BVA9505884 
DOCKET NO.  90-26 344     )       DATE
          )
          )

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

THE ISSUES

1.  Entitlement to an increased evaluation for the residuals of a
gunshot wound to the left leg, currently evaluated as 30 percent
disabling.

2.  Entitlement to special monthly compensation under the
provisions of 38 U.S.C.A. § 1114(k) (West 1991), on account of
the loss of the use of the left foot.

3.  Entitlement to special monthly compensation for a dependent
spouse based on the need for regular aid and attendance of
another person.

ATTORNEY FOR THE BOARD

John J. Crowley, Associate Counsel

INTRODUCTION

The veteran had recognized guerrilla service from February 1945
to November 1945 and Regular Philippine Army service from
November 1945 to May 1946.

This matter is currently before the Board of Veterans' Appeals
(Board) on appeal from November 1989 and January 1994 rating
decisions of the Department of Veterans Affairs (VA) regional
office (RO).  In a December 1990 decision, the Board upheld the
RO's denial of the veteran's claim of entitlement to basic
eligibility for pension benefits and entitlement to an increased
evaluation for the residuals of a gunshot wound of the left leg.
The veteran filed a timely appeal to the United States Court of
Veterans Appeals (Court).  In May 1992, the General Counsel for
the Department of Veterans Affairs (General Counsel) filed a
motion for summary affirmance, for acceptance of this motion in
lieu of a brief, and for a stay of proceedings.  In March 1993,
the Court granted the General Counsel's motion with regard to the
veteran's claim for nonservice-connected pension benefits and the
Board's decision was affirmed.  As to the claim of entitlement to
increased evaluation for the residuals of a gunshot wound of the
left leg, the General Counsel's motion was denied by the Court
and the decision was remanded to the Board with instructions.
The Court indicated that the Board had not provided reasons or
bases for the Board's implicit rejection under 38 C.F.R. §§ 4.63
and 4.71(a), Diagnostic Code 5284 (1991), for special monthly
compensation and a 40% rating for loss of use of one foot as the
result of muscle damage.  Thus, the Court remanded the case to
the Board to provide this analysis.  Accordingly, the Board will
directly address the issue of entitlement to special monthly
compensation under the provisions of 38 U.S.C.A. § 1114(k) (West
1991), as a result of the loss of the use of the left foot.

In October 1993, the Board remanded the case to the RO for
additional development.  During this time, in October 1993, the
veteran filed a claim of entitlement to special monthly
compensation for his dependent spouse.  In a January 1994 rating
decision, the veteran's claim was denied.  A notice of
disagreement was filed by the veteran in March 1994, and a
statement of the case was issued in May 1994.  A substantive
appeal was received by the RO in July 1994.  Under EF v.
Derwinski, 1 Vet.App. 324, 326 (1991), the Board must review all
issues which are reasonably raised from a liberal reading of the
veteran's substantive appeal.  Accordingly, while the veteran's
July 1994 substantive appeal is not perfectly clear as to his
intent to appeal the issue of entitlement to special monthly
compensation for a dependent spouse to the Board, the Board will
interpret the July 1994 substantive appeal as such.  Accordingly,
the issue of entitlement to special monthly compensation for a
dependent spouse is currently before the Board.  The Board also
notes that in his July 1994 substantive appeal the veteran may be
seeking entitlement to a total disability evaluation based on
individual unemployability.  This issue has not been adjudicated
by the RO and is not inextricably intertwined with the issues now
in appellate status.  Parker v. Brown 7 Vet.App. 116 (1994).
Thus, it is not before the Board at this time.  It is referred to
the RO for appropriate action.

The veteran is unrepresented in his appeal.

CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends that his service-connected residuals of a
gunshot wound to the left leg are more disabling than reflected
by the currently assigned 30 percent evaluation.  The veteran
contends that this claim is supported by the medical evidence.
He also contends that he is entitled to an increased evaluation
based on the need for regular aid and attendance of his dependent
spouse.

DECISION OF THE BOARD

The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991), has reviewed and considered all of the
evidence and material of record in the veteran's claims file.
Based on its review of the relevant evidence in this matter, and
for the following reasons and bases, it is the decision of the
Board that the preponderance of the evidence is against the
veteran's claims for entitlement to an increased evaluation for
the residuals of a gunshot wound to the left leg, for entitlement
to special monthly compensation under the provisions of
38 U.S.C.A. § 1114(k) (West 1991), and for special monthly
compensation for a dependent spouse based on the need for aid and
attendance.

FINDINGS OF FACT

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

2.  The residuals of the veteran's gunshot wound to the left leg
include a scar at the anterolateral middle third of the left leg,
measuring 1 centimeter, found to be flat, nontender, and the
probable entry wound.  Another scar on the posterior aspect,
middle third, left leg, measuring 2 x 2 centimeters, found to be
nontender and the probable exit wound.  The residuals of the
gunshot wound to the left leg also includes a healed fracture of
the fibula and left ankle swelling with pain.  Strength of the
left leg is normal.  No neurologic deficit is found.

3.  The veteran has a service-connected disability which has been
rated as 30 percent disabling from January 1985.

4.  The veteran's spouse's disabilities currently consist of
bilateral immature cataracts with arteriosclerotic fundi; myopic
compound astigmatism; and hypertension, controlled.  Corrective
vision was 20/25 for both eyes.  Headaches and knee joint pain
have also been indicated.

5.  The veteran's spouse is not bedridden and can feed, dress and
bathe herself and can respond to the needs of nature unassisted;
she does not require the assistance of another person to
ambulate.

6.  The veteran's spouse does not have a single disability rated
or ratable at 100 percent and is not bedridden in fact.

CONCLUSIONS OF LAW

1.  The criteria for an evaluation in excess of 30 percent for
the residuals of a gunshot wound of the left leg have not been
met.  38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R.
§§ 3.321(d), 4.2, 4.3, 4.7, 4.10, 4.40, Part 4, Diagnostic
Codes 5284 and 5311 (1994).

2.  The criteria for loss of use of the left foot have not been
met.  38 U.S.C.A. § 1114(k) (West 1991); 38 C.F.R. § 4.63 (1994).

3.  Entitlement to additional compensation for a dependent spouse
based on the need for regular aid and attendance of another
person is not warranted.  38 U.S.C.A. §§ 1115, 5107 (West 1991);
38 C.F.R. §§ 3.351, 3.352(a) (1994).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

Initially, the undersigned finds the veteran's claims to be well
grounded within the meaning of 38 U.S.C.A. § 5107(a), in that his
allegations as to the severity of the residuals of his gunshot
wound, as well as his contentions regarding the severity of the
disabilities of his wife, are plausible.  In view of the evidence
of record, including the veteran's evidentiary assertions that
must be presumed to be true for the purposes of determining
whether his claims are well grounded, the Board finds that his
claims are plausible and thus well grounded within the meaning of
38 U.S.C.A. § 5107 (West 1991).  King v. Brown, 5 Vet.App. 19
(1993).

I.  Background

The veteran filed a claim for VA compensation in August 1950 for
a gunshot wound to the left tibia.  He indicated that he had been
wounded in action on April 24, 1945, at Mapala, Pingkian, Nueva
Vizcaya, during an enemy encounter.

At a March 1951 VA orthopedic examination, the examiner noted
that the veteran had sustained a through-and-through gunshot
wound of the left leg. There was a one centimeter diameter scar
on the lateral aspect of the middle third of the left leg
identified as the wound of entrance.  The scar was nonadherent or
painful.  There was a scar at the same level on the posterior
aspect identified as the exit wound which measured 2.5 by .5
centimeters and was depressed, adherent and non painful.  Slight
limitation of motion in dorsal flexion of the foot and slight
muscular atrophy of the leg were found.  There was hypothesia of
the left leg from the middle third level down the posterior
aspect.  The examiner identified the muscle injury as involving
muscle group XI.  X-rays were interpreted as showing an old
healed fracture of the mid-shaft of the left fibula.  The
fragments were in good alignment, with extensive bone reaction at
the site of the fracture.  The diagnosis was a residual gunshot
wound to the left leg with a healed fractured left fibula with
bone reaction at the site of the fracture, limitation of motion
of left foot, involvement of Muscle Group XI, and hypoesthesia.
The Board finds this examination report provides the most
authoritative description of the original injury in accordance
with the provisions of 38 C.F.R. §§ 4.41, 4.47, 4.48, 4.49, 4.50
(1994).

In an April 1951 rating decision, service connection for a
gunshot wound to the left leg with a fractured fibula and limited
ankle motion was granted and a 20 percent evaluation was awarded.
Since this determination, the veteran has undergone several
evaluations and examinations of his gunshot wound.  Although the
Board is directed to review the recorded history of a disability
in order to make a more accurate evaluation, the regulations do
not give past medical reports precedence over current findings.
Francisco v. Brown, 7 Vet.App. 55 (1994).  Accordingly, the
undersigned will specifically cite to the most recent and
pertinent medical examinations.

In August 1986, the Board, finding that the residuals of the
veteran's gunshot wound to the left leg included muscle loss,
calcific densities in the soft tissues, deformity of the fibula,
and complaints of pain and swelling, granted the veteran's claim
of an increased evaluation and increased the veteran's evaluation
for his gunshot wound from 20 percent to 30 percent disabling.
In September 1989, the veteran filed a claim for an increased
evaluation of his service-connected gunshot wound.  He submitted
a September 1989 statement from Gaspar B. Guiab, M.D., who
certified that he physically examined the veteran that month with
the following findings: (1)  A fractured left fibula, secondary
to gunshot, with limited ankle motion; (2) severe secondary pain;
(3) general body weakness; and (4) an inability to walk,
secondary to the left fibula fracture, except on crutches.

In March 1990, the veteran indicated a desire to seek additional
compensation for the medical assistance of his spouse.  He
submitted a statement from Roger R. Salviejo, M.D., dated in what
appears to be 1987, indicating that the veteran's spouse was
being treated for essential hypertension, status post "CVA,"
thrombosis, from 1984 to 1987.  In May 1990, the veteran's spouse
underwent an examination to determine her need for regular aid
and attendance.  The examiner stated that the veteran's spouse
was able to feed herself, bathe her upper extremities and had a
good grip.  It was also found that she was able to attend to the
needs of nature.  It was noted that the veteran's spouse went to
church every Sunday and was able to visit her neighbors 2 times a
week.  On physical examination, both lower extremities had good
propulsion and no atrophy.  She was able to walk one block
without the assistance of another person.  The diagnosed
conditions were essential hypertension and status post CVA,
probable thrombosis.  Eye examination revealed uncorrected vision
of 20/200 on both eyes corrected to 20/20.  The diagnosis was
myopic astigmatism, right eye and hyperopic compound astigmatism,
left eye.

In January 1991, Aurora T. Agustin, M.D., certified that the
veteran's spouse had been confined to the Magsaysay District
Hospital from November 1981 to December 1981 due to CVA, cerebral
embolism.

In February 1991, Asterlo A. Saquing, Jr., M.D., stated that the
veteran's spouse had been confined to his clinic in May, 1990,
due to hypertensive encephalopathy, stroke in resolution, with
signs of hemiparesis and blood pressure of 220/130.  Dr. Saquing
indicated that she underwent frequent checkups for hypertension.
In a February 1992, Dr. Salviego related that the veteran's
spouse was tested in July 1990, because of headaches, dizziness,
and hypertension.  Blood pressure was 190/110.  Dr. Salviego did
not reveal the results of testing other than the spouse's blood
pressure.

In an October 1993 statement from what appears to be Dr. Saquing,
the physician certifies that the veteran's spouse had been
confined at his clinic in May 1990, December 1992, and October
1993, for one day periods due to frequent attacks of
hypertension, transient ischemic attacks and hemiplegia.

In a November 1993 statement received by the RO in January 1994,
Cecilia J. Ranjo, the records officer of the Magsaysay District
Hospital, certified that the veteran's spouse had been
hospitalized in December 1981 due to a cerebral embolism.

Apparently based on the additional evidence, in December 1993 the
veteran's spouse underwent an additional VA examination to
determine whether or not she required aid and attendance of
another person.  It was noted that the veteran's spouse required
an attendant in reporting for this examination.  She was found,
however, to be well built and well nourished.  The veteran's
spouse was not hospitalized.  While her upper extremities were
found to be quite weak, the examiner concluded that she could
adequately perform activities of daily living.  Lower extremities
showed slight atrophy but with no weakness nor contractures.  She
was not limited to her house premises and claimed she could walk
for 2 to 3 blocks unassisted.  She was capable of attending
church once a week.  Eye examination revealed lens opacities,
bilateral, with arteriosclerotic changes of fundi.  Corrective
vision was 20/25 for both eyes.  Blood pressure was 150/80.  She
complained of headaches and knee joint pain.  No deformity of the
lumbar, thoracic or cervical spine was found.  The veteran's
spouse used a cane for ambulation.  She indicated that she was
able to leave her house or premises "not very often."  The
diagnosis was bilateral immature cataracts with arteriosclerotic
fundi; myopic compound astigmatism; and hypertension, controlled.
A photograph of the appellant's spouse was associated with the
examination report.

At a December 1993 VA peripheral nerve examination of the
veteran, the examiner found no neurologic deficit.  Neurological
examination showed upper extremities with no focal weakness, no
atrophy, no sensory deficit, and deep tendon reflexes were active
and equal.  The veteran's coordination was normal.  There was no
focal weakness in the lower extremities, no sensory deficit, and
deep tendon reflexes were active and equal.  The veteran did limp
on his left and walked with a single crutch.  There were no
findings of specific involvement of any major nerve, muscle
wasting or atrophy which may represent the direct effect of nerve
damage to the lower extremities.

At additional VA examinations performed in December 1993 and
January 1994, it was determined that the muscle penetrated by the
gunshot wound was Muscle Group XI.  No tissue loss was found.
There was a scar at the anterolateral middle third, left leg,
measuring 1 centimeter, flat, nontender, which was found to be
the probable entry wound.  There was another scar on the
posterior aspect, middle third, left leg, measuring
2 x 2 centimeters, which was depressed, nontender, and was noted
to be the probable exit wound.  There were no adhesions and no
damage to tendons.  A healed fracture of the left fibula was also
found.  The veteran complained of pain and swelling of the left
ankle and left knee.  Swelling in the left knee and left ankle,
with an infected wound on the suprapatellar area of the left
knee, was indicated.  There was no false motion or shortening of
the left leg.  Strength of the left leg was normal and there was
evidence of pain over the left knee and left ankle.  X-ray
studies of the left knee joint revealed hypertrophic osteophytes
on the articular edges of the femur, tibia and patella, and on
the tibial spines.  The joint space was asymmetric, slightly
narrow medially.  Similar changes were seen in the tibiofibular
joint.  The impression was hypertrophic arthritic changes in the
left knee which appeared more of the degenerative osteoarthritic
type.  X-ray studies of the veteran's left ankle revealed a
fairly well maintained joint except for minimal marginal lipping
in the distal tibial end.  The proximal joints of the foot as
seen in the lateral view appeared normal.  The X-ray examiner's
impression was minimal degenerative arthritis, left ankle.

The final diagnosis found a gunshot wound injury to Muscle
Group XI, left leg, with degenerative joint disease of left knee
and left ankle.  A fracture of the left fibula, midshaft, with
residuals of osteoarthritis and peritendinitis, was also found.

II.  Entitlement to an Increased Evaluation for the
Residuals of a Gunshot Wound to the left leg.

Disability evaluations are determined by the application of a
schedule of ratings which is based on average industrial
impairment.  38 U.S.C.A. § 1155; 38 C.F.R. § Part 4.  Separate
diagnostic codes identify the various disabilities.  In rating
disability from injuries of the musculoskeletal system, attention
is to be given first to the deeper structures injured, bones,
joints, and nerves.  A compound comminuted fracture, for example,
with muscle damage from a missile, establishes severe muscle
injury, and there may be additional disability from malunion of
the bone, ankylosis, etc.  A through-and-through injury, with
muscle damage, is always at least a moderate injury, for each
group of muscles damaged.  This section is to be taken as
establishing entitlement to a rating of severe grade when there
is a history of compound comminuted fracture and definite muscle
or tendon damage from the missile.  38 C.F.R. § 4.72 (1994).
Injury to the posterior and lateral crural muscles, Muscle
Group XI, if severe, warrants a 30 percent evaluation.
38 C.F.R., Part 4, Diagnostic Code 5311.  A severe foot injury
also warrants a 30 percent evaluation.  38 C.F.R. Part 4,
Diagnostic Code 5284.  With actual loss of use of the foot, the
schedule of ratings indicates that the veteran should be
evaluated as 40 percent disabling.  Id.

The statute allows entitlement to special monthly compensation
under the provisions of 38 U.S.C.A. § 1114(k) as a result of loss
of the use of a foot.  Loss of the use of a foot, for the
purposes of special monthly compensation or a 40 percent
evaluation under 38 C.F.R. § 5284 Part 4, Diagnostic Code 5284,
will be held to exist when no effective function remains other
than that which would be equally well served by an amputation
stump at the site of election below the knee or with the use of a
suitable prosthetic appliance.  The determination will be made on
the basis of the actual remaining function of the foot and
whether the acts of balance and propulsion, etc., in the case of
the foot, could be accomplished equally well by an amputation
stump with a prosthesis.  38 C.F.R. § 4.63.  Extremely
unfavorable complete ankylosis of the knee, or complete ankylosis
of two major points of an extremity, or shortening of the lower
extremity by 3 1/2 inches (8.9 centimeters) or more, will be
taken as loss of use the foot.  38 C.F.R. § 4.63(a).  Complete
paralysis of the external popliteal nerve (common peroneal) and
consequent footdrop, accompanied by characteristic organic
changes including trophic and circulatory disturbances and other
concomitants confirmatory of complete paralysis of this nerve,
will also be taken as the loss of use of the foot.  38 C.F.R.
§ 4.63(b).

In evaluating a service-connected disability, the Board has
considered the current examination reports in light of the whole
reported history to ensure that the current rating accurately
reflects the elements of the disability present.  38 C.F.R.
§ 4.29.  The Board also considers the ability of the veteran's
left leg to function under the ordinary conditions of daily life
and the undersigned recognizes that pain and weakness are
important elements of the functional impairment of the
musculoskeletal system.  38 C.F.R. §§ 4.10 and 4.40.

 The residuals of the veteran's gunshot wound to the left leg
includes a scar at the anterolateral middle third of the left
leg, measuring 1 centimeter, found to be flat, nontender, and the
probable entry wound.  Another scar on the posterior aspect,
middle third of the left leg, measuring 2 x 2 centimeters, found
to be depressed, nontender and the probable exit wound.  The
residuals of the gunshot wound to the left leg also includes a
healed fracture of the fibula and left ankle swelling with pain.
Strength of the left leg is normal.  No neurologic deficit is
found.  As noted by both the Court and the Board in its previous
determination of this claim, the veteran is in receipt of the
highest evaluation for a severe injury to Muscle Group XI, the
posterior and lateral crural muscles.  The veteran is also in
receipt of the highest evaluation for a severe foot injury under
38 C.F.R. Part 4, Diagnostic Code 5284.  In order for the veteran
to receive a 40 percent evaluation under 38 C.F.R. Part 4,
Diagnostic Code 5284, a finding of loss of use of the veteran's
left foot must be found.  This would also entitle the veteran to
special monthly compensation under 38 U.S.C.A. § 1114(k).  The
evidence, however, would support no such finding.  Recent VA
examinations have found no evidence of neurological difficulties
in the left leg.  In addition, strength of the left leg was
normal.  While the VA examiners have indicated that the veteran
walks with a limp, this would not be sufficient, for the purposes
of  38 C.F.R. § 4.63, to show that  the veteran would be equally
well served by an amputation stump.  The veteran is able to
propel and balance himself without the use of a prosthetic
appliance.

With regard to Dr. Guiab's statement that the veteran is unable
to walk without crutches secondary to the residuals of his
gunshot wound, as noted above, the criteria for loss of use is
whether active balance and propulsion could be accomplished
equally well by an amputation stump with prosthesis.  38 C.F.R.
§ 4.63.  The recent VA examinations would not support Dr. Guiab's
opinion that the veteran requires two crutches to ambulate.  With
regard to the weight the Board should place on Dr. Guiab's
opinion versus the weight it should place on the VA opinions, in
Guerrieri v. Brown, 4 Vet.App. 467 (1993), the Court held:

The probative value of medical opinion evidence is
based on the medical expert's personal examination of
the patient, the physician's knowledge and skill in
analyzing the data, and the medical conclusion that
the physician reaches. . . .  As is true with any
piece of evidence, the credibility and weight to be
attached to these opinions [are] within the province
of the [BVA as] adjudicators . . . .

Guerrieri at 470-71 (1993).

Based on a review of the relevant evidence in this matter, the
Board concludes that the current medical findings would not
support Dr. Guiab's opinion that the veteran requires two
crutches to ambulate.  The neurological examination of
December 1993, which was essentially normal, noted that the
veteran did limp on his left and walked with a single crutch.
The December 1993 orthopedic VA examination found no damage to
the tendon, no tissue loss, and normal strength.  While the
veteran complained of pain during his examinations, swelling in
the left ankle has been found, and it has been noted that the
veteran walks with a single crutch, these findings would not
support a determination that the veteran could move equally well
with an amputation stump and a prosthesis.  Moreover, shortening
of the lower extremity, ankylosis, paralysis, or circulatory
disturbance in the veteran's left leg has not been found.
Significantly, Dr. Guiab does not reveal the basis for his
opinion.  Accordingly, the Board finds that it must give greater
weight to the more recent VA opinions, which supply facts which
support their diagnoses, than to the opinion of Dr. Guiab, who
has not supplied the rationale for his findings.

The Board further notes that while the veteran has complaints of
left knee pain, he is not service connected for this condition.
As clearly revealed by the March 1951 VA examination, the
examination which was the basis for the award of service
connection by the RO in 1951, the gunshot wound to the left leg
was below the veteran's left knee.  No evidence at that time of a
left knee injury associated with the gunshot wound was found.
Accordingly, any disability the veteran may have with regard to
his left knee must, as much as is possible, be disassociated from
his current evaluation.  The March 1951 VA examination did note
limitation of motion of the left foot.  The examiner at this time
appears to associate the veteran's left foot disability to his
service connected gunshot wound.  Accordingly, the disability
evaluation must, and has, included the veteran's left foot,
including the left ankle.  While swelling of the left ankle was
found during the recent VA examination, there was no false motion
or shortening and no intra-articular involvement found.  The
undersigned finds that this disability is fully compensated by
the veteran's current evaluation, as the function of muscle group
XI is propulsion, plantar flexion of the foot, stabilizing the
arch, flexion of the toes and flexion of the knee.  38 C.F.R.
§ 4.73, Code 5311.

The undersigned has considered a separate evaluation for the
veteran's ankle disability under 38 C.F.R. Part 4, Diagnostic
Code 5271 (1994), for limitation of motion of the ankle.  The
evidence, however, would not support a finding of moderate
limitation of motion of the ankle.  The recent VA examinations,
as well as the statements of the veteran's private physicians,
reveal no limitation of motion in the ankle.  Recent X-ray
studies of the veteran's left ankle revealed a fairly
well-maintained joint except for minimal marginal lipping in the
distal tibial end.  A disability evaluation for limitation of
motion of the ankle below moderate would be noncompensable.  Id.
Further, implicit within the language of 38 U.S.C.A. § 1155, is
the concept that the rating schedule may not be employed as a
vehicle for compensating a claimant twice (or more) for the same
symptomatology; such that the result would overcompensate the
veteran for the actual impairment of his earning capacity.
Brady v. Brown, 4 Vet.App. 203, 206 (1993).

The undersigned has considered all other potential applicable
provisions of 38 C.F.R. Parts 3 and 4 (1994), whether or not they
have been raised by the veteran, as required by Schafrath v.
Derwinski, 1 Vet.App. 589 (1991).  The undersigned has found no
section that provides a basis upon which to assign a higher
disability evaluation for the reasons discussed herein.  Further,
the Board has given consideration to the provisions of 38 C.F.R.
§ 3.321(b)(1); however, the evidence fails to show that the
disability at issue is so exceptional or unusual as to warrant
the assignment of an extraschedular evaluation.  While the Board
would not dispute that the veteran has pain and limitation
associated with his service-connected gunshot wound, this
disability is contemplated by the award of the current evaluation
of 30 percent.  Of particular significance to the undersigned in
the determination of whether the veteran should receive an
extraschedular evaluation is the veteran's failure (after
numerous statements submitted to both the Board, the Court, and
the RO) to allude to any specific limitations in his abilities as
a result of his service-connected condition.  Review of the
veteran's numerous written statements reveals no complaints
concerning limitation of motion, medication used to treat pain,
limitations in his earning capacity as a result of his service-
connected disability, or any medical evidence of treatment (other
than evaluations for compensation purposes) for his left leg
condition over the last 50 years.  While the veteran did sustain
a fracture of the fibula as a result of the gunshot wound, the
30 percent evaluation fully contemplates this disability.  The
recent VA examinations would not support the assignment of an
extraschedular evaluation.

In light of the foregoing, the preponderance of evidence is
against the veteran's claim for an increased evaluation of his
service-connected gunshot wound to the left leg.  Consequently,
the benefit of doubt does not apply, as the applicable statute,
38 U.S.C.A. § 5107(b) expressly provides that the benefit of
doubt rule applies only when the evidence is in relative
equipoise.  Gilbert v. Derwinski, 1 Vet.App. 49, 53-56 (1990).
See also Hayes v. Brown, 5 Vet.App. 60, 69-70 (1993).

III.  Entitlement to Aid and Attendance for a Dependent
Spouse

Additional compensation is provided for a married veteran
receiving compensation at the 30 percent rate or greater whose
spouse is in need of regular aid and attendance.  38 U.S.C.A.
§ 1115(1)(e) and (2).  The law and regulations provide for
compensation purposes a person shall be considered to be in need
of regular aid and attendance if such person is: (1) a patient in
a nursing home on account of mental or physical incapacity, or
(2) helpless or blind, or so nearly helpless or blind as to need
the regular aid and attendance of another person.  38 C.F.R.
§ 3.351.

Determinations as to the need for aid and attendance must be
based on actual requirements of a person's personal assistance
from others.  The following will be accorded consideration in
determining the need for regular aid and attendance: an inability
of the claimant to dress or undress herself, or to keep herself
ordinarily clean and presentable; frequent need of adjustment of
any special prosthetic or orthopedic appliances which by reason
of a particular disability cannot be done without aid; an
inability of the claimant to feed herself through loss of
coordination of the upper extremities or through extreme
weakness; an inability to attend to the wants of nature; or
incapacity, physical or mental, which requires care or assistance
on a regular basis to protect the claimant from the hazards or
dangers incident to her daily environment.  38 C.F.R. § 3.352(a).

The December 1993 VA examination, the most recent evaluation of
the spouse's condition, found bilateral immature cataracts with
arteriosclerotic fundi; myopic compound astigmatism; and
hypertension, controlled.  The examining physician reported that
the veteran's spouse was able to walk without assistance of
another person for 2 to 3 blocks, to dress herself, and was able
to perform adequately the activities of daily living.  Moreover,
the May 1990 examination found that the spouse was able to feed
herself and attend to the needs of nature.

On the basis of a review of the entire medical evidence of
record, the Board finds that the veteran's spouse does not meet
the requirements for aid and attendance of another person.  The
recent examinations demonstrate clearly that the veteran's spouse
is not bedridden, is able to dress herself, feed herself, and
attend to her needs of nature.  Additionally, the spouse was not
shown to be unable to protect herself from the hazards of her
environment.  See 38 C.F.R. § 3.352(a).  Furthermore, it is
evident that the veteran's spouse is ambulatory with the
assistance of a cane.  While it is clear that she cannot ambulate
for long distances and suffers from occasional headaches, pains,
as well as several medical difficulties, she is not shown to meet
the criteria based on a need for regular aid and attendance of
another person.  The veteran's spouse's eyesight, while impaired,
would not meet the requirements enumerated under 38 C.F.R.
§ 3.351(c)(1), which requires that the claimant be blind or
nearly so blind as to have corrected visual acuity of 5/200 or
less, in both eyes, or concentric contraction of the visual field
to 5 degrees or less.  As noted by the VA examination of December
1993, the spouse's corrected vision was 20/25 for both eyes.  The
spouse does not have a single disability which the undersigned
could rate as 100 percent disabling nor is she bedridden in fact.
None of the statements of the spouse's physicians would support a
finding that she is in need for regular aid and attendance of
another person.  The spouse's very periodic and brief
hospitalizations would also not support this finding.

In light of the foregoing, the preponderance of evidence is
against the veteran's claim of entitlement to an increased
evaluation based on his spouse's need for regular aid and
attendance of another person.  Consequently, the benefit of doubt
does not apply

ORDER

Entitlement to an increased evaluation for the residuals of a
gunshot wound to the left leg is denied.

Entitlement to special monthly compensation under the provisions
of 38 U.S.C.A. § 1114(k) on account of loss of use of the left
foot is denied.

Entitlement to aid and attendance benefits for a dependent spouse
is denied.

          RICHARD B. FRANK
          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.