BVA9503098 DOCKET NO. 94-02 961 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Seattle, Washington THE ISSUES 1. Entitlement to an increased evaluation for residuals of a gunshot wound to the left forearm (Muscle Group VII) with ulnar neuropathy, currently rated as 30 percent disabling. 2. Entitlement to an increased (compensable) evaluation for residuals of a gunshot wound to the left thigh (Muscle Group XIII). 3. Entitlement to an increased evaluation for post-traumatic stress disorder, rated as 30 percent disabling prior to February 1, 1994, and as 100 percent disabling from February 1, 1994. 4. Entitlement to a total rating for compensation purposes on the basis of individual unemployability, prior to February 1, 1994. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD T. Hal Smith, Counsel INTRODUCTION The veteran served on active duty from September 1951 to September 1954 and from December 1954 to December 1960. This appeal arises from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. The issue of entitlement to a total rating for compensation purposes based on individual unemployability was properly developed and certified for appeal. We note, however, that upon rating determination in July 1994, a total schedular evaluation for post-traumatic stress disorder (PTSD) was granted, effective from February 1, 1994. This determination renders the issue entitlement to a total rating based on individual unemployability moot as of February 1, 1994. It does not, however, render the issue of a total rating moot prior to that date. The Board's decision at this time is confined to the issues which have been fully developed for appellate review. These issues do not include the issue raised by the representative, entitlement to an earlier effective date for the assignment of a total disability rating. Instead, with specific reference to the PTSD and individual unemployability issues, the Board will consider the question of whether it is factually ascertainable that entitlement is demonstrated during the appeal period, but prior to February 1, 1994. CONTENTIONS OF APPELLANT ON APPEAL Essentially, it is asserted that increased evaluations are warranted for residuals of gunshot wounds to the left forearm and left thigh. The veteran reports cramping and numbness of the fourth and fifth digits of the left hand. He also reports some pain in the wrist with twisting motion. There is loss of sensory function in the left ulnar nerve. He states that walking is difficult. Additionally, it is argued that he is unable to maintain substantially gainful employment as a result of his service-connected disorders. 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 an increased evaluation for residuals of a gunshot wound to the left forearm with ulnar neuropathy. The preponderance of the evidence, however, is in favor of an increased evaluation of 10 percent for residuals of a gunshot wound to the left thigh. The preponderance of the evidence is also in favor of an increased evaluation of 70 percent for post-traumatic stress disorder (PTSD) prior to February 1, 1994 and a total rating for compensation purposes based on individual unemployability prior to February 1, 1994. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's claim has been developed. 2. Current manifestations of the left forearm disorder with ulnar neuropathy include complaints of persistent pain and paresthesia, cramping and numbness of the fourth and fifth digits of the left hand, decreased grip strength and some limitation of motion of the left arm and left wrist. 3. Current manifestations of the left thigh disorder include decreased range of motion and some weakness in the left hip, and result in moderate disability. 4. The PTSD caused severe social and industrial impairment prior to February 1, 1994. 5. The veteran has reported a sixth grade education and occupational experience as a truck driver; he last worked in 1990. 6. The veteran's service-connected disorders precluded employment prior to February 1, 1994. CONCLUSIONS OF LAW 1. The schedular requirements have not been met for a rating in excess of 30 percent for residuals of a gunshot wound to the left forearm with ulnar neuropathy. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.102, 3.321, 4.7 and Part 4, Diagnostic Codes 5307 and 8516 (1994). 2. The schedular requirements have been met for a rating of 10 percent for residuals of a gunshot wound to the left thigh. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.102, 3.321, 4.7 and Part 4, Diagnostic Code 5313 (1994). 3. The schedular requirements for a rating of 70 percent for PTSD prior to February 1, 1994, are met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321, 4.132, 4.7, Part 4, Diagnostic Code 9411 (1994). 4. The criteria for the assignment of a total rating based on individual unemployability due to service-connected disabilities prior to February 1, 1994, are met. 38 U.S.C.A. §§ 1155, 5107(b) (West 1991); 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim is well-grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991); that is, he has presented a claim which is plausible. Further, we are satisfied that all relevant facts have been properly developed. There is no indication that there are additional records which have not been obtained which would be pertinent to the veteran's claim. Thus, no further assistance is required to comply with the duty to assist as mandated by 38 U.S.C.A. § 5107(a). Godwin v. Derwinski, 1 Vet.App. 419 (1991); White v. Derwinski, 1 Vet.App. 519 (1991). Increased Evaluations Disability evaluations are based upon the average impairment of earning capacity as determined by a schedule for rating disabilities. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1993). Separate rating codes identify the various disabilities. 38 C.F.R. Part 4. In determining the current level of impairment, the disability must be considered in the context of the whole recorded history, including service medical records. 38 C.F.R. §§ 4.2, 4.41 (1993). An evaluation of the level of disability present also includes consideration of the functional impairment as it affects the veteran's ability to engage in ordinary activities, including employment, and the effect of pain on the functional abilities. 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59 (1993). An Increased Evaluation for Residuals of a Gunshot Wound to the Left Forearm with Ulnar Neuropathy It is contended that an increased evaluation is warranted for this disorder. A brief history of the events preceding this appeal is as follows: Service connection for residuals of a gunshot wound to the left forearm (minor extremity) was established by rating action in November 1963. A 10 percent evaluation was assigned, effective from July 25, 1963. This disability rating was increased to 20 percent, effective from November 23, 1965, upon rating determination in January 1966. This increase was amended to 30 percent upon rating determination in December 1967, and classification of the service-connected disorder was changed to reflect ulnar nerve damage. The 30 percent rating was confirmed and continued by the RO in March 1968 and by the Board in June 1968. This appeal ensued following rating determinations in April and May 1991 which also confirmed and continued the 30 percent rating. A temporary total rating was established for a brief period in 1991, but the disability rating was returned to 30 percent, and the veteran continues his appeal. He is right handed. The service medical records show that the veteran sustained a gunshot wound to the left arm in October 1952 when he was struck by small arms fire. The injury to the left forearm resulted in a comminuted compound fracture of the left ulna with ulnar nerve involvement. On the initial VA examination in 1963, he had normal left shoulder, elbow and wrist motion. In September 1991, following complaints of increased pain in the left arm with spasms, locking and numbness, the veteran underwent debridement of the left elbow and ulnar nerve transposition. (The claims file shows that a separate disability rating of 10 percent for degenerative joint disease of the elbow was established upon rating decision in October 1992.) In October 1991, he reported an increase in pain since the surgery in the elbow and hand. He was unable to use the hand for usual purposes. Upon VA orthopedic examination, there was evidence of hyperesthesias and loss of strength in the hand and forearm. Subsequent outpatient treatment records show left elbow pain and paresthesia. There was decreased sensation and range of motion involving the fifth finger. Upon VA neurological examination in July 1992, the veteran reported cramping of the fourth and fifth digits of the left hand with numbness in those two fingers. He also experienced pain the wrist. Electromyography and nerve conduction studies undertaken in the last week were reported to have shown progressive loss of sensory function in the left ulnar nerve as well as persistent slowing diffusely in the left ulnar arm as well as focal slowing in the proximal to mid forearm segment on the left. Sensory deficits in the left ulnar distribution were noted which included tingling in the second through fifth digits of the left hand. Additionally, there was pain in the ulnar nerve distribution. There was slight weakness on left wrist flexion. The neurologist opined that there was electrodiagnostic evidence of diffuse neuropathy in the left ulnar nerve, peripheral neuropathy and mild carpal tunnel syndrome on the left. In January 1993, the veteran reported persistent pain and paresthesia associated with the ulnar distribution of the left hand. There was decreased grip strength. In September 1993, the examiner noted that the veteran could perform duties that limited lifting with the left arm to 15 pounds. 38 C.F.R. Part 4, Diagnostic Code 5307 provides for a 30 percent rating when there is severe injury to this muscle group (function: flexion of the wrist and fingers). This is the maximum disability rating for this disorder. The veteran currently receives a 30 percent rating, and is therefore not eligible for an increased evaluation under these schedular criteria. We note, however, the Diagnostic Code 8516 regarding paralysis of the ulnar nerve is also applicable in this case as there is ulnar damage associated with this injury. Under these criteria the veteran could receive a disability rating of 50 percent if clinical findings showed that there was complete paralysis of the ulnar nerve of the minor extremity with "griffin claw" deformity due to flexor contraction of the ring and little fingers, very marked atrophy in the dorsal interspaces and the thenar and hypothenar eminences, loss of extension of the ring and little fingers, an inability to spread (or reverse) the fingers, an inability to adduct the thumb, and weakness of flexion of the wrist. Clearly, the veteran's service-connected gunshot wound residuals are severe as indicated by the clinical findings listed above. However, he receives the maximum disability rating for injury to the muscle group involved and complete paralysis of the ulnar nerve is not demonstrated. The injury involving Muscle Group VII and that involving the ulnar nerve do not affect entirely different functions as would require combined ratings pursuant to 38 C.F.R. § 4.55(g). Thus, it is concluded that the 30 percent rating in effect is appropriate and increased evaluation is not warranted. We do not consider that the schedular rating assigned, which contemplates severe disability, is inadequate because the post- surgical pathology is not consistent with marked interference with employment and frequent periods of hospitalization are not shown. In this regard, we note that the impairment does not preclude gripping or lifting or movement of the fingers of the hand. An Increased Evaluation for Residuals of a Gunshot Wound to the Left Thigh A brief history of the events preceding this appeal is as follows: Service connection for residuals of a gunshot wound to the left thigh was established upon rating decision in November 1963. A noncompensable rating was assigned, effective from July 25, 1963, and has been confirmed and continued on numerous occasions over the years, and is still in effect. The veteran asserts that a compensable rating is warranted. The service medical records show that the veteran sustained a penetrating gunshot wound to the left thigh in October 1952 as he was struck by small arms fire. The thigh wound resulted in a retained metallic fragment in the lateral posterior soft tissues of the left leg medial to the head of the fibula. The shell fragment was removed in February 1958. Orthopedic findings pertaining to the left lower extremity upon VA examination in October 1963 included a 3 inch scar which was about 1/4 inch in width on the lateral aspect of the proximal leg. This was the result of surgery for the removal of the foreign body and also was the area of the gunshot wound. Scarring was described as well-healed and non-tender. He had full hip and knee motion. More recently, we note that upon VA examination in March 1991, the veteran reported that he occasionally experienced paresthesia in the left lateral leg. Examination showed scars over the lower extremity. At a personal hearing in May 1992, he testified that he had difficulty walking in that his left heel gave away. Upon VA neurological examination in July 1992, cold was decreased in a stocking distribution in the legs below the knees, but especially medially. Light touch produced tingling below the left knee, and pinprick was increased in that same area. Motor examination of the lower extremities showed that he was able to walk on his heels and toes on both sides and could hop on both sides, but he accomplished this somewhat poorly on the left. Knee jerks were 1 bilaterally and ankle jerks were absent bilaterally, but becoming trace on the left with reinforcement. The diagnoses included peripheral neuropathy, possibly alcoholic, affecting upper and lower extremities. Subsequent records show that the veteran was hospitalized at a VA facility in late 1993 to early 1994 principally for PTSD symptoms. A medical examination upon admission indicated that left hip flexion and rotation range of motion were decreased. Residual weakness as a result of the gunshot wound of the left leg was noted. The noncompensable rating that is currently in effect for the left thigh disorder contemplates slight injury to Muscle Group XIII (posterior thigh group). Diagnostic Code 5313. To warrant an evaluation of 10 percent, there must be moderate injury. For a rating of 30 percent, there must be moderately severe injury. As the clinical findings above show, this was a penetrating wound with a retained fragment which was later removed. The most recent findings pertaining to the left thigh injury indicate some weakness and limitation of hip motion. We conclude that there is now moderate disability warranting a rating of 10 percent for injury to the posterior thigh group under the criteria described above. On the other hand, the record does not show a through and through injury or deep penetrating wound with debridement or prolonged infection or sloughing of soft parts or other findings which establish that there is moderately severe disability involving Muscle Group XIII. Entitlement to an Increased Evaluation for PTSD, Rated as 30 Percent Disabling, Prior to February 1994, and as 100 percent Disabling from February 1994. A brief history of the events leading up to this appeal as to this issue may be briefly summarized. Service connection was established for PTSD upon rating decision in December 1991. A 10 percent rating was assigned, effective from June 12, 1991. This rating was increased to 30 percent by rating action in October 1992, effective from the June 1991 date. The 30 percent rating was confirmed and continued on numerous subsequent decisions. A temporary total rating was established by rating action in January 1994, effective from October 27, 1993, to January 31, 1994, which was followed by a total schedular rating, effective from February 1, 1994. The question currently on appeal is whether a rating in excess of 30 percent is warranted prior to the grant of a 100 percent schedular rating. The severity of the veteran's service-connected psychiatric disorder is assessed by VA for compensation purposes by application of the criteria set forth in Diagnostic Code 9411 of the VA Schedule for Rating Disabilities (Schedule), 38 C.F.R. Part 4. The veteran is currently in receipt of a 30 percent rating which is warranted when there is "definite" impairment in the ability to maintain effective and wholesome relationships with people and when psychoneurotic symptoms result in such reductions in initiative, flexibility, efficiency and reliability levels as to produce "definite" industrial impairment. A 50 percent rating is warranted where the ability to establish or maintain effective or favorable relationships with people is considerably impaired; and where, by reason of psychoneurotic symptoms, the reliability, flexibility and efficiency levels are so reduced as to result in considerable industrial impairment. A 70 percent rating is warranted where the ability to establish and maintain effective or favorable relationships with people is severely impaired; 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 rating is warranted where the attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community; there are 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. Demonstratably unable to obtain or retain employment. In Hood v. Brown, 4 Vet.App. 301 (1993), the Court of Veterans Appeals stated that the term "definite" in 38 C.F.R. § 4.132 was "qualitative" in character, whereas the other terms were "quantitative" in character, and invited the Board to "construe" the term "definite" in a manner that would quantify the degree of impairment for purposes of meeting the statutory requirement that the Board articulate "reasons or bases" for its decision. 38 U.S.C.A. § 7104(d)(1) (West 1991). In a precedent opinion, dated November 9, 1993, the General Counsel of VA concluded that "definite" is to be construed as "distinct, unambiguous and moderately large in degree." It represents a degree of social and industrial inadaptability that is "more than moderate but less than rather large." O.G.C. Prec. 9-93 (Nov. 9, 1993). The Board is bound by this interpretation of the term "definite." 38 U.S.C.A. § 7104(c) (West 1991). With these considerations in mind, the Board will address the merits of the claims at issue. Following a VA social survey and examination conducted in October 1991, service connection was established for PTSD upon rating decision in December 1991. As indicated earlier, a 10 percent rating was assigned. On psychiatric examination October 1991, it had been noted that the veteran had recently been seen at a VA medical center on an outpatient basis. He experienced intrusive thoughts of his military service and sleep impairment. He startled rather easily, but indicated that he did not avoid others. He did, however, report that he had a "short fuse" when discussing his temper. He admitted some chronic trouble with his memory and concentration at times. Upon mental status examination, he presented in a neutral manner with flat and constricted affect. He did not describe current suicidal or homicidal ideation or intent. There was no evidence of psychotic thought process, though there was a general paranoid stance toward the world. He also exhibited a tendency to prefer being alone and isolated. His mood was somewhat sad, depressed and guilty and his affect was mood congruent. The final diagnoses included history of alcohol dependence, currently in remission by self report, PTSD, chronic dysthymia and rule out unspecified personality disorder. The examiner indicated it remained unclear as to the relative impact that the veteran's premorbid character problems, significant alcoholism and subsequent PTSD had upon his overall level of past and current functioning. At a May 1992 personal hearing, the veteran related that his PTSD had been diagnosed over a year earlier. He continued to be seen for psychiatric treatment and was on medication. On psychiatric examination on June 24,1992, conducted by a board of two psychiatrists, it was noted on mental status examination that the veteran attempted to present a benign facade, but when traumatic events were discussed, he became severely agitated, depressed and tearful as well as angry. His mood was one of agitation and depression. His affect was appropriate to expressed thought content. He reported sleep disturbance and daily, intrusive thoughts of his Korean experiences. He had severe startle response and hypervigilance. He, at times, awakened at night, and grabbed a gun and searched the house for intruders. He described feeling of emotional numbing and showed severe emotional lability. He had frequent anger outbursts. The examiners determined that the veteran did meet the criteria for the diagnosis of PTSD. They indicated that over the years, he had medicated himself with alcohol. When not drinking his PTSD symptoms were worse. They did not feel that the appellant exhibited signs of a personality disorder. They opined that he appeared to have "severe" social impairment and "moderate" occupational impairment as a result of PTSD. Based on the veteran's testimony and on the clinical findings at the June 1992 examination, a hearing officer determined that a 30 percent evaluation for PTSD was warranted. This rating was enacted by rating determination in October 1992. VA outpatient treatment records from late 1992 into early 1993 show that the veteran continued to experience nightmares. He was hospitalized in July and August 1993 where he remained for approximately 10 days for PTSD with dissociative states. His symptoms included intrusive thoughts of Korea, feelings of grief and loss related to his war experiences, sleep disturbance, poor concentration and memory loss. The Global Assessment Scale was 50 which corresponds to serious symptoms. Subsequent records show continued outpatient treatment with rehospitalization in October 1993 through January 1994 for participation in a 12 week PTSD treatment program. His PTSD was described as chronic and severe, and a 100 percent schedular rating was granted from February 1, 1994 by rating determination in July 1994. Based upon this evidence, we are of the opinion that there was severe impairment due to PTSD prior to February 1, 1994. In this regard, we note the psychiatric opinion in mid 1992 of severe social and moderate industrial impairment. We also note the psychiatric assessment of serious symptoms recorded later that year. During this time, the veteran participated in outpatient treatment, but despite this treatment, he was also hospitalized for inpatient treatment of PTSD. The criteria for assignment of the next higher evaluation of 100 percent for PTSD under Diagnostic Code 9411 are quite clear. To be eligible, the veteran must have totally incapacitating psychoneurotic symptoms resulting in virtual isolation in the community. Prior to February 1, 1994, the clinical evidence did not show that this was the case. He had maintained relationships with his wife and family and did not exhibit symptoms showing repudiation of reality. Entitlement to a Total Rating for Compensation Purposes on the Basis of Individual Unemployability When the veteran filed his claim for increased ratings in February 1991, he also reported that he was unable to work as a result of his service-connected disorders. Thus, a claim for a total rating on the basis of individual unemployability was filed on that date. While the record shows that the veteran was ultimately granted a 100 percent schedular evaluation as a result of PTSD, effective from February 1, 1994, the question of whether the veteran is entitled to a total rating on the basis of individual unemployability prior to that date is still to be addressed. A statement by the veteran received at the RO in February 5, 1991, has been viewed as the date that the veteran filed a claim for a total rating for compensation purposes based on individual unemployability. At that time, service connection was in effect for residuals of a gunshot wound to the left forearm, rated as 30 percent disabling; residuals of a gunshot wound to the right leg, rated as noncompensable; residuals of a gunshot wound to the left thigh, rated as noncompensable; residuals of a fracture to the left fibula, rated as noncompensable; a left neck scar rated as noncompensable; right inguinal herniorrhaphy, rated as noncompensable; and for an appendectomy, rated as noncompensable. A combined disability rating of 30 percent was in effect. Upon rating determination in December 1991, service connection for PTSD was granted and a 10 percent rating was assigned. A combined disability rating of 40 percent was then in effect. In October 1992, the RO increased the veteran's disability rating for PTSD to 30 percent. Additionally, a separate disability rating for degenerative joint disease of the left elbow was established as a disorder that was directly due to and proximately the result of the service connected left upper extremity disorder. The veteran's combined disability rating was then 60 percent. As set forth previously, it is the decision of the Board that a 10 percent rating for the left thigh disability and a 70 percent rating for PTSD is warranted during the period prior to February 1, 1994, resulting in a combined rating of 80 percent. In circumstances such as the instant case, where the veteran is less than totally disabled under the schedular criteria, it must be found that service-connected disorders prevent him from securing and maintaining a substantially gainful occupation, provided that: if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. 4.16(a) (1994). Pursuant to 38 C.F.R. § 4.16(b) (1994), however, even if the veteran does not meet the foregoing percentage standards for a total rating, and if he is unable to secure and follow a substantially gainful occupation by reasons of service-connected disabilities, he shall be rated totally disabled. It is the function of the Board to weigh and analyze the evidence and to make determinations as to the credibility of the evidence. 38 U.S.C.A. § 5107(b) (West 1991); Sanden v. Derwinski, 2 Vet.App. 97, 100 (1993). Where the preponderance of the evidence is in favor of the veteran's claim, or the evidence for and against the claim is approximately in balance, the benefit sought is to be granted. 38 U.S.C.A. § 5107(b) (West 1991); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). A review of the entire record in this case leads us to conclude that the preponderance of the evidence is in favor of a total rating on the basis of individual unemployability prior to February 1, 1994. The veteran reports a sixth grade education and employment experience primarily as a truck driver although he worked as a carpenter in the 1960's. He last worked in October 1990. In November 1990, the veteran reported locking , edema and pain in the left upper extremity. He also complained of numbness in the same area. Decreased usage over time was noted by the examiner, and it was indicated that the veteran lost his job "yesterday" as a result of these problems. Examination of the left elbow showed mild medial edema with warmth and erythema. He could open and close all the fingers except the fifth finger which flexed at the metacarpophalangeal joint but not at the distal interphalangeal joint. There was no extension of the "fifth fingers." In February 1991, when the veteran filed his claim for a total disability rating, he reported that he was unable to drive his truck as a result of left arm problems, to include locking and pain. As a result of the filing of the veteran's claims in February 1991, a VA examination was conducted in March of that year. At that time, the physician noted that the veteran had stopped driving his truck approximately one year earlier as a result of problems with his elbow and forearm, to include lack of strength and the inability to hold on to objects. Additionally, he had abnormal sensation to cold and decreased extension of his fingers with locking of his elbow when he would steer. Subsequent records show persistent pain, weakness and limited motion in the left upper extremity. In January 1992, the veteran's treating orthopedist opined that the veteran could not operate his equipment due to the left upper extremity disabilities and "should be considered disabled due to these problems." In addition, psychiatric examination resulted in an opinion of "severe" social impairment due to PTSD, and upon July 1993 psychiatric hospitalization, a Global Assessment of Functioning was consistent with serious symptoms. Finally, following psychiatric hospitalization in early 1994, it was reported that he had been unable to work since 1990 because of PTSD and worsening war wounds which had continued to cause great difficulty since separation from service in his work, family relations and social functioning. We believe that the evidence related above demonstrates that the veteran's service-connected disorders were of such severity as to render him unemployable prior to February 1, 1994, in that he was precluded from securing and maintaining a substantially gainful occupation consistent with his education and employment background during that time. He has limited education and work experience. Prior to February 1994, the evidence showed severe PTSD and worsening of the left thigh disability. With respect to the left upper extremity, there is medical opinion that he was unable to continue to drive a truck and was, furthermore, disabled by reason thereof. We accordingly conclude that the preponderance of the evidence shows that the veteran was precluded from obtaining and maintaining a substantially gainful occupation as a result of service-connected disorder prior to February 1, 1994. Based on the claim filed in 1991, the effective date is to be determined by the RO. 38 U.S.C.A. §§ 1155, 5107(b) (West 1991); 38 C.F.R. §§ 3.321, 3.340, 3.341, Part 4, 4.16 (1994). ORDER An increased evaluation for residuals of a gunshot wound to the left forearm with ulnar nerve neuropathy is denied. (CONTINUED ON NEXT PAGE) An increased evaluation for residuals of a gunshot wound to the left thigh is granted, subject to controlling regulations applicable to payment of monetary awards. Entitlement to a total rating for compensation purposes on the basis of individual unemployability is granted, subject to controlling regulations applicable to payment of monetary awards. Entitlement to an increased evaluation for PTSD to 70 percent is granted, subject to controlling regulations applicable to the payment of monetary awards. NANCY I. PHILLIPS Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.