BVA9505725 
DOCKET NO.  92-11 610     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Pittsburgh,
Pennsylvania

THE ISSUES

1.  Entitlement to an increased evaluation for a duodenal ulcer
with spastic colon, currently evaluated as 20 percent disabling.

2.  Entitlement to a compensable evaluation for a right inguinal
area scar.

3.  Whether new and material evidence has been submitted to
reopen a claim of entitlement to service connection for a low
back disability.

4.  Whether new and material evidence has been submitted to
reopen a claim of entitlement to service connection for post
traumatic stress disorder (PTSD).

5.  Entitlement to service connection for a right wrist
disability as secondary to service connected right lower
extremity disabilities.

6.  Entitlement to a total disability evaluation based upon
individual unemployability.

7.  Entitlement to service connection for a skin disorder claimed
as a residual of exposure to herbicides in Vietnam (or Agent
Orange).

8.  Entitlement to a separate disability rating for a spastic
colon.

9.  Entitlement to service connection for retained foreign bodies
in the right elbow.

10.  Entitlement to a separate grant of service connection for
claimed right foot drop as secondary to service connected right
peroneal neuritis.

11.  Entitlement to service connection for a right eye
disability.

12.  Entitlement to an increased evaluation for right peroneal
neuritis, currently evaluated as 10 percent disabling.

13.  Entitlement to an earlier effective date for the assignment
of service connection for the residuals of right knee injury.

14.  Whether the veteran is eligible for financial assistance in
acquiring an automobile or other conveyance or special adaptive
equipment.

15.  Whether there was clear and unmistakable error in a rating
decision in October 1983 which denied entitlement to service
connection for PTSD.

16.  Whether there was clear and unmistakable error in a rating
decision in November 1981 which denied entitlement to service
connection for a low back disability.

17.  Entitlement to service connection for a low back disability
as secondary to service connected right lower extremity
disabilities.

WITNESSES AT HEARINGS ON APPEAL

Appellant and his wife

ATTORNEY FOR THE BOARD

L. M. Barnard, Counsel

INTRODUCTION

The veteran served on active duty from June 1966 to June 1969; he
served in the Republic of Vietnam from May 30, 1967 to May 21,
1968.

This appeal arises from a December 1990 rating decision of the
Pittsburgh, Pennsylvania, Department of Veterans Affairs (VA),
Regional Office (RO), which denied entitlement to the benefits
sought.  In June 1991, a rating action was issued which denied
entitlement to individual unemployability.  In January 1992, the
veteran and his wife testified at a personal hearing conducted at
the RO.  Following this hearing, a rating action was issued in
May 1992 which denied entitlement to the benefits sought.  In
September 1992, a hearing was conducted before a member of a
Board section.  Following this hearing, the case was remanded in
July 1993 for further development.  A rating action was
subsequently issued in April 1994, which confirmed and continued
the denials.  Another hearing was held before a member of the
Board in September 1994.

In reviewing the record, it has been noted that the veteran
appears to be raising a claim for entitlement to service
connection for a cervical spine disability, as well a claim that
clear and unmistakable error was committed when the RO failed to
assign a compensable evaluation for his right knee injury
residuals between 1969 and 1980.  However, as these issues have
not been properly developed for appellate review, and are not
inextricably intertwined with an issue on appeal, they are hereby
referred to the RO for appropriate action.

CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends, in essence, that service connection should
be granted for a skin disorder, retained foreign bodies in the
right elbow and for the residuals of trauma to the right eye.  He
asserts that he was exposed to Agent Orange while serving in
Vietnam, and that he has had skin problems ever since.  He states
that he suffered shrapnel fragment wounds in the right elbow when
an explosion destroyed a jeep he was riding in.  Further, he
states that he had a foreign object removed from his right eye in
service and that this caused the onset of visual difficulties in
this eye.

He has also requested that an increased evaluation be assigned to
his duodenal ulcer with spastic colon, right inguinal area scar,
and his right peroneal neuritis.  In regard to his ulcer and
spastic colon, the veteran has asserted that he experiences
constant pain, bloating, diarrhea and nausea.  He states that his
peroneal neuritis is more disabling than the current evaluation
would suggest.  He says that this injury has caused constant
pain, numbness and right foot drop.  He stated that his inguinal
scar was sensitive and often aches.

The veteran has also requested that he be granted service
connection for right foot drop, a right wrist disability and a
low back disability as a direct result of his service-connected
right peroneal neuritis.  He states that the peroneal nerve
damage has now resulted in the onset of right foot drop.  He
alleges that he has experienced several falls because of his
difficulties with his right lower extremity.  These falls have
resulted in right wrist and low back injuries and their resultant
residuals, to include pain and limitation of motion.

He further alleges that he has submitted new and material
evidence that supports his contentions that he suffered a back
injury in service that has resulted in the development of a
chronic back disability.  He also states that there is sufficient
new and material evidence to support a finding that he suffers
from PTSD as a result of his Vietnam service.

Because of his various disabilities, the veteran contends that he
is unable to maintain substantially gainful employment.  In fact,
he notes that he has been unable to work since 1988.

Several other issues have also been raised by the veteran.  He
alleges that the RO committed clear and unmistakable error when
it denied service connection for PTSD and a low back disability.
He has requested that he be granted financial assistance in
obtaining special adaptive equipment for his automobile.  He
asserts that his right lower extremity disabilities have rendered
this extremity useless and has made the use of hand controls a
must.  He has requested that an earlier effective date be
assigned to the grant of service connection for residuals of the
right knee injury.  Finally, he has alleged that a separate
disability evaluation should be assigned to his service connected
spastic colon.

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 files.
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 evidence supports an increased evaluation for
right peroneal neuritis, duodenal ulcer with spastic colon, and a
separate compensable evaluation for the residuals of right knee
injury, supports a finding that new and material evidence has
been submitted to reopen a claim for service connection for PTSD,
as well as a grant of service connection for PTSD, and supports a
grant of a total disability evaluation due to individual
unemployability.  The preponderance of the evidence is against
service connection for right wrist, skin, right elbow, claimed
right foot drop, right eye, and low back disabilities, against an
increased evaluation for a right inguinal area scar, against a
finding that new and material evidence has been submitted to
reopen a claim for direct service connection for a low back
disability, against finding clear and unmistakable error in the
prior denials of service connection for PTSD and a low back
disability, and against financial assistance for adaptive
equipment.  It is also the decision of the Board that the veteran
has failed to allege error of either fact or law in the decision
of the RO which allowed an earlier effective date to June 20,
1969, for the grant of service connection for residuals of a
right knee injury, and that a separate rating for a spastic colon
may not be assigned.

FINDINGS OF FACT

1.  The veteran's duodenal ulcer with spastic colon is manifested
by abdominal pain, very frequent periods of diarrhea and
essentially constant abdominal distress; impairment of health,
periodic vomiting or recurrent hematemesis or melena are not
shown.

2.  The veteran's right inguinal area scar is manifested by
subjective complaints of sensitivity, with no objective findings.

3.  The RO denied entitlement to service connection for a low
back disability in November 1981.

4.  Additional evidence submitted since that time fails to show
that the veteran's current back disability, to include arthritis,
was related to an event in service, or that arthritis manifested
to a compensable degree within one year of separation.

5.  The RO denied entitlement to service connection for PTSD in
October 1983.

6.  Additional evidence submitted since that time reveals that
the veteran suffers from PTSD as a result of his service.

7.  There is no causal relationship between the veteran's service
connected right lower extremity disabilities and the injury that
led to the right wrist disability.

8.  The veteran's service connected disabilities do prevent him
from working at a substantially gainful occupation.

9.  The veteran's skin rash noted in service was acute and
transitory in nature, resolving by discharge, and it is not shown
to be related to any disorder noted after discharge; the
veteran's current skin disorder is not shown to be related to
herbicide (or Agent Orange) exposure.

10.  Under the schedule for rating disabilities, a rating for
ulcer disease cannot be combined with a rating for a spastic
colon.

11.  The veteran's right elbow disability was not present during
service.

12.  The veteran  does not suffer from foot drop that is
demonstrated by a loss of active movement of the muscles with a
dangling right foot or that is a separate and distinct
manifestation or disability from the right foot impairment that
is due to the right peroneal injury already service connected.

13.  The veteran's inservice right eye complaints, which
consisted of the removal of a foreign object, were acute and
transitory in nature and resolved without residuals.

14.  The veteran's right peroneal neuritis is manifested by
severe incomplete paralysis of the common peroneal nerve.

15.  The veteran's residuals of injury to the right knee are
currently manifested by limitation of motion, posterior lateral
pain and x-ray evidence of a chip fracture.

16.  The veteran was granted an earlier effective date for his
service-connected right knee injury residuals to June 20, 1969,
the day following separation from service.

17.  The veteran has actual remaining function in the right foot
such that balance and propulsion would not be equally well
accomplished by an amputation stump below the knee with suitable
prosthetic appliance; therefore, the veteran does not have loss
of use of the right foot as the result of service connected
disability.

18.  The RO denied entitlement to service connection for PTSD in
October 1983; this decision was consistent with the evidence in
the file at that time and constituted a reasonable exercise of
rating judgment.

19.  The RO denied entitlement to service connection for a low
back disability in November 1981; this decision was consistent
with the evidence in the file at that time and constituted a
reasonable exercise of rating judgment.

20.  There is no causal relationship between the veteran's
service-connected right lower extremity disabilities and the
injuries that led to the development of a low back disability.

CONCLUSIONS OF LAW

1.  The criteria for a 30 percent disability evaluation for
duodenal ulcer with spastic colon have been met.  38 U.S.C.A.
§§ 1155, 5107(a) (West 1991); 38 C.F.R. §§ 3.321, 4.7, 4.110,
4.112, 4.113, 4.114 and Diagnostic Codes 7305, 7319 (1994).

2.  The criteria for a compensable evaluation for a right
inguinal area scar have not been met.  38 U.S.C.A. §§ 1155,
5107(a) (West 1991); 38 C.F.R. § 3.321, Part 4, including §§ 4.1,
4.2, and Diagnostic Codes 7803, 7804, 7805 (1994).

3.  Evidence received since the RO denied entitlement to service
connection for a low back disability in 1981 is not new and
material, and the November 1981 decision of the RO is thus final
and the claim is not reopened.  38 U.S.C.A. §§ 1101, 1110, 1112,
1113, 5107(a), 5108, 7105 (West 1991); 38 C.F.R. §§ 3.104(a),
3.156(a), 3.303(c), 3.307, 3.309, 20.302 (1994).

4.  Evidence received since the RO denied entitlement to service
connection for PTSD in 1983 is new and material, and the claim is
reopened.  38 U.S.C.A. §§ 5107(a), 5108, 7105 (West 1991); 38
C.F.R. §§ 3.104(a), 3.156(a), 20.302 (1994).

5.  PTSD was incurred in wartime service.  38 U.S.C.A. §§ 1110,
5107(a) (West 1991); 38 C.F.R. § 3.304(f) (1994).

6.  The veteran's right wrist disability is not proximately due
to or the result of his service connected right lower extremity
disabilities.  38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R.
§ 3.310(a) (1994).

7.  The veteran is unemployable due to service connected
disabilities.  38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38
C.F.R. §§ 3.340, 3.341, 4.16 (1994).

8.  A chronic skin disorder was not incurred in or aggravated by
service, nor may it be presumed to have been so incurred.  38
U.S.C.A. §§ 1110, 1113, 1116, 5107(a) (West 1991); 38 C.F.R.
§§ 3.303(b), 3.307(a)(6), 3.309(e) (1994).

9.  A separate disability rating for the service-connected
spastic colon may not be assigned.  38 C.F.R. §§ 4.14, 4.114
(1994).

10.  A right elbow disability, to include retained foreign
bodies, was not incurred in or aggravated by active duty.  38
U.S.C.A. § 1110, 5107(a) (West 1991).

11.  The veteran is service-connected for the right foot
impairment due to residuals of a right peroneal nerve injury; he
does not have a right foot drop that may be separately service
connected and rated.  38 U.S.C.A. §§ 1110, 1153 (West 1991); 38
C.F.R. §§ 3.310(a), 4.14, 4.55(g) (1994).

12.  The veteran does not a chronic right eye disability which
was incurred in or aggravated by service.  38 U.S.C.A. §§ 1110,
5107(a) (West 1991); 38 C.F.R. § 3.303(b) (1994).

13.  The criteria for a 30 percent evaluation for right peroneal
neuritis have been met.  38 U.S.C.A. §§ 1155, 5107(a) (West
1991); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.10, and Diagnostic
Code 8621 (1994).

14.  A separate 10 percent rating for the service-connected
residuals of injury to the right knee is warranted.  38 U.S.C.A.
§§ 1155, 5107(a) (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.10, 4.40
and Code 5257 (1994).

15.  The veteran has alleged no error of fact or law in the
determination of the earlier effective date of June 20, 1969, for
the grant of service connection for right knee injury residuals.
38 U.S.C.A. §§ 5107(a), 7105(d)(5) (West 1991).

16.  The eligibility criteria for financial assistance in
acquiring an automobile or other conveyance or special adaptive
equipment have not been met.  38 U.S.C.A. §§ 3901, 3902, 5107(a)
(West 1991); 38 C.F.R. §§ 3.808, 4.63 (1994).

17.  The decision to deny service connection for PTSD in October
1983 was not clearly and unmistakably erroneous.  38 U.S.C.A.
§§ 5107(a), 7105 (West 1991); 38 C.F.R. § 3.105(a) (1994).

18.  The decision to deny service connection for a low back
disability in November 1981 was not clearly and unmistakably
erroneous.  38 U.S.C.A. §§ 5107(a), 7105 (West 1991); 38 C.F.R.
§ 3.105(a) (1994).

19.  The veteran's low back disability is not proximately due to
or the result of his service connected right lower extremity
disabilities.  38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R.
§ 3.310(a) (1994).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The veteran's claims, with the exception of the claim for an
earlier date for service connection of right knee injury
residuals, are well grounded within the meaning of 38 U.S.C.A.
§ 5107(a).  That is, we find that he has presented claims which
are plausible.  We are also satisfied that all relevant facts
have been properly developed.  The record is devoid of any
indication that there are other records available which should be
obtained.  Therefore, no further development is required in order
to comply with the duty to assist mandated by 38 U.S.C.A.
§ 5107(a).
I.  Service connection claims

Under the applicable criteria, service connection may be granted
for a disability the result of disease or injury incurred in or
aggravated by service.  38 U.S.C.A. § 1110 (West 1991).

For the showing of a chronic disease in service there is required
a combination of manifestations sufficient to identify the
disease entity, and sufficient observation to establish
chronicity at the time, as distinguished from merely isolated
findings or diagnosis including the word "chronic."  Continuity
of symptomatology is required where the condition noted during
service is not, in fact, shown to be chronic or where the
diagnosis of chronicity may be legitimately questioned.  When the
fact of chronicity in service is not adequately supported, then a
showing of continuity after discharge is required to support the
claim.  38 C.F.R. 3.303(b) (1994).

A. Entitlement to service connection for a
skin disorder claimed as a residual of
exposure to herbicides in Vietnam (or Agent
Orange).

According to 38 C.F.R. § 3.307(a)(6) (1994), the term herbicide
agent means a chemical in an herbicide used in support of the
United States and allied military operations in the Republic of
Vietnam during the Vietnam era.  The diseases listed at 38 C.F.R.
§ 3.309(e) (1994) shall be service connected if they manifest to
a degree of 10 percent or more at any time after service, except
that chloracne or other acneform disease consistent with
chloracne and porphyria cutanea tarda shall have become manifest
to a degree of 10 percent or more within one year after the last
date on which the veteran was exposed to an herbicide agent
during active military, naval, or air service.

If a veteran was exposed to an herbicide agent during active
military, naval, or air service, the following diseases shall be
service connected if the requirements of 38 C.F.R. § 3.307(a)(6)
are met even though there is no record of such disease: chloracne
or other acneform disease consistent with chloracne; Hodgkin's
disease; multiple myeloma; Non-Hodgkin's lymphoma; porphyria
cutanea tarda; respiratory cancers (cancer of the lung, bronchus,
larynx or trachea); soft-tissue sarcoma (other than osteosarcoma,
chondrosarcoma, Kaposi's sarcoma, or mesothelioma).  The term
soft-tissue sarcoma includes the following: adult fibrosarcoma;
dermatofibrosarcoma protuberans; malignant fibrous histiocytoma;
liposarcoma; leiomyosarcoma; epithelioid leiomyosarcoma
(malignant leiomyoblastoma); rhabdomyosarcoma; ectomesenchymoma;
angiosarcoma (hemangiosarcoma and lymphangiosarcoma);
proliferating (systemic) angioendotheliomatosis; malignant glomus
tumor; malignant hemangiopericytoma; synovial sarcoma (malignant
synovioma); malignant giant cell tumor of the tendon sheath;
malignant schwannoma, including malignant schwannoma with
rhabdomyoblastic differentiation (malignant Triton tumor),
glandular and epithelioid malignant schwannomas; malignant
mesenchymoma; malignant granular cell tumor; alveolar soft part
sarcoma; epithelioid sarcoma; clear cell sarcoma of the tendons
and aponeuroses; extraskeletal Ewing's sarcoma; congenital and
infantile fibrosarcoma; and malignant ganglioneuroma.  38 C.F.R.
§ 3.309(e) (1994).

The new regulations pertaining to Agent Orange exposure, expanded
to include all herbicides used in Vietnam, now provide for a
presumption of exposure to herbicide agents for veterans who
served on active duty in Vietnam during the Vietnam era.
38 C.F.R. § 3.307(a)(6) (1994).  The veteran's active duty
included service in Vietnam during the Vietnam era from May 30,
1967, to May 21, 1968.  Consequently, it is presumed that he was
exposed to Agent Orange or other herbicide agents while in
Vietnam.

The veteran's service medical records reveal that in June 1967 he
presented with complaints that he felt slightly nauseated.  He
had also developed an elevated rash.  The physical examination
conducted at that time was within normal limits.  The diagnosis
was undiagnosed disease manifested by a skin rash.  His last day
of service in Vietnam was on May 21, 1968.  The remainder of the
service medical records make no reference to a skin disorder.

Following his discharge from the military, the veteran was
examined by VA in October 1969.  Except for some mild pustular
acne over the face and upper chest, the examination of his skin
was normal.  A July 1976 VA examination found that his skin was
normal.

A November 1982 outpatient treatment record from the VA
Dermatology clinic noted that he had numerous mild skin
complaints.  These included recurrent folliculitis on the groin
and buttocks, recurrent lesions on the penis, probable herpes and
cysts behinds the left ear that occasionally become infected.  No
disease associated with exposure to Agent Orange was diagnosed.

During his January 1991 personal hearing, the veteran indicated
that he was receiving money from the Agent Orange Fund.  VA
outpatient treatment records developed between January 1990 and
March 1992 reflect treatment for a erythematous macular rash, a
nodular lesion and seborrheic keratoses of the face in February
1991.  In April 1991, objective examination revealed a 3 mm light
brown scaly papule on the left forearm, two red papules on the
face and two brown papules that dimpled when pinched on the left
shoulder.  The assessment was questionable seborrheic keratoses
on the left forearm and rosacea.  In July 1991, rosacea,
seborrheic keratosis, questionable dyshidrotic eczema and xerosis
were diagnosed.

In September 1992, the veteran testified at a personal hearing,
during which he indicated that he suffers from chloracne as a
result of his exposure to Agent Orange in service.  He stated
that this condition first began in service and was noted as a
rash.  He said that he currently is being treated with topical
ointments.  He admitted that the diagnosis now is rosacea, and
contended that the symptoms that he now has are basically the
same as those he had in service.

In January 1994, the veteran was examined by the VA.  It was
noted that he was exposed to Agent Orange during service, and
that he did have one complaint of a rash in service.  Since that
time, the veteran has complained of acne, multiple cysts, redness
of the neck, and dry and cracking skin of the tips of the
fingers.  The objective examination found that there were
telangiectasia's and hyperpigmentation of the face and neck.  He
also had numerous telangiectasia's of the upper chest.  There
were about ten small acneform lesions on the chest and back.
There was also

dry hyperkeratosis of the tips of the fingers without vesicles.
A dermal papule with a "dimple sign" was present on the right
posterior thigh.  All clinical tests were negative.  The
diagnoses were poikiloderma of Civatte of the face and neck;
telangiectasia's of the chest; acne vulgaris of the chest and
back; hand dermatitis; and dermatofibroma of the right posterior
thigh.

The veteran testified at a personal hearing in September 1994.
He stated that he applies topical medication to treat what he
called chloracne.  He noted that in 1983 a punch biopsy had
diagnosed erythemas, which is redness caused either by chemical
poisoning or sunburn.  He commented that the January 1994 VA
examination had diagnosed acneiform lesions that were caused by
exposure to Agent Orange.  He admitted during this testimony that
no doctor had ever told him that his skin condition was related
to Agent Orange exposure, nor that chloracne had ever been
diagnosed, although he asserted that his symptoms were consistent
with this disability.

The veteran's wife submitted a statement in September 1994 which
noted that, prior to his service, the veteran's skin was clear.
However, after his return form Vietnam, his skin, particularly
his neck, was very red.  He also had cysts removed and suffered
from blisters on his fingers.

After carefully reviewing the evidence of record, it is the
opinion of the undersigned that entitlement to service connection
for a skin disorder the result of exposure to Agent Orange is not
warranted.  Initially, it is noted that the veteran is presumed
to have been exposed to Agent Orange during his tenure in
Vietnam.  However, such exposure is not enough to establish
entitlement to service connection for a skin disability.  The
veteran has been diagnosed with many different skin disorders, to
include rosacea, hyperkeratosis, telangiectasia's, acne vulgaris,
dermatitis, and eczema.  The mild pustular acne noted in October
1969 was more than 2 years after the presentation of the acute
and transitory rash in June 1967, and more than 1 year after he
left Vietnam in May 1968.  There is no medical evidence that the
mild pustular acne represented chloracne or an acneform disease
consistent with chloracne, and in any event there is no medical
evidence that such a skin disorder became manifest to a 10
percent degree within one year after he left Vietnam.  The
veteran has never been diagnosed with any of the diseases
enumerated in 38 C.F.R. § 3.309(e) (1993), which are the only
diseases for which a presumption of service connection is
warranted.

The United States Court of Appeals for the Federal Circuit
recently determined that the Veterans' Dioxin and Radiation
Exposure Compensation Standards (Radiation Compensation) Act,
Pub.L. No. 98-542, § 5, 98 Stat. 2715, 2727-29 (1984) does not
preclude a veteran from establishing service connection with
proof of actual direct causation.  Combee v. Brown, 34 F. 3d 1039
(Fed. Cir. 1994).  However, the United States Court of Veterans
Appeals (Court) has held that where the issue involves medical
causation, competent medical evidence which indicates that the
claim is plausible or possible is required to set forth a well-
grounded claim.  Grottveit v. Brown, 5 Vet.App. 91, 93 (1993).

The veteran's assertions of medical causation alone are not
probative because lay persons (i.e. persons without medical
expertise) are not competent to offer medical opinions.  Moray v.
Brown, 5 Vet.App. 211 (1993); Grottveit v. Brown, 5 Vet.App. 91
(1993); Espiritu v. Derwinski, 2 Vet.App. 492 (1992).

Again, the veteran did experience an acute skin rash shortly
after he arrived in Vietnam in June 1967.  However, no further
treatment for a skin problem was noted in the service medical
records.  Clearly, this condition resolved by discharge.  No
further mention of a chronic skin problem was made until 1982,
several years after separation.  Therefore it cannot be argued
that continuity of symptomatology has been established, thus
demonstrating that no chronic skin disorder began in service.

It is therefore concluded that the preponderance of the evidence
is against a finding of entitlement to service connection for a
chronic skin disability as the result of exposure to Agent
Orange; and against a finding that any of his current skin
disorders are related to his period of service.

B.  Service connection for retained foreign
bodies in the right elbow.

The veteran has alleged that he received shrapnel fragment wounds
to the right elbow in service, and that service connection should
be granted for the retained fragments.

A review of the service medical records reveals no clinical
records pertaining to an injury of the right elbow.  His May 1969
separation examination noted his comment that he had been treated
for his right elbow.  However, the nature of the disorder and the
type of treatment received was not indicated.  The objective
examination of the upper extremities was completely negative.

Two VA examinations, conducted in October 1969 and July 1976, are
also negative for any complaints involving this elbow.  The
objective examinations were also silent as to any disability of
this joint.  A January 1991 VA outpatient treatment record
referred to the removal of shrapnel from the veteran's right
elbow.

The veteran testified at a personal hearing in January 1992
during which he stated that he had been injured when a jeep he
was riding in was either hit with mortar fire or ran over a land
mine.  In either case, he said that he received shrapnel
fragments in the right elbow.  He claimed that a recently
performed MRI found metallic fragments in the elbow.

A second personal hearing was held in September 1992 at which
time he stated that he felt that a March 1990 fall had possibly
shifted the metallic fragments in his elbow so that they were now
affecting the nerves.

A January 1994 VA neurological examination showed that there was
mild generalized weakness in the right upper extremity.  In
February 1994, the veteran was examined by VA.  He gave a history
of receiving a shrapnel fragment wound to the right elbow in 1967
or 1968 after an explosion.  The objective examination revealed
that range of motion was 0 to 120 degrees with pain upon extreme
flexion.  He displayed 80 degrees of pronation and supination
without pain.  There was tenderness to palpation over the lateral
aspect of the arm, as well as over the lateral epicondyle with
even light touch.  The right upper extremity displayed 5/5 motor
strength.  A July 1991 x-ray study was reviewed and was noted to
reveal no evidence of shrapnel or foreign bodies in the right
elbow.  The diagnosis was chronic pain in the right elbow of
unclear etiology.

In April 1994, a private physician noted that the veteran
complained of neck and right arm pain which appeared to be
secondary to a herniated disc at C6-7.  There were degenerative
changes at this level as well.  These changes were compromising
the nerve root and causing his right upper extremity symptoms.

In September 1994, the veteran testified at a personal hearing.
He stated that the problems with his right elbow did not manifest
itself until after his March 1990 fall.  He said that he was
unaware of the metal fragments in his elbow.  However, after his
1990 fall, an MRI was performed.  He asserted that this study had
something to do with shifting the metal fragments.  As a
consequence, these fragments were now pressing against the
interosseous and ulnar nerves.  He commented that he received
this shrapnel fragment wound during the Tet offensive, and that
it was noted on his 1969 separation examination.

After carefully reviewing the evidence of record, it is the
conclusion of the undersigned that entitlement to service
connection for retained foreign bodies in the right elbow is not
warranted.  It is noted that the veteran's separation examination
contains one mention, by the veteran, that he had been treated
for a right elbow injury.  However, such a claim could not be
verified by a review of the objective clinical records.  These
records make no reference to treatment for any type of right
elbow injury, let alone a shrapnel fragment wound.  While the
veteran continues to assert throughout his testimony that he
received shrapnel fragment wounds, it is noted these claims
cannot be confirmed with the objective evidence.  The post
service records included two VA examinations, one conducted in
October 1969, the other in July 1976.  Neither of the
examinations made any reference to a right elbow disability.

In fact, artifacts were not noted in the record until a June 1991
MRI of the right forearm.  This test was performed after the
veteran had injured his right upper extremity in a fall in March
1990.  The report of this study began with a history of a right
elbow fracture.  The MRI was requested to rule out reflex
sympathetic dystrophy following a right wrist fracture in March
1990.  Noted were metallic artifacts in the proximal right
forearm, possibly related to reported fracture of the right
elbow.  No mention was made of shrapnel fragments or wounds.
Further, as noted above, a July 1991 X-ray study revealed no
evidence of shrapnel in the right elbow.  Significantly, no
external scarring was ever referred to, despite the expectation
that such scarring would have resulted from shell fragments.
Moreover, the veteran contended during his September 1994 hearing
that, prior to his 1990 fall, he had been unaware of any foreign
bodies in his right elbow, an assertion that is not credible,
considering the traumatic nature of any shrapnel fragment wound.
It is unlikely that he would have been unaware of these fragments
had they been obtained as he alleges.  Therefore, while
questionable evidence of artifacts in the right forearm was noted
after his March 1990 injury, there is absolutely no objective
evidence of record to relate these to his period of active duty.
Rather, they appear to be related to an injury sustained after
service.  Therefore, the preponderance of the evidence is against
a finding of entitlement to service connection for retained
foreign bodies in the right elbow, as the result of shrapnel
fragment wounds.

C.  Entitlement to service connection for
the residuals of trauma to the right eye.

A review of the service medical records reveals that, in November
1968, a small woody foreign body was removed from the veteran's
right eye.  Visual acuity in this eye was noted to be 20/30.  It
was also mentioned that he did wear glasses.  The separation
examination performed in May 1969 made no reference to an eye
disability.

In October 1969, the veteran was examined by VA.  His eyes were
noted to be normal, with visual acuity of 20/30.  A July 1976 VA
examination found that his pupils were round and regular.  They
responded equally and were reactive to light.  The movements of
the eye were normal.  Visual acuity was 20/20.  A January to
February 1983 VA eye examination was also normal.  None of the
examinations referred to any residuals caused by the removal of a
woody fragment from his right eye.

An October 1990 VA record noted that the veteran's bilateral
visual acuity was 20/25.  VA outpatient treatment records
developed between January 1990 and March 1992 noted his
complaints in January 1991 of problems with visual acuity in the
right eye.  He gave a history of a shrapnel wound to this eye.
It was noted that he needed glasses in order to drive.  The
assessment was rule out Hollenhurst plaques.  In July 1991 he
continued to complain of decreased visual acuity in the right
eye.  He gave a history of a shrapnel wound to this eye.

In September 1992 the veteran testified at a personal hearing.
He said that he was seen in service in 1968 for a problem with
his right eye.  He stated that the record does not refer to a
diagnosis but that he believed that his retina was referred to.
He said that he was issued glasses while in the service.  He
stated that he currently suffers from recurrent infections and
swelling in this eye as a result of the inservice injury.

A September 1993 VA examination noted his bilateral decreased
visual acuity.  A January 1994 neurological examination found
full visual fields, with pupils that were normal in appearance,
and were reactive to light and accommodation.  There was full
extraocular movement without nystagmus.

The veteran then testified at an additional personal hearing in
September 1994.  He stated that he had a foreign body removed
from his right eye while in service.  He noted that VA had
diagnosed conjunctivitis, corneal abrasions and Hollenhorst
plaques, which he said were developmental abnormalities.  He
rendered his opinion that the removal of the foreign body in
service had caused scarring that was affecting his vision.

After a careful review of the evidence of record, it is the
opinion of the undersigned that a finding of entitlement to
service connection for the residuals of trauma to the right eye
is not warranted.  Initially, it is noted that a small woody
foreign body was removed from the veteran's right eye in November
1968, after he left Vietnam.  However, no other treatment was
recorded.  The separation examination of May 1969 made no
reference to any complaints referable to this eye, nor were any
residuals identified.  The VA examination conducted in October
1969, shortly after his discharge, also noted no trauma residuals
of the right eye.  What was noted was visual acuity of 20/30, the
same visual acuity that was noted in November 1968 when the
foreign body was removed.  Clearly, the minor trauma to the right
eye, manifested by a small woody fragment in the eye, was acute
and transitory in nature, resolving without residuals.  This
finding is confirmed by the treatment records developed after
separation which show some slight decrease in visual acuity,
which has never been related to trauma.  While the veteran's
opinion that the removal of the foreign body caused scarring that
has effected his vision has been noted, the veteran is a lay
person who is not qualified to render an opinion as to medical
causation.  Espiritu v. Derwinski, 2 Vet.App. 492 (1992).  The
objective medical evidence of record contains no such opinion.
No record has ever mentioned that the veteran suffers from
traumatic loss of vision in the right eye.  Therefore, the
preponderance of evidence is against finding entitlement to
service connection for the residuals of trauma to the right eye.

II.  Increased and separate evaluation claims

Under the applicable criteria, disability evaluations are
determined by the application of a schedule of ratings which is
based on the average impairment of earning capacity.  Separate
diagnostic codes identify the various disabilities.  38 U.S.C.A.
§ 1155 (West 1991); 38 C.F.R. Part 4 (1994).  When a question
arises as to which of two evaluations shall be assigned, the
higher evaluation will be assigned if the disability picture more
nearly approximates the criteria required for that rating.
Otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7
(1994).

VA has a duty to acknowledge and consider all regulations which
are potentially applicable based upon the assertions and issues
raised in the record and to explain the reasons used to support
the conclusion.  Schafrath v. Derwinski, 1 Vet.App. 589 (1991).
These regulations include, but are not limited to, 38 C.F.R.
§ 4.1, that requires that each disability be viewed in relation
to its history and that there be an emphasis placed upon the
limitation of activity imposed by the disabling condition, and 38
C.F.R. § 4.2 which requires that medical reports be interpreted
in light of the whole recorded history, and that each disability
must be considered from the point of view of the veteran's
working or seeking work.  38 C.F.R. § 4.10 states that, in cases
of functional impairment, evaluations are to based upon lack of
usefulness, and medical examiners must furnish, in addition to
etiological, anatomical, pathological, laboratory and prognostic
data required for ordinary medical classification, full
description of the effects of the disability upon a person's
ordinary activity.  This evaluation includes functional
disability due to pain under he provisions of 38 C.F.R. § 4.40.
These requirements for the consideration of the complete medical
history of the claimant's condition operate to protect claimants
against adverse decisions based upon a single, incomplete or
inaccurate report and to enable VA to make a more precise
evaluation of the level of disability and any changes in the
condition.

A.  Entitlement to an increased evaluation
for right peroneal neuritis.

Under Diagnostic Code 8521, a 10 percent evaluation is warranted
for mild incomplete paralysis of the common peroneal nerve.  A 20
percent evaluation requires moderate incomplete paralysis and 30
percent evaluation requires severe incomplete paralysis.  A 40
percent evaluation requires complete paralysis, evidenced by foot
drop and slight droop of the first phalanges of all toes.  There
is an inability to dorsiflex the foot, extension (dorsal flexion)
of the proximal phalanges of the toes and abduction of the foot
are lost; adduction is weakened; and anesthesia covers the entire
dorsum of the foot and toes.

The evidence of record indicates that the veteran injured his
right lower extremity as the result of a car accident in 1969.
Throughout the 1970's the veteran complained of right knee pain
and instability, as well as numbness in the right leg.  A January
1981 EMG revealed evidence of involvement of the peroneal nerve
at the site of the traumatic right knee injury.  An April 1981
private medical record included his complaint that his right
lower extremity numbness was worsening.  A neurological
examination revealed that there was sensory hypalgesia over the
peroneal distribution.  The impression was possibility of right
peroneal neuropathy.  A December 1981 EMG confirmed the
involvement of the right peroneal nerve.

A VA treatment record from April 1982 revealed that the diagnosis
was right peroneal nerve entrapment neuropathy.  He underwent a
right peroneal nerve exploration, decompression and neurolysis.
The post surgical diagnosis was the same.

A private record from June 1982 contained the same complaints of
right lower extremity numbness.  It was noted that the most
recent EMG had noted no changes in the status of the right
peroneal nerve.  The assessment was status post peroneal nerve
decompression and peroneal nerve neuropathy on the right side.
Sympathetic blocks were performed in January 1983.  While this
made the foot feel warmer, it did not improve the pain.

A January to February 1983 VA examination contained the veteran's
history that he had injured his right knee in 1969.  He
experienced swelling in the knee, which eventually subsided;
however, right lower extremity numbness ensued.  During this
examination, he complained that he still had numbness at and
below the knee level; he also stated that his right leg
occasionally felt unstable.  The physical examination revealed
that the circumference of the right calf was about a quarter of
an inch smaller than the left.  There was an S shaped, six inch
scar along the lateral side of the right knee, which was numb to
pinprick.  The lower aspect of the right foot, particularly the
second and third toes, were quite cold.  The pedal pulses were
palpable.  His toes were numb upon testing.  Flexion of the third
and fourth toes seemed somewhat less complete than the left.  The
right knee flexed to 80 degrees, and extended to 180 degrees.
Patellar and ankle reflexes were present.  The diagnoses were
residuals of an injury to the right knee and right peroneal
neuritis.

A June 1983 VA outpatient treatment record included the veteran's
complaints of right leg numbness, pain, and weakness.  He stated
that he experienced pain that radiated from the lateral aspect of
the right hip, which occasionally radiated into the anterior
thigh down the leg to the lateral aspect of the foot and ankle.
His right knee was noted to be normal at that time.  The
diagnosis was peripheral neuropathy with post laminectomy
syndrome.

The veteran testified at two personal hearings in 1992, in
January and September.  During the January hearing he stated that
he had injured his right knee in an explosion.  During the
September hearing he said that between 1969 and 1990 he had
experienced repeated right leg give way.  He said that he had no
control over this extremity and was now forced to wear a brace.
He felt that his right leg give way was related to his right leg
injury.

The veteran submitted an April 1993 statement from his private
physician which stated that the veteran had suffered from right
lateral thigh and calf numbness ever since his 1969 accident in
service.  Since the initial injury, he had experienced episodes
of pain and right knee swelling.  His complaints continued and a
neurolysis was eventually performed.  However, his pain
continued.  It was noted that he had an abnormal gait due to the
right leg injury.  The assessment was right leg dysfunction
caused by the right leg injury.

A July 1993 VA x-ray revealed degenerative changes involving the
posterior horn of the right medial meniscus without a tear.  The
lateral meniscus appeared normal.  The ligaments were
unremarkable.  A September 1993 VA examination noted the
veteran's chief complaints of severe right lower extremity
instability and a limp.  The right lower extremity showed a
decrease in patellar and Achilles tendon reflexes.  An
examination of the right knee revealed that there was no swelling
of the joint.  Range of motion was 0 to 120 degrees.  Right foot
plantar flexion was to 30 degrees with dorsiflexion of 0 degrees.
It was noted that the veteran had right peroneal nerve disease
with decompression and subsequent complete foot drop for which he
wears a prosthesis.  The diagnoses were right external peroneal
nerve syndrome with surgical intervention; right leg peroneal
nerve inflammation and decompression of the peroneal nerve.

A private physician noted in September 1993 noted that the
veteran had been wearing a brace since the 1969 right lower
extremity injury to compensate for right leg weakness and
"turning in " of the ankle.  He underwent a right peroneal
decompression without significant improvement.  He was wearing a
lateral wedge to prevent inversion of the ankle.  The physical
examination revealed that he ambulated with a conventional cane
held in the left hand.  No distinct gait deviations were
appreciated.  The evaluation of the lower extremities revealed
normal musculature and normal range of motion.  No frank atrophy
or weakness was detected.  An EMG noted that all muscles of the
right lower extremity were normal.  The assessment was right leg
and knee pain.

A January 1994 neurological examination noted right peroneal
nerve dysfunction.  An EMG revealed that the right superficial
peroneal sensory demonstrated normal latency with borderline
decreased amplitude.  Plantar flexion was 5+ and dorsiflexion was
4+.  Dorsiflexion of the foot in eversion and inversion was 4+ as
well.  The ankle reflex was absent on the right.  The diagnosis
stated that the veteran had some mild weakness of the right foot
upon dorsiflexion, eversion and inversion.  This would correlate
with his complaints that his foot tends to turn in when he
removes the foot brace.  The diagnosis did not indicate the
presence of foot drop.  The February 1994 VA examination of the
right knee revealed no effusion or swelling.  Posterior lateral
pain was noted.  There was a large hypertrophic scar on the
posterior lateral aspect of the right knee extending into the
posterior proximal calf.  This was tender to palpation, though
there was no palpable swelling or masses.  There was a negative
Tinel's sign over this scar.  Range of motion was from 5 to 110
degrees.  The knee displayed no crepitus or varus and valgus
instability.  A July 1991 x-ray was reviewed, which was
essentially unremarkable except for the possibility of a small
chip fracture in the intercondylar notch.  The diagnosis was
chronic peroneal nerve injury of the right lower extremity.

In April 1994, the veteran's private physician noted that the
veteran's right leg was still unstable and required the use of an
AFO brace to stabilize the ankle.

After carefully reviewing the evidence of record, it is the
opinion of the undersigned that a 30 percent disability
evaluation under Diagnostic Code 8621 for the veteran's right
peroneal nerve injury is justified.  The record reveals that the
veteran suffers from incomplete paralysis of the nerve that is
severe in nature.  This is demonstrated by the fact that his
right foot "turns in" or inverts upon ambulation.  Furthermore,
this inversion of the foot has made it incumbent upon the veteran
to wear a brace in order to stabilize the ankle enough so that he
can walk without falling.  Signifi-cantly, the September 1993 VA
examination had also shown that plantar flexion was limited to 30
degrees, with dorsiflexion to 0 degrees.  He also experiences
persistent numbness in the right leg, with weakness and pain.
This evidence indicates that the residuals of this right peroneal
injury are severe in degree.

However, a 40 percent disability under this code is not
justified.  Significantly, it is noted that the veteran does not
suffer from complete paralysis of the right foot.  He does not
have foot drop, as noted by the January 1994 VA examination, nor
does he exhibit slight droop of the first phalanges of all toes.
What he does have is a difficulty with lateral motion of the
foot.  Further, the evidence does not indicate that extension of
the proximal phalanges of the toes and abduction of the foot are
lost.  Finally, he does not, based on the evidence, experience
anesthesia covering the entire dorsum of the foot and toes.
Hence, no more than a 30 percent disability evaluation is
warranted.

B.  A separate compensable rating for
residuals of injury to the right knee
joint.

Generally, the evaluation of the same disability under various
diagnoses is to be avoided.  Disability from injuries to the
muscles, nerves, and joints of an extremity may overlap to a
great extent, so that special rules are included in the
appropriate bodily system for their evaluation.  Dyspnea,
tachycardia, nervousness, fatigability, etc., may result from
many causes; some may be service connected, others, not.  Both
the use of manifestations not resulting from service connected
disease or injury in establishing the service connected
evaluation and the evaluation of the same manifestation under
different diagnoses are to be avoided.  38 C.F.R. § 4.14 (1994).

However, the United States Court of Veterans Appeals (Court) has
held that a disability can be assigned a separate disability
evaluations under different diagnostic codes, providing that the
symptomatology so rated is not duplicative or overlapping.
Esteban v. Brown, 6 Vet.App. 259 (1994).  Therefore, the
veteran's right lower extremity peroneal nerve disability will be
rated under Diagnostic Code 8621, which is based on Code 8521,
paralysis of the peroneal nerve.  The right knee joint disability
will be rated under Code 5257, which refers to impairment of the
knee.  Such a separate evaluation is permissible given that the
symptomatology addressed by these two disability codes is not
duplicative, and is warranted by the facts in this case.  38
C.F.R. § 4.25(b) (1994).  Slight impairment of either knee,
including recurrent subluxation or lateral instability, will be
rated 10 percent disabling.  For a 20 percent rating, a moderate
impairment of the knee is required.

It is the opinion of the undersigned that a separate compensable
evaluation for the residuals of the injury to the right knee is
warranted.  The most recent evidence of record demonstrates that
motion of the knee is limited from 5 degrees of extension to 110
degrees of flexion.  There is also some evidence of pain in the
joint, as is demonstrated by his complaints of posterior lateral
pain.  The record evidences slight degree of impairment of the
right knee, even though the complaints of instability are not now
confirmed on clinical examination.  The chip fracture is evidence
of the old trauma, but any resulting impairment from this
fracture is not shown.  However, no more than a 10 percent
disability evaluation is justified.  The evidence does not
indicate that the impairment of the knee is moderate in nature,
particularly in light of the amount of range of motion.  See, 38
C.F.R. § 4.71a, Diagnostic Codes 5260, 5261 (1994).

Additionally, the evidence does not indicate that additional
compensation is warranted on an extraschedular basis under 38
C.F.R. § 3.321.  This disability has not resulted in frequent,
repeated, periods of hospitalization, nor has it, standing alone,
caused marked interference with employment.

C.  Entitlement to an increased evaluation
for a duodenal ulcer with spastic colon.

The veteran's gastrointestinal disease is rated under Diagnostic
Codes 7305-7319.  38 C.F.R. §§ 4.27, 4.114 (1994).  For many
years, he has had ulcer disease, clinically identified in the
duodenum and rated under Diagnostic Code 7305.  38 C.F.R.
§§ 4.110, 4.114 (1994).  In the lower gastrointestinal tract, his
disability has been assessed as either an irritable bowel
syndrome or a spastic colon syndrome; in either case the
appropriate diagnostic code is 7319.  38 C.F.R. §§ 4.113, 4.114
(1994).  While the current 20 percent disability evaluation is
based on the ulcer disease, as set forth below we find that a
rating under Diagnostic Code 7319 would be more appropriate.

In the instant case, the veteran has in effect requested that an
increased evaluation be assigned to his duodenal ulcer with
spastic colon under either Diagnostic Code 7305 or 7319.
Diagnostic Code 7305, which rates duodenal ulcers, provides that
a 20 percent disability evaluation is warranted for a moderate
condition, manifested by recurring episodes of severe symptoms
two or three times a year averaging 10 days in duration, or with
continuous moderate manifestations.  A 40 percent evaluation
requires a moderately severe condition.  This is described as
less than severe but with impairment of health manifested by
anemia and weight loss, or by recurrent incapacitating episodes
averaging 10 or more in duration at least four or more times a
year.  A 30 percent disability evaluation for irritable colon
syndrome under Diagnostic Code 7319 requires that the condition
be severe in nature, manifested by diarrhea, or alternating
diarrhea and constipation, with more or less constant abdominal
distress.

A review of the service medical records reveals that the veteran
was seen in July 1968 for complaints of stomach pain.  At that
time there was no change in bowel movements.  The abdominal
examination was essentially normal, save for tenderness in the
lower quadrants and hyperactive bowel sounds.  The impression was
spastic colon syndrome.  By the 25th of that month, he was
complaining of abdominal pains that had lasted for five days.  He
noted that the pains were sharp in nature; he also reported an
intolerance to certain foods and coffee.  The abdomen was soft
and non-tender.  The impression was dyspepsia, rule out peptic
ulcer disease.  In November 1968, he presented with complaints of
a slight, sharp umbilical pain, which was throbbing in nature.
He noted that a bland diet had greatly helped in alleviating his
symptoms.  The objective examination found a mildly tender peri-
umbilical area.

As part of a VA examination performed in October 1969, an upper
gastrointestinal  (UGI) series was conducted.  This revealed that
the veteran's esophagus, stomach and duodenum appeared normal.
The physical examination showed that his abdomen was soft and
tender across the duodenum, mid-abdomen, and the left side of the
umbilical area.  No disease of the UGI tract was diagnosed.

An October 1974 private hospital report revealed that the veteran
was complaining of abdominal pain and diarrhea.  There was no
particular dyspepsia, nausea or vomiting.  The physical
examination revealed a moderate amount of tenderness in the left
lateral abdominal quadrant.  The impression was irritable bowel
syndrome.

In July 1976, the veteran was examined by VA.  A UGI series
showed that the duodenum was definitely deformed.  There was
slight tenderness on the left side of the abdomen.  The diagnosis
was active ulcer disease.  Throughout the 1970's, the veteran
continued to be treated for complaints of abdominal pain, and
diarrhea.  In 1976 he noted blood in the stool.  A March 1979 VA
examination referred to these complaints of recurrent abdominal
distress with diarrhea.  An UGI series was normal, except for a
minimal deformity of the duodenal bulb.  He displayed moderate
tenderness in the epigastrium and right lower quadrant.  The
diagnosis was duodenal ulcer with spastic colon.

A March to May 1980 VA examination report indicated that the
veteran still suffered from bloody, loose stool, accompanied by
nausea and a bloated feeling.  Again, an UGI series revealed
active ulcer disease in the duodenal bulb.  Another examination
performed by VA between January and February 1983 contained his
continuing complaints of epigastric distress, heartburn,
gaseousness, abdominal cramping and diarrhea with occasional
bright red blood.  He stated that his weight had slipped from 180
to 160 pounds.  The objective examination showed that his abdomen
was tender to palpation in both lower quadrants.  The sigmoid
colon felt spastic, and his epigastrium was sensitive.  The
diagnosis was peptic ulcer disease and spastic colon.

These symptoms persisted into 1990.  A VA outpatient treatment
record from September 1990 noted his chief complaints as sharp,
burning umbilical pain and nausea.  He also complained of
diarrhea with occasional bloody stool.  The abdomen was soft with
diffuse tenderness to palpation.  There were no masses or
organomegaly.  In January 1991, he was hospitalized by VA, at
which time dyspepsia, gastroesophageal reflux disease (GERD) and
a history of peptic ulcer disease were diagnosed.  Throughout
1991, his complaints of persistent, daily, occasionally bloody
diarrhea continued and probable irritable bowel syndrome was
diagnosed.

In January 1992, the veteran testified at a personal hearing.  He
stated that his stomach condition had progressively worsened
since 1990.  He noted that he suffered from constant diarrhea,
and experienced stomach cramps, heartburn, indigestion and gas.
He noted that his diarrhea occurred 5 to 6 times each day.  A
March 1992 VA outpatient treatment record confirmed the diagnosis
of irritable bowel syndrome.  An August 1992 flexible
sigmoidoscopy was normal.  Probable GERD was diagnosed, as was
diarrhea.

In a September 1992 personal hearing, the veteran stated that his
ulcer and his colitis had increased in severity.  He noted that
he was taking Zantac for his stomach trouble.  He also said that
he had to be cautious about what he eats.  He suffered from
heartburn, diarrhea, belching and abdominal cramps.

A September 1993 VA examination noted that the veteran did not
appear to be anemic or malnourished.  He stated that his diarrhea
was almost constant, occurring 4 to 5 times per day, with no
intermittent constipation.  This diarrhea was accompanied by
intestinal rumbling, eructation and flatulence.  The diagnosis
was spastic colitis.  Active peptic ulcer disease since 1968 was
also noted.  Again, he was not anemic and was without periodic
vomiting.  However, he did experience constant reflux.  There was
no current hematemesis or melena.  He complained of pain in the
epigastric area and left lower quadrant.  The diagnosis was
active peptic ulcer disease.

In January 1994, the veteran underwent an extensive evaluation by
VA.  The UGI examination recorded his complaints of nausea and
heartburn.  The objective examination noted that he did not
appear to be anemic.  He denied vomiting and recurrent
hematemesis or melena.  He experienced pain in the substernal
area, as well as under the left ribs.  The right lower quadrant
was noted to be constantly painful and tender.  The diagnosis was
some sort of acid peptic disease which is partially controlled
with antacids, Sucralfate, Cimetidine and Gaviscon.

An intestinal examination was also performed.  He recounted
experiencing 6 to 7 bowel movements per day.  At times there was
blood mixed with the stool.  He was not anemic or malnourished.
He noted that he occasionally had some constipation.  Tests were
negative for ova or parasites.  The flexible sigmoidoscopy showed
normal mucosa and random biopsies were within normal limits.  The
diagnosis was that he most likely suffered from irritable bowel
syndrome, although there was a possibility that he harbored a
pathogen that had not been discovered through conventional tests.

VA outpatient treatment records developed between October 1993
and April 1994 noted that he continued to complain of suffering
from 6 to 7 bouts of diarrhea each day.  This was accompanied by
abdominal cramping, gas, heartburn and belching.  The impression
was that his condition was beginning to sound like irritable
bowel syndrome with alternating constipation and diarrhea with
cramps and bloating.

After a careful review of the evidence of record, it is the
opinion of the undersigned that a 30 percent disability
evaluation under Diagnostic Code 7319 is warranted.  As noted
above, a 30 percent disability under this code requires that
there be severe irritable colon syndrome manifested by diarrhea,
or alternating diarrhea and constipation, with more or less
constant abdominal distress.  The evidence in the case clearly
shows that he experiences constant diarrhea, abdominal distress
and pain.  Hence, the disability picture presented here more
closely approximates the higher disability evaluation under this
code.  38 C.F.R. § 4.7 (1994).

However, a 40 percent disability evaluation under Code 7305 for
the veteran's ulcer disease is not warranted.  The symptoms of
this aspect of his gastrointestinal disability are no more than
moderate in degree.  He has not demonstrated impairment of health
manifested by anemia and weight loss as required to justify a 40
percent disability rating.  38 C.F.R. § 4.112 (1994).  While he
does have symptoms associated with ulcer disease, and
gastrointestinal reflux, the recent medical evidence does not
show periodic vomiting or recurrent hematemesis or melena.
Moreover, he has no evidence of incapacitating episodes averaging
10 or more days in duration at least four times a year.
Therefore, a higher disability evaluation under this code is not
justified.

Nor does the evidence of record establish that an extraschedular
evaluation is warranted under 38 C.F.R. § 3.321.  The disability
in question has not resulted in frequent periods of
hospitalization.  While this disability may contribute to his
difficulties maintaining employment, it alone has not caused
marked interference with employment.

In conclusion, the evidence of record supports a finding of
entitlement to a 30 percent disability evaluation for his peptic
ulcer disease with spastic colon.

D.  Entitlement to a separate rating for a
spastic colon.

It has already been noted that, generally, the evaluation of the
same disability under various diagnoses is to be avoided.
Disability from injuries to the muscles, nerves, and joints of an
extremity may overlap to a great extent, so that special rules
are included in the appropriate bodily system for their
evaluation.  Dyspnea, tachycardia, nervousness, fatigability,
etc., may result from many causes; some may be service connected,
others, not.  Both the use of manifestations not resulting from
service connected disease or injury in establishing the service
connected evaluation and the evaluation of the same manifestation
under different diagnoses are to be avoided.  38 C.F.R. § 4.14
(1994).

According to Esteban v. Brown, 6 Vet.App. 259 (1994), in
determining whether a separate rating is justified, it must be
determined that none of the symptomatology of the conditions in
question is duplicative or overlapping.  As has been clearly set
forth in our grant of an increased rating for the veteran's
gastrointestinal disability, there are symptoms of both ulcer
disease and the irritable bowel or spastic colitis.

The veteran stated during his September 1992 hearing that this
condition has been identified as colitis and should, therefore,
be service connected as a distinct disability.  During his
September 1994 personal hearing, he stated that the spastic colon
symptoms had been present since service and should be separate
from his duodenal ulcer disability.

However, it is the opinion of the undersigned that assigning a
separate evaluation for this disorder would violate the specific
regulatory prohibition set forth in 38 C.F.R. § 4.114 (1994).
The Board is bound by the regulations.  The upper and lower
gastrointestinal disabilities are rated under codes included in
the range cited, from 7301 to 7329.  We have, by this decision,
rated the predominant disability picture, and assigned an
increased rating under Diagnostic Code 7319 based on the more or
less constant distress he experiences.  We also found that the
overall disability picture does not warrant elevation to the next
higher evaluation, 40 percent under Diagnostic Code 7305, since
the criteria are not met.  Finally, the Schedule for Rating
Disabilities contains express prohibitions against awarding
separate ratings; in this instance, a rating under Code 7305 may
not be combined (38 C.F.R. § 4.25 (1994)) with a rating under
Code 7319.  See Bierman v. Brown, 6 Vet. App. 125, 130; Crowley
v. Brown, No. 92-1329 (U.S. Vet. App. Sept. 20, 1994).
Accordingly, a separate rating for the irritable bowel/spastic
colon disease must be denied.

E.  Entitlement to an increased evaluation
for a right inguinal area scar.

According to Diagnostic Code 7805, scars are to be rated based
upon the limitation of function of the affected part.  In the
case of superficial scars a 10 percent disability evaluation is
warranted for those that are poorly nourished with repeated
ulceration, 38 C.F.R. Part 4, Code 7803 (1994), or which are
tender and painful on objective demonstration.  38 C.F.R. Part 4,
Diagnostic Code 7804 (1994).

A review of the service medical records revealed that the veteran
began to complain of a painful lump in the right inguinal area in
July 1966.  This was tender to palpation.  By September 1966,
right inguinal adenopathy was diagnosed.  He continued to treated
for this condition, and in July 1967, this node was dissected.
His separation examination referred to bilateral hernia scars.

The veteran was examined by VA in October 1969.  This examination
noted the presence of a one inch right inguinal scar, the result
of the removal of a lymph node in service.  No other findings in
relation to this scar were noted.  The diagnosis was scar,
excision lymph nodes, right inguinal scar.  A July 1976 VA
examination noted bilateral groin scars.  No tenderness, pain or
ulceration was noted.  The diagnosis was scar, post-operative,
right inguinal area.

The veteran testified at a personal hearing in September 1992
wherein he initially stated that he had had no trouble with his
right inguinal scar.  He then testified that all of the scars on
his body were sensitive.  He said that this right inguinal scar
would often ache, although he referred to no specific treatment
for this scar.

After carefully reviewing all of the evidence of record, it is
the opinion of the undersigned that a compensable evaluation for
a right inguinal scar is not warranted.  The evidence does not
show that this scar is poorly nourished with repeated
ulcerations, nor that is it painful and tender upon objective
demonstration, as would be required to justify a 10 percent
disability evaluation.  While the veteran claimed during his
September 1992 hearing that this scar was sensitive, the
objective medical evidence does not substantiate this assertion.
On the contrary, no objective findings were ever made as to this
scar, except to note its existence.  Therefore, it is concluded
that the preponderance of the evidence is against the veteran's
claim for entitlement to a compensable evaluation for his right
inguinal scar.

Nor does the evidence of record establish that an extraschedular
evaluation is warranted under 38 C.F.R. § 3.321.  The disability
in question has not resulted in frequent periods of
hospitalization.  Nor is there any indication that this
disability has caused marked interference with employment.

In conclusion, a compensable evaluation for his right inguinal
scar is not warranted.

III.  Secondary service connection claims

Under the applicable criteria, service connection may be granted
for disabilities which are proximately due to or the result of a
service connected disease or injury.  38 C.F.R. § 3.310(a)
(1994).

A.  Entitlement to a separate grant of
service connection for right foot drop as
secondary to service connected right
peroneal neuritis.

The veteran has claimed that he now suffers from right foot drop
as a direct consequence of his right peroneal nerve injury.

VA outpatient treatment records developed between July and
October 1990 contained an August notation that the veteran had
right foot drop and peroneal nerve hypesthesia.  In September,
foot drop from his peroneal nerve injury was noted.  He was
wearing a brace on this extremity.  In October, he was noted to
have right foot drop.

During a September 1992 personal hearing, the veteran testified
that he had had foot drop ever since the original injury, but
that it had not been diagnosed until 1990.  When asked if he
could move his toes upward, he responded that his foot was bent
inward.  He asserted that he had to wear a brace to keep his foot
immobile.  He commented that his right ankle was completely
useless, that he had no voluntary use of this joint.

A VA examination was conducted in September 1993.  The veteran's
chief complaint was that he had foot drop.  The physical
examination reported that he had right foot drop.  Plantar
flexion was to 30 degrees and dorsiflexion was 0 degrees.  The
diagnosis was right foot drop secondary to peroneal nerve
disease.

The veteran underwent an extensive neurological examination
performed by VA in January 1994.  This examination noted that the
veteran was wearing an in-shoe foot  brace that extended to the
knee; he stated that he wore this device to maintain stability in
the right lower extremity.  Plantar flexion was 5+ and
dorsiflexion was 4+.  Dorsiflexion of the foot in eversion and
inversion was 4+ as well.  The ankle reflex was absent on the
right.  The diagnosis stated that the veteran had some mild
weakness of the right foot upon dorsiflexion, eversion and
inversion.  This would correlate with his complaints that his
foot tends to turn in when he removes the foot brace.  The past
diagnoses of "foot drop" were noted.  However, it was noted this
diagnosis may not be fully appropriate considering the degree of
strength he has and the lack of EMG evidence or visual evidence
of changes in the right leg.

A private physician noted in April 1994 that the veteran had
right foot drop.  This was allegedly related to his right
peroneal nerve injury.

In September 1994, the veteran testified at a personal hearing,
at which time he reiterated his contention that he has had to
wear a brace since the knee injury to prevent the foot from
inverting.  He went on to state that he was able to dorsiflex the
right foot; in other words, he was able to raise it up.  He then
said that without the brace he is able to flex the foot but that
he has no lateral control.  In fact, without this foot brace he
would fall.

After carefully reviewing the evidence of record, it is the
conclusion of the undersigned that entitlement to a separate
grant of service connection for right foot drop secondary to his
peroneal nerve injury is not warranted.  Initially, we observe
that while "foot drop" was diagnosed in the past, the recent and
extensive VA neurological examination performed in January 1994
did not confirm this diagnosis.  It was noted that the veteran
did have some mild weakness on dorsiflexion, inversion and
eversion of the right foot.  This was noted to be consistent with
his complaints that the foot "turns in" without a foot brace.
However, the objective examination with the brace removed was not
consistent with a diagnosis of foot drop.  The veteran was noted
to be able to dorsiflex and flex the right foot.  Moreover, the
motor strength tests revealed a degree of strength that would not
be present if he had foot drop.  Finally, the veteran admitted
during his September 1994 personal hearing testimony that he was
able to raise the foot upward.  Clearly, the preponderance of the
evidence is against a finding that the veteran actually has foot
drop in the sense that the foot dangles and drops as a result of
a lack of active muscle movement due to the peroneal nerve
impairment.

Further, the right foot impairment that is demonstrated is
already service-connected, and we have recognized the severity of
the disability by granting a 30 percent evaluation for the
peroneal nerve injury residuals under the appropriate diagnostic
code.  Our finding of a severe, incomplete paralysis was based in
large measure on the right foot impairment.  To grant separate
service connection for the peroneal nerve impairment of the right
foot, and rate the right foot separately under a musculoskeletal
or muscle injury code would be overlapping and duplicative of the
manifestations now rated under the appropriate peroneal nerve
code.  38 C.F.R. § 4.55(g) (1993).  This would constitute
pyramiding.  38 C.F.R. § 4.14 (1994).  Accordingly, separate
service connection and rating for the veteran's right foot
(peroneal nerve) disabilities is not warranted.  Bierman v.
Brown, 6 Vet. App. 125 (1994); Crowley v. Brown, No. 92-1359
(U.S. Vet. App. Sept. 20, 1994).

B.  Entitlement to service connection for a
right wrist disability as secondary to his
service connected right lower extremity
disabilities.

A review of the record reveals that, while incarcerated in March
1990, the veteran slipped and fell in the shower, injuring his
right wrist.  A private treatment record from June 1990 indicated
that he had either slipped on a substance on the floor or fell
due to his leg giving out.  The shower was not equipped with
railings and the veteran fell on his outstretched arm.

VA outpatient treatment records developed between July and
October 1990 noted the history of the March 1990 fall.  He was
placed in several splints and a cast, but was placed in only a
thumb spica from May to June 1990.  The physical examination
revealed positive snuff box tenderness and swelling; there was
pain upon movement of the thumb and wrist.  A July 1990 x-ray
revealed a radiolucent shadow on the navicular, most likely due
to a partial division of the navicular bone rather than a
fracture.  An August wrist tomogram showed no nonunion of the
scaphoid, although snuff box tenderness was still present.  A
September x-ray, which provided a poor view, suggested that union
was occurring.  However, by October, it was noted that there was
still nonunion with significant sclerosis.  The physical
examination revealed a tender snuff box and a tender radial
tubercle.  The assessment was healing dorsal scaphoid fracture.
It had been suggested that the veteran had fallen because of his
right leg.

The veteran submitted statements from private physicians dated in
January 1991.  Each of these provided the opinion that the
veteran experienced problems with ambulation due to his right
lower extremity disability and that this disability caused him to
fall frequently.  It was also stated that he had developed reflex
sympathetic dystrophy in the right wrist, which was noted to be
an incapacitating disease.

During a January 1991 examination, the veteran's right wrist was
noted to be in a splint.  There was minimal to no swelling.  He
was capable of performing 70 degrees of extension, 30 degrees of
flexion, 35 degrees of ulnar deviation, and 15 degrees of radial
deviation upon passive motion.  Active motion revealed 45 degrees
of extension and 25 degrees of flexion.  Supination and pronation
were limited.  Grip strength was poor.  The assessment was of
weakness and decreased range of motion due to a long period of
immobilization.  The diagnosis was still unclear.  In March, the
splint had been removed, although he continued to complain of
pain.

A private EMG performed in April 1991 noted some weakness in the
anterior interosseous nerve distribution, with mild abnormality
of the muscle group supplied by the nerve.  A May 1991 x-ray
report revealed a tiny spur on the distal portion of the fifth
distal phalanx.  The June 1991 MRI report noted that a November
1990 MRI of the right wrist revealed no significant abnormality;
the 1991 study revealed no evidence of reflex sympathetic
dystrophy.

A July 1991 physical examination noted that it was unlikely that
the veteran was suffering from reflex sympathetic dystrophy
(e.g., there were no pathogenic skin changes).  However, he still
complained of right elbow and wrist pain  An MRI and a cervical
thermogram were negative.  No source for the elbow and scaphoid
pain could be identified.  Some improvement was noted in
September, although he continued to refer to diffuse upper
extremity pain.  Again, it was noted that his symptoms were not
characteristic of reflex sympathetic dystrophy.  An October
clinical examination mentioned his persistent complaints of upper
extremity pain.  There was acute pain over the snuff box and a
positive Finkelstein's test.  The shoulder displayed decreased
range of motion but the right hand was not cold or discolored.
It was felt that his major problems included tendonitis, medial
and lateral epicondylitis, DeQuervain's tendonitis and
infraspinatus tendonitis.  Nerve conduction studies and EMG tests
were consistent with posterior and anterior interosseous nerve
dysfunction.

VA outpatient treatment records from September to December 1991
revealed his continuing complaints of tenderness and numbness in
the epicondyle area.  The September clinical examination was not
convincing for reflex sympathetic dystrophy.  In October,
decreased pinprick sensation was noted, as was tenderness over
the lateral epicondyle.  In December numbness on the right thumb
and the right fifth finger were present.

During a January 1992 personal hearing, the veteran stated that
he was in the shower, which had no handrails, when his leg gave
out.  He attempted to catch himself; instead, he fell and broke
his wrist.

The veteran testified at another personal hearing in September
1992 wherein he again stated that he had fallen in the shower,
suffering a right wrist fracture, because of the instability of
his right leg.

A March 1993 VA outpatient treatment record indicated that the
veteran had a very complicated history of pain in the right
wrist, elbow and hand.  All tests provided negative results,
although a provisional diagnosis of reflex sympathetic dystrophy
had been made.  He had decreased grip strength, and deep tendon
reflexes were 2/4 bilaterally with complaints of pain upon elbow
motion.  An x-ray found no evidence of a fracture or of
degenerative changes.

The veteran was provided with an extensive VA examination
performed in January and February 1994.  The January neurological
examination noted his complaints of numbness in the right arm, as
well as discomfort.  Motor testing revealed generalized weakness
in this extremity at full flexion and extension.  There was also
mildly decreased sensation particularly in the first three digits
of the right hand.  An EMG study was normal.  The diagnosis noted
that these right upper extremity problems appeared to be
secondary to the past right elbow and hand injuries.  The
physical examination showed that the veteran complained of
tenderness to palpation over the dorsal radial wrist and at the
first carpal metacarpal joint.  He displayed 5/5 strength in the
abductor pollicis longus and extensor pollicis longus muscles.
Several past x-rays were reviewed and there was no evidence of
previous fractures or dislocations.  The diagnosis was chronic
pain of the right distal radius and wrist joint of unclear
etiology other than probable synovitis.

After a careful review of the evidence of record, it is the
opinion of the undersigned that entitlement to service connection
for a right wrist disability secondary to the veteran's service
connected right lower extremity disabilities is not warranted.
The objective evidence of record supports a finding that the fall
in March 1990 was not due to instability of either the right
ankle or right knee joints.  The evidence of record shows that,
despite some inversion of the right ankle, the right ankle joint
was fairly strong (as is evidenced by the January 1994 VA
examination).  Also, while he states that the right knee was
subject to give way, there is no objective evidence to support
this contention; no instability has been found on examination.
The opinions of the private physicians that his fall was caused
by his leg are noted; however, these opinions were based upon the
history of the fall as provided by the veteran.  We accept as
most probative of the circumstances the earlier recorded history
that he had either slipped on a substance on the floor or his leg
had given out.  Considering the fact that the veteran maintains
good strength in the right lower leg, we are persuaded that the
environment, a shower with a likelihood of a slippery floor,
provides the best explanation of the cause of the fall.
Therefore, it is concluded that the preponderance of the evidence
is against the veteran's claim for service connection for a right
wrist disability as secondary to his service connected right
lower extremity disabilities.

C.  Entitlement to service connection for a
low back disability secondary to the
service connected right lower extremity
disabilities.

The veteran has contended that his right peroneal nerve injury
has caused his leg to give way, resulting in back injuries.  He
asserts that these injuries resulted in a chronic back
disability.  Therefore, service connection should be granted.

The objective evidence reveals that the veteran was admitted to a
private hospital in August 1975 complaining of back and right leg
pain.  He stated that he had injured his back while at work on
July 18, 1975.  He recounted that he had fallen backwards,
striking his back and his leg on a fare box on a bus.  According
to the veteran, he had never had any trouble with his back prior
to this.  Significantly, he made no mention of his fall being
caused by his right lower extremity.

In December 1980, the veteran suffered another back injury at the
Post Office, his place of employment.  He apparently slipped on
some grease or water spillage.  Again, no mention was made of his
right lower extremity as a contributing factor in his fall.

Throughout the 1980's, the veteran continued to complain about
back pain.  A January to February 1983 VA examination noted his
contention that he had fallen in 1979 after his right leg gave
out in him.

In January 1991, the veteran's private physicians agreed with him
that his right leg disability was responsible for the development
of a back disorder.  One reported that the veteran's abnormal
gait had caused a back disability to begin.  The other opinion
reported that the veteran's back disability was related to his
right peroneal nerve injury.

In January 1992, the veteran testified at a personal hearing.  He
stated that at the time that he injured his back at the Post
Office in December 1980, he had had trouble with his right leg
giving out on him.  He admitted that this fall had been caused by
his slipping in some grease or water on the floor.  However, he
asserted that the fall was caused, at least in part, by his right
leg difficulties.  At his September 1992 hearing, the veteran
alleged that both the 1975 and the 1980 falls had been the result
of his right leg giving way.

In April 1993, a private physician wrote that the veteran's
abnormal gait, that was the result of his peroneal nerve injury,
would increase the strain on his low back.  This increasing
strain would, in turn, result in chronic degenerative changes
which would further compromise his back functioning.

Finally, the veteran testified at a personal hearing before the
Board in September 1994, at which time he stated that the record
indicated that his abnormal gait, the result of the peroneal
nerve injury, had caused his back to deteriorate.  He also
asserted that his peroneal nerve injury had aggravated his
congenital stenosis.

After carefully reviewing the evidence of record, it is the
opinion of the undersigned that entitlement to service connection
for a back disorder secondary to his service connected peroneal
nerve injury is not warranted.  Initially, it is noted that the
veteran injured his back on two occasions, in 1975 and 1980, in
falls that occurred at his places of employment.  The exact cause
of the 1975 fall was not indicated, other than he had fallen
backwards and struck his low back and leg.  However, what is
significant is that, at the time of the August 1975
hospitalization for this injury, the veteran made no reference to
being plagued by right leg instability that was resulting in
falls, despite the fact that the time of treatment on the back
would have been an ideal time to seek treatment for his leg.
Moreover, no mention was made of the veteran suffering from an
abnormal gait.

The veteran then suffered an additional fall in 1980 at the Post
Office.  The record pertaining to this fall clearly indicates
that he had slipped on either grease or water on the floor.  No
mention was made of an abnormal gait, nor did the contemporaneous
record refer to right leg give way.

The veteran's private physicians, in the late 1980's and 1990's,
rendered their opinions that the veteran now suffers from
degenerative changes in the back because of falls that occurred
due to an abnormal gait and right leg give way caused by his
right peroneal nerve injury.  However, the contemporaneous
records pertaining to these falls made absolutely no reference to
right peroneal nerve injury symptoms as being the precipitating
factors in his falls.  Rather, each fall appeared to be caused by
environmental factors.  These physician's opinions were based
upon history given by the veteran.  The Board is not required to
accept these opinions, where there are discrepancies regarding
the injuries, and the opinions are based on the history provided
by the veteran to the physician.  Swann v. Brown, 5 Vet.App. 229,
233 (1993).

It is therefore concluded that the objective evidence of record
does not suggest that the residuals of the veteran's service
connected right peroneal injury played any role in his low back
injuries.  In fact, no residuals of this service connected
disability, such as an abnormal gait, were referred to at the
time of the 1975 and 1980 injuries.  While he may now suffer from
degenerative changes, these changes, as well as any other chronic
disability of the low back, appear more likely from the record to
be the result of these injuries, which, as noted, were not
related to his service connected right lower extremity
disability.  Therefore, it is concluded that the preponderance of
the evidence is against the veteran's claim for service
connection for a low back disability as the result of his service
connected right peroneal nerve injury.

IV.  New and material evidence claims

The applicable criteria state that a notice of disagreement shall
be filed within one year from the date of mailing of the
notification of the initial review and determination; otherwise,
that determination will become final and is not subject to
revision on the same factual basis.  The date of the notification
will be considered the date of mailing for purposes of
determining whether a timely appeal has been filed.  38 U.S.C.A.
§ 7105 (West 1991); 38 C.F.R. §§ 3.104(a), 20.302 (1994).  If new
and material evidence is presented or secured with respect to a
claim which has been disallowed, the Secretary shall reopen the
claim and review the former disposition of the claim.  38
U.S.C.A. § 5108 (West 1991).  "New and material evidence" means
evidence not previously submitted to agency decisionmakers which
bears directly and substantially upon the specific matter under
consideration, which is neither cumulative nor redundant, and
which by itself or in conjunction with evidence previously
assembled is so significant that it must be considered in order
to fairly decide the merits of the claim.  38 C.F.R. § 3.156(a)
(1994).

A.  Whether new and material evidence has
been submitted to reopen a claim of
entitlement to service connection for a low
back disability.

Service connection may be granted for a disability the result of
disease or injury incurred in or aggravated by service, 38
U.S.C.A. § 1110 (West 1991), or, when a veteran has served 90
days or more during a period of war, and arthritis becomes
manifest to a compensable degree within one year following
separation, such disease shall be presumed to have been so
incurred, even though there is no evidence of such disease during
the period of service.  This presumption is rebuttable by
affirmative evidence to the contrary.  38 U.S.C.A. §§ 1101, 1112,
1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994).

The evidence which was of record when the RO considered this
issue in 1981 will be briefly summarized.  The service medical
records are completely silent as to any low back disability.
While they refer to a neck and shoulder injury, no mention is
made of the low back.

A VA examination performed in October 1969 contained no reference
to any complaints concerning the low back.  The objective
examination of the back was completely normal.

A private hospital record from August 1975 revealed that the
veteran was admitted after injuring his low back in a fall at his
place of work.  He noted that he had fallen backwards, striking
his back against a fare box on a bus.  He apparently twisted his
back, developing severe back pain.  According to the veteran he
had had no back trouble prior to this injury.  There were no
radicular symptoms.  The physical examination found tenderness to
palpation in the right L5 to S1 area with mild paravertebral
muscle spasm.  Flexion was limited to 50 degrees, and extension
was to 15 degrees.  Straight leg raises were negative
bilaterally.  A neurological examination was within normal limits
and x-rays revealed no definite bone or joint abnormality.  The
diagnosis was acute lumbosacral strain.  A June 1976 VA
examination, while containing an orthopedic examination of his
right knee, made no mention of a back disability.  In fact, all
other joints were normal.  A private outpatient treatment record
from April 1981 noted his complaints of a backache that had
developed three days before.

In November 1981, the RO issued a rating action which denied
entitlement to service connection for a back disability.  This
decision stated that the veteran's service medical records were
completely silent as to any complaints of or treatment for a back
disability.  Moreover, the veteran had not been treated for a
chronic back disorder following his discharge from service.
Therefore, service connection was denied.

The evidence submitted since the November 1981 denial of this
issue included private treatment records developed between April
1981 and January 1983.  In April 1981, the veteran alleged that
he had injured his back in an explosion which destroyed a jeep in
which he was riding.  He said that he hurt his right leg and
noticed the onset of mild low back pain.  Since that time, he had
fallen at the Post Office in December 1980, which had caused the
back pain to worsen.  The neurological examination revealed that
he displayed sensory hypalgesia over the L5-S1 distribution on
the right.  There was mild tenderness over the sciatic notch and
deep tendon reflexes were normal.  The impression was lumbar
nerve root compression to be ruled out.  Throughout 1981 and
1982, the veteran continued to seek treatment for a painful low
back.  In 1981, he underwent a lumbar diskectomy.

In November 1988, the veteran was examined by a private
physician.  Again, he reported the history of injuring his low
back in an explosion in service.  He stated that he exacerbated
this injury in service when he was involved in a motor vehicle
accident in 1969.  His chief complaints revolved around pain in
the low back, which radiated down the right side.  A sensory
examination revealed global hypalgesia throughout the entire
right lower extremity.  Diminished range of motion in the low
back was noted.  A CT scan revealed congenital stenosis, as well
as marked degenerative stenosis.  The impression was post-
laminectomy syndrome.

In August 1989, a private examination noted the veteran's
complaint that he had developed burning pain and numbness in the
left leg.  His low back had decreased range of motion, although
his reflexes were normal, save for the right ankle jerk, which
was absent.  A CT scan revealed congenital stenosis and facet
hypertrophy which was causing a L5 root filling defect.  The
impression was recurrent pain, with a suggestion of S1
radiculopathy on the left.

Numerous VA outpatient treatment records developed between May
1981 and July 1992 revealed the same type of complaints from the
veteran.  These records also contained his allegation that he had
originally injured his back in an explosion in 1967, while
serving in Vietnam.  His low back pain, radiculopathy and
limitation of motion were persistent.  These problems were
resistant to various type of treatment, including conservative
therapies and surgical intervention.  A July 1992 x-ray revealed
a gross annular bulge at L4-5 on the left, transversing the left
L5 neural nerve sleeve; a developmentally narrow spinal canal;
and a small laminectomy defect on the right side without
significant post surgical scarring.

A March 1993 MRI found no evidence of disc herniation; rather, it
noted the presence of enhancing scar tissue at the L4-5 and L5-S1
levels, and spinal stenosis at L2-3, predominantly congenital in
nature.  In April 1993, a private physician noted that the
veteran had injured his back in December 1980 when he fell while
working at the Post Office.  This resulted in chronic back pain
and the development of a herniated disc at the L4-5 level.  It
was noted that conservative treatment was tried; when this
failed, a laminectomy was performed in 1982.  In 1988, a car
accident exacerbated his back pain.  Tests showed spinal stenosis
from L2 through L5, with post operative changes at L5 to S1.  By
1989, S1 radiculopathy was suggested and limited range of motion
was present.  He had congenital narrowing of the spinal canal
which was complicated by the development of a herniated disc at
L4-5.  In September 1993, the veteran's private physician noted
the history of being injured in an explosion in 1968.

The veteran was examined by VA in September 1993, at which time
he complained of constant low back pain that radiated down the
left leg more than the right.  He displayed decreased sensation
in the extremities.  He had left lower extremity peripheral
neuropathy secondary to marked discogenic disease.  Range of
motion studies were not done since he had marked instability
without his cane.  The diagnosis was L4-5 and L5-S1 congenital
stenosis with a history of fasciectomy, laminectomy and
diskectomy.

The veteran underwent an extensive examination by VA in January
and February 1994.  During this examination he again stated that
he had hurt his back in an explosion that occurred in 1967 or
1968 while he was in the military.  The January 1994 neurological
examination revealed complaints of bilateral leg numbness.  Some
mild spasm in the left paravertebral and lower sacral areas was
noted.  Straight leg raises were negative.  Full range of motion
was not possible due to instability.  The sensory examination
revealed generalized hypoesthesia over both legs but without any
specific neurologic distribution.  Vibratory sense was also
decreased.  The diagnosis noted that the veteran's lower
extremity symptoms were difficult to explain.  They were noted to
be likely due to post laminectomy syndrome.  There was no
evidence of a major neurologic dysfunction.

The orthopedic examination conducted in February 1994 diagnosed
lumbar spine degenerative changes; status post L4-5 lumbar
laminectomies, possible lateral transverse process fusion from
L4-S1 with chronic lumbar mechanical back pain.

A private physician noted in April 1994 that the veteran suffered
from congenital spinal stenosis.  He opined that this stenosis
was aggravated by his period of service.

After a careful review of the complete record, it is the opinion
of the undersigned that the additional evidence which the veteran
has submitted is not "new and material."  Accordingly, his claim
is not reopened and the Board's 1981 decision remains final.

"New" evidence means more than evidence which was not previously
physically of record.  To be "new," additional evidence must be
more than merely cumulative.  Colvin v. Derwinski, 1 Vet.App. 171
(1991).  The additional evidence presented in this case is only
cumulative.  The evidence previously of record indicated that the
veteran never complained of a back injury in service, nor was he
treated for one.  A post service VA examination had found that
the back was normal.  The first notation of back pain was not
noted until after he injured his back at work in 1975.  Even so,
a VA examination performed in 1976 found the back to be normal.
The evidence submitted after the 1981 denial, while containing
his unsubstantiated history of suffering a back injury during an
explosion in 1967, show nothing more.  These records do not
establish, through objective evidence, that he ever experienced
an injury in service.  Moreover, these records do not show that
any degenerative changes in the low back were present to a
compensable degree within one year of his separation.

Similarly, the additional evidence is not "material."  Assuming,
without deciding, that the additional evidence is relevant and
probative, there is no reasonable possibility that the additional
evidence, when viewed in context with all the evidence, both old
and new, would change the outcome.  See Colvin and Smith v.
Derwinski, 1 Vet.App. 178 (1991).  The additional evidence
contains no objective proof that the veteran suffered a back
injury in service, nor does it establish that any arthritic
condition manifested to a compensable degree within one year
following discharge.  The service medical records leave no doubt
that no back injury was ever complained of by the veteran.  These
records are absolutely silent as to back injury.  While the
veteran has alleged that he was injured in an explosion in 1967,
the objective record does not corroborate this.  What the record
does show is that he injured his low back in 1975 after falling
at work.  He re-injured his back in 1980 when he slipped on a wet
surface at his job with the Post Office.  It was after these two
events that the veteran began to suffer from chronic low back
pain.  Moreover, none of the evidence suggests that degenerative
changes were present to a compensable degree by June 1970 (one
year after his separation).  It has been noted that the veteran
has congenital stenosis of the lower spine.  However, this is a
developmental defect for which service connection cannot be
granted by regulation.  38 C.F.R. § 3.303(c) (1994).  Therefore,
it is found that the veteran has submitted no objective evidence
that would tend to link his current back disability to an event
in service.  It is the conclusion of the undersigned that new and
material evidence which would serve to reopen this claim has not
been submitted.

B.  Service connection for PTSD.

In order to establish entitlement to service connection for PTSD,
there must be medical evidence establishing a clear diagnosis of
the condition, credible supporting evidence that the claimed
inservice stressor actually occurred, and a link, established by
medical evidence, between current symptomatology and the claimed
inservice stressor.  38 C.F.R. § 3.304(f) (1994).

After carefully reviewing the evidence of record, it is the
conclusion of the undersigned that the evidence submitted since
the October 1983 decision by the RO is new and material.  The
evidence submitted, numerous medical records and a statement from
the Environmental Support Group, includes new and material
evidence.  That is, it is evidence which has not previously been
considered and which is relevant and probative of the issue being
considered.  Colvin v. Derwinski, 1 Vet.App. 171 (1991).  It is
apparent that this evidence, when viewed in the context of all
the evidence of record, might change the outcome of the decision.
Given this determination, the claim is reopened and the entire
evidence of record must be considered in determining whether
entitlement to service connection is warranted.

The record revealed that the veteran's primary occupation during
his period of service was as a military police officer.  He
received three National Defense Service Medal, the Vietnam
Service Medal, and the Republic of Vietnam Campaign Medal.  There
is no indication that he received any combat badges.

A review of the service medical records revealed no complaints of
or treatment for a psychiatric disorder.  After service, the
veteran underwent a psychiatric evaluation by VA in June 1983.
During this examination, he stated that he witnessed some
terrible things while he was stationed in Vietnam.  He stated,
for example, that his best buddy had had his head shot off and
that he had gotten splattered with the blood.  He said that he
saw children shot which, to his consternation, he had begun to
enjoy.  The mental status examination revealed that he was a
plethoric person, with no delusions or hallucinations.  He
reported poor sleep, that was plagued by dreams of Vietnam.  He
was moody and short-tempered.  It seemed obvious to the examiner
that the veteran had post traumatic stress neurosis.

VA outpatient treatment records developed between June 1990 and
February 1991 revealed that in June 1990 he recounted
experiencing anger and violent episodes.  These episodes were
related to events that occurred in Vietnam.  The assessment was
adjustment disorder with depressed mood versus major affective
disorder; rule out PTSD.  On November 8, 1990, he complained of
sleep problems.  He stated that he had been an MP in the service
and that his duties varied.  He reported an incident when he was
supposed to go on patrol; however, he was not feeling well and a
buddy replaced him.  The jeep that they were riding in was hit
with mortar fire and the men were killed.  The veteran said that
he was on the patrol that found their bodies.  He also said that
he saw combat in the TET offensive.  He felt that he should have
died in Vietnam.  The mental status examination noted that his
speech was well organized and that he displayed no evidence of
psychotic disorganization.  There were suicidal thoughts present,
but there was no intent.  He also had thoughts of harming others,
but had no intent of doing so.  He commented that he avoided any
materials, particularly movies, that would remind him of the war.
He also reported survival guilt.  The assessment was of symptoms
consistent with PTSD.  On the November 16, it was noted that his
War Stress Inventory results were also consistent with a finding
of PTSD.  The assessment was severe PTSD and alcohol abuse.  On
December 5, he noted that he was increasingly irritable and
experiencing combat content nightmares.  He was placed on
Clonazepam and was advised against alcohol use.  On February 11,
1991, he reported to his session with complaints of agitation,
depression and nervousness.  He displayed the same symptoms of
PTSD.  He recounted increased agitation, and more recall of
Vietnam experiences.  He also complained of a startle response.
It was noted that therapy had brought out and somewhat worsened
some of his PTSD symptoms.  He apparently suffered from gruesome
nightmares.  He was demanding, argumentative, angry, and had a
problem with authority.  He was preoccupied with Vietnam, but
because he felt that he could not talk to anyone about it, he
felt isolated.  The diagnoses were major affective disorder,
severe PTSD; and rule out personality disorder.

In January 1992, the veteran testified at a personal hearing.  He
reiterated that he was an MP during the war.  He said that he
would patrol villages and would sometimes guard POW's.  There
were daily encounters with the enemy, through sniper fire and
rocketing of the camp.  He repeated the incident where two
friends had been killed when their jeep was destroyed.  He
stressed that it was supposed to be him in that jeep going on
patrol, not his friend.  He also stated that a friend, Billy
Bird, had his head blown off, an incident that he witnessed.  He
said that the ammunition dump that was across from his camp was
blown up during the TET offensive.  He reported helping with body
bags during the battle (he vividly recalled the blood sloshing
inside the bags).  After service, he reported developing an
attitude and a drinking problem.  He experienced survival guilt,
depression, anger, anxiety, nightmares, flashbacks and a startle
response.

Between February 1991 and April 1993, the veteran continued to
receive treatment from the VA.  Throughout 1991, he was seen for
depression and irritability.  These symptoms would occasionally
improve, but were easily aggravated, particularly by the Persian
Gulf War.  In April 1992, it was noted that he had made very
little physical or emotional progress.  In May 1992, he reported
dreams and nightmares of a violent nature.  He was prone to
violent verbal outbursts and had a depressive affect.  In June,
his primary issues revolved around anger, agitation and intrusive
PTSD symptoms relating to combat experiences.  The diagnoses were
PTSD, depression, and a mixed personality disorder.

In July 1993, the Environmental Support Group was asked to
confirm the veteran's reported stressors.  Their correspondence
confirmed that the 97th Artillery Group's camp was subjected to
enemy mortar attack on the night of November 5, 1967.  This
roughly coincided with the testimony of the veteran.  Moreover,
the Long Binh area, where the veteran was stationed, was subject
to significant combat actions during the TET offensive.  Further,
this report confirmed the veteran's statement that the Ling Binh
ammunition depot was attacked by enemy forces resulting in the
destruction of several pads of ammunition.  The destruction of
the jeep in October to November 1967 could not be confirmed,
although the records did confirm that a "Bill Bryd" had been
killed on November 11, 1967.

The veteran was then examined by VA in October 1993.  While he
conceded that he was not involved in daily combat, he stated that
he did have combat exposure.  His symptoms included nightmares,
difficulty sleeping, sweats, jumpiness at loud noises, intrusive
thoughts, anger, irritability, rage attacks, distrust of people,
and social withdrawal.  The mental status examination showed that
he had an angry affect, which was also somewhat resigned and sad.
His mood was depressed and angry.  His speech was clearly
articulated and normal in rate rhythm, tone and form.  There was
no overt psychosis, hallucinations or delusions.  There was also
no current suicidal or homicidal ideation.  The diagnosis was
moderate to severe PTSD.  His increasing physical problems were
making it more difficult for him to cope with stress, thus
exacerbating his PTSD.

In July 1994, correspondence was received from his treating VA
psychologist.  It was noted that the veteran had been in
treatment for four years.  After extensive evaluation, it was the
opinion of the author that the veteran had primary PTSD,
secondary depression and a personality disorder.  He experienced
documented recurrent morbid and gruesome nightmares about Vietnam
combat experiences, increased anxiety, social withdrawal,
alienation, outbursts of anger and violent feelings.  He also
suffered from survivor guilt.

In September 1994, the veteran testified at a personal hearing
before the Board.  He stated that he has a diagnosis of PTSD,
which should be enough to entitle him to service connection.  He
also commented that his statements about his stressors had been
consistent throughout the years, thus adding to their
credibility.

After carefully reviewing the record, it is the opinion of the
undersigned that entitlement to service connection for PTSD has
been established.  The evidence of record indicates that, while
the veteran was not involved in direct combat, he did suffer
through traumatic events that would be markedly disturbing to
anyone.  The Environmental Support Group (ESG) confirmed that the
veteran's unit was present at the locations that he indicated and
that the events that he described, such as the destruction of the
ammunition depot, did take place.  The veteran had indicated that
a friend named Billy Bird had been killed; the ESG confirmed that
a Bill Bryd was killed in November 1967.  While all of the
specific information provided by the veteran, such as loading
body bags, could not be confirmed, the information provided by
the ESG was consistent with the general information given by the
veteran.  Therefore, giving the veteran the benefit of the doubt,
the veteran did experience the requisite stressors during his
tour of duty to support a diagnosis of PTSD.  Moreover, he has
several confirmed post-service diagnoses of this disorder,
demonstrating numerous symptoms consistent with this disability.
In conclusion, it is found that the evidence supports a finding
of entitlement to service connection for PTSD.

V.  Entitlement to a total disability
evaluation due to individual
unemployability.

According to the applicable laws and regulations, disability
evaluations are determined by the application of a schedule of
ratings which is based on the average impairment of earning
capacity.  38 U.S.C.A. § 1155 (West 1991).  Total disability
ratings for compensation may be assigned where the schedular
rating for the service connected disability or disabilities is
less than 100 percent when it is found that the service connected
disabilities are sufficient to produce unemployability without
regard to advancing age.  38 C.F.R. §§ 3.340, 3.341, 4.16 (1994).

The record indicates that the veteran has undergone training as a
police officer, and worked as such until 1988.  He also had
obtained a contractor's license, and had training in drafting.
Service connection is in effect for a duodenal ulcer with spastic
colon, and right peroneal neuritis, each assigned a 30 percent
disability evaluation.  A right knee disability has been assigned
a 10 percent disability rating.  A noncompensable evaluation is
in effect for a right inguinal area scar.  He has a combined
evaluation of 60 percent.  He is also service connected, by this
decision, for PTSD.  He is receiving Social Security benefits due
to his disabilities.

The evidence of record includes a 1983 report from a private
physician which noted that his physical limitations, including
his right peroneal neuritis and the subsequent foot disability,
rendered him unable to return to work in any capacity for an
indefinite period.

In January 1991, there was a note in his VA outpatient treatment
records that he was 100 percent disabled.  During a September
1992 personal hearing, the veteran stated that he had been
completely disabled since 1988.  He said his various disabilities
have rendered him unemployable.  A private physician in March
1993 noted that he was functionally unemployable; therefore, he
was found to be totally and permanently disabled.

A private vocational evaluation performed in April 1993, noted
that the veteran spent most of his time at home, reading.  He
apparently had extensive training, including a contractor's
license, drafting and the police academy.  He appeared to be
highly motivated to seek training to maintain employment, but
could no longer do so because of his disabilities.  In April
1994, his private physician noted that he was permanently and
totally disabled, primarily due to his PTSD.

After a careful review of the evidence of record, it is the
opinion of the undersigned that the veteran's service connected
disabilities have rendered him unable to secure or follow any
substantially gainful occupation.  The record indicates that the
veteran is totally disabled by his PTSD alone, which, as part of
this decision, has been service connected.  He is plagued by
anger, depression, nightmares, intrusive thoughts of Vietnam,
rage attacks, social withdrawal, and distrust of people.  This
disability is severe in nature based on the medical assessments
of record and has resulted in a significant degree of impairment
upon his ability to work.  Furthermore, he is unable to engage in
any type of employment that would require physical labor due to
his right peroneal neuritis and his right knee disorder.  Despite
his past willingness to seek additional training, and while he
does have transferable skills, the current medical assessments
are to the effect that he could not maintain substantially
gainful employment for which he would be qualified by prior
experience.

Under the circumstances, it is the conclusion of the undersigned
that the veteran is entitled to a total disability evaluation
based on individual unemployability due to service connected
disabilities.

VI.  Whether clear and unmistakable error
was committed in 1981 and 1983, which
denied service connection for a low back
disability and PTSD, respectively.

Service connection may be granted for a low back disability, to
include arthritis, if it was incurred in or aggravated by
service, or if arthritis develops to a compensable degree within
one year of separation therefrom.  38 U.S.C.A. §§ 1101, 1110,
1112, 1113, (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994).  It is
further noted that the law grants a period of one year form the
date of the notice of the result of the initial determination for
initiating an appeal by filing a notice of disagreement;
otherwise, that determination becomes final and is not subject to
revision on the same factual basis in the absence of clear and
unmistakable error.  38 U.S.C.A. § 7105 (West 1991); 38 C.F.R.
§ 3.105(a) (1994).

In regard to the low back disability, it is noted that the
service medical records were completely silent as to any
complaints of or treatment for a low back disability.  A VA
examination conducted in October 1969 contained no complaints
referable to the low back.  The objective examination revealed
that the back was within normal limits.  There was no indication
in the file of a back disability until 1975.  In August of that
year, the veteran reported to private hospital complaining of
back pain after suffering a fall at work.  He indicated at that
time that he had had no back trouble prior to this incident.  The
physical examination revealed pain, and limitation of motion.
However, an x-ray was negative.  The diagnosis was acute
lumbosacral strain.  There was no mention of any follow-up
treatment following his hospital discharge.  A June 1976 VA
examination found that his back was clinically normal.  He then
re-injured his back in December 1980, after slipping and falling
at work at the Post Office.

The veteran testified in September 1992 that he had originally
injured his low back in the military in 1969, and that he re-
injured it in 1975 and 1980.  However, he reiterated that this
back disability had begun in service.

After carefully reviewing this evidence, it is the opinion of the
undersigned that the November 1981 rating decision was not
clearly and unmistakably erroneous.  The evidence has revealed
that the decision in 1981 to deny service connection for a back
disability was a reasonable exercise of rating judgment.  The
evidence in the record at the time of the 1981 decision did not
support a grant of service connection.  Rather, it showed that a
back disability was not present in service, and that any pre-
existing stenosis was not aggravated by such service, as is
evidenced by the complete lack of any inservice complaints.  The
evidence revealed that the veteran injured his back post-service,
in 1975 and 1980.  There was also no indication in 1981 that the
veteran developed arthritis within one year of his separation
from service.  While the veteran's contention that he initially
injured his back in service has been considered, it is not
supported by the objective evidence of record.  The denial in
1981 was consistent with the evidence in the file at that time
and was thus not erroneous.

In regard to the PTSD claim, the evidence in the file in October
1983 included the service medical records which were silent as to
any complaints of or treatment for a psychiatric disorder.
Following his discharge from the military, the veteran was
examined by VA in June 1983.  The report indicated that the
veteran reported witnessing terrible things in Vietnam.  He
reported seeing a friend's head blown off.  He complained of
having sleep difficulties, as well as trouble controlling his
temper.  The mental status examination revealed that he had no
delusions or hallucinations, although he reported frequent dreams
about the war.  He was moody and hot tempered.  The examiner
reported that it seemed obvious that the veteran had a post
traumatic neurosis.

At a September 1992 personal hearing, the veteran stated that he
had been diagnosed with PTSD by VA psychiatrist.  However, he
asserted that the 1983 rating action ignored this diagnosis and
denied the claim.  Since that time, he reported being
consistently treated for and diagnosed with PTSD.

After a careful review of the evidence, it is the opinion of the
undersigned that the October 1983 rating decision denying service
connection was not clearly and unmistakable erroneous.  The
evidence in the record at the time of this decision indicated
that the veteran was psychiatrically normal during service.
There was no evidence of any psychiatric difficulties until the
June 1983 VA examination.  The examiner stated at that time that
it appeared obvious that the veteran had a post traumatic
neurosis.  However, no stressors were developed, nor was any
testing performed to confirm the diagnosis.  Therefore, the
evidence did not substantiate the diagnosis.  The decision to
deny the claim, based upon this evidence, was a reasonable
exercise of rating judgment.  An unconfirmed diagnosis, without
evidence of stressors, is an insufficient basis upon which to
grant service connection for PTSD.  Therefore, it is the
conclusion of the undersigned that the October 1983 rating action
was consistent with the evidence then in the file and thus was
not erroneous.

VII.  Whether the veteran is eligible for
financial assistance in acquiring an
automobile or other conveyance or special
adaptive equipment.

According to the applicable criteria, a certificate of
eligibility for financial assistance in the purchase of one
automobile or other conveyance will be provided any eligible
veteran or service member whose service connected disability
includes one of the following: loss or permanent loss of use of
one or both feet; or loss or permanent loss of use of one or both
hands; or permanent impairment of vision of both eyes to the
required specified degree.  38 U.S.C.A. §§ 3901, 3902 (West
1991); 38 C.F.R. § 3.808 (1994).  38 U.S.C.A. § 1114(k) provides
additional monthly compensation for loss of use of a foot.  The
term "loss of use" is defined by regulation as that condition
where 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 with use of suitable prosthetic
appliance.  The determination will be made on the basis of the
actual remaining function, whether the acts of balance,
propulsion, etc., could be accomplished equally well by an
amputation stump with prosthesis.  Complete paralysis of the
external popliteal nerve (common peroneal) and consequent foot
drop will be taken as loss of use of the foot.  38 C.F.R.
§§ 3.350(a)(2), 4.63 (1994).

Initially, it is noted that the veteran does not have service
connected eye or hand disabilities.  Nor, as explained below,
does he meet the regulatory definition of loss of use of the
right foot.

In October 1990, the veteran was evaluated for hand controls by
VA.  It was noted that, with his history of nerve root
compression, low back pain and right lower extremity numbness,
hand controls were necessary.

The veteran does have a neurological deficit involving the right
lower extremity.  This includes some inversion of the right foot.
There have been some past diagnoses of foot drop.  However,
according to the January 1994 VA examination, the veteran had
some mild weakness of the right foot in dorsiflexion, inversion
and eversion, which was confirmed by EMG studies.  These findings
were noted to be consistent with his complaints that, without his
brace, his foot would turn inwards.  The diagnosis of foot drop
was noted to be not fully appropriate given the strength he had
in the foot, as well as by the lack of EMG evidence and visual
evidence of changes in the right leg.

The veteran testified at hearings in January and September 1992.
During each hearing, he stated that he had applied for adaptive
equipment, and that he had been told by VA physicians that he
needed hand controls in order to drive safely.  He stated that
his right leg and back conditions required that he obtain this
equipment.

A private physician wrote in April 1994 that the veteran required
adaptive equipment.  The veteran then testified at an additional
hearing in September 1994, wherein he reiterated his need for
hand controls because it was becoming impossible for him to drive
without them.  He asserted that his back and peroneal neuritis
necessitated obtaining this special equipment.  Moreover, he
noted that a handicapped license plate had been authorized by his
state.

After carefully reviewing the evidence of record, it is the
opinion of the undersigned that the veteran is not entitled to
financial assistance in obtaining special adaptive equipment for
his automobile.  Initially, it is noted that disability caused by
his low back disorder is not for consideration, since this is not
a service connected disability.  While the veteran does have a
neurological disorder involving the right lower extremity, it is
the conclusion of the undersigned that this disability has not
resulted in loss of use of this extremity, as is required to
justify assistance in obtaining adaptive equipment.  The term
"loss of use" is defined by regulation as that condition where 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 with use of suitable prosthetic appliance.  The
determination will be made on the basis of the actual remaining
function, whether the acts of balance, propulsion, etc., could be
accomplished equally well by an amputation stump with prosthesis.
Complete paralysis of the external popliteal nerve (common
peroneal) and consequent foot drop will be taken as loss of use
of the foot.

The objective evidence of record indicates that the veteran has
not suffered loss of use of the right lower extremity.  The VA
examination has shown that the veteran is able to plantar flex
this foot, although it is slightly limited.  Muscle strength was
assessed, and remains good in the right leg.  It cannot be said
that there is so little remaining function of the right extremity
that he would be equally well served by an amputation stump below
the knee with appropriate prosthetic.  While he cannot dorsiflex
beyond the 0 degree plane, the evidence does not demonstrate that
there is complete paralysis of the right foot, with consequent
foot drop.  While the veteran's foot tends to invert upon
walking, the objective examination of January 1994 does not show
that active motion of the right ankle joint is absent.  There
were movements present, although some mild weakness was noted.

In addition, the veteran's September 1994 personal hearing
testimony leaves no doubt that he does not experience foot drop
as the result of his peroneal neuritis.  While he has some
difficulty with the foot turning inward, which requires the
wearing of a foot brace, he is able to raise the foot up and
down.  In fact, the VA examination noted that he actually had a
considerable amount of strength in the foot, as well as no EMG
evidence of foot drop.

In conclusion, it is found that the veteran does not have loss of
use of a foot, as is required to warrant financial assistance in
acquiring special adaptive equipment.  Therefore, the
preponderance of the evidence is against the veteran's claim.

VIII.  Entitlement to an earlier effective
date for the grant of service connection
for residuals of a right knee injury.

The veteran had raised a claim for entitlement to an earlier
effective date for the grant of service connection for peroneal
neuritis, which has been rated as a residual of the right knee
injury.  He stated that he had injured the right leg in service
and had suffered from neurological symptoms since that time.  He
filed his claim for this disability within one year following his
separation and has argued that service connection should have
been granted effective the day following his discharge.

In April 1994, the RO issued a rating action which stated that
the VA examinations that had been conducted in 1969 and 1976 had
made no neurological findings.  The veteran complained of
numbness during a June 1979 examination.  It was noted that the
veteran had originally been service connected for right knee
injury residuals, assigned a noncompensable evaluation from March
31, 1976.  His disability was reclassified as right peroneal
neuritis, residuals of a right knee injury, and a 10 percent
evaluation was assigned, effective December 2, 1980.  It was
found that the assignment of service connection for peroneal
neuritis effective December 2, 1980 was correct, for this was the
first time that it could reasonably be shown to have existed.
However, it was found that the rating action dated in July 1976
was clearly and unmistakably erroneous in not establishing
service connection for right knee injury residuals effective from
the day following separation from service.  It was stated that a
VA examination in 1969 had noted the residuals of the right knee
sprain suffered in service.  Therefore, it was found that service
connection for the residuals of a right knee injury should have
been effective from June 20, 1969.

According to 38 U.S.C.A. § 7105(d)(5) (West 1991), the Board may
dismiss any appeal that fails to allege specific error of fact or
law in the determination being appealed.  In the instant case,
the veteran had requested that an earlier effective date be
assigned to the right knee injury residuals.  This was granted by
the rating action issued in April 1994.  In fact, the effective
date for service connection was made the day following his date
of discharge; that is, June 20, 1969.  This is the date requested
by the veteran.  Therefore, this appeal is dismissed, as the
benefit sought on appeal by the veteran has been granted.  It is
again pointed out that the new issue of assignment of a
compensable evaluation effective from June 20, 1969, has been
referred to the RO for adjudication.

ORDER

Service connection for a skin disorder claimed as a residual of
exposure to herbicides in Vietnam (or Agent Orange) is denied.

Service connection for retained foreign bodies in the right elbow
is denied.

Service connection for residuals of trauma to the right eye is
denied.

A 30 percent disability evaluation for duodenal ulcer disease
with spastic colon is granted, subject to the laws and
regulations governing the award of monetary benefits.

A compensable evaluation for a right inguinal area scar is
denied.

A 30 percent disability evaluation for right peroneal nerve
injury residuals is granted, subject to the laws and regulations
governing the award of monetary benefits.

A separate 10 percent disability evaluation for residuals of
injury to the right knee is granted, subject to the laws and
regulations governing the award of monetary benefits.

A separate grant of service connection for right foot drop
secondary to service-connected right peroneal nerve neuritis is
denied.

Service connection for a right wrist disability as secondary to
service-connected right lower extremity disabilities is denied.

Service connection for a low back disability as secondary to
service-connected right lower extremity disabilities is denied.

New and material evidence not having been submitted to reopen a
claim of entitlement to service connection for a low back
disability, the benefit sought on appeal is denied.

Service connection for PTSD is granted.

A total disability evaluation based upon individual
unemployability is granted, subject to the laws and regulations
governing the award of monetary benefits.

Clear an unmistakable error not having been found in a rating
decision in November 1981 which denied entitlement to service
connection for a back disability, the appeal is denied.

Clear and unmistakable error not having been found in a rating
decision in October 1983 which denied entitlement to service
connection for PTSD, the appeal is denied.

Eligibility for financial assistance in acquiring an automobile
or other conveyance or special adaptive equipment is denied.

The appeal for an earlier effective date for service connection
of the residuals of a right knee injury is dismissed.

Separate service connection for a spastic colon is denied.

          KENNETH R. ANDREWS, JR.
          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.