BVA9505965 DOCKET NO. 92-07 671 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in No. Little Rock, Arkansas THE ISSUES 1. Entitlement to restoration of a 70 percent rating for post- traumatic stress disorder. 2. Entitlement to service connection for a stomach disorder, to include peptic ulcer disease. 3. Entitlement to a total rating on the basis of individual unemployability due to service-connected disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD C.M. Flatley, Counsel INTRODUCTION The veteran had active service from May 1942 to June 1945. Entitlement to service connection for a stomach disorder, to include peptic ulcer disease, on a direct basis, was denied by a December 1993 rating decision; appellate review is, therefore, limited to direct service connection. The Board of Veterans' Appeals (Board) notes, however, that in a 1991 statement, the veteran's private physician suggested an association between the veteran's service-connected psychiatric impairment and his peptic ulcer disease. The veteran may wish to pursue a claim of secondary service connection in this regard; the matter is therefore referred to the regional office (RO) for appropriate action. After developing additional evidence in this case, the Board, in accordance with Thurber v. Brown, 5 Vet.App. 119 (1993), informed the appellant in a March 1995 letter of the additional evidence developed, and provided an opportunity to respond. In a March 1995 response, the representative stated that no further evidence, argument, or comment would be submitted. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his service-connected psychiatric disorder has become worse in recent years and that reduction of the evaluation in effect for the disorder was not appropriate. It is also asserted that the veteran's service-connected disabilities, particularly his back disability, render him unable to obtain and retain substantially gainful employment. He essentially contends that service connection for a stomach disorder is warranted. 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 evidence of record is in favor of restoration of a 70 percent disability evaluation for post-traumatic stress disorder (PTSD) and a total rating on the basis of individual unemployability and that a well-grounded claim of service connection on a direct basis for a stomach disorder, to include peptic ulcer disease, has not been presented. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. Prior to March 1, 1992, the veteran's post-traumatic stress disorder was manifested by complaints of nightmares, frequent intrusive thoughts of World War II, startle reaction, and chronic anxiety; material improvement in the veteran's post-traumatic stress disorder has not been demonstrated subsequent to March 1, 1992. 3. No competent medical evidence has been submitted to link a stomach disorder, to include peptic ulcer disease, first shown many years after the veteran's separation from service, to any incident of service. 4. Other than PTSD, the veteran's service-connected disabilities consist of degenerative arthritis of the lumbar spine, with degenerative disc disease, currently rated at 60 percent; a wound of Muscle Group IV on the right, currently rated at 30 percent; and scars of the right third toe and left knee, currently rated as noncompensably disabling. 5. The service-connected disabilities are of sufficient severity as to preclude the veteran from engaging in all types of substantially gainful employment, consistent with his education and occupational history. CONCLUSIONS OF LAW 1. The criteria for restoration of a 70 percent evaluation for the veteran's post-traumatic stress disorder have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, §§ 3.344, 4.1, 4.132, Diagnostic Code 9411 (1994). 2. The veteran's claim of service connection on a direct basis for a stomach disorder is not well-grounded. 38 U.S.C.A. § 5107. 3. A total rating on the basis of individual unemployability due to service-connected disability is warranted. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341(a), 4.16 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Review of the record indicates that, unless otherwise noted below, the veteran has submitted a well-grounded claim. 38 U.S.C.A. § 5107(a). The Department of Veterans Affairs (VA) therefore has a duty to assist the veteran in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet.App. 78, 81-82 (1990). I. Post-traumatic Stress Disorder. Entitlement to service connection for post-traumatic stress "neurosis" was allowed by a December 1981 rating decision and a 50 percent evaluation was assigned. The determination was based upon clinical data recorded on VA psychiatric examination in November 1981, which included the veteran's World War II combat experiences and complaints of psychiatric symptomatology. It was noted that the veteran was taking an antidepressant and continued to experience depression. The veteran was anxious and depressed on examination. Nightmares associated with his combat experiences, startle reaction, and crying spells were noted. No unusual ideas or thinking disorders, perceptive disturbances, or ideas of reference, were found. The veteran was well-oriented and his memory was intact. The diagnosis was post-traumatic stress neurosis. In a March 1982 letter from the McCrory Clinic, it was noted that the veteran had been treated since 1974 with psychotropic agents for "nerves." On VA psychiatric examination in November 1983, it was reported that the veteran had not received formal psychiatric treatment subsequent to service, but had been prescribed medication from private physicians and that anxiety neurosis had been present. The veteran reported that he continued to have nightmares of combat situations approximately twice per week and that he was unable to watch "war pictures." He complained of anxiety, exacerbated by loud noises and crowds. Startle reaction and, at times, social isolation, sadness, and insomnia were reported. He noted that since his retirement in 1975, his activities included doing work around the house and visiting friends at a coffee shop in the morning and in the afternoon. He noted that at night, he watched television, played cards with his wife, or otherwise remained occupied. He stated that age and fewer work duties had tended to cause an increase in his anxiety and related symptomatology. On examination, the veteran was tremulous, anxious, and sad, with a mildly blunted affect. It was difficult for the veteran to relate interpersonally. No psychotic process was found; the veteran's cognitive functions were intact and conversation was direct, logical, and coherent. His judgment was described as good and his insight was low. The examiner commented that the veteran's symptomatology, with the history of major trauma, confirmed the presence of post-traumatic stress disorder and that the veteran's symptomatology appeared to have worsened secondary to age, retirement, and resulting reduction in his ability to cope with stress. The diagnosis was chronic post-traumatic stress disorder. By a March 1984 rating decision, a 70 percent evaluation was assigned for the veteran's post-traumatic stress disorder. In an unsigned July 1990 letter, Fred E. Wilson, M.D., wrote that the veteran's disabilities included anxiety neurosis and that the veteran had become depressed during the past two years. On VA psychiatric examination in October 1990, the veteran reported that he experienced combat nightmares once or twice per month, at times awakening him. Frequent intrusive thoughts of the war were reported; the veteran became tearful on discussing his wartime experiences. Sensitivity to noises was also noted. The veteran indicated that he avoided watching television because he did not want to see combat films. He stated that at times, he was uncomfortable in crowds. He reported no "problems" with his wife of 49 years, and noted that he went to the coffee shop in the morning and in the afternoon to visit with friends, where they either played cards or talked. It was noted that the veteran no longer engaged in fishing due to his back disorder, but he occasionally hunted. He denied sleep impairment, except in response to an event which would cause anxiety. On mental status examination, the veteran appeared significantly anxious; discomfort increased on discussing his military experiences. The predominant moods were ones of anxiety and depression; his expression was appropriate to content. The veteran's thought processes were logical, with no loosening of associations or confusion. There was an occasional tremor of the right hand. No gross impairment in memory was noted and that veteran was oriented in three spheres. No delusions were present. His insight and judgment were adequate. The diagnosis was chronic post-traumatic stress disorder. By a November 1990 rating decision, a reduction of the evaluation in effect for the veteran's post-traumatic stress disorder from 70 percent, in effect from May 4, 1983, to 30 percent was proposed. In a May 1991 letter from the McCrory Clinic, a 30-year history of treatment of the veteran was noted; it was further noted that he had experienced severe anxiety neurosis during that time. His symptoms had reportedly increased to the extent that he had withdrawn from interactions with others. It was noted that he was unable to cope with crowds and loud noises and that no improvement in his anxiety was anticipated. On VA psychiatric examination in June 1991, the veteran reported that he was taking medication for his "nerves." He stated that he continued to hunt from his vehicle and continued to visit with friends at the coffee shop. The veteran reported that he and his wife visited their children often. He also noted that he spent winter months in Florida, at a location where the same group of people returned each year. It was noted that while there, he engaged in activity such as shuffleboard, card-playing, hunting and fishing. It was noted that the veteran enjoyed his social contacts in Florida. On examination, the veteran reported that he slept from approximately 10:30 p.m. to 7:00 a.m. and felt well-rested. He reported that he experienced nightmares, which awakened him for extended and recurrent periods of time. With the exception of a mild anxiety level and a slight hand tremor, examination revealed essentially unremarkable results. No increased startle reflex, for example, was noted, and the veteran's speech was fluent, logical and coherent; his mood was stable. The examiner commented that the veteran's post-traumatic stress disorder was well-controlled, that the veteran was able to socialize extensively, engage in hunting activities, and demonstrated no increased startle reflex. At a personal hearing conducted in October 1991, the veteran testified that he became tremulous and unable to talk in situations where he went to "meet people in a certain way." Transcript (T.) at 1. He stated that his association with close friends was limited to going to the coffee shop and that he did not remain at the shop for prolonged periods of time. T. at 2. The veteran stated that activity at home included watching sporting events on television and that he was no longer able to hunt due to his back and right leg symptomatology; his hunting activity was limited to hunting from the back of a truck. T. at 2, 3, 15. He stated that he experienced nightmares approximately twice per week. T. at 4. The veteran reported that his post- traumatic stress disorder had become worse and that he sought treatment from private physicians once or twice monthly. T. at 5, 6. The veteran's wife testified that his psychiatric condition had not improved and that he had more difficulty communicating. T. at 8. She also confirmed the occurrence of nightmares and noted the veteran's decreased ability to socialize. T. at 10. The veteran's wife noted that the veteran engaged in activity at home such as cooking and reading and that he was less active than in the past. T. at 11, 12. The proposed reduction was effectuated by a December 1991 rating decision and an effective date of March 1, 1992 was assigned. At a VA psychiatric examination in November 1993, the veteran's history was reviewed. On examination, the veteran stated that he experienced flashbacks associated with "the war" and that his "nerves" bothered him. It was also noted that the veteran was under treatment for carcinoma of the colon, metastatic to the bladder, and he reported that the aforementioned psychiatric symptomatology had increased in the last year and one-half in association with treatment of his carcinoma. The veteran's employment history included that as a carpenter and a Superintendent of Public Works, until he was awarded Social Security disability benefits at the age of 58. The veteran reported that he went to the coffee shop to "kill time" and that he did almost no work around the house. It was also noted that he was no longer able to engage in hunting and fishing; he continued to be bothered by crowds and noises. The veteran reported that he had "regular" dreams approximately two or three times per month, but dreamed about the war every night. With regard to his "flashbacks," the veteran essentially stated that thoughts of the war ran through his mind. Unexpected noises reportedly startled the veteran and he noted that he had lost interest in activities that he previously enjoyed. He also stated that his thoughts were persistent and difficult to eliminate, and that most of the time he used tranquilizers to allow him to sleep. On examination, the veteran reported that his depression had increased in the past few years and that he experienced occasional crying spells when nervous. His thought processes were normal. It was noted that the veteran had attended school through the ninth grade and had not received a general equivalency diploma. Depression and anxiety were found on examination. The veteran's insight was superficial and his judgment was "good." The veteran's wife reported that the veteran had become nervous "all the time" in the last few years. The diagnosis was chronic post-traumatic stress disorder, delayed. The examiner assigned a global assessment of functioning of 40, currently and for the previous year. A global assessment of functioning score of 40 equates to some impairment in reality testing (e.g., speech is at times illogical, obscure or irrelevant) or communication or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family and is unable to work). American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders 12 (3d ed. rev. 1987). Initially, the Board notes that disability ratings are based, as far as practicable, upon the average impairment of earning capacity attributable to specific injuries. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. In this case, a 30 percent evaluation for post-traumatic stress disorder represents definite social and industrial impairment. 38 C.F.R. § 4.132, Diagnostic Code 9411. A 70 percent evaluation for post-traumatic stress disorder represents severe impairment in the ability to establish and maintain effective or favorable relationships with people and reflects that psychoneurotic symptoms are of such severity and persistence as to result in severe impairment in the ability to obtain or retain employment. 38 C.F.R. § 4.132, Diagnostic Code 9411. As noted above, the evaluation in effect for the veteran's post- traumatic stress disorder was reduced to 30 percent after a 70 percent evaluation had been in effect for a period of nearly nine years. In determining the appropriate evaluation for the veteran's post-traumatic stress disorder, the Board must first point out that in cases in which a disability has been rated at a particular level for five years or more, reduction of the evaluation requires special analysis under 38 C.F.R. § 3.344(a). Brown v. Brown, 5 Vet.App. 413 (1993). The provisions of 38 C.F.R. § 3.344(a) state that rating agencies will handle cases affected by change of medical findings or diagnosis, so as to produce the greatest degree of stability of disability evaluations consistent with the laws and VA regulations governing disability compensation and pension. 38 C.F.R. § 3.344(a). It is essential that the entire record of examinations and the medical-industrial history be reviewed to ascertain whether the recent examination is full and complete, including all special examinations indicated as a result of the general examination and the entire case history. Id. This applies to treatment of intercurrent diseases and exacerbations, including hospital reports, bedside examinations, examinations by designated physicians, and examinations in the absence of, or without taking full advantage of, laboratory facilities and the cooperation of specialists in related lines. Id. Examinations less full and complete than those on which payments were authorized or continued will not be used as a basis of reduction. Id. In this case, the Board notes that veteran's VA psychiatric examinations conducted in October 1990 and June 1991, taken together, were comprehensive and included a review of the veteran's complaints and, particularly on examination in 1991, history of symptomatology. The Board has no basis upon which to conclude that the examinations upon which the reduction was based were less full and complete than the evaluation upon which the 70 percent rating was based. 38 C.F.R. § 3.344 also provides that ratings on account of diseases subject to temporary or episodic improvement, for example, psychoneurotic reaction, will not be reduced on any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. 38 C.F.R. § 3.344(a). As indicated above, the veteran's disability rating was reduced after two examinations were conducted and subsequent to the submission of a private medical statement. The United States Court of Veterans Appeals (Court) has recently discussed the applicability of 38 C.F.R. § 3.344, and has emphasized that when the issue is whether the RO was justified in reducing a veteran's protected rating, the Board is required to establish, by a preponderance of the evidence and in compliance with 38 C.F.R. § 3.344(a), that a rating reduction is warranted. See Kitchens v. Brown, No. 93-256 (U.S.Vet. App. Jan. 19, 1995); Brown v. Brown, 5 Vet.App. 413 (1993). In this case, although the provisions of 38 C.F.R. § 3.344(a) have ostensibly been met, the Board focuses on the underlying premise of 38 C.F.R. § 3.344, to produce stability in disability evaluations. Coupled with the requirement to show such improvement by a preponderance of the evidence, the Board is unable to conclude that the reduction in the veteran's case was proper. Review of the record establishes that at the time of the assignment of the 70 percent rating, the veteran reported that he engaged in such activity as visiting his friends at a coffee shop and doing work around the house. Such activity was also noted on the examinations which provided the basis of the RO's reduction. More importantly, the mental status examinations in 1983 and 1990 are similar in showing the predominant symptom as anxiety. Further, the private treating doctor as if 1991 anticipated no improvement of "severe" anxiety. The Board recognizes that upon review of the record, it appears that the veteran's symptomatology and apparent degree of social inadaptability fluctuated to a degree from the time of the initial assignment of a 70 percent rating. The veteran's social interaction during his winter months in Florida, for example, were noted on VA examination in June 1991 and may have indicated more extensive social adaptability than indicated prior thereto. In this regard, however, the Board must also point out that a private physician from whom the veteran had been receiving treatment for 30 years noted, prior to the reduction, that the veteran had become more withdrawn. In addition, the veteran's testimony essentially elucidated the true extent of the veteran's ability to engage in social interaction, which apparently was not as extensive as previously indicated. The veteran's loss of interest in activities which he previously enjoyed, as well as the occurrence of such symptomatology as nightmares more frequently than reported on the examinations, also provide an indication as to the extent of his impairment associated with post-traumatic stress disorder. The Board emphasizes that currently, the veteran's global assessment of functioning score is commensurate with some impairment in reality testing or communication or major impairment in several areas, such as work, family relations, judgment, thinking, or mood. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders at 12. Significantly, it appears that the veteran experiences major impairment in the social and industrial areas. Overall, the Board concludes that the pertinent evidence of record does not establish improvement in the veteran's psychiatric status by a preponderance of the evidence. Kitchens v. Brown, No. 93-256 (U.S.Vet. App. Jan. 19, 1995); Brown v. Brown, 5 Vet.App. 413 (1993). For the foregoing reasons, the VA, therefore, has not met its burden of proof in reducing the veteran's 70 percent evaluation. As demonstrated by VA and private clinical findings and his personal testimony, the veteran continues to experience appreciable symptomatology, similar to that which was shown at the time of the assignment of a 70 percent rating. Accordingly, restoration of the 70 percent evaluation for PTSD is appropriate. II. Stomach Disorder. Service medical records are negative for a stomach disorder, to include peptic ulcer disease. A report of the veteran's hospitalization at a VA facility in February and March 1967 reflects a history of "...recurrent bouts of stomach pain with diagnosis of peptic ulcer for the past 20 years." It was noted further that a diagnosis of an ulcer was made subsequent to an upper gastrointestinal series conducted in 1964. The discharge diagnosis was peptic disease, active. In a letter from John D. Ashley, M.D., received in November 1976, it was noted that the veteran had developed an ulcer in 1964 and had undergone a vagotomy and pyloroplasty in 1967, with little or no trouble since. The diagnoses included history of ulcer, treated with vagotomy and pyloroplasty. In a statement dated in October 1977, James E. Rowe, M.D., wrote that the veteran had been hospitalized in September 1977 and that he was being treated for disabilities including a gastric ulcer. History of gastric resection in 1967 was reiterated on VA examination in April 1981. A report of the veteran's May 1981 hospitalization at United Hospitals reflects evaluation for possible peptic ulcer disease. It was noted that peptic ulcer disease had occurred on two to three occasions previously, with acute ulcer and "one bleed." The diagnosis was duodenal ulcer. A report of the veteran's hospitalization the following October reflects diagnoses including peptic ulcer disease. As noted above, adjudication of the veteran's claim presupposes the submission of a well-grounded claim, that is, one which is meritorious on its own or capable of substantiation. Murphy, 1 Vet.App. at 81; 38 U.S.C.A. § 5107(a). The claim must be accompanied by supporting evidence sufficient to justify a belief that by a fair and impartial individual that the claim is plausible. Tirpak v. Derwinski, 2 Vet.App. 609, 610 (1992). In this case, the Board concludes that the veteran's claim of entitlement to service connection for a stomach disorder, to include peptic ulcer disease, is not well-grounded. In this regard, we point out that the Court has determined that in cases in which the veteran has submitted no cognizable evidence to support a claim, the claim cannot be well-grounded. Tirpak, 2 Vet.App. at 611 (1992); Grottveit v. Brown, 5 Vet.App. 91, 93 (1993). Such is the case here. First, service medical records, as shown above, reflect no findings of a stomach disorder. Further, peptic ulcer disease was initially noted many years after separation from service, and the clinical evidence of record is silent as to a relationship between the veteran's period of service and peptic ulcer disease. Although a 20-year history of the disorder was noted in 1967, placing onset of the disorder a few years after the veteran's separation from service, the history is not substantiated. There is no indication of the disorder in service, and the record otherwise fails to substantiate any relationship between the veteran's service and peptic ulcer disease. Upon review of the veteran's file, therefore, the Board concludes that he had presented no cognizable evidence to support his claim; as such, the veteran's claim in this regard is not plausible and must be dismissed. 38 U.S.C.A. § 5107. III. Total Rating on the Basis of Individual Unemployability. As noted above, the veteran's service-connected disabilities consist of degenerative arthritis of the lumbar spine with degenerative disc disease, currently rated at 60 percent; post- traumatic stress disorder; residuals of a wound of Muscle Group IV, currently rated at 30 percent; and scars on the right third toe and left knee, each rated as noncompensably disabling from August 1946. Review of the record reflects that the veteran has consistently complained of low back and right shoulder pain and symptomatology such as limitation of motion. On VA examination in July 1976, for example, he complained of arthritis and bursitis in the shoulders and difficulty in the grasping function of the right hand; the diagnosis was residuals of shrapnel wounds of the right scapular region, the distal left thigh and the right third toe. On orthopedic examination, complaints of back and right leg pain, increasing since the veteran's injury, were noted. Subsequent to an x-ray study, the diagnoses were degenerative arthritis of the lumbar spine and degenerative disc disease at L5-S1 with neurologic deficit in both lower extremities. The veteran reported on examinaiton that he had been unemployed since September 1975. The veteran's complaints, with increased symptomatology, were reiterated on VA examination in August 1976 and in a letter from John D. Ashley, M.D., received in November 1976. By an August 1976 rating decision, the evaluation in effect for the veteran's arthritis of the lumbar spine was increased from 10 percent, in effect from October 1949, to 20 percent, effective in June 1976. The 10 percent evaluation for the veteran's wound of Muscle Group IV, right, in effect from August 1946, continued. The Board notes that the records shows no appreciable impairment associated with the veteran's scars on the right toe and left knee, as illustrated by the noncompensable evaluations in effect. In an October 1977 report from James E. Rowe, M.D., it was noted that cervical osteoarthritis and degenerative disc disease at C 5-6 and C6-7 were present in addition to mild osteoarthritis with some narrowing of the L5-S1 intervertebral disc space. It was also noted that the veteran was permanently and totally disabled. Continued impairment of the lumbar spine and right shoulder was noted on VA examination in December 1977; the veteran reportedly had been employed as a construction worker and had not worked in the previous two years. His disability was manifested primarily by pain and limitation of motion. The diagnoses were residuals, shrapnel wound of the right shoulder by history, degenerative arthritis of the lumbar spine, mild to moderate, and degenerative disc disease, L5-S1, with neurological deficit. Impairment associated with arthritis was also noted in a January 1978 letter from Fred E. Wilson, M.D. By an April 1978 rating decision, a 40 percent evaluation was assigned the veteran's degenerative arthritis of the lumbar spine and degenerative disc disease, L5-S1, effective in October 1977. By an October 1979 rating decision, the evaluation for residuals of an injury to Muscle Group IV was increased to 20 percent, effective in September 1979. The increase occurred subsequent to a VA examination which showed complaints of right shoulder impairment, such as difficulty driving nails and decreased right hand grip and a reported inability to work as a carpenter for the previous four years. In addition to findings similar to those noted above, findings referable to the low back noted on VA examinations in May 1980 and April 1981 include a mild degree of lumbar musculature spasm, absent ankle jerk on the right, and positive straight leg raising on the right indicating nerve root irritation. Tenderness over the acromioclavicular joint and an inability to raise the right shoulder beyond 90 degrees were also noted. By June 1981 rating decision, a 60 percent evaluation was assigned for the lumbar spine disability and a 30 percent evaluation was assigned for wound of Muscle Group IV, effective in April 1980. Right shoulder and back pain are noted intermittently in private office visit entries dated from 1981 to 1983. The remainder of the record, in pertinent part, reflects continued impairment generally. In an unsigned July 1990 letter, for example, Fred E. Wilson, M.D., wrote that the veteran's disabilities included degenerative disc disease, degenerative joint disease, and anxiety neurosis. It was noted that his degenerative joint disease had progressed to the extent that his activity was limited, with difficulty with ambulation and radicular pain in the right leg. The veteran's symptoms were reportedly precipitated by minimal activities such as walking. It was also noted that the veteran had become depressed over the past two years and that he was totally disabled mentally and physically. On VA orthopedic examination in October 1990, the veteran complained of constant low back pain and occasional giving way of the right leg, which, he noted, caused him to fall. An inability to bend or lift, and increased pain on walking or stair-climbing were noted. Intermittent pain in the right shoulder and slight weakness on the right were also noted. On examination of the right upper extremity, findings included tenderness of the right shoulder, with normal range of motion diminished by 50 percent and strength and grip strength diminished by 25 percent. Tenderness of the lumbar spine, with range of motion described as 40 percent and strength of the lower extremities diminished by 50 percent, were noted. Sensation was intact and the veteran ambulated with a slight limp. He was able to heel and toe walk and deep tendon reflexes were physiologic. Straight leg raising was negative. The diagnoses were degenerative arthritis with degenerative disc disease of the lumbar spine and wound of the right shoulder, Muscle Group IV. In addition to the occupational experience noted above, the veteran reported on VA psychiatric examination in June 1991, that he had worked in farming, and as a school bus driver. He noted that he had not worked since 1975 due to physical limitations. He further noted that he was unqualified for an occupation which did not require physical labor. Pertinent regulations provide that total disability 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 disability, provided that, in pertinent part, if there is only one such disability, the disability shall be rated at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability rated 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341 (a), 4.16(a). The regulations further provide that the existence or degree of nonservice-connected disability or disabilities will be disregarded where the aforementioned percentages for the service-connected disabilities are met and where, in the judgment of the rating agency, the service- connected disabilities render the veteran unemployable. Id. As discussed above, the veteran's lumbar spine disability is rated at 60 percent, and, with the restoration of the 70 percent evaluation for PTSD, discussed above, the veteran's combined evaluation meets the percentage rating requirement. It must then be determined whether the veteran is capable of engaging in a substantially gainful occupation. Upon review of the record in its entirety, the Board concludes that he is not. As illustrated above, the veteran has experienced significant impairment the lumbar spine and right shoulder as a result of limitation of motion of the affected areas and pain. Decreased strength of the right upper extremity has been recorded. The record, as noted above, also establishes appreciable impairment associated with the veteran's post-traumatic stress disorder, particularly upon exposure or communication with people unknown to the veteran. The record also shows that the veteran has a ninth grade education and has occupational experience in large part involving manual labor, such as construction. Lay statements of record dated in the early 1980's indicate that he had limited ability to engage in physical labor and that due to his health generally, he was unable to continue in his most recent employment as Public Works Director. We note that an opinion provided by the veteran's private physician highlights the veteran's inability to retain gainful employment. The Board stresses that the veteran's nonservice-connected disabilities are not for consideration in the determination as to the veteran's unemployability. As demonstrated above, however, the medical evidence in 1990 and 1991 shows significant restrictions attributable to the veteran's service-connected disabilities alone, primarily post-traumatic stress disorder, lumbar spine disability, and residuals of an injury to Muscle Group IV on the right. In light of such physical and psychiatric limitations and restrictions, and affording due consideration to the veteran's occupational and educational history, the record does not establish that the veteran is able to engage in substantially gainful occupation. The Board concludes that the veteran is totally disabled as a result of his service-connected disabilities. ORDER Entitlement to restoration of a 70 percent evaluation for post- traumatic stress disorder is granted, subject to the regulations governing the payment of monetary benefits. The claim of service connection for a stomach disorder is dismissed. Entitlement to a total rating on the basis of individual unemployability due to service-connected disability is granted, subject to the regulations governing the payment of monetary benefits. M. SABULSKY 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.