Citation Nr: 0006366 Decision Date: 03/09/00 Archive Date: 03/17/00 DOCKET NO. 98-11 857 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Oakland, California THE ISSUES 1. Entitlement to an initial rating in excess of 50 percent for post traumatic stress disorder (PTSD). 2. Entitlement to service connection for chronic kidney disability. 3. Entitlement to service connection for chronic bilateral eye disability. 4. Entitlement to service connection for chronic disability manifested by numbness of the fingers. REPRESENTATION Appellant represented by: R. Edward Bates, Attorney at Law ATTORNEY FOR THE BOARD Artur F. Korniluk, Associate Counsel INTRODUCTION The veteran had active military service from May 1968 to December 1969. This matter comes to the Board of Veterans' Appeals (Board) from Department of Veterans Affairs (VA) Oakland Regional Office (RO) rating decisions which in February 1997 granted service connection for PTSD (effective August 22, 1996, the date of receipt of the claim), assigning it a 30 percent rating, and in March 1998 denied entitlement to total disability rating based on individual unemployability due to service-connected disability (TDIU) (the claim was filed by the veteran in April 1997), and service connection for chronic kidney and bilateral eye disability, and chronic disability manifested by numbness of the fingers. By rating decision in March 1998, the evaluation of the service-connected PTSD was increased from 30 to 50 percent, effective August 22, 1996. In view of AB v. Brown, 6 Vet. App. 35, 38 (1993), the claim remains in controversy where less than the maximum available benefit is awarded. During the pendency of the appeal, the rating criteria under which mental disorders are evaluated have been amended and re-designated as 38 C.F.R. § 4.130 (1999), effective November 7, 1996. A liberalizing change in a regulation during the pendency of a claim must be applied if it is more favorable to the claimant, and if the Secretary has not enjoined its retroactive application. Marcoux v. Brown, 10 Vet. App. 3, 6 (1996), citing Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). However, in view of the favorable resolution of the veteran's appeal, as discussed below, it is clear that he has not been prejudiced by the nonutilization of the amended VA regulations and by the Board's review of his increased rating claim on the merits. See Bernard v. Brown, 4 Vet. App. 383 (1993). In view of a favorable resolution of the veteran's appeal with regard to the claim of an increased rating for PTSD (effective from the date of the award of service connection therefor), as discussed below, his April 1997 TDIU claim is moot. See 38 C.F.R. § 4.16. In February 2000, the veteran's representative submitted additional evidence, portions of which were not previously of record, including VA vocational rehabilitation program records. Initial consideration of this evidence by the RO was waived in writing by the representative under 38 C.F.R. § 20.1304(c) (1999). FINDINGS OF FACT 1. The veteran's service-connected PTSD is manifested by symptoms including frequent nightmares, flashbacks, recurrent and intrusive thoughts and recollections, anxiety, depression, outbursts of anger and irritability, social isolation, mistrust of people, difficulty controlling emotions and short temper, avoidance of crowded places, inability to work with others, and concentration and memory impairment. 2. PTSD is his only compensable service-connected disability; it is shown to be severely disabling, rendering him unable to obtain or retain gainful employment. 3. There is no current medical diagnosis of chronic disability of the veteran's kidney, eyes, or manifested by numbness of the fingers, and competent medical evidence does not show that any such claimed disability is linked to active service, any incident occurring therein, or any Agent Orange exposure during service. CONCLUSIONS OF LAW 1. The schedular criteria for a 70 percent rating for PTSD have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.129, 4.130, 4.132, Diagnostic Code 9411 (1996). 2. The veteran's service-connected PTSD precludes him from securing or following a substantially gainful occupation. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.16(c), 4.129, 4.130, Diagnostic Code 9411 (1996). 3. The veteran has not presented a well-grounded claim of service connection for chronic kidney disability. 38 U.S.C.A. § 5107(a) (West 1991). 4. The veteran has not presented a well-grounded claim of service connection for chronic bilateral eye disability. 38 U.S.C.A. § 5107(a) (West 1991). 5. The veteran has not presented a well-grounded claim of service connection for chronic disability manifested by numbness of the fingers. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Increased rating claim: The veteran's claim of a rating in excess of the currently assigned 50 percent for his service-connected PTSD is well grounded, Murphy v. Derwinski, 1 Vet. App. 78 (1990), as it stems from the rating initially assigned at the time of the February 1997 grant of service connection for that disorder. Shipwash v. Brown, 8 Vet. App. 218 (1995). Once determined that a claim is well grounded, VA has a duty to assist in the development of evidence pertinent to the claim. 38 U.S.C.A. § 5107(a). The Board is satisfied that all relevant facts have been properly developed, and that VA has satisfied its duty to assist. Godwin v. Derwinski, 1 Vet. App. 419 (1991). Disability ratings are based, as far as practicable, on average impairment of earning capacity attributable to specific disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Generally, the degrees of disability specified are considered adequate to compensate for loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Consideration must be given to the ability of the veteran to function under the ordinary conditions of daily life. 38 C.F.R. § 4.10. If there is a question as to which of two evaluations should apply, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). A claim placed in appellate status by disagreement with the initial rating award and not yet ultimately resolved is an original claim, as opposed to a new claim for increase. Fenderson v. West, 12 Vet. App. 119 (1999). On the other hand, where entitlement to compensation has already been established, disagreement with an assigned rating is a new claim for increase, based on facts different from a prior final claim. Suttmann v. Brown, 5 Vet. App. 127, 136 (1993); Proscelle v. Derwinski, 2 Vet. App. 629, 631-32 (1992) (in a claim for increased rating, appellant claims the disability has increased in severity since a prior final decision). In such claims, the present level of disability is of primary concern; although a review of the recorded history of a disability is required to make a more accurate evaluation, past medical reports do not have precedence over current findings. 38 C.F.R. § 4.2 (1999); Francisco v. Brown, 7 Vet. App. 55 (1994). Impairment of one's social and industrial skills indicates an inability to adapt to various social and industrial environments. In evaluating the appellant's social and industrial adaptability, "those abnormalities of conduct, judgment, and emotional reactions which affect economic adjustment, i.e., which produce impairment of earning capacity" are considered. 38 C.F.R. § 4.129. Social inadaptability, reflecting the ability to establish healthy interpersonal relationships, is evaluated only as it affects industrial adaptability. Id. The severity of disability is based upon actual symptomatology, as it affects social and industrial adaptability. Two of the most important determinants of disability are time lost from gainful work and decrease in work efficiency. VA must not underevaluate the emotionally sick veteran with a good work record, nor must it overevaluate his or her condition on the basis of a poor work record not supported by the psychiatric disability picture. It is for this reason that great emphasis is placed upon the full report of the examiner, descriptive of actual symptomatology. The record of the history and complaints is only preliminary to the examination. The objective findings and the examiner's analysis of the symptomatology are the essentials. The examiner's classification of the disease as "mild," "moderate," or "severe" is not determinative of the degree of disability, but the report and the analysis of the symptomatology and the full consideration of the whole history by the rating agency will be. 38 C.F.R. § 4.130. Service connection for PTSD was granted by RO rating decision in February 1997, and a 30 percent evaluation was assigned. That decision was based on the veteran's service records showing combat service in Vietnam, and post service clinical evidence of PTSD relative to in-service, combat-related stressors. March and June 1989 disability determination notices from the Social Security Administration (SSA) (including various medical records), reveal that the veteran was not found disabled for SSA disability purpose. Medical records from the SSA show that he experienced various psychological and mental health problems since service in Vietnam, including lack of concentration and energy, difficulty sleeping and nightmares, irritability and anger, and memory impairment. In February 1989, the examining psychiatrist indicated that the veteran's psychiatric and physical symptoms greatly limited his overall psychosocial and occupational functioning, that he had severe difficulties following simple tasks, and that he experienced severe difficulties functioning in occupational and social settings. On VA psychiatric examination in January 1997, the veteran indicated that he experienced nightmares, flashbacks, intrusive thoughts and recollections about his Vietnam service, increased startle response, social isolation, frequent outbursts of anger, depression, hypervigilance, and paranoia, noting that he received regular treatment and therapy. Reportedly, he was twice divorced and had one adult daughter; he indicated that he was a self-employed construction contractor, noting that he had no interest in any activity except work; reportedly, he lost many jobs due to his anger and short temper, and because he found it difficult to work for other people. On examination, moderately severe PTSD was diagnosed, and Global Assessment of Functioning (GAF) score 50-55 was assigned. The examiner indicated that the veteran's most disabling symptoms were persistent symptoms of increased arousal and outbursts of anger and rage, difficulty relating to people on the job, and avoidance of stimuli reminding him of Vietnam. VA medical records from July 1996 to October 1997 reveal intermittent treatment for PTSD as manifested by nightmares, difficulty sleeping, flashbacks, outbursts of anger, and depression. On clinical evaluation in June 1997, it was noted that he was unemployable and afraid of people; a GAF score 45 was assigned. On examination in October 1997, a VA psychiatrist indicated that the veteran suffered from severe PTSD with symptoms including depression, insomnia, anxiety, nightmares, hypervigilance, paranoia and suspiciousness, and avoidance of crowded places. In November 1997, the veteran submitted to the RO a package of various documents, including his own written statements and original and photocopies of various photographs depicting scenes from Vietnam, describing the nature of psychological/mental health impairment reportedly experienced by him since returning from Vietnam. Also included with the package was an October 1997 letter from the veteran's friend (an attorney) wherein he indicated that he assisted the veteran in obtaining "proper" disability rating for his PTSD. On VA psychiatric examination in November 1997, including a review of the claims file, the veteran indicated that he experienced hypervigilance, flashbacks, "constant" intrusive thoughts and recollections (triggered by stimuli reminding him of Vietnam, such as aircraft passing overhead and the smell of diesel fuel), anxiety, increased startle response, concentration and memory impairment, depression, feeling helpless and hopeless, decreased interest in "normal" daily activities, nightmares and difficulty sleeping, and daily outbursts of anger. Reportedly, he was a self-employed construction-work contractor, but he had not worked since 1995. On examination, he was disheveled, his expression was broad, affect subdued, and motor activity was remarkable for generalized tension but speech was without deviation. Cognitive examination was indicative of ability to perform moderately detailed instructions while maintaining adequate attention and concentration; his PTSD symptoms impaired his ability to adequately deal with normal daily stress and significantly impaired his ability to adequately interact with others. PTSD, major depression, and insomnia were diagnosed; a GAF score of 55 was assigned. Based on the foregoing evidence, the evaluation of the veteran's service-connected PTSD was increased from 30 to 50 percent by RO rating decision in March 1998. An undated article from C. Schiro-Geist, Ph.D., Generally Accepted Vocational Principles, received by the RO in June 1998, describes, in general terms, various criteria utilized to evaluate a person's capacity to function in an employment setting in relation to physical and mental impairment that may affect the person. A June 1998 Mental Residual Functional Capacity Assessment from the veteran's clinical social worker, listing numerous categories for evaluation, indicates that his PTSD was productive of severe impairment in "understanding" and memory, moderate to severe impairment in sustained concentration and persistence, moderately severe to severe impairment in social interaction, and mild to severe impairment in adaptation. On VA psychiatric examination in December 1998, including a review of the claims file, the veteran indicated that he had recurrent and intrusive recollections about Vietnam, that various stimuli reminded him of Vietnam, that he experienced frequent nightmares and flashbacks, anxiety, hypervigilance, increased startle response, concentration and memory impairment, depression, helplessness and hopelessness, anhedonia, and outbursts of anger. Reportedly, he was self employed, but had not worked since November 1995. On examination, he appeared disheveled and unshaven, had a broad expression and affect with a subdued manner; his speech was without evidence of any deviation; his motor activity was remarkable for generalized tension and frequent gesturing. The examiner indicated that performance on cognitive examination was indicative of an ability to follow moderately detailed instructions while maintaining adequate attention and concentration; his PTSD symptoms were productive of significant impairment in the ability to interact with others and dealing with normal daily stress. PTSD, major depression, and insomnia were diagnosed, and GAF score of 55 was assigned. On thorough review and discussion of the evidence of record and contemporaneous examination in December 1998, the examining VA psychiatrist observed that the clinical evidence of record (including, inter alia, the June 1998 Mental Residual Functional Capacity Assessment from the veteran's clinical social worker) portrayed the veteran as being "severely" impaired by PTSD, yet numerous lengthy and detailed letters written by the veteran over the years reflected a significant organizational ability and time spent reasoning and researching; he opined that the June 1998 clinical assessment from the veteran's social worker was rather unbelievable as the vast majority of the categories was marked as being productive of "severe" impairment and she found that his "ability to carry out very short and simple instructions" was productive of "moderately severe" impairment; the examiner also pointed out further inconsistencies in the clinical evidence of record which suggested that the veteran's PTSD produced "severe" impairment based on the observation that an individual who can cogently write lengthy documents of rebuttal in such an organized, researched, and detailed fashion had capabilities far beyond one who would be considered to have "severe" impairment, performing even simple tasks. VA medical records from October 1997 to January 1999 reveal intermittent treatment for the veteran's PTSD. A January 1999 clinical treatment summary from the Vet Center (prepared by two clinical social workers) indicates that the veteran received psychiatric treatment from a VA psychiatrist and therapy from clinical social workers for symptoms including nightmares, flashbacks, insomnia, outbursts of anger, avoidance of crowds, hypervigilance, reaction to people of Oriental descent, anxiety, mistrust, hypersensitivity, irritability, and depression. It was indicated that he carried diagnoses of chronic PTSD and dysthymic disorder; his GAF score was noted as "42 - long term unemployability and socially isolated." Reportedly, he was also considered totally disabled by his treating psychiatrist. VA vocational rehabilitation program records from March 1997 to February 1998, submitted to the Board in February 2000, reveal that the veteran did not qualify for vocational rehabilitation because it was not feasible that he would benefit from the program due to his disabilities. A February 1998 vocational rehabilitation and counseling services report reveals that he did not have a high school diploma and would only be a candidate for work in an entry level position in a groundskeeper, hand-packer, or packager occupation. A February 1998 letter to the veteran noted that his GAF score was 50, indicative of serious impairment in social, occupational, and academic functioning; his interest testing scores and ability scores "suggest[ed] employment objectives with jobs requiring minimal academic preparation." Currently, the veteran's service-connected PTSD is rated under Diagnostic Code 9411 (1996), and a 50 percent evaluation is assigned consistent with evidence showing that the ability to establish or maintain effective or favorable relationships is considerably impaired, and because of the psychoneurotic symptoms, the reliability, flexibility, and efficiency levels are so reduced as to result in considerable industrial impairment. A 70 percent evaluation is warranted where the ability to establish or maintain effective or favorable relationships with people is severely impaired, and the psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain or retain employment. A 100 percent evaluation is warranted where the attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community, the veteran has totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic and explosions of aggressive energy resulting in profound retreat from mature behavior, or the veteran is demonstrably unable to obtain or retain employment. Based on the entire evidence of record, as discussed above, the Board believes that the schedular criteria for a 70 percent rating for PTSD have been met under the "old" Diagnostic Code 9411. In particular, the evidence reveals that the veteran has experienced persistent and frequent symptoms including nightmares, difficulty sleeping, increased startle response, hypervigilance, social isolation, distrust of others, inability to interact effectively with people, and outbursts of anger and irritability despite ongoing psychiatric treatment and therapy; the record shows that he has a history of two failed marriages, and there is no indication that he has any close friends or relatives with whom he maintains regular contact. The evidence of record indicates that his PTSD symptoms, overall, are in fact productive of severe impairment. The Board notes that the veteran underwent a thorough VA psychiatric examination in December 1998 which included a detailed review of the entire claims file. The examiner concluded, essentially, that the veteran was not severely disabled by his PTSD (as concluded by his treating psychiatrists and therapists who have a regular and presumably trust-based relationship) because he displayed a remarkable ability to write numerous, lengthy, detailed, organized, and well-researched letters, indicative of significant organizational ability (at the same time, the examiner concluded in December 1998, that the veteran's PTSD symptoms were productive of significant impairment in his ability to interact with others and in dealing with normal stresses of the daily life). As noted above, the veteran did submit numerous lengthy and detailed letters to the RO. However, he also acknowledged in November 1997, that numerous people assisted him in the preparation of various submissions to the RO; an October 1997 letter from his friend (an attorney) also shows that the veteran received help in providing evidence in support of his claim. Thus, it is not entirely clear which correspondence was or was not prepared solely by the veteran. In view of the foregoing, the Board finds more persuasive the conclusions of the veteran's treating psychiatrist and therapists, that the severity of his PTSD symptoms, overall, reflect severe impairment. The benefit of the doubt in this regard is resolved in his favor. 38 C.F.R. § 3.102 (1999). The Board notes that 38 C.F.R. § 4.16(c) was deleted from the rating schedule, effective November 7, 1996; however, as the veteran's claim for an increased rating for PTSD stems from the original rating decision awarding service connection therefor (in response to his claim which was filed before the regulatory change occurred), and he is 70 percent disabled for his sole, service-connected compensable disability, 38 C.F.R. § 4.16(c) remains applicable to his claim. See Karnas, 1 Vet. App. at 313. The assignment of a 100 percent schedular rating is warranted in cases in which a veteran is rated 70 percent disabled due to a psychiatric disorder, the psychiatric disorder is the veteran's only compensable disability, and the psychiatric disorder is found to preclude him from securing or following a substantially gainful occupation. 38 C.F.R. § 4.16(c); Swan v. Derwinski, 1 Vet. App. 20 (1990). In this case, the veteran is service connected only for PTSD. The entirety of the evidence indicates that he has not worked in several years due to inability to interact with others and difficulty being in crowded places, mistrust of people, suspiciousness, short temper, and problems controlling his emotions and frequent outbursts of anger and irritability. The Board notes that a VA psychiatrist opined on examination in December 1998, that the veteran had the mental capacity to follow moderately detailed instructions while maintaining adequate attention and concentration. Yet, VA vocational rehabilitation program records, as identified above, reveal that he would only be a candidate for entry-level positions in a groundskeeper, hand-packer, or packager occupation. However, the entirety of the evidence indicates that his short temper, outbursts of anger, mistrust of people, difficulty being around and interacting with people, and problems controlling emotions would prevent him from being able to obtain or retain positions which would require him to follow a supervisor's instructions. In light of the above, the Board finds that the veteran is demonstrably unable to secure or follow a substantially gainful occupation because of his service-connected PTSD. Thus, a 100 percent schedular evaluation is warranted pursuant to 38 C.F.R. § 4.16(c). Service connection claims: Service connection may be allowed for a chronic disability, resulting from an injury or disease, incurred in or aggravated by the veteran's period of active service. 38 U.S.C.A. § 1110 (West 1991). Service connection may also be allowed on a presumptive basis for cardiovascular-renal diseases, if the pertinent disability becomes manifest to a compensable degree within one year after separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). Congenital or developmental defects and refractive error of the eye are not diseases or injuries within the meaning of applicable legislation. 38 C.F.R. § 3.303(c). Thus, service connection may not be granted for defects of congenital, developmental or familial origin, absent superimposed disease or injury. See VA O.G.C. Prec. Op. 82-90 (July 18, 1990), 55 Fed. Reg. 45,711 (1990). If a veteran had wartime service in Vietnam (as is the case here), service connection may also be allowed on a presumptive basis for certain diseases associated with exposure to Agent Orange, if the disease becomes manifest to a compensable degree within a specified period of time after the veteran's separation from service. 38 U.S.C.A. § 1116 (West 1991); 38 C.F.R. §§ 3.307(a), 3.309(e) (1998); see also McCartt v. Brown, 12 Vet. App. 164 (1999). The following diseases shall be service connected if the veteran was exposed to Agent Orange if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there is no record of such disease during service, and provided further that the requirements of 38 C.F.R. § 3.307(d) are satisfied: chloracne or other acneform disease consistent with chloracne (if the disease becomes manifest to a compensable degree within one year after the last date on which the veteran was exposed to an herbicide agent), Hodgkin's disease, multiple myeloma, non-Hodgkin's lymphoma, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers, and soft-tissue sarcoma. 38 C.F.R. § 3.309(e). For a showing of 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 a diagnosis including the word chronic. Continuity of symptomatology is required when 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, a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1999). The U.S. Court of Appeals for Veterans Claims (the Court) has held that lay observations of symptomatology are pertinent to the development of a claim of service connection, if corroborated by medical evidence. See Rhodes v. Brown, 4 Vet. App. 124, 126-127 (1993). The Court established the following rules with regard to claims addressing the issue of chronicity. Chronicity under the provisions of 38 C.F.R. § 3.303(b) is applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under the Court's case law, lay observation is competent. If the chronicity provision is not applicable, a claim may still be well grounded if (1) the condition is observed during service, (2) continuity of symptomatology is demonstrated thereafter and (3) competent evidence relates the present condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488, 495 (1997). A lay person is competent to testify only as to observable symptoms. A lay person is not, however, competent to provide evidence that the observable symptoms are manifestations of chronic pathology or diagnosed disability. Falzone v. Brown, 8 Vet. App. 398, 403 (1995). A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between the disability and an injury or disease incurred in service. Watson v. Brown, 4 Vet. App. 309, 314 (1994). However, service connection may be granted for a post-service initial diagnosis of a disease that is established as having been incurred in or aggravated by service. 38 C.F.R. § 3.303(d) (1999). The threshold question is whether the veteran has presented evidence that his claim is well grounded. See 38 U.S.C.A. § 5107(a). A well-grounded claim is a plausible claim. Murphy, 1 Vet. App. at 81. A mere allegation that a disability is service connected is not sufficient; the veteran must submit evidence in support of his claim which would justify a belief by a fair and impartial individual that the claim is plausible. In order for a claim to be well grounded, there must be competent evidence of current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the in-service injury or disease and a current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Where the determinative issue involves a question of medical diagnosis or causation, competent medical evidence to the effect that the claim is plausible or possible is required to establish a well-grounded claim. Libertine v. Brown, 9 Vet. App. 521 (1996); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). A lay person is not competent to make a medical diagnosis or to relate a medical disorder to a specific cause. See Grivois v. Brown, 6 Vet. App. 136, 140 (1994), citing Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Therefore, lay statements regarding a medical diagnosis or causation do not constitute evidence sufficient to establish a well-grounded claim under 38 U.S.C.A. § 5107(a). See Grottveit, 5 Vet. App. at 93. The veteran's service medical records do not reveal any report or clinical finding of any symptom referable to the kidneys, eyes, or fingers; no pertinent clinical findings were indicated on service separation medical examination in December 1969; on examination, his visual acuity was reported to be 20/20, bilaterally. On VA Agent Orange medical examination in March 1985, the veteran indicated that he experienced intermittent symptoms of dribbling urine and blurred vision for a year, noting that he was exposed to Agent Orange during service in Vietnam. Clinical impression on examination was history of Agent Orange exposure. Records from the SSA, dated from March 1985 to June 1989 (including VA medical records) reveal that the veteran reported experiencing various health problems due to alleged Agent Orange exposure in Vietnam. On medical examination in January 1989, he indicated that his eyes were tiring easily and that he had occasional double vision; on examination, there was no evidence of neurologic or genitourinary impairment; vision in the left eye was 20/100 and 20/30 on the right; the examiner indicated that he did not find anything wrong with the veteran except that his vision was impaired, and he suggested that he see an optometrist for refraction and appropriate glasses (glasses were prescribed by VA in March 1989). On ophthalmologic examination in February 1989, he indicated that he had a history of Agent Orange exposure and that he had vision impairment for 20 years; on examination, his vision was correctable to 20/20, bilaterally, and it was suspected that he had refractive error. On psychiatric examination in February 1989, the veteran indicated that he was exposed to Agent Orange in Vietnam and noted, in pertinent part, that he began to have vision impairment after service. An Axis III diagnosis of Agent Orange exposure was indicated. On VA general medical examination in March 1997, the veteran indicated that he had nonspecific, intermittent left kidney pain for 7 years, denying a history of injury or trauma or medical treatment for the pain. He indicated that he experienced symptoms of intermittent numbness of the fingers and loss of grip strength for the past 4 or 5 years, but he denied receiving any medical treatment therefor. In January 1997, he reported experiencing a temporary loss of vision, for about 60 seconds, but did not experience any subsequent problems; he indicated that he used glasses for reading. On examination, the pupils were equal and reactive to light and accommodation, eye movements were normal, conjunctiva and sclerae were normal and not jaundiced; he used glasses for reading and his vision with glasses was normal; fundus examination was normal, and there was no evidence of hemorrhage, exudate, or microaneurysms; genitourinary examination was normal. Numbness in fingers of both hands, unknown etiology, was diagnosed. VA medical records from July 1996 to January 1999 reveal intermittent treatment associated with various symptoms and illnesses. On several such occasions, the veteran reported experiencing kidney pain, vision impairment, and numbness of the fingers. On psychiatric examination in January 1997, he stated that he was exposed to Agent Orange in service, and that he experienced numbness of the fingers. In June 1997, it was indicated that he had possible neurological problems. On psychiatric examination in November 1997, the examiner indicated that the veteran reported a history of nondescript kidney problem. In October 1998, he indicated that he had history of left kidney pain and blurred vision. On psychiatric examination in December 1998, he indicated that he had "some kidney problems" which he related to Agent Orange exposure; an Axis III diagnosis of kidney difficulty of unknown etiology, per patient history, was indicated. On complete eye examination in December 1998, there was no evidence of any injury or disease involving the eyes; his vision refraction was correctable to 20/20, bilaterally. It was indicated that he had low myopia and that ocular health was unremarkable. In numerous written correspondence to the RO, the veteran indicated that he experienced bilateral eye problems, kidney impairment, and numbness of the fingers of both hands since active service, suggesting that such impairment and disabilities were related to his Agent Orange exposure in Vietnam. Based on the foregoing, the Board finds that the claims of service connection for chronic kidney and bilateral eye disabilities, and disability manifested by numbness of the fingers are not well grounded. On numerous occasions during post-service medical treatment, on VA compensation and pension examinations, on examinations performed in conjunction with his claim for SSA benefits, and in numerous correspondence to the RO, the veteran has suggested that he was exposed to Agent Orange during service in Vietnam, suggesting a link between the claimed kidney, eyes, and fingers disabilities and exposure to Agent Orange. 38 U.S.C.A. § 1116(a)(1) provides that a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, and has a disease referred to in paragraph (2) of this section, shall be presumed to have been exposed during such service to an herbicide agent unless there is affirmative evidence to establish that he was not exposed to any such agent during service (the veteran satisfies the first prong of the requirement in that he did have requisite service in Vietnam). The specific diseases presumed to have been incurred as a result of Agent Orange exposure are listed in 38 U.S.C.A. § 1116(a)(2) and 38 C.F.R. § 3.309(e) (1998) and were enumerated above; however, the entirety of the medical evidence of record is devoid of a diagnosis of any such disability. In McCartt, 12 Vet. App. 164, the Court held that neither the statutory (38 U.S.C.A. § 1116) nor the regulatory (38 C.F.R. § 3.307(a)(6)(iii)) presumption will satisfy the in-service incurrence element of Caluza, 7 Vet. App. 498 where the veteran has not developed a condition listed in either 38 U.S.C.A. § 1116(a) or 38 C.F.R. § 3.309(e). Thus, service connection for the claimed disabilities of the kidneys, the eyes, or the fingers may not be established on a presumptive basis. Although the evidence of record reveals intermittent reports of symptoms suggestive of kidney pain, eye problems consisting of vision impairment, and symptoms of numbness of the fingers, organic diseases or injuries shown to cause recurrent kidney pain, vision impairment, and/or numbness of the fingers were not evident in service; although numbness of the fingers and kidney pain were indicated during his post- service medical treatment, an organic disease shown to cause such symptoms has never been identified on examinations after service separation; several examinations of the eyes, as discussed above, showed refractive vision impairment (correctable to 20/20, bilaterally) but failed to demonstrate the presence of chronic disease or disability of the eyes (of service origin or otherwise). Thus, as there is no current medical diagnosis of chronic disabilities of the kidneys or the eyes, or disability manifested by numbness of the fingers, the claims must be denied as not currently well grounded. See Rabideau, 2 Vet. App. 14; see also Brammer v. Derwinski, 3 Vet. App. 223 (1992) (in the absence of proof of a present disability there can be no valid claim); Sanchez- Benitez v. West, No. 97-1948 (U.S. Vet. App. Dec. 29, 1999) (pain alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection may be granted). The Board is mindful of the veteran's contention that he has experienced symptoms of recurrent kidney pain, vision impairment, and numbness of the fingers since active service. While the credibility of his contention is not challenged and his competence to testify with regard to observable symptoms of recurrent pain, numbness, and vision impairment is noted, consistent with Cartright v. Derwinski, 2 Vet. App. 24 (1991), he is simply not competent, as a layman, to render a medical diagnosis of chronic organic disability manifested by kidney pain, numbness of the fingers, or vision impairment, or to provide an etiological link between active service and any current symptomatology. See Grivois, 6 Vet. App. at 140, citing Espiritu, 2 Vet. App. at 494. Finally, the evidence of record does not show, nor is it contended by or on behalf of the veteran, that the claimed kidney or eye disabilities, or disability manifested by numbness of the fingers, are related to combat service; thus, the provisions of 38 U.S.C.A. § 1154(b) (West 1991) are not applicable in these claims. If a claim is not well grounded, the Board has no jurisdiction to adjudicate the claim. Boeck v. Brown, 6 Vet. App. 14 (1993). A not well-grounded claim must be denied. Edenfield v. Brown, 8 Vet. App. 384 (1995). If the initial burden of presenting evidence of a well-grounded claim is not met, VA has no duty to assist the veteran in the development of the claim. Morton v. West, 12 Vet. App. 477 (1999); Murphy, 1 Vet. App. at 81-82. The RO has advised the veteran of the evidence necessary to establish a well-grounded claim, and he has not indicated the existence or availability of any medical evidence (not already of record) that would well ground his claims of service connection for chronic kidney or bilateral eye disabilities, or disability manifested by numbness of the fingers. Epps v. Brown, 9 Vet. App. 341, 344 (1996), aff'd sub nom. Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). ORDER A 100 percent schedular evaluation for PTSD under the provisions of 38 C.F.R. § 4.16(c) is granted, effective August 22, 1996, subject to the law and regulations governing the payment of monetary awards. Service connection for chronic kidney disability is denied. Service connection for chronic bilateral eye disability is denied. Service connection for chronic disability manifested by numbness of the fingers is denied. J. F. Gough Member, Board of Veterans' Appeals