judge_norm: DEREK R BROWN

text: Service connection for PTSD is denied.

text:
Citation Nr: 0012000
Decision Date: 05/05/00    Archive Date: 05/12/00

DOCKET NO.  96-35 318	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Cleveland,
Ohio

THE ISSUE

Entitlement to service connection for post-traumatic stress
disorder (PTSD).

REPRESENTATION

Appellant represented by:	The American Legion

WITNESS AT HEARINGS ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

Steven D. Reiss, Counsel

INTRODUCTION

The veteran served on active duty from October 1942 February
1946.

This matter comes before the Board of Veterans' Appeals
(Board) on appeal from a June 1995 rating decision of the
Department of Veterans Affairs (VA) Regional Office (RO) in
Cleveland, Ohio, which denied the veteran's claim of
entitlement to service connection for PTSD.  The veteran
timely appealed this determination to the Board.

When this matter was initially before the Board in February
1998, it was remanded for further development and
adjudication, which has been accomplished.  The Board again
remanded this case in August 1999 in light of the veteran's
request that he be afforded the opportunity to testify at a
hearing held before a Member of the Board at the local VA
office.  Thereafter, in April 2000, the veteran, accompanied
by his accredited representative, presented testimony at such
a hearing to the undersigned Board Member.

FINDINGS OF FACT

1.  The veteran did not engage in combat.

2.  The diagnoses of PTSD are not based on credible evidence
that the claimed stressors actually occurred.

CONCLUSION OF LAW

PTSD was not incurred in or aggravated by service. 38
U.S.C.A. �� 1110, 5107(a) (West 1991); 38 C.F.R. � 3.304(f)
(1999).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The claim of entitlement to service connection for PTSD is
well grounded within the meaning of 38 U.S.C.A. � 5107(a),
that is, the veteran has presented a claim that is not
inherently implausible.  Moreover, following the February
1998 and August 1999 remands, the Board is satisfied that all
relevant facts have been properly developed and that no
further assistance is required to comply with the duty to
assist mandated by 38 U.S.C.A. � 5107(a).  In this regard,
the Board notes that treatment records of the veteran's care
at the Fort Wayne, Indiana, Vet Center, have not been
associated with the claims folder.  Although VA is deemed to
have constructive knowledge of documents that are generated
by VA agents or employees, a remand to obtain those records
and readjudicate the claim is not required unless those
materials could be determinative of the claim.  See Dunn v.
West, 11 Vet. App. 462, 466 (1998).  Here, the record shows
that the veteran has clearly been diagnosed as having PTSD,
and the sole question is whether that diagnosis is based on a
corroborated service-related stressor.  Because treatment
records would not speak to this question, they could be
determinative of the outcome of the claim.  As such, a remand
is not warranted.  See Id.

Background

In an October 1994 statement, the veteran identified several
in-service stressful events in support of his PTSD claim.  He
indicated that, in February 1943, while carrying a ten-gallon
fuel can, it caught on fire and that, as a result, he
sustained third-degree burns "all over (his) torso, arms and
hands."  The veteran stated that the burns were of such
severity that he was hospitalized and had to fed by the
hospital staff because he was physically unable to do so on
his own for more than one month; he reported that he was not
discharged until June 1943.  In addition, the veteran stated
that he suffers from nightmares and intrusive thoughts
regarding this injury.

A second in-service stressor purportedly occurred in October
or November 1943, while serving on Guadalcanal when he
witnessed an ammunition ship explode approximately one-fourth
to one-third a mile away.  The veteran reported that, due to
the explosion, "stuff," including body parts, were "flying
through the air."  He also indicated that he has nightmares
relating to this incident.

The service medical records are negative for any complaints
or diagnosis of PTSD, and indeed, the veteran does not
contend otherwise.  While service medical records do reflect
treatment for various disorders there is no reference to any
burn injuries.  The February 1946 separation examination,
reflects that the veteran's skin and extremities were normal,
and he was psychiatrically normal.

The veteran's service personnel records, dated from October
1942 to February 1946, reflect his duty assignments and
locations during his period of service, but they do not
reflect any service in combat.  Moreover, his service
separation and personnel records do not reflect his receipt
of any medal or decoration denoting combat service.  There
was no award of the Purple Heart Medal, or any award for
combat or valor, and the veteran does not contend otherwise.

VA outpatient treatment records from July 1994 note that the
veteran complained of suffering from numerous PTSD symptoms,
including nightmares, flashbacks, rage, anger and night
sweats, for many years.  He indicated that many of his
nightmares were related to an in-service explosion that
caused him to sustain burns on his legs, arms and torso.
Based on the foregoing, the veteran was accepted into a 45-
day VA PTSD hospitalization treatment program.

The veteran was thereafter treated at the VA hospital in
Dayton, Ohio, from July to September 1994, for evaluation of
his PTSD symptoms.  The hospitalization report indicates
that, during the treatment, he participated in both group and
individual counseling sessions, and that he was diagnosed as
having PTSD, and rule out intermittent explosive disorder
deferred.

In addition, in an April 1995 report, a readjustment
counselor at the Vet Center reported that the veteran
sustained burns over 60 percent of his body as the result of
a Japanese Zero attack on the company with which he was
serving.  The examiner stated that he suffered from numerous
nightmares "of being strafed and burned," and that as a
result, the veteran has suffered from PTSD since his
discharge from service.  The Board observes that the Japanese
Zero attack constitutes the third alleged in-service stressor
in support of the veteran's PTSD claim.

Also of record is a June 1984 Social Security Administration
(SSA) decision, which granted entitlement to disability
benefits from that agency, effective September 10, 1982.  In
making this determination, SSA did not cite to a psychiatric
disability.

Based on the above evidence, in a June 1995 rating action,
the RO denied service connection for PTSD.  In doing so, the
RO explained that, although the record showed that the
veteran had been diagnosed as having the disorder, there was
no evidence corroborating the veteran's claimed in-service
stressors.

In July 1996 rating decision that was issued to the veteran
as part of the Statement of the Case, the RO confirmed and
continued the denial of service connection for PTSD.  In
doing so, the RO noted the three claimed in-service stressors
and indicated that, notwithstanding his reported history of
suffering severe burn injuries and of receiving an extensive
period of hospitalization, the service medical records, which
it reported appeared complete, were negative for any such
injury or subsequent hospital treatment.  Further, with
regard to the explosion of the ammunition ship, the RO stated
that, because the examiners who diagnosed him as having PTSD
did not cite to that stressor, even if accepted as true, it
would not support a grant of service connection for PTSD.

Further, in his June 1996 Notice of Disagreement, the veteran
asserted an informal claim for service connection for burns
of the upper torso.  In July 1996, the RO denied this claim
as not well grounded on the basis that the service medical
records do not show any complaints, treatment or findings of
any burns in service, and at separation, his skin was shown
to be normal.  The RO notified the veteran of this later that
same month and the veteran did not appeal.

In February 1997, the veteran testified at a hearing
conducted before a hearing officer at the RO.  He reported
that he had engaged in combat in Okinawa, Japan, with the 4th
Marine Division.  In addition, the veteran reiterated that he
sustained burn injuries as a consequence of an attack by a
Japanese Zero on his unit and a fuel can fire.  With regard
to the fuel can fire, he reported that he was treated at the
U.S. Naval Hospital at New River for burn injuries from
approximately February 14 to either April or May 1943.  The
veteran further stated that if he currently exposed his hands
and arms to the sun, the burn scars would be apparent within
fifteen to twenty minutes of that exposure.  In addition, he
reported having a number of symptoms that he attributed to
his PTSD, including nightmares, nervousness, avoidance
behavior, sleep disorder, anger, impaired concentration and
hypervigilance.  The veteran challenged the adequacy of the
VA psychiatric examination that was conducted during his
hospitalization, and indicated that he was willing to report
to another one.  Finally, because the service medical records
did not reflect treatment for burn scars, the hearing officer
indicated that the RO would attempt to associate those
hospital records.

In compliance with the RO's request for further service
medical records, and particularly for treatment of burn scars
at the Camp Lejeune/New River, North Carolina, Naval medical
facility for the period from 1943, the National Personnel
Records Center (NPRC) indicated in April 1997 that all
available records had been furnished to the RO.  Thereafter,
in June 1997, after conducting a "more extensive search"
for additional service medical records, and again
specifically for treatment of burn scars at the cited in-
service medical facility for the period from February 14 to
May 31, 1943, the NPRC reported that no such records had been
found.

In August 1997, the RO confirmed and continued the denial of
this claim.  In doing so, the RO acknowledged the veteran's
February 1997 hearing testimony, but cited to the absence of
any evidence to substantiate the veteran's claim that he
sustained burn scars in service.  In addition, the RO
observed that the veteran had provided two different accounts
regarding the origin of the burn scars.

When this case was initially before the Board in February
1998, the Board noted that there was a lack of any
contemporary medical evidence supporting the veteran's
allegations of stressors.  Because the RO had not made any
effort, however, to obtain any records from the United States
Armed Services Center for Research of Unit Records (USASCRUR)
the Board remanded the claim for further development.  The
Board instructed the RO that if that development corroborated
the veteran's claimed stressors, it should schedule the
veteran for a VA psychiatric examination.  In addition,
noting the veteran's outstanding request for a Board hearing,
the Board directed that he should be scheduled for one unless
he indicated otherwise.

In compliance with the Board's instructions, in May 1998, the
RO wrote to USASCRUR in an attempt to corroborate the
veteran's alleged in-service stressors.  In a June 1998
letter, USASCRUR notified the RO that, because the veteran
served with the Marines, Headquarters, United States Marine
Corps (USMC) would be the appropriate body from which to
request that information.  In June 1998, Headquarters Marine
Corps notified the RO that it was unable to verify the
requested information and indicated that the veteran's
records had been transferred to the National Archives.  As
such, the Marine Corps indicated that the information should
be requested from the Naval Historical Center (NHC).

Pursuant to the June 1998 letter, in June and September 1998,
the RO requested that the NHC attempt to corroborate the
veteran's alleged in-service stressors.  In a September 1998
response, the NHC stated that the only ammunition ship was
destroyed in the manner claimed by the veteran took place
more than 850 miles from where the veteran was stationed.
Based on the additional information, the RO declined to
schedule the veteran for another VA psychiatric examination,
and instead, in March 1999, confirmed and continued the
denial.

When this matter was thereafter before the Board in August
1999, it was remanded in light of the veteran's outstanding
request for a Board hearing.  As noted in the introduction to
this decision, in April 2000, the veteran testified at a
hearing conducted before the undersigned Board Member.
During the hearing, the veteran reiterated his claimed in-
service stressors as well as the psychiatric symptomatology
that he attributed to his PTSD.  In addition, he reported
that he and a fellow serviceman essentially reassigned
themselves to the 22nd Regiment of the 6th Marine Division.
He stated that, in April 1945, he participated in combat in
Okinawa with the latter unit.

Analysis

In order to establish service connection, the facts, as shown
by the evidence, must demonstrate that a disease or injury
resulting in current disability was incurred during service
or, if pre-existing active service, was aggravated therein.
38 U.S.C.A. � 1110.

Service connection for PTSD requires medical evidence
establishing a clear diagnosis of the condition, credible
supporting evidence that the claimed in-service stressors
actually occurred, and a link, established by medical
evidence, between the current symptomatology and the claimed
in-service stressors.  38 C.F.R. �3.304(f); see also Cohen v.
Brown, 10 Vet. App. 128, 137-138 (1997); Moreau v. Brown, 9
Vet. App. 389, 394-395 (1996).

The evidence necessary to establish the occurrence of a
recognizable stressor during service to support a diagnosis
of PTSD will vary depending upon whether the veteran engaged
in "combat with the enemy."  The United States Court of
Appeals for Veterans Claims (Court) has repeatedly instructed
that VA must make a specific finding as to whether the
veteran engaged in combat.  See Gaines v. West, 11 Vet.
App. 353, 359 (1998); Cohen, 10 Vet. App. at 145.
Participation in combat, a determination that is to be made
on a case by case basis, requires that the veteran have
personally participated in events constituting an actual
fight or encounter with a military foe or hostile unit or
instrumentality.  See VAOPGCPREC 12-99 (October 18, 1999).
If VA determines that the veteran engaged in combat with the
enemy and his alleged stressor is combat-related, then his
lay testimony or statement is accepted as conclusive evidence
of the stressor's occurrence and no further development or
corroborative evidence is required, providing that such
testimony is found to be "satisfactory," i.e., credible,
and "consistent with the circumstances, conditions, or
hardships of service."  See 38 U.S.C.A. � 1154(b) (West
1991).  If, however, VA determines either that the veteran
did not engage in combat with the enemy or that the veteran
did engage in combat, but that the alleged stressor is not
combat related, the veteran's lay testimony, by itself, is
not sufficient to establish the occurrence of the alleged
stressor.  Instead, the record must contain service records
that corroborate the veteran's testimony or statements.  See
Cohen, 10 Vet. App. at 147.

Based on the objective evidence, it is clear that an acquired
psychiatric disorder was not shown present during service,
and a psychosis was not manifested to a compensable degree
within a year of service.  The Board turns, therefore, to the
primary contention that he has PTSD due to events that took
place during his World War II service, and after carefully
reviewing the evidence of record, the Board specifically
finds that the veteran did not engage in combat with the
enemy.  Hence, his assertions regarding his stressors are
insufficient, standing alone, to establish that they actually
occurred.  Id.  As such, some form of credible supporting
evidence is necessary.

In this light, it follows that a diagnosis of PTSD need not
be accepted if it is predicated on a rendition of events that
is unsupported by the record.  As the Court has noted, the
Board is entitled to be skeptical of a diagnosis of PTSD
rendered many years following service based solely on a
history related by the veteran, as the diagnosis can be no
better than the facts alleged by him.  Swann v. Brown, 5 Vet.
App. 229, 233 (1993); see also Reonal v. Brown, 5 Vet. App.
458, 460-61 (1993). (A medical opinion based upon an
incomplete and inaccurate history is of no probative value.)

It is noteworthy that in recent years VA revised the criteria
for diagnosing and evaluating mental disorders. The revisions
became effective November 7, 1996.  38 C.F.R. � 4.130 (1999).
On and after that date, all diagnoses of mental disorders for
VA purposes must conform to the fourth edition of the
DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, Fourth Edition
(DSM-IV).  38 C.F.R. � 4.125 (1999).  Although DSM- IV
changes the requirements for establishing the sufficiency of
a stressor for purposes of diagnosing PTSD, it bears emphasis
that there must also be evidence establishing the occurrence
of the stressor or stressors alleged by the veteran.  Cohen,
10 Vet. App. at 142.  Here, the Board's rejection of the
veteran's claim for service connection for PTSD is expressly
based on a finding that there is no credible evidence that
the claimed stressors actually occurred.  The adoption by VA
of DSM-IV is, therefore, immaterial to a resolution of this
aspect of the veteran's appeal.  Moreover, an opinion by a
mental health professional based on a post service
examination of the veteran may not be used to establish the
occurrence of the stressor.  Id.

With respect to the veteran's claimed stressors, there is no
independent evidence of record, apart from the veteran's own
testimony, to corroborate any of his stressors.  The service
medical and personnel records, as well as the investigations
completed by the NPRC, and upon the advice of the USASCRUR,
the USMC and NHC, were negative with respect to the claimed
incidents.  Simply stated, there is no validation of any of
the events by fellow servicemen, and service records and unit
histories do not confirm their occurrence.  The nature of the
veteran's account is further suspect in view of the fact that
it has changed over time with, e.g., he was burned due to a
fuel can fire and thereafter reported that he received
extensive burns over the same areas of his body due to a
Japanese Zero attack on the unit in which he was serving.
Hence, in the absence of objective support that any of these
events occurred, to include medical evidence of any inservice
burn scar, the Board finds that there is no credible
supporting evidence that verifies any of the claimed
stressors.

In addition, although the veteran asserts that he engaged in
combat activities while with the 22nd Marine Regiment, 6th
Marine Division, there is no independent credible evidence of
record indicating that he either actually engaged in combat,
or, more significantly, that he actually served with that
unit.  Indeed, his service personnel records do not reflect
that he was attached to the 22nd Marines, or that he served
in combat on Okinawa.  In this regard, the Board notes that
only official service department records can establish if and
when an individual was serving on active duty, active duty
for training, or inactive duty for training.  Cahall v.
Brown, 7 Vet. App. 232, 237 (1994); Duro v. Derwinski, 2 Vet.
App. 530, 532 (1992).  As the Court noted, if a veteran
disagrees with the information contained in those records,
his remedy, if any, must be pursued with the Board Correction
of Military Records for the appropriate service department.
Id.

With regard to his other reported stressors, the Board
observes that service medical and personnel records have been
obtained from the NPRC.  In this regard, the Board notes
that, based on the veteran's reported in-service treatment,
from approximately February to May or June 1943 at Camp
Lejeune/New River, North Carolina, pursuant to the RO's
request, the NPRC performed subsequent searches and
thereafter determined that no additional service medical
existed.  As such, these records provide no verification that
any of the alleged stressors occurred.  Indeed, the records
fail to show any complaints, findings, symptoms, or treatment
for any burns, or for any injuries related to a ship
explosion.  They do, however, reflect treatment for other
conditions during this period, but are negative for even a
reference to the reported burn injuries.  This absence of any
corroboration reduces the claimant's credibility.

In sum, although the veteran has been diagnosed by different
examiners as having PTSD, all those diagnoses were made many
years after service and were based solely on the veteran's
reported history.  No diagnosis of PTSD or other psychiatric
disability has been made on his actual verified military
history or associated with an evaluation of any claimed
stressors based on all of the evidence.  Although an examiner
can render a current diagnosis based upon an examination of
the veteran, an opinion regarding the etiology of the
underlying condition, without a thorough review of the
record, can be no better than the facts alleged by the
veteran.  Swann, 5 Vet. App. at 233.

In his statements and hearing testimony, the veteran has
asserted that he has PTSD as a consequence of experiences
during his period of military service during World War II.
Although the veteran is certainly capable of providing
evidence of symptomatology, "the capability of a witness to
offer such evidence is different from the capability of a
witness to offer evidence that requires medical knowledge."
Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992).

Hence, the Board finds that the preponderance of the evidence
is against the veteran's claim that he has PTSD due to a
stressor or stressors that occurred during his period of
military service.  The record is devoid of any credible
supporting evidence of the claimed stressors; there are only
the recollections of the veteran made decades after service
unsupported by the service medical and administrative
records.  As indicted above, such evidence is inadequate to
meet the requirements set forth in 38 C.F.R. � 3.304(f).  The
Board, therefore, finds that the preponderance of the
evidence is against the claim for service connection for
PTSD.  38 U.S.C.A. �� 1110, 5107(a); 38 C.F.R. �� 3.303,
3.304(f).

In reaching this decision the Board considered the doctrine
of reasonable doubt, however, as the preponderance of the
evidence is against the appellant's claim, the doctrine is
not for application.  Gilbert v. Derwinski, 1 Vet. App. 49
(1990).

ORDER

Service connection for PTSD is denied.

	DEREK R. BROWN
	Member, Board of Veterans' Appeals


series: legacy

judge_norm: JANE E SHARP

judge_role: Member, Board of Veterans' Appeals

disposition: denied

text:
Citation Nr: 0013000
Decision Date: 05/17/00    Archive Date: 05/24/00

DOCKET NO.  98-19 455	)	DATE
	)
	)

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

THE ISSUE

Entitlement to Department of Veterans Affairs (VA) benefits.

REPRESENTATION

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

WITNESSES AT HEARING ON APPEAL

Appellant and S.A.

ATTORNEY FOR THE BOARD

G. A. Wasik, Associate Counsel

INTRODUCTION

This matter is before the Board of Veterans' Appeals (Board)
on appeal of a September 1997 hearing officer's decision of
the Department of Veterans Affairs (VA) Regional Office (RO).

The Board notes the appellant submitted additional evidence
in support of her claim in October 1999 which was subsequent
to the issue on appeal being certified to the Board for
disposition.  Such evidence consists of duplicates of
evidence previously of record as well as a stock certificate
from the Philippine Veterans Bank and a statement from the
appellant.  Under 38 C.F.R. � 20.1304(c) (1999), any
pertinent evidence submitted by the appellant directly to the
Board within 90 days following notification to her of
certification of the appeal and transfer of records to the
Board must be referred to the RO for review and preparation
of a supplemental statement of the case unless this
procedural right is waived by the appellant.  The Board has
determined after a review of the evidence submitted that a
remand of the issue on appeal is not required to comply with
38 C.F.R. � 20.1304(c) as the evidence submitted is
duplicative of evidence previously of record or is not
relevant.

FINDING OF FACT

The U.S. Army Reserve Personnel Center has certified that the
appellant's husband had no service as a member of the
Philippine Commonwealth Army, including the recognized
guerillas, in the service of the United States Armed Forces.

CONCLUSION OF LAW

The requirements of basic eligibility for VA benefits based
on qualifying service by the appellant's deceased husband
have not been met.  38 U.S.C.A. �� 101(2), 107 (West 1991 &
Supp. 1999); 38 C.F.R. �� 3.1(d), 3.8, 3.9(a), 3.203 (1999).

REASONS AND BASES FOR FINDING AND CONCLUSION

Factual Background

Associated with the claims file are numerous documents which
have been submitted by the appellant and prior claimants who
have alleged entitlement to VA benefits based on the service
of the appellant's deceased husband.  Affidavits attest to
the fact the appellant's husband was last seen in a Japanese
prisoner of war camp and was executed by the Japanese.
Documents prepared by the Armed Forces of the Philippines
note that the appellant's husband was a 1st Lieutenant with
the 71st Infantry of the Army of the Philippines in the
service of the United States Armed Forces.  The documents do
not vary in the spelling of the appellant's husband's name or
the unit he was assigned to.

Form 3101 received in February 1949 includes a notation that
the appellant's husband had no recognized guerilla service.
This form indicates that the appellant's husband had service
with the Armed Forces of the United States as an officer with
the 71st Infantry.  He was listed as beleaguered from
December 8, 1941 to April 9, 1942, a prisoner of war (POW)
from April 10, 1942 to "March 16, 1942," and missing
from"March 17, 1942" to October 23, 1944.  The document was
prepared by the (US) Adjutant General's Office.

The record reflects that for a period of time the parents of
the appellant's husband received VA benefits based on his
service.

Pursuant to a request for clarification from the RO, VA Form
3101, dated in February 1951, was prepared by the (US)
Adjutant General's Office.  It indicates that the appellant's
husband had no recognized guerrilla service nor was he a
member of the Commonwealth Army in the service of the Armed
Forces of the United States.  The transmittal letter for this
VA Form 3101 includes the notation the February 1951
determination supercedes all prior determinations of service.

Subsequent VA Form 3101's received in August 1979 and June
1994 confirmed the February 1951 determination.  The August
1979 document was prepared by the US Army Adjutant General's
Office, and states that evidence submitted was insufficient
to warrant a change in the May 1951 determination.  The June
1994 document was prepared by the United States Army Reserve
Personnel Center (ARPCEN) and also states that evidence
submitted was insufficient to change the certification of
February 1951.  The July 1997 document includes the notation
that the positive certification dated in February 1949 was
revoked in February 1951.

In a letter of December 1996 to the appellant, the RO
explained the process of verifying service and advised that
to reopen her claim new and material evidence had to be
submitted and that such had not been submitted.

In March 1997 the appellant had an informal hearing at the
RO.  Thereafter, by a May 1997 letter to ARPERCEN, the RO
provided identifying information regarding the appellant's
husband and asked that a review be made of available service
records to confirm whether he performed military service with
the Philippine Army.  In July 1997 ARPCEN replied that
records on file at that center revealed that the positive
certification of February 1949 had been revoked in February
1951 and that the subject of the inquiry had no service as a
member of the Philippine Army or as a recognized guerilla.

The transcript of a June 1999 local RO hearing reflects the
appellant's testimony that she married her husband in
November of 1940 and that he entered military service
sometime in 1940.  She reported that she thought he had been
discharged in 1941 and that she last saw him in 1944 when her
daughter was born. .  The appellant's daughter testified that
her grandparents received VA benefits as a result of her
father's service.

Criteria and Analysis

The law authorizes payment of death compensation or death
pension benefits to a surviving spouse of a "veteran."
38 U.S.C.A. �� 1121, 1541 (West 1991).

The term "veteran" means a person who served in the active
military, naval or air service and who was discharged or
released under conditions other than dishonorable.  38 C.F.R.
� 3.1(d).

Service in the Regular Philippine Scouts is included for
pension, compensation, dependency and indemnity compensation
and burial benefits.  38 C.F.R. � 3.8(a).

Service as a Philippine Scout in the Regular Army inducted
between October 6, 1945, and June 30, 1947, inclusive, and in
the Commonwealth Army of the Philippines from and after the
dates and hours when called into service of the Armed Forces
of the United States by orders issued from time to time by
the General Officer, U.S. Army, pursuant to the Military
Order of the President of the United States dated July 26,
1941, is included for compensation benefits, but not for
pension or burial benefits.

Service department certified recognized guerrilla service and
unrecognized guerrilla service under a recognized
commissioned officer, only if the person was a former member
of the United States Armed Forces (including the Philippine
Scouts), or the Commonwealth Army, prior to July 1, 1946, is
included for compensation benefits, but not for pension or
burial benefits.  38 C.F.R. � 3.8(c) and (d).

For the purpose of establishing entitlement to VA benefits,
the VA may accept evidence of service submitted by a
claimant, such as a DD Form 214, Certificate of Release or
Discharge from Active Duty, or original Certificate of
Discharge, without verification from the appropriate United
States service department under the following conditions: (1)
the evidence is a document issued by the United States
service department; (2) the document contains needed
information as to length, time and character of service; and,
(3) in the opinion of the VA the document is genuine and the
information contained in it is accurate.  38 C.F.R. �
3.203(a) (1999).

The United States Court of Appeals for Veterans Claims
(hereinafter, "the Court")" has held that the, "VA is
prohibited from finding, on any basis other than a service
department document, which VA believes to be authentic and
accurate, or service department verification, that a
particular individual served in the U.S. Armed Forces."  Duro
v. Derwinski, 2 Vet. App. 530, 532 (1992).  The evidence
submitted in support of the appellant's claim was prepared by
the Philippine Government and lay persons.  VA laws and
regulations do not provide for acceptance of documents
prepared by a foreign government as proof of service and the
appellant has not submitted any documentation sufficient to
validate her husband's claimed service.  The service
department conclusion was that the appellant's husband had no
verified service.  "Service department findings are binding
on the VA for purposes of establishing service in the U.S.
Armed Forces."  Id.; see also Dacoron v. Brown, 4 Vet. App.
115, 120 (1993).  Thus, on the basis of the evidence of
record, there is no demonstration of qualifying military
service in this case.  Inasmuch as the United States service
department's verification of the appellant's husband's
service is binding on the VA, the Board concludes that the
appellant's husband was not a "veteran" for purposes of
entitlement to VA benefits.  Therefore, the appellant's claim
for entitlement to VA benefits must be denied as a matter of
law.  See Sabonis v. Brown, 6 Vet. App. 426 (1994).

The Board notes that the record contains no United States
service documents in support of the appellant's claim; nor
has she provided, via her own statements or other evidence,
any further information different from that previously
submitted, which would warrant another request for re-
certification.  Accordingly, the VA has fulfilled its duty
under 38 C.F.R. � 3.203(c).

ORDER

The appeal for basic eligibility for VA benefits is denied.

	JANE E. SHARP
	Member, Board of Veterans' Appeals


judge_norm: C P RUSSELL

disposition: dismissed

text: The appeal is dismissed.

text:
Citation Nr: 0014000
Decision Date: 05/26/00    Archive Date: 06/05/00

DOCKET NO.  97-30 575	)	DATE
	)
	)

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

THE ISSUE

Entitlement to an effective date earlier than February 11,
1997, for the grant of a compensable evaluation for service-
connected residuals of a shell fragment wound of the left
calf and foot.

(The issue of whether the Board of Veterans' Appeals (Board)
committed clear and unmistakable error (CUE) in its October
1989 decision which addressed whether an increased rating for
residuals of a shell fragment wound of the left calf and foot
was warranted and did not address whether the reduction of
the veteran's rating for that disability from 10 percent to 0
percent was proper is addressed in a separate decision and
docket number.)

REPRESENTATION

Appellant represented by:	Paralyzed Veterans of America,
Inc.

WITNESS AT HEARINGS ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

M. C. Graham, Counsel

INTRODUCTION

The veteran served on active duty from April 1968 to April
1970.

The instant appeal arose from a September 4, 1997, rating
decision of the Department of Veterans Affairs (VA) Regional
Office (RO), in Jackson, Mississippi, which granted an
increased evaluation, to 10 percent, for the service-
connected shell fragment wound of the left calf and foot,
effective from June 11, 1997.  By rating decision dated
September 15, 1997, the RO granted an earlier effective date
of February 11, 1997, for the grant of a 10 percent
evaluation for the service-connected shell fragment
residuals, finding CUE in the September 4, 1997, rating
decision which had assigned the June 11, 1997, effective
date.  Since this claim has not been withdrawn, an effective
date earlier than February 11, 1997, remains at issue on
appeal.  See AB v. Brown, 6 Vet. App. 35 (1993) (a claim
remains in controversy where less than the maximum available
benefits are awarded).

In November 1998 the veteran appeared at a hearing using
videoconference techniques before the undersigned member of
the Board.

FINDINGS OF FACT

1.  By a decision entered in September 4, 1997, the RO
granted an increased evaluation, to 10 percent, for the
service-connected shell fragment wound of the left calf and
foot, effective from June 11, 1997.  An NOD with regard to
that decision was received at the RO on September 12, 1997.
By rating decision dated September 15, 1997, the RO granted
an earlier effective date of February 11, 1997, for the grant
of a 10 percent evaluation for the service-connected shell
fragment residuals.  A statement of the case was issued to
the veteran on September 30, 1997.  A substantive appeal was
received at the RO in October 1997.

2.  By a decision entered on or after April 2000, the Board
found that an October 27, 1989, Board decision contained CUE
in that it addressed the issue of whether an increased rating
for residuals of a shell fragment wound of the left calf and
foot was warranted and did not address whether the reduction
of the veteran's rating for that disability from 10 percent
to 0 percent was proper.  The 2000 decision also granted
entitlement to an award of 10 percent for residuals of shell
fragment wound of the left calf and foot for the period from
September 1, 1988, to February 10, 1997.

CONCLUSION OF LAW

The appeal of the claim of entitlement to an effective date
earlier than February 11, 1997, for the grant of a
compensable evaluation for service-connected residuals of a
shell fragment wound of the left calf and foot is moot.
38 U.S.C.A. �� 5110, 7104, 7105(d) (West 1991 & Supp. 1999);
38 C.F.R. �� 3.400, 20.101 (1999).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The RO granted an increased evaluation, to 10 percent, for
the service-connected shell fragment wound of the left calf
and foot, effective from June 11, 1997, by a decision entered
in September 4, 1997.  38 C.F.R. � 3.400 (1996).  An NOD with
regard to that decision was received at the RO on September
12, 1997.

By rating decision dated September 15, 1997, the RO granted
an earlier effective date of February 11, 1997, for the grant
of a 10 percent evaluation for the service-connected shell
fragment residuals, finding CUE in the September 4, 1997,
rating decision which had assigned the June 11, 1997,
effective date.  However, the September 15 rating decision
granted less than the maximum available benefits.  See AB v.
Brown, 6 Vet. App. 35 (1993).

A statement of the case was issued to the veteran on
September 30, 1997.  The appeal was thereafter perfected when
a timely substantive appeal was received at the RO in October
1997.  38 U.S.C.A. � 7105 (West 1991); 38 C.F.R. �� 20.200,
20.201, 20.202, 20.302 (1999).

Subsequently, however, on or after March 2000, the Board
found that an October 27, 1989, Board decision contained CUE
in that it addressed the issue of whether an increased rating
for residuals of a shell fragment wound of the left calf and
foot was warranted and did not did not address whether the
reduction of the veteran's rating for that disability from 10
percent to 0 percent was proper.  That decision also granted
entitlement to an award of 10 percent for residuals of shell
fragment wound of the left calf and foot for the period from
September 1, 1988, to February 10, 1997.  That decision
represents a full grant of the benefit sought on appeal
inasmuch as it establishes a 10 percent disability award for
the veteran's service-connected shell fragment wound of the
left calf and foot on a continuous basis from the date
following his separation from service to the present.  See
38 U.S.C.A. � 5110 (West 1991 & Supp. 1999).

Because a 10 percent disability evaluation from September 1,
1988, to February 10, 1997, the period at issue in this case,
has already been established, no justiciable error of fact or
law remains with respect to the matter developed for appeal.
The appeal must therefore be dismissed as moot.  38 U.S.C.A.
�� 7104, 7105(d) (West 1991 & Supp. 1999); 38 C.F.R. � 20.101
(1999).

ORDER

The appeal is dismissed.

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


judge_norm: BETTINA S CALLAWAY

condition: knee

text:
Citation Nr: 0015000
Decision Date: 06/07/00    Archive Date: 06/15/00

DOCKET NO.  99-00 769	)	DATE
	)
	)

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

THE ISSUE

Entitlement to service connection for a right knee disorder,
patella-femoral syndrome.

REPRESENTATION

Appellant represented by:	The American Legion

ATTORNEY FOR THE BOARD

D.  Havelka, Counsel

INTRODUCTION

The veteran's active military service extended from January
1991 to January 1995.

This appeal comes before the Board of Veterans' Appeals
(Board) on appeal from an October 1995 rating decision by the
Department of Veterans Affairs (VA) Regional Office (RO) in
New Orleans, Louisiana.  That rating decision, in part denied
service connection for a right knee disorder.

FINDINGS OF FACT

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

2.  There is no competent medical evidence of a current right
knee disability.

CONCLUSION OF LAW

The appellant has not presented a well grounded claim for
service connection for a right knee disorder, patella-femoral
syndrome, and therefore there is no statutory duty to assist
the appellant in developing facts pertinent to this claim.
38 U.S.C.A. �� 101(16), 1110, 5107(a) (West 1991); 38 C.F.R.
� 3.303(b) (1999).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

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), 1131 (West 1991);
38 C.F.R. �� 3.303, 3.304 (1999).

The law provides that "a person who submits a claim for
benefits under a law administered by the Secretary shall have
the burden of submitting evidence sufficient to justify a
belief by a fair and impartial individual that the claim is
well grounded."  38 U.S.C.A. � 5107(a) (West 1991)(emphasis
added).  Establishing a well grounded claim for service
connection for a particular disability requires more than an
allegation that the disability had its onset in service or is
service-connected; it requires evidence relevant to the
requirements for service connection and of sufficient weight
to make the claim plausible and capable of substantiation.
See Franko v. Brown, 4 Vet. App. 502, 505 (1993); Tirpak v.
Derwinski, 2 Vet. App. 609, 610 (1992); Murphy v. Derwinski,
1 Vet. App. 78, 81 (1990).

The three elements of a "well grounded" claim are: (1)
evidence of a current disability as provided by a medical
diagnosis; (2) evidence of incurrence or aggravation of a
disease or injury in service as provided by either lay or
medical evidence, as the situation dictates; and, (3) a
nexus, or link, between the inservice disease or injury and
the current disability as provided by competent medical
evidence.  See Caluza v. Brown, 7 Vet. App. 498, 506 (1995),
aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996);  see also
Epps v Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997);
38 U.S.C.A. � 1110 (West 1991); 38 C.F.R. � 3.303 (1999).

Generally, competent medical evidence is required to meet
each of the three elements.  However, for the second element
the kind of evidence needed to make a claim well grounded
depends upon the types of issues presented by a claim.
Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993).  For some
factual issues, such as the occurrence of an injury,
competent lay evidence may be sufficient.  However, where the
claim involves issues of medical fact, such as medical
causation or medical diagnoses, competent medical evidence is
required.  Id. at 93.

In this case, the determinative issues presented by the claim
are (1) whether the veteran had a right knee disorder during
service; (2) whether he has any current right knee
disability; and, if so, (3) whether this current disability
is etiologically related to active service.  The Board
concludes that medical evidence is needed to lend plausible
support for all of the issues presented by this case because
they involve questions of medical fact requiring medical
knowledge or training for their resolution.  Caluza v. Brown,
7 Vet. App. 498, 506 (1995); see also Layno v. Brown, 6 Vet.
App. 465, 470 (1994); Espiritu v. Derwinski, 2 Vet. App. 492,
494-95 (1992).

The veteran's service medical records appear to be complete.
They contain entrance and separation examination reports
along with treatment records which span the veteran's entire
period of military service.  On entrance examination in
February 1990 the veteran's knees were noted to be normal.  A
service department treatment record reveals that in October
1991 the veteran had complaints of right knee pain on
climbing hills and stairs.  Physical examination revealed no
edema or erythema.  Range of motion was normal.  There was
tenderness to palpation above the patella and some crepitus
was noted.  The assessment was mild patella-femoral syndrome
of the right knee.  The veteran was treated with Motrin and
limited duty.  He was referred to physical therapy.  In
November 1991 a physical therapy follow-up consultation was
conducted.  The veteran reported being able to run with
little discomfort but that climbing stairs caused pain.
Again, examination revealed tenderness of the right knee and
moderate crepitus.  Range of motion was normal and some
minimal edema was noted.  The veteran was treated with:  ice
packs, continued limited duty, and rehabilitative exercise.
Subsequently there is no indication in any of the service
medical records that the veteran had continued problems with
right knee pain.  In November 1994 a separation examination
of the veteran was conducted.  On the accompanying report of
medical history the veteran reported a history of "trick of
locked knee."  The examiner noted "PFS [patella-femoral
syndrome] right knee -stable with NSAIDS, ice."  On the
actual examination report the veteran's lower extremities
were normal with no abnormalities noted by the examiner.  The
notes section of the examination report indicates "PFS
[patella-femoral syndrome] right knee - stable."  The Board
also notes that the veteran's separation examination was not
conducted by a physician but rather by an enlisted corpsman.

In November 1995 a VA general medical examination of the
veteran was conducted.  The veteran reported a history of
patellofemoral syndrome.  He complained of moderate right
knee pain especially with activity.  No objective findings
with respect to the right knee were noted and the diagnosis
was "history of patellofemoral syndrome secondary to
trauma."  In May 1996 a VA joints (orthopedic) examination
of the veteran was conducted.  The veteran reported an
inservice right knee injury and that he gets right knee pain
when running.  Range of motion of the right knee was normal
with flexion to 140 degrees and extension to 0 degrees.
There was no swelling of the right knee.  X-ray examination
of the right knee was normal.  The diagnosis was "no disease
or pathology of the right knee."

There is no objective medical evidence of any current right
knee disability.  With no current disability the veteran does
not meet the first element required for the claim to be well
grounded.  See Caluza, 7 Vet. App. at 506.  The existence of
a current disability is the cornerstone of a claim for VA
disability compensation. 38 U.S.C.A. � 1110, 1131 (West
1991); see Degmetich v. Brown, 104 F. 3d 1328 (1997) (holding
that Secretary's and Court's interpretation of sections 1110
and 1131 of the statute as requiring the existence of a
present disability for VA compensation purposes cannot be
considered arbitrary and therefore the decision based on that
interpretation must be affirmed).

The Board notes that the veteran filed his claim
approximately 7 months after he separated from service, and
approximately 9 months after his November 1994 separation
examination.  The existence of patellofemoral syndrome was
noted on separation examination.  The court has held that
where veteran filed disability claim one month after service,
diagnosis of a disorder during the separation examination
provides evidence of both a current condition and a
relationship to service.  Hampton v. Gober, 10 Vet. App. 481
(1997).  However, the circumstances in the present case are
different.  The examiner who conducted the November 1994
separation examination was not a physician, but rather an
enlisted corpsman.  The notation of patellofemoral syndrome
appears have been made by history alone and the condition was
indicated to be stable.  Moreover, there were no objective
findings of the presence of any right knee disorder on
separation examination.  The examiner specifically indicated
that the veteran's lower extremities, which includes his
right knee, were normal.  More recently the veteran has been
examined by two VA physicians.  Both of these physicians
failed to find any objective evidence of a current right knee
disorder on examination.  As such, the competent medical
evidence of record reveals an absence of the claimed right
knee disability.  With no current disability the veteran's
claim cannot be well grounded.

The Board has thoroughly reviewed the claims file.  However,
we  find no evidence of a plausible claim.  Since the veteran
has not met his burden of submitting evidence sufficient to
justify a belief by a fair and impartial individual that the
claim is well grounded, it must be denied.  See Boeck v.
Brown, 6 Vet. App. 14, 17 (1993) (if a claim is not well-
grounded, the Board does not have jurisdiction to adjudicate
it).

Where a claim is not well grounded, VA does not have a
statutory duty to assist a claimant in developing facts
pertinent to the claim, but VA may be obligated under 38
U.S.C.A. � 5103(a) to advise a claimant of evidence needed to
complete his application.  This obligation depends on the
particular facts of the case and the extent to which the
Secretary has advised the claimant of the evidence necessary
to be submitted with a VA benefits claim.  Robinette v.
Brown, 8 Vet. App. 69, 78 (1995).  Here, unlike the situation
in Robinette, the veteran has not put the VA on notice of the
existence of any specific, particular piece of evidence that,
if submitted, could make his claims well grounded.  See also
Epps v. Brown, 9 Vet. App. 341 (1996).  Accordingly, the
Board concludes that VA did not fail to meet its obligations
under 38 U.S.C.A. � 5103(a) (West 1991).

	(CONTINUED ON NEXT PAGE)

ORDER

Because it is not well-grounded, the veteran's claim for
service connection for right knee disorder, patella-femoral
syndrome, is denied.

	BETTINA S. CALLAWAY
	Member, Board of Veterans' Appeals


judge_norm: R F WILLIAMS

condition: hip

disposition: granted

text:
Citation Nr: 0016000
Decision Date: 06/16/00    Archive Date: 06/22/00

DOCKET NO.  98-13 842A	)	DATE
	)
	)

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

THE ISSUES

1.  Entitlement to service connection for a left hip
condition, as secondary to service connected disabilities.

2.  Entitlement to an increased evaluation for traumatic
arthritis right knee, currently evaluated as 10 percent
disabling.

3.  Entitlement to an increased evaluation for traumatic
arthritis left knee, currently evaluated as 10 percent
disabling.

4.  Entitlement to an assignment of a disability evaluation
higher than 10 percent for instability of the right knee.

5.  Entitlement to an assignment of a disability evaluation
higher than 10 percent for instability of the left knee.

6.  Entitlement to an increased evaluation for metatarsalgia,
left foot, currently evaluated as 10 percent disabling.

7.  Entitlement to an increased evaluation for residuals left
wrist injury, currently evaluated as 10 percent disabling.

REPRESENTATION

Appellant represented by:	Wisconsin Department of
Veterans Affairs

ATTORNEY FOR THE BOARD

Kelli A. Kordich, Associate Counsel

INTRODUCTION

The veteran served on active duty from June 1978 to November
1986.

This matter comes before the Board of Veterans' Appeals
(Board) on appeal, part,  from a May 1998 RO decision of the
Department of Veterans Affairs (VA) Regional Office (RO) in
Milwaukee, Wisconsin, which denied ratings in excess of 10
percent for traumatic arthritis of the left and right knees;
a rating in excess of 10 percent for residuals of a left
wrist injury; a rating in excess of 10 percent for
metatarsalgia of the left foot; and denying service
connection for a left hip condition as secondary to the
service connected disabilities.  An RO decision in April 1999
granted service connection and assigned 10 percent ratings
for the veteran's instability of the knees, effective from
July 1, 1997.  The veteran appeals for the initial assignment
of a higher rating for each knee.

FINDINGS OF FACT

1.  There is no medical evidence to show that the veteran's
left hip arthritis was caused or worsened by his service-
connected bilateral knee or bilateral foot disabilities.

2.  The veteran's traumatic arthritis of the right knee is
manifested by pain and  slight limitation of motion.

3.  The veteran's traumatic arthritis of the left knee is
manifested by pain and slight limitation of motion.

4.  The veteran's right knee instability is slight in degree.

5.  The veteran's left knee instability is moderate in
degree.

6.  The veteran's metatarsalgia of the left foot is
manifested by no more than moderate functional impairment.

7.  The veteran is right hand dominant; his left wrist
disability is manifested by pain, slight limitation of
motion, and slight loss of strength; it is not productive of
dorsiflexion of less than 15 degrees, palmer flexion limited
in line with the forearm, favorable ankylosis in  20 to 30
degrees of dorsiflexion, or unfavorable ankylosis, but the
overall disability picture is consistent with mild incomplete
paralysis of the left lower radicular nerve group.

CONCLUSIONS OF LAW

1.  The veteran's claim for secondary service connection for
a hip condition is not well grounded.  38 U.S.C.A. � 5107
(West 1991).

2.  The criteria for entitlement to a disability evaluation
in excess of 10 percent for the veteran's service-connected
traumatic arthritis right knee have not been met.  38
U.S.C.A. � 1155, 5107 (West 1991); 38 C.F.R. Part 4,
including �� 4.7, 4.40-4.45, 4.59, 4.71a, and Diagnostic
Codes 5003-5010, 5260, 5261 (1999).

3.  The criteria for entitlement to a disability evaluation
in excess of 10 percent for the veteran's service-connected
traumatic arthritis left knee have not been met.  38 U.S.C.A.
� 1155, 5107 (West 1991); 38 C.F.R. Part 4, including �� 4.7,
4.40-4.45, 4.59, 4.71a, and Diagnostic Codes 5003-5010, 5260,
5261 (1999).

4.  The criteria for entitlement to the initial assignment of
a disability evaluation in excess of 10 percent for the
veteran's service-connected instability right knee have not
been met.  38 U.S.C.A. � 1155 (West 1991); 38 C.F.R. Part 4,
including �� 4.7, 4.71a, and Diagnostic Code 5257 (1999).

5.  The criteria for entitlement to the initial assignment of
a 20 percent evaluation for the veteran's service-connected
instability left knee have been met.  38 U.S.C.A. � 1155
(West 1991); 38 C.F.R. Part 4, including �� 4.7, 4.71a, and
Diagnostic Code 5257 (1999).

6.  The criteria for entitlement to a disability evaluation
in excess of 10 percent for the veteran's service-connected
metatarsalgia, left foot have not been met.  38 U.S.C.A.
� 1155 (West 1991); 38 C.F.R. Part 4, including �� 4.7, 4.40,
4.45, 4.71a, and Diagnostic Code 5279, 5284 (1999).

7.  The criteria for a 20 percent rating for residuals of a
left wrist injury have been met.  38 U.S.C.A. � 1155 (West
1991); 38 C.F.R. Part 4, including �� 4.7, 4.20 4.40, 4.45,
4.71a, Diagnostic Codes 5214, 5215; 38 C.F.R. � 4.124a, 8599-
8512 (1999).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

I.  Service connection

The issue before the Board involves a claim of entitlement to
service connection.  Applicable law provides that service
connection will be granted if it is shown that the veteran
suffers from disability resulting from an injury suffered or
disease contracted in line of duty, or for aggravation of a
preexisting injury suffered or disease contracted in line of
duty, in active military service.  38 U.S.C.A. � 1131;
38 C.F.R. � 3.303.  Applicable regulations provide that
disability which is proximately due to or the result of a
service-connected disease or injury shall be service
connected.  38 C.F.R. � 3.310(a).  In addition, the United
States Court of Appeals for Veterans Claims has held that
secondary service connection may also be granted for the
degree of aggravation to a nonservice-connected disorder
which is proximately due to or the result of a service-
connected disorder.  Allen v. Brown, 7 Vet. App. 439, 448
(1995).  The Board notes that this may be referred to as
secondary service connection by way of aggravation.  That an
injury occurred in service alone is not enough; there must be
chronic disability resulting from that injury.  If there is
no showing of a resulting chronic condition during service,
then a showing of continuity of symptomatology after service
is required to support a finding of chronicity.  38 C.F.R.
� 3.303(b).  Service connection may also be granted for any
disease diagnosed after discharge, when all the evidence,
including that pertinent to service, establishes that the
disease was incurred in service.  38 C.F.R. � 3.303(d).

However, it should be noted at the outset that statutory law
as enacted by the Congress charges a claimant for VA benefits
with the initial burden of presenting evidence of a well-
grounded claim.  38 U.S.C.A. � 5107(a).  A well-grounded
claim has been defined by the Court as "a plausible claim,
one which is meritorious on its own or capable of
substantiation."  Murphy v. Derwinski, 1 Vet. App. 78, 91
(1990).  Where the determinative issue involves a medical
diagnosis, competent medical evidence to the effect that the
claim is "plausible" or "possible" is required.  Grottveit v.
Brown, 5 Vet. App. 91, 92-93 (1993).  A claimant therefore
cannot meet this burden merely by presenting lay testimony
and/or lay statements because lay persons are not competent
to offer medical opinions.  Espiritu v. Derwinski, 2 Vet.
App. 492 (1992).  Consequently, lay assertions of medical
causation cannot constitute evidence to render a claim well-
grounded under 38 U.S.C.A. � 5107(a); if no cognizable
evidence is submitted to support a claim, the claim cannot be
well-grounded.  Tirpak v. Derwinski, 2 Vet. App. 609, 611
(1992).

In order for a service connection claim to be well-grounded,
there must be competent evidence:  i) of current disability
(a medical diagnosis); ii) of incurrence or aggravation of a
disease or injury in service (lay or medical evidence), and;
iii) of a nexus between the inservice injury or disease and
the current disability (medical evidence).  Epps v. Gober,
126 F.3d 1464, 1468 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet.
App. 498, 506 (1995).  Moreover, the truthfulness of evidence
is presumed in determining whether a claim is well-grounded.
King v. Brown, 5 Vet. App. 19, 21 (1993).  The Board
emphasizes, however, that the doctrine of reasonable doubt
does not ease the veteran's initial burden of submitting a
well-grounded claim.  38 U.S.C.A. � 5107(b); Gilbert v.
Derwinski, 1 Vet. App. 49, 55 (1990).

Alternatively, the Court has indicated that a claim may be
well grounded based on application of the rule for chronicity
and continuity of symptomatology, set forth in 38 C.F.R.
� 3.303(b).  See Savage v. Gober, 10 Vet. App. 488 (1997).
The Court held that the chronicity provision applies where
there is evidence, regardless of its date, which shows that a
veteran had a chronic condition either in service or during
an applicable presumption period and that the veteran still
has such condition.  That evidence must be medical, unless it
relates to a condition that the Court has indicated may be
attested to by lay observation.  If the chronicity provision
does not apply, a claim may still be well grounded "if the
condition is observed during service or any applicable
presumption period, continuity of symptomatology is
demonstrated thereafter, and competent evidence relates the
present condition to that symptomatology."  Savage, 10 Vet.
App. at 498.

A. Hip condition as secondary to the service connected
disabilities

The veteran contends that his hip condition is secondary to
his left knee, right knee, and left foot disabilities.

Service medical records show that in 1984 the veteran
sustained an injury to his left hand and underwent fusion of
the scaphoid using left iliac crest bone graft.  The veteran
was service connected for left iliac crest bone graft donor
site.  There is no evidence of a left hip condition in
service.

A VA examination in April 1988 showed full range of motion of
the hip.  X-rays revealed slight deformity at the interior
superior iliac spine region of the left pelvis of non-
specific appearance, which was noted to be possibly related
to previous injury or osteochondroma; the radiologist did not
link the abnormality to service.

In an October 1997 VA examination the veteran reported using
a cane on the right to reduce left hip pain.  He indicated
that the pain was constant and increased when he went down
stairs, upon prolonged sitting, or with motion.  There were
no flare-ups of pain but it had become progressively worse
over the past year.  The examination showed no Trandenberg's
Sign, but both hips had decreased range of motion.  There was
no crepitation in the hip joint or tenderness.  Muscle
strength was about 4/5 around the hip joint; similar range of
motion and muscle strength findings were noted on the right.
There was no tenderness on the right hip.  The examiner
diagnosed bilateral hip arthritis, etiology unknown.

VA outpatient treatment records indicate complaints of left
hip pain.  April 1997 to September 1998 outpatient records
show treatment for left hip pain and x-rays dated September
1997 revealed a bone density in the right iliac crest.   A
bone scan was negative.  No abnormalities were seen in the
hips to suggest osteomyelitis or septic arthritis.  It was
noted that no abnormality was seen to explain the veteran's
complaint of left hip pain.  A January 1999 report indicated
complaints of left hip pain, and a report dated in February
1999 contained an assessment of left hip degenerative joint
disease, "milder but increased symptoms".
An April 1999 VA physical therapy record indicates signs and
symptoms of left hip pain were consistent with bursitis.

The evidence establishes that the veteran has degenerative
joint disease of the left hip; however, there is no medical
evidence suggesting a nexus or link between the arthritis and
his service connected disabilities.  The April 1988 VA x-ray
report indicated that the slight deformity found at the
interior superior iliac spine region of the left pelvis could
possibly be related to previous injury or osteochondroma, but
the radiologist did not link the abnormality to service.  The
Board notes that the record shows that the veteran underwent
a bone graft from this same area in 1984 and service
connection is in effect for the graft site.  There was no
evidence of arthritis and the examination noted full range of
motion of the hip.

An October 1997 VA examiner noted left hip arthritis,
etiology unknown.

The veteran is no doubt sincere in his belief that his
symptomatology is related to his service connected
disabilities.  However, where the determinative issue is one
of medical causation, only those with specialized medical
knowledge, training, or experience are competent to provide
evidence on the issue, and the veteran is a layperson, unable
to render a medical opinion for these purposes.  Espiritu, 2
Vet. App. at 494-95.  The Board hereby advises him that a
medical diagnosis suggesting a link to service or to a
service-connected disability is necessary to well-ground his
claim.

The Board is unaware of any information in this matter that
would put VA on notice that any additional relevant evidence
may exist that, if obtained, would well ground the veteran's
claim.  See McKnight v. Gober, 131 F.3d 1483 (Fed. Cir.
1997); Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995).

II.  Increased ratings

The veteran claims that he has suffered an increase in the
severity of his service-connected disabilities.  When a
veteran is seeking an increased rating, such an assertion of
an increase in severity is sufficient to render the increased
rating claim well-grounded.  38 U.S.C.A. � 5107(a); Proscelle
v. Derwinski, 2 Vet. App. 629, 632 (1992).  With a well-
grounded claim arises a statutory duty to assist the veteran
with the development of evidence in connection with his
claim.  38 U.S.C.A. � 5107(a).  The Board finds that the
record as it stands is adequate to allow for equitable review
of the veteran's increased rating claims and that no further
action is necessary to meet the duty to assist the veteran.

Disability evaluations are determined by the application of
the Schedule For Rating Disabilities, which assigns ratings
based on the average impairment of earning capacity resulting
from a service-connected disability.  38 U.S.C.A. � 1155; 38
C.F.R. Part 4.  Where there is a question as to which of two
evaluations shall be applied, the higher evaluation will be
assigned if the disability picture more nearly approximates
the criteria required for that rating.  Otherwise, the lower
rating will be assigned.  38 C.F.R. � 4.7.

In order to evaluate the level of disability and any changes
in condition, it is necessary to consider the complete
medical history of the veteran's condition.  Schafrath v.
Derwinski, 1 Vet. App. 589, 594 (1991).  However, where an
increase in the level of a service-connected disability is at
issue, the primary concern is the present level of
disability.  Francisco v. Brown, 7 Vet. App. 55 (1994).

It should also be noted that when evaluating disabilities of
the musculoskeletal system, 38 C.F.R. � 4.40 allows for
consideration of functional loss due to pain and weakness
causing additional disability beyond that reflected on range
of motion measurements.  DeLuca v. Brown, 8 Vet. App. 202
(1995).  Further, 38 C.F.R. � 4.45 provides that
consideration also be given to weakened movement, excess
fatigability and incoordination.

A. Traumatic arthritis right and left knee

The veteran contends that the current evaluations assigned to
his traumatic arthritis of his right and left knee do not
accurately reflect the severity of his symptomatology.
A September 1997 VA bone scan showed increased uptake noted
in both knees, consistent with severe degenerative disease in
all three compartments.

An October 1997 VA examination showed valgus deformity of
both knees of approximately 10 to 15 degrees.  Range of knee
motion was slightly limited bilaterally:  Extension was
actively -5 and passively 0.  Flexion of the knee was to 110
actively and to 115 degrees passively.  X-rays showed severe
degenerative joint disease.  The examiner noted that, because
of the arthritis, the veteran had decreased activity or
exercise and had gained weight to 300 pounds, and that the
increased weight had aggravated his arthritis (of the knees).

A January 1999 VA examination showed hesitant, guarded
flexion of the right knee from 0 to 120 degrees; hesitant,
guarded flexion of the left knee from 0 to 110 degrees with
grimace.  X-ray of the knees found loss of joint space in the
lateral compartments of both knees with subchondral
sclerosis, flattening of the arterial surfaces and some
marginal spurring.  Diagnosis was degenerative changes, both
knees.

VA outpatient treatment records dated September 1998 to
February 1999 show complaints of bilateral knee pain.
February 1999 showed pseudolaxity to varus on the left, range
of motion was from 5 to 130 degrees bilaterally.  April 1999
VA physical therapy records show range of motion noted as
right flexion 5/5 and extension 4-/5 with pain lateral joint
line; left flexion 4+/5 and extension 3+/5 with pain at
lateral joint line.  Ligament testing noted slight laxity
left anterior cruciate ligament (ACL), and bilateral laxity
medial collateral ligament (MCL).

The veteran's traumatic arthritis of the right and left knees
have each been evaluated as 10 percent disabling under the
provisions of 38 C.F.R. � 4.71a, Diagnostic Code 5010.
Diagnostic Code 5010 states that traumatic arthritis is to be
rated as degenerative arthritis under Diagnostic Code 5003.
Diagnostic Code 5003, in turn, states that the severity of
degenerative arthritis, established by x-ray findings, is to
be rated on the basis of limitation of motion under the
appropriate diagnostic code for the specific joint or joints
affected.

The severity of limitation of knee flexion is evaluated under
DC 5260.  Under this code, a 10 percent rating is warranted
if knee flexion is limited to 45 degrees, and a 20 percent
rating is warranted if knee flexion is limited to 30 degrees.
In this case, the veteran's flexion of his right knee has
ranged from 120 to 130 degrees and his left knee from 110
degrees to 130 degrees.  As both numbers are well in excess
of 30 degrees for both knees, a 20 percent rating is not
warranted under this code for either knee.

The severity of limitation of knee extension is evaluated
under DC 5261.  Under this code, a 10 percent rating is
warranted if knee extension is limited to 10 degrees, and a
20 percent rating is warranted if knee extension is limited
to 15 degrees.  In this case, the veteran's extension for
both knees has ranged from full (zero degrees) to 5 degrees.
As the degree of limitation of extension falls far short of
the 15 degrees of limitation required for the assignment of a
20 percent rating, a higher evaluation is not warranted under
this code for either knee.

In reviewing the relevant medical evidence, the Board finds
that the veteran's arthritis of the right and left knees were
not manifested by more than slight limitation of motion.  In
fact, under the applicable rating criteria, the minimal
limitation of motion that was evident does not support a
compensable rating under Diagnostic Code 5260 or 5261.  Since
there was x-ray evidence of arthritis and some limitation of
motion, the separate 10 percent rating for each knee was
appropriate.  38 C.F.R. � 4.71a, Diagnostic Code 5003.
However, the slight limitation of motion shown here for both
knees falls far short of what is required for a rating in
excess of 10 percent.  The Board notes that the veteran's
instability of the knees are rated separately (see C below).

As the preponderance of the evidence is against the claims,
the benefit of the doubt doctrine is not applicable, and the
claims must be denied.  38 U.S.C.A. �� 5107(b); Gilbert, 1
Vet. App. at 49.

B. Metatarsalgia, left foot

The veteran contends that the current evaluation assigned for
his metatarsalgia, left foot does not accurately reflect the
severity of his symptomatology.

A May 1988 rating decision granted service connection and
assigned a 10 percent evaluation for left foot metatarsalgia
based on service medical record notation of "post frostbite"
with complaints of left foot pain which was associated with
"mechanic abnormality".

Upon an October 1997 VA examination the veteran reported
bilateral foot pain only when he walked.  He indicated that
the foot pain was most painful early in the morning when he
woke up and that, after moving, the pain subsided.  Cold
weather increased the pain and after walking about 20
minutes, the pain was from 3 to 4/10 to 8 or 9/10.  The
examination showed the veteran with hallux valgus
bilaterally, left worse than right, with 25 degrees on the
left and 50 degrees on the right.  There was a callous
formation at the metatarsal head and second toe bilaterally,
and swelling of the MP joint bilaterally, especially the left
big toe.  There was no tenderness of the right MP joint.
Dorsiflexion was to 20 degrees and plantar flexion to 30
bilaterally.  IP joint range of motion was dorsiflexion to 0
degrees and plantar flexion to 60 degrees, bilaterally.
There was no tenderness to the sole bilaterally.  The
diagnosis was hallux valgus deformity of bilateral great toe
and degenerative joint disease of the toe bilaterally.

A January 1999 VA examination showed the veteran's complaints
of decreased range of motion of the great toe.  With walking
he experienced an increased pain which he described as sharp,
catching, with any activity that would seem to hyperextend
the toe.  The examination noted amputation of the second and
third toes.  Hallus valgus deformity of the great toe was
noted with tenderness on firm palpation.  The veteran was
able to ambulate very slowly with a significant antalgic gait
using a cane.  The veteran did not try to ambulate without
the cane.  He refused to rise up on heels and toes because of
complaints of pain.

The veteran has been rated under Diagnostic Code 5279 which
specifically addresses metatarsalgia and Morton's disease.
However, Diagnostic Code 5279 provides for a maximum
schedular rating of 10 percent.  Under Diagnostic Code 5284,
a foot disability, including residuals of a foot injury, is
rated 10 percent when moderately disabling, 20 percent when
productive of moderately severe disability, and 30 percent
when productive of severe foot disability.

Upon consideration of all the evidence presented, the Board
concludes that the veteran's left foot metatarsalgia has not
been shown to be productive of more than moderate foot
disability.  Accordingly, the preponderance of the evidence
is against entitlement to a rating in excess of 10 percent.

The veteran does not have weak foot or claw foot, so
Diagnostic Codes 5277 and 5278 would not apply.  Diagnostic
Code 5280 provides for a maximum evaluation of 10 percent for
severe or operated unilateral hallux valgus.  There are no
other applicable diagnostic codes for the veteran's foot
disability.  Therefore, the benefit of the doubt doctrine
does not apply, and the claim must be denied.  38 U.S.C.A.
� 5107(b); Gilbert, 1 Vet. App. at 49.

The potential application of various provisions of Title 38
of the Code of Federal Regulations have also been considered
but the record does not present such "an exceptional or
unusual disability picture as to render impractical the
application of the regular rating schedule standards."
38 C.F.R. � 3.321(b)(1).  In this regard, the Board finds
that there has been no showing by the veteran that the
service connected disorder at issue has resulted in marked
interference with employment or necessitated frequent periods
of hospitalization so as to render impractical the
application of the regular rating schedule standards.  In the
absence of such factors, the Board finds that criteria for
submission for assignment of an extraschedular rating
pursuant to 38 C.F.R. � 3.321(b)(1) are not met.  See Bagwell
v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet.
App. 218, 227 (1995).

C. Assignment of a higher evaluations for instability of the
knees

The veteran is appealing the original assignments of
disability evaluations following an award of service
connection, and, as such, the claims for the increased
evaluations are well-grounded.  38 U.S.C.A. � 5107(a);
Shipwash, 8 Vet. App. at 224.  The Board finds that all
relevant facts have been properly developed, and that all
evidence necessary for equitable resolution of the issue has
been obtained.  No additional action is necessary to meet the
duty to assist the veteran.  38 U.S.C.A. � 5107(a).
Moreover, since the present appeal arises from initial rating
decisions which established service connection and assigned
the initial disability evaluations, it is not the present
level of disability which is of primary importance, but
rather the entire period is to be considered to ensure that
consideration is given to the possibility of staged ratings;
that is, separate ratings for separate periods of time based
on the facts found.  Fenderson v. West, 12 Vet. App. 119, 127
(1999).
The veteran contends that the current evaluations assigned to
his instability of his right and left knee do not accurately
reflect the severity of his symptomatology.

An RO decision in April 1999 granted service connection for
the veteran's right and left knee instability and assigned 10
percent ratings for each knee.

In an October 1997 VA examination the veteran complained of
constant knee pain, more severe on the left.  The examination
showed valgus deformity of bilateral knees which was about 10
to 15 degrees.  The range of motion was slightly limited
bilaterally.  The extension actively -5, passively 0.
Flexion actively 110, passively 115 degrees.  Muscle strength
was 4/5 in flexion and extension left knee.  There was no
effusion or tenderness at the joint spaces.  However, the
veteran had a loose collateral ligament, noted to be "about
1 cm".  There was no anterior or posterior drawer sign.
There was no tenderness in popliteal area and there was
crepitation at the patellofemoral joint.  The right knee had
tenderness at the lateral facet joint of patellofemoral
joint.  No tenderness at the medial facet joint nor
tibiofemoral joint medially or laterally.  There was lateral
knee instability of 'about 1 cm", but there was no anterior
or posterior drawer sign.  No popliteal tenderness or Baker's
cysts found.

In a January 1999 VA examination the veteran reported right
knee pain as constant and aching at a 6 to 10+ on a pain
scale.  He reported stiffness with any periods of flexion
over 20 minutes and he was not able to stand more than 15
minutes.  The veteran reported he was unable to sit with his
knees flexed greater than 90 degrees.  He indicated he could
walk two to three miles and did not complain of decreased
range of motion.  He felt that his knees were stiff and were
"frozen" in the morning, but denied giving out sensation.  He
reported decreased endurance and strength and swelling with
increased weight bearing activity.  The examiner noted that
the veteran did not have a brace for his right knee.  The
examination showed hesitant, guarded flexion of the right
knee from 0 to 120 degrees, and the veteran complained of
tenderness with firm pressure to the patella as well as
palpation of the entire patellar area.  Crepitus was
significant with passive range of motion.  As for the left
knee, the veteran complained of a giving out sensation
causing the knee to buckle, which resulted in falls.  He
reported that he fell frequently and had difficulty ascending
and descending stairs.  The veteran described constant knee
pain at an eight to nine on the pain scale, tenderness, and a
catching sensation.  It was noted that he did not have a
brace for either knee.  He reported increased pain with
flexion of the muscles and with cold, and he noted that a
total knee replacement had been suggested.  He denied locking
sensation and reported that he tried pool therapy but found
that this aggravated the joint pain after the session.  He
also reported increased stiffness with cold weather.  The
veteran indicated that he was unable to squat because of
pain, and it was noted that he had used a cane for the past
year.  The examination showed hesitant, guarded flexion, from
0 to 110 degrees, with grimace.  He complained of pain with
pressure to the patella as well as pressure to the area
surrounding the patella.  The veteran remained very guarded
and protected of knees with varus and valgus stress, which
produced pain bilaterally.  Lachman's test was positive on
the left; the veteran refused to do one leg hips and to squat
for fear of falling.  X-rays of the knees found loss of joint
space in the lateral compartments of both knees with
subchondral sclerosis, flattening of the arterial surfaces
and some marginal spurring.  The diagnosis was degenerative
changes, both knees.

VA outpatient treatment records dated September 1998 to
February 1999 show complaints of bilateral knee pain.
February 1999 showed range of motion of right knee was from 5
to 130 degrees; pseudolaxity to varus on the left, range of
motion was from 5 to 130 degrees.  VA physical therapy
records dated April 1999 indicated bilateral knee pain as an
intense dull, throbbing ache bilaterally along the medial and
lateral joint lines, posterior joint line on the left, and
superior patella on the right.  The veteran also reported
that the left knee buckled more than the right, and he
indicated that signs and symptoms increased in the knees
while walking for more than one hour after resting, upon
walking up and down stairs, or while sitting with knees more
than 90 degrees for one hour on the bus.  The examiner noted
bilateral valgus, left greater than right.  Range of motion
of the knees was noted as right flexion 5/5, extension 4-/5
with pain at lateral joint line; left flexion 4+/5 and
extension 3+/5 with pain at lateral joint line.  Ligament
testing revealed slight laxity  of the left anterior cruciate
ligament (ACL), and bilateral laxity of the medial collateral
ligament (MCL).

The veteran's knee disabilities (other than arthritis) are
rated pursuant to Diagnostic Code 5257, which provides for
evaluating an impairment of the knee involving recurrent
subluxation or lateral instability.  A 10 percent evaluation
is assigned for slight impairment, 20 percent for moderate
impairment, and 30 percent for severe impairment.

Following a review of all the evidence in this case, the
Board finds that the veteran has moderate impairment of the
left knee, which supports an increased rating to 20 percent,
but no more than slight impairment on the right.  The October
1997 VA examination found no positive anterior or posterior
drawer sign but there was lateral knee instability of the
right knee of about 1 cm.  The examination showed a 10 to 15
degree valgus deformity of both knees.  Muscle strength was
4/5 in flexion and extension left knee.  In the January 1999
VA examination the veteran reported a giving out sensation in
the left knee.  VA physical therapy records dated April 1999
indicated bilateral valgus left greater than right.  Ligament
testing noted slight laxity left anterior cruciate ligament
(ACL), and bilateral laxity medial collateral ligament (MCL).

In view of the findings of both slight ACL and MCL
instability on the left, and considering the veteran's
symptoms, it is the Board's judgment that the overall
disability picture for the left knee is consistent with
moderate functional impairment, thereby supporting an
increased rating to 20 percent under Code 5257.  As there is
no medical evidence of subluxation or more than slight
instability of the right knee, the  Board finds that a rating
in excess of 10 percent is not warranted under Code 5257.  As
the benefit of the doubt doctrine is not applicable, the
claim for a rating in excess of 10 percent for right knee
instability under Diagnostic Code 5257 must be denied.
38 U.S.C.A. � 5107(b) ; Gilbert, 1 Vet. App. 49.

The Board notes that since the veteran's instability of the
knees are rated under Diagnostic Code 5257, the provisions of
38 C.F.R. �� 4.40, 4.45, and the analysis required under
DeLuca, are not for application.  See Johnson v. Brown, 9
Vet. App. 7, 11 (1997) (Diagnostic Code 5257 not predicated
on loss of range of motion, 38 C.F.R. �� 4.40, 4.45, with
respect to pain, do not apply).

D.  Assignment of a higher evaluation for residuals of a left
wrist injury

The Board finds the veteran's claim for an increased rating
for his service connected left wrist disability is well
grounded within the meaning of 38 U.S.C.A. � 5107(a).  The
Court has held that, when a veteran asserts that a service-
connected disability has increased in severity, the claim is
well grounded.

Service medical records show that in May 1984 the veteran
underwent a triscaphium fusion (scaphoid trapezium trapezoid
joint) of the left wrist.  A left iliac bone graft was
performed at that time.

In an October 1997 VA examination, the veteran gave a history
of  falling in May 1984 and undergoing a fusion operation
with bone graft shortly thereafter.  He reported no recent
left wrist pain.  The diagnosis was ankylosis (loss of
motion) of the left wrist.

A January 1999 VA examination of the veteran revealed a
history of numbness of the fourth and fifth fingers of the
left hand.  The veteran complained of decreased strength with
gripping and stabbing pains on the dorsal aspect of the
wrist.  It was noted that the veteran had a surgical fusion
of the bones of the left wrist while in the service.  He
complained of a "knot" pointing to the dorsal surface of the
wrist.  He also complained of his hand feeling cold
regardless of the season and pain of 8 to 9 on a pain scale
of 1 to 10 with any gripping movement.  He reported that when
his hand was at rest he had no pain and reported decreased
motor control and strength and endurance of the left wrist.
The veteran indicated that he avoided lifting and carrying
anything because of pain.  He did not have any supportive
braces or splints for the left hand and did not report any
radiation of pain to the left hand.  The examiner noted that
the veteran was right hand dominant.  The veteran had no
specific treatment at the time for the left hand and
described discomfort as occurring on a daily basis.  The
veteran did not describe dislocation or subluxation.
The examination showed a 1 mm nodule which was firm and
moveable on the dorsal aspect on the ulnar side of the left
wrist.  It was more prominent when the hand was slightly
flexed.  The veteran was able to demonstrate forward flexion
of 35 degrees and hyperextension to 25 degrees of the left
wrist.  Hand grasp of the left hand was 4/5.  The veteran was
unable to approximate the fourth finger of the left hand to
the thumb.  He had decreased ability to hold an object from
the examiner's grasp.  There was no crepitus with minimal
passive range of motion and there was minimal tenderness with
firm palpation.  The diagnosis was post fusion of left wrist
with degenerative changes.

Limitation of dorsiflexion of either wrist to less than 15
degrees or limitation of palmar flexion of either wrist to in
line with the forearm warrants a 10 percent evaluation.  38
C.F.R. � 4.71a, Diagnostic Code 5215 (1999).  Ankylosis is
considered to be favorable when the joint is fixed in 20
degrees to 30 degrees of dorsiflexion.  Ankylosis is
considered to be unfavorable when the joint is fixed in any
degree of palmar flexion, or with ulnar or radial deviation.
A 30 percent evaluation is warranted for favorable ankylosis
in 20 degrees to 30 degrees of dorsiflexion of the wrist of
the major (dominant) upper extremity.  38 C.F.R. � 4.71a,
Diagnostic Code 5214, and Note.

An October 1997 VA examination included an assessment of
ankylosis of the left wrist, but there was no indication of
complete immobility of the wrist, ankylosis with the joint is
fixed in 20 degrees to 30 degrees of dorsiflexion, or
unfavorable ankylosis.  In fact, the degree of limitation of
motion of the left wrist was not reported.  The January 1999
VA examination, however, was thorough in nature and included
range of motion findings.  That evaluation did not even show
compensable limitation of motion.  See Code 5215.  There was
indication that pain, flare-ups of pain, weakness,
incoordination, or any other pertinent symptom or clinical
finding resulted in any additional limitation of motion to a
degree that would support a higher rating under the
applicable rating criteria.  However, in addition to pain and
some limitation of motion, there is medical evidence of
weakness, including some secondary loss of grip strength of
the left hand.   It is the Board's judgment that the
disability picture is analogous to mild incomplete paralysis
of a lower radicular nerve group. When an unlisted condition
is encountered it will be permissible to rate under a closely
related disease or injury in which not only the functions
affected, but the anatomical localization and symptomatology
are closely analogous.  38 C.F.R. � 4.20 (1999).  Under
Diagnostic Codes 8512 (pertaining to the lower radicular
nerve group), a 20 percent evaluation is warranted for mild
incomplete paralysis involving the major or minor upper
extremity.  A 30 percent rating is warranted for moderate
incomplete paralysis involving the minor upper extremity.  38
C.F.R. � 4.124a, Diagnostic Code 8512 (1999).  The Board
finds that the clinical findings summarized above are
analogous to mild, but no more than mild, incomplete
paralysis of the left lower radicular nerve group affecting
the veteran's non-dominant left wrist and hand.  Accordingly,
an increased rating to 20 percent for residuals of a left
wrist injury is warranted.

ORDER

Entitlement to service connection for a left hip condition,
as secondary to service connected disabilities is denied.

Entitlement to a rating in excess of 10 percent for traumatic
arthritis right knee is denied.

Entitlement to a rating in excess of 10 percent for traumatic
arthritis left knee is denied.

Entitlement to the assignment of an initial rating in excess
of 10 percent for instability of the right knee is denied.

Entitlement to the assignment of an initial rating of 20
percent  for instability of the left knee is granted, subject
to the law and regulations governing the payment of VA
monetary benefits.

Entitlement to a rating in excess of 10 percent for
metatarsalgia of the left foot is denied.

Entitlement to a 20 percent rating for residuals of a left
wrist injury is granted, subject to the law and regulations
governing the payment of VA monetary benefits.

	R. F. WILLIAMS
	Member, Board of Veterans' Appeals


judge_norm: L W TOBIN

disposition: remanded

text:
Citation Nr: 0017000
Decision Date: 06/27/00    Archive Date: 07/05/00

DOCKET NO.  94-32 377	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs (VA) Regional Office (RO)
in Huntington, West Virginia

THE ISSUES

1.  Entitlement to service connection for heart disease, on a
direct basis or as secondary to service-connected post-
traumatic stress disorder (PTSD).

2.  Entitlement to ratings higher than 10 percent from
September 9, 1991 through November 6, 1997, 30 percent from
November 7, 1997 through September 30, 1998, and 50 percent
from October 1, 1998 through October 6, 1999, for service-
connected PTSD.

REPRESENTATION

Appellant represented by:	Disabled American Veterans

ATTORNEY FOR THE BOARD

Debbie A. Riffe, Counsel

INTRODUCTION

The veteran served on active duty from December 1965 to
December 1969.  This case comes to the Board of Veterans'
Appeals (Board) from a January 1992 RO decision which denied
service connection for heart disease, and which granted
service connection and a 10 percent rating for PTSD effective
from September 9, 1991.  The Board remanded the case in
November 1997.

In a November 1998 decision, the RO assigned ratings of 30
percent effective April 16, 1998 and 50 percent effective
October 1, 1998, for the service-connected PTSD.  In a July
1999 decision, the RO assigned a 30 percent rating for PTSD
effective November 7, 1997.  In a March 2000 decision, the RO
assigned a 100 percent rating for PTSD, effective October 7,
1999.  The veteran continues his appeal for higher ratings
for PTSD prior to October 7, 1999.  See Fenderson v. West, 12
Vet.App. 119 (1999).  He also continues to appeal for service
connection for heart disease on a direct basis or as
secondary to service-connected PTSD.

REMAND

This case was previously remanded to the RO in November 1997
in order to afford the veteran a personal hearing at the RO
before a member of the Board (i.e., Travel Board hearing).
The veteran was scheduled to appear at an April 1998 Travel
Board hearing; however, in March 1998 the RO canceled the
scheduled hearing so that additional development of the
claims could be accomplished, in particular VA examinations.
After the RO granted part of his PTSD claim in a November
1998 decision, the veteran stated that he wished to continue
both of his appeals but that he did not wish to be scheduled
for another Travel Board hearing.  However, in his latest
communication (on a VA Form 9) in February 1999, the veteran
indicated that he still desired a Travel Board hearing.  In a
May 2000 statement, the veteran's representative requested
that the file be remanded to the RO so that the veteran could
be afforded his hearing.  38 U.S.C.A. � 7107 (West 1991 &
Supp. 1999); 38 C.F.R. �� 19.75, 19.76, 20.703, 20.704
(1999).  Thus, the veteran's case is remanded for the
following action:

The RO should schedule the veteran for a
Travel Board hearing.  After the hearing
is conducted, the case should be returned
to the Board, in accordance with
appellate procedures.

	L. W. TOBIN
	Member, Board of Veterans' Appeals

Under 38 U.S.C.A. � 7252 (West 1991 & Supp. 1999), only a
decision of the Board of Veterans' Appeals is appealable to
the United States Court of Appeals for Veterans Claims.  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) (1999).