
would be served by remanding the case with instructions to
provide additional assistance to the appellant.  Relevant service
medical records include inpatient reports surrounding a right
knee injury in October 1989 and subsequent right knee surgeries
performed in April 1990, April 1991, and June 1991.  Relevant
postservice medical reports of record include a sufficiently
detailed and comprehensive VA examination dated in March 1992.

After reviewing the record, the Board concludes that service
medical records and postservice clinical reports of record are
adequate for determining whether an increased evaluation is
warranted for residuals of a right knee injury, and the duty to
assist the appellant in the development of facts pertinent to his
claim as contemplated by 38 U.S.C.A. �5107(a) and applicable case
law has been satisfied.

Disability evaluations are determined by the application of a
schedule of ratings which is based on average impairment of
earning capacity.  38 U.S.C.A. � 1155 (West 1991); 38 C.F.R. Part
4, � 4.1 (1993).  Separate diagnostic codes identify the
various disabilities.  Where there is recurrent subluxation,
lateral instability or other impairment of a knee, a ten percent
evaluation may be assigned where the disability is slight; 20
percent for moderate disability; and 30 percent for severe.  38
C.F.R. Part 4, Code 5257 (1993).  Moreover, a 20 percent
evaluation may be assigned where there is evidence of dislocated
cartilage, with frequent episodes of "locking," pain, and
effusion into the knee joint.  38 C.F.R. Part 4, Code 5258.
Evaluations for limitation of flexion are assigned as follows:
Flexion limited to 60 degrees is zero percent; flexion limited to
45 degrees is 10 percent; flexion limited to 30 degrees is 20
percent; and flexion limited 15 degrees is 30 percent. 38 C.F.R.
Part 4, Code 5260 (1993).  Evaluations for limitation of
extension of the knee are assigned as follows:  Extension limited
to 5 degrees is zero percent; extension limited to 10 degrees is
ten percent; extension limited to 15 degrees is 20 percent;
extension limited to 20 degrees is 30 percent; extension limited
to 30 degrees is 40 percent; and extension limited to 45 degrees
is 50 percent.  38 C.F.R. Part 4, Code 5261 (1993).  Under
Diagnostic Code 5024, tenosynovitis is rated as degenerative
arthritis on the basis of limitation of motion of the affected
parts.  38 C.F.R. Part 4, Code 5024-5003 (1993).

Service medical records indicate the appellant injured his right
knee in October 1989 while playing football.  As a result, a
partial meniscectomy of the lateral posterior horn of that knee
was performed in April 1990.  Service medical records further
show that due to a reinjury of that knee in December 1990,
reconstruction of the anterior cruciate ligament (ACL) with a
patellar tendon bone graft was performed in April 1991.
Subsequently, the appellant reported an acute onset of right knee
pain and effusion, resulting in June 1991, arthroscopic surgery.
In October 1991, the appellant was seen for a periodic physical,
at which time he denied any complications associated with his
right knee surgeries.  By a rating decision dated in July 1992,
the appellant was granted service connection and assigned a 10
percent evaluation for residuals of his right knee injury based
upon painful limitation of motion.

During a March 1992 VA orthopedic examination, the appellant
complained of pain and swelling in his right knee with stair
climbing, squatting, or running, but denied any locking or
"giving way."  He reported occasional "clicking" but no
instability.  The objective clinical examination of his right
knee revealed patellofemoral pain and patellar tenderness
secondary to ACL reconstruction surgery.  However, bilateral knee
motion was zero to 135 degrees.  Normal range of motion of the
knee measures zero to 140 degrees.  See 38 C.F.R. � 4.71, Plate
II.  Thus, limitation of motion of the right knee was no more
than slight in degree, and does not warrant an increased rating
under Codes 5260 or 5261.  Furthermore, there was no evidence of
instability, ligamentous laxity, subluxation, or effusion of the
right knee joint as to warrant a moderate evaluation under Code
5257.  While an x-ray of the right knee indicated some medial
joint space narrowing, no calcification or loose bodies in the
joint were found that might produce painful motion.  The
orthopedic examiner assessed patella-femoral pain and tendonitis
with excellent stability of the knee.

On the compensation and pension portion of the examination, it
was noted that there was normal muscle tone and bulk throughout
the body.  Motor strength testing was reported as "5 throughout."
Reflexes were also 2+ throughout.

Taking into account the entire evidentiary record, the current
symptomatology of the appellant's right knee does not more nearly
approximate the criteria required for an evaluation in excess of
10 percent.  38 C.F.R. � 4.7, 4.71a, Diagnostic Codes 5024-5003,
5257, 5260, 5261 (1993).  Again, the recent clinical evidence of
record does not reveal any instability, ligamentous laxity,
subluxation, effusion or more than slight limitation of motion of
the appellant's right knee, and there is no x-ray evidence of
significant degenerative changes.  The current evaluation
contemplates some complaints of pain, especially on extended use.

In addition, an extraschedular evaluation is not warranted, as
there exists no evidence of an unusual or exceptional service-
connected disability of the right knee such as to render
impractical the application of regular schedular provisions.
38 C.F.R. � 3.321(b)(1) (1993).  For instance, it is not shown
that the appellant has current residuals of a right knee injury
that require frequent hospitalization or markedly interfere with
his employment.  Since the preponderance of the evidence is
against allowance of this issue, the benefit of the doubt
doctrine is inapplicable.  38 U.S.C.A. � 5107(b) (West 1991).

ORDER

An evaluation in excess of 10 percent for residuals of a right
knee injury is denied.

          MICHAEL D. LYON
          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:
BVA9420000
DOCKET NO.  93-03548      )       DATE
          )
          )

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

THE ISSUE

Entitlement to service connection for Post-traumatic stress
disorder.

REPRESENTATION

Appellant represented by: Puerto Rico Public Advocate for
Veterans Affairs

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

D. Cohen

INTRODUCTION

The appellant had active service from November 1966 to November
1968.  The appellant served in Vietnam and was awarded the Purple
Heart and Combat Infantry Badge.

This matter is currently before the Board of Veterans' Appeals
(Board) on appeal from a rating decision by the San Juan, Puerto
Rico, Regional Office (RO) of the Department of Veterans Affairs
(VA).  A hearing was held in July 1992 at the RO.  A transcript
of that hearing is of record  The case is now ready for appellate
review.

CONTENTIONS OF APPELLANT ON APPEAL

The appellant contends that as a result of his traumatic war
experiences, while serving in Vietnam, he has post-traumatic
stress disorder (PTSD).

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 against the
veteran's claim for service connection for PTSD.

FINDINGS OF FACT

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

2.  There is an insufficient basis to confirm the current
presence of PTSD.

CONCLUSION OF LAW

PTSD was not incurred in or aggravated during service.  38
U.S.C.A �� 1110, 5107(a) (West 1991); 38 C.F.R. � 3.303 (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

We note that we have found that the veteran's claim is well
grounded within the meaning of 38 U.S.C.A � 5107(a).  That is, we
find that he has presented a claim that is plausible.  We are
also satisfied that all relevant facts have been properly
developed and that no further assistance to the veteran  is
required to comply with the duty to assist mandated by 38 U.S.C.A
� 5107(a).

Under the law, service connection may be granted for disability
resulting from disease or injury incurred in or aggravated by
wartime service. 38 U.S.C.A � 1110.

Service medical records do not disclose complaints or findings
referable to psychiatric pathology.

A statement dated August 1991 from Dr. Lopez-Pagan details his
treatment of the veteran from 1980 until August 1991.  Dr. Lopez-
Pagan relates a history of episodes of anxiety, nervousness,
fears, nightmares, visual and auditory hallucinations immediately
after discharge and prior to the veteran being treated by Dr.
Lopez-Pagan.  Dr. Pagan states that when he began treating the
veteran in 1980 he found the veteran very anxious with severe
episodes of insomnia and suicidal ideations.  Dr. Lopez-Pagan
diagnosed the veteran as suffering from PTSD.  Dr. Lopez-Pagan
last treated the veteran in August 1991 at which time he found
him to be very depressed and experiencing auditory
hallucinations.

A November 1991 VA examination of the veteran  was conducted by
two psychiatrists after reviewing his claims folder, which
included the statement by Dr. Lopez-Pagan.  Following their
examination of the veteran, the VA psychiatrists concluded that
there was no gross psychiatric disorder for an Axis I
determination, except for alcohol abuse by history.  It was also
noted that Dr. Lopez-Pagan is an Internist and Cardiologist.

A statement dated July 1992 from Dr. Coira details his treatment
of the veteran from March 1992 through July 1992.  Dr. Coira
relates the veteran's history of poor interpersonal relations
with co-workers and supervisors.  The veteran's complaints
included: always being sad; ill humored; becomes aggressive with
relatives; insomnia; having horrible nightmares related to his
Vietnam experiences; having flashbacks to Vietnam when he hears
the noise of a helicopter; becoming easily enraged; feels he has
been treated unjustly; people are out to get him; unable to
concentrate; unable to deal with guilty feelings; always thinking
of killing himself to solve his problems.  A diagnosis of PTSD
was reported.

The July 1992 VA examination was conducted by a VA psychiatrist
who prefaced her report by stating that she carefully examined
the veteran's claims folder, which included both private
physician's statements, before interviewing him.  The examiner
noted that there was a lot of vagueness, throughout the
interview, in the symptoms referred by the veteran.  Also the
veteran was very evasive and superficial in all of his answers.
The veteran consistently denied being involved in any violent
activity or becoming destructive or aggressive.  Although his
thought content made mention of vaguely recurrent memories of
Vietnam experiences, at no time did the veteran describe what
could be considered a dissociative episode, flashback or
hallucination.  He expressed no feelings of guilt regarding his
Vietnam experiences.  Based on these findings the VA psychiatrist
stated that she could find no reason to sustain a diagnosis of
PTSD.

It is important to note that the VA doctors had reviewed Dr.
Coira's findings prior to speaking with the veteran.  They
specifically questioned the veteran in detail about some of the
symptoms that Dr. Coira described.  The veteran's responses
contradicted Dr. Coira's findings.  Because Dr. Coira's findings
were contradicted by the veteran any diagnosis derived from those
findings is suspect.

Dr. Lopez-Pagan stated that he has treated the veteran since
1980.  However the veteran indicated at his 1991 VA exam that he
had lived in New York for thirty years and did not move to Puerto
Rico until 1989.  Additionally, Dr. Lopez-Pagan's statement is
written on letterhead which indicates he is an
Internist/Cardiologist, not a mental health professional.
Furthermore, the 1991 VA examination was performed approximately
three months after Dr. Lopez-Pagan indicated the veteran last
visited his office yet in the opinion of two VA psychiatrists the
veteran exhibited none of the litany of symptoms that Dr. Lopez-
Pagan described.

The comprehensive VA psychiatric examinations of the veteran do
not support a diagnosis of PTSD.  When questioned in detail the
veteran's responses did not support the findings of the private
physicians.  The diagnoses of the private physicians are rejected
because the Board finds the probative value of the comprehensive
clinical review and findings conducted by VA to far exceed the
contradictory evidence of record.

ORDER

The claim for service connection for PTSD is denied.

          ROBERT E. SULLIVAN
          Member, Board of Veterans' Appeals

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

(CONTINUED ON NEXT PAGE)

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: WILLIAM J REDDY

text:
BVA9421000
DOCKET NO.  93-08 155     )       DATE
          )
          )

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

THE ISSUE

Entitlement to a compensable evaluation for calluses of both
feet.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

Jeffrey J. Schueler, Associate Counsel

REMAND

The veteran had active duty from November 1969 to January 1972.

The veteran was scheduled for Department of Veterans Affairs'
(VA) examinations in March and May 1991.  The veteran was unable
to be examined at those times since he was in residence at St.
Elizabeth's Hospital in Washington, D.C.  A report of contact
form dated in April 1991 shows that a social worker at St.
Elizabeth's wanted to know if a podiatrist at that facility could
examine the veteran and send the examination report to the VA.
The claims folder includes treatment records prepared at St.
Elizabeth's Hospital through April 1991.  It is not clear,
however, whether the April 1991 clinical records associated with
the claims folder were prepared as an examination and, in any
event, the April 1991 clinical record submitted does not provide
the information required for an adequate evaluation.  The
veteran's representative argues that the clinical evidence of
record is inadequate for rating purposes and was not in
accordance with the VA Physician's Guide for Disability
Evaluation Examinations.  We agree, and the RO should, therefore,
attempt to acquire more accurate and complete information on the
veteran's foot disorder.    It is also indicated that the veteran
may be seeking service connection for additional disability of
the feet, other than calluses.

To ensure that VA has met its duty to assist the appellant in
developing the facts pertinent to the claim, the case is REMANDED
to the regional office (RO) for the following development:

1.  The RO should request that the veteran
supply the names and addresses of any
individuals or treatment facilities that
have treated him for a foot disorder since
separation from active service, with the
exception of St. Elizabeth's Hospital, and
the dates of such treatment.  After
receiving proper authorization from the
veteran, if necessary, the RO should obtain
copies of those records and associate them
with the claims folder.

2.  After securing the necessary release,
the RO should obtain and associate with the
claims folder treatment records from St.
Elizabeth's Hospital in Washington, D.C.,
for the veteran's foot disorder since April
1991.

3.  The veteran should be afforded a VA
examination to determine the nature and
severity of his disability of both feet.
The claims folder should be made available
to the examiner for review before the
examination.  The examinations should be
conducted in accordance with the VA
Physician's Guide for Disability Evaluation
Examinations, Chapter 2, Section IX, at 2-
12 (1985), and all findings should be
reported in detail.  If necessary, copies
of the applicable sections of the VA
Physician's Guide for Disability Evaluation
Examinations should be provided to the
examiner prior to the examination.  The
examiner should be asked to offer an
opinion concerning what complaints and
symptomatology can be attributed to the
veteran's service-connected calluses and
what complaints and symptomatology are
attributable to any other disorder of the
veteran's feet.

4.  After the development requested above
has been completed to the extent possible,
the RO should again review the claim.  The
RO should adjudicate the issue of service
connection or all disorders of the feet
found on examination, other than calluses.
If any benefit sought on appeal, for which
a notice of disagreement has been filed,
remains denied, the appellant and
representative should be furnished a
supplemental statement of the case and
given the opportunity to respond thereto.

Thereafter, the case should be returned to the Board, if in
order.  The Board intimates no opinion as to the ultimate outcome
of this case.  The appellant need take no action unless otherwise
notified.

          WILLIAM J. REDDY
          Member, Board of Veterans' Appeals

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

Under 38 U.S.C.A. � 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals.  This remand is in the nature of a
preliminary order and does not constitute a decision of the Board
on the merits of your appeal.  38 C.F.R. � 20.1100(b) (1993).


judge_norm: JOAQUIN AGUAYO-PERELES

condition: psychiatric

text:
BVA9422000
DOCKET NO.  89-41 536     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Louisville,
Kentucky

THE ISSUE

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

REPRESENTATION

Appellant represented by: Roger W. Rutherford, Attorney at
Law

ATTORNEY FOR THE BOARD

C. R. Olson, Counsel

INTRODUCTION

The veteran's active military service extended from May 1968 to
November 1970.

This matter comes before the Board of Veterans' Appeals (Board)
on appeal from an October 1988 and subsequent rating decisions by
the Department of Veterans Affairs (VA) Regional Office (RO) in
Louisville, Kentucky.  The October 1988 rating decision continued
the denial of service connection for a psychiatric disorder,
which had previously been denied by an unappealed April 1986
rating decision.

In July 1990, the Board remanded the case for the purpose of
documenting and verifying the alleged stressors and for
examination of the veteran.  In August 1990, the RO asked the
veteran to provide additional details of the alleged stressors to
assist in documenting those events.  He did not respond.  The
examination was conducted in November 1990.  The RO continued to
deny the claim.

In August 1991, the Board denied service connection for an
acquired psychiatric disorder, to include post traumatic stress
disorder (PTSD).  The Board found that, since the unappealed
denial of April 1986, new and material evidence had not been
submitted to reopen the claim.

The veteran appealed to the United States Court of Veterans
Appeals (Court).  The Court vacated the August 1991 decision of
the Board and remanded the matter to the Board for further
development.  [citation redacted].  The Court did not
retain jurisdiction.

In August 1993, the Board remanded the case to the RO.  The RO
was to again request details of the alleged stressors form the
veteran.  He was to be told that failure to respond might result
in adverse action.  Regardless of whether the veteran responded,
the RO was to review the file and prepare a summary of all
claimed stressors and forward the summary to the United States
Army and Joint Services Environmental Support Group (ESG) for
verification.  The requested development has been completed.  The
Board now proceeds with its review of the appeal.

CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends that the RO committed error in denying
service connection for PTSD.  He argues that he has PTSD as a
result of combat experiences in Vietnam.  Alleged stressors
include rocket and mortar shelling, the sniper death of a soldier
eating next to him, a stand off attack while driving back to his
unit, and deaths in racial incidents.

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 grant
of service connection for PTSD.

FINDINGS OF FACT

1.  The RO has obtained all relevant evidence necessary for an
equitable disposition of the veteran's appeal.

2.  A psychiatric disorder was not present in service.

3.  There is no credible supporting evidence that the claimed
inservice stressors actually occurred.

4.  The veteran did not engage in active combat with the enemy
while in Vietnam.

5.  The veteran does not have PTSD as the result of disease or
injury during service.

CONCLUSION OF LAW

An acquired psychiatric disorder, including PTSD was not incurred
in or aggravated by active military service.  38 U.S.C.A.
�� 101(16), 1110 (West 1991); 38 C.F.R. � 3.304(f) (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The veteran's claim is "well grounded" within the meaning of
38 U.S.C.A. � 5107(a) (West 1991).  That is, he has presented a
claim which is plausible.  Since the unappealed rating decision
of April 1986, information has been added to the file which, if
believed, could result in an allowance of the claim.  Therefore,
new and material evidence consisting of statements from the
veteran, records from his service units and other information has
been submitted and the claim is reopened.  38 U.S.C.A. � 5108
(West 1991).  All relevant facts have been properly developed and
no further assistance to the veteran is required to comply with
the duty to assist mandated by 38 U.S.C.A. � 5107(a).

Service connection may be granted for a disability resulting from
disease or injury incurred in or aggravated by active military
service.  38 U.S.C.A. �� 101(16), 1110 (West 1991).

The service medical records do not show any complaints, findings
or diagnoses of a psychiatric disorder.  When the veteran was
examined for separation from service, in November 1970, the
examining physician reported the veteran's head, ears and
psychiatric status were normal.  Therefore, there is no basis for
granting service connection for an acquired psychiatric disorder
as being present in service.

The service medical records do show that the veteran was treated
for an upper respiratory infection, in January 1970, at
Headquarters and Headquarters Company, XXIV Corp.  He was treated
for another infection, in June 1970, at the 326th Medical
Battalion, 101st Airborne Division.

The service personnel records show that the veteran was in
Vietnam from September 1969 to December 1970.  He was assigned to
the 17th Signal Platoon in October 1969 and to the Heavy Cable
Construction Detachment in March 1970.  He was present in Vietnam
during three campaigns.  He received awards and decorations for
his Vietnam service; however, he did not receive any combat
awards or decorations.  There is no record of the award of a
Bronze Star Medal.

Private and VA medical reports from 1978 to 1983 indicate that
the veteran sustained a significant back injury during his
civilian work, in 1977.

In September 1984, the veteran asked for help at a VA medical
center.  Complaints included shakes, inability to sleep, and
violence.  He saw a psychologist and told of being exposed to a
great deal of death and combat in Vietnam.  He complained of
dreams, nightmares and sleep problems.  He reported using a fifth
of whiskey every 2 to 3 days.  He also told of suicidal and
homicidal behavior, sexual dysfunction and financial
difficulties.  He appeared to be depressed and his affect was
flat.  The assessment was manic depressive episode, rule out
PTSD, and alcohol dependence.

In November 1984, a VA psychologist gave a deposition for the
veteran's use in a Social Security claim.  The psychologist
reported that the veteran had undergone psychological testing,
including a Minnesota Multiphasic Personality Inventory (MMPI).
The profile was reported to be consistent with PTSD.  Stressors
reported by the veteran were a buddy being killed in a rocket
attack, an incident in which three other buddies died and an
incident in which another soldier, next to him at a snack bar,
was shot and killed.  The psychologist noted that the veteran
also told him of receiving a Bronze Star for a reason that was
unknown.  It was noted that the veteran's memory was vague.
Symptoms following service reportedly include emotional numbing,
sleep problems, marital problems, alcohol abuse, tension,
anxiety, rage reaction, chronic irritability, difficulty
concentrating and memory impairment.  The diagnosis was probable
PTSD.  The psychologist explained that he had spent several hours
with the veteran but felt that further evaluation was required to
confirm the diagnosis.

The report of the August 1985 VA examination shows that the
veteran complained of thoughts of suicide, nightmares and
flashbacks of combat experiences.  He reported serving in combat
and having a Bronze Star.  He said his nerves were bad, that he
had family problems, that he did nothing during the day and that
he could not be around other people.  The diagnosis was PTSD
relating to Vietnam combat experience associated with
intermittent alcohol abuse, difficulty being around people, major
recurring depression, and recurring suicidal ideation.

The veteran was admitted to a VA medical center for observation
and evaluation in January 1986.  He felt that he was incapable of
working because of his nerves.  He reported nightmares involving
rockets and mortars exploding.  Other stressors reported were a
racial incident in which three soldiers were shot.  He said that
once, while driving a truck, he and some other were pinned down
by incoming fire.  He reportedly witnessed another soldier being
shot while eating.  On another occasion, a metal fragment struck
his bed when he was not in it.  He described irritability and
insomnia.  He preferred to isolate himself.  He admitted abusing
alcohol and marijuana.  He reported post service violence against
his boss, family members and others.  In February 1985, he shot a
man in the chest and was briefly jailed.  On mental status
examination, findings were essentially normal except that: his
affect was somewhat restricted; his judgment was impaired and he
was considered impulsive.  A diagnosis of PTSD was provisional
because of the vagueness of the stressors.  Specific details were
somewhat difficult to obtain from him.  Other diagnoses were
alcohol abuse, marijuana abuse, anti-social personality traits,
and intermittent explosive disorder.

In a letter dated in November 1987, J. A. Florence, M.D.,
reported that he had only seen the veteran once, in June 1986.
At that time, the doctor felt that the veteran was suffering from
a major depression.  The veteran stated that he had PTSD as a
result of his Vietnam experiences.  There was no question that he
suffered from a psychiatric disorder manifested by anxiety, bad
dreams and inability to deal with some routine activities of
daily living.

The report of the January 1988 VA examination shows that the
veteran said he had frequently been shot at.  He believed that he
killed some enemy soldiers but was unable to recall exact
numbers.  He stated that he saw several of his comrades killed in
ambushes and rocket attacks.  He said that he came under rocket
attacks on numerous occasions.  He also alluded to racial
problems and smoking marijuana in Vietnam.  He said that after
service he had the "shakes" so badly that he could not hold a
coffee cup.  He reported numerous encounters with the law after
service and stated that he had been charged and successfully
accused of beating his wife, rape, burglary, and several
assaults, including assault with a deadly weapon.  He said that
he shot a man in self defense 2 years prior to the examination.
He also reported episodes of suicidal ideation.  He reported that
he last worked in 1978 when he hurt his back while working as a
carpenter.  He also said that he stopped school in the 8th grade
after previously failing 2 grades.  He worked in a youth corps
until service.  He described his current problems as insomnia,
irritability, difficulty concentrating, Vietnam flashbacks and
keeping loaded weapons.  The clinical impression was PTSD and
borderline personality.  It was noted that psychological testing
was not available and further testing was recommended.

Several psychological tests were performed in August 1988.  A
score of 41 on the PTSD subscale of the MMPI was interpreted as
indicating a 90 percent probability that the veteran was
experiencing PTSD.  However, the other test findings showed that
the veteran's functioning was in the low average range of
intelligence.  He had high anxiety, agitation, and poor
interpersonal skills.  Many somatic complaints were present.  His
cooperation was minimal and he was guarded and cautious in his
response.  Many times he presented specific problems which were
contradicted upon evaluation.  He exhibited difficulty
controlling impulses, especially in regard to emotionally charged
situations.  The diagnoses were malingering, and antisocial
personality disorder.  Stressors were considered to be financial,
marital and physical.

The report of an August 1988 VA psychiatric examination shows
that the veteran complained that he never left Vietnam.  He told
of poor sleep and nightmares and waking up violent and hateful.
He did not want to associate with people.  When questioned about
stressors, he repeated almost word for word information contained
in the claims folder, namely frequent ambushes, rockets falling
around him, a soldier killed by a sniper and a white soldier
shooting black soldiers.  He admitted frequent violence,
particularly against his wife.  During the examination, the
veteran was cooperative and extremely polite.  At times, he was
extremely vague or stated that he could not remember.  Affect was
blunted.  There was no evidence of acute emotional distress.  He
reported an enormous appetite and chain smoking.  Nightmares of
Vietnam were said to occur at least twice a week.  He told of
having had suicidal thoughts.  He reported being nervous around
people and did not want to associate with anyone.  He said that
he was easily startled and sometimes had flashbacks.  However,
the examiner noted that the veteran's description was not very
convincing.  On memory testing, the examiner found the
reliability of the veteran's answers to be questionable.  The
examiner discussed the veteran's responses, pointing out that he
described his symptoms and stressors in a vague manner.  There
was some suspicion that the veteran was exaggerating his
symptoms.  It was noted that although the veteran had given
responses compatible with PTSD, the final conclusion was
malingering.  The psychiatrist concluded his report with
diagnoses of substance and alcohol abuse by history, intermittent
explosive disorder, and antisocial traits.  Stressors were
unemployment and martial conflict.  Another VA psychiatrist
stated that he had examined the veteran and agreed with that
conclusion.

The veteran was again examined by VA psychiatrists in November
1990.  The veteran said he had an 8th grade education.  After
service, he worked various jobs and had numerous episodes of
violence.  He reported that during his service in Vietnam, he
installed cable all over the country.  He said that he used his
weapon 10 to 12 times.  He said that while on assignment in Chu
Lai, a man eating across from him was shot by a sniper and his
head fell into his food.  He stated that 4 to 5 months before
returning home, a rocket struck in front of his bunker and
sprayed metal fragments.  He said he could see hot metal and felt
that one of the pieces would kill him.  He said that he
subsequently saw a doctor because of headaches and ringing in his
ears.  He admitted using marijuana in Vietnam and after service.
After service, he worked in a coal mine.  He was fired after he
threatened another person with a gun.  He had not worked for the
past ten years.  He reported that after service, he was very
nervous and scared.  He told of insomnia and difficulty sleeping
because of bad dreams.  He said that he felt like the war was not
over and that he never left Vietnam.  He reported that he could
not stand loud noises, lightening or thunder storms.  He did not
like to be touched because he became very anxious.  He did not
have any friends because everyone was afraid of him.  He did not
like to be around large groups of people and could not stand loud
noises.  He liked to build furniture, read and watch television.
He complained of chronic headaches, high blood pressure, stomach
ulcers, bad legs, back pain, and bone disease.  He was alert,
oriented, cooperative, tremulous, with a constricted affect and
anxious mood.  Concentration was good and memory was intact.
Judgment was considered good.  Insight was adequate.   Diagnoses
were chronic PTSD, alcohol abuse in remission, and intermittent
explosive disorder.

The veteran was subsequently examined by another VA psychiatrist
in November 1990.  He reported an 8th grade education followed by
service in a youth corp before entering active military service.
He said that his job in Vietnam was to hang cable, but that he
spent most of his time on patrol.  He stated that he spent much
time in combat.  He reported that he was awarded a Bronze Star
but never received the medal.  He said that ringing in his ears
began after a rocket attack.  Following service, he worked for a
coal mine and then did construction, injuring himself in 1979.
He said that he did not sleep.  He complained of nervousness.  He
reported nightmares of Vietnam and dreams of buddies who were
killed.  Mental status examination showed a nervous twitch and
anxiety.  He was cooperative.  His mood was mildly depressed.
His affect was appropriate.  There were no thought abnormalities.
Insight and judgment were intact.  The psychiatric diagnosis was
anxiety disorder, not otherwise specified.  It was commented that
the veteran appeared to be suffering more because of injuries
that occurred after service when he injured his back.  The
examiner did not believe that the anxiety symptoms were due to
any service connected type of trauma.  Psychological testing was
recommended to follow-up on his anxiety symptoms.  However,
detailed psychological testing had been done in August 1988.

The RO sent information provided by the veteran as well as
information from the claims folder to ESG.  In a letter dated in
May 1994, ESG responded with a report from the veteran's parent
unit, the 1st Signal Brigade.  The Brigade operated over 250
sites.  The great majority of enemy activities directed against
brigade units had been stand-off mortar and rocket attacks.  No
losses were reported.  The report from the 2nd Battalion, 94th
Artillery for the period from 1 May to 31 July 1970, shows that
severe rocket and mortar attacks occurred frequently during May
1970.  In June 1970, a rocket caused moderately severe damage to
the new mess hall.  One man in the mess hall was wounded.  The
one wounded man was the only casualty for that reporting period.
ESG said that the veteran would have to provide greater detail
for any further search.  The veteran has been repeatedly asked
for those details by examiners and the RO but has consistently
not provided them.  See Wood v. Derwinski, 1 Vet.App. 190 (1990).

Service connection for PTSD requires medical evidence
establishing a clear diagnosis of the condition, credible
supporting evidence that the claimed inservice stressor actually
occurred, and a link established by medical evidence, between
current symptomatology and the claimed inservice stressor.  If
the claimed stressor is related to combat, service department
evidence that the veteran engaged in combat, or that the veteran
was awarded the Purple Heart, Combat Infantryman Badge, or
similar combat citation will be accepted, in the absence of
evidence to the contrary, as conclusive evidence of the claimed
inservice stressor.  38 C.F.R. � 3.304(f) (1993).

The first requirement for service connection for PTSD is a clear
diagnosis.  There is no clear diagnosis of PTSD in this case.
All of the diagnoses of PTSD had been based in significant part
on the veteran's uncorroborated description of alleged stressors.
These statements are not credible because of the many
inconsistencies in the record.  The service personnel records do
not show the Bronze Star claimed by the veteran.  The ESG reports
do not show the mortar and rocket fatalities reported by the
veteran.  Longitudinal review of the record shows that the
veteran has embellished his story to the extent that, by November
1990, he was alleging frequent patrol duty, which would be
significant and was not mentioned earlier.

Shortly before the veteran began seeking treatment for a
psychiatric disorder, he fell and sustained a back injury which
resulted in serious disability, loss of work and financial and
marital problems.  It appears that the most comprehensive and
credible examination reports failed to link the veteran's current
psychiatric disorder to the alleged stressors in service.  The
two psychiatrists who examined the veteran in August 1988 noted
that the veteran was malingering and that his stressors were
unemployment and marital conflict.  In November 1990 a VA
psychiatrist commented that the veteran appeared to be suffering
more because of injuries that occurred after service when he
injured his back.

In addition to a clear diagnosis, there must be credible
supporting evidence that the claimed inservice stressor actually
occurred.  In this case, the RO has repeatedly asked the veteran
for the details of his stressors, describing the kind of details
that are needed to verify the alleged stressors.  The veteran has
consistently responded with limited information, without
sufficient identifying detail warranting additional research for
verification.  Psychiatrists and psychologists have also asked
for stressor details in face to face discussions, but have not
produced the necessary detail.  Examiners have even commented
negatively on credibility of the alleged stressors noting the
vague descriptions provided by the veteran.

ESG has been able to confirm that there were rocket and mortar
attacks on bases where the veteran might have been.  However,
these were not the fatal attacks he has reported.  This leads the
Board to conclude that there is no credible evidence to support
the claimed stressors.  ESG could not verify anything in relation
to any of the other alleged stressors.  The record does not
contain any other form of support for the alleged stressors.
There is no credible supporting evidence that the claimed
inservice stressors actually occurred.  The evidence in this case
does not meet the second criteria for service connection for
PTSD.

If the claimed stressor is related to combat, service department
evidence that the veteran engaged in combat, or that the veteran
was awarded the Purple Heart, Combat Infantryman Badge, or
similar combat citation will be accepted, in the absence of
evidence to the contrary, as conclusive evidence of the claimed
inservice stressor.  38 C.F.R. � 3.304(f).

Where it is determined based on the absence of recognized
military citations or other supportive evidence, that the veteran
did not engaged in combat with the enemy, the veteran's lay
testimony by itself, is not enough to established the occurrence
of the alleged stressor.  Instead, the record must contain
service records which corroborate the veteran's testimony as to
the occurrence of the alleged stressor.  Zarycki v. Brown, 6
Vet.App. 91 (1993).  In this case, the claimed stressors are
related to combat.  However, the service personnel records and
the reports from ESG do not demonstrate that the veteran
participated in combat.  In any event, neither the veteran's
military specialty (lineman) nor his service records, disclose
that his duties exposed him to more than an ordinary stressful
environment, even given the fact that service in a combat zone is
stressful to some degree to all who are there, but the mere
presence there may not constitute a valid stressor.  Finally, it
should be noted that various examiners have specifically alluded
to the veteran's being an unreliable historian and the evidence,
in this regard, has shown that to be the case.

While the record in this case contains some evidence to support
the veteran's claim, it is, however, not in relative equipoise.
In fact, the preponderance of the evidence is against the claim.
There is no approximate balance of positive and negative evidence
such as to resolve the matter on the basis of reasonable doubt.
Therefore, service connection for the veteran's psychiatric
disorder, including PTSD is denied.

ORDER

Service connection for a psychiatric disorder, including PTSD is
denied.

          JOAQUIN AGUAYO-PERELES
          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.