Citation Nr: 9917959 Decision Date: 06/29/99 Archive Date: 07/07/99 DOCKET NO. 90-22 693 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in No. Little Rock, Arkansas THE ISSUES 1. Entitlement service connection for residuals of a spinal injury, a disorder manifested by blurred vision, residuals of ear infections, a heart disorder, residuals of a right leg/heel injury, a left wrist disability and residuals of a chest injury. 2. Entitlement to an evaluation in excess of 10 percent for service-connected residuals of a medial meniscectomy of the left knee with degenerative joint disease, for the period April 8, 1987 to September 8, 1997. 3. Entitlement to an evaluation in excess of the currently assigned 20 percent for service-connected residuals of a medial meniscectomy of the left knee, subsequent to September 8, 1997. 4. Entitlement to an evaluation in excess of the currently assigned 10 percent for service-connected degenerative joint disease of the left knee. 5. Entitlement to a total evaluation based on individual unemployability (TDIU) due to service-connected disability. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J. M. Daley, Associate Counsel INTRODUCTION This appeal was initiated from a decision of the Wichita, Kansas, Department of Veterans Affairs (VA) Regional Office (RO). The veteran has since moved to Arkansas and the case is now within the jurisdiction of the North Little Rock RO. In March 1991, pursuant to a February 1991 remand by the Board of Veterans' Appeals (Board), the RO wrote to the veteran asking him to identify and authorize the release of various records including those pertaining to his claimed service related injuries purportedly sustained on October 9, 1984. Although he submitted copies of additional medical records they were not relevant to the material requested by the RO. Accordingly, and because the RO did not undertake all of the Board's requested development, the case was remanded again in August 1994. Again the veteran was not cooperative with the RO's attempts to develop the record. To the extent that the veteran is claiming that he has a back disability is related on a secondary basis to his service- connected left knee disability, that matter is referred to the RO for initial consideration. The issues of an increased rating for the veteran's left knee disability and entitlement to TDIU benefits will be addressed in the remand below. FINDINGS OF FACT 1. The veteran had no active duty and there is no satisfactory evidence that he was injured in line of duty during his claimed but unverified period of active duty for training on April 8 and 9, 1984 or that he was on inactive duty training when he was assaulted on October 9, 1984. 2. There is no competent evidence of record showing that the veteran has blurred right eye vision, residuals of ear infections, a heart disorder, residuals of injury to the right leg/heel, a left wrist disorder, a back disability or residuals of a chest injury that are causally related to incidents of verified active duty for training (ADT) or inactive duty training (IDT), transportation to or from such duty, or otherwise related to service. CONCLUSION OF LAW The veteran's claims of entitlement to service connection for blurred right eye vision; residuals of ear infections; a heart disorder; residuals of injury to the right leg/heel; a left wrist disorder; a back disability; and residuals of a chest injury are not well grounded. 38 U.S.C.A. § 101(24), 1131, 5107(a) (West 1991); 38 C.F.R. §§ 3.303, 3.6 (1998). REASONS AND BASES FOR FINDING AND CONCLUSION Legal Criteria The term "veteran" is defined in 38 U.S.C.A. § 101(24) (West 1991) as "a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable." Active military, naval, and air service is defined to include active duty, any period of active duty for training (ADT) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training (IDT) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 C.F.R. § 3.6(a) (1998). The General Counsel of the VA has defined what constitutes an "injury" sustained during a period of Inactive Duty for Training. See VAOGCPRECOP 86-90 (July 18, 1990). Under 38 U.S.C.A. § 7104(c) (West 1991 & Supp. 1998), VA General Counsel precedent opinions are binding on the Board. The United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (hereinafter, "the Court"), upheld that determination in Brooks v. Brown, 5 Vet. App. 484 (1993), noting that 38 U.S.C.A. § 101(24) (West 1991) clearly distinguishes between disease and injury for the purpose of service connection based on ADT or IDT. Brooks v. Brown, at 485. Regulations also provide that when an individual is authorized or required by competent authority to perform ADT or IDT and is disabled from an injury incurred while proceeding directly to or returning directly from such ADT or IDT he/she shall be deemed to have been on ADT or IDT at that time, as the case may be. The VA will determine whether such individual was so authorized or required to perform such duty, and whether the individual was disabled from injury so incurred. In making such determinations, there shall be taken into consideration the hour on which the individual began to proceed or return; the hour on which the individual was scheduled to arrive for, or on which the individual ceased to perform, such duty; the method of travel performed; the itinerary; the manner in which the travel was performed; and the immediate cause of disability or death. Whenever any claim is filed alleging that the veteran is entitled to benefits by reason of this paragraph, the burden of proof shall be on the veteran. 38 C.F.R. § 3.6(e) (1998). Service-connected means, with respect to disability or death, that such disability was incurred or aggravated, or that the death resulted from a disability incurred or aggravated, in line of duty in the active military, naval, or air service. 38 C.F.R. § 3.1(1) (1998). In order to establish service connection for a claimed disability the facts must demonstrate that a disease or injury resulting in current disability was incurred in the active military service or, if pre-existing active service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Where there is a chronic disease shown as such in service or within the presumptive period under 38 C.F.R. § 3.307 so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). This rule does not mean that any manifestation in service will permit service connection. To show chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the disease identity is established, there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required where the condition noted during service or in the presumptive period is not shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). The Court has established the following rules with regard to claims addressing the issue of chronicity. The chronicity provision of 38 C.F.R. § 3.303(b) is applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under the Court's case law, lay observation is competent. If the chronicity provision is not applicable, a claim may still be well grounded if (1) the condition is observed during service, (2) continuity of symptomatology is demonstrated thereafter and (3) competent evidence relates the present condition to that symptomatology. Savage v. Gober, 10 Vet. App. 489 (1997); see also Grottveit v. Brown, 5 Vet. App. 91, 93 (1993) (where the issue involves questions of medical diagnosis or an opinion as to medical causation, competent medical evidence is required). Service connection may also be granted for a disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Facts Service department records verify, in pertinent part, that the veteran performed ADT with the Army National Guard from December 31, 1976 to March 31, 1977; and that he was on ADT with the Kansas Army National Guard on June 6, 1977, and with the Army Reserve on March 4, 1984. It appears that he also was on ADT from March 31, 1984 to April 1, 1984. Service records also verify that the veteran had a period of IDT from August 27 to August 28, 1977. The veteran has alleged additional periods of training duty during which he claims to have sustained injuries for which he seeks service connection; that matter will be addressed below. The record reflects that on a report of medical history of March 1977, after completion of a period of ADT with the Kansas Army National Guard, the veteran denied recurrent back pain, eye trouble, ear trouble, pain or pressure in his chest, palpitations or a pounding heart, and foot trouble. He indicated "YES" to having or having had scarlet fever and rheumatic fever, and also to having or having had heart trouble. The accompanying report of medical examination shows that all body systems were clinically evaluated as normal. Service records reflect that on June 6, 1977, while on two weeks ADT, the veteran slipped on some steps and fell, injuring his left knee. Various service department documents and medical records regarding the accident do not reflect any other injuries sustained in the fall. A Statement of Medical Examination and Duty Status dated in August 1977 indicates that the veteran was treated for flu- like symptoms while on IDT from August 27 to August 28, 1977. Such appeared to have been brought on by over exertion and over heating caused by strenuous training. On a reserve report of medical history completed in May 1978, the veteran denied recurrent back pain, eye trouble, ear trouble, pain or pressure in his chest, and foot trouble. He indicated "YES" to having or having had scarlet fever and rheumatic fever, and also appears to have answered "YES" and then changed that answer to "NO" pertinent to heart trouble. He certified that he was in excellent physical health at that time. The examiner noted that the veteran had had rheumatic fever at six years of age, without cardiac problems shown on frequent subsequent examinations. The accompanying report of medical examination shows that all body systems were clinically evaluated as normal except for a left wrist scar. That report indicates that the veteran was in "excellent physical health." On an Army National Guard report of medical history completed in June 1982, the veteran denied recurrent back pain, eye trouble, ear trouble, palpitation or a pounding heart, foot trouble and heart trouble. He reported having or having had scarlet fever and rheumatic fever, pain or pressure in his chest, and a "trick" or locked knee. The accompanying report of medical examination shows that all body systems were clinically evaluated as normal. On an Army Reserve report of medical history completed in November 1983, the veteran denied all relevant symptoms, reporting only a history of scarlet fever and rheumatic fever. The second page of that report is not associated with the claims file. The accompanying report of medical examination shows that all body systems were clinically evaluated as normal, with the exception of the heart. However, the only notation regarding the heart was that no heart murmurs were heard. The veteran's blood pressure was 120/80. He was noted to have no defects or diagnoses. It appears that in 1984 the veteran was the commander of a detachment of an Army Reserve Military Police POW Camp. For simplicity, this detachment will be referred to as the "POW Camp Det." A Statement of Medical Examination and Duty Status (DA Form 2173) from the Irwin Army Hospital at Fort Riley, Kansas, to the Commander of the POW Camp Det. indicates that the veteran injured his left knee on April 1, 1984 at Omaha, Nebraska, when he twisted it stepping off a step, and that he was seen at Irwin Army Hospital on April 3. The nature and extent of the injury was noted to be probable left knee strain. It was reportedly determined, based on medical records, that the injury had been in line of duty. This part of the report (Section I) is dated April 13, 1984 and, although prepared for the signature of a major, was signed by a sergeant first class. Section II, to be completed by the unit commander or unit adviser, reflects that the veteran was on a period of ADT from March 30, 1984 to April 1, 1984, that a formal line of duty investigation was not required and that the injury was considered to have been incurred in line of duty. This section of the report was signed by D. G., a staff sergeant who identified himself as records custodian. Section II is dated April 9, 1984. A copy of orders for this period of ADT is of record. Thereafter the veteran received military incapacitation pay for several years. The veteran has submitted a copy of military orders number 102-22, dated April 11, 1984, indicating that he was ordered to ADT for the period April 7 and April 8, 1984, to attend a Commanders' Course in Omaha, Nebraska. The veteran has also submitted a photocopy copy of DA Form 2173, Report of Medical Examination and Duty Status, purporting to be from the Allen County Hospital to the Commander of the POW Camp Det. Section I indicates that the veteran was seen at the hospital on April 9, 1984, after having fallen down stairs at a hotel on April 8, 1984, while attending a "Commanders Course." The details of the accident ("how, when, where) were reported to be a brain concussion, blurred vision and facial trauma. Additionally, it was indicated that the injuries were incurred in line of duty and were likely to result in a claim against the government for future medical care. That portion of the report is dated April 20, 1984, and reflects the signature of R. Hull, M.D., (attending physician or patient administrator). Orders 102-022 were referenced as being attached. Section II, labeled "To Be Completed by the Unit Commander or Unit Adviser" indicates that the veteran was on ADT at the time the injuries were sustained and that the veteran started down some stairs using crutches when his knee gave out, the crutches tangled, and he landed striking the left side of his head and chest on a steel railing and tool box on the landing. It was noted that the veteran was referred to Dr. Hull at the Allen County Hospital with follow-up at Irwin Army Hospital, and that the veteran was provided a brace for a back injury and referred to the Chief of Prosthetics and Sensory Aids Service. It was further indicated that the injuries were incurred in line of duty, and that no formal line of duty investigation was required. That portion of the report, which was to be signed by the unit commander or unit adviser, was signed by the veteran, as "Commander,"and is dated April 11, 1984. No associated medical records are on file. According to a copy of a letter of April 14, 1984, to the veteran, as the Commander of the POW Camp Det, continuation of pay and allowances based on his injury of April 1, 1984 was requested. The veteran authorized the continuation. Military records indicate that, due to his left knee disability, the veteran was placed on incapacitation pay as of April 30, 1984, which was subsequently extended on several occasions. A medical record dated in May 1984 reflects that the veteran was evaluated for hypertension. He had had left knee surgery the day prior to physical examination. He denied headaches, blurred vision, chest pains or palpitations. Heart and eye examinations revealed no abnormalities. The impression was transient blood pressure, post operatively, now normal and at times borderline. A low salt diet and periodic checks of blood pressure were suggested. The veteran has submitted a photocopy of a letter to "Valley Federal," on what appears to be Army letterhead stationary, although the letterhead is virtually illegible. The letter, signed by D. G., SSG, FTUS, is dated "September 13, 1984," and confirms that the veteran was on 100 percent disability due to injuries sustained while "on active duty with the Army." It was stated that he was injured on 1 April, 8 April and "9 October 1984." The veteran has submitted a photocopy of DA Form 2173, Statement of Medical Examination and Duty Status, purporting to be from Dr. Hull to the Commander of the POW Camp Det. Section I reflects that the veteran had reportedly been returning home from a period of inactive duty training at Irwin Army Hospital at Fort Riley, Kansas, on October 9, 1984, when he was beaten by two unknown individuals at a rest stop on I-70, and sustained a head injury, fractured "vertebrates," right knee and left elbow injuries, and chipped and broken teeth. The injuries were reported to have been sustained in line of duty. The report reflects that the veteran was treated at the Allen County Hospital at "1255 am" on October 9 and that he was examined at "1330" on October 10. That section of the report was signed by Dr. Hull and is dated October 16, 1984. Section II, to be completed by the unit commander or unit adviser, states that, while returning from Irwin Army Hospital at Fort Riley, the veteran was injured at a rest stop at Alma, Kansas, when he was hit in the back of the head with a blunt object, and hit and kicked in the face. Reportedly, he sustained multiple depression fractures of the right frontal maxillary sinus with posterior displacement of fracture fragment, a linear fracture involving the left frontal sinus, a brain concussion, fractured "vertebrates" and laceration of the spine. It was indicated that the injuries were incurred in line of duty, that a formal line of duty investigation was not required, and that the veteran was on inactive duty training at the time. The report, which was to be signed by the unit commander or unit adviser, bears the signature of D. G., SSG, Rec. Custodian. A copy of an Allen County Hospital record dated October 10, 1984, which was submitted by the veteran, reflects that he arrived at the emergency room via automobile at 12:55 AM, complaining of having been hit on the back of his head with a pipe three times and hit on the forehead at the left eye. The incident reportedly occurred between 10 and 11 PM on October 9. His personal physician was listed as Dr. Hull but a Dr. Walters was called. The veteran's left eye was bruised and swollen. There was a small superficial laceration under his right eye, and his forehead was bruised. There was a bump on the right side of the back of his head. The report notes that the veteran had had two to four beers that evening. There were small lacerations on his forehead and abrasions on the right knee and both elbows. The left pupil was slightly more sluggish than the right pupil, and right eye vision was blurred. He was sent home with orders to observe for concussion symptoms. Disposition was at 1:25 AM. The veteran has also submitted two copies of a medical record, purportedly from Dr. Hull. One copy contains only an entry dated October 10, 1984, noting that the veteran had been to the emergency room the previous evening and that he had bruises and abrasions to his face and eyes and the right arm, and a laceration under the right eye. There was a boot mark on his forehead and complaints of a chipped lower incisor. The nares had dried blood. He also had a contusion with hematoma to occiput. On this copy of the medical record, it appears that prior and subsequent had been blanked out in copying the document. In another copy submitted by the veteran, the October 10 entry is preceded and followed by additional entries. A September 5, 1984 entry noted that the veteran's "knee gave out again" and that he hit his ribs on a tackle box. It was also noted that last April his knee gave out and he fell and hit his left side. Since then he reportedly felt a catching in the left side with some discomfort. An October 10, 1984, x-ray report submitted by the veteran reflects that he had a depression fracture involving the right frontal maxillary sinus with slight posterior displacement of the fracture fragment; and a linear fracture involving the left frontal sinus. In a letter of October 10, 1984 to Dr. Hull, G. Francis, D.O., stated that he had reviewed the veteran's x-rays and commented that there was a significantly displaced fracture of the front table of the frontal sinus. A copy of an insurance form submitted by the veteran and signed by him on October 19, 1984, indicates that CHAMPUS was his insurer, that he had been injured on October 9, 1984, that his condition was related to an accident, and that the diagnoses were facial pain, blurred vision and a brain concussion. The veteran has submitted a copy of a US Government emergency treatment record dated November 9, 1984, which, according to the veteran, is from the Irwin Army Hospital. A head injury was listed as the chief complaint. That report indicates that the veteran fell down stairs and hit a rail post approximately a week earlier, with subsequent pain in the frontal area and headaches. Examination revealed no forehead tenderness. Eye examination and examination of the central nervous system were normal. Prior skull X-rays were reviewed and noted to show no fracture. The impressions were post traumatic headaches, and no acute neurologic deficit. That record reflects a notation that "PAD-CHAMPUS says LOD [line of duty] not required since PT is already covered by 3 informal LOD's previously this year." (Based on a comparison of that notation and documents known to have been hand printed by the veteran, the notation appears to have been written by him.) In August 1986, a Medical Evaluation Board (MEB) met to evaluate the veteran's left knee pain and instability complaints. His past medical history of injuries included a laceration of the left forearm in 1974, without any other injury noted. Physical examination revealed a left wrist scar and decreased sensation to light touch over the ulnar aspect of the ring finger and the entire little finger. The diagnoses were left knee anterior cruciate insufficiency with rotatory instability; status post partial medial meniscectomy; and chondromalacia of the medial femoral condyle of the left knee. The recommendation was that the veteran was unfit for continued duty due to his knee and that referral to a physical evaluation board (PEB) was warranted. On a report of medical history completed in September 1986 for the MEB, the veteran stated that he was in good health "except for my knee problem and headaches." He denied recurrent back pain, eye trouble, ear trouble, pain or pressure in his chest, palpitation or a pounding heart and foot trouble. He indicated a history of scarlet fever and rheumatic fever, and also to heart trouble. He also claimed lameness and a "trick" or locked knee. He noted that he needed two operations on his knee and a nasal passage operation. A service medical officer noted no sequelae from the veteran's childhood history of scarlet fever and rheumatic fever, and that his various complaints were the result of injury to the head and knee. The veteran was noted to have sustained a knee injury in July 1977; as a result of the knee injury, he reportedly had fallen down stairs and fractured bones in his head that resulted in frequent headaches. It was further noted that he had had a heart murmur when he was young, during an episode of rheumatic fever, and that he had incurred a laceration to his left wrist in 1977, resulting in numbness to the fourth and fifth digits and medial hand with a decreased range of motion on the fifth digit. The accompanying report of medical examination shows that all body systems were clinically evaluated as normal except for the lower extremities, with left medial collateral ligament and anterior cruciate ligament knee laxity, and a neurologic deficit in the form of decreased pain sensation in the ulnar aspect of the left hand, decreased adduction in the fifth digit of the right hand, and scarring over the left eye and on the ulnar aspect of the left forearm. The veteran's blood pressure was 140/80. Of record are copies of what appear to be various insurance forms tending to indicate that the veteran originally injured his left knee in April 1986, that he had to quit working as of April 1, 1986, that his duties had been construction work, and that he had fallen off a ladder and down stairs. A report of a service department medical evaluation board (MEB) dated in September 1986 shows diagnoses of 1) left knee anterior cruciate insufficiency with rotatory instability; 2) status post partial medial meniscectomy; and 3) chondromalacia of the medial femoral condyle of the left knee. The full medical board report indicates that the veteran underwent an arthroscopic partial medial meniscectomy in April 1984 and since then had experienced episodes of giving way and pain along the medial joint line, with occasional swelling and intermittent lateral knee pain. The report notes prior injury to the left forearm in 1974, with residual decreased sensation over the fingers of the left hand. Physical examination revealed a scar on the ulnar aspect of the distal forearm with decreased light touch sensation over the ulnar aspect of the ring finger and over the entire little finger. Findings regarding the left knee included full range of motion, mild crepitance, and instability. The examining physician indicated it was unlikely that the veteran's condition would be significantly changed without reconstruction of his anterior cruciate ligament. The veteran was found unfit for continued duty and submitted a rebuttal letter that is not of record. His case was referred to a Physical Evaluation Board (PEB). In October 1986, the PEB found the veteran disabled due to left knee instability and associated degenerative joint disease. The PEB report does not acknowledge any of the other disabilities claimed by the veteran as service related. The veteran did not agree with the board and requested a hearing. The veteran has submitted a transcript of a December 1986 Physical Evaluation Board hearing at which it was stated that he had injured his left knee during ADT in 1977 and that it had been troublesome thereafter, eventually requiring surgery in 1984. The transcript reflects nothing regarding the April 1, 1984 injury or any other injury claimed to be related to service. (It does indicate that the veteran's service personnel records erroneously indicated that he had received the Parachute Badge and had completed Basic Airborne School, and apparently that he had the Expert Infantryman Badge, which also was erroneous.) As of April 8, 1987, the veteran was placed on the Temporary Disability Retired List. His rank was First Lieutenant. In April 1987, the veteran applied for VA benefits for a bilateral knee disability. In a statement received in June 1987, he additionally claimed entitlement to VA benefits for other physical problems. He stated that a doctor recently advised him that since he had a history of heart trouble, stated to be rheumatic fever/heart murmur, he could be suffering from stroke residuals. The veteran reported a lump in his right lower leg, a reoccurring right ear infection and blurred right eye vision. An April 1987 private medical record notes that the veteran expressed a "new complaint" of right knee pain. Examination of the right knee was "basically normal." The physician believed that the veteran was trying to avoid weight bearing on the left leg and that he had stress overload. In June 1987, the veteran reported for a VA examination of his left knee. He reported multiple complaints but only one injury - to his knee in 1977. He did not mention any back disability. The report of examination notes that the veteran's carriage and posture were good; his head, face and neck were normal; his ear canals were clear; and his tympanic membranes were normal. External eye examination was normal. The cardiovascular system was normal, without evidence of murmur. The veteran's blood pressure was 138/90. A chest x- ray was normal. A left knee x-ray showed minimal degenerative changes with narrowing of the medial aspect of the joint space and slight hypertrophic spurring of the tibial plateau. Examination of the musculoskeletal system showed a moderate left limp in gait. In a rating decision dated in August 1987, the RO granted service connection for residuals of a left knee medial meniscectomy with degenerative joint disease, and assigned a 10 percent disability evaluation, effective April 23, 1987. At that time the RO denied service connection for disability of the heart, ear, right leg, left wrist, back and eyes. The RO cited the absence of evidence of heart disease in service or on current examination; the absence of significant ear injury or evidence of disease in service or on current examination; the absence of chronic residuals of any right leg injury; the absence of evidence that the veteran's left wrist scar was the result of service and the absence of eye problems on current examination. A medical record reflects evaluation of headaches in August or September 1988. The veteran complained of left-sided headaches with an aura as well as mild nausea and blurred vision. In August 1988, the veteran was seen at the VA for evaluation of complaints of chronic left knee pain. He also complained of severe headaches since September 1984 when he reportedly fell and struck his left facial area. Upon neurologic evaluation he gave a history of throbbing pain in the left supra orbital and maxillary areas. He complained of left sided numbness a year earlier that cleared up in one day. The impression was to rule out mixed headaches. X-rays in September 1988 showed some sinus abnormalities. The record contains a letter dated in October 1988 from the Department of the Army advising the veteran that he had been found medically unfit for duty. The veteran has submitted a copy of a November 1988 letter that purports to be his rebuttal to the October 1988 MEB findings. In his letter, the veteran indicated that the record used by the MEB was incomplete in that he had sustained at least five other injuries, shown in line of duty statements, that should be taken into consideration. The veteran indicated that he had possession of original Statements and Examination and Duty Status and that he had mailed certified copies to the military but they had been lost three times. In support of his claim, the veteran submitted a substantive appeal in December 1988, along with a folder containing approximately 96 exhibits. Along with his substantive appeal, the veteran provided a list of the exhibits, identifying and/or commenting on them. In part, he identified exhibit 10 as a September 13, 1984 statement from Staff sergeant G., confirming the veteran's 100 percent disability, and exhibit 12 as a travel voucher for a trip to Irwin Army Hospital on October 9, 1984 for evaluation "for continuation." A private progress note dated in January 1989 indicates that the veteran was using a left knee brace. The impression was chronic instability of the left knee with probable arthritic changes. In a private medical record of January 1989 the veteran was noted to complain of pain in the right knee and heel. A calcaneal spur had been shown on radiographs. Findings were plantar fasciitis. A letter dated in January 1989 indicates private neurologic evaluation of the veteran's complaints of chronic left-sided headaches and spells of head turning. A follow-up letter noted that the physical examination "remains normal and is remarkable only for a few beats of gaze-evoked nystagmus on lateral gaze." A VA outpatient record dated in April 1989 indicates that the veteran presented with complaints of left knee pain. The diagnosis was severe knee pain. In May 1989 it was noted that the veteran worked on a farm and that his chores probably aggravated his knee. Other May records show an impression of opiate addiction and indicate that the veteran had obtained multiple prescriptions for Percocet. One note indicates that the veteran should not be allowed to carry his own records unless in a secure container as several progress notes containing information pertinent to Percocet overuse were missing. A mental health record dated in May 1989 indicates that the veteran introduced himself as "Colonel." In connection with a VA psychological consultation in May 1989, a member of the psychology staff noted that the veteran evidenced strong symptoms of addiction, including escalating use, tolerance, "Dr. shopping for prescriptions," and denial. The veteran reported former heavy alcohol use. According to a May 1989 VA hospital record, the veteran was recently under federal investigation for having engaged in fraudulent misrepresentation to obtain drugs. It was further noted that the veteran had been an Army officer for 16 years and reportedly had attained the rank of lieutenant colonel. A Social Security Administration report of May 1989 indicates that the veteran was under investigation for possible submission of phony documents in connection with his claim. Reportedly, he had had some documents typed up that he had been trying to get a doctor to sign. It was also noted that an individual in the community said he saw the veteran all the time and he was not using a brace or cane. In June 1989 the veteran underwent a right L4-L5 hemilaminectomy and diskectomy at the University of Kansas Medical Center. In October/November 1989, the veteran was afforded VA examinations. At that time he complained of left knee problems as well as residuals of injuries to his back and right leg. He reported a medical history of having been assaulted in the fall of 1984, sustaining head, back and leg injuries as a result. He also reported that he had been involved in a 1/4 ton jeep accident in 1981, that he fell off a ladder in 1986, that a grenade exploded in his hand in 1979, and that he had been thrown off the back of a hay truck in June 1988. He complained of a ruptured L4 and L5, low back pain, right hip pain, right leg and foot numbness, a right ankle bone spur, occasional sharp chest pain, occasional blurred vision, a catch and throbbing in the left side of the lower ribs. The veteran reported using a double upright left knee brace and a cane in his right hand for ambulation. Relevant to the veteran's orthopedic complaints, diagnoses were: status post diskectomy; residual right radicular pain; early left knee degenerative joint disease; right knee chondromalacia and right plantar fasciitis. The report of an eye evaluation notes complaints of a mild blur, without history of injury. Past medical history was noted to include hypertension. Examination revealed a healthy retina. The impression was healthy internal and external eye, with 20/20 vision and with mild astigmatic correction bilaterally. The examiner concluded that eye examination was normal. Upon further examination, no pathology was found in the head, face or neck. The veteran's heart was normal in size, with a regular rate and rhythm. Chest excursion was normal. No active disease was found in the chest. No pathology was found to palpation or percussion. The impression was hypertension, not being treated. In one VA examination report dated in November 1989, the veteran was noted to describe chronic left facial pain with radiation to the occiput after an injury occurring in the fall of 1984, while he was serving in a military police capacity. He reported that he was hit with a steel pipe on the back of the head and then in the face. The examiner noted that no records were available to check the veteran's claims. Examination of the oral cavity, neck and ears was unremarkable. The examiner was unable to find the fractures the veteran reported from the past. The assessment was: 1) history of facial and head trauma in 1984 resulting in possible chronic pain and possible seizures. Little documentation is available concerning these problems; 2) history of chronic sinus problems, again little documentation is available. The patient's complaints of pain are more consistent with a chronic post-traumatic pain than they are with chronic sinusitis. This is supported by his negative x- rays to date; History of fractures, maxillary and frontal sinuses, not shown on x-ray. The examiner stated that CT scan would be of greater benefit in that evaluation; 4) otherwise normal ear, nose and throat examination. A record from Saint Joseph Health Center, dated sometime in 1989, reflects that the veteran indicated he had been diagnosed with a brain tumor nine months earlier. The veteran was noted to believe that the tumor was related to his headaches and blurred vision. It was also noted that he complained of bilateral knee pain, that he had had disc repair in "June 84," and that his right leg gave out and was somewhat numb. The veteran underwent additional lumbar disc surgery in January 1990 at St. Luke's Hospital. In a January 1990 letter to the RO, the veteran stated that he had had four "fractured vertebrates" in his lower back in the line of duty as the commander of "the military police unit" in a mid-western city. In a letter dated in February 1990, J.M., MD., indicated that the veteran was no longer able to perform any work due to his physical health. The doctor indicated that the veteran had to use leg braces and crutches to be ambulatory, and that he also required use of a wheelchair. In support of that statement the physician attached copies of records associated with the veteran's June 1989 back surgery. A report of VA hospitalization from July to August 1990 reflects diagnoses that include chronic back pain and a decubitus ulcer. The veteran was admitted after a reported drug overdose, having been transferred from a county hospital. In regard to his history, it was noted that he indicated he had been in the Army from 1981 to 1989 as a "lieutenant colonel," and that he refused to talk about certain things because he had several lawsuits going against a variety of people and the government. While hospitalized he was uncooperative and evasive. Hospital records note that there was no evidence of murmur or gallop and that regular heart rhythm was regular. Records dated in October 1990 indicate that the veteran had a three-month history of circular decubitus on the sacrum after a seizure episode. Such was surgically closed without complications post- operatively. At the time of VA examination in January 1991, the veteran complained of back pain, right hip/leg and foot pain. Examination of the head, face and neck was unremarkable. Both ear canals were obstructed with wax upon examination. Eye examination was normal. Cardiac examination was normal, without evidence of murmurs, gallops or bruits. The veteran's blood pressure was 120/80. Neurologic examination included notation of the veteran's complaints of headaches. Diagnoses were post-traumatic headaches, generalized tonic- clonic seizures and probable right L5 radiculopathy. In a VA report of social and industrial survey dated in January 1991, it was noted that the veteran had served in the Army from 1971 to 1989 and served in combat in Vietnam from March 1 to June 6, 1973. His service-connected disabilities reportedly were sustained while in service as the commander of a military police unit, when he responded to a call for police assistance at a rest area on an interstate highway where a woman reportedly was being harassed by a group of motorcycle "bikers." While responding, he was attacked and severely beaten and rendered unconscious by the bikers. In a February 1992 private medical record it was noted that the veteran sustained a gunshot wound two years earlier that had entered his shoulder and exited his back. Physical examination was negative except for his shoulder. An October 1992 private medical report indicates that the veteran "claim[ed] to be a retired government police officer" and to have a history of multiple injuries incurred in line of duty, such as knife wounds, gunshot wounds, and a closed head wound while engaged in some sort of activity with a biker gang in a remote area of Kansas in 1987. In an October 1992 private medical report it was noted that the veteran had had a seizure in July 1990, at which time he sustained a low back disc injury and that he also reported having had a closed head injury during service. The veteran stated that the head injury caused the 1990 seizure. He also was noted to have had a knife wound of the left wrist in 1971. Records dated in March 1993 indicate that the veteran recently fell down a flight of stairs at a private medical center and injured his low back and left shoulder. Associated x-ray reports note a prior history of a laminectomy from L4 downward through L5 to S1, with narrowed intervertebral spaces at L4 to L5 and L5 to S1 probably due to old degenerated discs. Also shown are diagnoses of probable defects within the interarticular parts at L5 to S1 and moderate osteoarthritis of the lumbar spine. Medical records reflect that in June 1993 the veteran complained of back pain that radiated down his leg and a burning sensation in the right leg with weakness of dorsiflexion. He was noted to have lumbar disc syndrome. In a letter dated in December 1993, J.C., M.D., noted that the veteran had a history of a military-related left knee injury, for which he wore a brace. Dr. J.C. noted that there was left knee pain on examination. Sensory function was intact. In August 1994, the RO was informed that the Alma Police Department found no records pertinent to an October 9, 1984 beating of the veteran. Also in August 1994, the RO was informed by the Iola Police Department that information requested pertinent to the veteran was "criminal history record information that can only be released to other criminal justice agencies by Kansas Law." The RO requested the veteran to obtain and submit such information, but he did not respond. In October 1994 the RO received copies of numerous documents from the Social Security Administration, including VA and private medical records. Any relevant documents are being reported in chronological order in this decision. Received in May 1995 from the Defense Finance Accounting and Service Center in Indianapolis, Indiana, were copies of the veteran's Army Leave and Earnings statements for 1984. In February 1996, the veteran reported for a VA examination of his joints. He reported that he had had no knee problems prior to 1985 when he fell down a flight of stairs at a commanders' conference. He reported feeling that the joint was unstable, frequently giving way. Objective examination revealed that the veteran limped on his left leg with heel- and-toe walking. There was no evidence of swelling, tenderness, redness, heat, effusion, dislocation or subluxation. The veteran had left knee motion from zero to 135 degrees. His muscle strength in the left lower extremity was 4/5 as compared to 5/5 on the right. There was no evidence of sensory deficit. There was evidence of mild lateral instability. The diagnoses were status post arthroscopic surgery for a tear of the medial meniscus of the left knee and degenerative joint disease of the left knee. A report of x-ray dated in February 1996 shows an impression of mild degenerative arthritic changes in the left knee. On VA examination in September 1997, the veteran reported having injured his left knee in the mid-1980s when he fell off a speaker's platform and when he fell down a flight of stairs. The veteran also reported having had four disc surgeries, most recently a few weeks earlier. Examination revealed left quadriceps atrophy, with a visible and palpable decrease in the size of the vastus medialis component of the left knee. The VA examiner noted that examination of the knee was difficult due to the fact that various positions required to examine the knee resulted in referred back pain. The VA examiner noted that the right anterior cruciate was more lax than the left anterior cruciate. The examiner also noted laxity of the collateral system with the knee fully extended or in slight flexion; stressing the knee resulted in back and leg pain. X-rays showed slight narrowing of the medial joint compartment and slight shortening of the anterior tibial spine. The impression was early degenerative disease of the medial joint compartment of the left knee joint. No diagnoses or etiologic opinions pertinent to the back were offered. The veteran appeared at a hearing before an RO hearing officer in April 1998, at which time he testified that during the period he was receiving incapacitation pay he had a green (active duty) identification card and had been led to believe that he was on active duty. He denied knowledge of having been on incapacitation status. He testified that because he had had to favor his left knee he developed back problems and that he had been told he would have back problems by the doctor who did his knee surgery. In regard to blurred vision, when asked when it started he said "Back during that time frame." In regard to ear infections he stated that they were not causing much of a problem. Regarding his 1977 knee injury he stated that it wasn't only his knee that had been injured but also "several other parts." He denied being aware of having heart disease but stated that he had been diagnosed with high blood pressure from time to time, initially back "during that time frame." In regard to his wrist, the veteran testified that there was a knot there and that he first developed it "Back during that timeframe." He testified that his chest injury occurred when he was returning from Irwin Army Hospital and "those guys jumped me." The veteran also testified to having been assaulted when he was on his way back from the Army hospital. He indicated that he chose to go to the Allen County hospital in his hometown, rather than going back to the Irwin Army Hospital, because it was late and "the system is notorious for you having to wait and wait and wait." He indicated that his hometown was about 50 miles from where the assault occurred. He said that to his knowledge there had been no police report. The veteran stated that he had hit his head twice, once during the altercation and once when he fell down some steps and hit the end of a banister. In regard to the fact that similar injuries had been reported as having occurred on claimed periods of training duty in April 1984 and November 1984 the veteran said he couldn't be sure whether he had been injured on both occasions. It was suggested in discussion between the representative and hearing officer that perhaps there had only been one incident rather than two. RO Hearing Transcript. Analysis Despite any allegations to the contrary, including that he served in combat in Vietnam, the veteran never served on active duty. Additionally, the period during which he received incapacitation pay was not active duty regardless of what he claims to have been told in that regard or the color of his ID card. See DOD Directive No 12241.1 (1992). In fact, if he truly believed that he had been on active duty from April 1984 until his retirement from the Army Reserve one would question why he claimed to have been on IDT in October 1984, when he was assaulted. In any event, the veteran has submitted copies of military orders and DA Forms 2173 purporting to show that he sustained multiple injuries, including a back injury and blurred vision, as the result of a fall on April 8, 1984 and a beating on October 9, 1984, all in line of duty. The former was reported to have occurred while he was on ADT and the latter while on IDT. However, since there has been no service department verification that the veteran was on any type of training duty on either occasion and the Department of the Army never acknowledged any of those injuries as service connected, the Board must consider whether the evidence submitted by the veteran is acceptable to establish the alleged duty status. If he was in a duty status, it would also have to be determined whether the injuries were incurred in line of duty. Initially, it must be noted that the DA Forms 2173 for the claimed April 8 and October 9 injuries were available only from the veteran. Attempts to obtain copies from official sources were unsuccessful. Although the veteran apparently had orders for active duty for training for April 8 and 9, there is no independent evidence that he actually executed those orders other than the DA Form 2173. The same applies to the claimed period of inactive duty training on October 9, 1984; however, for that period there are no orders, formal or informal. There is a striking similarity between the injuries claimed to have been sustained on April 8 and those of October 9, 1984, even though the April incident was reported as a fall and that October one as an assault. There are also similarities between the alleged April 8 incident and incidents referenced in a copy of a September 5, 1984 private medical record entry and a November 9, 1984 government hospital record. Although the veteran purportedly was treated at the Allen County Hospital and by Dr. Hull for the claimed April 8 and October 9 injuries, there is no medical evidence confirming that any injuries were sustained on April 8, 1984. In that regard, it must be noted that the veteran has been uncooperative in providing or authorizing the release of evidence that would be helpful in deciding this case. In any event, the entire DA Form 2173 for the alleged April 8 incident appears, to the layperson's eye, to have been prepared on one typewriter even though Section I purportedly was completed by the Allen County Hospital and Section II was completed by the veteran as Commander of the POW Camp Det. It is further noted that the form is addressed to the Commander of the POW Camp Det. (hence, to the veteran) even though under Army Regulations, the form should have been sent to the officer having special court martial authority for units in the area. Army Regulation 600-3, Table 3-1, 15 June 1980. Additionally, the veteran signed the form as the unit commander, thereby purporting to make a line of duty determination regarding himself. On its face this was improper. The DA Form 2173 for the claimed assault in October 1984 also is problematic. It, too, appears to have been written on one typewriter, while its parts were authored by a private physician (Section I) and an Army enlisted member (Section II). It also was improperly addressed to the veteran as the Commander of the POW Camp Det. Additionally, it purports to show that the veteran was on inactive duty training status (on the basis of having been ordered to, and in the process of returning from, Irwin Army Hospital) at the time he was assaulted. In support of his duty status, the list of exhibits submitted with his December 1988 substantive appeal cites item 12, a travel voucher for a trip to the Irwin Army Hospital on October 9. However, there is no exhibit 12. Nor is there any other service department evidence that the veteran was ordered formally or informally to appear at Irwin Army Hospital on April 9 or any evidence that he was seen there on that date. Clearly the veteran did sustain a beating on October 9. There is an Allen County Hospital report showing significant injuries from an assault at a rest stop on the evening in question. However, the Allen County report does not show any fractured "vertebrates" as noted in the DA Form 2173 and in a January1990 statement written by the veteran. The two individuals who purportedly prepared the DA Form 2173 were Dr. Hull and Staff Sergeant D.G. While the sergeant might not know a vertebrate from vertebrae, one would expect Dr. Hull to. Thus, this one errant "t" certainly suggests that the veteran wrote the DA Form 2173. The same hospital report shows that the veteran had been drinking and that the incident occurred between 10 and 11 PM. Were the evidence regarding this incident otherwise accepted as legitimate, the drinking and late hour of the incident would raise a question of whether the veteran was returning "directly" from his "training." 38 C. F. R. 3.6(E). To this day, despite expecting the VA to pay for his injuries, the veteran has never adequately explained what happened. His subsequent story to VA medical personnel that he was answering a civilian police call to aid a woman in distress is absurd. And finally, inactive duty training for individuals receiving incapacitation pay is specifically prohibited. At the veteran's RO hearing the matter was raised as to whether the claimed injuries were sustained in one or two incidents. The veteran seemed unsure, due to the passage of time and some traumatic things that had happened. Regardless of his current mental state, in 1988 he submitted to the VA two DA Forms 2173 in support of his claim for service connection. Those two forms purportedly were written within days of the claim injuries and they specifically allege two separate incidents - one involving a fall in April 1984 and one involving an assault in October 1984. Thus, a current plea of poor memory or intervening trauma can not explain away the gross evidentiary discrepancies in this case. Nor do the veteran's allegations of documents having been lost or mishandled by Army personnel impress the this Board Member as a plausible explanation for the absence of any corroborating evidence from official sources. Finally, there is the statement of September 13, 1984, signed by Mr. G., the Army sergeant, confirming that the veteran was on 100 percent disability due to injuries sustained on April 1 and 8 and "9 October 1984." How Mr. G. knew a month before the fact that the veteran would be injured on October 9, and why the veteran would choose to submit such an incredible statement defy explanation. The DA 2173 forms in question have been submitted to the VA to show not only that the veteran was in a training status at the time the incidents occurred but also that he sustained injuries for which he is seeking service connection and payment of money. Thus, to even suggest that the similarity of the injuries claimed to have occurred six months apart perhaps reflects a single incident innocently reported as two, is to ignore the gravity of the matter. See RO Hearing Transcript. There are sufficient reasons for rejecting the veteran's credibility as to duty status and related matters, ranging from his trying to pass himself off as a colonel to his having claimed combat service in Vietnam. In conclusion, the undersigned Board Member finds there is no satisfactory evidence that the veteran was in a training duty status on April 8 and that on that date he sustained the injuries alleged on the relevant DA Form 2173. The undersigned also finds that the veteran was not on inactive duty training on October 9, when he did sustain multiple injuries in a beating. To make it clear, the DA Forms 2173 are rejected as lacking credibility and having no positive value in the claim for service connection; in other words, they are not what they purport to be. Despite, the above findings the Board must still consider whether the disabilities at issue were incurred in or aggravated by the veteran's verified reserve service or are otherwise service related. The threshold question to be answered in the veteran's appeal is whether he has presented evidence of well-grounded claims. "[A] person who submits a claim for benefits under a law administered by the Secretary shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded." 38 U.S.C.A. § 5107(a); Carbino v. Gober, 10 Vet. App. 507 (1997); Anderson v. Brown, 9 Vet. App. 542, 545 (1996). A well-grounded claim is "a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of [section 5107(a)]." Murphy v. Derwinski, 1 Vet. App. 79, 81 (1990). In Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992), the Court held that a claim must be accompanied by supportive evidence and that such evidence "must 'justify a belief by a fair and impartial individual' that the claim is plausible." For a claim to be well grounded, there generally must be (1) a medical diagnosis of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. See Anderson, supra; Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (table). If a claim is not well grounded, the application for service connection must fail, and there is no further duty to assist the veteran in the development of his claim. 38 U.S.C.A. § 5107, Murphy v. Derwinski, 1 Vet. App. 78 (1990). The Court has held that in order for a claim to be well- grounded, there must be competent evidence of incurrence or aggravation of a disease or injury in service, of a current disability, and of a nexus between the in-service injury or disease and the current disability. See generally Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (table). Medical evidence is required to prove the existence of a current disability and to fulfill the nexus requirement. Lay or medical evidence, as appropriate, may be used to substantiate service incurrence. See Layno v. Brown, 6 Vet. App. 465, 469 (1994); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). As the record in this case does not establish that the veteran possesses a recognized degree of medical knowledge, his own opinions as to medical diagnoses and/or causation are not competent. As lay statements, such are not sufficient to establish a plausible claim. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). First, it is noted that the veteran has claimed residuals of ear infections, particularly in the right ear; blurred vision; a back injury/disability, and residuals of injury to the chest and right leg. The veteran also has claimed entitlement to service connection for a heart disorder, for a left wrist scar, and for a right heel disorder. The claims file contains competent diagnoses of hypertension. There is also medical evidence that the veteran has a scar on his left wrist, that he has right foot fasciitis, and that he has a lumbar spine disability, primarily post-operative disc disease. There is no clear and competent, contemporary medical evidence that the veteran currently has any diagnosed disability of the eyes, ears or chest. A claim for service- connection for a disability must be accompanied by evidence which establishes that the claimant currently has the claimed disability. Absent proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) ; Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). In any case, to the extent that the available private and VA medical records show that the veteran currently has any of the disabilities for which he has claimed service connection, in order to present a well-grounded claim, there must still be evidence of service incurrence and a nexus between each currently diagnosed disability and the veteran's service. See Caluza, supra. A review of the claims file fails to show that the veteran has submitted competent evidence of in- service incurrence or any nexus existing between events of service and current diagnoses. As here the Board is considering only whether the claims of service connection are well grounded, the credibility of the veteran and of the evidence will not be discussed. Rather, it is emphasized that, despite the veteran's complaints, an MEB and PEB completed prior to his being placed on the Temporary Disability Retired List, acknowledged only his left knee disability as having been incurred in service. Moreover, the only diagnoses resulting from such evaluation were those pertinent to the left knee, and the left wrist scar, with neurologic findings associated with the latter. Although he has previously indicated that the Army erred and that such would be corrected, there is no evidence that the Army subsequently acknowledged any additional disabilities as being service related. The veteran is currently service-connected for his left knee disability. Although service documents do acknowledge the presence of a left wrist scar, there is no document reflecting that the veteran complained of or received treatment for injury to his left wrist while on ADT or IDT. The undersigned Board Member has carefully reviewed all service medical records and duty statements contained in the claims file. There is no notation of treatment or complaints of injury to the left wrist while on ADT or IDT. Rather, in connection with in-service medical evaluations, the veteran gave a history of left wrist injury in or around 1974, at which time he was not on duty. In short, there is no competent medical evidence or opinion relating the scar and any related disability to the veteran's periods of ADT/IDT. Absent such, that claim must be denied as not well-grounded. See Caluza, supra. Prior to April 1, 1984, the date at which the veteran re- injured his left knee, service records are absent evidence of any diagnosed chronic disability of the eyes, ears, heart, spine/back, right leg/heel or chest. The basis for the veteran's ear and heart complaints are unclear; i.e., he does not allude to specific in-service treatment for such. Moreover, service records, from the veteran's recognized periods of ADT or IDT, do not note any heart or ear problems. In May 1984, after the veteran had already been placed on incapacitation pay and was thus not on "duty" for the purpose of obtaining VA benefits, he was evaluated for hypertension. However, his pressure was noted to vary between normal and "borderline" and the impression was transient blood pressure, post operatively. There is no competent evidence that any subsequent chronic hypertension/heart disorder is of service origin or was caused or aggravated by the knee surgery. There is no competent, medical evidence that the veteran has any eye disorder that had its onset during or was aggravated by any verified period of training duty. Although he reported that his right eye was blurry when he was treated at Allen County Hospital for the injuries sustained when he was beaten in October 1984, that beating has been determined not to have occurred while the veteran was in a duty status. Even were the DA Form 2173 reporting the claimed April 8 injuries to be accepted as credible evidence for the purpose of determining whether the service connection claims are well grounded, and even though it refers to "blurred vision" and having struck his chest, the claimed accident did not occur during a verified period of training duty and there is no contemporaneous medical evidence of the injuries. Although a September 5, 1984 medical records, which according to the veteran is from Dr. Hull, notes a history of the veteran having hit his "left side" when his knee gave out and he fell in April, the veteran has, in essence, refused to produce or authorize the release of any April 1984 medical records that may have been prepared by Dr. Hull. Additionally, the evidence of record does not reflect that the veteran continued to complain of any diagnosed eye or chest problems and there is no competent medical opinion relating any currently diagnosed eye or chest disorder to service. In regard to the right leg, the veteran initially claimed a lump on the leg. A lump on the leg was not shown during any period of verified training duty and there is no medical evidence he currently has a right leg disorder of any nature that is service related. (To the extent that he may be claiming a right knee disorder, service connection for a right knee disorder, characterized as chondromalacia, had been granted and then severed.) In regard to service connection for a back disability, the medical evidence shows that the veteran has disc disease for which he has undergone surgery. There is no competent evidence of any back injury or back disability during a verified period of training duty. In the DA Form 2173 for the alleged April 9, 1984 accident, a reference to a "brace for back injury" was noted in the portion of the report signed by the veteran. The portion that bears the name of Dr. Hull says nothing of a back injury and there is no medical evidence of any back injury related to that claimed accident. Nor is there any other competent evidence that the veteran's disc disease, claimed "fractured vertebrates" or any other back disorder is the result of any incident of a verified period of training duty. Thus, this claim is not well grounded. Regarding the claimed right foot or heel injury, there is no evidence that such was incurred during a period of verified training duty. In fact, the initial reference to such a problem appears to have been in early 1989. The veteran has been noted to have a heel spur and fasciitis, with no evidence or opinion that such is of service origin or is otherwise related to any verified period of training duty. The veteran himself is not competent to offer a medical diagnosis or opinion as to medical causation, and he is not competent to establish the etiology of any identified disorders; thus, his statements are not sufficient to establish a plausible claim. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Absent competent evidence that any incident of ADT or IDT resulted in permanent disability for which service connection is now before the Board, the veteran's claims relevant to a left wrist scar/disorder; an ear disorder; an eye disorder (blurred vision); a right lower extremity disorder; a chest disorder, a back disability and hypertension must be denied as not well grounded. The Board recognizes that the Court has held that there is some duty to assist the veteran in the completion of his application for benefits under 38 U.S.C.A. § 5103 (West 1991 & Supp. 1998) even where his claims appear to be not well- grounded where a veteran has identified the existence of evidence that could plausibly well-ground the claim. See generally, Beausoleil v. Brown, 8 Vet. App. 459 (1996); and Robinette v. Brown, 8 Vet. App. 69 (1995), as modified in this context by Epps v. Brown, 9 Vet. App. 341, 344 (1996). In the instant case, however, the veteran has not identified any medical evidence that has not been submitted or obtained, which will support well-grounded claims. The VA has made numerous attempts to assist the veteran in obtaining all available service, medical and otherwise, in support of his claims. Thus, the VA has satisfied its duty to inform the veteran under 38 U.S.C.A. § 5103(a). See Slater v. Brown, 9 Vet. App. 240, 244 (1996). ORDER Service connection for a disorder manifested by blurred right eye vision; a right ear infection; a heart disorder; residuals of injury to the right leg/heel; a left wrist disorder, an injury to the spine/back and residuals of a chest injury is denied. REMAND The Board further notes that in the instant case the veteran is technically not seeking an increased rating for his left knee disability since his appeal arises from the original assignment of a disability rating, his notice of disagreement having been filed in September 1987. However, when a veteran is awarded service connection for a disability and subsequently appeals the initial assignment of a rating for that disability, the claim continues to be well grounded. Fenderson v. West, No. 96-947 (U.S. Vet. App. Jan. 20, 1999); Shipwash v. Brown, 8 Vet. App. 218, 224 (1995). By way of history, the RO granted service connection for residuals of a medial meniscectomy with degenerative joint disease, and assigned a 10 percent disability, effective April 23, 1987. In a decision dated in December 1989, the RO changed the assigned effective date to April 8, 1987. In July 1998, pursuant to VAOPGCPREC 23-97 (July 1, 1997), the RO awarded a separate 10 percent disability evaluation for left knee arthritis, effective September 8, 1997. Also in July 1998, the RO increased the previously assigned disability evaluation for residuals of a medial meniscectomy from 10 percent to 20 percent, also effective September 8, 1997. Although the percentage increase and the separate grant of service connection for arthritis, represent a grant of benefits, i.e., increased compensation based on left knee impairment, the United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (hereinafter, "the Court") has held that a "decision awarding a higher rating, but less than the maximum available benefit...does not...abrogate the pending appeal...." AB v. Brown, 6 Vet. App. 35, 38 (1993). In any case, subsequent to the RO's grant, the veteran's representative has continued to include discussion of the evaluation assigned for left knee arthritis and/or residuals of a medial meniscectomy in statements made in connection with the veteran's continued appeal. Thus, the Board will continue to address both the evaluation of arthritis and other impairment of the left knee in this decision. Subsequent to the last remand the Court rendered a decision in DeLuca v. Brown, 8 Vet.App. 202 (1995). Although the veteran was afforded compensation examinations after the issuance of that decision, they did not specifically address whether the left knee joint exhibited weakened movement, excess fatigability, or incoordination, and whether pain could significantly limit functional ability during flare-ups or when the joint is used repeatedly over a period of time. See DeLuca; 38 C.F.R. §§ 4.40, 4.45 (1995). The Court has indicated that these determinations should be made by an examiner and should be portrayed by the examiner in terms of the additional loss in range of motion due to these factors (i.e., in addition to any actual loss in range of motion noted upon clinical evaluation). 38 C.F.R. §§ 4.2, 19.9 (1995). Thus, this case remanded to the RO for the following: 1. The RO should afford the veteran the opportunity to submit or identify any additional evidence pertinent to his left knee disability. After securing any necessary release, the RO should obtain any evidence identified. 2. The RO should contact the Social Security Administration and request copies of any records pertaining to the veteran subsequent to those previously provided, along with a copy of any decision in his case. 3. The veteran should be afforded a VA orthopedic examination pertinent to his left knee. Examination by the September 1997 examiner is permissible. The claims folder and a separate copy of this remand should be made available to the examiner and reviewed before the examination. The examiner should respond to the following: a) Record all pertinent medical complaints, symptoms, and clinical findings, including specifically active and passive ranges of the left knee in terms of degrees. The examiner should identify any left knee laxity, characterizing such in terms of mild, moderate or severe. b) The examiner should also comment on the functional limitations, if any, residual to the veteran's service- connected left knee disability. The examiner is requested to specifically comment on: I) whether pain is visibly manifested on movement of the joints; ii) the presence and degree of, or absence of, muscle atrophy attributable to each service-connected disability; iii) the presence or absence of changes in condition of the skin indicative of disuse due to the service connected disability, or iv) the presence or absence of any other objective manifestation that would demonstrate disuse or functional impairment due to pain attributable to the service- connected left knee disability. The examiner must specifically state whether the veteran's complaints and any claimed subjective manifestations are in keeping with the objectively demonstrated knee pathology. If necessary to ascertain that, the veteran should be afforded imaging or other diagnostic studies. c) The examiner should also include comment on the impact, if any, of the veteran's knee disability on his ability to engage in employment of a sedentary or nonstrenuous nature. 4. After the development requested above has been completed to the extent possible, the RO should again review the record and ensure that such is adequate for appellate review. See Stegall v. West, 10 Vet. App. 489 (1998). The RO should then review the record and re- adjudicate the issue of an increased rating for the left knee disability, with consideration of the Court's decision in Fenderson v. West, No. 96-947 (U.S. Vet.App. Jan. 20, 1999. The RO should also re-adjudicate the issue of entitlement to TDIU benefits in view of additional evidence obtained. If any benefit sought on appeal remains denied, the veteran and his representative should be furnished a supplemental statement of the case, containing all potentially applicable laws and regulations not previously included, and given the opportunity to respond thereto. Thereafter, the case should be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The appellant need take no action unless otherwise notified. This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Veterans Appeals for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1996) (Historical and Statutory Notes). In addition, VBA's ADJUDICATION PROCEDURE MANUAL, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44-8.45 and 38.02-38.03. J. E. SHARP Member, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1998).