BVA9506418 DOCKET NO. 91-39 616 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Baltimore, Maryland THE ISSUES 1. Entitlement to service connection for a cervical spine disorder characterized as arthritis. 2. Entitlement to service connection for a thoracic spine disorder characterized as arthritis. 3. Entitlement to service connection for a left hip disorder characterized as bursitis. 4. Entitlement to a total rating for compensation purposes based on individual unemployability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD J. T. Hutcheson, Associate Counsel INTRODUCTION The veteran had active military service from February 1963 to February 1967. This matter came before the Board of Veterans' Appeals (hereinafter "the Board") on appeal from an August 1990 rating decision of the Baltimore, Maryland Regional Office (hereinafter "the RO") which denied both service connection for arthritis of the cervical spine, arthritis of the thoracic spine with X-ray changes at T10, and bursitis of the left hip and an increased disability evaluation for the veteran's service-connected residuals of a lumbar spine laminectomy with fusion. In August 1992, the Board remanded this appeal to the RO for additional action. In April 1994, the RO, in pertinent part, recharacterized the veteran's service-connected lumbar spine disorder as residuals of a lumbar fusion with post-operative arachnoiditis and polyradiculopathy evaluated as 60 percent disabling and denied both a total rating for compensation purposes based on individual unemployability and special monthly compensation due to the loss of use of the left lower extremity. In formulating its decision, the RO clarified that the disability evaluation assigned to the veteran's service-connected lumbar spine disorder specifically encompassed his arachnoiditis-related left hip symptoms. In April 1994, the veteran conveyed his satisfaction with the recharacterization of his service-connected lumbar spine disorder and advanced his disagreement with the denial of a total rating for compensation purposes based on individual unemployability. In October 1994, the veteran submitted a written statement expressing his complete agreement with the assignment of a 60 percent disability evaluation for his service-connected lumbar spine disorder. The veteran has been represented throughout this appeal by the Disabled American Veterans. CONTENTIONS OF APPELLANT ON APPEAL The veteran asserts on appeal that the RO erred in denying both service connection for a cervical spine disorder, a thoracic spine disorder and a left hip disorder and a total rating for compensation purposes based on individual unemployability. He contends that he incurred a chronic disorder of the entire spine and the left hip as a consequence of injuries sustained during active military service or, in the alternative, secondary to his service-connected post-operative lumbar spine disorder. He advances that his spinal and hip disabilities necessitated his medical retirement in 1980 and have rendered him unable to secure and follow any form of substantially gainful employment. The accredited representative argues that the veteran's service-connected disabilities have increased in severity since the most recent Department of Veterans Affairs (hereinafter "VA") examination and his medications have affected his employability. The accredited representative requests that the instant appeal be again remanded to the RO in order to afford the veteran an additional examination. The Board's attention is directed to the provisions of 38 C.F.R. § 4.18 (1993). DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), following review and consideration of all evidence and material of record in the veteran's claims file, it is the Board's decision that a preponderance of the evidence is adverse to his claim for service connection for a cervical spine disorder, a thoracic spine disorder and a left hip disorder. The evidence supports a total rating for compensation purposes based on individual unemployability. FINDINGS OF FACT 1. The RO has obtained all relevant evidence necessary for an equitable disposition of the veteran's appeal. 2. A cervical spine disorder was not shown during active military service and the veteran's current cervical spine disability became manifest many years after service separation. The veteran's cervical spine disability has not been shown to have originated during active military service. 3. Service connection is currently in effect for residuals of a lumbar fusion with post-operative arachnoiditis and polyradiculopathy evaluated as 60 percent disabling; an anxiety reaction evaluated as noncompensable; and thrombophlebitis evaluated as noncompensable. The veteran has a combined rating of 60 percent. 4. An etiological relationship between the veteran's cervical spine disability and his service-connected residuals of a lumbar fusion with post-operative arachnoiditis and polyradiculopathy has not been demonstrated. 5. A thoracic spine disorder was not shown during active military service and the veteran's current thoracic spine disability became manifest many years after service separation. The veteran's thoracic spine disability has not been shown to have originated during active military service. 6. An etiological relationship between the veteran's thoracic spine disability and his service-connected residuals of a lumbar fusion with post-operative arachnoiditis and polyradiculopathy has not been demonstrated. 7. A left hip disorder was not shown during active military service and the veteran's trochanteric bursitis of the left hip became manifest many years after service separation. The veteran's trochanteric bursitis has not been shown to have originated during active military service. 8. An etiological relationship between the veteran's trochanteric bursitis of the left hip and his service-connected residuals of a lumbar fusion with post-operative arachnoiditis and polyradiculopathy has not been established. 9. The veteran has reported completing three years of college. He has occupational experience as a corpsman, a sanitarian, a drug company "detail man," a customer service representative, a county health inspector, a governmental security officer and a supervisor. He reports last working on a full-time basis in 1980. 10. The veteran's service-connected disabilities are of such severity as to preclude him from securing and following some form of substantially gainful employment consistent with his education and work experience. CONCLUSIONS OF LAW 1. A cervical spine disorder was not incurred in or aggravated by active military service and arthritis may not be presumed to have been incurred during active military service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.303(d), 3.307, 3.309 (1993). 2. A cervical spine disorder is not proximately due to or the result of the veteran's service-connected residuals of a lumbar fusion with post-operative arachnoiditis and polyradiculopathy. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. § 3.310(a) (1993). 3. A thoracic spine disorder was not incurred in or aggravated by active military service and arthritis may not be presumed to have been incurred during active military service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.303(d), 3.307, 3.309 (1993). 4. A thoracic spine disorder is not proximately due to or the result of the veteran's service-connected residuals of a lumbar fusion with post-operative arachnoiditis and polyradiculopathy. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. § 3.310(a) (1993). 5. A left hip disorder was not incurred in or aggravated by active military service and arthritis may not be presumed to have been incurred during active military service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.303(d), 3.307, 3.309 (1993). 6. A left hip disorder is not proximately due to or the result of the veteran's service-connected residuals of a lumbar fusion with post-operative arachnoiditis and polyradiculopathy. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. § 3.310(a) (1993). 7. A total rating for compensation purposes based on individual unemployability is warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.16, 4.18 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, it is necessary to determine if the veteran has submitted a well-grounded claim within the meaning of 38 U.S.C.A. § 5107(a) (West 1991), and if so, whether the VA has properly assisted him in the development of his claim. A "well-grounded" claim is one which is not implausible. A review of the record indicates that the veteran's claim is plausible. In turning to the accredited representative's request that this appeal be remanded so that an additional VA examination may be conducted to determine whether there has been a material change in the veteran's service-connected disabilities, the Board observes that the veteran was afforded thorough VA orthopedic and neurological examinations in May and September 1993 which resulted in the assignment of an increased disability evaluation for his service-connected lumbar spine disorder. Further, the veteran has submitted several written statements questioning the need for additional physical examination. As the accredited representative's assertion as to material change appears to be grounded solely upon his personal opinion and in light of the veteran's sentiments, the Board finds that further examination is not appropriate. Accordingly, an additional remand in order to allow for further development of the record is not necessary. I. Cervical Spine Disorder The veteran advances that he sustained a cervical spine disorder as the result of spinal trauma sustained during active military service or, in the alternative, secondary to his service-connected post-operative lumbar spine disorder. Service connection may be granted for a disability arising from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Where a veteran served continuously for ninety days or more during a period of war or during peacetime service after December 31, 1946, and arthritis becomes manifest to a degree of ten percent within one year of termination of such service, such disease shall be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1993). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. Presumptive periods are not intended to limit service connection to diseases so diagnosed when the evidence warrants direct service connection. The presumptive provisions of the statute and VA regulations implementing them are intended as liberalizations applicable when the evidence would not warrant service connection without their aid. 38 C.F.R. § 3.303(d) (1993). The veteran's service medical records indicate that he complained of pain in the left lumbar region associated with motion in September 1965. He reported that he had injured his "back" while straining to move a filing cabinet during the preceding evening. An April 1966 naval hospital summary notes that the veteran complained of "back" pain of one day's duration. He reported that the pain began after he had twisted while reaching for a toothbrush and/or turned to pick up a towel when washing his hands. A physical examination of the veteran was reported to be essentially normal except for severe tenderness in the midline of the low back with marked muscle spasms. The veteran was diagnosed as suffering from severe acute lumbosacral strain. At the February 1967 physical examination for service separation, the examiner noted no abnormalities of the spine. At a November 1967 VA examination for compensation purposes, the veteran neither complained of nor exhibited any abnormalities of the neck or the cervical spine. Private treatment records dated between 1969 and 1973 relate that the veteran complained of back pain and limitation of motion. A March 1969 entry indicates that the veteran presented a history of having injured his lumbar spine during high school and again while in active military service. He also related having injured his "back" in a parachute jump during active military service. A March 1971 treatment record shows that the veteran complained of occasional neck tightness. An April 1971 treatment entry notes that the veteran complained of occasional discomfort in the back of the neck. In January 1972, the veteran exhibited an "overall restriction of motion" including limited motion of the neck. An impression of "symptoms more of an arthritic nature" was advanced. Written statements from the veteran dated in February 1973 advance that he began to experience low back complaints in May 1966 as a result of his naval corpsman duties which required strenuous physical activity including lifting and carrying wounded servicemen. He stated that he was subsequently hospitalized for a month during active military service and again in 1968 following service separation. Written statements from the veteran dated in November 1973 and February 1975 relate that he had been accepted into active military service with a "scoliosis spine." A February 1975 written statement from the veteran advances that: During my four years of active duty, from Feb., 1963, to Feb., 1967, with the U. S. Navy Medical Corps I was treated many times for my back that was (sic) never documented because of [my] being staff at the U. S. naval hosp. and also at [the] 32nd. St. Naval Station, San Diego, Calif. ... And upon the induction physical, the examining physician noted on the chart that I had a scoliosis spine. At an April 1975 VA examination for compensation purposes, the veteran related that his service-connected lumbar disorder had "caused condition in lower neck." The examination report contains no findings as to the cervical spine. A July 1975 treatment record from Jay W. McRoberts, M.D., shows that the veteran complained of episodes of pain and tightness in the left side of the neck and the upper border of the left trapezius over the preceding several weeks. On examination, the veteran exhibited limited left lateral bending and left lateral rotation of the neck with some spasm of the upper border of the left trapezius. X-ray studies of the cervical spine revealed no abnormalities. An impression of cervical strain was advanced. At a May 1976 hearing before a panel of the Board, the veteran testified that he experienced severe neck stiffness. An April 1980 pan myelogram report from Allyn M. Cohen, M.D., reveals that the veteran complained of pain upon movement of the neck and exhibited mild ventral ridging at the C4-5 and C5-6 interspaces and no evidence of a herniated disc. Dr. Cohen commented that the cervical spine abnormality was probably related to either an extra-arachnoid injection of contrast material or the veteran's prior surgery. The doctor recommended that clinical correlation be obtained. At a July 1980 VA examination for compensation purposes, the veteran complained of severe pain and muscle spasms of the back of the neck; limitation of motion of the neck and painful headaches. The examination report advances no clinical findings as to the cervical spine. A June 1981 statement from Eli M. Lippman, M.D., reports that the veteran complained of neck and back pain. He related that he had been assaulted by his supervisor and sustained injuries to the neck. Dr. Lippman diagnosed the veteran as suffering from residuals of a traumatic injury to the cervical spine with suspected cervical spine disc pathology. An October 1988 statement from Sam Wiesel, M.D., notes that the veteran exhibited pain of "questioned" etiology and radiological evidence of degenerative arthritis at C5-6 and post-operative lumbar spine residuals. Dr. Wiesel commented that the veteran "probably had peripheral arthritis and/or some type of neuropathy." A November 1988 magnetic resonance imaging study from J. Kaplan, M.D., shows that the veteran suffered from a small posterior lateral disc herniation centrally and to the left at the level of C5-6. The veteran's February 1991 substantive appeal conveys that he suffers from pronounced intervertebral disc syndrome affecting the cervical spine. In an undated written statement received in March 1991, the veteran asserts that: How these problems are interrelated and correlated to injury; every place in my spine where there has been traumatic injury or having to over compensate for pain[,] I have developed degenerative arthritis in those areas alone. In my cervical spine[,] there is a herniated disc at C5 & 6 level along with degenerative arthritis. At the May 1992 hearing before the Board, the veteran testified that he has developed traumatic arthritis of the spine in areas where he had sustained injuries to the spine due to either injury or his lumbar spine surgery. He stated that he had injured his back during active military service when he jumped off a helicopter while picking up an injured man and when he attempted to subdue a berserk marine and fell over a filing cabinet and a desk. A May 1993 VA orthopedic evaluation reports that a X-ray study of the cervical spine revealed early changes consistent with spondylosis which were most marked at the C5-C6 level. The VA examiner advanced an impression of "ruleout arthrosis-spondylosis in the cervical spine." At the September 1993 VA examination for compensation purposes, the examiner commented that the myelogram study conducted in April 1980 was unremarkable. A September 1993 VA bone scan study showed no cervical abnormalities. A January 1994 written statement from the veteran conveys that he suffers from a chronic cervical spine disorder and has received treatment since 1983. The Board has reviewed the probative evidence of record including the veteran's testimony and argument on appeal. The veteran's service medical records establish that he sustained a chronic lumbar spine disorder for which service connection has been established. However, the records make no reference to a cervical spine injury or other evidence consistent with the onset of a cervical spine disorder. The first objective evidence of such a disability is private clinical documentation dated in 1971 and 1972 conveying that the veteran exhibited arthritic symptoms affecting the cervical spine. As the claimed disorder was not manifested until approximately five years after service separation and has not been shown to have originated during the veteran's period of active military service, the Board finds that service connection for a cervical spine disorder including arthritis is not merited on a direct or primary basis. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137 (West 1991); 38 C.F.R. §§ 3.303(d), 3.307, 3.309 (1993). Therefore, it is necessary to next consider the issue of secondary service connection. Service connection may be granted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (1993). Service connection is currently in effect for residuals of a lumbar fusion with post-operative arachnoiditis and polyradiculopathy, an anxiety reaction and thrombophlebitis. The clinical record contains only minimal evidence as to the etiology of the veteran's current cervical spine disorder. The April 1980 pan myelogram report from Dr. Cohen opines that the veteran exhibited mild ventral ridging at the C4-5 and C5-6 interspaces possibly related to his prior surgery whereas the June 1981 statement from Dr. Lippman advances a diagnosis of residuals of a 1981 traumatic injury to the cervical spine with suspected cervical spine disc pathology. While Dr. Lippman's diagnosis clearly fails to support the veteran's claim, Dr. Cohen's findings raise a possible causal connection between a cervical abnormality and the veteran's service-connected lumbar spine disorder. However, the doctor's comments were clearly advanced as no more than a tentative impression which required further clinical correlation. The subsequent clinical findings of record do not confirm Dr. Cohen's impression. In fact, the report of the September 1993 VA examination characterized the April 1980 study as unremarkable. Therefore, the Board finds Dr. Cohen's statement insufficient evidence upon which to establish an award of secondary service connection. The veteran has testified and advanced in numerous written statements on appeal that the claimed disorder arose secondary to his service-connected lumbar spine disorder. The United States Court of Veterans Appeals (hereinafter "the Court") has held that a lay witness is generally not capable of offering evidence involving medical knowledge such as the causation of a particular condition. Espiritu v. Derwinski, 2 Vet.App. 492, 494 (1992). In the absence of competent and persuasive evidence establishing an etiological relationship between the claimed disorder and the veteran's service-connected disabilities, the Board concludes that service connection is not warranted. Accordingly, service connection for a cervical spine disorder is denied. II. Thoracic Spine Disorder The veteran asserts on appeal that he incurred a thoracic spine disorder as the result of trauma sustained during active military service or, in the alternative, secondary to his service-connected post-operative lumbar spine disorder. The veteran's service medical records make no reference to either a thoracic spine disorder or symptoms indicative of the onset of such a disability. At the February 1967 physical examination for service separation, the veteran was found to exhibit no abnormalities of the spine. Private treatment records dated in January 1972 show that the veteran complained of tenderness of the lower thoracic spine and the low back with some muscle spasm. On examination, the veteran exhibited an "overall restriction of motion." An impression of "symptoms more of an arthritic nature" was advanced. The veteran's November 1973 written statement advances that he exhibited a "scoliosis" spine shortly after service entrance. Clinical documentation from Dr. McRoberts dated in September 1975 states that the veteran complained of suffering from a backache after twisting his back when knocked into a swimming pool during the preceding week. He clarified that he experienced increasing lower thoracic area pain of one day's duration after having been involved in a work-related altercation. Dr. McRoberts observed that the veteran exhibited tenderness of the spinous process of T10 and parathoracic muscle spasms. Contemporaneous X-ray studies of the thoracolumbar spine revealed a solid fusion from L4 to S1 and no other abnormalities. An impression of back strain was advanced. At the May 1976 hearing, the veteran testified that he suffered from back pain under the shoulder blades. At an August 1976 VA examination for compensation purposes, the veteran complained of chronic back pain and muscle spasms under his scapula. He exhibited point tenderness at T8 upon palpation and no objective evidence of paravertebral muscle spasms. Contemporaneous X-ray studies of the thoracic spine revealed no evidence of bone, joint or intervertebral disc space pathology. The VA examiner commented that the veteran's complaints of point tenderness and distress could not be explained by the clinical findings. An October 1979 VA treatment record relates that the veteran complained of pain in the mid-thoracic area. An impression of a thoracic vertebra disorder was advanced. At the July 1980 VA examination for compensation purposes, the veteran complained of severe and uncontrollable muscle spasms of the mid-back area. The examination report contains no findings as to the thoracic spine. A June 1981 statement from Eli M. Lippman, M.D., reports that the veteran complained of back pain. He reported that he had been assaulted by his supervisor and sustained injuries to the upper back. Dr. Lippman diagnosed the veteran as suffering from residuals of a traumatic injury to the dorsal (thoracic) spine with symptomatic chronic dorsal (thoracic) spine strain. An October 1988 statement from Sam Wiesel, M.D., notes that the veteran complained of pain in the mid-back. Dr. Wiesel stated that X-ray studies of the thoracic spine revealed no abnormalities. A March 1990 VA hospital summary and associated treatment records convey that a computerized tomography study of the spine revealed mild and generalized degenerative arthritis of T10 and evidence "highly suspicious" of a hemangioma or osteoporosis of T10. The veteran's February 1991 substantive appeal conveys that he suffers from pronounced intervertebral disc syndrome affecting the thoracic spine. An undated written statement from the veteran received in March 1991 advances that he suffers from "narrowing of T10 and painful T10 disc area." A second undated written statement from the veteran received in March 1991 asserts that: Narrowing of T-10 developed as the next weak spot from excessive stress having to overcompensate for pain and having a lumbar fusion done, and with the right side of the fusion broken also developed degenerative arthritis. A May 1991 VA treatment entry states that the veteran exhibited some tenderness over the mid-thoracic spine. An impression of severe arthritis of the spine was advanced. A September 1992 VA treatment entry notes that the veteran exhibited some osteoporosis of the thoracic spine commensurate with his age. A May 1993 VA orthopedic evaluation conveys that the veteran exhibited percussion tenderness at T6 and T10. An impression of "ruleout arthrosis-spondylosis in the dorsal(thoracic) spine with a history of a T10 lesion." At the September 1993 VA examination for compensation purposes, the veteran exhibited some paravertebral muscle spasms in the thoracic area. A contemporaneous bone scan revealed no abnormalities in the thoracic vertebral column. The Board notes that a thoracic spine disorder was not shown during active military service and the first clinical evidence of such a disability was reported in January 1972. Given this fact and in the absence of any objective evidence showing that the veteran's current thoracic spine disorder originated during service, the Board concludes that service connection may not be allowed on a direct or primary basis. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137 (West 1991); 38 C.F.R. §§ 3.303(d), 3.307, 3.309 (1993). Therefore, it is necessary to consider the issue of secondary service connection. The clinical record does not establish an etiological relationship between the claimed disorder and the veteran's lumbar spine disorder. The private clinical documentation of record instead indicates that the veteran sustained repeated post-service traumatic injuries to the thoracic spine when he was pushed into a pool in 1975 and involved in employment-related altercations in 1975 and 1981. The Board observes that the veteran has repeatedly asserted on appeal that the claimed disorder arose secondary to his service-connected lumbar spine disorder. In light of the Court's holding in Espiritu and the absence of any supporting clinical documentation, the veteran's argument is not persuasive. Therefore, the Board concludes that service connection is not warranted on a secondary basis. Accordingly, service connection for a thoracic spine disorder is denied. III. Left Hip Disorder The veteran contends that he sustained a left hip disorder characterized as bursitis during or as the result of his active military service. His service medical records do not refer to either bursitis of the left hip, other left hip disorders or symptoms indicative of the onset of such a disability. At the February 1967 physical examination for service separation, the veteran was found to exhibit no lower extremity abnormalities. Private treatment records dated in March 1971 and January 1973 indicate that the veteran exhibited no hip abnormalities on radiological examination. At the August 1976 VA examination for compensation purposes, the veteran complained of hip pain. The examiner commented that there were no objective findings to explain the veteran's distress. At the November 1978 VA examination for compensation purposes, the veteran related experiencing severe pain and extreme tenderness over the back of the left hip which was exacerbated by weather changes. On examination, the veteran complained of severe pain and muscle tightness in the back of the left hip while moving his lumbar spine; performing straight leg raising tests and walking on his heels. The veteran was diagnosed as suffering from post-operative residuals of a lumbar laminectomy and lumbosacral fusion. An October 1979 VA treatment record indicates that the veteran complained of bilateral hip pain. At the July 1980 VA examination for compensation purposes, the veteran exhibited "complete" flexion of the hips. An August 1980 written statement from the veteran advances that he experienced "intensive" pain in his hips. A March 1990 VA hospital summary conveys that the veteran complained of hip pain. He was diagnosed as suffering from trochanteric bursitis of the left hip. A March 1990 VA treatment entry notes that the veteran reported using a cane for ambulation when his hips are stiff. In his February 1991 substantive appeal, the veteran states that he has been treated for bursitis of the hip as the result of "having to compensate for pain." An October 1991 VA treatment record indicates that the veteran complained of left hip muscle spasms. On examination, the veteran exhibited myoclonus of the left hip induced by movement of the left leg. At the May 1992 hearing on appeal, the veteran testified that he suffers from left hip pain secondary to overcompensation for his low back pain. He stated that the clinical documentation is in error to the extent that it shows a diagnosis of bursitis of the left hip. He clarified that while he suffers from left hip complaints, he was actually treated for bursitis of the right hip. A January 1993 VA treatment entry notes that the veteran complained of hip pain. He was diagnosed as suffering from peripheral neuropathy secondary to his service-connected post-operative lumbar disorder. At the March 1993 VA examination for compensation purposes, the veteran exhibited a good range of motion of the hip and no hip abnormality on radiological examination. Contemporaneous X-ray studies of the hips revealed no abnormalities. The veteran was diagnosed as suffering from post-operative residuals of a lumbar fusion with radiating pain and no evidence of radiculopathy or radiological evidence of disc or spinal stenosis. The VA neurological examiner commented that X-rays showed minimal sclerosis and arthritis of the hips. A May 1993 VA treatment record relates that the veteran exhibited a normal range of motion of the hips. At the September 1993 VA examination for compensation purposes, the examiner noted the veteran's prior history of trochanteric bursitis of the left hip. A contemporaneous bone scan revealed no left hip abnormalities. The examiner commented that the veteran's "current left foot and left hip problem is secondary to post-myelographic arachnoiditis involving multiple roots." The Board observes that a left hip disability was not shown during active military service and the first clinical documentation of such a disorder is the March 1990 diagnosis of trochanteric bursitis of the left hip. In the absence of any clinical documentation establishing that a left hip disorder originated during active military service or that arthritis of that joint became manifest to a compensable degree within one year of service separation, the Board finds that service connection is not warranted on a direct or primary basis. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137 (West 1991); 38 C.F.R. §§ 3.303(d), 3.307, 3.309 (1993). In turning to the issue of secondary service connection, the Board acknowledges that the report of the September 1993 VA orthopedic examination conveys that the veteran's "current left foot and hip problem" is secondary to his service-connected post-myelographic arachnoiditis involving multiple roots. However, the VA examiner does not indicate that the veteran is currently suffering from a chronic hip disorder. In the absence of such a diagnosis, the physician's comments may be reasonably construed as establishing that while the veteran's service-connected lumbar spine neurological symptomatology affects his left hip, it has not resulted in the manifestation of a chronic left hip disorder. The disability evaluation for the veteran's lumbar spine disorder was increased expressly upon express consideration of his left current hip symptoms as a component of his service-connected disorder. In the absence of objective evidence establishing an etiological relationship between the onset of a chronic left hip disorder and the veteran's service-connected lumbar spine disorder, service connection on a secondary basis is not warranted. Accordingly, service connection for a left hip disorder is denied. IV. Total Rating The veteran advances that his service-connected disabilities are productive of significant physical impairment which has rendered him unable to secure and follow any form of substantially gainful employment consistent with his education and occupational experience. Total ratings for compensation purposes may be assigned where the combined schedular rating for the veteran's service-connected disability or disabilities is less than 100 percent when it is found that the service-connected disabilities are sufficient to render the veteran unemployable without regard to either his advancing age or the presence of any nonservice-connected disorders. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.340, 3.341 (1993). The provisions of 38 C.F.R. § 4.16(a) (1993), elaborate, in pertinent part, that: Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities: Provided That, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. ... It is provided further that the existence or degree of nonservice-connected disabilities or previous unemployability status will be disregarded where the percentages referred to in this paragraph for the service-connected disability or disabilities are met and in the judgment of the rating agency such service-connected disabilities render the veteran unemployable. The provisions of 38 C.F.R. § 4.18 (1993) clarify that: A veteran may be considered as unemployable upon termination of employment which was provided on account of disability, or in which special consideration was given on account of the same, when it is satisfactorily shown that he or she is unable to secure further employment. With amputations, sequelae of fractures and other residuals of traumatism shown to be of static character, a showing of continuous unemployability from date of incurrence, or the date the condition reached the stabilized level, is a general requirement in order to establish the fact that present unemployability is the result of the disability. However, consideration is to be given to the circumstances of employment in individual claims, and, if the employment was only occasional, intermittent, tryout or unsuccessful, or eventually terminated on account of the disability, present unemployability may be attributed to the static disability. Where unemployability for pension previously has been established on the basis of combined service-connected and nonservice-connected disabilities and the service-connected disability or disabilities have increased in severity, § 4.16 is for consideration. Further, a total rating may be granted irrespective of the combined schedular rating where it is shown that the veteran's service-connected disabilities render him unemployable. 38 C.F.R. § 3.321 (1993). In turning to the facts of the instant appeal, service connection is in effect for residuals of a lumbar fusion with post-operative arachnoiditis and polyradiculopathy evaluated as 60 percent disabling; an anxiety reaction evaluated as noncompensable; and thrombophlebitis evaluated as noncompensable. The veteran has a single rating of 60 percent. Therefore, the veteran does meet the schedular requirements set forth in 38 C.F.R. § 4.16(a) (1993). Given this fact, it is necessary to next address whether the veteran's service-connected disabilities render him unemployable. The veteran has reported completing three years of college. He has occupational experience as a hospital orderly, a sanitarian, a drug company "detail man," a customer service representative, a county health inspector, and a security officer. He reports last working on a full-time basis in January 1980. A July 1982 statement from the Montgomery County Government shows that the veteran received a disability retirement effective as of July 7, 1982. At the May 1992 hearing on appeal, the veteran testified that he was medically retired from a county government security position in 1980 due his back disorder; has not been gainfully employed since that time; and is currently a "house dad." He stated that he spends his days writing "nasty editorials" and otherwise acting like a citizen activist. He states that his back disability is exacerbated by prolonged periods of sitting or walking. He is unable to do many household chores due his physical impairment. At the September 1993 VA examination for compensation purposes, the veteran complained of low back pain; a burning pain in both buttocks; pain just above the knee and in the left ankle and the heels; and an abnormal gait. He reported that he had been employed as a security officer until his retirement in 1983 due to low back, buttock and leg pain. On orthopedic examination, the veteran walked with an unusual gait; a listing to the left side; flexion of the left knee and the use of a cane. He exhibited marked restriction of motion of the lumbar spine with careful voluntary guarding; little or no paralumbar muscle spasms; marked tightness of the hamstrings and no motor or sensory deficits. On neurological evaluation, the veteran was found to be anxious and to exhibit paravertebral muscle spasms in the thoracic and lumbar areas. Contemporaneous magnetic resonance imaging studies revealed minimal disc bulging at the L3 level with stenosis and adhesive arachnoiditis with clumping of nerve roots, dural ectasia and peridural adhesions. The veteran was diagnosed with spondylosis at right L5-S1; residuals of a bilateral lateral lumbar fusion including low back and buttock pain, arachnoiditis and polyradiculopathy; and left leg and hip problems secondary to arachnoiditis involving multiple nerve roots. The examiner commented that the veteran's gait appeared to be of a "more or less contrived or habitual pattern." In his November 1993 Application for Increased Compensation Based on Unemployability, the veteran advances that due to his back, "there is no way I can perform to a daily routine or work a 40 hour week!!!" A January 1994 written statement from the veteran asserts that he was medically retired from his last position "as all of my spinal injuries, including my VA disability for the low back , thusly contributing to my 100 percent back disability." He states further that: I haven't worked any since I was retired out on 7 July 1982; in fact in reality it was before this date that I hadn't worked any or been able to work due to all my spinal injuries. It is physically impossible for me to work a 40 hour work week or be able to perform to a routine of day in and day out work responsibilities thusly making me totally unreliable for employable purposes due to my very painful back disabilities. Plus the fact, I would most certainly end up using far more sick leave than what I would ever earn within a year; needless to say, an employer needs a productive employee not down time. In written statements dated in April 1994, the veteran asserts that he is entitled to a total rating for compensation purposes based on individual unemployability as he was "retired out on 100 percent disability from [the] Government" and his back disability has continued to worsen since that time. He clarifies that "the record and the evidence clearly shows the veteran's unemployability is the direct result of a combination of service-connected and nonservice-connected disability." The Board has conducted a careful longitudinal review of the record. The veteran's service-connected post-operative lumbar disorder is clearly productive of significant physical impairment which prevents him from retaining employment which requires manual labor. However, the more difficult question is whether sedentary employment is also contra-indicated. Since the veteran meets the schedular criteria, his nonservice connected disabilities are not considered in this determination. We note that the veteran has worked in sedentary positions in the past, and has some college training. Nonetheless, considering the symptomatology associated with his low back, which includes lower extremity radiculopathy and constant low back pain, it is doubtful that full time employment is possible. The Board must resolve benefit of the doubt in the veteran's favor, and thus a total rating for compensation purposes based upon individual unemployability is granted. ORDER Service connection for a cervical spine disorder is denied. Service connection for a thoracic spine disorder is denied. Service connection for a left hip disorder is denied. A total rating for compensation purposes based on individual unemployability is granted subject to the law and regulations concerning payment of benefits. E. W. SEERY 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 granting less than the complete benefit, or benefits, sought on appeal is appealable to the Court 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.