BVA9503501 DOCKET NO. 90-47 710 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Oakland, California THE ISSUES 1. Entitlement to service connection for disability of the cervical spine, separate and apart from the service-connected peripheral nerve injury, left arm. 2. Entitlement to service connection for tachycardia. 3. Entitlement to an evaluation in excess of 40 percent for residuals of peripheral nerve injury of the left arm. 4. Entitlement to an evaluation in excess of 10 percent for hypertension. 5. Entitlement to an effective date earlier that February 10, 1992 for an award of compensation benefits for a total rating based on individual unemployment due to service-connected disability. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD G. Wm. Thompson, Counsel INTRODUCTION The veteran had verifiable active service from May 1969 to April 1970, and from August 1970 to August 1976. The veteran's enlisted qualifications record (DA Form 20), shows that he was in Vietnam from June 1970 to April 1971. There are no records showing combat awards or decorations for the veteran. This case was previously before the Board of Veterans' Appeals (Board) and remanded in May 1991, for additional development. The Department of Veterans Affairs (VA) Oakland, California, Regional Office (RO) has returned the case to the Board for further appellate consideration. In the course of this appeal the issues of entitlement to service connection for disability of the cervical spine, entitlement to an increased rating for hypertension, and entitlement to an earlier effective date for an award and payment of a total rating were developed for appeal. The veteran also raised the issue of entitlement to service connection for tachycardia. This issue was denied by rating action in November 1992, and it was addressed in the November 1992 Supplemental Statement of the Case. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in essence, that the RO erred in not finding that the evidence of record supports entitlement to service connection for disability of the cervical spine and tachycardia, increased evaluations for peripheral nerve injury of the left arm and hypertension, and entitlement to an earlier effective date for award and payment of a total rating. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the claim for entitlement to service connection for disability of the cervical spine separate and apart from the service-connected peripheral nerve injury, left arm, is not well- grounded; the preponderance of the evidence is against entitlement to service connection for tachycardia; the preponderance of the evidence is against entitlement to an increased evaluation for residuals of peripheral nerve injury to the left arm, and hypertension; and the preponderance of the evidence is against entitlement to an effective date earlier than February 10, 1992, for an award and payment of a total rating based on individual unemployability due to service connected disability. FINDINGS OF FACT 1. Disability of the cervical spine, separate and apart from the service-connected peripheral nerve injury, left arm, was not demonstrated in service or for years thereafter. 2. There is no convincing evidence showing a relationship between the post-service disability of the cervical spine and any incident of service. 3. Tachycardia was not demonstrated in service or for years thereafter. 4. Tachycardia is not related to service or a service connected disability. 5. The service-connected residuals of peripheral nerve injury, left arm, (minor extremity) are principally manifested by complaints of chronic pain, limitation of motion due to complaints of pain, sensory abnormality, and some muscle atrophy of the left deltoid. 6. The incomplete peripheral neuropathy is productive of not more than severe impairment. 7. The service-connected hypertension is principally manifested by requirement for medication, and diastolic pressure predominately less than 110 millimeters of mercury. 8. The manifestations associated with the service-connected peripheral nerve injury to the left arm and hypertension do not render impractical the application of the regular schedular standards. 9. The veteran's September 1989 substantive appeal, in a May 1991 Board Remand, was construed to be a claim for entitlement to a total rating; in October 1991 the veteran filed a formal application for increased compensation based on unemployability. 10. Received February 10, 1992 was the veteran's claim for service connection for post traumatic stress disorder (PTSD). 11. In March 1992 the veteran withdrew his claim for PTSD; in June 1992 he asked that his claim for PTSD be reinstated. 12. By rating action in November 1992 service connection was granted for PTSD, and a 50 percent rating was assigned; his combined rating was 70 percent, and individual unemployability was granted effective February 10, 1992. CONCLUSIONS OF LAW 1. The appellant's claim for service connection for disability of the cervical spine, separate and apart from the service- connected peripheral nerve injury, left arm is not well-grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. Tachycardia was not incurred in or aggravated by active military service, and it is not proximately due to or the result of a service connected disability. 38 U.S.C.A. §§ 1110, 1131, 5107(a) (West 1991); 38 C.F.R. §§ 3.303, 3.310(a) (1994). 3. An evaluation in excess of 40 percent for residuals of peripheral nerve injury, left arm, is not warranted. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38 C.F.R. § 4.124, Diagnostic Codes 8610, 8510 (1994). 4. An evaluation in excess of 10 percent for hypertension is not warranted. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38 C.F.R. § 4.104, Diagnostic Code 7101 (1994). 5. An effective date earlier that February 10, 1992 for a total disability rating due to individual unemployability is not warranted. 38 U.S.C.A. §§ 5107(a), 5110(a) (West 1991); 38 C.F.R. § 3.400 (a) (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION Cervical Spine In Boeck v. Brown, 6 Vet.App. 14 (1993), the United States Court of Veterans Appeals (the Court) held that A veteran claiming entitlement to VA benefits has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. See 38 U.S.C.A. § 5107, and Tirpak v. Derwinski, 2 Vet. App. 609, 610-11 (1992). If a claim is not well grounded, the Board does not have jurisdiction to adjudicate the claim. See Grottveit v. Brown, 5 Vet.App. 91, 93 (1993). The veteran contends that his cervical spine disability had its onset in service. He claims that military medical records show damage to C4 through C6, and that the current cervical disc anomalies and osteophytes from C2 through C7 are directly related to his injury in service. A well-grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). Although the claim need not be conclusive, it must be accompanied by supporting evidence sufficient to justify a belief by a fair and impartial individual that the claim is plausible. See Tirpak. In this case, the appellant has failed to submit medical evidence of a relationship between the cervical spine, first demonstrated many years following service, and the motorcycle accident in service, or the service-connected peripheral nerve injury to the left arm. Service medical records show that the veteran was involved in a motorcycle accident in March 1975, suffering multiple contusions. X-ray studies of the cervical spine, and a myelogram in 1975 were normal. Electromyogram studies revealed compromise of axillary and suprascapular nerves, more severe in the axillary nerve. The final diagnosis was peripheral nerve injury, axillary. There were no other references to cervical spine injury or disease in the service medical folder, and the spine was normal on the separation examination in June 1976. VA examination in July 1977 did not reveal the presence of cervical spine disability; there was mild reversed lordosis on X- rays but no other abnormality of the cervical spine demonstrated. J. Gambin, M.D., in December 1983 described the veteran's left upper extremity disability and identified the sensory loss, associated with the residuals of the peripheral nerve injury, as being in the C6, C7 distributions. This indicates the location of the root nerve, and not disability of the cervical spine itself. Later in the 1980's, Dr. Gambin and other private physicians reported C5-C6 nerve root injury. In January 1986 the veteran complained of neck pain radiating up into the back of his head causing headaches. Shoulder and neck spasms "as a consequence of the emotional content of our discussion" were reported in March 1987. Private evaluation in December 1987 did not reveal any disability of the cervical spine. VA X-ray studies of the cervical spine in January 1988 were normal. Private examination in March 1989 noted normal neck examination, with thick neck musculature. A VA examiner in June 1989 indicated that the veteran had persistent sensory abnormality involving C2 through C8 roots. Private physical therapy evaluation in November 1989 showed good range of motion of the cervical spine without complaints of pain. Extremity reflexes were present and equal bilaterally for C5 through C7. Palpation of the cervical spine revealed muscle tightness and tenderness. A VA magnetic resonance imaging (MRI) in August 1991 was interpreted as showing bulging discs and osteophytes at various levels of the cervical spine. A VA medical advisor to the RO rating board, in May 1994, reviewed the veteran's medical records, and determined that the changes in the cervical spine appeared to be "age-related" and distinctly dissociable from the service-connected left arm disability. In summary, the service medical records, VA records, and private records do not show disc or bone disability of the cervical spine prior to 1992, or objective medical evidence of a relationship between the post-service cervical spine disability and the service-connected peripheral nerve injury to the left arm. In this case there is no objective medical evidence showing the existence of a current cervical spine disability, separate and apart from the service-connected peripheral nerve injury, left arm, etiologically related to any incident of service. The veteran himself is not shown to possess the medical expertise to determine the etiology of his various medical symptoms or their relationship to service, and his claims of medical causation are of limited probative value. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Since the evidence does not present a plausible basis for entitling him to service-connected disability compensation under 38 C.F.R. § 3.310, he has failed to submit a well-grounded claim under 38 U.S.C.A. § 5107(a) (West 1991). In light of Grivois v. Brown, 6 Vet.App. 136 (1994), purported adjudication of claims which are not well-grounded are a nullity in contemplation of law. Though the RO obtained a medical advisor opinion without proper notification to the appellant or his representative, in apparent violation of the "fair process" principle described in Thurber v. Brown, 5 Vet.App. 119 (1993), this error is harmless. Harmless error is trivial and not prejudicial to the substantive rights of the party assigning it. Black's Law Dictionary 718 (6th ed. 1990). The Court has found that error is harmless when it does not change the resolution of the claim. Sanchez v. Derwinski; 2 Vet.App. 330, 333 (1992). Here, the veteran failed to submit a plausible claim and the medical advisor opinion is superfluous. Tachycardia A well-grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). In this instance, the veteran has submitted a well-grounded claim and the VA has met its duty to assist by obtaining or attempting to obtain all relevant evidence. The requirements mandated by 38 U.S.C.A. § 5107(a) have been fulfilled. In essence, service connection is in order if a chronic disease or disability is incurred in service; or if a disability is proximately due to or the result of a service-connected disease or injury. 38 U.S.C.A. §§ 1110, 1131, 5107(a) (West 1991); 38 C.F.R. §§ 3.303, 3.310(a) (1994). The veteran contends that his tachycardia is a symptom of heart damage due to his service-connected hypertension. Service medical records, while reflecting hypertension, do not show tachycardia. While private and VA records show that the veteran has been under treatment for hypertension since service, the hypertension has not always been under good control. A private examination in July 1982 noted that the veteran reported intermittent episodes of palpitations, sweating and nervousness. VA records show that in December 1987 the veteran reported drinking 1/2 gallon of hard liquor a week. In May 1989 he reported "spells" of flushing, shortness of breath, palpitations and increased blood pressure for 2 years. Private outpatient treatment records show that in December 1988 the veteran reported a multi-year history of rapid heartbeat. The assessment was probable supraventricular tachycardia. In January 1989, after a treadmill walk, the plan was to get a chest X-ray and schedule the veteran for an echocardiogram with "likely or considered alcoholic myopathy". When seen in February the veteran reported being off alcohol for 4 to 6 weeks. The assessment was possible alcohol induced autonomic dysfunction, consider pulmonary hypertension. In March 1989 it was noted that chest X-ray was normal and an echocardiogram showed mild left ventricular dilatation but normal left ventricular systolic function. The possibility of a pheochromocytoma was considered. When examined by the VA in June 1989 rapid pulse rate was reported. The veteran reported that 2 months before he had been told he had liver damage. His alcohol intake was 1/2 gallon a week. A private echocardiogram in October 1990 showed normal two-dimensional and Doppler echocardiogram; the intracardiac dimensions of the study were compared to a prior study of February 1989 and represented resolution of mild left atrial and left ventricular dilation. Private records show that in August 1990 it was noted that an extensive work up was negative, to include pheochromocytoma and thyroid disease. The pertinent assessment was palpations, suspect that the spells are psychological. In October 1990 it was noted that an electrocardiogram was entirely normal. Later in October it was reported that there was some decrease in palpitations, and the examiner felt that in light of the veteran's substance abuse, control of symptoms was possible at this point. When examined by the VA in November 1991, the diagnoses included no clear-cut evidence of hypertensive cardiovascular disease or valvular disease, and symptomatic complaints of episodic paroxysmal tachycardia, not evidenced during examination, etiology remains unclear and unknown. The veteran underwent a VA cardiovascular evaluation in July 1992. The assessment was that the veteran's sinus tachycardia could be a result either of hypertensive disease, coronary artery disease, or cardiomyopathy due to a long history of alcohol consumption. The examiner opined that which of the aforementioned etiologies was causing the rhythm disturbance could not be determined; however, with the veteran's significant history of alcohol consumption in the past and continued current consumption, as compared to minimal or absent findings of evidence for cardiac dilation on echocardiogram and normal exercise tolerance test, it was more probable that the veteran's tachycardia was the "result of alcohol consumption and related alcohol heart disease." While the veteran and his representative have stressed the first part of the July 1992 diagnosis, as proof of a relationship between the veteran's hypertension and the tachycardia, they have ignored the final conclusion of the examiner, that is was more probable that the tachycardia was related to the veteran's alcohol abuse. This opinion is also supported by several earlier private opinions that it was likely the veteran had alcoholic cardiomyopathy. In essence, the clinical picture reflects that while tachycardia could possibly have any number of causes, including the service-connected hypertension, the most likely cause is substance abuse, which is not shown to be related to service. Further, there is no objective definitive medical assessment that the tachycardia is etiologically or causally related to the veteran's hypertension. "A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service." Watson v. Brown, 4 Vet.App. 309, 314 (1993). In this case no such relationship has been medically demonstrated. The veteran himself is not shown to possess the medical expertise to determine the etiology of his various medical symptoms or their relationship to service, and his claims of medical causation are of limited probative value. See Espiritu, supra 492. The Board is not persuaded by the evidence of record that there exists a basis for entitlement to service connection for tachycardia. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. Peripheral Nerve Injury, Left Arm Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. The term "incomplete paralysis" with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less that the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124 (1994) Incomplete paralysis or neuritis, severe, minor extremity, warrants a 40 percent rating. Complete paralysis of all shoulder and elbow movements lost or severely affected, hand and wrist movements not affected, minor extremity, warrants a 60 percent. 38 C.F.R. § 4.124, Diagnostic Codes 8510, 8610 Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet.App. 55 (1994). In March 1975 the veteran sustained an injury to the left arm, minor extremity, in a motorcycle accident. The final diagnosis was peripheral nerve injury, axillary. The VA examination diagnosis in July 1977 was residuals of injury to the left circumflex nerve, with loss of deltoid muscle mass and decreased strength, left upper extremity. By rating action in September 1977 a 20 percent rating was assigned for peripheral nerve injury, left arm. The veteran's complaints on examination in 1977 and 1978 were primarily weakness, hyperesthesia and paresthesia. Records show private treatment for left arm complaints of weakness from 1978 to 1980. On VA examination in 1981 the veteran complained of pain on motion of the left shoulder. The diagnosis was history of contusion to the left shoulder; history of diagnosis of peripheral nerve injury, left arm; residual pain, loss of range of motion and weakness in the left arm. By rating action in September 1981, a 30 percent evaluation for the left arm was assigned. Private medical records show that the veteran's complaints of chronic left arm pain began in the early 1980's and by the mid 1980's he was reported to have chronic neuropathic pain in the left upper extremity, with no relief. A December 1987 private medical evaluation was performed, associated with the veteran's claim for injuries sustained on the job. The physical findings were minimal limitation of motion of the left shoulder, with pain on motion, no motor disturbance, atrophy of the deltoid, supraspinatus and infraspinatus and pronator teres muscles, some decreased sensation in the area of the axillary nerve over the deltoid. and motor strength testing revealed only a pain type of weakness in the proximal shoulder muscles. The examiner opined that the veteran had 75 percent loss of function for the left arm, based on pain, weakness, atrophy and sensory loss. An electromyogram was performed by the VA in January 1988. The impression was changes in the left infraspinatus and deltoid muscles, probably from severe old local trauma A March 1989 rating action assigned a 40 percent evaluation for the left arm peripheral nerve injury. VA examination was performed in June 1989 and there was no reported atrophy. Limitation of motion of the left shoulder due to pain was noted. The veteran lacked 50 degrees of forward flexion, 90 degrees of abduction, 10 degrees of external rotation and 10 degrees of internal rotation of the left shoulder. There were areas of hypesthesia defined, strength was intact and left upper extremity reflexes were 1 plus and equal. A physical therapist, in November 1989 noted 85 pounds of grip strength on the right and 73 pounds on the left. The veteran continued to received private medical treatment for chronic left arm pain in the 1990's. A neurological examination was performed by the VA in July 1991. At that time it was recorded that deep tendon reflexes were 1-2 plus and equal in the upper extremities. The examiner noted that it was very difficult to determine whether the loss of motion was secondary to pain or muscle weakness. Distally, the strength appeared to be good. Marked atrophy over the left deltoid area was noted. Sensory aberration was noted. The examiner noted that the veteran did develop a chronic pain syndrome secondary to brachial plexus injury, which had resulted in marked disability because of dysfunction in the left upper extremity. A general medical examination in July 1991, and neurology examination in November 1991 resulted in essentially the same physical findings as the neurology examination in July 1991. When hospitalized at a VA facility for disability not at issue, in February and March 1992, the veteran was seen by a neurologist for chronic left arm and shoulder pain, with no change. In summary, there have been no significant physical changes referable to the left upper extremity for at least a decade. The veteran has sensory changes in the area of the left shoulder, limitation of motion associated with complaints of pain, and some atrophy of the left deltoid. There is good motor function and reflexes for the left upper extremity. No articular changes have been reported. The veteran's most significant problem with the left upper extremity is chronic pain, as indicated by the record. Because of the pain he has limited motion of the left shoulder, and constantly seeks pain relief. However, physically, there has been no significant deterioration of the left upper extremity over the years. He has not lost all shoulder and elbow movements, and his hand-wrist movements have not been affected. The paralysis of the peripheral nerves is significantly less than complete. Under the rating criteria such changes are required for the next higher evaluation, 60 percent. There is no basis for an increased evaluation for the service-connected residuals of peripheral nerve injury, left arm. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.124, Diagnostic Code 8610. In exceptional cases where the schedular evaluations are found to be inadequate, an extraschedular evaluation may be approved. The Board has considered the service-connected residuals associated with peripheral nerve injury, left arm. While some interference with employment, requiring physical labor is precluded, the Board concurs with the private examiner in December 1987, that indicated that the veteran's left shoulder did not preclude all employment. We do not find frequent periods of hospitalization, or other factors which would render impractical the application of the regular schedular standards in regard to this disability. There is no basis for an extraschedular evaluation for the left arm peripheral nerve injury under 38 C.F.R. § 3.321(b)(1). Hypertension Hypertensive vascular disease (essential arterial hypertension), With diastolic pressure predominately 110 or more with definite symptoms warrants a 20 percent evaluation. When diastolic pressure is predominately 100 or more a 10 percent rating is assigned. 38 C.F.R. § 4.104, Diagnostic Code 7101. The veteran had elevated blood pressure readings in service, and has been followed for hypertension since service, receiving private and VA treatment. A 10 percent evaluation was assigned by rating action in September 1977, reduced to noncompensable in a rating action in September 1981, and the Board, in a decision in June 1983, restored the 10 percent rating which has been in effect since that time. The veteran has taken a variety of medications in an attempt to control his hypertension, with limited success. VA and private medical records, from 1989 to 1992, do not show sustained blood pressure readings predominately 110 millimeters of mercury or more. Typical of this period are records from Dr. Abel, one of the veteran's treating physicians, from 1989 to 1991. Dr. Abel's outpatient records show approximately 25 blood pressure reading, with 2 readings during some examinations, from 1989 to 1991; the highest diastolic reading was 106 and the lowest 70, with 19 readings below 100, and 15 readings that were 90 or less. When examined by the VA in July 1991 the veteran's blood pressure was 160/115, with a pulse of 90. The diagnosis was hypertension with diastolic of 115 currently while taking Lopressor, hydrochlorothiazide, and Cardizem. VA cardiovascular examination was performed in November 1991. A brief history was given, to include current medications, and the examiner noted that control of the veteran's blood pressure was variable. It was reported that there was no clear-cut evidence of coronary artery disease. The first reading, in a sitting position was 160/90, and in the standing position the reading was 140/110. Recumbent the reading was 158/100. The veteran's pulse was 80 and regular. The pertinent diagnosis was hypertension, treated but not evidently controlled and no clear-cut evidence of hypertensive cardiovascular disease or valvular disease. A VA cardiovascular examination was again performed in July 1992. A review of his cardiovascular complaints, previous evaluations, and tests, was made. Examination of the heart showed regular rate and rhythm with no murmurs and no gallops. Carotid pulses were 2 plus without bruits, and radial pulses were normal. No jugular vein distention was found. Blood pressure readings while sitting, lying, standing, after 2 minutes of exercise, and after 2 minutes of rest were: 148/105; 142/97; 154/106; 133/92; and 135/111, respectively. Pulse rates in the same positions were 66, 67, 106, 82, and 56, respectively. An electrocardiogram was within normal limits. The pertinent assessment was long standing hypertension. In order for a 20 percent evaluation for the service-connected hypertension to be warranted, diastolic pressure, predominately 110 or more, with definite symptoms, must be objectively demonstrated. Clearly the evidence, private and VA, does not show diastolic pressure is predominantly 110 or more. In fact, the private records from Dr. Abel do not show diastolic pressure readings are predominately 100 or more. The associated complaints of dizziness, fatigue and chest pain are contemplated in the current evaluation. There is no basis for an evaluation in excess of 10 percent for the service-connected hypertension. 38 U.S.C.A. § 1155; 38 C.F.R.. § 4.104, Diagnostic Code 7101. There is no indication in the record that the schedular evaluations are inadequate to evaluate the impairment of the appellant's earning capacity due to his hypertension, and it does not present such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards. Thus, the provisions of 38 C.F.R. § 3.321 (1993) relating to extraschedular evaluations are not applicable here. We have also considered all other potentially applicable provisions of 38 C.F.R. Parts 3 and 4 (1993), whether or not they have been raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet.App. 589 (1991). We have found no section that provides a basis upon which to assign a higher disability evaluation. Effective Date Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C.A. § 5110(a) West 1991); 38 C.F.R. 3.400 (1994). The effective date for an increase in disability compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability had occurred if the claim is received within 1 year from such date otherwise, date of receipt of claim. 38 U.S.C.A. § 5110(a) (West 1991); 38 C.F.R. 3.400 (o)(2)(1994). A specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid to any individual under the laws administered by the VA. 38 U.S.C.A. § 5101(a) (West 1991); 38 C.F.R. § 3.151 (1994). Any communication or actions, indicating an intent to apply for one or more benefits under the laws administered by the VA, from a claimant, his or her duly authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui juris may be considered an informal claim. Such informal claim just identify the benefit sought. Upon receipt of an informal claim, if a formal claim had not been filed, an application form will be forwarded to the claimant for execution. If received within 1 year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155 (1994). When there is evidence from a private physician, in a claim for increase or to reopen, the effective date of compensation benefits, if otherwise in order, will be the date of receipt of such evidence, when the evidence furnished by or in behalf of the claimant is within the competence of the physician, and shows the reasonable probability of entitlement to benefits. 38 C.F.R. § 3.157 (1994). It is contended that the evidence of record shows that in the 1980's the veteran was unable to retain employment due to his emotional and physical disabilities, that Dr. Gambin's June 17, 1977 report should have been accepted by the VA as an informal claim for unemployability, and that the VA failed in its duty to assist by not securing the veteran's Social Security records. Basically, the question before the Board is when was a claim for a total rating filed, and when was the date entitlement arose. The Board, in the May 1991 Remand, construed statements by the veteran in his September 1988 Substantive appeal as a claim for a total rating. A formal claim for a total rating was received in October 1991. A rating action in March 1992 denied a total rating. The veteran's service connected disabilities at the time were peripheral nerve injury left arm rated at 40 percent, hypertension rated at 10 percent and left varicocele, rated as noncompensable, for a combined 50 percent evaluation. The award of service-connection for PTSD was by rating action in November 1992, and a 50 percent evaluation was assigned. In that same rating action a total rating was granted on the basis of the combination of the veteran's service-connected disabilities, which were found to render him unemployable. Because the total rating award hinged on the grant and rating of PTSD, the date of the veteran's claim for PTSD becomes important. In fact, entitlement to a total rating did not arise until the grant of service connection for PTSD, and the effective date for that award was February 10, 1992. There was a private diagnosis of post traumatic stress disorder in February 1988, and when hospitalized by the VA in February and March 1992, there was a diagnosis of PTSD. Received February 10, 1992, was the veteran's claim for post traumatic stress disorder. Received in early March 1992, before any rating action on PTSD, was a certified statement from the veteran, in which he withdrew his PTSD claim. In a letter in June 1992 the veteran asked to reinstate his claim for PTSD. The RO liberally construed the effective date for the award of the total rating as February 10, 1992, the date the veteran first requested service connection for PTSD, and later canceled. In regard to the effective date for PTSD, there was no claim in conjunction with the diagnosis in 1988, and the date of admission to the hospital in 1992 was February 3, 1992. The date of the first claim for PTSD was February 10, 1992. The effective date for the award of PTSD is the latter of the date of claim or date entitlement arose. There is no basis for an effective date earlier that February 10, 1992 for an award and payment of compensation benefits for a total rating based on individual unemployability due to service connected disability. 38 U.S.C.A. § 5110. In regard to the contentions advanced, the letter from Dr. Gambin was dated June 13, 1977, and it was received in December 1987, in support of the veteran's claim for an increased rating for left arm disability. This opinion only addressed the veteran's ability to perform jobs that would be physically demanding on the left upper extremity. It did not state that the veteran was precluded from all forms of substantially gainful employment for which he was qualified. Further, the statement did not identify a total rating as the benefit sought. In fact there is evidence of record, at the time the statement in 1977, that the veteran was in fact working, and continued to work at various jobs until May 1987. The reports in the 1980's of the veteran's depression, and personality disorder, which at the time were not service connected did not equate to a claim for a total disability rating. The regulations require that a specific claim must be filed, and the benefit identified. As for any Social Security records, such records would be applicable to the veteran's claim for a total rating, and the RO granted a total rating without such records. It has not been contended that such records would impact on the date of the veteran's claim for PTSD. In essence, there is no showing that the veteran is unemployable due to his physical disabilities and no basis for granting service connection for PTSD prior to February 10, 1992. Only when his physical and psychiatric disabilities are considered in conjunction is sufficient symptomatology presented to preclude gainful employment. ORDER The claim for service connection for disability of the cervical spine, separate and apart from the service-connected peripheral nerve injury, left arm, is dismissed. Entitlement to service connection for tachycardia is denied. Entitlement to increased evaluations for residuals of peripheral nerve injury, left arm, and hypertension is denied. Entitlement to an effective date earlier than February 10, 1992 for an award of compensation benefits for a total rating based on individual unemployability due to service connected disability is denied. THOMAS J. DANNAHER 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.