BVA9500213 
DOCKET NO.  93-01 520     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office and Insurance
Center in Philadelphia, Pennsylvania

THE ISSUES

1.  Entitlement to an increased disability rating for post-
traumatic stress disorder, currently rated as 50 percent
disabling.

2.  Entitlement to an increased disability rating for residuals
gunshot wound, left leg, currently rated as 10 percent disabling.

3.  Entitlement to an increased disability rating for residuals
shell fragment wound, right thigh, currently rated as 10 percent
disabling.

4.  Entitlement to an increased (compensable) disability rating
for residuals shell fragment wound, right hand.

REPRESENTATION

Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

K. Keyes, Associate Counsel

INTRODUCTION

The veteran served on active duty from May 1967 to May 1970.

This matter comes before the Board of Veterans' Appeals (Board)
from June 1990 and November 1991 rating decisions of the
Department of Veterans Affairs (VA) Regional Office (RO) and
Insurance Center in Philadelphia, Pennsylvania.  The June 1990
rating decision confirmed and continued a 30 percent disability
rating for post-traumatic stress disorder (PTSD); a 10 percent
disability rating for residuals gunshot wound, left leg; a 10
percent disability rating for residuals shell fragment wound,
right thigh; and a noncompensable disability rating for residuals
shell fragment wound, right hand.  The November 1991 rating
decision granted an increased rating to 50 percent for PTSD.

In a January 1993 statement of the veteran's representative,
reconsideration of a February 1991 Board decision on the issue of
individual unemployability is requested.  With regard to this
statement, the Board notes that, if a veteran seeks
"reconsideration", in the sense that that term is used in 38
C.F.R. § 20.1000 (1993), of a prior Board decision, a motion for
reconsideration must be filed according to the requirements set
forth in 38 C.F.R. § 20.1001(a), (b) (1993).  However, if the
representative was using the term "reconsideration" in a more
general sense in an attempt to tack the issue of individual
unemployability on to the issues presently before the Board on
appeal, the Board observes that this issue has not been
reasonably raised, either expressly or through a liberal reading
of the documents presently before the Board, since the prior
Board decision in February 1991, and the issue was not
adjudicated by the RO or developed for appellate consideration by
the Board.  Therefore, the Board refers the issue to the RO for
action deemed appropriate and proceeds with its review of the
issues presently on appeal.  See Holland v. Brown, 6 Vet.App.
443, 446 (1994) (it is not inappropriate for the Board to decide
a claim for an increased disability rating based on the criteria
in the Schedule for Rating Disabilities (38 C.F.R., Part 4) while
referring the question of entitlement to a total rating based on
individual unemployability to the RO because the inquiries
undertaken to determine entitlement to benefits in each instance,
while complementing each other, involve different
considerations); see also Bernard v. Brown, 4 Vet.App. 384, 391-
94 (1993) (not inappropriate for Board to remand case to RO for
further development of issues that have not previously been
considered).

CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends that the RO committed error in denying his
claims for increased disability ratings for his service-connected
PTSD, currently rated as 50 percent disabling; for residuals
gunshot wound, left leg, currently rated as 10 percent disabling;
for residuals shell fragment wound, right thigh, currently rated
as 10 percent disabling; and for residuals, shell fragment wound,
right hand, currently assigned a noncompensable rating.
Specifically, he testified at a personal hearing that he
experiences numbness and constant pain in his right hand; that
his right leg cramps, swells, turns red and hot, that his right
knee gives way on occasion, that pain radiates up from his right
knee to his right thigh, and that he experiences numbness in his
right foot; that he experiences numbness in his left foot on
occasion; and that he has frequent nightmares and intrusive
thoughts of Vietnam a couple of times a day.

DECISION OF THE BOARD

The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991), has reviewed and considered all of the
evidence and material of record in the veteran's claims file.
Based on its review of the relevant evidence in this matter, and
for the following reasons and bases, it is the decision of the
Board that, in resolving reasonable doubt in favor of the
veteran, the evidence warrants entitlement to the next higher or
70 percent rating for PTSD.  It is also the decision of the Board
that the preponderance of the evidence is against the claims for
increased disability ratings for residuals of a gunshot wound,
left leg; residuals of a shell fragment wound, right thigh; and
residuals of a shell fragment wound, right hand.

FINDINGS OF FACT

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

2.  PTSD is manifested objectively by a blunted affect, slow
speech, poor eye contact, many somatic concerns and complaints,
minimal insight, mild to moderate anxiety, and mild depression,
and subjectively by recurrent and intrusive distressing
recollections about Vietnam, nightmares, feelings of detachment,
and hypervigilance.

3.  Residuals of a gunshot wound, left leg, are manifested by the
presence, shown by x-ray, of a single rectangular piece of
shrapnel about ½ centimeter in size lying between the tibia and
fibula at about the midportion of the leg.

4.  Residuals of a shell fragment wound, right leg, are
manifested by a small circular scar about 0.5 centimeter in
diameter on the inner side of the right lower thigh, just above
the knee; there is no scar of exit; and the small entrance scar
has no adherence to the underlying tissues and does not affect
muscles, nerves, or blood vessels.  X-rays reveal a rounded piece
of metal, about 0.5 centimeter in size, in the soft tissue
posteriorly behind the distal right femoral shaft.

5.  Residuals of a shell fragment wound, right hand, are
manifested by small scars on the dorsum of two fingers of the
right hand.

6.  The symptoms of the veteran's service-connected PTSD are of
such severity and persistence as to result in severe impairment
in the ability to obtain or retain employment.

CONCLUSIONS OF LAW

1.  The criteria for a disability rating of 70 percent, and not
in excess thereof, for PTSD have been met.  38 U.S.C.A. § 1155,
5107(b) (West 1991); 38 C.F.R. §§ 3.102, 4.7, 4.130, 4.132,
Diagnostic Code 9411 (1993).

2.  The criteria for a disability rating in excess of 10 percent
for residuals gunshot wound, left leg, have not been met.  38
U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.56, 4.73, Diagnostic
Code 5311 (1993).

3.  The criteria for a disability rating in excess of 10 percent
for residuals shell fragment wound, right thigh, have not been
met.  38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.56, 4.73,
Diagnostic Code 5314 (1993).

4.  The criteria for an increased (compensable) disability rating
for residuals shell fragment wound, right hand, have not been
met.  38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.31, 4.71a,
4.73, Diagnostic Codes 5309, 5220-5223 (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The veteran's claims are well-grounded within the meaning of
38 U.S.C.A. § 5107(a) (West 1991).  He has presented claims which
are plausible.  All relevant facts have been properly developed.
No further assistance to the veteran is required to comply with
the duty to assist mandated by 38 U.S.C.A. § 5107(a) (West 1991).

I.  Post-Traumatic Stress Disorder.

The veteran is currently assigned a 50 percent disability
evaluation for his service-connected PTSD.  A 50 percent rating
is assigned when the evidence shows that the ability to establish
or maintain effective or favorable relationships with people is
considerably impaired, and, by reason of psychoneurotic symptoms,
the reliability, flexibility and efficiency levels are so reduced
as to result in considerable industrial impairment.  38 C.F.R.
Part 4, Code 9411 (1993).  The next higher or 70 percent
disability evaluation is warranted when the evidence shows that
the ability to establish and maintain effective or favorable
relationships with people is severely impaired, and the
psychoneurotic symptoms are of such severity and persistence that
there is severe impairment in the ability to obtain or retain
employment.  A 100 percent or total disability rating
contemplates that the attitudes of all contacts except the most
intimate are so adversely affected as to result in virtual
isolation in the community and includes totally incapacitating
psychoneurotic symptoms bordering on gross repudiation of reality
with disturbed thought or behavioral processes associated with
almost all daily activities such as fantasy, confusion, panic and
explosions of aggressive energy resulting in profound retreat
from mature behavior.  The totally disabled person is
demonstrably unable to obtain or retain employment.

A May 7, 1991, VA psychiatric examination, upon which the RO
relied at least in part in increasing the veteran's disability
evaluation to 50 percent, showed the veteran to be conscious,
alert, and oriented to all three spheres without gross memory
impairment.  His affect was blunted.  He had no loosening of
associations.  He complained of auditory hallucinations and of
the feeling that people were talking about him.  He was
moderately depressed, but not suicidal or homicidal.  He had fair
insight into his problem, and his judgment was not grossly
impaired.  The veteran continued to have persistent and intrusive
distressing recollections of events in Vietnam and distressing
dreams that interrupted his sleep.  The examiner noted that the
veteran had severe social as well as industrial impairment.

In March 1992, the veteran was afforded another VA psychiatric
examination.  His affect was blunted, his speech slow, and he
spoke in short sentences.  He maintained poor eye contact and did
not volunteer much information about himself.  He expressed many
somatic concerns and had many somatic complaints.  He walked with
difficulty.  The examiner rated the veteran "45" on the day of
the examination and "45" for the past year on the Global
Assessment of Functioning (GAF) Scale.  A rating of "45" on this
scale is midway between a rating of "50" for "[s]erious symptoms
(e.g., suicidal ideation, severe obsessional rituals, frequent
shoplifting) or any serious impairment in social, occupational,
or school functioning (e.g., few friends, conflicts with peers or
co-workers)" and a rating of "40" for "[s]ome impairment in
reality testing or communication (e.g., speech is at times
illogical, obscure, or irrelevant) or major impairment in several
areas, such as work or school, family relations, judgment,
thinking, or mood (e.g., depressed man avoids friends, neglects
family, and is unable to work; child frequently beats up younger
children, is defiant at home, and is failing at school)".  Quick
Reference to the Diagnostic Criteria from DSM-IV 46-47 (1994).
The examiner diagnosed PTSD of moderate severity.

Although the more recent examination, which characterized the
veteran's PTSD as "moderately severe," may suggest a slight
improvement in his condition when compared to the earlier
examination, which noted "severe" social and industrial
impairment, the regulations caution against relying solely on
classifications of diseases by examiners as "mild," "moderate,"
or "severe" in determining the degree of disability and recommend
instead consideration of "the report and the analysis of the
symptomatology and the full consideration of the whole history"
of the disorder.  38 C.F.R. § 4.130 (1993).  In this regard, the
Board notes that the veteran is regularly examined at a VA
outpatient mental hygiene clinic, and numerous outpatient
treatment records of these visits are in the claims file.
Progress notes from mental status examinations over the years
have consistently described the veteran's social and industrial
impairment (on a scale which contemplates mild, moderate, severe,
and profound impairment) as "severe" or "profound" or
"severe-profound."  In addition, the medical progress notes
reflect a constant theme of encouraging the veteran "to socialize
more" and to develop a hobby or interest or pursue an activity.
The veteran apparently has very few friends, although he
sometimes fishes with a cousin and occasionally sees his brother
and sister, and he has frequently reported "being uncomfortable .
. . around people since Vietnam."

In weighing the evidence showing the persistence over the years
of the impairment in the ability to establish and maintain
effective or favorable relationships with people; the frequent
classifications by examiners of a "severe" level of social and
industrial impairment; and the consistent findings of minimal
insight, flat or blunted affect, moderate anxiety, and mild to
moderate depression against the evidence reflecting consistent
findings of normal orientation, memory, consciousness,
appearance, associations, judgment; the lack of hallucinations,
delusions, homicidal or suicidal ideations; and an alcohol
dependence problem which may or may not be related to the
veteran's PTSD, the Board finds the evidence in this case to be
in equipoise as to whether the degree of disability more nearly
approximates considerable social and industrial impairment or
severe impairment in the ability to obtain or retain employment.
Accordingly, the Board resolves the benefit of the doubt in favor
of the veteran.  38 U.S.C.A. § 5107(b) (West 1991); 38 C.F.R.
§§ 3.102, 4.7, 4.132, Diagnostic Code 9411 (1993).

II.  Residuals, Gunshot Wound, Left Leg.

Residuals of a gunshot wound to the left leg are currently rated
as 10 percent disabling.  The 10 percent rating contemplates
moderate impairment to Muscle Group XI of the Schedule for Rating
Disabilities.  Muscle group XI pertains to posterior and lateral
crural muscles, or calf muscles, specifically the triceps surae
(gastrocnemius and soleus) which control propulsion and plantar
flexion of the foot; the tibialis posterior and peroneus longus
which affect the stabilizing arch; the flexor hallucis longus and
the flexor digitorum longus which control flexion of toes; and
the popliteus which controls flexion of the knee.  Slight
impairment to this muscle group is assigned a noncompensable
disability evaluation.  To warrant the 20 percent rating, the
evidence must demonstrate moderately severe impairment to this
muscle group; and the highest or 30 percent schedular rating
contemplates severe impairment.  38 C.F.R. § 4.73, Diagnostic
Code 5311 (1993).

Unlike the claims for his other shrapnel injuries, the veteran
did not claim service-connection for the injury to his left leg
until 1988 when he reported for a VA examination with a copy of a
page from his service medical records showing that in March 1968
he had sustained a penetrating shrapnel wound to his lower left
leg.  His separation examination report notes shrapnel wounds to
right hand and both legs, and the examiner noted no serious
residual difficulty regarding these wounds.  On his original
application for VA compensation or pension in June 1970, the
veteran claimed shrapnel injuries to the right hand and right leg
only.

Upon examination in 1988, the veteran reported that the injury to
the left leg had been to the midportion of the front of the leg.
The veteran was unable to show the examiner a scar, and the
examiner was unable to find one.  However, an x-ray of the left
lower leg revealed the presence of a single rectangular piece of
shrapnel about a ½ centimeter in size lying between the tibia and
fibula at about the midportion of the leg.  In light of this
evidence, the RO granted service connection for a shell fragment
wound (the wound was later characterized on a rating decision
document as a "gunshot" wound) and assigned a 10 percent rating.
As noted above, the 10 percent rating contemplates a moderate
degree of impairment to the muscles of the calf.

Upon VA examination in May 1991, the examiner observed a scar on
the left anterior leg, but, consistent with a more recent
examination of the veteran's scars, muscles, and peripheral
nerves conducted in March 1992, no impairment to muscle or nerve
function of the left leg was noted.  Upon examination in March
1992, no scar was noted.  Although the veteran testified in
February 1992 that he occasionally experiences numbness of his
left foot, no complaints or findings of impairment to the muscles
or nerves of the left leg have been noted upon examinations over
the years or upon VA clinical progress notes.

The regulations provide much guidance in evaluating the various
degrees of impairment that may result from the effects of
missiles, including impairment involving scars, deeper
structures, muscle injuries, muscle weakness, muscle damage,
muscle patterns, and muscle groups.  38 C.F.R. §§ 4.47, 4.48,
4.49, 4.50, 4.51, 4.52, 4.53, 4.54, 4.55, 4.56 (1993).  For
example, in addition to the designation of degrees of impairment
to muscle groups as "slight," "moderate," etc., the regulations
set forth specific factors, such as the type of injury, history
and complaint, and objective findings, to be considered in the
evaluation of disabilities residual to healed wounds involving
muscle groups due to gunshot or other trauma.  38 C.F.R. § 4.56
(1993).

In this regard, the type of injury envisioned by the regulations
as causing "slight" (insignificant) disability of muscles is a
simple wound of muscle without debridement, infection or effects
of laceration.  The history and complaint includes service
department records of a wound of slight severity or relatively
brief treatment and return to duty; healing with good functional
results; and no consistent complaint of cardinal symptoms of
muscle injury or painful residuals.  (Cardinal or principal
symptoms include weakness, undue fatigue-pain, and uncertainty or
incoordination of movement.  38 C.F.R. § 4.50 (1993)).  Objective
findings of slight disability include minimum scar; slight, if
any, evidence of fascial defect or of atrophy or of impaired
tonus; no significant impairment of function and no retained
metallic fragments.  38 C.F.R. § 4.56(a) (1993).

In contrast, the type of injury noted by the regulation as
causing "moderate" disability of muscles includes a through and
through or deep penetrating wound of relatively short track by a
single bullet or small shell or shrapnel fragment.  History and
complaint includes evidence of hospitalization for treatment of
the wound, and objective findings include signs of moderate loss
of deep fascia or muscle substance or impairment of muscle tonus,
and of definite weakness or fatigue in comparative tests.  38
C.F.R § 4.56(b) (1993).

The Board notes that the description in the medical reports of
the residual effects of the wound that the veteran sustained to
his left leg is consistent in every way with the description in
the regulations of a slight or insignificant disability of
muscles except that the veteran did retain a metal fragment in
his left leg.  Therefore, his disability has been rated as 10
percent disabling, the rating for a moderate degree of
impairment.  38 C.F.R. §§ 4.56(b), 4.73, Diagnostic Code 5311
(1993).  The degree of impairment contemplated by the regulations
for a "moderately severe" disability of muscles is a far greater
degree of impairment than any of the complaints or findings shown
by the evidence in the claims file regarding the residuals of the
veteran's left leg wound.  For example, the type of injury
envisioned is a through and through or deep penetrating wound by
a small high velocity or a large low velocity missile with
debridement or prolonged infection or with sloughing of soft
parts and intermuscular cicatrization.  The history and complaint
must show a prolonged period of hospitalization for treatment of
a wound of severe grade, and objective findings include marked or
moderately severe loss of muscle strength and endurance.  38
C.F.R. § 4.56(c) (1993).  Accordingly, the Board concludes that
the occasional numbness of the left foot described by the veteran
is adequately compensated by the current rating, and that his
disability does not involve the degree of impairment which would
approximate the "moderately severe" impairment required for the
next higher rating of 20 percent.  38 C.F.R. §§ 4.7, 4.73,
Diagnostic Code 5311 (1993).

III.  Residuals, Shell Fragment Wound, Right Thigh.

Residuals of a shell fragment wound to the right thigh are
currently rated as 10 percent disabling.  The 10 percent rating
contemplates moderate impairment to Muscle Group XIV of the
Schedule for Rating Disabilities.  Muscle group XIV pertains to
the muscles of the anterior thigh, specifically the sartorius
which controls simultaneous flexion of the hip and flexion of the
knee and acts with the hamstrings in synchronizing movements of
the hip and knee; the rectus femoris which affects extension of
the knee and acts with the hamstrings in synchronizing movements
of the hip and knee; the vastus externus, vastus intermedius, and
vastus internus which affect extension of the knee; and the
tensor vaginae femoris which affects tension of the fascia lata
and iliotibial (Maissiat's) band and acts with the gluteus
maximus in postural support of the body.  Slight impairment to
this muscle group is assigned a noncompensable disability
evaluation.  To warrant the 30 percent rating, the evidence must
demonstrate moderately severe impairment to this muscle group;
and the highest or 40 percent schedular rating contemplates
severe impairment.  38 C.F.R. § 4.73, Diagnostic Code 5314
(1993).

The veteran's service medical records show that he sustained a
shell fragment wound to the right side of the knee or the medial
lower right thigh in February 1968.  X-rays taken in March 1968
revealed a small foreign body alongside the distal femur.  Upon
examination in April 1968, the examiner noted that the fragment
was deep in soft tissue and was not removed.  The examiner also
noted that the fragment wound was well healed with minimal
induration and that removal of the fragment was not indicated.
Upon separation, the examiner noted no serious residual
difficulty with any of the veteran's shrapnel wounds.  Upon VA
examination shortly after separation in July 1970, the examiner
noted a 3/8 inch circular entry wound scar over the medial aspect
of the right distal femur.  There was no exit or surgical scar,
no muscle loss or atrophy, and the veteran had full range of
motion of the right knee.

Upon the most recent VA examination conducted in March 1992 of
the veteran's scars, muscles, and peripheral nerves, the examiner
noted a one inch scar over the medial aspect of the right
mid-thigh from a shell fragment wound.  Examination of the
muscles revealed no erythema or deformities.  There was full
range of motion of all peripheral joints with the hip being
flexed 125 degrees bilaterally and extended 125 degrees
bilaterally.  The knee was flexed and extended 140 degrees
bilaterally.  Abduction of the hip was 45 degrees bilaterally.
Examination for scars noted no abnormalities pertaining to the
shell fragment wound of the right thigh other than the one inch
scar, and the examination of the peripheral nerves resulted in
normal findings with no abnormalities in sensory or motor
function, no effusions or erythemas, and full range of motion in
all peripheral joints.

The Board notes that the findings on the March 1992 examination
are consistent with previous examination findings over the years.
For example, in September 1988, a VA examiner noted that the
veteran's legs were equal in length and equal in circumference at
the thighs and calves, showing no muscle atrophy.  There was full
range of motion in the hips, knees, and ankles.  The patellar and
Achilles tendon reflexes were active and equal.  Pedal pulses
were normal.  There was normal dorsiflexion and power of the toes
and a negative Babinski's sign.  (Babinski's sign reveals loss or
lessening of the Achilles tendon reflex in sciatica which
distinguishes it from hysteric sciatica.  Dorland's Illustrated
Medical Dictionary 1520 (27th ed. 1988) ("Dorland's")).  The
veteran reported no sensory losses in his legs.  A search for
scars showed only a small circular scar about 0.5 centimeter in
diameter on the inner side of the right lower thigh, just above
the knee.  There was no scar of exit, and this small scar had no
adherence to the underlying  tissues and did not affect muscles,
nerves, or blood vessels.  Similarly, upon VA examination in
January 1990, an examiner reported that the scars from the
shrapnel wounds were minimal, mostly small puncture scars that
were hardly visible and which did not interfere with the
underlying function of the legs and did not involve the muscles,
nerves, or blood vessels.

In comparing the consistent findings of examiners over the years
regarding the degree of impairment resulting from the shell
fragment wound to the right thigh with the description in the
regulations of the factors to be considered in evaluating the
degree of impairment resulting from such healed wounds, the Board
concludes that the impairment described by the veteran is
adequately compensated by the current rating, and that his
disability does not involve the degree of impairment which would
approximate the "moderately severe" impairment required for the
next higher rating of 30 percent.  38 C.F.R. §§ 4.7, 4.56, 4.73,
Diagnostic Code 5314 (1993).

IV.  Residuals, Shell Fragment Wound, Right Hand.

Residuals of a shell fragment wound to the right hand are
currently assigned a noncompensable disability rating under
Diagnostic Code 5309 in the Schedule for Rating Disabilities.
That code is used to rate impairment to Group IX, the intrinsic
muscles of the hand, including thenar eminence; short flexor,
opponens, abductor and adductor of thumb; hypothenar eminence;
short flexor opponens and abductor of little finger, 4
lumbricales; 4 dorsal and 3 palmar interossei.  A note about
function states that in general the forearm muscles act in strong
grasping movements and are supplemented by the intrinsic muscles
in delicate manipulative movements.  Instead of a rating scale
providing percentages of disability, there is another note under
this code which states, "The hand is so compact a structure that
isolated muscle injuries are rare, being nearly always
complicated with injuries of bones, joints, tendons, etc.  Rate
on limitation of motion, minimum 10 percent."

The Schedule for Rating Disabilities provides a system for rating
the severity of ankylosis and limitation of motion of single
digits and combinations digits.  38 C.F.R. § 4.71a, Diagnostic
Codes 5216 to 5223 (1993).  Ankylosis is immobility and
consolidation of a joint due to disease, injury, or surgical
procedure.  Dorland's at 91.  Diagnostic Codes 5216 through 5219
are used to rate unfavorable ankylosis of the fingers which is
ankylosis or limited motion that prevents flexion of the tips of
the fingers to within 2 inches of the median transverse told of
the palm.  38 C.F.R. § 4.71a, Diagnostic Codes 5216-5219, Note
(b) (1993).  Diagnostic Codes 5220 through 5223 are used to rate
favorable ankylosis of the fingers which is ankylosis or limited
motion that permits flexion of the tips to within 2 inches of the
transverse fold of the palm.  Limitation of motion of less than 1
inch in either direction is not considered disabling.  38 C.F.R.
§ 4.71a, Diagnostic Codes 5220-5223, Note (a) (1993).

The veteran's service medical records reflect that he sustained a
shell fragment wound to the right hand in October 1968.  A
treatment note states, "Dressing, cleaned and suture finger."
His separation examination report noted no serious residual
difficulty with any of his shrapnel wounds.  Upon VA examination
in July 1970, the examiner noted a laceration measuring 1½ inch
on the dorsum of his fourth finger of his right hand over the
proximal phalanx.  Another laceration was noted over the dorsum
of the proximal phalanx of the third digit.  The examiner noted
that there was no muscle loss or nerve damage.

During VA examination in March 1992, the veteran reported that he
had problems with manipulation of both hands and sustained
movements.  For example, holding an object for a long period of
time precipitated pain in both hands, the right more so than the
left.  Upon examination, the examiner observed normal grip and
function of the hands.  Dorsiflexion was 75 degrees bilaterally,
plantar flexion 80 degrees bilaterally, ulnar deviation 45
degrees bilaterally, and radial deviation 20 degrees bilaterally.
The examiner observed one inch scars of the dorsal aspect of the
third and fourth fingers of the right hand; no other
abnormalities were noted.  Examination of the peripheral nerves
was normal.  There were no abnormalities in sensory or motor
function.  There were no effusions or erythemas, no atrophy, and
good function in the upper extremities.

The March 1992 examination is consistent with findings on earlier
examinations.  For example, in January 1990, a VA examiner noted
two small linear scars in the right hand involving the long and
ring fingers.  The examiner also noted that there was no
interference with underlying function and no involvement of the
muscles, nerves, or blood vessels.  The examiner observed that
the veteran had good circulation in his hands, that they were
warm and had excellent pulses.  There were no signs of arthritis
in the joints of his arms or hands, no heat, no redness, no
swelling, no deformities, and no limitation of motion in the
joints.  There was no atrophy in the long muscles of the arms or
the small muscles of the hands.  Similarly, upon VA examination
in September 1988, the examiner noted very fine, barely visible
scars on the backs of the bases of the adjacent areas of index
and long fingers where lacerations had occurred.  The scars did
not interfere with the excursion of the underlying soft tissues,
including the tendons, and there was no evidence of neurovascular
damage in the hand.  The veteran was able to fully open and close
his hand.

The regulatory note under Diagnostic Code 5309 states that
disabilities of the hand shall be rated "on limitation of motion,
minimum 10 percent."  In addition, the Schedule for Rating
Disabilities does not set forth a noncompensable evaluation in
the section for rating ankylosis of the fingers.  However, a note
under this section does provide that "[l]imitation of motion of
less than 1 inch in either direction is not considered
disabling."  38 C.F.R. § 4.71a, Diagnostic Codes 5220-5223, Note
(a) (1993).  In addition, the regulations specifically provide
that "[i]n every instance where the schedule does not provide a
zero percent evaluation for a diagnostic code, a zero percent
evaluation shall be assigned when the requirements for a
compensable evaluation are not met."  38 C.F.R. § 4.31 (1993).
In accordance with these regulations, the Board observes that a
minimum requirement of limitation of motion of finger of more
than 1 inch is required to warrant compensation.  Because the
evidence shows that the veteran suffers no limitation of motion
or other abnormality with regard to his right hand, the RO
properly assigned a noncompensable rating for the residuals of
the shell fragment wound of the right hand.  The Board concludes
from the medical evidence in the claims file regarding the
veteran's right hand that his disability does not involve the
degree of impairment required for a compensable rating.  38
C.F.R. §§ 4.31, 4.71a, 4.73, Diagnostic Code 5309 (1993).

ORDER

A 70 percent rating for PTSD is granted, subject to the laws and
regulations governing the payment of monetary awards.

An increased schedular rating for residuals gunshot wound, left
leg, is denied.

An increased schedular rating for residuals shell fragment wound,
right thigh, is denied.

An increased (compensable) schedular rating for residuals shell
fragment wound, right hand, is denied.

          JAN DONSBACH
          Member, Board of Veterans' Appeals

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

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