Citation Nr: 0810711 Decision Date: 04/01/08 Archive Date: 04/14/08 DOCKET NO. 06-13 422 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUES 1. Entitlement to service connection for bilateral hip arthritis, to include as secondary to residuals of a fracture of the left ankle with post-traumatic arthritis. 2. Entitlement to service connection for a heart condition, to include as secondary to hypertension. 3. Entitlement to an initial evaluation in excess of 10 percent for post traumatic stress disorder (PTSD). ATTORNEY FOR THE BOARD W. Donnelly, Associate Counsel INTRODUCTION The veteran served on active duty with the United States Army from June 1964 to March 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2004 decision by the Pittsburgh, Pennsylvania, Regional Office (RO) of the Department of Veterans Affairs (VA), which denied service connection for bilateral hip and heart disabilities, and granted service connection for PTSD, rated as 10 percent disabling. The veteran filed a motion for reconsideration in October 2004, and a new decision was promulgated in January 2005. As the second decision did not satisfy the veteran's claims, he filed a Notice of Disagreement in May 2005. A Statement of the Case was issued in March 2006, and the veteran perfected his appeal with the timely filing of a VA Form 9, Appeal to Board of Veterans' Appeals, in April 2006. The Board notes that the veteran initiated an appeal regarding the assigned evaluation for residuals of a left ankle fracture. A rating decision granting an increased, 20 percent evaluation was issued in March 2006. The veteran has stated in September 2006 correspondence that this is a full grant of the benefit sought, and that he did not wish to pursue the claim. The evaluation of a left ankle disability is therefore no considered here. FINDINGS OF FACT 1. Currently diagnosed bilateral hip arthritis was not shown during service or within the first post-service year, and is not shown to be due to residuals of a left ankle fracture; the preponderance of the competent medical evidence is against a findings of a nexus to service or service connected disability. 2. There is no currently diagnosed chronic heart disease or disability; findings of occasional erratic heart beats represent isolated laboratory findings without an underlying disability. 3. PTSD is manifested by no more than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, due to such symptoms as irritability, sleep disturbance, paranoia, and hypervigilance. CONCLUSIONS OF LAW 1. Service connection for bilateral hip arthritis is not warranted. 38 U.S.C.A. §§ 1110, 1112, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2007). 2. Service connection for a heart condition is not warranted. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2007). 3 The criteria for assignment of a 30 percent evaluation for PTSD are met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.130, Diagnostic Code 9411 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VA's Duties to Assist and Notify As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs (VA) has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2007). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice must inform the claimant of any information and evidence not of record that is necessary to substantiate the claim. The veteran should be informed as to what portion of the information and evidence VA will seek to provide, and what portion of such the claimant is expected to provide. Proper notification must also invite the claimant to provide any evidence in his possession that pertains to the claim in accordance with 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the U.S. Court of Appeals for Veterans Claims held that, upon receipt of an application for a service-connection claim, 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating, or is necessary to substantiate, each of the elements of the claim, including notice of what is required to establish service connection and that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. With regard to the claims of service connection for bilateral hip arthritis and a heart condition, although the notice provided did not address either the rating criteria or effective date provisions that are pertinent to the appellant's claim, such error was harmless given that service connection is being denied, and hence no rating or effective date will be assigned with respect to this claimed condition. With regard to the evaluation of PTSD, the Board notes that the veteran requested and was supplied with a copy of the applicable Diagnostic Codes and relevant evaluation criteria in September 2005. Moreover, because the claimed benefit, service connection for PTSD, was granted, additional notice is not required, and any defect in the notice is not prejudicial. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). Here, the VCAA duty to notify was satisfied by way of a letter sent to the appellant in March 2004 that fully addressed all notice elements and was sent prior to the initial AOJ decision in this matter. The letter informed the appellant of what evidence was required to substantiate the claims and of the appellant's and VA's respective duties for obtaining evidence. The appellant was also asked to submit evidence and/or information in her or his possession to the AOJ. VA additionally has a duty to assist the veteran in the development of the claim. This duty includes assisting the veteran in the procurement of service medical records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the appellant. See Bernard v. Brown, 4 Vet. App. 384 (1993). The RO has obtained complete service medical records. The veteran submitted copies of service medical records, a statement from a private treating physician, Dr. MCM, and copies of clinical records. The appellant was afforded medical examinations in February and June 2004 according to VA compensation and examination protocols; the veteran resides overseas and the examinations were performed on a contract basis by private examiners. Significantly, the appellant has not identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. The veteran has not supplied requested release forms to allow VA to obtain complete current treatment records from the military health clinics where the veteran is seen. Hence, no further notice or assistance to the appellant is required to fulfill VA's duty to assist the appellant in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Service Connection Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Some chronic diseases may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C.A. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service. Watson v. Brown, 4 Vet. App. 309, 314 (1993); see also Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). To establish service connection, there must be: (1) a medical diagnosis of a current disability; (2) medical or, in certain cases, 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. Hickson v. West, 12 Vet. App. 247, 252 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd 78 F.3d 604 (Fed. Cir. 1996). A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997). See also Bostain v. West, 11 Vet. App. 124, 127 (1998) citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992) (a layperson without the appropriate medical training and expertise is not competent to provide a probative opinion on a medical matter, to include a diagnosis of a specific disability and a determination of the origins of a specific disorder). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Bilateral Hip Arthritis The veteran alleges alternatively that he injured his hips and was diagnosed with arthritis is service, and that the bilateral hip disability has developed secondary to an altered gait related to his service connected fractured left ankle. Service medical records reveal that the veteran fractured his left ankle in 1968, in Vietnam. A notation in December 1971 shows complaints of right hip pain. The examiner noted possible arthrosis of the right hip; rheumatoid arthritis testing was negative. No x-rays were taken. Aspirin was prescribed. In December 1977, during treatment for left ankle pain, the doctor noted that there was no complaint of hip pain on either side. No x-rays were performed. On separation examination in February 1989, the examiner noted no objective signs or symptoms of hip pain or arthritis. On his list of subjective complaints, however, the veteran indicated he had joint pain, and the examiner commented that the veteran reported "some residual left ankle and left hip arthritis, which is exacerbated by cold environment" related to the left ankle fracture. No x-rays the hips are of record. A February 2004 VA contract examination by Dr. VS was limited to evaluation of the left ankle. The examiner noted complaints of recurrent left ankle pain with exertion, but commented that the veteran favored the left leg due to right hip pain. Dr. VS stated that the veteran's gait was somewhat slowed, but was symmetrical on even ground. There was marked limitation of motion and function of the ankle. In June 2004, a second contract examination was performed by Dr. VS to specifically consider the claimed bilateral hip disability. The service medical records were not available for review. The veteran reported the onset of bilateral hip problems in the early 1970's, and cited the December 1971 and February 1989 references in service medical records. He reported bilateral aching pain, with severe, sharp pains at night when the weather is bad. He reported some fatigability and lack of endurance; the hips grew painful after walking for 25 minutes or so. The examiner found measurable limitation of motion in passive and active movement, secondary to pain. There was slight reduction in ranges with repeated movement. The examiner noted that with exertion, there was a limp due to left sided ankle pain. X-rays showed slight to moderate osteoarthritis of the hips, bilaterally. The examiner opined that because the degenerative changes of the left and right hips were essentially equal, a causal connection between the bilateral hip disability and the left ankle disability was contraindicated. It would be expected that the left ankle pain would cause favoring (additional exertion) of the right leg and hip, resulting in greater disability of that joint. X-ray findings were "almost completely symmetrical." The examiner did comment, however, that as per the veteran's reported history, hip pain seems to have been ongoing since service. He repeated, however, that the service medical records would have to be checked for corresponding entries. Dr. MCM opined in a March 2004 memorandum that, following examination and review of the medical chart, the left hip arthritis was due to the ankle injury. He cited documented reports of left hip and ankle pain dating back to 1970. He stated that a connection was medically probable due to changed gait mechanics. His opinion did not address the right hip complaints and findings. Despite the above noted statements from doctors indicating that hip pain seemed to have been ongoing since service, and that left hip arthritis was due to the service-connected ankle injury, the Board finds, as is explained below, that service connection for bilateral hip arthritis is not warranted on a direct, presumptive, or secondary basis. Direct service connection is not warranted in the absence of evidence of the claimed condition in service. Here, while service medical records note complaints of right hip pain in 1971, and of left hip pain in 1989, there is no radiographic evidence confirming a diagnosis of arthritis at any point during service or within a year after separation from service. The veteran's complaint of pain is the sole evidence of disability at that time, and each complaint is isolated and singular. The right hip is referred to only once, in 1971, while the left hip pain is mentioned only on separation. Although the veteran does state (in 1989) that he has long standing complaints, the service records document no ongoing chronic problems or complaints to corroborate his statement. Similarly, there are no records of treatment since service documenting continuity or chronicity of hip problems. There is no probative medical evidence relating current hip problems to the in-service complaints. When Dr. VS noted the veteran's history of hip pain that seemed to be ongoing since service, he properly indicated that such ongoing complaints would have to be corroborated by service medical records. Review of the records reveals no such corroboration. Although Dr. MCM cited documented complaints of hip pain dating back to the 1970's, but he fails to supply such documents. The service records to which he appears to refer are, as noted, completely silent with regard to continuity of complaints. Without corroboration by medical evidence of a diagnosis, the veteran's assertion that arthritis was present in service is not competent evidence. The veteran is a layperson and a diagnosis of arthritis is not subject to observation by a lay person. While symptoms of arthritis (pain, stiffness, etc) are subject to observation and description by the lay veteran, the record contradicts the veteran's assertions of continuing problems. In the absence of evidence of a chronic disease or diagnosis in service, or of competent evidence of a nexus to the in- service treatment, direct service connection must be denied. Consideration is given to service connection by presumption under 38 C.F.R. § 3.307, as arthritis is a chronic disease under 38 C.F.R. § 3.309(a). The problem, however, is that there is no evidence of arthritis within the first post service year, the applicable presumptive period. While the veteran complained of arthritis on separation examination, there are no clinical or radiographic findings corroborating his assertion, and there is no documentary evidence of any complaint or treatment for the condition within a year of separation. A diagnosis of hip arthritis is not confirmed until June 2004 x-rays. The veteran's statements indicating that he had arthritic symptoms within the year following service are outweighed by the absence of any record showing treatment for these claimed problems. Presumptive service connection is not warranted. Finally, the veteran alleges that the bilateral hip disability is secondary to his service connected residuals of a left ankle fracture. He maintains that a limp resulting from the ankle disability has caused wear and tear on the hips, resulting in the current arthritic changes. The Board is well aware that Dr. MCM opined that it was medically probable that the left hip problem could be due to the limp caused by the service-connected ankle disability. That being said, however, the Board ascribes greater weight to the opinion against the veteran's claim, as provided by the orthopedic surgeon, Dr. VS. This opinion is made up of well- supported and reasoned conclusions. Unlike Dr. MCM, Dr. VS considered the presence of disability in both hips when offering his opinion as to a possible nexus to the ankle disability. He concluded that since both hips showed equal degenerative changes on x-ray, there must have been equal strain placed on both joints. [Such would not have been the case if the service-connected left ankle disorder was the cause of the strain.] Had that been the case, the veteran would have needed to compensate for the left sided limp, which would have caused greater strain of the right hip, and hence advanced degeneration relative to the left hip. The fact that the hips show equal degeneration indicates an etiology other than the one-sided left ankle disability. Accordingly, secondary service connection must be denied as well. In conclusion, entitlement to service connection for a bilateral hip disorder is denied under all applicable theories of recover. Heart Condition The veteran alleges that his long-standing service connected hypertension has resulted in a current heart condition. He argues that direct service connection is warranted based on in-service findings, or that secondary service connection is warranted based on current records. As is explained below, the Board finds that service connection for a heart condition must be denied under any theory, as there is no currently diagnosed disease or disability of the heart. Service medical records reveal repeated findings of abnormal electrocardiograms, or EKGs, showing an intermittent irregular heart beat. While the veteran was tested on numerous occasions, and complained at times of skipped beats and chest pains, no heart disease or condition was ever diagnosed. The abnormal tests were monitored, but at no time did any doctor indicate the presence of disease or disability. The veteran was under treatment for hypertension. Treatment records from the WBD clinic in Germany reveal ongoing treatment for hypertension, but no diagnosis of a heart disease or disability is indicated. During a February 2004 VA contract examination by Dr. PK (an internist and cardiologist), the examiner reviewed service medical records and post service treatment records. He noted findings of tachycardia on exertion and complaints of pressure on the chest during service. He also noted a normal June 2003 EKG. Physical examination showed a regular heart action without murmurs. The veteran denied cardiac symptoms such as angina, dizziness, or syncope. Notation on an EKG report read as follows: "air exertional function without evidence of a coronary or hypertensive heart disease." Hyperlipidemia was noted. No heart disease or condition was diagnosed. In the absence of any current diagnosis of heart disease, there can be no grant of service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The documented variances in the heart beat, as noted on EKG in service, are laboratory findings, and not in an of themselves a disability. In the absence of underlying disease, the claim must be denied. Evaluation of PTSD Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Compensation for service-connected injury is limited to those claims which show present disability. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as "staged" ratings." Fenderson v. West, 12 Vet. App. 119, 126-127 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If the evidence for and against a claim is in equipoise, the claim will be granted. A claim will be denied only if the preponderance of the evidence is against the claim. See 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). PTSD is rated under Diagnostic Code 9411 according to a general set of criteria applicable to psychiatric disabilities. The General Rating Formula for Mental Disorders (found at 38 C.F.R. § 4.130) provides the following ratings for psychiatric disabilities: A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication, a noncompensable (0 percent) rating. Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication, a 10 percent rating. Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events), a 30 percent rating. Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships, a 50 percent rating. Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships, a 70 percent rating. Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name, a 100 percent rating. 38 C.F.R. § 4.130. The veteran has submitted numerous statements describing PTD symptomatology. The veteran reports that he is not sociable, that he avoids reminders of his Vietnam experiences, that he is hypervigilant and paranoid, and that he has nightmares and intrusive thoughts of Vietnam. During a February 2004 VA contract examination by Dr. SDA, the veteran reported that he tried to avoid interaction with people, taking jobs that provided social isolation, such as a cashier, farm worker, or security guard. Although he is a security guard, he does not carry a weapon and actively avoids those who do, as he is paranoid about the potential for violence. He is constantly aware of his surroundings and plans possible defensive responses to feared occurrences. He is quick to feel he is being inequitably treated and often holds grudges. He is antisocial, with strained work relationships. The examiner commented that the veteran's degree of paranoia and antisocial behaviour was unusual. It was noted that the veteran had abused alcohol in the past and that he reported recurrent depressive episodes. The veteran was well oriented at the interview; speech and thought were normal in direction and content. He denied homicidal or suicidal ideation. Severe PTSD was diagnosed. A Global Assessment of Functioning (GAF) score of 40 was assigned, indicating "[s]ome impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) 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...." Richard v. Brown, 9 Vet. App. 266, 267 (1996) (citing DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 4th ed. (DSM-IV) at 32). The Board finds that the described symptomatology warrants assignment of an increased rating to 30 percent (and no higher) for PTSD. The veteran is socially isolated and his hypervigilance is of such a degree as to reflect paranoia. His work relationships are strained, and he adjusts his duties and activities to avoid reminders of Vietnam. He reports recurrent dreams and intrusive thoughts. While he has continued to work, he has done so in roles requiring less and less human interaction. The impairment, while not severe, clearly is greater than mild, and warrants assignment of a 30 percent evaluation. The Board has considered whether or not an even higher rating is warranted of the veteran's PTSD. The severity of his disability, however, does not approximate the criteria for the next higher rating. A higher 50 percent evaluation is not warranted, as the veteran continues to generally perform well at work in his isolation and he demonstrates no thought or mood disturbances. Additionally, he does not exhibit a flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks more than once a week, or impaired judgment. Accordingly, an increased rating is warranted, to 30 percent, and no higher. (CONTINUED ON NEXT PAGE) ORDER Service connection for bilateral hip arthritis is denied. Service connection for a heart condition is denied. An evaluation of 30 percent for post traumatic stress disorder is granted, subject to the laws and regulations governing payment of monetary benefits. ____________________________________________ DENNIS F. CHIAPPETTA Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs